Alveolar hydatid disease

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Aveolar Hydatid Disease
Other namesAlveolar echinococcosisAlveolar colloid of the liver,Alveolococcosis, Multilocular echinococcosis
Specialty Infectious diseases, helminthologist  OOjs UI icon edit-ltr-progressive.svg
Causesinfection of larval stage Echinococcus multilocularis

Alveolar hydatid disease (AHD) is a form of echinococcosis, or a disease that originates from a parasitic flatworm. AHD is caused by an infection of the flatworm species Echinococcus multilocularis . [1] Although alveolar echinococcosis is rarely diagnosed in humans and is not as widespread as cystic echinococcosis (caused by Echinococcus granulosus ), it is also still a serious disease that has a significantly high fatality rate. [2] It is considered one of the most life-threatening helminthic infections humans can have. [2]

Contents

It is most prevalent in China, Eastern France, Switzerland, Austria, Bulgaria, Turkey, Iran, Japan, Afghanistan, and Russia, and is mostly confined to the Northern hemisphere, south to around the 40th or 45th degree of Northern latitude, save some cases reported in Northern Africa. [2] [3] [4] [5] [6]

Signs and symptoms

As the larvae grow in the liver, they create lesions. [2] If untreated, this progresses into abdominal mass and/or pain, jaundice, and finally liver failure. [7]

Cause

AHD is caused by the larval stage of E. mulitilocularis, a species of flatworm found in the Northern Hemisphere. [2] Humans make poor intermediate hosts for the worm, as they play no role in their life cycle. [5] However, when exposed the worms will still infect them. A major risk factor is when their domesticated dogs and cats eat wild, infected (typically arvicolid) rodents. [5] [8] [9] Their feces then will contain the worms' eggs, which have fully developed larval worms inside. [5] Humans become infected after eating food or water contaminated by embryonated eggs, or by handling an infected host like dogs and cats or by skinning infected foxes. [8] [10]

Pathophysiology

Once ingested by humans, "the oncospheres hatch in the stomach or small intestine, become activated, penetrate the epithelial layer, and migrate via blood and lymphatic vessels to the visceral organs, primarily the liver, where they develop to another larval stage, the metacestode." [5] The larval growth resembles a slow-moving liver tumor and it is able to destroy both the liver parenchyma and its function. [2]

Diagnosis

Due to its infiltration into biliary and vascular liver tissue, it can be difficult to differentiate AHD and liver cancer. [2]

Management

Early detection and treatment and radical surgery is key to preventing fatality from AHD. [2] Treatment may include liver resection to remove the larvae and chemotherapy using benzimidazoles. [7] Chemotherapy must continue for many years, sometimes for the remainder of the patient's life. [11] Failure to comply with these expensive and difficult treatments will likely result in death for the patient. [7]

Prognosis

The disease is often progressive and destructive. [12] The growth happens slow, and so many people do not get symptoms until the later stages. [6] Central necrotic cavities are common in advanced stages of the disease. [13]

Epidemiology

AHD is not as common as diseases caused by other flatworms, but it is still prevalent in the Northern hemisphere. It is not uncommon in China, with some communities having a 5% or more infection rate. [14] [15] In Europe, it is considered an emerging disease. [7] The increasing fox populations of Europe correlate with heightened reported cases. [16]

History

In 1855, Rudolf Virchow, the German pathologist, recognized that the disorder that was at the time known as colloid carcinoma of the liver, which was known for its tumor-like lesions in the liver, were actually caused by an Echinococcus species. For 100 year it was debated whether the species was E. granulosus or a different species. It was finally settled by two publications between 1954 and 1955, the former from Alaska and the latter from Germany. [5]

Society and culture

AHD is confined to the Northern hemisphere. [3] There are about 18,235 reported cases every year with 95% hailing from China. [17]

Research directions

Wildlife research is working to detect the parasite in new areas. [18]

Related Research Articles

<span class="mw-page-title-main">Echinococcosis</span> Parasitic disease of tapeworms of the Echinococcus type

Echinococcosis is a parasitic disease caused by tapeworms of the Echinococcus type. The two main types of the disease are cystic echinococcosis and alveolar echinococcosis. Less common forms include polycystic echinococcosis and unicystic echinococcosis.

<span class="mw-page-title-main">Trichinosis</span> Parasitic disease due to invasion by Trichinella spp.

