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P540 Cysticercosis: correlation between serological and radiological diagnosis
S120
17th ECCMID / 25th ICC, Posters
days during 30 days) and one patient with triclabedazole 10 mg/Kg in alone doses. One had diarrhoea after bithiolol administration but it was not necessary to withdraw medication. Every patient recovered. During follow up serology become negative and eosinophilia disappeared. Conclusion: The most frequent clinical manifestations of fasciolosis are abdominal pain, fever and weight loss. Eosinophilia is the most frequent laboratory data. Although diagnosis may be established by observation of parasite eggs in faeces, most of the cases can be diagnosed by serology. Biothiolol was a very effective and safe treatment against Fasciola hepatica. P538 Investigation of Toxocara canis antibodies in patients with eosinophilia and comparison of two methods: ELISA and Western Blot ¨ Y.A. Oner, E. Artinyan (Istanbul, TR) Objectives: Eosinophylic cells, which are only present in gastrointestinal mucosa and form a very little part of peripheric leucosites, the blood levels are controlled districtly in healthy individuals. However, in many diseases (allergic diseases, parasitic infections and cancer), the count of eosinophylic cells increase meaningfully. Especially in parasitic infections the blood counts of these cells can reach 50,000 cells/mL. Larva migrans (visceral, ocular, cutaneous), in which eosinophilia is a constant finding and is transmitted by pets to humans, is described as the migration of Toxocara spp. larvas to the internal organs, eye or dermal tissues with pathological damage. Almost in all articles and books the primary factor of the disease is mentioned to be Toxocara canis. Methods: The most prefered method in serological diagnosis is to detect specific anti-Toxocara antibodies. If these antibodies are found to be positive then it is suggested to use Western Blot technique in the distinctive diagnosis of the illness. In our study, in a study group patients with eosinophilia, we compared ELISA and Western Blot methods which is found to be more specific and sensitive than ELISA. Results: In 92 sera, 25 of them were evaluated as positive (27.2%), five of them were evaluated as equivocal (5.4%) and finally 62 (65.3%) of them were found to be negative with ELISA method. On the other hand, same 92 sera were studied with Western Blot technique; 45 of them were found to be positive with the molecular weight bands of 24, 28, 30 and 35 kDa and 47 of them were evaluated as negative while no anti-Toxocara antibody specific molecular weight bands were formed on the strips. Conclusion: According to these data; when eosinophilia having blood counts are encountered, the diagnosis probability of Toxocariasis is very high. Moreover, our study indicated once more that in serological diagnosis of Toxocariasis, Western Blot method is a more valuable method with its high specificity and sensitivity than ELISA method.
Test results
Serum numbers (n)
%
ELISA(+) WB(+) ELISA(−) WB(+) ELISA(?) WB(+) ELISA(+) WB(−) ELISA(−) WB(−) Total
23 17 5 2 45 92
25 18.5 5.4 2.2 48.9 100
P539 Acanthamoeba castellanii is a model for eukaryote-prokaryote interaction and a human pathogen H. Abd, A. Saeed, B. Advinsson, G. Sandstr¨om (Stockholm, SE) Objectives: A. castellanii is a free-living amoeba inhabiting aquatic environments and isolated from different environments. The aim is to study its features, its interaction with pathogenic bacteria and its detection from samples.
