Hydatid disease Aetiology clinical features and management

Hydatid disease Aetiology clinical features and management

Echinococcus granulosus is a tapeworm of dogs. The ingested eggs release theonchosphere, which penetrates the gut mucosa and spreadsby vascular or lymphatic channels to other organs, mostoften the liver, with lung, spleen, brain, eye, bone and othertissues infected less often. Cyprus, Turkey, Middle Easterncountries, the Turkana area of Kenya, and South Americaare among the endemic areas.

Clinical features The clinical presentation is very variable. Unexplainedpainless hepatomegaly is fairly common, but an expandingcyst can cause right upper quadrant abdominal discomfort.Rupture of the cyst may produce pleuritic discomfort,abdominal pain and tenderness, and allergic manifestationssuch as urticaria and anaphylaxis. Rupture of hydatidcysts is infrequent, although the consequences of releaseof daughter cysts to seed the peritoneal cavity areserious.Pulmonary hydatids may be symptomless and may befound on chest X-ray. They may rupture spontaneously.Hydatid material, membranes and scolices with bookletsmay be coughed up and disseminate endobronchially toseed the lungs bilaterally, causing numerous small cysts inboth lung fields. Bone and joint hydatids cause pain,swelling, and sinuses that discharge hydatid material. Thelatter may follow surgical exploration. The cyst wall maycalcify.

Diagnosis There may be blood eosinophilia and positive serologicaltests, but a viable cyst may be present without eosinophiliaor positive serology. Ultrasound and CT scanning allow accurate localization and measurement ofhydatid cysts in internal organs. Bone hydatid producesareas of lucency surrounded by sclerosis. Joints aredestroyed.

Management Management is difficult. Albendazole is given in doses of400 mg twice daily for 12 weeks and appears to be effective.However, surgical treatment is probably needed formost cases. There is increasing experience with percutaneousaspiration of cysts under ultrasound guidance. Solitarypulmonary hydatids can often be excised with therelevant segments or lobe. Excision of hepatic hydatids ismore difficult. Surgery for hydatids of the CNS requiresgreat care to avoid rupture.

Complications Secondary bacterial infection of a hydatid cyst is notuncommon. Amoebic abscess, pyogenic abscess and perihepaticsepsis must be considered in the differential diagnosiswhen liver cysts are concerned. Gallium scanningmay help to indicate bacterial infection and blood culturesshould be taken. Amoebic serology is strongly positive inamoebic liver abscess. When infected hydatid cyst is probable, vigorous antibiotic treatment is needed first, followedby safe surgical drainage of the cysts. Hydatid disease ofbone is very difficult to treat, as it causes pain and destructionof affected areas. Neither drug treatment nor surgeryis very effective, although on occasion, when disease islimited to the femur, total excision of the affected bonewith prosthetic replacement, including hip and knee joints,can be carried out.

Prevention and control Regular deworming of dogs, killing of stray dogs, and safedisposal or boiling of offal are important control measures.These measures, plus effective communication of thedangers of hydatid disease among populations in Icelandand New Zealand, have controlled the disease.

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