Echinococcosis, signs and symptoms, diagnosis and management.

A seminar on echinococcosis or hydiatid cyst.

1. Echinococcosis ( hydatid disease) Home Monday, August 28, 2017

2. ECHINOCOCCOSIS Is a parasitic disease caused by tapeworms of the genus  Echinococcus Cystic hydatid disease → Echinococcus granulosus Alveolar hydatid disease → Echinococcus multilocularis 2

3. Transmission Humans are infected through ingestion of parasite eggs in contaminated food, water or soil, or through direct contact with animal hosts. The larvae hatch, penetrate the gut , and are carried by the vascular or lymphatic systems to the liver , lungs , and less commonly bones, brain, or heart. 3

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5. CLINICAL MANIFESTATIONS Asymptomatic, or regress spontaneously Symptoms (non specific) Abdomen → abdominal pain , vomiting, a palpable mass, increased abdominal girth. Liver→ hepatomegaly, obstructive jaundice and hepatic failure . Lung → chest pain, cough, or hemoptysis. Mass effects can be noted in the brain and bone. Anaphylaxis can occur with cyst rupture from trauma or intraoperatively 5

6. DIAGNOSIS Symptoms and signs are usually nonspecific Ultrasonography Chest radiograph CT or MRI Serologic studies Biopsy 6

7. DIFFERENTIAL DIAGNOSIS Benign hepatic cysts Bacterial hepatic abscesses hepatoma or metastatic tumor . Lung abscess TB 7

8. TREATMENT For CE1 and CE3 small cystic lesions that are <5 cm in diameter, albendazole chemotherapy alone (15 mg/kg/day divided bid PO for 1-6 mo ; maximum: 800 mg/day) may result in a high rate of cure . For larger CE1 and CE3 lesions , ultrasound- or CT-guided PAIR ( p ercutaneous a spiration, i nstillation, and r easpiration ) along with prophylactic chemotherapy. CE2 management is with surgery . 8 Open Types

9. TREATMENT cont’d . CE4 and CE5 cysts are in the process of degeneration and usually do not require specific therapy . They can be managed with serial imaging studies to document resolution (watch and wait ). Small thoracic cysts may resolve with chemotherapy , but most cysts require operative removal . Surgery is the treatment of choice for complicated cysts, including ruptured cysts, cysts communicating with the biliary tract, large pulmonary cysts, or cysts of the central nervous system or bones. 9

10. TREATMENT cont’d . Alveolar hydatidosis frequently requires radical surgery , including partial hepatectomy , lobectomy, or liver transplantation. Medical therapy with albendazole should be continued for 2 yr after presumably curative surgery. In patients who are not operative candidates or whose lesions are not amenable to surgical cure, albendazole long-term suppressive therapy should be used to slow the progression, but the infection generally recurs if albendazole is stopped. 10

11. LARGEST DISCOVERY!! The Largest hydatid cyst contained 37 litres of fluid!! and was removed from 80 year old Abdullah Bakhet Al Hagawe by Dr. Abdul Rahman Arishi and Dr. Mohammad Shahid Hussain Khan, at the King Fahd Central Hospital in Jizan , Saudi Arabia, on 12 January 2005. The main cysts had multiple daughter cysts attached and was found in his abdomen. 11

12. REFERENCES Nelson textbook of pediatrics, 20 th edition,  1753ff , Chapter 304, 2016. http:// emedicine.medscape.com/article/178648-overview http://www.who.int/mediacentre/factsheets/fs377/en / 12

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