Pulmonary cystic echinococcosis

Abdominal hydatid disease: role of imaging in diagnosis, complications, and management

Hydatid disease is a relatively common parasitic infection. Incidence can reach more than 50 per 100,000 person-years in endemic areas. It can affect all organs but favors the liver and lungs. Presentation is often asymptomatic. Imaging plays a crucial role in diagnosis in conjunction with serology. Primary evaluation is usually by ultrasound, often followed by CT or MRI, to understand disease extent, including lesion size, internal architecture, multiplicity, location, and adjacent structure involvement. CT better detects lesion calcifications. MRI is advantageous for certain complications such as biliary communication. Cystic lesions with membranes or daughter cysts are highly indicative of hydatid disease. In comparison, diagnosis during the inactive stage can pose challenges at imaging and often also requires tissue sampling. Due to varying appearances at different developmental stages, hydatid disease can mimic various pathologies ranging from cysts to malignancy. Image-guidance aids management. Treatment is based on cyst type, size and location; with uncomplicated cysts typically amenable to PAIR (puncture, aspiration, injection, and re-aspiration) or modified catheterization technique (MoCAT) using scolicidal agents. In contrast, surgical intervention is required for complicated cysts such as those located in a hepatic subcapsular location, those that exhibit biliary communication, or have ruptured.

Pulmonary echinococcosis mimicking tuberculosis in a child from a dual-endemic region: a case report

Background

Pulmonary echinococcosis represents a significant health challenge, particularly in endemic regions, and is associated with substantial morbidity and mortality. Its nonspecific clinical presentation and radiological diversity often lead to misdiagnosis. Here, we report a case of pulmonary echinococcosis initially misdiagnosed as pulmonary tuberculosis.

Case presentation

We report a case of a 13-year-old girl from a region endemic for both echinococcosis and tuberculosis. She initially presented with recurrent cough, hemoptysis, night sweats, and a pulmonary cystic lesion and was diagnosed with pulmonary tuberculosis. However, her condition progressively deteriorated despite antituberculosis therapy. Ultimately, surgical intervention and histopathological examination confirmed pulmonary echinococcosis, and the patient achieved complete recovery after therapy.

Conclusion

For patients from regions endemic for both tuberculosis and echinococcosis who present with cough, hemoptysis, or pulmonary cystic or cavitary lesions, it is crucial to differentiate pulmonary echinococcosis from pulmonary tuberculosis. The final diagnosis should be supported by other microbiological-serological and/or histopathological tests.

Primary Pulmonary Hydatid Cyst: A Rare Presentation

Hydatid disease is a zoonotic disease that is endemic in certain parts of India, especially rural India. Although most cases of hydatid disease affect the liver, it can occasionally affect other organs such as the spleen, lungs, spine, and intestines. We present a case of a hydatid cyst in the lung without any coexisting lesion in the liver.

Case Report: Pulmonary echinococcosis misdiagnosed as bronchogenic pulmonary cysts

Echinococcosis, also known as hydatid disease, is a zoonotic parasitic infection that poses a significant risk to human health. This article delineates the diagnostic and therapeutic course of a patient afflicted with pulmonary echinococcosis who was admitted to the Department of Thoracic Surgery II at Yunnan Cancer Hospital in April 2024. The patient exhibited a history of extensive exposure to livestock and a penchant for consuming undercooked meat. Prior to undergoing surgical intervention, the patient was initially diagnosed with bronchogenic pulmonary cyst. However, subsequent pathological examination revealed a diagnosis of pulmonary echinococcosis. The rarity of the disease and the paucity of experience in diagnosis and treatment rendered the patient's case a valuable opportunity to elucidate the diagnostic and therapeutic journey. This report aims to provide a comprehensive reference for the accurate identification and treatment of pulmonary echinococcosis in future clinical practice.

HLA class II profile in patients with different stages of cystic echinococcosis according to the WHO ultrasound imaging classification

The factors involving in the natural history and determinants of different features of human cystic echinococcosis (CE) are not adequately understood. Several host-related factors including the genetic structure of the host and human leukocyte antigens (HLAs) are believed to be involved in the natural history of CE in humans. The present study was conducted to investigate the association between HLA class II genes and active and inactive stages of hepatic cystic echinococcosis. Echinococcus granulosus cyst samples and patient information were collected from the biobank of the Iranian Hydatid Disease Registry from 2019 to 2022. HLA-DRB and HLA-DQB were characterized by PCR method. CE patients were categorized into three active (CE1 and CE2), inactive (CE4 and CE5), and transitional (CE3) stages according to the WHO ultrasound classification of CE. In total, 77 participants including 38 patients (36.8% men and 63.2% women) with different stages of CE as well as 39 healthy individuals (38.5% men and 61.5% women) were included in the study. Findings of the study showed that the frequency of HLA-DRB1*03 was significantly lower in the patients compared to the healthy individuals. The frequencies of HLA-DQB and HLA-DRB alleles were not differed significantly between active, inactive, and transitional stages of E. granulosus cysts. Findings of this study indicate the potential role of this allele in the susceptibility of human to cystic echinococcosis. Further large-scale studies in different endemic countries are required to document the significance of HLA-DQB and HLA-DRB as a host-related factor in the natural history of CE in human.

The impact of detailed history taking: a case report of pediatric pulmonary and hepatic hydatid disease from Ecuador

Background

Echinococcosis is a uncommon condition in pediatric patients, and encompasses alveolar and cystic forms, predominantly affecting the lungs and liver. Transmission occurs primarily through zoonotic means, such as the contamination of water and food by infected dog and other canid feces. Diagnosis can be challenging due to nonspecific symptoms that often mimic pneumonia.

The case

A 6-year-old female patient from a rural area in Ecuador who initially presented with nonspecific symptoms indicative of pneumonia. However, further investigation into socio-environmental factors led to a diagnosis of pulmonary and hepatic hydatid disease.