Methods: Cultivation, viable count, PCR and microscopy. Results: A. castellanii grew tenfold and survived for more than 30 days showing a long survival time compared to survival of macrophages. We found that trophozoites as well as cysts emitted autofluorescence helping in the diagnosis of Acanthamoeba and its viability. It is well known that trophozoites feed on different cells by phagocytosis. We observed that A. castellanii could also take up trophozoite or cyst from its cell cultures. The importance of Acanthamoeba species is their ability to be predators or hosts to different bacteria. Our studies showed that the facultative intracellular bacterium Francisella tularensis multiplied inside vacuoles of A. castellanii while the extracellular bacterium Pseudomonas aeruginosa killed this amoeba by type III secretion system effector’s proteins. Surprisingly, Vibrio cholerae that is considered as an extracellular bacterium multiplied in the cytoplasm of A. castellanii and behaved same behaviour of the facultative intracellular bacteria Shigella sonnei and S. dysenteriae. Several Acanthamoeba species are human pathogens. The trophozoites enter human body through respiratory tract, injured skin, invade the central nervous system to cause granulomatous amoebic encephalitis and colonise the cornea causing amoebic keratitis. As evidence to the increasing importance of Acanthamoeba infections, we diagnosed the first Nordic case of fatal meningoencephalitis and two cases of amoebic keratitis caused by A. castellanii. Conclusions: Characteristics of A. castellanii such as long life because of encystation as well as excystation, phagocytosis, autofluorescence, resistance to many antibiotics, predator, host and victim to different bacteria, make it an ideal unicellular organism to study the interaction between eukaryotes and prokaryotes and to be used as a powerful tool for the culture of some intracellular bacteria in addition to its increased role as human pathogen. P540 Cysticercosis: correlation between serological and radiological diagnosis A. Rodr´ıguez Guardado, E. G´omez, M. Rodr´ıguez P´erez, A. Sempere, ´ R. L´opez-Roger Roger, P. Su´arez Leiva, V. Asensi Alvarez, J.A. Cart´on S´anchez (Oviedo, ES) Objective: Human infections due to Taenia solium are common in underdeveloped countries but they are not frequent in Europe. We describe our experience in the diagnosis and management of cystecercosis in Asturias, a province in northern Spain. Methods: We have retrospectively reviewed each patient with cisticercosis positive serological result in the Hospital Universitario Central of Asturias (HUCA), during a period of six years (2000–2006). Serum samples of each patient were tested for Taenia solium antigen, antibodies and vesicular fluid using an ELISA test. Computerised tomography or nuclear magnetic resonance were also done on all patients. Results: We have studied ten cases. None presented significant underlying diseases. Four of them were Spanish and there were six immigrants, four from Ecuador and two from Brasil. The mean age was 45 years (range of age 34−59). Six were female. Cephalea (three cases), epilepsy and subcutaneous nodules (two cases) were the most frequent symptoms. Two patients remained asymptomatic. Eosinophilia in blood tests was not found in any of them. Faeces of each one were examined looking for parasite eggs and were negative. Nine patients presented Taenia solium antibodies, six were positive for vesicular fluid and one for Taenia solium antigen. Three patients were diagnosed of neurocistycercosis, only one of them was positive to T. solium antigen. In two cases of them the computerised tomography was negative. The nuclear magnetic resonance was positive in the three cases Two patients with neurocysticercosis were treated with albendazol during 30 days and steroids in the first seven days. One patient was treated with praziquantel three doses during one day. All the patients cured. The rest of patients received one doses of praziquantel (5 mg/kg). All patients recovered. Conclusions: Presence of Taenia solium antibodies in serum seems to be useful for cysticercosis diagnosis. However, a positive antigen result in CSF does not seem to indicate a central nervous system infection. Nuclear magnetic resonance is more useful than computerised
