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94.1-ECHINOCOCCOSIS IN FORENSIC PATHOLOGY IN SPAIN. PROF.GARFIA.A

94.1-HYDATA Cysts IN SOUTHWEST OF SPAIN. A POINT OF FORENSIC VIEW. histopathological FINDINGS IN LUNGS AND LIVER.

PROF. GARFIA.A

94.1-HIDATIDOSIS Patologia FORENSICS EN EN EL SURO DE ESPAÑA: HALLAZGOS Pulmonary Y HEPÁTICOS.

PROF. GARFIA.A

94.1-hydatidosis IN FORENSIC PATHOLOGY IN SOUTHWEST SPAIN: PATHOLOGICAL FINDINGS IN LIVER AND LUNG.

PROF.GARFIA.A


Introduction

           Echinococcosis - hydatid disease- is the most wide spread serious human parasitic infection in the world caused by two main helminth -cestode- types: Echinococcus granulosus and Echinococcus multilocularis.

             It is endemic in areas with tropical or subtropical climates particularly in Mediterranean countries, Australia, Africa and South America.

             Humans become infected through contact with definite host or consumtion of contaminated food. After the parasite enters the body, larval stage of Equinococcus forms cysts. Predominate locations of hydatd cysts are liver and lungs but other organs can also be affected (heart, spleen, muscles,etc).

          Very serious complication of the hydatid disease is rupture of the cyst that can lead to sudden death or anaphylactic shock.                 The rupture of hydatid cyst is very rare and can occur spontaneously or iatrogenically, following serious injuries, or even minor trauma. In addition to allergic reactions to components within the cyst fluid the content of the cyst includes infective protoscolices, which when liberated from the cyst can spill into others  areas and develop into new hydatid cysts.
       Potentially fatal complications of cyst rupture, also include asphyxia by drowning from the hydatid fluid, impaction of the membrane in the glottis, and severe hemorrhage. 
    
            

             I report a case of female patient which presented a sudden unexpected death due to the rupture of a cyst with massive pulmonary lung HYDATA Dissemination Through the tracheobronchial tree.


Introduction

hydatidosis remains a zoonosis endemic in many parts of the world, especially in North Africa, Southern Europe, China and South America. In Spain, several regions are included in traditionally endemic areas. Among them are: Extremadura, Andalucia, Castilla-Leon, Navarra and Catalonia. Although Spain has ceased to be a notifiable disease in some regions, the disease is far from being eradicated. In 2008 appeared, in Salamanca, the results of a study on this disorder in a conference organized by the English Association of Hydatid Disease, Institute of Natural Resources and Agricultural Biology of Salamanca (IRNAS), conducted by Dr. Javier Pardo, MD Internal Medicine Service of Hospital Universitario de Salamanca. According to data offered by Dr. Brown, in the province of Salamanca are recorded between 10 and 12 cases per year, per 100,000 inhabitants.
        Desgraciadamente, no poseo datos estadísticos recientes (referentes a incidencia, morbo/mortalidad, etc.), de esta parasitosis, en Andalucía ni en Extremadura (ambas, regiones endémicas). 
           Se presenta un caso de muerte súbita inesperada a consecuencia de la rotura de un quiste hidatídico pulmonar con inundación del árbol tráqueobronquial y diseminación pulmonar masiva de escólices, seguida de hemoptisis y sofocación. 

CASE NO 1
Case description
It was one patient, 62 years from the Community of Extremadura in the Southwest English.
The patient with no history of interest, entered into an Emergency Hospital for filing Refererencia to dyspnea and hempotisis, which was followed by exitus.


Autopsy Findings
were autopsy findings were nonspecific, describing the existence of a widespread severe congestion and the presence of a cyst in the left lower lung lobe. It issued a diagnosis of sudden death of cardiac origin, acute myocardial infarction.


