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].

• Pain

  This leads to signs and symptoms of upper abdominal pain, chest pain, and cough with sputum and blood The treatment of Echinococcus is undertaken using anti-parasitic medications and sometimes, the condition may require surgical interventions. [dovemed.com]

  The first symptoms which arise are cholestatic jaundice and upper abdominal pain. Chest pain, dyspnea, cough, and hemoptysis are the symptoms that may lead to the incidental detection of lung involvement. [symptoma.com]

  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]

  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. [cdc.gov]

• Asymptomatic

  However, such a cyst is usually asymptomatic and found accidentally during surgery, radiographic examination or evaluation for other conditions. [symptoma.com]

  The disease can progress to the cirrhotic stage after a long latent, asymptomatic period. [orpha.net]

  Conversely, the primary cyst can die early in its development, and the disease can thus remain completely asymptomatic. [news-medical.net]

• Fever

  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]

  Cyst rupture can cause fever, urticaria, and serious anaphylactic reactions. Diagnosis is with imaging, examination of cyst fluid, or serologic tests. [merckmanuals.com]

  Colorado tick fever virus Corynebacterium diphtheriae Coxiella burnetii Coxsackievirus Creutzfeldt-Jakob agent, Kuru agent Crimean-Congo hemorrhagic fever virus Cryptococcus neoformans Cryptosporidium parvum Cyclospora spp. [phac-aspc.gc.ca]

• Weight Loss

  Presenting symptoms were those of typical mass effect with RUQ pain, pruritus, malaise, and recent weight loss. [ncbi.nlm.nih.gov]

  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]

  In humans, the larval forms of E. multilocularis do not fully mature into cysts but cause vesicles that invade and destroy surrounding tissues and cause discomfort or pain, weight loss, and malaise. [cdc.gov]

  Non-specific signs include anorexia, weight loss and weakness. [who.int]

• Hunting

  If the risk of infection does exist, reindeer herding dogs and hunting dogs should be dewormed from time to time with a medicine effective against echinococcosis. [ouluek.fi]

  This parasite is maintained in eastern Finland in a sylvatic life cycle involving wolves and moose; in the present case, the infection was presumably transmitted by hunting dogs. [ncbi.nlm.nih.gov]

  Parasite Cause(s) Ingestion of infested fecal material from primary host or cyst from intermediate host Symptoms Cysts; liver, lung or kidney damage, anaphylactic shock Mortality Rate Low Treatments Surgical removal of cysts Show Information Appearances Hunting [house.wikia.com]

  Splash Panel Edit Category: {{s.name}} {{s.name}} Edit Content item: {{i.title}} {{i.title}} I will be: Hunting Fishing Snowmobiling Camping MORE THINGS TO DO I want to visit: State Parks Trails MORE PLACES TO GO > Buy a License Online fish, hunt, ORV [michigan.gov]

• Cough

  This leads to signs and symptoms of upper abdominal pain, chest pain, and cough with sputum and blood The treatment of Echinococcus is undertaken using anti-parasitic medications and sometimes, the condition may require surgical interventions. [dovemed.com]

  Complications Cyst rupture may cause allergic reaction, coughing, coughing up blood, and spread of the infection to multiple organs. [sunshinehealthfoodstore.com]

  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]

• 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]

  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]

• 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]

  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. [merckmanuals.com]

  Pulmonary cysts can rupture, causing cough, chest pain, and hemoptysis. [msdmanuals.com]

• Abdominal Pain

  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. [cdc.gov]

  This leads to signs and symptoms of upper abdominal pain, chest pain, and cough with sputum and blood The treatment of Echinococcus is undertaken using anti-parasitic medications and sometimes, the condition may require surgical interventions. [dovemed.com]

  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]

  Abdominal pain, nausea and vomiting commonly occur when cysts invade the liver. If the lung is affected, clinical signs include chronic cough, chest pain and shortness of breath. [who.int]

• Nausea

  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]

  […] years 5–10 years Onset Usually asymptomatic Typically nonspecific symptoms Hepatic Single hepatic cyst (hydatid cyst) Symptoms depend on the location and size of the cyst Cyst rupture may cause anaphylactic reaction Hepatomegaly → RUQ pain Malaise, nausea [amboss.com]

