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Echinococcosis

Hydatid Disease

Echinococcosis is a disease caused by the parasites called tapeworms belonging to the Echinococcus genus. Humans get infected by ingesting the parasite eggs in contaminated water, food, or soil, and through having direct contact with the animal hosts.


Presentation

Cystic echinococcosis

The clinical presentation of cystic echinococcosis (CE) is extremely variable. Humans stay asymptomatic for a long period of time after being infected, as the cysts usually grow slowly. The presenting features depend on the number of cysts, size, and the mass effect on the organ and surrounding tissues.

Common symptoms include poor appetite, nausea, vomiting, pain, and discomfort in the upper abdomen. On physical examination, abdominal distention or palpable mass, and hepatomegaly may be detected.

Potential manifestations leading to the diagnosis of CE are the mechanical effect a cyst has on its adjacent tissues with obstruction of the biliary tree while embolism and acute hypersensitivity reactions due to a cyst rupture or leakage with anaphylaxis can also occur. However, such a cyst is usually asymptomatic and found accidentally during surgery, radiographic examination or evaluation for other conditions.

Liver cysts should be included in the differential diagnoses of jaundice, portal hypertension, ascites and colicky pain. They may be misdiagnosed as alveolar echinococcosis, hematomas, amebic or pyogenic liver abscess, metastases, adenoma, hepatocellular carcinoma, textiloma, and lymphoma [1] [2].

Alveolar echinococcosis

Alveolar echinococcosis (AE) results from infection with Echinococcus multilocularis in its larval stage. It is rare but potentially life-threatening [3] [4]. The incubation period can last from five to fifteen years. During the initial phase, patients are typically asymptomatic. The first symptoms which arise are cholestatic jaundice and upper abdominal pain [5].

Chest pain, dyspnea, cough, and hemoptysis are the symptoms that may lead to the incidental detection of lung involvement. The lungs can be affected by means of hematogenous dissemination or invasion through the diaphragm [6] [7].