Conclusion

The timely and accurate diagnosis of this infectious disease enabled the patient to receive appropriate treatment and surgical intervention, leading to her complete recovery.

Treatment of uncomplicated hepatic cystic echinococcosis (hydatid disease)

BACKGROUND

Cystic echinococcosis is a parasitic infection mainly impacting people living in low- and middle-income countries. Infection may lead to cyst development within organs, pain, non-specific symptoms or complications including abscesses and cyst rupture. Treatment can be difficult and varies by country. Treatments include oral medication, percutaneous techniques and surgery. One Cochrane review previously assessed the benefits and harms of percutaneous treatment compared with other treatments. However, evidence for oral medication, percutaneous techniques and surgery in specific cyst stages has not been systematically investigated and the optimal choice remains uncertain.

OBJECTIVES

To assess the benefits and harms of medication, percutaneous and surgical interventions for treating uncomplicated hepatic cystic echinococcosis.

SEARCH METHODS

We searched CENTRAL, MEDLINE, two other databases and two trial registries to 4 May 2023. We searched the reference lists of included studies, and contacted experts and researchers in the field for relevant studies.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) in people with a diagnosis of uncomplicated hepatic cystic echinococcosis of World Health Organization (WHO) cyst stage CE1, CE2, CE3a or CE3b comparing either oral medication (albendazole) to albendazole plus percutaneous interventions, or to surgery plus albendazole. Studies comparing praziquantel plus albendazole to albendazole alone prior to or following an invasive intervention (surgery or percutaneous treatment) were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were symptom improvement, recurrence, inactive cyst at 12 months and all-cause mortality at 30 days. Our secondary outcomes were development of secondary echinococcosis, complications of treatment and duration of hospital stay. We used GRADE to assess the certainty of evidence.

MAIN RESULTS

We included three RCTs with 180 adults and children with hepatic cystic echinococcosis. Two studies enrolled people aged 5 to 72 years, and one study enrolled children aged 6 to 14 years. One study compared standard catheterization plus albendazole with puncture, aspiration, injection and re-aspiration (PAIR) plus albendazole, and two studies compared laparoscopic surgery plus albendazole with open surgery plus albendazole. The three RCTs were published between 2020 and 2022 and conducted in India, Pakistan and Turkey. There were no other comparisons. Standard catheterization plus albendazole versus PAIR plus albendazole The cyst stages were CE1 and CE3a. The evidence is very uncertain about the effect of standard catheterization plus albendazole compared with PAIR plus albendazole on cyst recurrence (risk ratio (RR) 3.67, 95% confidence interval (CI) 0.16 to 84.66; 1 study, 38 participants; very low-certainty evidence). The evidence is very uncertain about the effects of standard catheterization plus albendazole on 30-day all-cause mortality and development of secondary echinococcosis compared to open surgery plus albendazole. There were no cases of mortality at 30 days or secondary echinococcosis (1 study, 38 participants; very low-certainty evidence). Major complications were reported by cyst and not by participant. Standard catheterization plus albendazole may increase major cyst complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 10.74, 95% CI 1.39 to 82.67; 1 study, 53 cysts; very low-certainty evidence). Standard catheterization plus albendazole may make little to no difference on minor complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 1.03, 95% CI 0.60 to 1.77; 1 study, 38 participants; very low-certainty evidence). Standard catheterization plus albendazole may increase the median duration of hospital stay compared with PAIR plus albendazole, but the evidence is very uncertain (4 (range 1 to 52) days versus 1 (range 1 to 15) days; 1 study, 38 participants; very low-certainty evidence). Symptom improvement and inactive cysts at 12 months were not reported. Laparoscopic surgery plus albendazole versus open surgery plus albendazole The cyst stages were CE1, CE2, CE3a and CE3b. The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on cyst recurrence in participants with CE2 and CE3b cysts compared to open surgery plus albendazole (RR 3.00, 95% CI 0.13 to 71.56; 1 study, 82 participants; very low-certainty evidence). The second study involving 60 participants with CE1, CE2 or CE3a cysts reported no recurrence in either group. The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on 30-day all-cause mortality in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole. There was no mortality in either group (2 studies, 142 participants; very low-certainty evidence). The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on major complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.50, 95% CI 0.13 to 1.92; 2 studies, 142 participants; very low-certainty evidence). Laparoscopic surgery plus albendazole may lead to slightly fewer minor complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.13, 95% CI 0.02 to 0.98; 2 studies, 142 participants; low-certainty evidence). Laparoscopic surgery plus albendazole may reduce the duration of hospital stay compared with open surgery plus albendazole (mean difference (MD) -1.90 days, 95% CI -2.99 to -0.82; 2 studies, 142 participants; low-certainty evidence). Symptom improvement, inactive cyst at 12 months and development of secondary echinococcosis were not reported.

AUTHORS' CONCLUSIONS

Percutaneous and surgical interventions combined with albendazole can be used to treat uncomplicated hepatic cystic echinococcosis; however, there is a scarcity of randomised evidence directly comparing these interventions. There is very low-certainty evidence to indicate that standard catheterization plus albendazole may lead to fewer cases of recurrence, more major complications and similar complication rates compared to PAIR plus albendazole in adults and children with CE1 and CE3a cysts. There is very low-certainty evidence to indicate that laparoscopic surgery plus albendazole may result in fewer cases of recurrence or fewer major complications compared to open surgery plus albendazole in adults and children with CE1, CE2, CE3a and CE3b cysts. Laparoscopic surgery plus albendazole may lead to slightly fewer minor complications. Firm conclusions cannot be drawn due to the limited number of studies, small sample size and lack of events for some outcomes.

