Liver transplantation for neotropical polycystic echinococcosis caused by Echinococcus vogeli: a case report

Genzini, Tércio; Siqueira, Nilton Ghiotti de; Noujaim, Huda Maria; Santos, Randolfo dos; Yamashita, Eduardo Tomohissa; Trevizol, Alisson Paulino; Perosa, Marcelo

doi:10.1590/0037-868216542013

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…LT is a good therapeutic option for patients with advanced stages that would not benefit from the cyst’s resection, as well as when there is biliary duct and blood vessels involvement or diffuse hepatic disease, leading to portal hypertension and cirrhosis 6 . In these cases, the LT combined with the antiparasitic drugs is the only potentially curative treatment, allowing satisfactory long-term results 14 .…”

Section: Discussionmentioning

confidence: 99%

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Preliminary Data on Liver Transplantation in Hydatidosis Disease

Castro

Hyppolito

Valença-Junior

et al. 2022

ABCD, arq. bras. cir. dig.

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- BACKGROUND: Hydatidosis is a rare and endemic parasitic disease in Brazil that causes the proliferation of cysts mainly in the liver, leading to many complications, such as compression of vessels and biliary ducts, liver failure, portal hypertension, and cirrhosis. The treatment of choice is the resection of the lesions combined with albendazole therapy. This disease is a rare indication for liver transplantation, a feasible treatment option in more advanced stages. AIM: The purpose of this study was to describe two cases of patients from northern Brazil who underwent liver transplantation due to hepatic hydatidosis. METHODS: This is a retrospective study with data collected from medical records. RESULTS: Case 1: A 51-year-old female patient presented pain in the right hypochondriac, dyspepsia, consumptive syndrome, and obstructive jaundice, with a previous diagnosis of Caroli’s disease with no possibility of surgical resection and a MELD score of 24. She underwent liver transplantation, and the anatomopathological result demonstrated hydatidosis. Case 2: A 52-year-old female patient presented multiple episodes of cholangitis in 30 years, with three liver resections and clinical treatment with albendazole for hydatidosis. She underwent liver transplantation due to recurrent cholangitis with a MELD score of 20. Both patients underwent post-transplant clinical therapy with albendazole, had good outcomes, and remain in follow-up without complications after 5 and 96 months, respectively. CONCLUSION: The patients benefited from the procedure and have a good prognosis due to the absence of metastasis, early reintroduction of antiparasitic drugs, and continuous follow-up.

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Section: Discussionmentioning

confidence: 99%

“…However, the cysts may be extrahepatic, causing different symptoms 16 . Other possible manifestations are hepatomegaly, weight loss, anemia, fever, and hemoptysis 6 .…”

Section: Introductionmentioning

confidence: 99%

Preliminary Data on Liver Transplantation in Hydatidosis Disease

Castro

Hyppolito

Valença-Junior

et al. 2022

ABCD, arq. bras. cir. dig.

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“…A única solução possível para a obstrução crônica dos canais biliares por cistos parece ser o transplante de fígado. A presença de múltiplos cistos nos lobos direito e esquerdo e no hilo hepático, causando obstrução biliar e colangites recorrentes, foram as principais indicações para o transplante de fígado em um paciente com DHP, infelizmente falecido no 31º dia pós-operatório por embolia pulmonar 26 .…”

Section: Discussionunclassified

“…Rev Pan-Amaz Saude 2013; 4(4): [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Ampliando a dimensão epidemiológica da doença e reafirmando sua principal ocorrência na Amazônia, reuniram-se 40 casos de DHP provenientes da Amazônia oriental, com a maior concentração deles nas proximidades do arquipélago do Marajó, Estado do Pará (PA) 9 . Em 2010, apresentaram-se estudos clínicos e terapêuticos de 60 casos observados no AC no período de 1999 a 2009, o que veio a ser forte indicativo de que é provável que essa parte da Amazônia seja a de mais elevada ocorrência da DHP 10 .…”

