ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2022, 7(3): 79–86
https://doi.org/10.26693/jmbs07.03.079
Clinical Medicine

Improvement of Treatment and Prevention of Liver Echinococcosis

Abbasalieva P. M.
Abstract

The purpose of the study was to determine optimal pathogenetically justified methods and means to improve the results of diagnosis and treatment of liver echinococcosis. Materials and methods. During treatment, on the 1st, 3rd, 5th, and 10th day of the postoperative period, patients were examined for the functional state of the liver by blood analysis for the amount of proinflammatory cytokines TNF-α, IL-6, IL-4 and IL-10, IL-1. The activity of humoral immunity was assessed based on the level of immunoglobulins IgA, IgG and IgM. Results and discussion. On the 1st day after the operation, the level of IgA increased and amounted to 5.56 ± 0.1 q/L. The improvement in the dynamics of indicators was observed on the 5th day of observations, and this trend persisted up to 10 days after surgical treatment. On day 5, a significant decrease in the concentration of the main proinflammatory cytokines TNF-α, IL-6 and IL-4 was revealed, compared with the indicators before treatment and on the first day after treatment – 12.5 ± 0.6 pg/ml; 11.7 ± 0.3 pg/ml and 4.0 ± 0.2 pg/ml, respectively. This treatment regimen resulted in a marked decrease in TNF-α, IL-6 and IL-10 levels on day 10. The initial level of cytokines and immunoglobulins indicates a pronounced immunosuppressive effect on the body of a parasitic disease. A significant decrease in cytokines IL-1, IL-6 and IL-10 in patients after surgery and a decrease in indicators after maintenance therapy can serve as a potential immunological marker for evaluating its effectiveness. When studying the cytokine profile in the patients we examined, there was a significant increase in the level of TNF-α and IL-6 in blood serum relative to the control values, which is directly dependent on the severity of the pathological process and the functional state of the liver and suppresses the secretion of anti-inflammatory cytokines, which was confirmed by data from foreign authors. As well as the works published earlier, the data of our studies show that Echinococcus granulosus cysts induce a strong antibody response in most patients, causing, at the same time, a reaction of antigen-specific antibodies of various classes with different intensity and specificity against the background of their synthesis and increased secretion. It is necessary to note an increase in quantitative and qualitative indicators of IgG, IgM and IgA levels in the blood serum of patients with liver echinococcosis, with IgG predominance. Conclusion. A comprehensive study of inflammatory mediators and the dynamics of cytokine levels makes it possible to diagnose complications in time and prevent possible relapses of the disease. The data obtained made it possible to justify the further use of imunofan and to develop recommendations for the management of patients with liver echinococcosis in the postoperative period

Keywords: liver echinococcosis, imunofan, biochemical blood test, cytokines, immunoglobulins