Delayed Surgical Treatment of a CE1 Lung Cyst Resulting in Pericystectomy of CE4 Cyst

Lung is the second most common locationof cystic echinococcosis (CE), after the liver. Diagnosis of lung CE is often incidental, and clinical manifestations depend on the location and size of the cyst, the most common being chest pain, shortness of breath, expectoration of fragments of endocyst, and haemoptysis. Surgery is the primary treatment, with a minor role for medical therapy. Delayed diagnosis and treatment may have important consequences. We present a case of lung CE in whichsurgical treatment was delayed due to the first wave of COVID-19. Since surgery could not be performed immediately, the patient was kept on albendazole and the cyst stage moved from CE1 to CE3a, to CE4, eventually requiring a more aggressive pericystectomy instead of the commonly performed endocystectomy. The clinical and imaging characteristics of a rare CE4 cyst of the lung are reported.

Primary Pulmonary Echinococcosis in the United States: A Case Report and Review of the Literature

We depict a unique case of a 34-year-old woman who presents to the emergency department with complaints of dyspnea and chest pain for the past month. A chest x-ray (CXR) from an earlier urgent care visit was concerning for large fluid opacity in the left lung and follow-up imaging revealed a cystic mass suspicious of a pulmonary cystic abscess. The patient underwent complete lobectomy and resection. Post-surgical biopsy confirmed pulmonary hydatid cystic mass and signs of rupture or seeding to liver tissue. The patient was discharged with adjuvant therapy and recommended imaging follow-up for the next decade. The diagnosis, treatment, and maintenance guidelines are discussed in this report which reveals controversy between experts given the lack of complete literature regarding echinococcosis. Our purpose in putting forward this case is to present a rare diagnosis of pulmonary echinococcosis in the United States and to emphasize the importance of early imaging and diagnosis to prevent cystic rupture and secondary organ dissemination.

Magnetic resonance imaging and next-generation sequencing for the diagnosis of cystic echinococcosis in the intradural spine: a case report

BACKGROUND

Cystic echinococcosis (CE) is a parasitic zoonotic disease caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most common sites for infection. Infection of the intradural spine is rare.

CASE PRESENTATION

A 45-year-old woman of Han ethnicity presented with a chronic history of recurrent lumbar pain. Magnetic resonance imaging of the lumbar spine revealed the classical characteristic of multiple cystic lesions of variable sizes, manifesting a "bunch of grapes" appearance, localized within the spinal canal at the L4-L5 vertebral level. In the meanwhile, metagenomic next-generation sequencing identified Echinococcosis granulosa. The patient underwent surgery to remove the cyst entirely and subsequently took albendazole 400 mg orally twice daily for 6 months.

CONCLUSION

Spinal CE should be suspected in patients with multiple spinal cystic lesions and zoonotic exposure. metagenomic next-generation sequencing serves as a robust diagnostic tool for atypical pathogens, particularly when conventional tests are inconclusive. Prompt and aggressive treatment for spinal cystic echinococcosis is imperative, and further research is warranted for improved diagnostic and therapeutic strategies.

Pulmonary cystic echinococcosis acquired during a short-term tourist travel

Background

Cystic echinococcosis is non-endemic in Denmark and primarily diagnosed in migrants from endemic areas. Here, we report a case of pulmonary cystic echinococcosis in a Danish woman with no history of longer-term stays abroad, only holiday travelling to tourist destinations. This is the first case reported in international literature from Denmark where the causative parasite was identified to species and genotype level.

Case

A 27-year-old pregnant Danish woman was admitted for examination because of haemoptysis for three months.Chest X-ray and computed tomography revealed a cystic structure in the left lung and a left-sided thoracotomy was performed to remove the cyst. Postoperative histopathological examination revealed a hyaline membrane and protoscoleces. Subsequently, infection with Echinococcus granulosus was confirmed by molecular methods. The causative agent was further characterised as E. granulosus sensu stricto G1, which is not known to have an established life cycle in Denmark. It was concluded that the infection was most likely acquired during a tourist travel to an endemic country. The patient was treated with albendazole for four weeks.

Conclusion

This case of pulmonary cystic echinococcosis in a person who had lived in Denmark and had history of only short-term tourist travelling abroad highlights that the disease may be acquired during tourist travelling. Thus, a diagnosis of cystic echinococcosis should be considered not only in migrants from endemic countries but also in travellers upon incidental findings of a lung or liver cysts. The case also exemplifies the importance of reaching a diagnosis at species and genotype level.

Proteomics investigation of human sera for determination of postoperative indicators of pulmonary cystic echinococcosis

BACKGROUND

Cystic echinococcosis (CE)/hydatidosis is an important zoonotic parasitic disease caused by the larval stage of Echinococcus granulosus. The disease is a major health problem all over the world. Finding specific and sensitive biomarkers for follow-up of CE in patients after surgery is essential. Using proteomics methods, the present study aimed to evaluate post-surgical treatment by finding probable biomarker/s in the serum of human lungs CE.

METHODS

A total of 24 human sera were tested. These sera included eight confirmed lung/s CE patients sera before surgery (BS), eight sera 12 months post-surgery (12MPS) as well as eight control sera from healthy people. Proteomics methods including 2DE and LC-MS/MS were performed on the specimens followed by bioinformatics analysis. Differentially expressed proteins (DEP) were detected and, separately integrated with protein-protein interaction (PPI) data to construct the PPI network.

RESULTS

A total of 171 protein spots were detected in three groups including BS, 12MPS, and control groups; of which a total of 106 DEP have been expressed based on fold changes > = 2 and p-value < 0.05. More analysis was performed and a total of 10 protein spots were selected for identification by mass spectrometry showing the following proteins: APOA1, BGN, SPP2, EAF1, ACOXL, MRPL55, MCTP2, SEPTIN1, B4GALNT1, and ZNF843. Based on centrality parameters of the PPI network (degree and betweenness) five Hub-bottlenecks proteins with significant centrality values were found including APOA1, BGN, SPP2, EAF1, and ACOXL.