Parasitology tomography in neurocysticercosis diagnosis. Albendazol is a very effective and safe treatment. Clinical and epidemiological results consistent with neurocysticercosis are needed in order to ask for antibody and antigen testing P541 Clinical forms of neurocysticercosis – Our experience S. Nikolic, G. Stevanovic, V. Peric, T. Stosic-Opincal (Belgrade, RS) Cysticercosis is one of the commonest parasitic diseases of the central nervous system and frequent cause of convulsions in endemic regions, where incidence rate is about 4% of population. Objective: The objective of our study was to analyse the clinical forms of neurocysticercosis in patients treated at our department. Method: The analysis of results of neuroradiological examinations (CT scanning, MR imaging), serological tests, neurological disorders and treatment of patients with neurocysticercosis. Results: In the period 2000–2005, a total of 65 patients with neurocysticercosis were treated. All patients underwent neuroradiological examinations: endocranial CT in 40 (62%) cases, endocranial MRI in 17 (26), and both CT and MRI of the endocranium in 8 (12%) patients. Parenchymal disease was found in 50 (78%) patients, ventricular in 8 (12%), and parenchymal and subarachnoid in 6 (9%) cases. Only one female patient had spinal form associated with parenchymal, ventricular and subarachnoid, and she had VP shunt implanted due to hydrocephalus. Out of 50 patients with parenchymal disease, cystic changes were verified in 27 (54%) cases, concurrent cysts and calcifications in 15 (30%), and only calcifications in 8 (16%) cases. Serological test results were positive in all patients with ventricular and subarachnoid forms as well as in the female patient with spinal cysticercosis. Out of 50 patients with parenchymal disease, 22 (44%) had positive results of serological tests. Clinical manifestation of disease correlated with number, extent and localisation of pathological changes. Medicamentous treatment (Albendazole, Praziquantel) was applied in 46 (81%) out of 57 patients with active disease, while 11 (19%) cases underwent surgical interventions (cyst extirpation, V-P shunt), followed by medicamentous therapy. Patients with calcifications were not treated. The outcome was favourable (decrease of a number of cysts, reduction of cyst size, cyst disappearance) in 45 patients (79%), and unchanged findings were observed in 12 (21%) treated patients. There was no lethal outcome. Conclusion: Parenchymal neurocysticercosis was most prevalent in our patients (77%), while other forms of disease were significantly more infrequent. Active disease (parenchymal, ventricular, subarachnoid, spinal) was detected in 57 (88%) patients. Outcome was favourable in 45 (79%), and unchanged findings were found in 12 (21%) treated patients. No lethal outcome was reported. P542 Strongyloidiasis hyperinfection: diagnosis problems and management in an intensive care unit C. Kummerlen, I. Yalaoui, S. Barbar, H. Rahmani, P. Sauder, M. Hasselmann (Strasbourg, FR) Introduction: Strongyloidiasis hyperinfection (StHI) results from a fulminant dissemination of strongyloides stercoralis larvae in the organism. It occurs essentially in immunocompromised subjects coming from endemic areas. Acute respiratory failure or severe neurologic disorders may require admission in ICU and population migrations may increase the number of StHI also in countries where S stercoralis is usually not present. A delayed or missed diagnosis may then rise different problems, as illustrated by this case report. Methods: A 80 years old bosnian man, living in France for 13 years, was admitted in the ICU for acute respiratory failure. He had a chronic obstructive pulmonary disease (COPD) with few exacerbations in the past years, with 2 of them accompanied by hypereosinophilia but no specific etiology was found. He developed StHI as he was treated with steroids. Larvae were fortuitously isolated in tracheal secretion and also found in stool and blood. Despite adequate antihelminthic treatment (ivermectine) and respiratory improvement, the patient died
S121 after 4 months from irreversible hypertonia probably due to a neurologic localisation of StHI. Results: This observation exemplifies 4 key points 1. StHI has to be evoked in patients coming from endemic areas, even years ago, specially before immunosuppressive treatment. In Europe, South Balkan, eastern and mediterranean countries are concerned. Early symptoms, as dysphagia and bronchospasm in our patient, related to parasitic migration are evocative. Eosinophilia is an alarming clue when present, but was not found. 2. Gram negative pneumonia or septicaemia are often associated and may delay the diagnosis of StHI. 3. Microscopic identification of larvae in the stool confirms the diagnosis, but a single examination may be insufficient. A positive serology test in a patient with a compatible history or a stay in an endemic area are sufficient grounds for empirical treatment. 4. StHI requires contact isolation and in ICU the risk of transmission is theorically high. In this observation, despite an ignored diagnosis, none transmission to healthcare workers was found. However, one other patient developed eosinophilia with a positive serology. Conclusion: In temperate non-endemic areas, StHI may be underappreciated. Clinical presentation and risk factors should raise awareness of this curable but potentially fatal parasitic infection and so facilitate early diagnosis and treatment.