Fever
  • In this report, we present an 8-year-old female patient admitted with cough, fever, and sputum persisting since 2 weeks; her chest radiography and computed tomography (CT) findings initially indicated Tbc, but the follow-up surgery led to a diagnosis[ncbi.nlm.nih.gov]
  • We present a case of hydatid disease in a 45 year male patient who presented with the history of vague flank pain, mild fever and hematuria.[ncbi.nlm.nih.gov]
  • She was admitted to hospital with a 1-week history of unresolving cough, coloured sputum with occasional haemoptysis and fever despite oral antibiotics. Radiology revealed a cavitating right lower lobe lung abscess.[ncbi.nlm.nih.gov]
  • The country has a meagre annual budget for health, which is being spent on known infections such as polio, dengue fever and hepatic viral infections.[ncbi.nlm.nih.gov]
  • Rupture of the cysts can produce fever, urticaria, eosinophilia, and anaphylactic shock, as well as cyst dissemination. In addition to the liver and lungs, other organs (brain, bone, heart) can also be involved, with resulting symptoms.[web.archive.org]
Fatigue
  • In the remaining third of cases, alveolar echinococcosis is detected incidentally during medical examination for symptoms such as fatigue, weight loss, hepatomegaly, or abnormal routine laboratory findings.[ottawapublichealth.ca]
  • Her main complaint was pain in the right hypochondrium without migration that started two months before admission to the hospital, fever, malaise, fatigue, moderate pain with spontaneous exacerbation, and partial remission.[intechopen.com]
Limited Mobility
  • Genetic homogeneity of east, southeast and central Iranian G6 and its low genetic diversity may be due limited mobility and contact between humans and camels from other regions because of large, inhospitable deserts. Copyright 2017 Elsevier B.V.[ncbi.nlm.nih.gov]
Cough
  • When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.[ncbi.nlm.nih.gov]
  • In this report, we present an 8-year-old female patient admitted with cough, fever, and sputum persisting since 2 weeks; her chest radiography and computed tomography (CT) findings initially indicated Tbc, but the follow-up surgery led to a diagnosis[ncbi.nlm.nih.gov]
  • Cardiac involvement is very uncommon - only about 0.01-2% of all cases.4,5 In most cases, the cysts develop asymptomatically, but heart cysts could manifest with chest pain, dyspnea, cough, hemophtisis and can complicate with rupture.[ncbi.nlm.nih.gov]
  • She was admitted to hospital with a 1-week history of unresolving cough, coloured sputum with occasional haemoptysis and fever despite oral antibiotics. Radiology revealed a cavitating right lower lobe lung abscess.[ncbi.nlm.nih.gov]
  • Lung disease may cause pain in the chest, shortness of breath and coughing.[dbpedia.org]
Hemoptysis
  • When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.[ncbi.nlm.nih.gov]
  • In case of disease progression, including progressive PA obstruction or life-threatening hemoptysis, surgical resection will be considered.[ncbi.nlm.nih.gov]
  • Herein, we report the case of a 36-year-old man who initially presented with pleuritic chest pain, hemoptysis, and dyspnea.[ncbi.nlm.nih.gov]
  • Symptoms depend on the organ involved—eg, jaundice and abdominal discomfort with liver cysts or cough, chest pain, and hemoptysis with lung cysts. Cyst rupture can cause fever, urticaria, and serious anaphylactic reactions.[msdmanuals.com]
  • Pulmonary involvement can produce chest pain, cough, and hemoptysis. Rupture of the cysts can produce fever, urticaria, eosinophilia, and anaphylactic shock, as well as cyst dissemination.[web.archive.org]
Dyspnea
  • When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.[ncbi.nlm.nih.gov]
  • Cardiac involvement is very uncommon - only about 0.01-2% of all cases.4,5 In most cases, the cysts develop asymptomatically, but heart cysts could manifest with chest pain, dyspnea, cough, hemophtisis and can complicate with rupture.[ncbi.nlm.nih.gov]
  • However, due to persistent symptoms of dyspnea, follow-up CT angiography of the chest was performed 3 months later. A persistent PA obstruction was found and the presumed diagnosis of embolism was questioned.[ncbi.nlm.nih.gov]
  • Herein, we report the case of a 36-year-old man who initially presented with pleuritic chest pain, hemoptysis, and dyspnea.[ncbi.nlm.nih.gov]
  • Chest pain, dyspnea, cough, and hemoptysis are the symptoms that may lead to the incidental detection of lung involvement. The lungs can be affected by means of hematogenous dissemination or invasion through the diaphragm.[symptoma.com]
Abdominal Pain
  • In this report we describe an unusual case of a 19-year-old woman who was admitted to our hospital for abdominal pain, nausea, and vomiting. Computed tomography revealed multi-organ abdominal echinococcosis.[ncbi.nlm.nih.gov]
  • Hepatic involvement can result in abdominal pain, a mass in the hepatic area, and biliary duct obstruction. Pulmonary involvement can produce chest pain, cough, and hemoptysis.[web.archive.org]