CONCLUSION

This study showed five proteins as hub-bottleneck proteins; of which APOA1 was more prominent. It can be concluded that a change in expression of this protein in patients' sera could be used as an indicator tool for the achievement of lungs CE surgical therapy.

Pulmonary Hydatid Cyst in Children and Adults: Diagnosis and Management

Hydatid cyst disease induced by Echinococcus granulosus is a parasitic disease known since ancient times. Today, it continues to be seen in many countries and creates serious problems. The lung is the second most frequently affected organ by hydatid cysts after the liver. Lung involvement is more prevalent in children than adults, and the growth of the cyst is faster in children. Hydatid cysts are mostly seen in the right lower lobe of the lung. Common symptoms are chest pain, cough, and shortness of breath, with the most diagnostic symptom being the expectoration of cyst fluid or membranes. In endemic areas, the diagnosis of hydatid cysts can usually be made easily by clinical findings, serology tests, and radiological findings. When the hydatid cyst ruptures and becomes complicated, it is clinically and radiologically confused with many diseases, especially lung cancer. Surgery is accepted as primary treatment of lung hydatid cysts all over the world. The surgical approach is related to several factors such as the size of the cyst, whether it is intact or complicated, unilateral or bilateral, solitary or multiple, and the presence of destruction of the lung parenchyma. Although it is stated by some surgeons that capitonnage is not required, the most frequently applied surgical technique is cystotomy and capitonnage. Pulmonary resection should be avoided as much as possible, particularly in children. Albendazole or mebendazole treatment in pulmonary hydatid cyst is generally used after surgery and to prevent recurrences.

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.

Anaphylactic shock due to ruptured pulmonary hydatid cyst in a young patient from Iran

Introduction

and importance: Hydatidosis is a zoonotic condition caused by contact with the tapeworm Echinococcus granulosus metacestode. The liver and lungs are the most prominent locations for cysts. This is a rare case of pulmonary hydatid cyst (PHC) rupture in a young woman following a severe cough.

Case presentation

On July 9, 2018, a 20-year-old woman presented to our hospital in northern Iran with a complaint of cough with excessive sputum, dyspnea, drooling, symptoms of nausea and vomiting, itching and urticarial. Imaging findings showed evidence of a large, space-occupying mass in the right lung. She underwent a thoracoscopic wedge resection (TWR) as a minimally invasive technique, to remove the wall and contents of the cyst. Also, anaphylactic shock occurred in the patient. Due to hemodynamic disorders and heart and respiratory failure, unfortunately, the patient expired.

Clinical discussion

The rupture of a hydatid cyst may result in irreversible damage. PHC rupture is a serious complication that causes excessive coughing and chest pain. A rupture into the pleural or pericardial cavity is a serious and potentially fatal disease.

Conclusion

Anaphylactic shock should be considered as one of the serious complications of PHC, particularly in young ones. Therefore, early diagnosis and appropriate treatment are essential to prevent severe complications such as anaphylactic shock.

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Anaphylactic shock due to ruptured pulmonary hydatid cyst in a young patient from Iran.

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Radiography and CT scan showed evidence of a large, space-occupying mass in the right lung.

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Early diagnosis and appropriate treatment are essential to prevent severe complications such as anaphylactic shock.

[Hepatic Hydatid Cyst: A Case Report]

Hydatid cysts are caused by an infestation with larval tapeworms of the genus Echinococcus. The disease is endemic in developing countries but has rarely been reported from immigrant workers in Korea. This paper reports a case of hepatic hydatid cyst in a 27-year-old female. She was referred with abdominal pain that had persisted for the past 2 months. The patient was a foreign worker from Mongolia. The physical examination was unremarkable, and blood tests showed peripheral blood eosinophilia and elevated liver enzymes. Abdominal ultrasonography showed a well-circumscribed cystic mass with septation in the liver. A surgical resection was performed for complete removal. After uncomplicated postoperative recovery, the patient was discharged with albendazole 400 mg twice daily. The hydatid cyst is an important disease that should be considered in the differential diagnosis of cystic lesions in the liver, particularly in those who have lived in endemic areas. A correct early diagnosis based on the typical image findings is important for early treatment before the rupture of the cyst, which is associated with low morbidity and mortality. A current surgical resection combined albendazole are effective treatments for hepatic hydatid cysts, associated with low recurrence rates.

Rupture of pulmonary hydatid cyst in pediatrics: A cross-sectional study

Introduction

Pulmonary hydatid cyst is a parasitic disease causing an endemic and a health burden in many regions. Lung cysts are more common than liver cysts in children and patients may remain asymptomatic. Cyst rupturing is not uncommon, and it is considered the most feared complication. In this cohort study, we aimed to identify the risk factors related to cyst rupture in a Jordanian pediatric population.

Methods

We retrospectively evaluated all pediatric patients who underwent cystostomy and capitonnage for pulmonary hydatid cyst between 2003 and 2020 at King Abdullah University Hospital.

Results

We found 43 patients with a mean age of 13 ± 4 years who suffered from 61 pulmonary cysts. 55.6% of them were males. The most prevalent symptom was shortness of breath. The rupture rate for patients was 39.5%, and 29.5% for cysts. None of the patients with cyst rupture had an anaphylactic reaction. The left lower lobe was the most common location for both intact and ruptured cysts. 25.6% of the patients had giant cysts (>10 cm) with a mean of 7.4 cm for all cysts. Patients with intact cysts had higher-rates of cough (42.3% vs. 29.4%) and lower-rates of shortness of breath (34.6% vs. 52.9%) than patients with ruptured cysts, which were not statistically significant. Although statistically insignificant, patients with ruptured cysts tended to have multiple cysts in one lung (29.4% vs. 7.7%, p = 0.180), and more complication rates (29.4% vs 7.7%, p = 0.09). Both groups had almost identical IgG-ELISA positive results. We found no significant association between cyst rupture and age, gender, presenting symptoms, cyst size, cyst location, and rate of postoperative complications.

