• children
• contrast-enhanced ultrasound
• diagnosis
• hepatic echinococcosis
• hepatoblastoma
• pediatrics
• ultrasound

• Diagnosis
• Disease characteristics
• Hepatic echinococcosis
• Laparoscopy
• Prognosis

• Humans
• Retrospective Studies
• China/epidemiology
• Male
• Laparoscopy/methods
• Echinococcosis, Hepatic/surgery
• Echinococcosis, Hepatic/epidemiology
• Echinococcosis, Hepatic/diagnosis
• Female
• Middle Aged
• Adult
• Treatment Outcome
• Aged
• Adolescent

• 2022E02133 This research was supported by the Regional Collaborative Innovation Project of Xinjiang Uygur Autonomous Region - Science and Technology Aid Program

Echinococcosis is a zoonotic disease caused by parasites belonging to the genus Echinococcus that primarily affect the liver. The western plateau and pastoral areas of China are high-risk regions for hepatic cystic echinococcosis and hepatic alveolar echinococcosis (HAE). The high late mortality rate associated with HAE underscores the critical need for early diagnosis to improve cure rates and mitigate the disease burden in endemic areas. Currently, the World Health Organization recommends ultrasonography as the preferred initial screening method for hepatic echinococcosis. However, distinguishing between specific types of lesions, such as those of hepatic cystic echinococcosis and HAE, and other focal liver lesions is challenging. To address this issue, contrast-enhanced ultrasound is recommended as a tool to differentiate solid and cysto-solid hepatic echinococcosis from other focal liver lesions, significantly enhancing diagnostic accuracy. In this comprehensive review, we discuss the progression of hepatic echinococcosis and detail the imaging features of various types of echinococcosis using conventional, contrast-enhanced, and intraoperative ultrasound techniques. Our objective is to provide robust imaging evidence and guidance for early diagnosis, clinical decision making, and postoperative follow-up in regions with high disease prevalence.

• Echinococcosis
• Zoonotic disease
• Ultrasound
• Contrast-enhanced ultrasound
• Diagnosis

• Echinococcus granulosus sensu stricto
• Algeria
• Haplotype
• Human
• Hydatid cyst
• Mt-CO1
• Ruminant

• Animals
• Cattle
• Humans
• Algeria/epidemiology
• Echinococcosis/epidemiology
• Echinococcosis/veterinary
• Echinococcus
• Echinococcus granulosus/genetics
• Electron Transport Complex IV/genetics
• Genetic Variation
• Genotype
• Haplotypes
• Ruminants
• Sheep

• Echinococcus multilocularis
• albendazole (ABZ)
• alveolar echinococcosis
• diagnose
• next-generation sequencing

Cystic echinococcosis (CE) is a neglected parasitic zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus (E. granulosus). This study aimed to understand the clinical characteristics of human CE in Ningxia Hui Autonomous Region (NHAR) located in northwest China and to investigate the antibody profiles against the recombinant E. granulosus antigen P29 (rEg.P29) in plasma of CE patients.

A total of 37 human CE patients, along with 37 healthy donors enrolled in this study and demographic and clinical data were analyzed, including age, gender, laboratory data, symptoms, and cysts description. Plasma levels of cytokines, total IgG, and total IgE were determined by sandwich ELISA kits. Specific antibodies against rEg.P29 and hydatid cyst fluid (HCF) were assessed by indirect ELISA.

The results revealed that females have a higher percentage of CE patients than males. The incidence of CE reached a peak in the 41–50 years-old group. The liver was the most frequent location, accounting for 91.9%. Based on the CT images, cysts of 34 patients who had liver involvement, were classified as 1 (2.9%) CE1, 12 (35.3%) CE2, 5 (14.7%) CE3a, 1 (2.9%) CE3b, and 15 (44.2%) CE5. Twenty-nine (78.4%) patients had a single cyst and 8 (21.6%) had at least two cysts. The most frequently reported symptom was upper abdominal pain. The plasma level of IL-6 and total IgE were significantly increased in CE patients compared with healthy donors. Additionally, IgG response to rEg.P29 in CE patients was significantly higher than in healthy donors, and the dominant IgG subclass was IgG4. Further analysis of different patient groups revealed that rEg.P29-specific IgG and IgG4 were only elevated in CE patients with CE2 type cysts.

This study systematically investigated the clinical characteristics of patients with CE and may provide a reference basis for the diagnosis and treatment of CE in NHAR. Furthermore, tests of specific IgG and IgG4 against rEg.P29 can be used as an assisted method for imaging techniques to identify cystic activity and determine the best therapeutic approach for CE.