  • We present the case of a 16-year-old patient who came to our clinic for upper abdominal pain.[ncbi.nlm.nih.gov]
Abdominal Mass
  • On the other hand, if the patient has cysts in the liver and is symptomatic, they will suffer from abdominal pain, abnormal abdominal tenderness, hepatomegaly with an abdominal mass, jaundice, fever and/or anaphylactic reaction.[en.wikipedia.org]
  • Axial contrast-enhanced maximum intensity projection image demonstrates a large abdominal mass (M) infiltrating the pericardium and right ventricular free wall (arrows) with an associated small right pleural effusion.[pubs.rsna.org]
  • The first reported case was a 54-year-old fisherman from Winnipeg, Manitoba, Canada who presented with an abdominal mass in 1928 [ 38 ]. The patient was operated on in 1928, but succumbed to his disease in 1935.[parasite-journal.org]
  • The main clinical manifestations include abdominal pain, palpable abdominal masses, loss of weight, jaundice, hepatomegaly, anaemia, fever, hemoptysis (in cases of lung involvement), and, in about 25% of patients, signs of portal hypertension and biliary[doi.org]
Abdominal Tenderness
  • On the other hand, if the patient has cysts in the liver and is symptomatic, they will suffer from abdominal pain, abnormal abdominal tenderness, hepatomegaly with an abdominal mass, jaundice, fever and/or anaphylactic reaction.[en.wikipedia.org]
Left Upper Quadrant Pain
  • An 8-year-old child from grazing areas of northwest China was referred to our hospital for the complaint of inpersistent precordial chest pain and left upper quadrant pain for 3 years.[ncbi.nlm.nih.gov]
Dyspepsia
  • Nausea and dyspepsia was reported by 10 patients (6.25%). An upper abdominal swelling or mass was noticed only by 5 patients (31.3%).[doi.org]
Chest Pain
  • When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.[ncbi.nlm.nih.gov]
  • Cardiac involvement is very uncommon - only about 0.01-2% of all cases.4,5 In most cases, the cysts develop asymptomatically, but heart cysts could manifest with chest pain, dyspnea, cough, hemophtisis and can complicate with rupture.[ncbi.nlm.nih.gov]
  • An 8-year-old child from grazing areas of northwest China was referred to our hospital for the complaint of inpersistent precordial chest pain and left upper quadrant pain for 3 years.[ncbi.nlm.nih.gov]
  • Herein, we report the case of a 36-year-old man who initially presented with pleuritic chest pain, hemoptysis, and dyspnea.[ncbi.nlm.nih.gov]
  • Pulmonary involvement can produce chest pain, cough, and hemoptysis. Rupture of the cysts can produce fever, urticaria, eosinophilia, and anaphylactic shock, as well as cyst dissemination.[web.archive.org]
Jaundice
  • The patient, who was presented with hepatomegaly, jaundice, and an infiltrative solid tumor, diagnosed by ultrasound and computed tomography. In contrast to hydatid cyst caused by echinococcus granulosus, this is a rare disease in Iran.[ncbi.nlm.nih.gov]
  • Liver cysts should be included in the differential diagnoses of jaundice, portal hypertension, ascites and colicky pain.[symptoma.com]
  • When the liver is affected the person may have abdominal pain, weight loss, and turn slightly yellow from jaundice. Lung disease may cause pain in the chest, shortness of breath and coughing.[dbpedia.org]
  • Symptoms depend on the organ involved—eg, jaundice and abdominal discomfort with liver cysts or cough, chest pain, and hemoptysis with lung cysts. Cyst rupture can cause fever, urticaria, and serious anaphylactic reactions.[msdmanuals.com]
Hepatomegaly
  • The patient, who was presented with hepatomegaly, jaundice, and an infiltrative solid tumor, diagnosed by ultrasound and computed tomography. In contrast to hydatid cyst caused by echinococcus granulosus, this is a rare disease in Iran.[ncbi.nlm.nih.gov]
  • Palpation showed hepatomegaly, abdominal palpable mass while inspection abdominal distension. Routine blood tests were within the normal ranges.[ncbi.nlm.nih.gov]
  • On physical examination, abdominal distention or palpable mass, and hepatomegaly may be detected.[symptoma.com]
  • This inflammatory process, which resembles a tumor, may result in hepatomegaly, cholestasis, jaundice, cirrhosis, portal hypertension, and the Budd-Chiari-syndrome. Aberrant intermediate hosts include humans and non-human primates.[dpz.eu]
  • Larger lesions cause hepatomegaly and epigastric pain.[ottawapublichealth.ca]
Hepatic Mass
  • Diagnostic methods Diagnosis of AE is based on: typical organ lesions detected by imaging techniques such as ultrasound (large hepatic mass with juxtaposed areas of internal hyper- and hypoechogenicity, irregular margins, and scattered calcification,[orpha.net]
  • Coronal thin-section (a) and three-dimensional (b) images from MR cholangiopancreatography show a hepatic mass (M) that compresses the hilar biliary ducts.[pubs.rsna.org]