Conclusion

The rupture of pulmonary hydatid cyst has clinical consequences in pediatric patients, further studies on larger populations are needed to identify factors that make patients more prone to rupture and prioritize them for clinical monitoring and management.

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Hydatid cyst rupture is a common serious complication in pediatrics with 39.5% of the diagnosed cases.

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About 25% of pediatric patients tend to develop giant cysts but the cyst size was not significantly associated with rupture.

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Pediatric patients with rupture pulmonary hydatid cyst have a low tendency to develop an anaphylactic reaction.

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Larger sample size is needed to define the risk factors and predictors of pulmonary hydatid cyst rupture.

A Huge Hydatid Pulmonary Cyst

This case report describes a patient with an unusually large pulmonary hydatid cyst and discusses important management issues.

Pulmonary Cystic Echinococcosis: Two Cases, Two Treatment Options

Cystic echinococcosis (CE) is a zoonotic infection caused by the tapeworm of the genus Echinococcus, a cestode endemic in many parts of the world. CE can affect any organ, with the lung being the second most commonly affected organ after the liver. For the management of pulmonary CE, guidelines recommend surgical resection of cysts with adjuvant anti-helminthic therapy. In cases where surgery is not possible, medical therapy alone can be used. However, to date, there is a paucity of data to advocate for one modality over the other. Here, we report two cases of pulmonary CE caused by E. granulosus, one was managed with surgery and adjuvant anti-helminthic therapy while the other was managed with medical therapy alone. Both patients had clinical and radiological resolution outlining the role and efficacy of both modalities of therapy.

Ten-year follow-up of children with hydatid cysts

Aim:

Hydatid cystic disease is an endemic parasitic disease that is common in the world. We aimed to review the demographic, clinical and laboratory findings, and treatments and outcomes of children with hydatid cyst disease, and to determine the factors affecting treatment response in two pediatric pulmonology centers in the central region of Turkey.

Material and Methods:

The clinical records of patients aged below 18 years who were followed up between January 2006 and December 2016 because of hydatid cyst disease were reviewed retrospectively. The patients’ ages at the time of diagnosis, sexes, living areas (rural /urban), dog contact history, presence of hydatid cyst in other family members, symptoms, organs involved, dimensions of cysts, laboratory results, treatments and post treatment responses, follow-up, and outcomes were noted.

Results:

In a period of 10 years, 50 pediatric patients were followed up with a diagnosis of hydatid cyst. The mean age was 9.3±0.5 years and 33 (66%) of the patients were male. Fifteen patients were living in a rural area and 35 were living in an urban area. Fifteen patients had a history of contact with a dog and 10% had a positive family history. Thirty-six patients had lung involvement, 25 had liver involvement, 14 (28%) had both lung and liver involvement, and six patients had organ involvement other than lung and liver. The indirect hemagglutination test for hydatid cyst was positive in 24 of 40 patients and Echinococcus granulosus-specific IgE positivity was detected in 8 of 17 patients. Surgery was performed in 31 patients with lung involvement and PAIR was performed in 13 patients who had liver involvement. Cyst excision was performed in two patients who had isolated spinal involvement. All patients were treated with albendazole, and additional praziquantel treatment was given to seven patients. Relapse occurred in seven patients in this period. The relapse frequency was higher in patients who had organ involvement other than in the lung and liver (p<0.05), and these patients’ treatment durations were longer compared with the others (p<0.05).

Conclusion:

Hydatid cysts can involve different organs in children. Patients with organ involvement other than the lung and liver should be followed up carefully in terms of recurrence.

Echinococcus Granulosus in Childhood: A Retrospective Study of 187 Cases and Newer Data

Echinococcus granulosus, first reported by Goeze in 1782, is the causative parasite of cystic echinococcosis (hydatidosis) especially for countries that are endemic areas. Since the 1970s, the incidence of echinococcosis in Greece has been very high. Nevertheless, with the implementation of special prevention measures in the 1980s, a large reduction in the incidence of hydatidosis meant that it reached European levels. Therefore, we analyzed the demographics, multiple organ localizations of the parasite, diagnosis, and conservative and optimal surgical treatment over a total period of 39 years, especially for pulmonary and hepatic echinococcosis in children. The higher incidence of pulmonary echinococcosis compared with other localizations, male predominance, wide range of age, and various cystic sizes were some of the main demographics. Because cystic echinococcosis remains a main public health problem, we advocate a meticulous clinical investigation and treatment methodology to bridge the gap between knowledge and awareness of this important disease.

A giant cystic echinococcosis of the lung in East Turkey

Introduction

Hydatid cyst disease is a zoonosis provoked by Echinoccocus.

Presentation of case

17 year old male applied to our clinic with complaints of fatigue, lassitude, right chest pain and spitting of watery expectoration proceeding in 6 months. Computed tomographic scan indicated a 130*110 mm smooth contoured cavitary lesion located in the right middle lobe of the lung. Treatment with cystotomy and capitonnage successfully. Histopathologic examination confirmed hydatid cyst. The patient recovered from all his complaints postoperatively and he was discharged from the hospital in 7 days. Albendazole was implemented for 3 months postoperatively. He was observed to be healthy in his three month follow-up visit.

Discussion

Pulmonary hydatid cysts are generally treated with surgery. Cystotomy and capitonnage, pericystectomy and enucleation are the commonly used surgical techniques.

Conclusions

Surgery is the treatment regimen for pulmonary hydatid cysts and antihelmintic therapy is adviced to eliminate recurrences postoperatively.

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Hydatid disease is an endemic disease provoked by Echinococcus granulosus.

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Preoperative diagnosis of hydatid cyst is assured with clinical, radiological and serological outcomes.

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Cystotomy and capitonnage, enucleation and pericystectomy are the commonly used surgical techniques.