P543 Primary muscle hydatidosis of the thigh in a pregnant woman M. Degioanni, A. Maccabruni, C. Bolla, G. Montrucchio, A. Biglino (Asti, Pavia, IT) Introduction: Primary skeletal muscle hydatidosis is a rare manifestation of cystic hydatid disease. We report a case of muscle hydatidosis of the thigh observed in a pregnant woman. Methods and Results: Our patient is a 30 years old moroccan woman who has been immigrated to Italy for seven years ago. At the fourth month of her third pregnancy she observed a painful swelling of the right thigh, without any other symptoms; an ultrasonographic scan of the thigh showed a noncalcified cystic mass with little round cystic inside in the posterior muscle compartment (diameter 13 cm). After delivery contrast CT and MRI of right thigh were performed showing that the mass had reached 15 cm in diameter. No additional cysts were found on CT of the thorax, abdomen and pelvis. As hydatidosis was strongly suspected, a specific serology was performed with positive result (IHA 1:320). Treatment with albendazole at 400 mg b.i.d. was immediately started; two months after the ultrasonographic scan showed that the primary cyst was smaller while all but one “daughter” cysts became smaller and oval, with increased echogenicity. The specific antibody titer (IHA) was 1:80. Surgical resection to remove the cyst “in toto” will be the next step of the treatment. Conclusion: Skeletal muscle hydatid cysts are generally misdiagnosed as either a pyogenic infection or a malignancy. Hydatid disease should be considered in the differential diagnosis of cystic muscular lesions and specific serology has to be performed because routine diagnostic procedures may not always be helpful. The correct diagnosis at the right time allows a radical cure of the disease P544 Fifteen-year experience with pulmonary hydatidosis: clinical manifestation, diagnosis and treatment B. Sharifi-Mood, A. Fazaeli, S. Izadi, S. Mokhtari (Tehran, IR) Background and Objective: Hydatid disease is a major world health problem and pulmonary hydatidosis is a widespread disease. It is presented with different clinical manifestations. In order to determine the most clinical manifestation, diagnostic tools and clinical outcome in our patients, we conducted this study. Patients and Methods: Forty-nine patients with pulmonary hydatid cysts who were admitted to our hospital in Zahedan (Southeat of Iran) between 1990 and 2005, evaluated. We retrospectively reviewed the patients’
17th ECCMID / 25th ICC, Posters
days during 30 days) and one patient with triclabedazole 10 mg/Kg in alone doses. One had diarrhoea after bithiolol administration but it was not necessary to withdraw medication. Every patient recovered. During follow up serology become negative and eosinophilia disappeared. Conclusion: The most frequent clinical manifestations of fasciolosis are abdominal pain, fever and weight loss. Eosinophilia is the most frequent laboratory data. Although diagnosis may be established by observation of parasite eggs in faeces, most of the cases can be diagnosed by serology. Biothiolol was a very effective and safe treatment against Fasciola hepatica. P538 Investigation of Toxocara canis antibodies in patients with eosinophilia and comparison of two methods: ELISA and Western Blot ¨ Y.A. Oner, E. Artinyan (Istanbul, TR) Objectives: Eosinophylic cells, which are only present in gastrointestinal mucosa and form a very little part of peripheric leucosites, the blood levels are controlled districtly in healthy individuals. However, in many diseases (allergic diseases, parasitic infections and cancer), the count of eosinophylic cells increase meaningfully. Especially in parasitic infections the blood counts of these cells can reach 50,000 cells/mL. Larva migrans (visceral, ocular, cutaneous), in which eosinophilia is a constant finding and is transmitted by pets to humans, is described as the migration of Toxocara spp. larvas to the internal organs, eye or dermal tissues with pathological damage. Almost in all articles and books the primary factor of the disease is mentioned to be Toxocara canis. Methods: The most prefered method in serological diagnosis is to detect specific anti-Toxocara antibodies. If these antibodies are found to be positive then it is suggested to use Western Blot technique in the distinctive diagnosis of the illness. In our study, in a study group patients with eosinophilia, we compared ELISA and Western Blot methods which is found to be more specific and sensitive than ELISA. Results: In 92 sera, 25 of them were evaluated as positive (27.2%), five of them were evaluated as equivocal (5.4%) and finally 62 (65.3%) of them were found to be negative with ELISA method. On the other hand, same 92 sera were studied with Western Blot technique; 45 of them were found to be positive with the molecular weight bands of 24, 28, 30 and 35 kDa and 47 of them were evaluated as negative while no anti-Toxocara antibody specific molecular weight bands were formed on the strips. Conclusion: According to these data; when eosinophilia having blood counts are encountered, the diagnosis probability of Toxocariasis is very high. Moreover, our study indicated once more that in serological diagnosis of Toxocariasis, Western Blot method is a more valuable method with its high specificity and sensitivity than ELISA method.
