Multiple echinococcal cysts in a patient with chickenpox: a case report

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Abstract

Echinococcosis is a human parasitic disease widespread in many countries because of population migration, occupational risk factors, and increased tourism. The clinical symptoms are non-specific and manifest late. Echinococcosis is often discovered incidentally in clinical practice. Diagnostic errors can result from low awareness of healthcare professionals regarding echinococcosis in regions with low incidence rates.

This article describes a case report of imported echinococcosis in a patient with chickenpox (varicella) diagnosed at Infectious Diseases Clinical Hospital No. 2 of the Moscow Healthcare Department in April 2021. The patient came from Kyrgyzstan, where he worked as a sheep farmer. Inpatient ultrasound and computed tomography of the abdomen and retroperitoneum revealed multiple cystic liver lesions of parasitic origin. An enzyme-linked immunosorbent assay revealed the IgG antibodies to Echinococcus antigens.

This clinical case highlights the ongoing relevance of echinococcosis in Russia and underscores the need for a comprehensive analysis of clinical, epidemiological, laboratory, and imaging data. These findings also suggest the importance of raising awareness among healthcare professionals about this infection, especially when treating migrants from endemic regions with cystic liver lesions and patients in high-risk groups.

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About the authors

Larisa N. Kokoreva

Sechenov First Moscow State Medical University

Email: kokoreva_l_n@staff.sechenov.ru
ORCID iD: 0000-0002-8154-8865
SPIN-code: 3966-1789

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Moscow

Olga V. Darvina

Sechenov First Moscow State Medical University

Email: darvina_o_v@staff.sechenov.ru
ORCID iD: 0000-0001-8496-3987
SPIN-code: 1561-9961

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Maria B. Sviridova

Sechenov First Moscow State Medical University

Email: sviridova_m_b@staff.sechenov.ru
ORCID iD: 0000-0003-0707-4259
SPIN-code: 8807-2640

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Moscow

Sona R. Ayvazyan

Sechenov First Moscow State Medical University

Email: ayvazyan_s_r@staff.sechenov.ru
ORCID iD: 0000-0002-3238-7540
SPIN-code: 7957-5685

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Karina T. Umbetova

Sechenov First Moscow State Medical University

Author for correspondence.
Email: umbetova_k_t@staff.sechenov.ru
ORCID iD: 0000-0003-0902-9267
SPIN-code: 3197-9205

MD, Dr. Sci. (Medicine), Assistant Professor

Russian Federation, Moscow

Elena T. Vdovina

Infectious Clinical Hospital No. 2, Moscow

Email: e23lena@mail.ru
ORCID iD: 0000-0002-4099-0032
SPIN-code: 5583-8569
Russian Federation, Moscow

Andrey N. Gorobchenko

Sechenov First Moscow State Medical University

Email: gorobchenko_a_n@staff.sechenov.ru
ORCID iD: 0000-0001-7245-574X
SPIN-code: 6658-9719

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Moscow

Olga Yu. Shabalina

Sechenov First Moscow State Medical University

Email: shabalina_o_yu@staff.sechenov.ru
ORCID iD: 0000-0003-0506-0961
SPIN-code: 5773-4882

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Olga A. Paevskaya

Sechenov First Moscow State Medical University

Email: paevskaya_o_a@staff.sechenov.ru
ORCID iD: 0000-0003-4917-3992
SPIN-code: 7410-3130

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Moscow

Olga F. Belaia

Sechenov First Moscow State Medical University

Email: ofbelaya@staff.sechenov.ru
ORCID iD: 0000-0002-2722-1335
SPIN-code: 3921-7227

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Natalia V. Kolaeva

Sechenov First Moscow State Medical University

Email: kolaeva_n_v@staff.sechenov.ru
ORCID iD: 0000-0002-4091-9973
SPIN-code: 2024-6580

MD, Cand. Sci. (Medicine); Assistant Professor

Russian Federation, Moscow

References

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  2. Larrieu E, Gavidia CM, Lightowlers MW. Control of cystic echinococcosis: Background and prospects. Zoonoses Public Health. 2019;66(8):889–899. doi: 10.1111/zph.12649 EDN: KHKCTB
  3. Skvortsov VV, Levitan BN, Gorbach AN. Echinococcosis and other parasitic liver diseases. Effective pharmacotherapy. 2020;16(30):88–91. doi: 10.33978/2307-3586-2020-16-30-88-91 EDN: GRTZSR
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  5. Manterola C, Rojas C, Totomoch-Serra A, et al. Echinococcus granulosus genotypes verified in human hydatid disease around the world. Systematic review. Rev Chil Infectol. 2020;37(5):541-549. doi: 10.4067/S0716-10182020000500541 EDN: UYSSXJ
  6. Alvarez Rojas AC, Romig T, Lightowlers MW. Echinococcus granulosus sensu lato genotypes infecting humans - review of current knowledge. Int J Parasitol. 2014;44(1):9-18. doi: 10.1016/j.ijpara.2013.08.008 EDN: SOVTDT
  7. Ruzibaev RYu, Kuryazov BN, Sapaev DSh, et al. Modern estimation of the problems of diagnosis and surgical treatment of echinococcosis. Bulletin of Pirogov National Medical & Surgical Center. 2019;14(1):137-139. doi: 10.25881/BPNMSC.2019.66.50.024 EDN: VKYELF
  8. Ito A, Budke CM. Culinary delights and travel? A review of zoonotic cestodiases and metacestodiases. Travel Med Infect Dis. 2014;12(6PtA):582-591. doi: 10.1016/j.tmaid.2014.06.009 EDN: UQXRHV
  9. Stojković M, Weber TF, Junghanss T. Clinical management of cystic echinococcosis: state of the art and perspectives. Curr Opin Infect Dis. 2018;31(5):383-392. doi: 10.1097/QCO.0000000000000485
  10. Shin DH, Jo HC, Kim JH, et al. An imported case of disseminated echinococcosis in Korea. Korean J Parasitol. 2019;57(4):429-434. doi: 10.3347/kjp.2019.57.4.429 EDN: KJFTXS
  11. Sarink MJ, Koelewijn R, Slingerland BCGC, et al. Performance of the commercially available SERION ELISA classic Echinococcus IgG test for the detection of cystic echinococcosis in clinical practice. J Helminthol. 2019;93(5):636-639. doi: 10.1017/S0022149X18000536
  12. Nikolenko VV, Belkina EV, Vorobieva NN, et al. A clinical case of hydatid echinococcosis in the Perm Krai. Perm Medical Journal. 2023;40(5):121-127. doi: 10.17816/pmj405121-127 EDN: PVCCZZ

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2. Fig. 1. Computed tomography of the abdominal organs of patient M.: a — heterogeneous fluid-filled lesion with additional smaller cystic inclusions and detached membranes within its thickness in segment 2 of the liver (blue arrow), accumulation of contrast agent along a narrow peripheral rim (yellow arrow); b — homogeneous cystic lesion of medium density with an unevenly calcified narrow peripheral capsule that does not accumulate contrast agent in segment 3 of the liver (green arrow); large heterogeneous volumetric lesion of irregular shape containing fluid, within which there are multiple small high-density inclusions, gas bubbles, presence of a gas-liquid level with a narrow uneven capsule that intensively accumulates contrast agent in segment 4B of the liver (red arrow).

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