Hydatid disease, caused by the tapeworm Echinococcus, primarily affects human organs such as the liver and lungs, leading to cystic echinococcosis (CE) and alveolar echinococcosis (AE). The condition has a significant prognosis difference between CE, which can be cured with surgery, and AE, which often requires long-term treatment. Common complications include cyst rupture and infection, with diagnostic approaches involving imaging and serological tests to confirm infection.

1. Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah, UAE
saad.alani@moh.gov.ae
*Hydatid disease
‘Pediatric
Echinococcosis’

2. *Definition
Hydatid disease is a parasitic
infestation by a tapeworm of the
genus Echinococcus
Ravis E, Theron A, Lecomte B, Gariboldi V. Pulmonary cyst embolism: a rare complication of hydatidosis.
Eur J Cardiothorac Surg. 2018 Jan 1. 53 (1):286-7.
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3. *Pathophysiology
Human echinococcosis is a
zoonotic infection caused by the
tapeworm of the genus
Echinococcus.
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4. *Pathophysiology (cont.)
*Three of the four known species are of
medical importance in humans. These are:
 E granulosus, causing cystic
echinococcosis (CE) (the most common )
E multilocularis, causing alveolar
echinococcosis (AE);
E vogeli.
Wang N, Zhong X, Song X, et al. Molecular and biochemical characterization of
calmodulin from Echinococcus granulosus. Parasit Vectors. 2017 Dec 4. 10 (1):597.
05/05/2018Pediatric Echinococcosis 4

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*Hydatid cysts
The excised hydatid
cysts shown here are an
example of a parasitic
(tapeworm!) infection
with Echinococcus sp.
https://thebileflow.wordpress.com/2012/10/31/pathology-hydatid-cyst

6. *Etiology
*Echinococcosis is caused by
larval cestodes of the phylum
Platyhelminthes (tapeworms).
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*Echinococcus granulosus
https://www.news-medical.net/health/Cystic-Echinococcosis-(Hydatid-Disease).aspx

8. *Etiology (Cont.)
*Their life cycle involves only
two hosts, one definitive and the
other intermediate.
*Humans act as an accidental
intermediate host
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9. *Life cycle
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*Life cycle (Cont.)

11. *Life cycle (Cont.)
*The life cycle has three developmental
stages:
(1) Adult tapeworm in the definitive host
(2) Eggs in the environment
(3) Metacestode in the intermediate host.
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12. *Life cycle (Cont.)
*The definitive host:
 Metacestodes are ingested by the
definitive host.
The metacestodes mature into the
tapeworm in the definitive host and, in
turn, release eggs into the environment.
Siracusano A, Delunardo F, Teggi A, Ortona E. Host-parasite relationship in cystic
echinococcosis: an evolving story. Clin Dev Immunol. 2012.
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13. *Life cycle (Cont.)
*The intermediate host
The intermediate host ingests the
eggs, which hatch into metacestodes,
which infest the liver, lungs,
muscles, and other organs of the
intermediate host
Siracusano A, Delunardo F, Teggi A, Ortona E. Host-parasite relationship in cystic echinococcosis:
an evolving story. Clin Dev Immunol. 2012.
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14. *E. granulosus
Two biological forms of E granulosus have
been recognized:
*The northern type
 is maintained in the tundra by a predator-
prey relationship between the wolf and large
deer, but dogs and coyotes can also become
infested.
Humans become infested in areas where
reindeer are domesticated.
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15. *E. granulosus
*Intermediate hosts for the European
type include camels, pigs, sheep, cattle,
goats, horses, and many other animals.
*The definitive host for the European
biotype is overwhelmingly the dog, but
it also occurs in foxes, hyenas, and
jackals.
*This is the most common biotype.
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16. *E. multilocularis
*The adult stage of E .multilocularis occurs
mainly in foxes and rarely in wolves,
coyotes, lynxes, cats, and black bears.
*The intermediate hosts for E.
multilocularis are eight families of rodents,
including mice, rats, hamsters, gerbils, and
squirrels.
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17. *E. vogeli
*E vogeli is a neotropical species
maintained in the bush dog and the
paca. It can easily infect other
mammals that are exposed to its feces.
* It is the most rare form of the
echinococci.
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18. *Fact
*Exposure to food and water
contaminated by the feces of an
infected definitive host or poor
hygiene in areas of infestation can
lead to echinococcosis.
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19. *Epidemiology
*The endemic areas are:
 The Mediterranean countries
 The Middle East
 The southern part of South America
, Iceland, Australia, New Zealand,
Southern parts of Africa ,are
intensive endemic areas
 Central Asia, particularly China
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20. *Epidemiology( Cont.)
*The incidence of:
 Cystic echinococcosis (CE) in
endemic areas ranges from1-220
cases per 100,000 inhabitants
Alveolar echinococcosis (AE) ranges
from 0.03-1.2 cases per 100,000
inhabitants
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21. *Prognosis
*Cystic echinococcosis (CE)
The prognosis is generally good
Complete cure is possible with total surgical
excision without spillage.
Spillage occurs in 2-25% of cases (depends
on location and surgeon's experience),
Operative mortality rate varies from 0.5-4%
for the same reasons.
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22. *Prognosis (Cont.)
*Alveolar echinococcosis (AE)
The prognosis is much worse.
Cure is only possible with early detection
and complete surgical excision.
In patients in whom the latter is not
possible, the addition of long-term
chemotherapy has decreased the 10-year
mortality rates from 94% to 10%..
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23. *Prognosis (Cont.)s
*Morbidity is usually secondary to:
Free rupture of the echinococcal cyst
(with or without anaphylaxis )
Infection of the cyst
Dysfunction of affected organs.
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24. *Prognosis (Cont.)
*Examples of dysfunction of affected organs are:
 Biliary obstruction
 Cirrhosis
 Bronchial obstruction
 Renal outflow obstruction
 Increased intracranial pressure
 Hydrocephalus
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25. *Complications
*Complications related to the parasite:
•Recurrence
•Metastasis
•Infection
•Spillage and seeding (secondary echinococcosis):
o Allergic reaction
o Anaphylactic shock
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26. *Complications (cont.)
*Complications related to the medical treatment
•Hepatotoxicity
•Anemia
•Thrombocytopenia
•Alopecia
•Embryotoxicity
•Teratogenicity
•Spillage and seeding (secondary echinococcosis)
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27. *Complications (cont.)
*Complications related to puncture, aspiration,
injection, and reaspiration (PAIR) intervention
•Hemorrhage
•Mechanical damage to other tissues
•Infections
•Allergic reaction or anaphylactic shock
•Persistence of daughter cysts
•Sudden intracystic decompression leading to
biliary fistulas
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28. *Clinical Presentation
*Many hydatid cysts remain asymptomatic
*Symptoms can be produced by:
 Mass effect
 Cyst complications
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29. *Clinical Presentation (Cont.)
*Organs affected by E granulosus are:
 The liver (63%)
 Lungs (25%)
 Muscles (5%)
 Bones (3%)
 Kidneys (2%)
 Brain (1%)
 Spleen (1%)
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30. *Clinical Presentation (Cont.)
*Pressure effects are initially vague.
*They may include:
 Nonspecific pain
 Cough
 Low-grade fever
 Sensation of abdominal fullness.
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31. *Clinical Presentation (Cont.)
*In the liver
The pressure effect of the cyst can produce
symptoms of obstructive jaundice and
abdominal pain.
With biliary rupture, the classic triad of biliary
colic, jaundice, and urticaria .
Passage of hydatid membranes in the emesis
(hydatid emesia) and passage of membranes in
the stools (hydatid enterica) may occur rarely.
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32. *Clinical Presentation (Cont.)
*Involvement of the lungs
Chronic cough
Dyspnea
Pleuritic chest pain
Hemoptysis
-Expectoration of cyst membranes and fluid
is observed with intrabronchial rupture
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33. *Clinical Presentation (Cont.)
* Cerebral involvement
Headache
Dizziness
Decreased level of consciousness
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34. *Clinical Presentation (Cont.)
* In bone infections
Occur and produce thin and
fragile bones, that can serve as
nidi for spontaneous fracture
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35. *Laboratory Studies
*Imaging modalities that can detect
findings suggestive of echinococcosis are:
i. Ultrasonography
ii. Chest radiography
iii. CT scans
iv. MRI
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*Ultrasonography
Multiple anechoic areas
with hyper echogenic
septa appearing as
rounded mass in right
lobe of the liver (6.5 x
4.85 cm). Multiple
large hydatid cysts (B-
mode ultrasound of the
liver).
http://www.oatext.com/ultrasound-of-echinococcal-liver-cysts.php

