OBJECTIVETo evaluate the efficacy of a novel compound derived from Traditional Chinese Medicine (TCM) for treatment of alveolar echinococcosis in the Kuming mouse.

METHODSThe compound was extracted from TCM by serial procedures including amalgamation of TCM drugs, boiling in a beaker, cold condensation using a reflux instrument, evaporation by mild heating and finally, formation of a deep brown powder. An animal model of alveolar echinococcosis was established concurrently. A bit of alveococcus tissue derived from alveolar echinococcosis in the mouse was transplanted into the peritoneal cavity of the musculus of a Kuming mouse. The duration of infection after inoculation was classified as either 1 week or 10 weeks; the animals were again divided into treated groups and control groups. Estimation of the alveococcus inhibitory rate and electron microscopic observation served as the main methods for assessment of efficacy. The infected mice in the treated groups were intra-gastrically administered once per day with the TCM extractive powder at doses of 20 mg.kg(-1) for three months continuously. All the animals were sacrificed and examined half a month after the end of TCM treatment.

RESULTSTotal wet weight of alveococcus collected from the 9 mice in the treated group after one week of infection was 37.8 g (x +/- s, 4.196 +/- 2.090 g), which was markedly lower than the amount collected from 10 mice of the control group (121.3 g, x +/- s, 12.1 +/- 4.3 g). Therefore, the inhibitory rate of the alveococcus was 65.7% (P < 0.01). Similarly, the total wet weight of alveococcus from 7 mice of the treated group after 10 weeks of infection was 4.3 g (x +/- s, 0.62 +/- 1.21 g), which was much lower than the amount collected from 6 mice of the control group (17.85 g, x +/- s, 2.93 +/- 3.28 g). The inhibitory rate of alveococcus was 80.6% (P < 0.01). Furthermore, the ultrastructural appearances of alveococcus showed obvious differences between the two groups.

CONCLUSIONTCM extractive powder for treatment of murine alveococcosis is considered to be a hopeful anti-echinococcus compound; it is a topic for further study.

Animals ; Echinococcosis ; drug therapy ; pathology ; Female ; Medicine, Chinese Traditional ; Mice ; Microscopy, Electron

Adult ; Benzimidazoles ; therapeutic use ; Echinococcosis, Pulmonary ; diagnosis ; drug therapy ; Female ; Humans

OBJECTIVE: More than 70% of hepatic alveolar echinococcosis (HAE) are inoperable. Thus, long-term, or even life-long, pharmacological treatment with benzimidazoles is necessary. For effective treatment, it is of great importance to employ imaging techniques to detect and monitor the non-resectable parasitic viability. Therefore, this study aimed to evaluate diffusion-weighted imaging (DWI) in assessing the viability of HAE in comparison to 18-fluoro-deoxyglucose (18F-FDG) positron emission tomography, combined with computed tomography (PET/CT). MATERIALS AND METHODS: Positron emission tomography, computed tomography and DWI (b-values: 0, 800 s/mm2) were retrospectively analysed in eight patients with clinically-verified HAE to, generate the apparent diffusion coefficient (ADC) map. The activity of HAE lesions in both techniques were determined independently by two radiologists according to the following standard: (+), marked focally or perilesionally increased FDG uptake/high signal intensity; (−), a hepatic defect without FDG uptake/no high signal intensity. Every lesion's maximum standardized uptake value (SUV(max)) on the PET/CT images and mean ADC values on the parametric ADC maps were measured respectively. Results of PET/CT and DWI were compared on a per-lesion-basis. Pearson's correlation coefficient was assessed for statistical analysis. RESULTS: A total of 14 HAE lesions were detected. Eight lesions (diameter 3–15 cm) showed perilesional hyper-signal intensity on DWI. This was visualised on PET/CT as increased FDG uptake. They mainly existed in the lesion's border with normal liver parenchyma. Five lesions (diameter < 2 cm) were detected as nodular hyperintensity on DWI and a ‘hot spot’ on PET/CT in the same distribution. One patient, who had received oral drug therapy for three years showed significantly decreased perilesional hyperintensity on the DWI and a hepatic defect without any FDG uptake on PET/CT. Pearson's correlation coefficient indicated a significant inverse correlation of the ADC and the SUV(max) (r = −0.67, p < 0.001). CONCLUSION: Diffusion-weighted imaging is capable of offering information on visually detecting the HAE lesions' viability and may be useful for routine application in the initial diagnosis of HAE.
Benzimidazoles ; Diagnosis ; Diffusion ; Drug Therapy ; Echinococcosis ; Echinococcosis, Hepatic ; Electrons ; Humans ; Liver ; Magnetic Resonance Imaging ; Parasites ; Positron-Emission Tomography and Computed Tomography ; Positron-Emission Tomography ; Retrospective Studies

