IngentaConnect Cystic echinococcosis in Tunisia: analysis of hydatid cysts that ...

Authors: Lahmar, S.¹; Rebaï, W.²; Boufana, B.S.³; Craig, P.S.³; Ksantini, R.²; Daghfous, A.²; Chebbi, F.²; Fteriche, F.²; Bedioui, H.²; Jouini, M.²; Dhibi, M.¹; Makni, A.²; Ayadi, M.S.²; Ammous, A.²; Kacem, M.J.²; Ben Safta, Z.²

Source: Annals of Tropical Medicine and Parasitology, Volume 103, Number 7, October 2009 , pp. 593-604(12)

Publisher: Maney Publishing

Abstract:

Echinococcosis/hydatidosis caused by Echinococcus granulosus has a widespread distribution in the human population of Tunisia, particularly in the north-west and centre-west of the country. In a recent study, the morphological features, fertility and viability of hydatid cysts that had been excised from patients in Tunis were explored, and the E. granulosus strain or genotype involved in each case was identified from morphology of the protoscolex hooks and the results of molecular genotyping. The hepatic cysts investigated came from 41 patients [31 women and 10 men, with a mean (S.E.) age of 43.41 (14.25) years] who were treated for cystic echinococcosis, by surgery but rarely with chemotherapy, at the La Rabta Hospital in Tunis, in the 12 months ending in June 2008. Most (56%) of these patients originated from rural areas in endemic governorates. Of the 60 hepatic cysts that were studied, 38.3% were located in the right lobe of the liver and 35.0% each involved both hepatic lobes. Almost a third (31.7%) of the excised cysts were degenerating, with the rest considered viable and either multivesicular (38.3%) or univesicular (30.0%). Almost all (93.3%) of the cysts were categorized as fertile, with a mean protoscolex viability of 21.8%. Protoscolex viability was relatively high in the viable univesicular cysts with a visible cyst wall and in the multivesicular and multiseptate cysts with daughter cysts, and lowest in the cysts that appeared to be solid calcified masses. The observed variation in protoscolex viability with cyst type, in cysts excised from patients before any chemotherapy, supports the cyst classification recommended by the World Health Organization but could also be compatible with the imaging-based 'Gharbi' classification. The results of the molecular genotyping showed that all 23 cysts investigated (which came from 20 of the patients) were caused by E. granulosus of the G1 genotype (also known as the 'sheep' or 'sheep-dog' strain).

Document Type: Research article

DOI: 10.1179/000349809X12502035776153

Affiliations: 1: Service de Parasitologie, Ecole Nationale de Médecine Vétérinaire, 2020 Sidi Thabet, Tunisia 2: Service de Chirurgie Générale Département 'A', Hôpital La Rabta, 1007 Tunis, Tunisia 3: Cestode Zoonoses Research Group, Biomedical Sciences Research Institute, School of Environment and Life Sciences, University of Salford, Salford M5 4WT, U.K.

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Cystic echinococcosis in Tunisia: analysis of hydatid cysts that have been surgically removed from patients