Lethal in vitro effects of optimized chitosan nanoparticles against protoscoleces of Echinococcus granulosus

Cystic Echinococcosis (CE) is a parasitic infection caused by the larval stage of Echinococcus granulosus. Exploring safe and effective scolicidal agents for the surgery is an urgent need for the successful treatment of CE. This study aimed to determine scolicidal activity of the synthesized chitosan nanoparticles. Physicochemical properties of synthesized nanoparticles were determined by using DLS, FTIR, and SEM. Different concentrations of chitosan nanoparticles from 125 to 1000 μg/ml were examined at different incubation times (10, 60, 120, and 180 min). Scolicidal and cytotoxic activity of chitosan nanoparticles were confirmed by eosin exclusion and hemolysis activity tests. FTIR spectra, zeta potential (+42 ± 2.08) and PDI (0.388 ± 0.034) value revealed that the chitosan nanoparticles were synthesized. Significant differences among the scolicidal effects of chitosan nanoparticles were observed in comparison to the control treatments and highest scolicidal activity was observed at 1000 μg/ml after 180 min exposure time. Hemolytic activity was not significant at all concentrations of chitosan nanoparticles. Our findings support the hypothesis that Chitosan nanoparticles have the potential to be a safe and efficient scolicidal agent candidate at very low concentrations and in a wide range of exposure time. Further in vivo studies are recommended to evaluate chitosan nanoparticle efficacy before clinical application.

Severe hypernatremia in children after surgical resection of hepatic echinococcosis: a rare and potentially fatal complication

Background Using effective scolicidal agents intraoperatively is essential to lessen the recurrence rate of hepatic echinococcosis. However, severe hypernatremia may occur after hypertonic saline (HS) has been applied as the scolicidal agent. The aim of this study is to report on pediatric patients with severe hypernatremia after hepatic echinococcus surgery. Methods Patients who presented to West China Hospital between January 2010 and February 2017 were retrospectively analyzed. Children under 16 years with echinococcosis treated by resection were included in the study. Results A total of 26 children were enrolled in this study, including 16 boys and 10 girls with a median age of 8 (2–16). 24 (92.3 %) cases were cystic echinococcosis (CE) and two (7.7 %) were alveolar echinococcosis (AE). According to Clavien-Dindo classification of surgical complications, the complication rate of all 26 patients was 19.2 %, among which three cases belonged to Grade I, one to Grade III b and 1 to Grade IV. Two children encountered severe hypernatremia (sodium: 155.3 mmol/L and 190.0mmol/L). Data showed classic clinical features of severe hypernatremia: profound and persistent bradycardia, hypotension and coma. After treatment, they recovered well without any neurologic sequelae. All patients were followed up regularly for a median time of 38 months (range 4–89 months); the overall disease-free survival was 100.0 %. Conclusions HS irrigation of intra-abdominal echinococcosis may cause acute hypernatremia and severe consequences. Diagnostic suspicion and early intervention are vital tools for avoiding morbidity and mortality.

Hypernatremia post hydatid cyst resection: case report

Hypernatremia or increased sodium level is defined as the plasma sodium level over 145 m mol/l. The electrolyte abnormality is associated with severe mortality (40-60%). Patients presenting acutely with this entity have varied clinical spectrum ranging from unresponsive state, dysphagia, shortness of breath, vomiting to seizures, coma or to even death. Iatrogenic hypernatremia usually a rare entity ensues after usage of hypertonic saline as scolicidal agent during hydatid cyst resection surgeries. There is a need of high level of suspicion, to be maintained in all patients being managed for clinical conditions requiring use of hypertonic saline (3-20% NS). Here we present a case of iatrogenic hypernatremia, post-surgical resection of hydatid cyst, with clinical manifestation and subsequent management in our tertiary care hospital.

In Vitro Scolicidal Activity of the Sesquiterpenes Isofuranodiene, α-Bisabolol and Farnesol on Echinococcus granulosus Protoscoleces

Cystic echinococcosis (CE) remains an important challenge both in humans and animals. There is no safe and suitable remedy for CE, so the discovery of new compounds with promising scolicidal effects, particularly from herbal sources, is of great importance for therapeutic uses in the treatment and prevention of CE reappearance. Sesquiterpenes are C15 organic compounds made up of three isoprene units and mostly occurring as fragrant components of essential oils. They are of economic importance for the cosmetic and pharmaceutical industry, and recently attracted the attention of the scientific community for their remarkable parasiticidal properties. In the present study, we have focused on three known sesquiterpenes, isofuranodiene (IFD), α-bisabolol (BSB), and farnesol (FOH), as important phytoconstituents of the essential oils of wild celery (Smyrnium olusatrum), chamomile (Matricaria chamomilla), and acacia farnese (Vachellia farnesiana), respectively. Protoscoleces were recovered from fertile hydatid cysts and were exposed to different concentrations of the three tested compounds for different exposure times. The viability of protoscoleces was confirmed by 0.1% eosin staining. Results of scolicidal activity evaluations showed that IFD possessed the best effect against Echinococcus granulosus protoscoleces (LC50 and LC90 values of 8.87 and 25.48 µg/mL, respectively), followed by BSB (LC50 of 103.2 µg/mL) and FOH (LC50 of 113.68 µg/mL). The overall toxicity of IFD differed significantly from those of FOH and BSB, while there was no significant difference in toxicity between the latter compounds (p > 0.05). The present study showed that IFD seems to be a promising scolicidal agent and can be further tested to become a candidate for CE treatment.

