Disseminated hydatidosis an unusual presentation: a case report
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Hydatidosis, also known as cystic echinococcosis, is a widespread zoonosis, caused by a tapeworm of the genus Echinococcus . It presents a significant public health concern, particularly in endemic areas. The occurrence of disseminated hydatid disease is uncommon, even in regions where it is endemic, with an incidence ranging from 1–8%. The definitive diagnosis relies on a parasitological method.
In this work, we present an unusual case of disseminated hydatid disease that was diagnosed in the central parasitology–mycology laboratory of ‘The Ibn Sina University Hospital’.
This is a 21-year-old patient residing in a rural area, who presented with heaviness-type pain in the right hypochondrium, accompanied with nausea and vomiting. During the examination, the patient mentioned the contact with dogs. Abdominal radiography (ultrasound and CT) revealed findings suggestive of multiple hydatid cysts located in the liver and peritoneum. This suspicion was confirmed by positive hydatid serology.
After 9 months of treatment with albendazole, the patient underwent surgery for excision of the cysts shown on the x-ray, as well as other cysts incidentally discovered intraoperatively at the pelvic and rectal levels. All of the extracted specimens were sent to the parasitology laboratory. The direct examination, along with the viability test, revealed the presence of hooks and scolex of non-viable Echinococcus granulosus .
Disseminated hydatidosis is a rare but serious presentation, and the positive diagnosis relies on several epidemiological, clinical, radiological and parasitological arguments. Medical and surgical treatments play a crucial role in determining the patient’s prognosis.
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This is a study that would be of interest to the field and community.
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Comments to Author
It was a good case report which will be adding to understanding the spectrum of the disease, especially for the residents.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
The authors accepted the suggestions, corrected and enriched the manuscript and I am pleased to recommend it for publication. However, there are many small bugs that need to be corrected. There are many typos: for example, there should be a space after the perio; space is required between E. and granulosus... Line 49. No capital letter needed: Spontaneous Lines 51-52. ″The confirmatory diagnosis is biological″. Just a little more specific. Lines 64-66. After numbers, one space is required, followed by ″mm″ Lines 70-71. I guess double parentheses should be different (There are several such situations in the text). The titer >1:1280 (the positivity threshold is ≥ 1:320). Line 144. Hepatic: this word should start with a lowercase letter Lines 145-146. ″alveolar Echinococosis″: can use an abbreviation …
Comments to Author
The authors accepted the suggestions, corrected and enriched the manuscript and I am pleased to recommend it for publication. However, there are many small bugs that need to be corrected. There are many typos: for example, there should be a space after the perio; space is required between E. and granulosus... Line 49. No capital letter needed: Spontaneous Lines 51-52. ″The confirmatory diagnosis is biological″. Just a little more specific. Lines 64-66. After numbers, one space is required, followed by ″mm″ Lines 70-71. I guess double parentheses should be different (There are several such situations in the text). The titer >1:1280 (the positivity threshold is ≥ 1:320). Line 144. Hepatic: this word should start with a lowercase letter Lines 145-146. ″alveolar Echinococosis″: can use an abbreviation ″AE″. Line 208: intracysticpressure→ intracystic pressure
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
line no-44: Kindly mention the species as cystic echinococcosis, also known as hydatid disease or hydatidosis, caused by infection with a species complex Echinococcus granulosus and alveolar echinococcosis, caused by infection with E. multilocularis. ( Reference - https://www.who.int/news-room/fact-sheets/detail/echinococcosis ) line no-45: Kindly cross check the incidence rate with recent data line no-52: Rewrite the sentence line no-54: did the author mean pain in the abdomen?? line no-56 - 58: Give the reference for the classification line no-60: Give the reference line no -70: biologically can be replaced with laboratory parameters line no- 71: kindly mention the exact name of the serological test line no-111: kindly elaborate which epidemiological data line no-121-122: no need of separate …
Comments to Author