  Persons with cystic echinococcosis often remain asymptomatic until hydatid cysts containing the larval parasites grow large enough to cause discomfort, pain, nausea, and vomiting. [cdc.gov]

  Abdominal pain, nausea and vomiting commonly occur when cysts invade the liver. If the lung is affected, clinical signs include chronic cough, chest pain and shortness of breath. [who.int]

  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. [symptoma.com]

• Abdominal Mass

  When the liver is involved, abdominal pain, nausea and abdominal mass are found (11). [caribbean.scielo.org]

  mass and no clearly defined diagnosis. 12 The typical appearance on imaging is a fluid-filled mass with a well-defined outer wall and internal septations. [aafp.org]

  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]

• Upper Abdominal Pain

  This leads to signs and symptoms of upper abdominal pain, chest pain, and cough with sputum and blood The treatment of Echinococcus is undertaken using anti-parasitic medications and sometimes, the condition may require surgical interventions. [dovemed.com]

  We present the case of a 16-year-old patient who came to our clinic for upper abdominal pain. [ncbi.nlm.nih.gov]

  The first symptoms which arise are cholestatic jaundice and upper abdominal pain. Chest pain, dyspnea, cough, and hemoptysis are the symptoms that may lead to the incidental detection of lung involvement. [symptoma.com]

  Following a long incubation period, infection with E. granulosus typically results in the formation of a single liver cyst (hydatid cyst), which may be asymptomatic or cause upper abdominal pain and other GI complaints. [amboss.com]

• 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]

• Chest Pain

  This leads to signs and symptoms of upper abdominal pain, chest pain, and cough with sputum and blood The treatment of Echinococcus is undertaken using anti-parasitic medications and sometimes, the condition may require surgical interventions. [dovemed.com]

  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]

• Hypertension

  In contrast, infection with E. multilocularis resembles a hepatic malignancy that invades and destroys the surrounding tissue, which can lead to complications such as portal hypertension, cholangitis, jaundice, and even cirrhosis. [amboss.com]

  This inflammatory process, which resembles a tumor, may result in hepatomegaly, cholestasis, jaundice, cirrhosis, portal hypertension and the Budd-Chiari-syndrome. Alternate hosts are e. g. humans and non-human primates. [dpz.eu]

  Liver cysts should be included in the differential diagnoses of jaundice, portal hypertension, ascites and colicky pain. [symptoma.com]

• Jaundice

  Liver cysts should be included in the differential diagnoses of jaundice, portal hypertension, ascites and colicky pain. [symptoma.com]

  Polycystic Echinococcosis, primarily caused by Echinococcus vogeli, affects the liver causing enlargement and jaundice, as well as the abdomen cavity. [iamat.org]

  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]

  Jaundice — The yellow-greenish coloring of the skin and eyes due to the presence of bile pigments. The presence of jaundice is usually, but not always, a sign of liver disease. [medical-dictionary.thefreedictionary.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]

  → RUQ pain Malaise, nausea, vomiting Hepatic cyst Hepatomegaly → RUQ pain Malaise, weight loss, nausea, vomiting Cyst that invades and destroys the liver and surrounding tissue Portal hypertension, Budd-Chiari syndrome Liver cirrhosis May resemble hepatocellular [amboss.com]

  This inflammatory process, which resembles a tumor, may result in hepatomegaly, cholestasis, jaundice, cirrhosis, portal hypertension and the Budd-Chiari-syndrome. Alternate hosts are e. g. humans and non-human primates. [dpz.eu]

• Blister

  These embryos penetrate the wall of the intestine and are carried in the bloodstream to vital organs such as the liver, lungs or brain, where they can develop into watery ‘blisters’ called hydatid cysts. [betterhealth.vic.gov.au]

• Rabies

  Effect of oral immunization against rabies on the red fox population in Hungary. Rabies Bull Eur. 1999 ; 23 : 12. Hansen GR, Woodall J, Brown C, Jaax N, McMara T, Ruiz A. Emerging zoonotic diseases. Emerg Infect Dis. 2001 ; 7 : 537. [doi.org]

