Diagnosis and treatment of pulmonary cystic hydatidosis

Paediatric pulmonary echinococcosis: A neglected disease

Echinococcosis is a worldwide public health problem causing considerable paediatric morbidity and mortality in endemic areas. The presentation of cystic echinococcosis (CE) varies by age. Unlike adults, where hepatic involvement is common, pulmonary CE is the dominant site in the paediatric population. Pulmonary cysts are typically first seen on chest X-ray, either as an incidental finding or following respiratory symptoms after cyst rupture or secondary infection of the cyst. In children, pulmonary cysts have a broad differential diagnosis, and a definitive diagnosis relies on the combination of imaging, serology, and histology. In countries with high infectious burdens from diseases such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), the diagnosis is additionally challenging, as atypical infections are more common than in developed countries. Pulmonary CE is treated with a combination of surgery and chemotherapy.

Radiotherapy for the treatment of pulmonary hydatidosis in sheep

Hydatidosis is an endemic disease causing a severe threat to public health. Drugs and surgery have been utilized for treatment, but their efficiency is not adequate. Therefore, new methods are required for treating such diseases. In this study, we attempt to evaluate the efficiency of radiotherapy for hydatidosis in sheep. The sheep naturally infected with pulmonary hydatid were randomly divided into four groups, including the control group subjected to no irradiation and the other three groups subjected to 30, 45, and 60 Gy irradiation, respectively. Gene expression of caspase-3 and gadd45a and protein expression of BCL-2 and BAX in the lung tissues were evaluated after treatment. Our data showed that the irradiation with a dose of 30, 45, and 60 Gy significantly induced the expression of caspase-3 and gadd45a. Immunohistochemical staining showed that the BCL-2 protein was downregulated after exposure to 45 Gy of irradiation, whereas the BAX expression was downregulated after irradiation at a dose of 45 and 60 Gy, respectively. On this basis, we speculated that 45 Gy might be a safe and effective dose for treating pulmonary hydatidosis in sheep, which induced lower expression of caspase-3 and gadd45a in the cyst and a downregulation of BCL-2 and BAX in the adjacent lung tissues.

The non-resolving lung cavity: a case of pulmonary cystic echinococcosis

The authors report a case of a 20-year-old woman who was diagnosed with pulmonary cystic echinococcosis. She was admitted to hospital with a 1-week history of unresolving cough, coloured sputum with occasional haemoptysis and fever despite oral antibiotics. Radiology revealed a cavitating right lower lobe lung abscess. After 4 weeks of treatment, follow-up radiology showed incomplete resolution. Bronchoscopy revealed a white, avascular cystic lesion in the right lower lobe and serology testing for Echinococcus granulosus was positive. Repeat imaging eventually confirmed the cystic lesion with the 'air bubble'sign. A thorough travel history, a high index of clinical suspicion and close follow-up are essential in making a diagnosis of pulmonary cystic echinococcosis.

A Girl with Disseminated Thoracic Echinococcosis

We present an unusual case of extensively disseminated pulmonary and thoracic echinococcosis in a 10-year-old girl. Thoracic echinococcosis should be considered in any child from an endemic country with cystic lesions on chest imaging. Confirmation of the diagnosis can be difficult and is important before surgery to reduce the risk of further dissemination and anaphylaxis.

Pulmonary cystic echinococcosis

PURPOSE OF REVIEW

Pulmonary cystic echinococcosis, a zoonosis caused by the larvae of the dog tapeworm Echinococcus granulosus, is considered as a major public health problem in countries where dogs are used to care for large herds. Despite its frequency and widespread endemicity, the literature on pulmonary cystic echinococcosis is scarce and not systematic. We aimed to summarize currently available information to provide a comprehensive overview for clinicians facing cases of pulmonary cystic echinococcosis.

RECENT FINDINGS

Despite discrepancies in the literature, some patterns can be discerned. The ratio of lung:liver involvement is higher in children than in adults. Most pulmonary cases are discovered incidentally on routine radiograph evaluation; also most infected individuals remain asymptomatic until the cyst enlarges sufficiently to cause symptoms. Symptoms are usually caused by mass effect from the cyst. Complications (cyst rupture, aggregated infection) change the clinical presentation, producing cough, chest pain, hemoptysis, or vomica. Diagnosis is obtained by chest radiographs or computed tomography, and supported by serology. Presurgical chemotherapy reduces the chances of seeding and recurrence. Treatment with benzimidazoles is an option when surgery is unavailable or complete removal is unfeasible.

SUMMARY

Diagnosis of pulmonary cystic echinococcosis is primarily made by imaging, and surgery remains the main therapeutic approach.