A case of Extrapulmonary intrathoracic hydatidosis with pseudochylothorax

Echinococcus is a great re-emerging public health issue. Intrathoracic and extra pulmonary hydatid cysts with pseudochylothorax are rare. There is no standard treatment in case of hydatidosis with pseudochylothorax. Pharmacotherapy approaches may be an option in case of long duration of disease and high risk for surgery.

Unusual Coexistence of Pulmonary Tuberculosis and Hydatid Disease

Tuberculosis and hydatidosis are both infectious diseases commonly involving the pulmonary system and exhibiting a wide spectrum of clinical manifestations of varying severity. The simultaneous occurrence of pulmonary tuberculosis and hydatid disease is extremely rare, reported sporadically in the literature. We herein report two cases where this rare coexistence was proven after radiological features aroused suspicion. The first patient was a young female with a short history of fever and cough. She had miliary mottling and a cystic lesion on imaging. Second patient was an elderly lady with a long-standing cough, dyspnea, and hemoptysis. She had multiple cystic and cavitatory lesions on imaging. Both of them were managed with medical therapy successfully. The possibility of hydatid tuberculosis coinfection should be kept in mind in endemic areas in the relevant clinical scenarios.

How to cite this article

Laldayal D, Utpat K, Joshi JM. Unusual Coexistence of Pulmonary Tuberculosis and Hydatid Disease. J Postgrad Med Edu Res 2018;52(1):36-39.

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.

Analysis of hospital records of children with hydatid cyst in south of Iran

The clinical manifestations of hydatidosis are various and related to anatomic location. Defining frequent symptoms and signs of the disease is imperative for early management of it. The aim of this report was to analyse the clinical features of infected children with hydatid cysts located in different organs. In this study, medical charts of 57 children between 3 and 16 years of age with hydatid cyst admitted to Pediatric Wards of Nemazee Hospital were evaluated over a 12 year period (from 2003 to 2014, prospectively). All the epidemiologic, clinical, paraclinical and therapeutic data were collected. The frequencies of hydatidosis in males and females were 42.1 and 56.1%, respectively. Hydatid cysts were found in the liver and lungs in 59.6 and 33.3% patients respectively and 2 patients had an asymptomatic cyst in the heart with concomitant liver and lung cysts. The right upper quadrant pain (100%) was the most common symptom in the liver cysts. Phlegm (78.9%), Dyspnea (57.9%), acute (47.4%) and chronic cough (47.4%) were mostly seen in lung hydatid cysts. Some symptoms such as fever (68.4%) and weakness (59.6%) were the most common presenting symptoms in both groups. All children were treated through surgical approaches plus medical treatment. In the present report, liver was the most common site of involvement in children. Liver hydatidosis should be considered in children with upper quadrant pain and pulmonary hydatidosis in children complaining of phlegm and dyspnoea.

Isolated pulmonary hydatid cyst: Misinterpreted as metastatic pulmonary lesion in an operated case of carcinoma breast in young female

Hydatidosis is caused by Echinococcus granulosus. Humans may be infected incidentally as intermediate host by the accidental consumption of soil, water, or food contaminated by fecal matter of an infected animal. Hydatidosis is one of the most symptomatic parasitic infections in various livestock - raising countries. Lung is the second most commonly affected organ following the liver. The symptoms depend on the size and site of the lesion. It can present as an asymptomatic pulmonary lesion to hemoptysis, chest pain, coughing anaphylaxis, and shock. There are very few reported cases of isolated lung hydatidosis without exposure to animals or nonvegetarian diet. For hydatidosis, serology and imaging are diagnostic tools. Surgical removal and/or chemotherapy are the main-stay of treatment. Here, we discuss a case of persistent left lower lobe cystic lesion in young female with a history of operated left breast carcinoma which was thought to be of metastatic lesion but ultimately confirmed as pulmonary hydatid cyst after unintended aspiration of cystic fluid to rule out malignancy. Pulmonary hydatidosis should always be considered as a differential diagnosis when dealing with a cystic lesion on radiology.

Ruptured pulmonary hydatid cyst: a case report

Ruptured pulmonary hydatid cyst (PHC) is an important clinical problem in endemic areas to echinococcal infection. Herein we present a rare case of ruptured PHC in an adolescent boy that was misdiagnosed as pulmonary tuberculosis in local health center. When sputum specimen was stained by acid-fast staining for detection of Mycobacterium tuberculosis, hooklets of Echinococcus granulosus were observed. A simple chest X-ray showed a multilobulated mass in the lower part of the left lung. Computed tomography scan verified existence of thick walled caviar lesion with irregular air-fluid level. The diagnosis was confirmed at the time of surgery. Misdiagnoses of PHC may even lead to irreparable damages. Therefore, accurate diagnosis is necessary to prevent severe complications.

Cystic Echinococcosis Epidemiology in Spain Based on Hospitalization Records, 1997-2012

BACKGROUND

Cystic echinococcosis (CE) is a parasitic disease caused by the tapeworm Echinococcus granulosus. Although present throughout Europe, deficiencies in the official reporting of CE result in under-reporting and misreporting of this disease, which in turn is reflected in the wrong opinion that CE is not an important health problem. By using an alternative data source, this study aimed at describing the clinical and temporal-spatial characteristics of CE hospitalizations in Spain between 1997 and 2012.

METHODOLOGY/PRINCIPAL FINDINGS

We performed a retrospective descriptive study using the Hospitalization Minimum Data Set (CMBD in Spanish). All CMBD's hospital discharges with echinococcosis diagnosis placed in first diagnostic position were reviewed. Hospitalization rates were computed and clinical characteristics were described. Spatial and temporal distribution of hospital discharges was also assessed. Between 1997 and 2012, 14,010 hospitalizations with diagnosis of CE were recorded, 55% were men and 67% were aged over 45 years. Pediatric hospitalizations occurred during the whole study period. The 95.2% were discharged at home, and only 1.7% were exitus. The average cost was 8,439.11 €. The hospitalization rate per 100,000 per year showed a decreasing trend during the study period. All the autonomous communities registered discharges, even those considered as non-endemic. Maximum rates were reached by Extremadura, Castilla-Leon and Aragon. Comparison of the CMBD data and the official Compulsory Notifiable Diseases (CND) reports from 2005 to 2012 showed that official data were lower than registered hospitalization discharges.