  (excluding B. mallei, B. pseudomallei ) R Rabies virus Respiratory syncytial virus Rhinovirus Rickettsia akari Rickettsia prowazekii Rickettsia rickettsii Ross river virus Rubella virus S Salmonella enterica spp. [phac-aspc.gc.ca]

  The disease burden can also be compared to that of rabies. Annual AE mortality is approximately one third of that due to rabies which has been estimated at approximately 55,000 [45], [46]. Nearly all is from Africa and Asia. [journals.plos.org]

  The ecology of dogs and canine rabies: a selective review. Rev Sci Tech. (1993) 12:51–71. doi: 10.20506/rst.12.1.663 PubMed Abstract | CrossRef Full Text 33. WSPA. Suffering in Slums: The Global Stray Dog Problem. (2010). [frontiersin.org]

  Summary of Recommendations – Quarantine & Rabies. A Reappraisal. Report by Advisory Group on Quarantine. MAFF Publications, Admail 6000, London, SW1A 2XX. MATHIS, A., DEPLAZES, P. & ECKERT, J. (1996). [cambridge.org]

• Seizure

  […] liver and subcutaneous tissues may be asymptomatic for many years, but pressure effects may develop; in sensitive areas, hydatids may cause blocking effects and mechanical compression leading to collapse of infected bones, blindness and epiletiform seizures [web.archive.org]

  A 36 year old male from Columbia was admitted to the hospital with seizures. [petsdocbox.com]

  Anti- Taenia solium larval stage IgG antibodies in patients with epileptic seizures. Trop Parasitol 2011;1:20-5. 17. Croker C, Redelings M, Reporter R, Sorvillo F, Mascola L, Wilkins P. [tropicalparasitology.org]

  The central nervous system can lead to seizures or symptoms due to an increase in the intracranial pressure [ 26 ]. Kidney disease can cause hematuria, and even glomerulonephritis and nephrotic syndrome have been described. [intechopen.com]

• Headache

  Headache, nausea, neutropenia, hair loss, and hepatotoxicity are the most commonly reported side effects of albendazole and mebendazole. [wjgnet.com]

  In 1997, subsequent indigenous case, a 26-year-old female from Palu, Central Sulawesi, was administered in the Cipto Mangunkusumo Hospital in Jakarta with chronic and progressive headache, space-occupying lesion, blurred vision since the last 6 months [intechopen.com]

  A recent study from Mexico reported that 25,341 DALYs were lost due to NCC associated epilepsy and severe chronic headaches. [19] In another study from Peru, it was found that treatment costs and productivity losses due to NCC consume 54% of an annual [tropicalparasitology.org]

• Convulsions

  Antigenic hydatid fluid spillage sensitizes individuals and may cause an allergic response, varying from mild pruritus and urticaria to anaphylactic shock, convulsion, and coma. [doi.org]

• Dizziness

  Because the drug may cause dizziness, patients should be cautious while driving or operating machinery. [sunshinehealthfoodstore.com]

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].

• Pericardial Effusion

  A case of sparganosis that presented as a recurrent pericardial effusion. Korean Circ J 2011; 41:38–42. 65. Lee KJ, Myung NH, Park HW. A case of sparganosis in the leg. Korean J Parasitol 2010; 48:309–312. 66. Chai JY. [ekjm.org]

  Other organs Heart infection might generate rupture with pericardial tamponade, cardiac insufficiency, embolism or pericardial effusion [ 23 - 25, 60, 64, 66 ]. [intechopen.com]

• Echinococcus Multilocularis

  B67.6 Echinococcus multilocularis infection, other and multiple sites B67.61 Echinococcus multilocularis infection, multiple sites B67.69 Echinococcus multilocularis infection, other sites B67.7 Echinococcus multilocularis infection, unspecified B67.8 [icd10data.com]

  Echinococcus Romania echinococcosis mitochondria patients genotyping surveys genetic variation zoonoses cattle intermediate hosts genotype pig swine Echinococcus multilocularis mutation haplotypes sequence analysis humans human Helminthologia ISSN : 1336 [agris.fao.org]

