Cystic echinococcosis therapy: Albendazole-loaded lipid nanocapsules enhance the oral bioavailability and efficacy in experimentally infected mice

International audience

Control programme for cystic echinococcosis in Uruguay

Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community’s participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.

A Review of the Genus Echinococcus Rudolphi, 1801

1. The genus Echinococcus Rudolphi, 1801, is reviewed. The recorded measurements of all species are shown in tables, and their taxonomic status is discussed. 2. Three species of Echinococcus can be distinguished by morphological criteria and are considered valid: E. granulosus, E. multilocularis and E. oligarthrus. The status of E. felidis and E. patagonicus is uncertain, but both may be conspecific with E. granulosus. Six species are considered synonyms of E. granulosus: E. cameroni, E. intermedius, E. longimanubrius, E. lycaontis, E. minimus and E. ortleppi.

Echinococcus Infections in Man and Animals in Kenya

1. Hydatid cysts are found in more than 30 per cent of all cattle, sheep and goats in Kenya, but the disease is prevalent in man only in the semi-desert area of Turkana. Up to the time of the present investigation the life-cycle of the parasite in East Africa had not been studied, but it was suggested that wild carnivores, such as hyenas and jackals, might be the main hosts of the adult worms. 2. One hundred and forty-three carnivores, representing 23 species, have been examined. Echinococcus adults were found in 27 out of 43 domestic dogs (Canis familiaris), in three out of four hunting dogs (Lycaon pictus), in one out of nine jackals (Thos mesomelas), and in three out of 19 hyaenas (Crocuta crocuta). 3. A detailed morphological study was made of the Kenya material. After comparison with specimens from other parts of the world, it was concluded that the only species occurring in Kenya was E. granulosus, but it is possible that the minor morphological and biological differences are evidence of distinct strains. Further laboratory studies are necessary to compare the parasite from man and animals in different parts of Kenya with material from elsewhere. 4. A search was made for larval hydatids in 92 ungulates representing 18 species, and in a miscellaneous collection of nearly 2,000 rodents and primates representing a further 31 species. Only one animal was positive, a wildebeest (Gorgon taurinus). 5. The infections in the wild carnivores were all very light; only domestic dogs were heavily infected. It is concluded that the main cycle of transmission in Kenya is between dogs and domestic livestock. 6. Turkana tribesmen are the most heavily infected people in Kenya, either because the strain of parasite is more pathogenic to man in that area, or, more probably, because of the intimate contact between children and the large number of infected dogs. A particularly dangerous custom in the area is the use of dogs to clean the face and anal regions of babies when they vomit or have diarrhea. No satisfactory explanation can be given for the rarity of the disease in man in many of the other areas of Kenya where hydatids are very common in domestic animals. 7. The control of the disease will depend upon an active health-education campaign, together with the destruction of all unregistered dogs and improvement in meat hygiene.

On the Ecology and Distribution of Echinococcus spp. (Cestoda: Taeniidae), and Characteristics of Their Development in the Intermediate Host. II. Comparative Studies on the Development of Larval E. multilocularis Leuckart, 1863, in the Intermediate Host

This paper reports the results of a comparative study of the development of the larval Echinococcus multilocularis Leuckart, 1863), and associated tissue reaction in naturally and experimentally infected mammals representing 31 species. The histogenesis of the larval cestode was traced in detail in arvicoline rodents of several species, and interspecific differences were defined. In arvicoline rodents, the developing larva exhibited host-specific characteristics within about a month after infection was established. The tissue reaction in Microtus oeconomus was characterized by the production of a large quantity of detritus around the larva, and by the formation of a thick epithelioid zone. In one subspecies, M. oeconomus innuitus, development of the larva was retarded, and the detrital mass was often calcified; in another, M. oeconomus operarius, the detritus rarely became calcified and the larva proliferated more rapidly. In M. pennsylvanicus, the tissue reaction was minimal, and little detritus was present. The characteristics of the tissue reaction in M. montebelli placed it in an intermediate position between the aforementioned species. In Clethrionomys rutilus, a thin epithelioid zone and an outer zone of loose collagenous fibers composed the adventitial layer; exogenous budding was retarded in this vole. A minimal tissue reaction occurred in Lagurus curtatus. In Lemmus spp., larger cysts were characteristic, but areas of small-cystic proliferation were always present. Similar differences in species or subspecies of Citellus and Dicrostonyx were described. Lesions of alveolar bydatid disease in man also were studied. The invasive growth of the larval cestode in the human liver involves a process comparable to small-cystic proliferation in the natural intermediate hosts. Although the later stages of development of the larval cestode are inhibited in man, exogenous proliferation of vesicles continues for the life of the host. The lesion in man was compared with a morphologically similar formation produced by anomalous development of the larval E. granulosus in the bovine liver. The latter is distinguished by the absence of areas of small-cystic proliferation. Non-echinococcal lesions found in the tissues studied, some of which resembled foci caused by the larval E. multilocularis, were briefly discussed.