Adult ; Albendazole ; therapeutic use ; Biopsy ; Brain ; parasitology ; pathology ; Echinococcosis, Hepatic ; complications ; drug therapy ; pathology ; Echinococcosis, Pulmonary ; etiology ; pathology ; Female ; Humans ; Male ; Middle Aged

Although alveolar echinococcosis (AE) can cause a serious disease with high mortality and morbidity similar to malign neoplasms. A 62-year-old woman admitted to a hospital located in Sivas, Turkey, with the complaints of fatigue and right upper abdominal pain. On contrast abdominal CT, a 54x70x45 mm sized cystic lesion was detected in the left lobe of the liver that was seen to extend to the posterior mediastinum and invade the diaphragm, esophagus, and pericardium. The cystic lesion was seen to be occluding the inferior vena cava and left hepatic vein at the level where the hepatic veins poured into the inferior vena cava. Bilateral pleural effusion was also detected. We discussed this secondary Budd-Chiari Syndrome (BCS) case, resulting from the AE occlusion of the left hepatic vein and inferior vena cava, in light of the information in literature.
Animals ; Anthelmintics/therapeutic use ; Budd-Chiari Syndrome/drug therapy/*etiology/parasitology ; Echinococcosis, Hepatic/*complications/drug therapy/parasitology ; Echinococcus multilocularis/isolation & purification ; Female ; Humans ; Middle Aged

Treatment of hydatid disease is mainly surgical, with medical treatment being reserved as a coadjuvant treatment. Use of effective scolicidal agents during surgery of cystic echinococcosis is essential to reduce the recurrence rate. The goal of this study was to evaluate the in vitro scolicidal effects of hydroalcoholic extracts of Satureja khuzestanica leaves and aqueous extracts of Olea europaea leaves on hydatid cyst protoscolices. Echinococcus granulosus protoscolices were collected from the liver of sheep infected with the hydatid cyst. Various concentrations of plant extracts were used in different exposure times for viability assay of protoscolices. Among the olive leaf extracts tested, 0.1% and 0.01% concentrations had strong scolicidal effects in 120 min. S. khuzestanica 0.1% had very strong scolicidal effects in 30, 60, and 120 min of exposure times and the mortality rate decreased with the lower concentration. The finding have shown that the scolicidal activity of S. khuzestanica against cystic echinococosis protoscolices were more effective, while the O. europaea extract showed less effects.
Animals ; Anthelmintics/*pharmacology ; Dose-Response Relationship, Drug ; Echinococcosis/drug therapy/*parasitology ; Echinococcus granulosus/drug effects/physiology ; Humans ; Olea/*chemistry ; Plant Extracts/*pharmacology ; Plant Leaves/chemistry ; Satureja/*chemistry

Animals ; Anthelmintics ; pharmacology ; therapeutic use ; Culture Media ; Echinococcosis ; drug therapy ; parasitology ; Echinococcus granulosus ; drug effects ; growth & development ; pathogenicity ; ultrastructure ; Parasitic Sensitivity Tests