Workup

Cystic echinococcosis

Ultrasound is the imaging modality of choice when diagnosing asymptomatic CE. It is non-invasive, safe, and relatively cost-effective.

The World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) suggested standard ultrasound classification based on the status of the cyst (active, transitional, or inactive) which depends on the sonographic appearance [8].

Ultrasound is not able to differentiate all the hydatid cysts from other lesions like liver abscesses and tumors. So, additional imaging studies like computed tomography (CT) and magnetic resonance imaging (MRI) are required. MRI is preferred as it provides better visualization of the liquid areas in the matrix than CT scans [9]. It also helps in the evaluation of CE prior to surgical intervention.

Immunodiagnosis can be used as a confirmation tool after a radiologic diagnosis has been made. It is also useful in the pharmacological and post-surgical follow-up of patients even though an immune response may not be detected in all of them [10] [11] [12].

Alveolar echinococcosis

The diagnosis of AE remains a challenge in spite of technical advances and resources. With this delay, management starts at a later stage, limiting the available treatment options. AE is characterized by a tumor-like growth which may infiltrate the surrounding structures [3]. Early detection can increase the rates of curative surgical resection [13].

Radiologic studies play a major role in diagnosing AE but histopathologic evaluation and PCR can confirm it. For several years, X-rays, ultrasound and other imaging methods such as CT scans and MRI have been used for diagnosing, managing, and following up cases of AE [14].

Ischemic Changes
  • His electrocardiogram revealed ischemic changes, but coronary angiography was normal. The diagnosis of cardiac echinococcosis was made by transthoracic echocardiography and contrast-enhanced CT and confirmed by pathologic examination.[ncbi.nlm.nih.gov]

Treatment

  • The risk of treatment in pregnant women who are known to have an infection needs to be balanced with the risk of disease progression in the absence of treatment.[web.archive.org]
  • The patients received both medical and surgical treatments (78.5%, n 187), only surgical treatment (10.5%, n 25), or only medical treatment (8.8%, n 21).[ncbi.nlm.nih.gov]
  • Treatment with formalin presented the most longest hospital stay (p less than 0.0001).[ncbi.nlm.nih.gov]
  • The patient died of hepatic hydatid cyst rupture due to refusing high-risk surgical treatment and other treatment.[ncbi.nlm.nih.gov]
  • treatment (1911) (14782119794).jpg 668 1 270; 181 KB Estratto da " " Categorie : Echinococcus Helminthiases Categorie nascoste: Uses of Wikidata Infobox Uses of Wikidata Infobox providing interwiki links[commons.wikimedia.org]

Prognosis

  • Prognosis mainly depends on the type of infestation (ie, whether it is cystic [CE] or alveolar echinococcosis [AE]). In CE, the prognosis is generally good, and complete cure is possible with total surgical excision without spillage.[emedicine.com]
  • Patient prognosis relies on proper treatment of all lesions.[ncbi.nlm.nih.gov]
  • Please find comprehensive information on Echinococcus regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis, and additional useful information HERE .[dovemed.com]
  • Prognosis AE is one of the most dangerous zoonotic diseases in the world and if untreated prognosis is poor. Early diagnosis and treatment of AE, especially during the asymptomatic period, are important for reducing morbidity and mortality.[orpha.net]

Etiology

  • Abstract The development of our knowledge of echinococcus disease has been outlined, and its etiology and distribution have been described.[web.archive.org]
  • In the last chapter the larva migrans syndrome is treated in detail with special attention to its etiology and and diagnosis. Reports on lesser known nematode zoonoses like mammomono gamosis and oesophagostomiasis are included.[books.google.it]
  • Etiology Alveolar echinococcosis (AE) occurs after ingestion of eggs of the parasite E.multilocularis.[orpha.net]
  • […] multilocularis (alveolar hydatid disease) or E. vogeli (polycystic hydatid disease) Humans become infected by eating food contaminated with tapeworm eggs, becoming intermediate hosts ( Wikipedia: Echinococcus [Accessed 5 January 2018] ) Pathophysiology / etiology[pathologyoutlines.com]
  • However, with the description of a new indigenous species, uncertainties arose about the etiologic role of E. oligarthrus in PE ( 30 ).[doi.org]