Test results
Serum numbers (n)
%
ELISA(+) WB(+) ELISA(−) WB(+) ELISA(?) WB(+) ELISA(+) WB(−) ELISA(−) WB(−) Total
23 17 5 2 45 92
25 18.5 5.4 2.2 48.9 100
P539 Acanthamoeba castellanii is a model for eukaryote-prokaryote interaction and a human pathogen H. Abd, A. Saeed, B. Advinsson, G. Sandstr¨om (Stockholm, SE) Objectives: A. castellanii is a free-living amoeba inhabiting aquatic environments and isolated from different environments. The aim is to study its features, its interaction with pathogenic bacteria and its detection from samples.
Methods: Cultivation, viable count, PCR and microscopy. Results: A. castellanii grew tenfold and survived for more than 30 days showing a long survival time compared to survival of macrophages. We found that trophozoites as well as cysts emitted autofluorescence helping in the diagnosis of Acanthamoeba and its viability. It is well known that trophozoites feed on different cells by phagocytosis. We observed that A. castellanii could also take up trophozoite or cyst from its cell cultures. The importance of Acanthamoeba species is their ability to be predators or hosts to different bacteria. Our studies showed that the facultative intracellular bacterium Francisella tularensis multiplied inside vacuoles of A. castellanii while the extracellular bacterium Pseudomonas aeruginosa killed this amoeba by type III secretion system effector’s proteins. Surprisingly, Vibrio cholerae that is considered as an extracellular bacterium multiplied in the cytoplasm of A. castellanii and behaved same behaviour of the facultative intracellular bacteria Shigella sonnei and S. dysenteriae. Several Acanthamoeba species are human pathogens. The trophozoites enter human body through respiratory tract, injured skin, invade the central nervous system to cause granulomatous amoebic encephalitis and colonise the cornea causing amoebic keratitis. As evidence to the increasing importance of Acanthamoeba infections, we diagnosed the first Nordic case of fatal meningoencephalitis and two cases of amoebic keratitis caused by A. castellanii. Conclusions: Characteristics of A. castellanii such as long life because of encystation as well as excystation, phagocytosis, autofluorescence, resistance to many antibiotics, predator, host and victim to different bacteria, make it an ideal unicellular organism to study the interaction between eukaryotes and prokaryotes and to be used as a powerful tool for the culture of some intracellular bacteria in addition to its increased role as human pathogen. P540 Cysticercosis: correlation between serological and radiological diagnosis A. Rodr´ıguez Guardado, E. G´omez, M. Rodr´ıguez P´erez, A. Sempere, ´ R. L´opez-Roger Roger, P. Su´arez Leiva, V. Asensi Alvarez, J.A. Cart´on S´anchez (Oviedo, ES) Objective: Human infections due to Taenia solium are common in underdeveloped countries but they are not frequent in Europe. We describe our experience in the diagnosis and management of cystecercosis in Asturias, a province in northern Spain. Methods: We have retrospectively reviewed each patient with cisticercosis positive serological result in the Hospital Universitario Central of Asturias (HUCA), during a period of six years (2000–2006). Serum samples of each patient were tested for Taenia solium antigen, antibodies and vesicular fluid using an ELISA test. Computerised tomography or nuclear magnetic resonance were also done on all patients. Results: We have studied ten cases. None presented significant underlying diseases. Four of them were Spanish and there were six immigrants, four from Ecuador and two from Brasil. The mean age was 45 years (range of age 34−59). Six were female. Cephalea (three cases), epilepsy and subcutaneous nodules (two cases) were the most frequent symptoms. Two patients remained asymptomatic. Eosinophilia in blood tests was not found in any of them. Faeces of each one were examined looking for parasite eggs and were negative. Nine patients presented Taenia solium antibodies, six were positive for vesicular fluid and one for Taenia solium antigen. Three patients were diagnosed of neurocistycercosis, only one of them was positive to T. solium antigen. In two cases of them the computerised tomography was negative. The nuclear magnetic resonance was positive in the three cases Two patients with neurocysticercosis were treated with albendazol during 30 days and steroids in the first seven days. One patient was treated with praziquantel three doses during one day. All the patients cured. The rest of patients received one doses of praziquantel (5 mg/kg). All patients recovered. Conclusions: Presence of Taenia solium antibodies in serum seems to be useful for cysticercosis diagnosis. However, a positive antigen result in CSF does not seem to indicate a central nervous system infection. Nuclear magnetic resonance is more useful than computerised