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References
  1. European Food Safety Authority & European Centre for Disease Prevention and Control. The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2017. EFSA J. 2018 Dec 12;16(12):e05500. PMID: 32625785. PMCID: PMC7009540. https://doi.org/10.2903/j.efsa.2018.5500
  2. World Health Organization: Echinococcosis. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/echinococcosis/.
  3. Musharapov DR, Gabdrakhimov SR, Panteleyev VS, Sokolov VP. Lecheniye infitsirovannogo i retsidivnogo ekhinokokkoza pecheni primeneniyem uglekislotnogo lazera i fotoditazina [Treatment of infected and recurrent liver echinococcosis using a carbon dioxide laser and photoditazine.] Lazernaya meditsina. 2010;1:18-19. [Russian]
  4. Shevchenko YuL, Stoyko YuM, Levchuk AL, Stepanyuk IV, Gromov KM. Diagnostika i lecheniye oslozhnennykh form ekhinokokkoza pecheni [Diagnosis and treatment of complicated forms of liver echinococcosis]. Vestnik Natsional'nogo mediko-khirurgicheskogo Tsentra im.NI Pirogova. 2012;7( 2):22-27. [Russian]
  5. Galeh TM, Spotin A, Mahami-Oskouei M, Carmena D, Rahimi MT, Barac A, et al. The seroprevalence rate and population genetic structure of human cystic echinococcosis in the Middle East: a systematic review and meta-analysis. Int J Surg. 2018;51:39-48. PMID: 29367032. https://doi.org/10.1016/j.ijsu.2018.01.025
  6. Symeonidis N, Pavlidis T, Baltatzis M, Ballas K, Psarras K, Marakis G, et al. Complicated liver echinococcosis: 30 years of experience from an endemic area. Scand J Surg. 2013;102(3):171-77. PMID: 23963031. https://doi.org/10.1177/1457496913491877
  7. Belli S, Akbulut S, Erbay G, Koçer NE. Spontaneous giant splenic hydatid cyst rupture causing fatal anaphylactic shock: a case report and brief literature review. Turkish J Gastroenterol. 2014;25:88-91. PMID: 24918138. https://doi.org/10.5152/tjg.2014.3521
  8. Dokumcu Z, Arslan S, Divarci E, Erdener A, Ozcan C. Thoracoscopic Treatment of Pulmonary Hydatid Cysts May Have a High Morbidity Risk in Children: Retrospective Analysis. Eurasian J Med. 2017 Oct;49(3):172-177. PMID: 29123439. PMCID: PMC5665625. https://doi.org/10.5152/eurasianjmed.2017.17080
  9. Gavara GIC, López-Andújar R, Ibáñez BT, Ángel JMR, Herraiz ÁM, Castellanos FO, et al. Review of the treatment of liver hydatid cysts. World J Gastroenterol. 2015;21(1):124-131. PMID: 25574085. PMCID: PMC4284328. https://doi.org/10.3748/wjg.v21.i1.124
  10. Obeid M, Mansou S, Damouny M, Farah A, Halloun K, Marjiyeh R, et al. A Conservative Management of Spontaneously Ruptured Liver Hydatid Cyst. Gastroenterol Res. 2021;14(2):125-128. PMID: 34007355. PMCID: PMC8110234. https://doi.org/10.14740/gr1373
  11. Maslennikova NA, Tikhonova YeP, Mikhaylova LA. Klinicheskiye aspekty proyavleniya ekhinokokkoza pecheni [Clinical aspects of liver echinococcosis]. Sovremennyye problemy nauki i obrazovaniya. 2018;5. [Russian]. Available from: http://www.science-education.ru/ru/article/view?id=27998
  12. Bartın MK. Hydatid cyst disease with extra hepatic localizations. Biomed J Sci Techn Res. 2019;19:14625-14628. [Russian]. https://doi.org/10.26717/BJSTR
  13. Kowalczyk M, Kurpiewski W, Zielinski E, Zadrozny D, Klepacki L, Juskiewicz W, et al. A rare case of the simultaneous location of Echinococcus multilocularis in the liver and the head of the pancreas: case report analysis and review of literature. BMC Infect Dis. 2019;19(1):661. PMID: 31340769. PMCID: PMC6657101.
  14. https://doi.org/10.1186/s12879-019-4274-y
  15. Nechaev VA, Bazhin AV, Egorova EA, Kovalevskaya AN, Novoselova E.V. Radiation research methods in the diagnosis of spinal echinococcosis (literature review and clinical observation). Radiology-practice. 2014;4:73-84. [Russian]
  16. Nishanov FN, Nishanov MF, Botirov AK, Otakuziev AZ. Etiopathogenetic aspects of recurrent liver echinococcosis and its diagnosis. Bulletin of surgery named after II Grekov. 2011;2:91-94.
  17. Piccoli L. Long-term Sonographic and Serological Follow-up of Inactive Echinococcal Cysts of the Liver: Hints for a "Watch-and-Wait" Approach. PLoS Negl Trop Dis. 2014;8(8):e3057. PMID: 25122222. PMCID: PMC4133254. https://doi.org/10.1371/journal.pntd.0003057