Epidemiology

  • We argue that population epidemiology surveys with ultrasound are warranted in Sahelian countries, including Niger.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America. 2 Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.[ncbi.nlm.nih.gov]
  • Author information 1 School of Health Services, Hacettepe University, Ankara, Turkey. 2 Department of Infectious Diseases, WHO Collaborating Centre for the Epidemiology, Detection and Control of CE and AE, European Union Reference Laboratory for Parasites[ncbi.nlm.nih.gov]
  • Electronic address: i.habib@murdoch.edu.au. 3 College of Veterinary Medicine, University of Basrah, Basrah, Iraq. 4 China-Australia Joint Research and Training Center for Veterinary Epidemiology, Huazhong Agricultural University, Wuhan, China; College[ncbi.nlm.nih.gov]
  • Research work should be carried out on the epidemiology and serodiagnosis of echinocossis in the different areas of Pakistan, which will be useful for the proper eradication of echinococcosis in this region.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Literature review and suggested pathophysiologic mechanisms underlying this phenomenon are presented.[ncbi.nlm.nih.gov]
  • […] commonly E. multilocularis (alveolar hydatid disease) or E. vogeli (polycystic hydatid disease) Humans become infected by eating food contaminated with tapeworm eggs, becoming intermediate hosts ( Wikipedia: Echinococcus [Accessed 5 January 2018] ) Pathophysiology[pathologyoutlines.com]
  • Pathophysiology In primary echinococcosis, metacestodes develop from oncospheres after peroral infection with E granulosus eggs. In secondary echinococcosis, larval tissue proliferates after being spread from the primary site of the metacestode.[emedicine.com]
  • Epidemiologic and Pathophysiologic Profile Alveolar echinococcosis occurs only in the northern hemisphere.[pubs.rsna.org]

Prevention

  • Author information 1 Department of Parasite Control, Qinghai Province Institute for Endemic Diseases Prevention and Control, Xining, China. 2 National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of[ncbi.nlm.nih.gov]
  • This has been achieved by the long-term application of prevention and control measures primarily targeted to deworming dogs, health education, meat inspection, and effective surveillance in livestock and human populations.[ncbi.nlm.nih.gov]
  • Prevention and control Cystic echinococcosis is a preventable disease as it involves domestic animal species as definitive and intermediate hosts.[web.archive.org]
  • This study could be used as a tool to prioritize and make decisions with regard to a surveillance system for this largely preventable yet neglected disease.[ncbi.nlm.nih.gov]
  • For an overview including prevention and control visit www.cdc.gov/parasites/echinococcosis/.[web.archive.org]

References

Article

  1. Cattaneo F, Graffeo M, Brunetti E. Extrahepatic textiloma long misdiagnosed as calcified echinococcal cyst. Case Rep Gastrointest Med. 2013;2013:261685.
  2. Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A. Hydatid disease from head to toe. Radiographics. 2003;23:475–494.
  3. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev. 2004;17:107–135.
  4. Nunnari G, Pinzone MR, Gruttadauria S, et al. Hepatic echinococcosis: clinical and therapeutic aspects. World J Gastroenterol. 2012;18:1448–1458.
  5. Ammann RW, Eckert J. Cestodes. Echinococcus. Gastroenterol Clin North Am. 1996;25:655–689.
  6. Kantarci M, Bayraktutan U, Karabulut N, et al. Alveolar echinococcosis: spectrum of findings at cross-sectional imaging. Radiographics. 2012;32:2053–2070.
  7. Aydinli B, Aydin U, Yazici P, Oztürk G, Onbaş O, Polat KY. Alveolar echinococcosis of liver presenting with neurological symptoms due to brain metastases with simultaneous lung metastasis: a case report. Turkiye Parazitol Derg. 2008;32:371–374.
  8. WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta tropica. 2003;85(2):253–61.
  9. Hosch W, Junghanss T, Stojkovic M, et al. Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents. NMR Biomed. 2008;21:734–754.
  10. Zhang W, McManus DP. Recent advances in the immunology and diagnosis of echinococcosis. FEMS Immunol Med Microbiol. 2006;47:24–41.
  11. Ito A. Serologic and molecular diagnosis of zoonotic larval cestode infections. Parasitol Int. 2002;51:221–235.
  12. Gottstein B. Molecular and immunological diagnosis of echinococcosis. Clin Microbiol Rev. 1992;5:248–261.
  13. Buttenschoen K, Carli Buttenschoen D, Gruener B, et al. Long-term experience of surgical treatment of alveolar echinococcosis. Langenbecks Arch Surg. 2009;394:689–698.
  14. Liu W, Delabrousse É, Blagosklonov O, et al. Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones. Parasite. 2014;21:74.

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Last updated: 2019-07-11 22:03