Trichinosis, also known as trichinellosis, is a parasitic disease caused by roundworms of the Trichinella type. During the initial infection, invasion of the intestines can result in diarrhea, abdominal pain, and vomiting. Migration of larvae to muscle, which occurs about a week after being infected, can cause swelling of the face, inflammation of the whites of the eyes, fever, muscle pains, and a rash. Minor infection may be without symptoms. Complications may include inflammation of heart muscle, central nervous system involvement, and inflammation of the lungs.

<span class="mw-page-title-main">Cyst</span> Closed sac growth on the body

A cyst, also traditionally known from Old English as a wen, is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac ; however, the distinguishing aspect of a cyst is that the cells forming the "shell" of such a sac are distinctly abnormal when compared with all surrounding cells for that given location. A cyst may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed surgically, but that would depend upon its type and location.

<span class="mw-page-title-main">Schistosomiasis</span> Human disease caused by parasitic worms called schistosomes

Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, bloody stool, or blood in the urine. Those who have been infected for a long time may experience liver damage, kidney failure, infertility, or bladder cancer. In children, it may cause poor growth and learning difficulty.

<span class="mw-page-title-main">Trematoda</span> Class of parasitic flatworms

Trematoda is a class of flatworms known as flukes or trematodes. They are obligate internal parasites with a complex life cycle requiring at least two hosts. The intermediate host, in which asexual reproduction occurs, is usually a snail. The definitive host, where the flukes sexually reproduce, is a vertebrate. Infection by trematodes can cause disease in all five traditional vertebrate classes: mammals, birds, amphibians, reptiles, and fish.

<span class="mw-page-title-main">Ascariasis</span> Disease caused by the parasitic roundworm Ascaris lumbricoides

Ascariasis is a disease caused by the parasitic roundworm Ascaris lumbricoides. Infections have no symptoms in more than 85% of cases, especially if the number of worms is small. Symptoms increase with the number of worms present and may include shortness of breath and fever in the beginning of the disease. These may be followed by symptoms of abdominal swelling, abdominal pain, and diarrhea. Children are most commonly affected, and in this age group the infection may also cause poor weight gain, malnutrition, and learning problems.

<span class="mw-page-title-main">Praziquantel</span> Medication

Praziquantel (PZQ), sold under the brandname Biltricide among others, is a medication used to treat a number of types of parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is used to treat schistosomiasis, clonorchiasis, opisthorchiasis, tapeworm infections, cysticercosis, echinococcosis, paragonimiasis, fasciolopsiasis, and fasciolosis. It should not be used for worm infections of the eye. It is taken by mouth.

<span class="mw-page-title-main">Helminthiasis</span> Any macroparasitic disease caused by helminths

Helminthiasis, also known as worm infection, is any macroparasitic disease of humans and other animals in which a part of the body is infected with parasitic worms, known as helminths. There are numerous species of these parasites, which are broadly classified into tapeworms, flukes, and roundworms. They often live in the gastrointestinal tract of their hosts, but they may also burrow into other organs, where they induce physiological damage.

<span class="mw-page-title-main">Albendazole</span> Chemical compound

Albendazole is a broad-spectrum anthelmintic and antiprotozoal agent of the benzimidazole type. It is used for the treatment of a variety of intestinal parasite infections, including ascariasis, pinworm infection, hookworm infection, trichuriasis, strongyloidiasis, taeniasis, clonorchiasis, opisthorchiasis, cutaneous larva migrans, giardiasis, and gnathostomiasis, among other diseases.

<i>Echinococcus</i> Genus of worms

Echinococcus is a genus within Cestoda, a parasitic class of the platyhelminthes phylum. Human echinococcosis is an infectious disease caused by the following species: E. granulosus, E. multilocularis, or E. vogeli.

<i>Echinococcus granulosus</i> Species of flatworm

Echinococcus granulosus, also called the hydatid worm, hyper tape-worm or dog tapeworm, is a cyclophyllid cestode that dwells in the small intestine of canids as an adult, but which has important intermediate hosts such as livestock and humans, where it causes cystic echinococcosis, also known as hydatid disease. The adult tapeworm ranges in length from 3 mm to 6 mm and has three proglottids ("segments") when intact—an immature proglottid, mature proglottid and a gravid proglottid. The average number of eggs per gravid proglottid is 823. Like all cyclophyllideans, E. granulosus has four suckers on its scolex ("head"), and E. granulosus also has a rostellum with hooks. Several strains of E. granulosus have been identified, and all but two are noted to be infective in humans.