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*Chest radiography
Chest radiograph –
huge hydatid cyst
Pinterest

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*CT scan of the abdomen
CT scan showing
hydatid cyst in the
right lobe of liver with
multiple daughter
cysts, filled with
stroma and not
containing any fluid.
Internet Scientific Publications

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Complications of
ruptured hydatid cyst:
Thick walled hydatid
cystic within the gall
bladder(Red
ResearchGate
*CT scan of the abdomen
(Cont.)

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*Liver hydatid cyst - MRI
Radiopaedia
T1w fl2d coronal:
A large cyst with
multiple daughter
cysts is seen in right
lobe liver, displacing
the diaphragm
upwards and right
kidney downwards.

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*Serologic tests are then used to help
confirm the diagnosis.
*The following types of serologic
testing for humans:
i. Indirect hemagglutination
ii. Indirect fluorescent antibody
iii. Enzyme immunoassay/enzyme-
linked immunosorbent assay
*Laboratory Studies (cont.)

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*Test sensitivities range from 60-95%.
*Liver cysts are more likely to yield
positive serologic test results than
pulmonary cysts.
*Laboratory Studies (cont.)

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*Positive test results are less likely with
calcified or dead cysts and more likely
with ruptured cysts.
*Stool evaluation for ova and parasites is
generally not useful for diagnosis
*Laboratory Studies (cont.)

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*Ultrasonography is the imaging study
of choice to diagnosis CE and AE
*Ultrasonographic positive findings are
then complemented or confirmed with
computed tomography (CT) and/or
magnetic resonance imaging (MRI)
*Laboratory Studies (cont.)

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*Chest radiography may reveal cysts in
the pulmonary fields
*Pulmonary cysts do not calcify and they
do not produce daughter cysts
*Approximately one-third of patients with
a positive finding on chest radiography,
have definable hepatic cysts.
*Laboratory Studies (cont.)

46. 05/05/2018Pediatric Echinococcosis 46
*Treatment & Management
*Four treatment approaches:
1. Anti-infective drug treatment
2. Surgery
3.Percutaneous treatment of the
hydatid cysts with the PAIR
( Puncture , Aspiration, Injection,
Re-aspiration) technique
4.“Watch and wait”

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*Hydatid cyst
The cyst appears
creamy and smooth
http://www.bjmp.org/content/giant-cerebral-hydatid-cyst-

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*Surgery for liver hydatid cyst
Liver hydatid
cyst - daughter
cysts
MEDtube

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*Hydatid cyst (cont.)
http://medind.nic.in/laa/t12/i4/laat12i4p388.htm

50. * Albendazole is the drug of choice
because of its greater absorption
from the GI tract to achieve higher
plasma levels
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*Treatment & Management
(cont.)

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