  Echinococcus granulosus - Image Copyright: sciencepics / Shutterstock Echinococcus multilocularis is found around the world in many arctic and temperate areas of the northern hemisphere. [news-medical.net]

  Last updated June 15, 2017 Echinococcus is a zoonotic (passed by animals), parasitic disease caused by Echinococcus granulosus or Echinococcus multilocularis worm, also commonly called the hydatid worm. [dovemed.com]

These ruptures are normally caused by trauma or medical treatment [5]. [microbewiki.kenyon.edu]

Development of new drugs and other treatment modalities receives very little attention, if any. [clinicaltrials.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]

In view of the inadequacy of treatment options, prevention plays a very important role in reducing the rate of infection. [sunshinehealthfoodstore.com]

There are 4 options for the treatment of cystic echinococcosis: percutaneous treatment of the hydatid cysts with the PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique; surgery anti-infective drug treatment “watch and wait”. [who.int]

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 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]

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 AE occurs after ingestion of eggs of the parasite E.multilocularis. Wild carnivores, mainly foxes, are the most important definitive hosts but domestic dogs and cats may also serve as definite hosts by ingestion of infected wild rodents. [orpha.net]

ECHINOCOCCOSIS OF BONE J Bone Joint Surg Am, 1945 Jul; 27 (3): 401 -411. http://dx.doi.org/ Abstract The development of our knowledge of echinococcus disease has been outlined, and its etiology and distribution have been described. [web.archive.org]

Etiology Pathogens: Echinococcus tapeworms [1][2] Echinococcus granulosus causes CE Echinococcus multilocularis causes AE Transmission Hand-to-mouth From the fur of definitive hosts (e.g., petting a dog or cat) Contaminated dirt (e.g., dog feces) [1] [amboss.com]

McManus DP (2002) The molecular epidemiology of Echinococcus granulosus and cystic hydatid disease. Trans R Soc Trop Med Hyg 96 Suppl 1: S151-157. McManus DP, Thompson RC (2003) Molecular epidemiology of cystic echinococcosis. [omicsonline.org]

For the near future, some aspects can change Echinococcus situation and probably modify prevalence and epidemiological data. [scielo.br]

We argue that population epidemiology surveys with ultrasound are warranted in Sahelian countries, including Niger. [ncbi.nlm.nih.gov]

Landscape epidemiology uses a wide variety of data and statistical techniques [ 5 ]. [idpjournal.biomedcentral.com]

Method Publications on alveolar echinococcosis throughout the world were systematically reviewed with special reference to ecology, epidemiology and countermeasures. [doi.org]

Literature review and suggested pathophysiologic mechanisms underlying this phenomenon are presented. [ncbi.nlm.nih.gov]

University Tropical Parasitology: Protozoans, Worms, Vectors and Human Diseases This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology, pathophysiology [coursera.org]

[…] granulosus causes CE Echinococcus multilocularis causes AE Transmission Hand-to-mouth From the fur of definitive hosts (e.g., petting a dog or cat) Contaminated dirt (e.g., dog feces) [1] Fecal-contaminated food or water (e.g., wild berries, mushrooms) [1] Pathophysiology [amboss.com]

[…] 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]

Medical Chemistry and Biochemistry (320) Physiology and Pathophysiology (267) Paediatrics, Neonatology (261) Internal Medicine (243) Biophysics (238) Infectology (198) Pathology and Forensic Medicine (194) Microbiology (157) Genetics (133) Surgery, Traumatology [portal.mefanet.cz]

The activities of dogs should be controlled to help prevent transmission of the parasite. Measures to stop the dog–sheep cycle include: Preventing dogs from eating infected offal, Preventing infected dogs from defecating on pastures grazed by sheep. [lrd.spc.int]

Prevention In view of the inadequate treatment options for Echinococcus, prevention plays a very important role in reducing the rate of infection. [sunshinehealthfoodstore.com]

There is no preventive medication or vaccine against Echinococcosis. Information last updated: July 4, 2016 [iamat.org]

Centers for Disease Control and Prevention (CDC) 1600 Clifton Rd. [dovemed.com]

As a complement, the emphasis needs to be put on prevention in the animal and food safety sector. [who.int]

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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.
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