Taxonomic Characters in the Genus Echinococcus (Cestoda: Taenlidae)

Not more than four species of cestodes of the genus Echinococcus Rudolphi, 1801, are recognized as valid. The larval stage of at least three of them is able to develop in man, causing respective types of hydatid disease. Accurate characterization of these cestodes, including both larval and adult stages, is essential for identification, upon which depends development of methods for preventing infection of man and domestic animals. Because morphological characteristics of the larval cestodes may be modified according to the species of host in which they develop, identification should be based upon taxonomic characters of specimens from the respective natural hosts, which can be identified by means of ecological investigations in endemic areas in combination with controlled infection of experimental animals. The morphological and biological characteristics of the known species are discussed, and the two species most important to public health and economically--E. granulosus (Batsch, 1786) and E. multilocularis Leuckart, 1863--are distinguished. French résumé: Trois espèces de cestodes du genre Echinococcus Rudolphi, 1801 ont été identifiées: E. granulosus (Batsch, 1786); E. multilocularis Leuckart, 1863; et E. oligarthrus (Diesing, 1863). On n'a pas encore déterminé avec certitude s'il fallait leur adjoindre E. patagonicus Szidat, 1960. Ce dernier mis à part, tous ces ténias sont connus pour provoquer chez l'homme des formes spécifiques d'échinococcose hydatique; l'infestation par les larves de E. granulosus est également fréquente chez les ongulés domestiques et la répartition de ce cestode est presque cosmopolite. E. multilocularis est très largement répandu dans l'hémisphère nord, tandis que E. oligarthrus ne se trouve que dans le centre et le sud de I'Amérique. Pour définir des critères morphologiques qui permettent de distinguer avec précision les différentes espèces d'Echinococcus, il convient de prendre les spécimens sur leurs hôtes naturels, sinon l'évolution du stade strobilaire se trouve habituellement retardée et le stade larvaire présente une gamme étendue de variations morphologiques. Pour identifier les hôtes naturels, il faut étudier l'écologie dans les zones d'éndemicité, ainsi que les manifestations de l'infection contrôlée chez des animaux d'expérience. Le stade strobilaire des ténias peut présenter plusieurs caractères spécifiques importants qui concernent notamment la taille, le nombre et la répartition des testicules, la position du pore génital dans les segments gravides, la forme de l'utérus gravide et, dans certains cas, la taille et la forme des crochets du rostre. La structure de la larve normalement développée est caractéristique de chacune des trois espèces relativement bien connues. Les caractéristiques biologiques jouent également un rôle important dans la différenciation de ces cestodes. Au stade larvaire, le laps de temps nécessaire au développement des scolex infectants est directement fonction de la durée de vie de l'hôte intermédiaire. La larve de E. multilocularis présente des scolex infectants dès le deuxième ou le troisième mois, alors qu'ils n'apparaissent qu'au bout d'un ou deux ans chez la larve de E. granulosus. Un tableau donne la liste comparative des caractéristiques taxonomiques qui permettent de faire la distinction entre ces deux espèces.

Redundancy and recombination in the Echinococcus AgB multigene family: is there any similarity with protozoan contingency genes?