line no-44: Kindly mention the species as cystic echinococcosis, also known as hydatid disease or hydatidosis, caused by infection with a species complex Echinococcus granulosus and alveolar echinococcosis, caused by infection with E. multilocularis. ( Reference - https://www.who.int/news-room/fact-sheets/detail/echinococcosis ) line no-45: Kindly cross check the incidence rate with recent data line no-52: Rewrite the sentence line no-54: did the author mean pain in the abdomen?? line no-56 - 58: Give the reference for the classification line no-60: Give the reference line no -70: biologically can be replaced with laboratory parameters line no- 71: kindly mention the exact name of the serological test line no-111: kindly elaborate which epidemiological data line no-121-122: no need of separate paragraph, could be placed in continuation of 1st paragraph of the discussion part. line no-124: the word contact can be replaced with acquire line no-127: costant contact can be rewritten as constant exposure line no-128-132: make it one paragraph line no-135-137: include anaphylaxix as one of the complication of rupture of cyst (reference - Mouaqit, O., Hibatallah, A., Oussaden, A., Maazaz, K., & Taleb, K. A. (2013). Acute intraperitoneal rupture of hydatid cysts: a surgical experience with 14 cases. World journal of emergency surgery : WJES, 8, 28. https://doi.org/10.1186/1749-7922-8-28 ) line no-144: Give a range/value of sensitivity of a particular investigation for the diagnostic test line no- 147: write the exact name of the seological test line no-178-179: write briefly about the preventive measures also in the discussion part
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
The topic is very interesting and significant not only for the domestic but also for the wider scientific public. The case report is rare and supported by laboratory and clinical evidence. The article is solidly written, but lacks a little more diagnostic-clinical detail and much improvement in discussion. Questions and suggestions for correction: Line 51: A little more information is missing, for example in the vicinity of Rabat. Line 52: Did he have his own dog, does he work with dogs, or is he in contact with stray dogs or something? Line 54: Was the patient then examined for the first time since the onset of symptoms? Where did he go for a check-up, a local health facility or another hospital? Line 56: Add some radiographic description (location, number, size of cysts). Line 59: Where was the …
Comments to Author
The topic is very interesting and significant not only for the domestic but also for the wider scientific public. The case report is rare and supported by laboratory and clinical evidence. The article is solidly written, but lacks a little more diagnostic-clinical detail and much improvement in discussion. Questions and suggestions for correction: Line 51: A little more information is missing, for example in the vicinity of Rabat. Line 52: Did he have his own dog, does he work with dogs, or is he in contact with stray dogs or something? Line 54: Was the patient then examined for the first time since the onset of symptoms? Where did he go for a check-up, a local health facility or another hospital? Line 56: Add some radiographic description (location, number, size of cysts). Line 59: Where was the serology done? Test manufacturer, country? Line 62: What did the monitoring include? Was the monitoring performed in the same institution? Line 63: Did he receive this dose of albendazole daily for 9 months? Lines 63-65: A more detailed first description is needed to compare this finding. Also, if there are any results from previous monitoring. Line 71: How did the patient feel then, was there any clinical deterioration? Was the eosinophil level determined and was there eosinophilia at any stage? Line 72: Was the first serological test and this test done in the same institution? Line 73: Was there any indication that there was widespread dissemination to other tissues and organs? Was an X-ray of the lungs done, for example? Line 112: Was the patient monitored even after the operative treatment? Line 122: Are there any data on the prevalence of surgical cases? What is the epidemiological situation in Morocco? Is cystic echinococcosis more common in certain regions? What is the situation in the region where the patient is from? Is there alveolar echinococcosis? Line 123: What is the epizootic situation regarding canine echinococcosis in Morocco, and the region where the patient is from? Is deworming mandatory? What is the prevalence of hydatidosis in sheep and cattle in Marocco? Line 152: Is there a program of preventive ultrasound examinations in Morocco ? Are there seroprevalence studies? Lines 161-162: How did you decide on 9 months of therapy? There is little comparison of the therapeutic approach in disseminated hydatidosis with the experience of other authors. Reference No 12: All capital letters of authors?
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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