<i>Echinococcus multilocularis</i> Species of flatworm

Echinococcus multilocularis, the fox tapeworm, is a small cyclophyllid tapeworm found extensively in the northern hemisphere. E. multilocularis, along with other members of the Echinococcus genus, produce diseases known as echinococcosis. Unlike E. granulosus,E. multilocularis produces many small cysts that spread throughout the internal organs of the infected animal. The resultant disease is called Alveolar echinococcosis, and is caused by ingesting the eggs of E. multilocularis.

<span class="mw-page-title-main">Eucestoda</span> Subclass of flatworms

Eucestoda, commonly referred to as tapeworms, is the larger of the two subclasses of flatworms in the class Cestoda. Larvae have six posterior hooks on the scolex (head), in contrast to the ten-hooked Cestodaria. All tapeworms are endoparasites of vertebrates, living in the digestive tract or related ducts. Examples are the pork tapeworm with a human definitive host, and pigs as the secondary host, and Moniezia expansa, the definitive hosts of which are ruminants.

<span class="mw-page-title-main">Cestoda</span> Class of flatworms

Cestoda is a class of parasitic worms in the flatworm phylum (Platyhelminthes). Most of the species—and the best-known—are those in the subclass Eucestoda; they are ribbon-like worms as adults, known as tapeworms. Their bodies consist of many similar units known as proglottids—essentially packages of eggs which are regularly shed into the environment to infect other organisms. Species of the other subclass, Cestodaria, are mainly fish infecting parasites.

<span class="mw-page-title-main">Hookworm vaccine</span>

Hookworm vaccine is a vaccine against hookworm. No effective vaccine for the disease in humans has yet been developed. Hookworms, parasitic nematodes transmitted in soil, infect approximately 700 million humans, particularly in tropical regions of the world where endemic hookworms include Ancylostoma duodenale and Necator americanus. Hookworms feed on blood and those infected with hookworms may develop chronic anaemia and malnutrition. Helminth infection can be effectively treated with benzimidazole drugs, and efforts led by the World Health Organization have focused on one to three yearly de-worming doses in schools because hookworm infections with the heaviest intensities are most common in school-age children. However, these drugs only eliminate existing adult parasites and re-infection can occur soon after treatment. School-based de-worming efforts do not treat adults or pre-school children and concerns exist about drug resistance developing in hookworms against the commonly used treatments, thus a vaccine against hookworm disease is sought to provide more permanent resistance to infection.

<i>Hymenolepis microstoma</i> Species of flatworm

Hymenolepis microstoma, also known as the rodent tapeworm, is an intestinal dwelling parasite. Adult worms live in the bile duct and small intestines of mice and rats, and larvae metamorphose in the haemocoel of beetles. It belongs to the genus Hymenolepis; tapeworms that cause hymenolepiasis. H. microstoma is prevalent in rodents worldwide, but rarely infects humans.

<i>Flemingia vestita</i> Species of legume

Flemingia vestita famously known as Sohphlang is a nitrogen fixing herb with characteristic tuberous root, belonging to the genus Flemingia. The root is edible and is a common vegetable in some Asian tribal communities. In addition, it has been traditionally used as an anthelmintic, the basis of which is scientifically validated.

The PAIR procedure is a noninvasive treatment option to remove hydatid cysts. PAIR is considered an alternative treatment for cystic echinococcosis and is often indicated for patients who do not respond to surgery or benzimidazoles

<i>Echinococcus vogeli</i> Species of flatworm

Echinococcus vogeli is a small cyclophyllid tapeworm found in Central and South America. E. vogeli, as well as other members of the genus Echinococcus, produce a disease called echinococcosis. Echinococcosis, also known has hydatidosis, is a result of ingesting the eggs of the genus Echinococcus. E. vogeli is similar to E. multilocularis in that both species produces many small cysts that spread throughout the internal organs of the infected animal. The ingestion of E. vogeli eggs, and the spreading of the cysts through infected host, will results in Polycystic Echinococcosis.

<span class="mw-page-title-main">Cat worm infections</span> Worm infections in cats

Cat worm infections, the infection of cats (Felidae) with parasitic worms, occur frequently. Most worm species occur worldwide in both domestic and other cats, but there are regional, species and lifestyle differences in the frequency of infestation. According to the classification of the corresponding parasites in the zoological system, infections can be divided into those caused by nematode and flatworms - in the case of the latter, mainly cestoda and trematoda - while other strains are of no veterinary significance. While threadworms usually do not require an intermediate host for their reproduction, the development cycle of flatworms always proceeds via alternate hosts.

