Genetic diversity of Echinococcus vogeli in the western Brazilian Amazon

Human polycystic echinococcosis is a parasitic infection caused by the larval stage of Echinococcus vogeli, which occurs in rural areas of Central and South America. Until now, little information on the genetic variability of E. vogeli is available. Here, 32 samples from human-excised E. vogeli cysts had a 396-bp sequence of the mitochondrial cytochrome oxidase I (COI) gene sequenced and compared to another 17 COI sequences representing nine Echinococcus species. A Bayesian COI tree revealed that all E. vogeli sequences formed a monophyletic and well-supported clade with an E. vogeli reference sequence. The occurrence of geographically restricted E. vogeli COI haplotypes suggests retention of ancestral polymorphisms with little migration in Acre, Brazil

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

The echinococcosis is a zoonosis whose etiological agents are nematodes of the genus Echinococcus. There are five species of Echinococcus, two of them, E. oligarthrus (Diesing, 1863) and E. vogeli (Rausch & Bernstein, 1972) only occur in neotropical areas. The echinococcosis by E. vogeli causes multiple hydatid cysts, mainly in the liver of intermediate hosts, of which one is the human being. The lack of knowledge about the disease makes the diagnosis is delayed or even misleading. The lack of systematic information on treatment is also difficult to assess the results and prognosis of patients with peritoneal and hepatic lesions caused by E. vogeli. Here we describe the clinical features of patients, we propose a radiological classification protocol used in the classification of alveolar echinococcosis (E. multilocularis "PNM" Classification, Kern et al., 2006), which was also suitable for polycystic echinococcosis (E. vogeli) and describe a therapeutic option for the treatment of hydatid disease which previously had only been used for cases of cystic echinococcosis (E. granulosus, PAIR-Puncture, Aspiration, Injection, Reaspiration, Brunnetti et al., 2001). A prospective cohort study was initiated in 1999 and by 2009 included 60 patients. We describe the main symptoms and signs: pain in upper abdomen (65%) and hepatomegaly (60%) and patients were classified according to the "PNM" classification and submitted to three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts- PAIR. After exclusion of two cases, due to inadequacy of the research protocol, the groups were distributed as follows: treatment with albendazole: n = 28 (48.3%, 28/58), surgical therapy: n = 25 (52.1%; 25/58) and PAIR: n = 5 (8.1%, 5 / 58). The results were stratified according to outcome of therapy: "Cure", represented by the disappearance of lesions after clinical or surgical treatment, "clinical improvement", defined as asymptomatic patients without weight loss and physiological functions preserved, "No Improvement" included patients who remained symptomatic, "Death" and "No Information", the monitoring did not allow a conclusion about the outcome. The three treatment groups together demonstrade lethality rate of 15.5% (9 / 58), "no improvement" 1.7% (1 / 58), "clinical improvement" in 40.0% (23/58) and "cure "in 32.8% (19/58). Regarding the outcome "death", there was no difference between therapies with albendazole or surgical treatment with 4 (14.2%) and 3 (12%) deaths respectively, but in the first group, albendazole, the outcome "cure" was 4.3% (1 / 23) and "clinical improvement" 74.0% (17/23), whereas in the "surgery" to "cure" represented 71.0% (17/24) and "clinical improvement" 16.7 (4 / 24). Therapy "PAIR" was associated with a lethality rate of 40% (2 / 5), cure in 20% (fifth) and clinical improvement in 40% (2 / 5). The "PNM" classification was useful to indicate such therapy in cases of polycystic hydatid disease. In conclusion, in the series studied surgical therapy has better results in the clinical therapy on the outcomes "cure" and "clinical improvement". The treatment for PAIR needs further studies.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

Leiomiossarcoma de jejuno

We describe a case of leiomyosarcoma of the jejunum in which abdominal computed tomography showed an intestinal tumor with a "sui generis" metalic artefact inside, which made us think of a benign disease (foreign body granuloma), because the patient lived in the rural area and he had a manioc flour mill, which is one the basic foods of the majority of the population of the north in Brazil. Because of the aspect of the tumor, we decided on a large scale resection, considering the possibility of a malignant tumor since we don't have frozen sections. This assured us of an adequate treatment for the tumor. This type of pathology should be remembered even though it only accounts for 0,2-2% of the intestinal tract tumors

Polycystic echinococcosis in the state of Acre, Brazil: contribution to patient diagnosis, treatment and prognosis

The lack of knowledge regarding polycystic hydatid disease results in delayed or even incorrect diagnosis. The lack of systematic information regarding treatment also makes it difficult to assess the results and prognosis in patients with peritoneal and hepatic lesions caused by Echinococcus vogeli. Here we describe the clinical features of patients, propose a radiological classification protocol and describe a therapeutic option for the treatment of hydatid disease that previously had only been used for cases of cystic echinococcosis (Echinococcus granulosus). A prospective cohort study was initiated in 1999 and by 2009 the study included 60 patients. These patients were classified according to the PNM classification (parasite lesion, neighbouring organ invasion and metastases) and placed in one of three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10 mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts via puncture, aspiration, injection and re-aspiration (PAIR). The results were stratified according to therapeutic outcome: "cure", "clinical improvement", "no improvement", "death" or "no information". The PNM classification was useful in indicating the appropriate therapy in cases of polycystic hydatid disease. In conclusion, surgical therapy produced the best clinical results of all the therapies studied based on "cure" and "clinical improvement" outcomes. The use of PAIR for treatment requires additional study

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

Neotropical polycystic echinococcosis (NPE) is a parasitic disease caused by cestodes of Echinococcus vogeli. This parasite grows most commonly in the liver, where it produces multiples cysts that cause hepatic and vessel necrosis, infects the biliary ducts, and disseminates into the peritoneal cavity, spreading to other abdominal and thoracic organs. In cases of disseminated disease in the liver and involvement of biliary ducts or portal system, liver transplantation may be a favorable option. We present a report of the first case of liver transplantation for the treatment of advanced liver NPE caused by E. vogeli