Numerous genetic variants of the Echinococcus antigen B (AgB) are encountered within a single metacestode. This could be a reflection of gene redundancy or the result of a somatic hypermutation process. We evaluate the complexity of the AgB multigene family by characterizing the upstream promoter regions of the 4 already known genes (EgAgB1-EgAgB4) and evaluating their redundancy in the genome of 3 Echinococcus species (E. granulosus, E. ortleppi and E. multilocularis) using PCR-based approaches. We have ascertained that the number of AgB gene copies is quite variable, both within and between species. The most repetitive gene seems to be AgB3, of which there are more than 110 copies in E. ortleppi. For E. granulosus, we have cloned and characterized 10 distinct upstream promoter regions of AgB3 from a single metacestode. Our sequences suggest that AgB1 and AgB3 are involved in gene conversion. These results are discussed in light of the role of gene redundancy and recombination in parasite evasion mechanisms of host immunity, which at present are known for protozoan organisms, but virtually unknown for multicellular parasites.

Purification and characterization of a specific antigen from Echinococcus multilocularis.

A polypeptide (Em2a) purified by affinity chromatography from the Echinococcus multilocularis metacestode showed a high degree of purity as assayed by SDS-PAGE and analytical isoelectrical focusing. A minor contamination with host albumin was revealed. Estimation of relative mol. mass gave a value of 54,000. The isoelectric point was found to be 4.8. Antigenic activity of the polypeptide was demonstrated by immunoprecipitation and western blotting. In these assays the protein was recognized only by homologous sera from patients infected with larval E. multilocularis. This antigen (Em2a) did not react in the ELISA with sera from patients infected with heterologous helminths; these sera were highly cross-reacting with antigen from E. granulosus hydatid fluid. Seventy-three (94%) from 78 investigated patients (alveolar echinococcosis) showed a seropositive reaction with the polypeptide Em2a.

Inferior vena cava syndrome due to Echinococcus multilocularis.

Alveolar echinococcosis is an invasive, tumor-like zoonosis, accidentally transmitted to humans. We present a case of recurrent inferior vena cava (IVC) syndrome due to alveolar echinococcosis and strongly suspected on transthoracic echocardiographic examination.

Hidatidose policística no Estado do Acre: contribuição para o diagnóstico, tratamento e prognóstico dos pacientes

A equinococose é uma zoonose cujos agentes etiológicos são helmintos do gênero Echinococcus. Há cinco espécies de Echinococcus, duas delas, o E. oligarthrus (Diesing, 1863) e o E. vogeli (Rausch & Bernstein, 1972) ocorrem apenas em zonas neotropicais. A equinococose pelo E. vogeli provoca cistos hidáticos múltiplos, principalmente no fígado dos hospedeiros intermediários, dos quais um deles é o ser humano. O pouco conhecimento acerca da doença faz com que o diagnóstico seja retardado ou até mesmo equivocado. A falta de sistematização nas indicações de tratamento também dificulta a avaliação dos resultados e prognóstico dos pacientes com lesões hepáticas e peritoneais causadas pelo E. vogeli. Neste trabalho, descrevemos o quadro clínico dos pacientes; propomos protocolo de classificação radiológica, utilizado na classificação da equinococose alveolar (E. multilocularis, Classificação “PNM”, Kern et al., 2006), que foi adequado também para a equinococose policística (E. vogeli); e descrevemos uma opção terapêutica para o tratamento dessa hidatidose que anteriormente só havia sido utilizada para casos de equinococose cística (E. granulosus, PAIR -Puncture, Aspiration, Injection, Reaspiration, Brunnetti et al., 2001). Uma coorte prospectiva foi iniciada no ano de 1999 e até 2009 foram incluídos 60 pacientes. Foram descritos os principais sintomas e sinais: dor no andar superior do abdome (65%) e hepatomegalia (60%) e os pacientes foram classificados conforme a Classificação “PNM” e submetidos a três modalidades terapêuticas: (i) quimioterapia com albendazol na dose de 10mg/Kg/dia, (ii) tratamento cirúrgico com ressecção dos cistos ou (iii) punção percutânea – PAIR. Após exclusão de 2 casos, por preenchimento inadequado do protocolo de pesquisa, os grupos foram assim distribuídos: terapêutica com albendazol: n=28 (48,3%; 28/58), terapêutica cirúrgica: n=25 (52,1%; 25/58) e PAIR: n=5 (8,1%; 5/58). Os resultados foram estratificados conforme o resultado da terapêutica: “Cura”, representada pelo desaparecimento das lesões após tratamento clínico ou cirúrgico; “Melhora clínica”, entendidas como pacientes assintomáticos, sem perda ponderal e com as funções fisiológicas preservadas; “Sem Melhora”, incluiu os pacientes que permaneceram sintomáticos; “Óbito”; e “Sem informação”, o acompanhamento não permitiu a conclusão sobre o desfecho. Nos três grupos terapêuticos a taxa de letalidade de 15,5% (9/58), “sem melhora” 1,7% (1/58), “melhora clínica” em 40,0% (23/58) e “cura” em 32,8% (19/58). Com relação ao desfecho “óbito”, não houve diferença entre as terapêuticas com albendazol ou cirúrgica com 4 (14,2%) e 3 (12%) óbitos respectivamente; porém, no primeiro grupo, albendazol, o desfecho “cura” foi de 4,3% (1/23) e “melhora clínica” 74,0% (17/23), enquanto que no grupo “cirurgia” a “cura” representou 71,0% (17/24) e “melhora clínica” com 16,7(4/24). A terapêutica “PAIR” foi associado a taxa de letalidade de 40% (2/5), cura em 20% (1/5) e melhora clínica em 40% (2/5). A Classificação “PNM” foi útil para indicar tipo terapêutica nos casos de hidatidose policística. Em conclusão, na série estudada a terapêutica cirúrgica apresenta melhor resultado que a terapêutica clínica quanto aos desfechos “cura” e “melhora clínica”. A terapêutica por PAIR necessita de mais estudos.