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Manifestações clínicas da doença hidática policística apresentadas por 26 pacientes atendidos no Hospital das Clínicas de Ribeirão Preto, Estado de São Paulo, Brasil

et al. 2013

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RESUMOObjetivando descrever as manifestações clínicas da doença hidática policística, procedeu-se à análise dos prontuários médicos de pacientes atendidos de novembro de 1978 a outubro de 2008 no Hospital das Clínicas de Ribeirão Preto, Estado de São Paulo, Brasil. Dentre os 26 pacientes encontrados, verificou-se que o fígado foi comprometido em 96,2% deles, os pulmões em 23,1% e tanto mesentério como o baço em 19,2%. Cistos calcificados foram verificados em 84,6% dos casos, indicando doença não recente. Emagrecimento, febre, náuseas, vômitos, diarreia, sensação de distensão abdominal, de plenitude epigástrica e, principalmente, dores epigástricas e/ou no hipocôndrio direito, em 80% dos casos, precederam o aparecimento de complicações. Na fase de agravamento, o crescimento das massas císticas, comprimindo estruturas condutoras de líquidos orgânicos, levou ao evento mais grave: icterícia persistente, observada em sete pacientes (26,9%), acompanhada por sinais de hipertensão portal em seis deles (19,2%), dadas por compressão no hilo hepático. Em três casos, a colestase seguiu o trânsito transdiafragmático do parasito para o tórax, em dois com evolução para fístula biliobrônquica; um dos pacientes faleceu no pós-operatório de tentativa terapêutica, e outro sobreviveu após colocação de prótese biliar. Um paciente com colestase crônica e hipertensão portal teve hemorragia digestiva fatal. A rotura de cistos em canais biliares, determinando icterícia transitória, foi observada em cinco pacientes (19,2%). A resolução espontânea dos cistos foi observada em dois pacientes. Admitindo-se que cistos recentes sejam mais permeáveis às drogas curativas, presume-se que o reconhecimento da doença em suas manifestações iniciais propiciará terapêutica mais eficaz.

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“…Moreover, the non-specificity of symptoms, the difficulty of laboratory diagnosis, the limited access to various endemic sites and misinformation of the affected populations all are involved in the difficulty of estimating the prevalence of human PE (Novo Alonso et al, 1993;D'Alessandro & Rausch, 2008;Kern et al, 2017). The E. vogeli metacestode usually grows in the liver, and the disease can have serious consequences for the patient (Genzini et al, 2013). The growth of multiple parasite cysts can cause hepatic and vascular necrosis, infect the bile ducts and spread to the peritoneal cavity, disseminating to other abdominal and thoracic organs, and can even lead to death.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of two heterologous recombinant antigens for the serological diagnosis of human polycystic echinococcosis

et al. 2022

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Polycystic echinococcosis (PE) is a zoonosis endemic in the Neotropical region of the Americas. It is caused by the larval stage of the cestode Echinococcus vogeli, which develops as harmful cysts that slowly grow in the liver, lungs and other organs of humans and other host species. Human PE diagnosis is usually based on clinical and epidemiological aspects and imaging techniques, often requiring confirmation by immunological assays. The currently available serological tests for detecting antibodies against Echinococcus spp. are mostly based on complex, variable and poorly characterized mixtures of native parasite antigens, which impairs specificity and/or sensitivity. In this scenario, the evaluation of well-characterized alternative antigens is urgently needed for the improvement of PE diagnosis. Here, two subunits (AgB8/1 and AgB8/2) of the major secretory antigen from Echinococcus granulosus (antigen B (AgB)), of diagnostic value for cystic echinococcosis, were validated for PE diagnosis. These antigens, produced as pure recombinant proteins (rAgB8/1 and rAgB8/2) in Escherichia coli, allowed detecting specific immunoglobulin G antibodies in sera from PE patients in an enzyme-linked immunosorbent assay, with sensitivities of 83.72% and 81.40%, respectively, and specificities of 83.12% and 80.09%, respectively. The use of recombinant proteins overcomes difficulties to obtain parasite material and reduced non-specific reactions and costs. Our results demonstrated reproducibility and accuracy high enough to be considered valid according to the acceptance criteria for Food and Drug Administration assay validation. This qualifies rAgB8/1 and rAgB8/2 as potential substitutes for the currently used parasite crude or partially purified antigens.

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Liver transplantation for neotropical polycystic echinococcosis caused by Echinococcus vogeli: a case report

Cited by 8 publications

References 7 publications

Preliminary Data on Liver Transplantation in Hydatidosis Disease

Preliminary Data on Liver Transplantation in Hydatidosis Disease

Manifestações clínicas da doença hidática policística apresentadas por 26 pacientes atendidos no Hospital das Clínicas de Ribeirão Preto, Estado de São Paulo, Brasil

Evaluation of two heterologous recombinant antigens for the serological diagnosis of human polycystic echinococcosis

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