• Clinical characteristics
• Echinococcus granulosus
• Hydatid disease
• Immunoglobulin
• Recombinant antigen P29

Hepatic cystic echinococcosis is a zoonotic parasitic disease caused by infection with Echinococcus granulosus that is widely distributed worldwide. As a special population, children are the key population for the prevention and treatment of echinococcosis, and are also the key target for monitoring in large-scale prevention and treatment. The symptoms of hepatic cystic echinococcosis in children are atypical and easy to be misdiagnosed, and irregular treatment can easily lead to recurrence or even death. This paper provides a review of the diagnosis and treatment modalities for hepatic cystic echinococcosis in children.

• Children
• Hepatic cystic echinococcosis
• Diagnosis
• Treatment

Liver echinococcosis is a severe zoonotic disease caused by Echinococcus (tapeworm) infection, which is epidemic in the Qinghai region of China. Here, we aimed to explore biomarkers and establish a predictive model for the diagnosis of liver echinococcosis.

Microarray profiling followed by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis was performed in liver tissue from patients with liver hydatid disease and from healthy controls from the Qinghai region of China. A protein–protein interaction (PPI) network and random forest model were established to identify potential biomarkers and predict the occurrence of liver echinococcosis, respectively.

Microarray profiling identified 1152 differentially expressed genes (DEGs), including 936 upregulated genes and 216 downregulated genes. Several previously unreported biological processes and signaling pathways were identified. The FCGR2B and CTLA4 proteins were identified by the PPI networks and random forest model. The random forest model based on FCGR2B and CTLA4 reliably predicted the occurrence of liver hydatid disease, with an area under the receiver operator characteristic curve of 0.921.

Our findings give new insight into gene expression in patients with liver echinococcosis from the Qinghai region of China, improving our understanding of hepatic hydatid disease.

• CTLA4
• FCGR2B
• Liver hydatid disease
• Qinghai region of China
• echinococcosis
• microarray profiling

Echinococcosis is endemic in pastoral regions of south, west and mid-Gansu province, China. The present study aimed to determine the prevalence of echinococcosis in east Gansu, and analyze its associated risk factors. A cross-sectional survey was conducted in 2011 in 12 villages of Xiaonangou township, Huan County in east Gansu province by ultrasound abdominal scan and auxiliary serotest, and a prevalence surveillance study from 2008 to 2014 was performed in one villages by ultrasonography screening. Questionnaire information analysis indicates that the risk factors are in association with the gender, age, and education level. The cross-sectional survey found a cystic echinococcosis prevalence of 2.21% (107/4837). Higher prevalence was seen in females (χ² = 4.198, P < 0.05), older ages (> 60 years) (χ²_trend = 96.30, P < 0.05), and illiterates (χ² = 90.101, P < 0.05). Prevalence surveillance showed changing profile of 3.35% in 2011 to 0.88% (1/113) in 2014.

Human alveolar echinococcosis (HAE), caused by the larvae of Echinococcus multilocularis, is a severe parasitic disease that is a major public health concern. New HAE cases in China account for 91% of the global HAE burden every year. Although there are a few studies and systematic reviews (SRs) on the prevalence of HAE in China, trends in the prevalence have not been estimated. This study aims to describe the overall variation in the trend of HAE prevalence in China, and provide evidence for preventive measures in the future.

Thirty-five eligible studies were retrieved from PubMed, Web of Science, EMBASE, CNKI, Wanfang Data, and VIP, and included in the SR and meta-analysis. An adjusted Agency for Healthcare Research and Quality checklist was used to evaluate study quality. The arcsine transformation was used to adjust the individual reported prevalence, and the pooled HAE prevalence was calculated. Heterogeneity was evaluated using the chi-square test and I² statistic. Forest plots were generated for the meta-analysis, and publication bias of the studies was assessed using the Egger’s test and funnel plots. We conducted subgroup analyses, sensitivity analyses, and meta-regression analyses to analyze the source of heterogeneity and factors potentially influencing the prevalence of HAE.

The meta-analysis indicated that the pooled HAE prevalence in China was 0.96% (95% CI: 0.71 to 1.25%). Factors potentially influencing HAE prevalence were female sex (OR = 1.60, 95% CI: 1.35 to 1.91, P<0.01), being ≥30 years old (OR = 4.72, 95% CI: 2.29 to 9.75, P<0.01), and being farmers and/or herdsmen (OR = 2.54, 95% CI: 1.60 to 4.02, P<0.01). The results of the meta-regression analysis (R² = 38.11%, P < 0.01) indicated that HAE prevalence is on a downward trend.

HAE prevalence has decreased over time and maintained low levels after 2005 in China. This decline was influenced by the utilization of One Health strategies as intervention measures. Therefore, these One Health strategies should be used as references to formulate future programs for HAE control. More high-quality epidemiological investigations and surveillance programs should be conducted in order to improve HAE control in the future.

