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#Hydatid Cyst (Echinococcosis)#
Human echinococcosis is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by parasites, namely tapeworms of the genus Echinococcus.
The two most important forms, which are of medical and public health relevance in humans, are cystic echinococcosis (CE) and alveolar echinococcosis (AE).
#Transmission#
A number of herbivorous and omnivorous animals act as intermediate hosts of Echinococcus. They become infected by ingesting the parasite eggs in contaminated food and water, and the parasite then develops into larval stages in the viscera.
Carnivores act as definitive hosts for the parasite, and harbour the mature tapeworm in their intestine. The definitive hosts are infected through the consumption of viscera of intermediate hosts that contain the parasite larvae.
Humans act as so-called accidental intermediate hosts in the sense that they acquire infection in the same way as other intermediate hosts, but are not involved in transmitting the infection to the definitive host.
Cystic echinococcosis infections in humans is principally maintained in a dog–sheep–dog cycle, yet several other domestic animals may also be involved, including goats, swine, cattle, camels and yaks.
Alveolar echinococcosis usually occurs in a wildlife cycle between foxes or other carnivores with small mammals (mostly rodents) acting as intermediate hosts. Domesticated dogs and cats can also act as definitive hosts.
#Signs and symptoms#
Cystic echinococcosis / hydatid disease
Human infection with E. granulosus leads to the development of one or more hydatid cysts located most often in the liver and lungs, and less frequently in the bones, kidneys, spleen, muscles and central nervous system.
Abdominal pain, nausea and vomiting are commonly seen when hydatids occur in the liver. If the lung is affected, clinical signs include chronic cough, chest pain and shortness of breath.
#Alveolar echinococcosis#
Alveolar echinococcosis is characterized by an asymptomatic incubation period of 5–15 years and the slow development of a primary tumour-like lesion which is usually located in the liver. Clinical signs include weight loss, abdominal pain, general malaise and signs of hepatic failure.
Larval metastases may spread either to organs adjacent to the liver (for example, the spleen) or distant locations (such as the lungs, or the brain) following dissemination of the parasite via the blood and lymphatic system. If left untreated, alveolar echinococcosis is progressive and fatal.
#Diagnosis#
Ultrasonography imaging is the technique of choice for the diagnosis of both cystic echinococcosis and alveolar echinococcosis in humans. This technique is usually complemented or validated by computed tomography (CT) and/or magnetic resonance imaging (MRI) scans.
#Treatment#
Both cystic echinococcosis and alveolar echinococcosis are often expensive and complicated to treat, sometimes requiring extensive surgery and/or prolonged drug therapy. 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”.
The choice must primarily be based on the ultrasound images of the cyst, following a stage-specific approach, and also on the medical infrastructure and human resources available.
For alveolar echinococcosis, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remain the key elements. If the lesion is confined, radical surgery can be curative. Unfortunately in many patients the disease is diagnosed at an advanced stage. As a result, if palliative surgery is carried out without complete and effective anti-infective treatment, frequent relapses will occur.
Dr. Imran Abdullah Khan
Minimal Access Surgeon
(Advanced Laparoscopic GI, Bariatric and Hernia Surgeon) |