Echinococcosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Asymptomatic for many years | *Asymptomatic for many years | ||
*Abdominal cysts- pain, distension, nausea | *Abdominal cysts- [[abdominal pain|pain]], distension, [[nausea/vomiting]] | ||
*Alveolar abscess-chest pain, shortness of breath, chronic cough | *Alveolar abscess- [[chest pain]], [[shortness of breath]], chronic [[cough]] | ||
*Musculoskeletal pain, blindness, headache, and stroke like symptoms if involving muscles, bones, eyes or brain | *Musculoskeletal pain, [[vision loss|blindness]], [[headache]], and [[stroke]]-like symptoms if involving muscles, bones, eyes or brain | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
===Work-up=== | ===Work-up=== | ||
*Abdominal | *[[ultrasound: Abdomen|Abdominal ultrasound]] (most widely used) | ||
*CT | *CT | ||
*MRI | *MRI | ||
Latest revision as of 00:47, 2 October 2019
Background
- 2 most important forms are cystic and alveolar caused by E. granulosus and E. multilocularis
- Humans are accidental immediate hosts by ingesting parasitic eggs from contaminated food, soil, water, or direct contact with definitive hosts
- Usual intermediate hosts-sheep, goat, swine, cattle, rodents and camel
- Definitive hosts-dogs, cats, fox, and wolves
- Ingested eggs then hatch, penetrate intestinal mucosa, and spread hematogenously to final destination to form cysts
Clinical Features
- Asymptomatic for many years
- Abdominal cysts- pain, distension, nausea/vomiting
- Alveolar abscess- chest pain, shortness of breath, chronic cough
- Musculoskeletal pain, blindness, headache, and stroke-like symptoms if involving muscles, bones, eyes or brain
Differential Diagnosis
Hepatic abscess
- Pyogenic abscess
- Aerobic: Escherichia coli, Klebsiella, Pseudomonas
- Anaerobic: Enterococcus, bacteroides, anaerobic streptococci
- Echinococcosis
- Amebiasis
- Benign cysts/malignancy
- Tuberculosis
- Mycosis
Evaluation
Work-up
- Abdominal ultrasound (most widely used)
- CT
- MRI
- ELISA-sensitivity inversely related to antigen sequestration in cysts
- Percutaneous aspiration
Management
- Tissue stage/hydatid disease: albendazole 400mg BID x 28 days, repeat as needed every 2 weeks x 3 cycles
- Surgical removal
- Do not aspirate cysts (risk of seeding disease or anaphylactoid reaction from spillage of hydatid sand which contains antigenic proteins)
- PAIR (Percutaneous aspiration, injection, reaspiration)
- Inject with 95% ethanol or hypertonic saline, leave in for 15 minutes, then reaspirate
Disposition
- Discharge (if no significant clinical complications)