• Disease control
• Human alveolar echinococcosis prevalence
• One health
• Systematic review and meta-analysis

• Alveolar echinococcosis
• Echinococcosis multilocularis Ulm Classification for Computed Tomography (EMUC-CT)
• Evolution
• Intercontinental
• Morphology

• albendazole
• bioavailability
• hepatic alveolar echinococcosis
• nanocrystalline drug
• pharmacodynamics

• Alveolar echinococcosis
• Echinococcus multilocularis
• Geographical distribution
• Maps
• Prevalence
• Worldwide epidemiology

• Animals
• China/epidemiology
• Echinococcosis/epidemiology
• Echinococcus multilocularis
• Europe/epidemiology
• Geography
• Global Health
• Humans
• Prevalence
• Republic of Korea/epidemiology

• KA 4356/3-1 Deutsche Forschungsgemeinschaft
• KR 5204/1-2 Deutsche Forschungsgemeinschaft
• NSFC Natural Science Foundation of China
• 81260232 Natural Science Foundation of China
• Ref. No. 2017-SF-158 Qinghai Science & Technology Department
• Ref. No. 2016-SF-A5 Science and Technology Major Project of Qinghai Province
• Qinghai Science & Technology Department
• Müller Holding Ltd. & Co. KG Ulm

• handwashing behavior
• rural areas
• school children
• structural equation model
• the Tibetan nationality
• theory of reasoned action

• Attitude to Health
• Child
• Female
• Hand Hygiene
• Health Behavior
• Humans
• Male
• Peer Group
• Schools
• Students
• Surveys and Questionnaires
• Tibet

Echinococcoses, caused by metacestodes of Echinococcus granulosus (cystic echinococcosis; CE) and E. multilocularis (alveolar echinococcosis; AE), represent major emerging parasitic diseases. These enzootic helminthiases invoke significant public health concerns and social burdens in endemic areas. The diseases are prevalent in the Qinghai-Tibetan Plateau, China, while community-based epidemiological studies have been scarcely reported. We surveyed echinococcosis patients in the southeastern Qinghai Province, China, to better understand the concurrent epidemiological situation in this area.

During July and August of 2013 and 2014, we screened echinococcosis patients at Yushu and Golog Prefectures, Qinghai Province, China, in a diagnostic campaign. A total of 2856 people (male:female ratio, 1:1.12; mean age, 34.6 years; age range, 6–88 years) were ultrasonographically examined for the presence of hepatic echinococcal cysts. We also collected serum samples from patients and analyzed antibody reactivity against recombinant forms of diverse E. granulosus antigen Bs (rEgAgB1-5) by enzyme-linked immunosorbent assay.

We detected 134 patients whose imaging scans were compatible with CE (115 cases) and AE (20 patients). One patient might have been infected with both CE and AE. The overall incidence was 4.7% (CE, 4.0%; AE, 0.7%). A large proportion (67.5%) of CE patients was diagnosed at active and transitional CE1-CE3 stages in their late 30s. The AE cases were generally detected at advanced stage in patients at early 20s (60%). Analysis of the receiver operating characteristic curve and Youden’s index indicated that rEgAgB2 was the most promising biomarker, followed by rEgAgB3 and rEgAgB1. Overall, sensitivity and specificity of rEgAgB1-3 were 84.5–92.7% and 91.9–94.6%, respectively. rEgAgB4 and 5 showed low sensitivity with high cross-reactivity.

Our results strongly suggest that disability-adjusted life years related to echinococcoses in Qinghai-Tibetan areas might be more serious than previously considered. Control and prevention strategy against CE and AE are highly required in these areas. In addition to ultrasonography, serological tests might provide supportive data. However, serological data should be carefully interpreted for differential diagnosis, especially in areas where both CE and AE are co-endemic.

The online version of this article (10.1186/s13071-019-3569-6) contains supplementary material, which is available to authorized users.

• Antigen B isoforms
• E. multilocularis
• Echinococcoses
• Echinococcus granulosus
• Immunoreactivity
• Qinghai-Tibetan Plateau
• Ultrasonography

• Echinococcus
• Echinococcus granulosus
• Echinococcus multilocularis
• alveolar echinococcosis
• cystic echinococcosis
• echinococcosis
• genetic epidemiology
• genome
• strains/genotypes
• transcriptome
• zoonosis

• Albendazole/therapeutic use
• Animals
• China/epidemiology
• Clinical Trials as Topic
• Cystectomy
• Disease Management
• Echinococcosis/epidemiology
• Echinococcosis/therapy
• Humans
• Quality of Life
• Transplantation, Autologous
• Zoonoses/epidemiology
• Zoonoses/parasitology
• Zoonoses/therapy