CONCLUSIONS

Hospitalizations distribution was uneven by year and autonomous region. Although CE hospitalization rates have decreased considerably due to the success of control programs, it remains a public health problem due to its severity and economic impact. Therefore, it would be desirable to improve its oversight and surveillance, since officially reported data are underestimating the real burden of CE in Spain.

Cystic pulmonary hydatidosis

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stages of the cestode Echinococcus granulosus. Worldwide, pulmonary hydatid cyst is a significant problem medically, socially, and economically. Surgery is the definitive therapy of pulmonary hydatidosis. Benzimidazoles may be considered in patients with a surgical contraindication. This review will focus on pathogenesis, lifecycle, clinical features, and management of pulmonary hydatid disease.

Cured Transudative Pleural Effusion: A Case Report

Echinococcosis or hydatid disease is a helminthic infection caused by larvae of tapeworm Echinococcus granulosus. While the cysts can involve all organs, liver is the most common site of infection and the lungs are the second most commonly involved organ in young adults. In addition to endemic areas its incidence is growing all around the world due to the ease of transcontinental travel. Disease presentation varies and usually is due to mass effect or dysfunction of the involved organ and surgical resection is the recommended treatment. Here we present the case of a young man with primary pulmonary echinococcosis with involvement of the entire right lung.

Surgical and Molecular Evaluation of Pediatric Hydatid Cyst Cases in Eastern Turkey

Cystic echinococcosis (CE) caused by Echinococcus granulosus is a major public health problem worldwide, including Turkey. The aim of the current study was to identify the strains and to estimate the potential risk factors of E. granulosus in operated pediatric cases in eastern Turkey. Ten pediatric patients (7 boys and 3 girls) living in rural areas, with ages ranging from 3 to 15 years old and various clinical histories, were included in this study. Eight patients had only liver hydatid cyst, while 1 patient had liver and lung hydatid cyst and the other liver, lung, and spleen, together. There were 2 ruptured liver cysts. After surgery, during follow-up, no increase was observed in hemagglutination levels, there were no mortalities, and there was no evidence of recurrence at 2 years post operation in all patients. Molecular analysis was performed on hydatid cyst samples obtained from the 10 pediatric cases. According to mt-12S rRNA PCR results, all cases were found to be G1/G3 cluster of E. granulosus sensu stricto.

Anaphylaxis due to ruptured pulmonary hydatid cyst in a 13-year-old boy

Hydatid cyst, a common disease in the world, is usually transmitted to humans through dog feces. Hydatid cyst is caused by Echinococcus granulosus. Diagnostic interventions for hydatid cyst include physical examination and chest x-ray tomography. Although the treatment options of hydatid cyst vary according to the clinical findings of the patients, the primary treatment may be considered as surgery. We herein reported the case of a child hospitalized due to pneumonia who developed anaphylaxis as a result of the rupture of a pulmonary hydatid cyst.

Pulmonary hydatid disease is difficult recognized in children

PURPOSE

Pulmonary hydatid disease is a significant health problem for children in endemic areas. Pulmonary hydatid disease is more frequent than hepatic hydatid disease in children. The aim of this study was to evaluate the characteristics of pulmonary hydatid disease for children in our province which is endemic for echinococcosis.

PATIENTS AND METHODS

This study was performed retrospectively between 2007 and 2012 by reviewing the medical records of patients (≤17 years) who were diagnosed with pulmonary hydatid disease. The medical records of these patients were evaluated with respect to the demographic characteristics of patients, management strategies, length of hospital stay, and outcomes.

RESULTS

A total of 120 (52.9% boys and 46.3% girls) patients with the diagnosis of pulmonary hydatid disease were enrolled in this study. The mean age was 10.15 ± 3.93 years. The significant numbers of patients were admitted with a ruptured hydatid disease and managed with lung preservation. The mean follow-up was 11.3 ± 3.8 (3-24) months. Recurrence was detected in three patients during follow-up.

CONCLUSION

Pulmonary hydatid disease is usually symptomatic. Hydatid disease must be considered in differential diagnosis while evaluating thoracic lesions in endemic areas.

Saucerization: a modified uncapitonnage method of surgery for pulmonary hydatidosis

BACKGROUND

There are contrary opinions regarding the surgical treatment of pulmonary hydatid cysts. We report our experience performing a modified version of uncapitonnage surgery, called "saucerization," for treating pulmonary hydatid cysts.

METHODS

A total of 78 patients with pulmonary hydatid cysts were studied regarding their surgery outcome and the complication rate. The procedure used for cyst evacuation depended on whether the cyst had ruptured. If ruptured, cystotomy was done; otherwise, enucleation was preferred. To deal with the residual cavity in an uncapitonnage manner, we removed the thin margins of the pericyst and closed the bronchial openings at the cavity floor. All patients were followed up at least for 6 months.

RESULTS

The intensive care unit stay ranged from 1 to 9 days. Incomplete lung expansion (six patients) was the main postoperative complication followed by wound infection (four patients) and persistent air leak (≥7 days) (one patient). There was one death. Dependence on mechanical ventilation and subsequent septic shock were also observed. The other patients exhibited no complications during the follow-up period.

CONCLUSIONS

Our experience demonstrated a low complication rate associated with removing the thin margins of the residual cavity and changing the shape of it into a "saucer." The results were satisfactory and comparable to the results of other studies on pulmonary hydatid cysts.