Morphological characteristics of the Pterodoras granulosus digestive tube (Valenciennes, 1821) (Osteichthyes, Doradidae)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Studies on the Helminth Fauna of Alaska. XXV. The Ecology and Public Health Significance of Echinococcus sibiricensis Rausch & Schiller, 1954, on St. Lawrence Island

The occurrence of a species of Echinococcus (Rudolphi, 1801) on St Lawrence Island was noted by the writers in early 1950. Recognition of its unusual host relationships led to an investigation of the ecology of this cestode, E. sibiricensis Rausch & Schiller, 1954. It is the purpose of this paper to report the results of this work, with emphasis on alveolar hydatid disease in man, of which this cestode is the etiologic agent.

Observations on Some Natural-Focal Zoonoses in Alaska

In Alaska, as in arctic and subarctic Eurasia, important natural-focal zoonoses are rabies, brucellosis, tularemia, trichinosis, alveolar hydatid disease, cystic hydatid disease, and diphyllobothriasis. Most frequently affected are aboriginal peoples in villages within biocenoses that include the natural parasite-host assemblages. Pathogens are transmitted to man from wild animals and from dogs, which are important as synanthropic hosts. The prevalence and rate of transmission of certain pathogens in natural foci are related to the numerical density of small mammals, especially rodents, which may themselves be involved as hosts, and on which the numbers of their predators ultimately depend, such as is evident in the natural cycles of Echinococcus multilocularis and of rabies virus. Some pathogens in northern regions exhibit biological Characteristics that separate them from morphologically indistinguishable strains at lower latitudes (e.g., Trichinella spiralis and E. granulosus). Host-parasite relationships may also differ, as in the Arctic where rabies virus is maintained in populations of foxes, without significant involvement of mammals of other groups. Faunal interchanges during and after the Pleistocene period have influenced the distribution of parasite-host assemblages in Alaska.

The Taxonomic Value and Variability of Certain Structures in the Cestode Genus Echinococcus (Rudolphi, 1801) and a Review of Recognized Species

Although cestodes of the genus Echinococcus have been much studied in the past, there is need for an evaluation of these morphological characters used as the basis for species differentiation. The generous cooperation of other investigators in providing necessary foreign material and the results of nearly five years of field work in Alaska make possible such a study. It is the purpose of the paper to evaluate morphological characters used at the species level to differentiate these cestodes, and to review the status of species currently considered valid.

Hepatic gene expression profile in mice perorally infected with Echinococcus multilocularis eggs

Alveolar echinococcosis (AE) is a severe chronic hepatic parasitic disease currently emerging in central and eastern Europe. Untreated AE presents a high mortality (>90%) due to a severe hepatic destruction as a result of parasitic metacestode proliferation which behaves like a malignant tumor. Despite this severe course and outcome of disease, the genetic program that regulates the host response leading to organ damage as a consequence of hepatic alveolar echinococcosis is largely unknown.