Parasitology tomography in neurocysticercosis diagnosis. Albendazol is a very effective and safe treatment. Clinical and epidemiological results consistent with neurocysticercosis are needed in order to ask for antibody and antigen testing P541 Clinical forms of neurocysticercosis – Our experience S. Nikolic, G. Stevanovic, V. Peric, T. Stosic-Opincal (Belgrade, RS) Cysticercosis is one of the commonest parasitic diseases of the central nervous system and frequent cause of convulsions in endemic regions, where incidence rate is about 4% of population. Objective: The objective of our study was to analyse the clinical forms of neurocysticercosis in patients treated at our department. Method: The analysis of results of neuroradiological examinations (CT scanning, MR imaging), serological tests, neurological disorders and treatment of patients with neurocysticercosis. Results: In the period 2000–2005, a total of 65 patients with neurocysticercosis were treated. All patients underwent neuroradiological examinations: endocranial CT in 40 (62%) cases, endocranial MRI in 17 (26), and both CT and MRI of the endocranium in 8 (12%) patients. Parenchymal disease was found in 50 (78%) patients, ventricular in 8 (12%), and parenchymal and subarachnoid in 6 (9%) cases. Only one female patient had spinal form associated with parenchymal, ventricular and subarachnoid, and she had VP shunt implanted due to hydrocephalus. Out of 50 patients with parenchymal disease, cystic changes were verified in 27 (54%) cases, concurrent cysts and calcifications in 15 (30%), and only calcifications in 8 (16%) cases. Serological test results were positive in all patients with ventricular and subarachnoid forms as well as in the female patient with spinal cysticercosis. Out of 50 patients with parenchymal disease, 22 (44%) had positive results of serological tests. Clinical manifestation of disease correlated with number, extent and localisation of pathological changes. Medicamentous treatment (Albendazole, Praziquantel) was applied in 46 (81%) out of 57 patients with active disease, while 11 (19%) cases underwent surgical interventions (cyst extirpation, V-P shunt), followed by medicamentous therapy. Patients with calcifications were not treated. The outcome was favourable (decrease of a number of cysts, reduction of cyst size, cyst disappearance) in 45 patients (79%), and unchanged findings were observed in 12 (21%) treated patients. There was no lethal outcome. Conclusion: Parenchymal neurocysticercosis was most prevalent in our patients (77%), while other forms of disease were significantly more infrequent. Active disease (parenchymal, ventricular, subarachnoid, spinal) was detected in 57 (88%) patients. Outcome was favourable in 45 (79%), and unchanged findings were found in 12 (21%) treated patients. No lethal outcome was reported. P542 Strongyloidiasis hyperinfection: diagnosis problems and management in an intensive care unit C. Kummerlen, I. Yalaoui, S. Barbar, H. Rahmani, P. Sauder, M. Hasselmann (Strasbourg, FR) Introduction: Strongyloidiasis hyperinfection (StHI) results from a fulminant dissemination of strongyloides stercoralis larvae in the organism. It occurs essentially in immunocompromised subjects coming from endemic areas. Acute respiratory failure or severe neurologic disorders may require admission in ICU and population migrations may increase the number of StHI also in countries where S stercoralis is usually not present. A delayed or missed diagnosis may then rise different problems, as illustrated by this case report. Methods: A 80 years old bosnian man, living in France for 13 years, was admitted in the ICU for acute respiratory failure. He had a chronic obstructive pulmonary disease (COPD) with few exacerbations in the past years, with 2 of them accompanied by hypereosinophilia but no specific etiology was found. He developed StHI as he was treated with steroids. Larvae were fortuitously isolated in tracheal secretion and also found in stool and blood. Despite adequate antihelminthic treatment (ivermectine) and respiratory improvement, the patient died