Hydatid disease is a parasitic infestation caused by the larval form of Echinocococcus. In human, the most commonly affected organs are liver and lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. In Korea, hydatid disease is rare and surgically treated cases have been reported in the Korean literature. However, it is expected to confront this disease sooner or later, because of recent increase in traveling to the endemic area and industrial workers originating from those areas. With this trend, we experienced a case of hydatid cyst of the liver in a male patient from Uzbekistan. This patient was presented with anaphylactic shock combined with hydatid cyst. We successfully treated using ultrasound-guided transhepatic percutaneous drainage [termed puncture, aspiration, injection, and re-aspiration (PAIR)] of the hydatid cyst and concomitant albendazole instead of surgery. In this clinical case report, we describe all the course of the patient and recommend the PAIR as a first choice method for treatment of hepatic hydatid cyst.
Adult ; Albendazole/therapeutic use ; Anaphylaxis/*complications ; Animals ; Anticestodal Agents/therapeutic use ; Drainage ; Echinococcosis, Hepatic/complications/drug therapy/radiography/*therapy ; Echinococcus/isolation & purification ; Humans ; Korea ; Male ; Uzbekistan

OBJECTIVETo evaluate the clinical efficacy of a new formulation of albendazole emulsion (AbzE) in cases of liver cystic hydatidosis.

METHODSTwo regimens of AbzE (10 mg.kg(-1).d(-1) and 12.5 mg.kg(-1).d(-1)) were given to 212 patients with liver cystic hydatidosis in courses ranging from 3 months to more than one year. Assessment of drug efficacy was essentially based on imaging signs with ultrasonography as the main tool. Assessments were performed at the end of different courses and in the follow-up study of 1 - 4 years after the cessation of therapy.

RESULTSAt the end of therapeutic courses, the overall cure rate of the 212 cases was 74.5%, with a 99.1% effective rate. In the follow-up study, the cure rate was 83.1%, effective rate was 89.3%, ineffective rate was 0.6%, and recurrence rate was 10.2%. The highest cure rate was observed in cases receiving AbzE 12.5 mg.kg(-1).d(-1) for 9 months. Retreatment of recurrent cases with AbzE obtained satisfactory results.

CONCLUSIONSAbzE surpassed other currently used antihydatidosis drugs or formulations with its promising efficacy and mild side effects, and could be recommended as a drug of choice in the treatment of cystic hydatidosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Albendazole ; administration & dosage ; adverse effects ; Child ; Child, Preschool ; Echinococcosis, Hepatic ; drug therapy ; Emulsions ; Female ; Humans ; Male ; Middle Aged

Human alveolar echinococcosis (AE), a hepatic disorder that resembles liver cancer, is a highly aggressive and lethal zoonotic infection caused by the larval stage of the fox tapeworm, Echinococcus multilocularis. E. multilocularis is widely distributed in the northern hemisphere; the disease-endemic area stretches from north America through Europe to central and east Asia, including northern parts of Japan, but it has not been reported in Korea. Herein, we represent a first case of AE in Korea. A 41-year-old woman was found to have a large liver mass on routine medical examination. The excised mass showed multinodular, necrotic, and spongiform appearance with small irregular pseudocystic spaces. Microscopically, the mass was composed of chronic granulomatous inflammation with extensive coagulation necrosis and parasite-like structure, which was revealed as parasitic vesicles and laminated layer delineated by periodic acid-Schiff (PAS) stain. Clinical and histologic features were consistent with AE. After 8 years, a new liver mass and multiple metastatic pulmonary nodules were found and the recurred mass showed similar histologic features to the initial mass. She had never visited endemic areas of AE, and thus the exact infection route is unclear.
Adult ; Albendazole/*therapeutic use ; Animals ; Anthelmintics/*therapeutic use ; Echinococcosis, Hepatic/*diagnosis/drug therapy/surgery ; Echinococcus/isolation & purification ; Female ; Humans ; Liver/*pathology/radiography ; Recurrence ; Republic of Korea ; Treatment Outcome ; Zoonoses