Hydatid cyst of the lumbar plexus: case report with review of literature

Background Hydatid disease is widely distributed worldwide; it is caused by a parasite belonging to the Echinococcus species. It mostly affects the liver and the lungs, involvement of the spinal canal is reported to be around 0.2%, but affection of the peripheral nerves is extremely rare. Case presentation A 42-year-old lady was complaining from left loin pain and backache, with pain in the outer aspect of the left thigh for the last 5 years. During clinical examination, the ankle and the knee reflexes were normal and there was no muscle wasting. There was hyperesthesia on the outer aspect of the left leg. Magnetic resonance imaging of the back demonstrated a cystic lesion between the 4th and the 5th lumbar vertebrae which was pushing the psoas muscle anteriorly and causing atrophy of the muscle. The patient received anthelminthic medications for 1 month before surgery with little improvement of the clinical and the radiological condition. During surgery the cyst was found to arise from the lumbar nerve sheath and was apparent to be hydatid cyst because it was containing small daughter cysts. Isolation of the cyst was done and complete evacuation with deroofing of the cyst was done. The cavity of the cyst was irrigated with a solution of chlorhexidine as a scolicidal agent. The patient was discharged home after 3 days with no post-operative complications, anthelminthic medications prescribed for 3 months. Conclusion The treatment options vary depending on the region affected by the cyst; it may be treated by complete cyst excision, evacuation, and deroofing. Preventing spillage of the contents of the cyst during surgery and the use of scolicidal agents are mandatory to decrease the rate of recurrence. It is very important to exclude other organ involvement particularly pulmonary involvement before surgery.

Evaluation of clinical, diagnostic and treatment aspects in hydatid disease: analysis of an 8-year experience

Background & Objective: Echinococcosis is still a common health problem. The aim of this study was to discuss our 8-year data in terms of diagnosis, treatment and follow-up of cystic Echinococcosis.Methods: A total of 178 patients who had hydatid cyst were analyzed retrospectively from the hospital records. The diagnosis of hydatid cyst was based on clinical-serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings.Results: A total of 178 medical records were evaluated; the male:female ratio was 0.73 and mean age 44.6±16.9 years. The most common symptom was abdominal pain (94, 52.8%). The mean cyst size was 9.5±3.9 cm. Eosinophilia was significantly higher in patients with complicated cyst (35.3%) (p=0.002). The average duration of hospitalization in surgical patients was shorter than non-surgical patients (p=0.026). There was no significant correlation between the preference of scolicidal agent (hypertonic saline, H2O2, povidone iodine) and recurrence in patients who underwent surgery (p>0.05). There was no significant difference between the patients who underwent radical and conservative surgery in terms of complication and recurrence (p=0.077, p=0.557). No significant difference was found between percutaneous and surgical treatment in terms of complication and recurrence (p=0.264, p=0.276).Conclusion: Even though considerable progress has been made, uncertainties remain in the diagnosis and treatment of Echinococcosis. Hence, standardized diagnostic and treatment procedures should be established with well-designed studies.Keywords: Echinococcosis, hydatid cyst, diagnosis, treatment.

The Lethal Effect of a Nano Emulsion of Satureja hortensis Essential Oil on Protoscoleces and Germinal Layer of Hydatid Cysts

Background: New scolicidal agents and novel therapeutic drugs are essential for better management of the zoonotic infection, hydatid disease. This study evaluated the effect of a nanoemulsion (NE) of Satureja hortensis essential oil (SHEO) on protoscoleces and germinal layer of hydatid cysts. Methods: This study was conducted from July to October 2016 in Shiraz University, Shiraz, Iran. Gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS) were performed to identify the main components of SHEO. To determine the scolicidal power of the NE of SHEO, live protoscoleces of hydatid cysts were exposed to two concentrations (1 and, 2 mg/mL) of the NE and incubated at 37 °C for 10 and 20 min. To evaluate the anti-hydatid effect of the NE of SHEO, the collected hydatid cysts from the abdominal cavities of the experimentally infected mice were immersed in the NE (0.5 mg/ml) and incubated at 22 °C for 24 h. Results: Carvacrol and γ-terpinene were the major components of the SHEO. NE of SHEO at the concentrations of 1 and 2 mg/mL showed 100% scolicidal power after 20 and 10 min respectively. Exposure of the hydatid cysts to the NE of SHEO resulted in crumpling of their germinal layer and detachment of this layer from the laminated layer. Conclusion: NE of SHEO showed a strong scolicidal activity as well as a profound lethal effect on the germinal layer of hydatid cysts. Accordingly, this product may be used as a natural scolicidal agent in hydatid cyst surgery. Furthermore, it may be used as a therapeutic tool for treatment of hydatid disease.

Spontaneous expulsion of a pulmonary hydatid cyst through bronchial rupture

The management of a pulmonary echinococcal cyst consists mainly of medical treatment with a scolicidal agent such as albendazole and surgical extirpation. Rarely, a pulmonary cyst may rupture into a bronchus and be spontaneously expelled. This may result in seeding elsewhere in the bronchial tree, or even the alimentary tract, but occasionally, as in our case, may result in a cure.