Histopathologic Study
received for histopathological study, the lower lobe of left lung.
1 .- Study .- macroscopic
lung lobe showed a cyst measuring 12 cm in diameter, which had a thick white wall 0.2 mm, approximately. The cyst, subpleural, appeared broken and meaningless. The rest of the lung parenchyma showed intense vascular congestion and multiple and extensive foci of hemorrhage.
2 .- .- Microscopic study
It was a cyst, lined by a dense fibrous tissue capsule (Fig. 1), by outside of which were infiltrated foci of plasma cell lymphoma, chronic inlamatorio. Microscopically, the wall structure appeared to consist of the germinative membrane (right of picture), and the adventitial fibrous, dense fibrous tissue. In different sections examined could not locate the remains of the membrane laminated. In the lung parenchyma, located in the periphery of the cyst, was a segmental bronchus containing scolices, at different stages of larval development, accompanied by bronchial epithelial membrane remnants-like Creola bodies found in bronchial asthma, and bleeding. Given this finding, the examination of numerous lung sections revealed the presence of numerous infectious scolices occupying the alveolar spaces. The rest of the lung parenchyma showed intense vascular congestion and hemorrhages bronchoalveolar multiple recent.

Fig.1.-Pulmón.Corte microscopic Masson trichrome stained. up to the wall of pulmonary hydatid cyst rupture and spill suffered contents into the bronchial tree. To the right is the germinative membrane. Prof.Garfia.A
Note .- During microscopic examination and the taking of photographs using different light filters, in order to improve the contrast of the protoscoleces found.

Fig. 2 .- Lung
. Hematoxylin-eosin-phloxine.
Court microscopic infectious protoscoleces showing two located in the alveolar spaces. The lung parenchyma appears congestive, with hemorrhagic foci, and morphological signs of emphysema-like air-fluid from submersion. Prof.Garfia

Fig.3 .- Pulmón.Hematoxilina-eosin-phloxine.
In court there are three infectious protoscoleces located in the alveolar spaces. Prof.Garfia.A

Fig.4.-Pulmón. Tricrómico-Masson.
Protoescólice infectious free in the alveolar spaces.
Note the emphysematous lung appearance and elongation and rupture of alveolar septa, similar to what occurs in the lungs of the drowned.
Prof.Garfia.A

Pulmón.Tricrómico Fig.5.-Masson.
infectious protoscoleces free in the alveolar spaces, from the rupture of a hydatid cyst subpleural. Prof.Garfia.A

Fig.6 Pulmón.Microscópico.Hematoxilina-eosina-floxina.-
protoscoleces located in the light of a bronchus (pictured center), accompanied by bleeding in the upper part of the preparation. Cyst is located beneath the bronchial epithelium detached. Prof.Garfia.A

Fig.7.-Pulmón.-hematoxylin-eosin-phloxine. Details protoscoleces, showing the crown of hooks, bronchial hemorrhage, and respiratory epithelium in the bottom of the picture. Prof.Garfia.A

Fig.8.-Pulmón.Corte microscopic bronchus stained with Masson trichrome, in whose light we can see a scolices free from hydatid cyst rupture mother, subpleural. Note that the protoscoleces is partially surrounded by an outer ring of cells, intensely stained, from the bronchial epithelium. Prof.Garfia.A

Fig.9. - Details of the previous figure. Some of the cells that form the seudocorona on scolices possess a ciliated epithelium, which indicates that it is a detachment (similar to a Body of Creola) of bronchial respiratory epithelium. There protoscoleces accompanying hemorrhage. Prof. Garfia.A






Bibliografía

Cystic Echinococcosis in Spain: Current Situation and Relevance for Other Endemic Areas in Europe.

Francisco A. Rojo-Vazquez ¹ ,  Javier Pardo-Lledias ² , Marcelo Von Francos-Hunefeld ³ , Miguel Cordero-Sanchez ⁴ , Rufino Alamo-Sanz ⁵ , Ana Hernandez-Gonzalez ⁶ , Enrico Brunetti ⁷ , March Siles-Lucas ^{6 *}

http://www.plosntds.org/article/info% 3Adoi% 2F10.1371% 2Fjournal.pntd.0000893 .