  18. Kern P, Menezes da Silva A, Akhan O, Müllhaupt B, Vizcaychipi KA, Budke C, et al. The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease. Adv Parasitol. 2017;96:259-369. PMID: 28212790. https://doi.org/10.1016/bs.apar.2016.09.006
  19. Kesik HK, Kilinc SG, Simsek S, Gul A. Occurrence of liver hydatid cysts in a donkey and molecular characterization of Echinococcus equinus. J Parasitol. 2019;105:442-445. PMID: 31192761. https://doi.org/10.1645/19-3
  20. Shangareeva RKh. Ekhynokokkoz pecheny u detey. Rol konservatyvnoy terapyy. [Echinococcosis of the liver in children. The role of conservative therapy]. Praktycheskaya medytsyna. 2014;77(1):78-83. [Russian]
  21. Nazyrov FG, Devyatov AV, Akbarov MM, Makhmudov UM, Babadzhanov AKh. [Chemotherapy and problems of recurrent liver echinococcosis]. Annaly khyrurgycheskoy gepatologyy. 2011;4:19-24.
  22. Karabulut K. Long-term outcomes of intraoperative and perioperative albendazole treatment in hepatic hydatidosis: single center experience. Ann Surg Treat Res. 2014;87(2):61-65. PMID: 25114884. PMCID: PMC4127902. https://doi.org/10.4174/astr.2014.87.2.61
  23. Guide 4: Bioethics Committees and Public Policy. Paris: UNESCO. UNESCO. 2019. Available from: https: //unesdoc.unesco.org/ark:/48223/pf000023323
  24. Gareev EM. Osnovy matematyko-statystycheskoy obrabotky medykobyologycheskoy ynformatsyy: (kratkyy obzor v dvukh chastyakh) [Fundamentals of Mathematical and Statistical Processing of Biomedical Information: (short review in two parts)]. Uchebnoe posobye dlya studentov y aspyrantov medytsynskykh vuzov. Ufa: BGMU; 2009. 346 p. [Russian]
  25. Li ZD, Mo XJ, Yan S, Wang D, Multiplex cytokine and antibody profile in cystic echinococcosis patients during a three-year follow-up in reference to the cyst stages. Parasit Vectors. 2020 Mar 14;13(1):133. PMID: 32171321. PMCID: PMC7071573. https://doi.org/10.1186/s13071-020-4003-9
  26. Amonov ShSh, Rakhmonov DA, Fayzyev ZSh. Sovremennye aspekty dyagnostyky khyrurgycheskogo lechenyya ekhynokkoza pecheny [Modern aspects of the diagnosis of surgical treatment of liver echinoccosis]. Vestnyk Avytsenny. 2019:21(3):480-488. [Russian]. https://doi.org/10.25005/2074-0581-2019-21-3-480-488
  27. Vafyn AZ, Mashurova EV. Ekspressyya tsytokynov u bolnykh ekhynokokkozom pecheny [Expression of cytokines in patients with liver echinococcosis]. Ann khyr gepatol. 2007;12(4):32-35. [Russian]
  28. Azyzzoda ZA, Kurbonov KM, Ryzoev VS. Maloynvazyvnye operatyvnye vmeshatelstva pry ekhynokokkoze pecheny [Minimally invasive surgical interventions for liver echinococcosis]. Vestnyk Avytsenny. 2019;21(1):116-120. [in Russian]. https://doi.org/10.25005/2074-0581-2019-21-1-116-120
  29. Güreser AS. Evaluation of the radiological, biochemical and serological parameters of patients prediagnosed as cystic echinococcosis in Çorum, Turkey. Mikrobiyoloji Bülteni. 2015;49(2):231-9. PMID: 26167823. https://doi.org/10.5578/mb.8656
  30. Huang X, Gruner B, Lechner CJ, Kern P, Soboslay PT. Distinctive cytokine, chemokine, and antibody responses in Echinococcus multilocularis-infected patients with cured, stable, or progressive disease. Med Microbiol Immunol. 2014;203:185-93. PMID: 24509604. https://doi.org/10.1007/s00430-014-0331-8
  31. Siles-Lucas M, Casulli A, Conraths FJ, Muller N. Laboratory diagnosis of Echinococcus spp. in human patients and infected animals. Adv Parasitol. 2017;96:159-257. PMID: 28212789. https://doi.org/10.1016/bs.apar.2016.09.003
  32. Diaz A. Immunology of cystic echinococcosis (hydatid disease). Br Med Bull. 2017;124:121-133. PMID: 29253150. https://doi.org/10.1093/bmb/ldx033
  33. Naik MI, Tenguria RK, Haq E. Detection of serum cytokines before and after pharmacological and surgical treatment in patients with cystic echinococcosis. J Helminthol. 2016;90:91-5. PMID: 25726962. https://doi.org/10.1017/S0022149X15000085
  34. Rogan MT, Bodell AJ, Craig PS. Post-encystment/established immunity in cystic echinococcosis: is it really that simple? Parasite Immunol. 2015;37:1-9. PMID: 25283301. https://doi.org/10.1111/pim.12149