References

  1. ↑ Wilson JF, Rausch RL, Wilson FR (March 1995). "Alveolar hydatid disease. Review of the surgical experience in 42 cases of active disease among Alaskan Eskimos". Annals of Surgery. 221 (3): 315–23. doi:10.1097/00000658-199503000-00015. PMC   1234575 . PMID   7717785.
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  3. 1 2 Schantz PM (1988). "Echinococcosis (Hydatid Disease)". Laboratory Diagnosis of Infectious Diseases. New York, NY: Springer New York. pp. 836–849.
  4. ↑ Rausch RL, Wilson JF, Schantz PM (June 1990). "A programme to reduce the risk of infection by Echinococcus multilocularis: the use of praziquantel to control the cestode in a village in the hyperendemic region of Alaska". Annals of Tropical Medicine and Parasitology. 84 (3): 239–50. doi:10.1080/00034983.1990.11812463. PMID   2222026.
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  6. 1 2 Bhatia JK, Ravikumar R, Naidu CS, Sethumadhavan T (December 2016). "Alveolar hydatid disease of the liver: A rare entity in India". Medical Journal, Armed Forces India. 72 (Suppl 1): S126–S129. doi:10.1016/j.mjafi.2015.12.005. PMC   5192168 . PMID   28050091.
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  8. 1 2 Kantarci M, Pirimoglu B, Kizrak Y (2014-03-28). "Diagnostic imaging and interventional procedures in a growing problem: Hepatic alveolar echinococcosis". World Journal of Surgical Procedures. 4 (1): 13–20. doi: 10.5412/wjsp.v4.i1.13 .
  9. ↑ Knapp J, Combes B, Umhang G, Aknouche S, Millon L (2016). "Could the domestic cat play a significant role in the transmission of Echinococcus multilocularis? A study based on qPCR analysis of cat feces in a rural area in France". Parasite. 23: 42. doi:10.1051/parasite/2016052. PMC   5782850 . PMID   27739398.
  10. ↑ Morris DL, Richards KS (1992). Hydatid disease : current medical and surgical management. Oxford [England]: Butterworth-Heinemann. ISBN   0-7506-1379-3. OCLC   24538737.
  11. ↑ Torgerson PR, Schweiger A, Deplazes P, Pohar M, Reichen J, Ammann RW, et al. (July 2008). "Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years". Journal of Hepatology. 49 (1): 72–7. doi:10.1016/j.jhep.2008.03.023. PMID   18485517.
  12. ↑ Amir-Jahed AK, Fardin R, Farzad A, Bakshandeh K (November 1975). "Clinical echinococcosis". Annals of Surgery. 182 (5): 541–6. doi:10.1097/00000658-197511000-00001. PMC   1344034 . PMID   1190858.
  13. ↑ Gottstein B (July 1992). "Molecular and immunological diagnosis of echinococcosis". Clinical Microbiology Reviews. 5 (3): 248–61. doi:10.1128/cmr.5.3.248. PMC   358243 . PMID   1498767.
  14. ↑ Craig PS, Deshan L, MacPherson CN, Dazhong S, Reynolds D, Barnish G, et al. (October 1992). "A large focus of alveolar echinococcosis in central China". Lancet. 340 (8823): 826–31. doi:10.1016/0140-6736(92)92693-a. PMID   1357252. S2CID   31696615.
  15. ↑ Budke CM, Jiamin Q, Zinsstag J, Qian W, Torgerson PR (July 2004). "Use of disability adjusted life years in the estimation of the disease burden of echinococcosis for a high endemic region of the Tibetan plateau". The American Journal of Tropical Medicine and Hygiene. 71 (1): 56–64. doi: 10.4269/ajtmh.2004.71.56 . PMID   15238690. S2CID   35630697.
  16. ↑ Schweiger A, Ammann RW, Candinas D, Clavien PA, Eckert J, Gottstein B, et al. (June 2007). "Human alveolar echinococcosis after fox population increase, Switzerland". Emerging Infectious Diseases. 13 (6): 878–82. doi:10.3201/eid1306.061074. PMC   2792858 . PMID   17553227.
  17. ↑ Nunnari G, Pinzone MR, Gruttadauria S, Celesia BM, Madeddu G, Malaguarnera G, et al. (April 2012). "Hepatic echinococcosis: clinical and therapeutic aspects". World Journal of Gastroenterology. 18 (13): 1448–58. doi: 10.3748/wjg.v18.i13.1448 . PMC   3319940 . PMID   22509076.
  18. ↑ Romig T, Dinkel A, Mackenstedt U (January 2006). "The present situation of echinococcosis in Europe". Parasitology International. 55 Suppl: S187-91. doi:10.1016/j.parint.2005.11.028. PMID   16352465.
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