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Echinococcosis
1.
2. Introduction
Echinococcosis, also called hydatid disease,
hydatidosis, or echinococcal disease, is a parasitic
disease of tapeworms of the Echinococcus type.
The Disease is zoonotic.
4. Classification
Class: Cestoda
Genus: Echinococcus
Species:
1. E. Granulosus (Causes Cystic/hydatid
echinococcosis)
2. E. multilocularis, the most virulent (Causes Alveolar
Echinococcosis).
3. Echinococcus vogeli & oligarthus (Causes polycystic
echinococcosis)
5. Epidemiology
E.granulosusE.granulosus is present virtually worldwide,
more common in sheep and cattle raising countries:
India- AP, Gujarat,Tamil Nadu,West Bengal,- AP,
Gujarat,Tamil Nadu,West Bengal, Orissa, Bihar,Orissa, Bihar,
Punjab, Haryana, HP, UP,Punjab, Haryana, HP, UP, Kashmir,
Delhi and Pondicherry. Kashmir, Delhi and Pondicherry.
E.multilocularisE.multilocularis -Northern hemisphere,
including central Europe and-Northern hemisphere,
including central Europe and the northern parts of
Europe, Asia, and North America.the northern parts of
Europe, Asia, and North America.
E.vogeli and E. oligarthus - Central and South America.-
Central and South America.
8. Definitive host: Definitive host: dog & other canine
Intermediate host:Intermediate host: sheep, cattle,
camel & human.
Infective stage: egg (gravid proglottid)
Sites of hydatid: liver, lungs, abdominal cavity,
spleen, kidneys, heart,liver, lungs, abdominal cavity,
spleen, kidneys, heart, bones, central nervous
system etc.
Man is a dead end host.
9. Transmission
Ingestion from contaminated grass, usually
for herbivores.
Contamination caused by poor hygiene,
followed by transfer to the mouth.
Accidental ingestion of contaminated soil,
berries or vegetables.
10. Morphology
Adult worm: 3-6 mm
Scolex- pyriform 300 µm, 4 suckers and a protrusible rostellum
with two circular rows of hooklets.
Neck- short, thick- short, thick.
Strobila- 3-4 proglottids usually (immature, mature and gravid).
13. Pathogenesis
Hydatid disease or echinococcosis can be either
primary (spread by ingestion) or secondary
(larval tissue proliferates after spread from the
primary site - usually from trauma). In primary
echinococcosis larval cysts develop in a single
organ in most cases (about 80% of cases). About
70% of cases involve the liver. The cysts have a
wall made from both host tissue (pericyst) and
larval origin (endocyst) The cysts are fluid-filled
and grow very slowly (about 1 cm in diameter
14. Contd.
The expanding hydatid cyst causes
pressure necrosis of surrounding
tissues, although as growth is slow a
good deal of accommodation may take
place before any vital structures are
compromised. This depends on the
location of the cyst.
15. Contd.
Cont. • Slow leakage of hydatid fluid
from the cyst sensitizes the patient and
elicits eosinophilia. • Rupture of an
abdominal hydatid cyst either through
trauma or in the course of surgery,
carries with it both the risk of
anaphylatic shock and the possibility of
spread of the germinal epithelium
which are capable of producing a new
16. Cond.
Rupture of a pulmonary cyst into a
bronchus may be marked by severe
allergic symptoms and coughing with
the production of blood flecked fluid
which may contain recognizable
hydatid tissue. At times this results in
spontaneous cure, but secondary
infection may lead to chronic lung
abscess.
18. Clinical Manifestations
Cysts may develop in any area of the body but
the lungs and liver are most frequently impacted,
followed by organs of the central nervous system.
A liver cyst may produce no symptoms for 10 -20
years until its large enough to be felt by physical
examination. Symptoms include:
Pain or discomfort in the upper abdominal region
or chest due to the presence of the tapeworm.
19. Contd.
Nausea and vomiting or coughing may occur as a
result of the growing cysts.
Unexplained weight loss.
Rupture of cyst can lead to allergic reactions,
anaphylatic shock and a hypersensitive reaction due
to a flood of foreign material in the body that can
result in death.
Pressure of the cyst on surrounding tissue or bones
may lead to blindness, collapse of infected bones or
even sudden death if the cyst is in the heart.
20. Diagnosis
1.Blood cell count
Hypereosinophilia is a rare feature of disease (< 10%).
Lymphopenia develops in 45% of cases.
2. CT scan for abdominal thoracic cysts.
3. X- ray tests.
4. Ultrasound examination.
5. Serological tests.
6. Detection of Antigens in faces by Elisa is currently the best technique.
7. New techniques like PCR is also used to identify the parasite from DNA
isolated from eggs or feaces.
22. Contd.
Complementary and continuous chemotherapy
with, preferably, albendazole is mandatory for at
least 2 years following surgery. Careful follow-up
examinations in these patients must continue for
at least 10 years. In all cases of palliative
operations, either surgical or ultrasonographically
guided, chemotherapy is mandatory and follows
the same therapeutic schedule as for patients
who have not undergone surgery.
23. Contd.
Intravenous amphotericin B (preferably as lipid
emulsion) may be used as a rescue chemotherapy in
patients resistant or intolerant to benzimidazoles.
Pilot trials with interferon-gamma and nitazoxanide
were unsuccessful. Interferon-alpha has yet to be
tested in a pilot trial.
Administer chemotherapy for at least 2 years after
radical liver transplantation and for life in patients who
demonstrate evidence of parasitic remnants in the
liver area and/or of distant metastases outside the
liver.
24. Contd.
Other medication
Additional medical treatment includes antibiotics and
antifungal agents for bacterial and fungal
superinfection of the lesions, cholangitis and/or
septicemia (mostly gram-negative bacteria, antibiotic-
resistant Streptococcus faecalis, Pseudomonas
aeruginosa, and Candida species after surgical
interventions), and chronic cholestasis (including
vitamin K and D supplementation).
Use propranolol to prevent digestive bleeding related to
portal hypertension.
25. Complication
HemorrhageHemorrhage
Mechanical damage to other tissue
Mechanical damage to other tissue
InfectionsInfections
Allergic reaction or anaphylactic shock
Allergic reaction or anaphylactic shock
Persistence of daughter cystsPersistence of daughter cysts
Sudden intracystic decompression leading to biliary fistulas - Chemical
sclerosing cholangitis.
26. Prevention
1. Health education programs focused on cystic echinococcosis and its agents.
2. Improved water sanitation attempt to target poor education and poor drinking
water sources
3. since humans often come into contact with Echinococcus eggs via touching
contaminated soil, animal feces and animal hair, another prevention strategy is
improved hygiene.
4. De-worming dogs and vaccinating dogs and other livestock, such as sheep, that
also act as hosts for E. granulosus.
5. Boiling livers and lungs that contain hydatid cysts during 30 minutes has been
proposed as a simple, efficient and energy- and time-saving way to kill the infectious
larvae.
6. Human Vaccine: Currently there are no human vaccines against any form of
echinococcosis. However, there are studies being conducted that are looking at
possible vaccine candidates for an effective human vaccine against echinococcosis.