[Parasitosis (I). Imported heart and lung lesions]

Imported parasitoses are an uncommon condition in our setting, although recently, the increase of migratory flow has been leading to an increase in the detected cases of these diseases. This fundamentally occurs in immigrants from tropical zones where these conditions are generally endemic. However, imported parasitoses are being increasingly diagnosed in Western persons who have lived in the tropics for different reasons. When examining a subject with cardiovascular syndromes with a possible parasitic origin, it could be useful to classify the possible geographic zone of origin in order to perform disease screening. Then, if the problem is mainly respiratory, it would be well to first rule out the existence of tuberculosis in the case of long stays and to individual the diagnosis according to the geographic area, season of the year, type of exposure and symptoms presented, in the case of shorter stays.

Infections

Lower respiratory tract infection is a very common illness in children and is a significant cause of morbidity and mortality. Clinical signs and symptoms are nonspecific especially in infants and younger children and some even present with nonrespiratory complaints. Infectious agents causing pneumonia is not limited to viruses and bacteria, but it could also be due to Mycoplasma, Mycobacteria, fungi, protozoa, and parasites. Coinfection with two or more microbial agents can also occur. The etiologic agent of lower respiratory infection in a child is often difficult to obtain, but the patient’s age can help narrow the possible cause. Microbiological tests are important but could be difficult to obtain especially in younger children. Various medical imaging modalities not only play an important role as an aid in diagnosis but can also help during and after therapy. Imaging can also help evaluate complications to pneumonia and exclude other causes of respiratory distress including underlying developmental anomalies, foreign body, gastroesophageal reflux disease, and aspiration. In this chapter, the imaging modalities utilized in the detection of pulmonary infections will be discussed. The spectrum of typical imaging findings for various etiologic agents in both immunocompetent and immunocompromised children will be presented.

Endobronchial echinococcosis presenting as non-resolving pneumonia

Hydatid disease of the lungs is caused by larval cysts of the Echinococcus tapeworm. Pulmonary cysts may occasionally invade bronchi or pleura as a result of coughing, trauma, or elevated intra-abdominal pressure. We present the case of a patient evaluated for non-resolving pneumonia whose radiographic and bronchoscopic findings were strikingly similar to those seen in pulmonary tuberculosis with endobronchial invasion; he was ultimately diagnosed with pulmonary echinococcosis. This case underscores the importance of considering unusual diagnoses even when typical features of more common conditions are present.

Serological diagnosis of lung cystic hydatid disease using the synthetic p176 peptide

Cystic hydatid disease (CHD) is a worldwide zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Diagnosis is based on imagenological tools (abdominal ultrasound, chest X-rays, or computed tomography [CT] scan). Serological antibody-detecting assays, using diverse native antigens, have been used as a supportive diagnostic tool, but their sensitivities and specificities differ greatly. The use of synthetic peptides as antigens should provide more reliability and allow better assessment and comparison of test formats and case series. The synthetic peptide p176, corresponding to the N-terminal extreme of the subunit of antigen B (AgB8/1), has shown promising performances for diagnosis of CHD. We evaluated the performance of the synthetic peptide p176 for the diagnosis of pulmonary hydatid disease in an enzyme-linked immunosorbent assay (ELISA) format. Sixty-one serum samples from patients with a diagnosis of pulmonary hydatidosis confirmed by surgery and 128 from healthy volunteers were tested. The overall sensitivity and specificity of the p176 ELISA for lung CHD were 78.69% and 96.88%, respectively. On bivariate analysis, positive serum antibody reactions were associated with the presence of complications and with the number of cysts (single/multiple). Only the presence of persistent complications significantly associated with seropositivity on multivariate logistic regression analysis (odds ratio [OR], 9.58; 95% confidence interval [CI], 2.15 to 42.6; P = 0.003). The p176 ELISA performs well for the diagnosis of lung CHD and adds an easily reproducible diagnostic assay to the existing diagnostic tools.

A case of pulmonary and hepatic cystic Echinococcosis of CE1 stage in a healthy Japanese female that was suspected to have been acquired during her stay in the United Kingdom

We herein report a case of a young Japanese female who was confirmed to have cystic echinococcosis (CE) 1 stage based on the World Health Organization Informal Working Group on Echinococcosis pathological classification of CE, and she was also suspected to be infected with eggs of the G1 Echinococcus granulosus sensu stricto during her stay in the United Kingdom and therefore, suffered from synchronous pulmonary and hepatic CE. Oral albendazole was administered initially, but rupture of a lung hydatid cyst was observed. To avoid additional rupture, we performed two surgeries. CE is very rare in Japan; all CE cases in Japan during the past two decades have been confirmed to be imported, and almost all cases are hepatic CE. This case is the first case report of a Japanese patient who had concomitant giant lung and liver CE with early-stage CE1 and was successfully treated by surgery and pharmacotherapy with a serological follow-up.

Cystic echinococcosis: late rupture and complication of a stable pulmonary cyst

Cystic echinococcosis is observed worldwide. Traditional management includes an invasive surgical approach with adjunctive chemotherapy. It has been suggested that observation alone may be appropriate in asymptomatic individuals with stable cysts. A case involving a 38-year-old Peruvian man with an asymptomatic bronchogenic cyst (suspected to be due to echinococcus, but never definitely diagnosed) is presented. The cyst was first noted in 1998, and was followed for 10 years during which time he remained asymptomatic with minimal radiographic change. One year later, in 2009, he presented with acute rupture of the cyst causing empyema. The patient required thoracotomy, decortication and resection of the ruptured cyst. Final pathology showed Echinococcus organisms. The patient responded well to treatment with albendazole and praziquantel, and became completely asymptomatic within six months. The present case demonstrates that echinococcal cysts may be at risk of spontaneous rupture, even after many years of clinical stability, thus supporting the case for resection of asymptomatic cysts suspected of being echinococcal at the time of diagnosis. In addition, the case illustrates that medical therapy with albendazole and praziquantel, in conjunction with surgical drainage, can be successful in the treatment of echinococcal empyema.