S121 after 4 months from irreversible hypertonia probably due to a neurologic localisation of StHI. Results: This observation exemplifies 4 key points 1. StHI has to be evoked in patients coming from endemic areas, even years ago, specially before immunosuppressive treatment. In Europe, South Balkan, eastern and mediterranean countries are concerned. Early symptoms, as dysphagia and bronchospasm in our patient, related to parasitic migration are evocative. Eosinophilia is an alarming clue when present, but was not found. 2. Gram negative pneumonia or septicaemia are often associated and may delay the diagnosis of StHI. 3. Microscopic identification of larvae in the stool confirms the diagnosis, but a single examination may be insufficient. A positive serology test in a patient with a compatible history or a stay in an endemic area are sufficient grounds for empirical treatment. 4. StHI requires contact isolation and in ICU the risk of transmission is theorically high. In this observation, despite an ignored diagnosis, none transmission to healthcare workers was found. However, one other patient developed eosinophilia with a positive serology. Conclusion: In temperate non-endemic areas, StHI may be underappreciated. Clinical presentation and risk factors should raise awareness of this curable but potentially fatal parasitic infection and so facilitate early diagnosis and treatment.
P543 Primary muscle hydatidosis of the thigh in a pregnant woman M. Degioanni, A. Maccabruni, C. Bolla, G. Montrucchio, A. Biglino (Asti, Pavia, IT) Introduction: Primary skeletal muscle hydatidosis is a rare manifestation of cystic hydatid disease. We report a case of muscle hydatidosis of the thigh observed in a pregnant woman. Methods and Results: Our patient is a 30 years old moroccan woman who has been immigrated to Italy for seven years ago. At the fourth month of her third pregnancy she observed a painful swelling of the right thigh, without any other symptoms; an ultrasonographic scan of the thigh showed a noncalcified cystic mass with little round cystic inside in the posterior muscle compartment (diameter 13 cm). After delivery contrast CT and MRI of right thigh were performed showing that the mass had reached 15 cm in diameter. No additional cysts were found on CT of the thorax, abdomen and pelvis. As hydatidosis was strongly suspected, a specific serology was performed with positive result (IHA 1:320). Treatment with albendazole at 400 mg b.i.d. was immediately started; two months after the ultrasonographic scan showed that the primary cyst was smaller while all but one “daughter” cysts became smaller and oval, with increased echogenicity. The specific antibody titer (IHA) was 1:80. Surgical resection to remove the cyst “in toto” will be the next step of the treatment. Conclusion: Skeletal muscle hydatid cysts are generally misdiagnosed as either a pyogenic infection or a malignancy. Hydatid disease should be considered in the differential diagnosis of cystic muscular lesions and specific serology has to be performed because routine diagnostic procedures may not always be helpful. The correct diagnosis at the right time allows a radical cure of the disease P544 Fifteen-year experience with pulmonary hydatidosis: clinical manifestation, diagnosis and treatment B. Sharifi-Mood, A. Fazaeli, S. Izadi, S. Mokhtari (Tehran, IR) Background and Objective: Hydatid disease is a major world health problem and pulmonary hydatidosis is a widespread disease. It is presented with different clinical manifestations. In order to determine the most clinical manifestation, diagnostic tools and clinical outcome in our patients, we conducted this study. Patients and Methods: Forty-nine patients with pulmonary hydatid cysts who were admitted to our hospital in Zahedan (Southeat of Iran) between 1990 and 2005, evaluated. We retrospectively reviewed the patients’