II. Epidemiology

  1. Endemic worldwide in sheep raising areas
    1. Mediterranean
    2. Prior Soviet Union block nations
    3. Australia
    4. South America
    5. Africa
  2. U.S. sources
    1. Immigrants to North America
    2. Western U.S. sheep farmers
    3. Southwestern Native Americans
    4. Native Inuits in Alaska and Canada (Caribou, wolves)
    5. Some cases along Mississippi

III. Etiology

  1. Echinococcus granulosis

IV. Pathophysiology

  1. Infection with the tapeworm Echinococcus larvae
    1. Produces expanding cysts (grow at 1-5 cm per year)
  2. Sites of involvement
    1. Liver (most common)
    2. Lung (second most common)
    3. Kidney
    4. Muscle
    5. Spleen
    6. Brain
    7. Bone
  3. Transmission
    1. Definitive Host: Dogs and other carnivores
    2. Intermediate host: Human, Sheep, Cattle
    3. Infections in Human by ingestion of ova

V. Symptoms

  1. Asymptomatic in 60% of cases (for 10-20 years)
  2. Cough
  3. Abdominal mass
  4. Hemoptysis
  5. Chest Pain

VI. Complications

  1. Cyst rupture
    1. Anaphylactic reaction
    2. Pyopneumothorax
    3. Mediastinal erosion

VII. Labs

  1. Complete Blood Count
    1. Eosinophilia may be present
  2. Skin test
    1. Casoni's Antigen
  3. Echinococcus serologic titer
    1. Test Sensitivity: 50% of lung infections
    2. EITB has highest sensitivity and Specificity
  4. Fine needle aspiration of cyst
    1. Tapeworm parts and Eosinophilic granules

VIII. Radiology

  1. Abdominal Ultrasound or CT: Liver or Kidney Cysts
  2. Chest XRay: Lung cysts
    1. Size: 1-10 cm in diameter
    2. Lower lobes and right side more commonly involved
    3. Consider CT Chest or MRI Chest

IX. Management

  1. Surgical excision of cysts
  2. Anti-Helminth agents (used concurrently with surgery)
    1. Albendazole (Albenza)
    2. Mebendazole (Vermox)
      1. Not available as of 2012

X. Prevention: Education program in endemic areas

  1. Carefully wash fruits and vegetables before ingestion
  2. Avoid water potentially contaminated by dog feces
  3. Hand Washing after soil exposure
  4. Treat dogs frequently with worming formulations
  5. Avoid feeding dogs the entrails of livestock

XI. Prognosis

  1. Mortality as high as 4-5% in untreated patients

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Related Studies

Ontology: Echinococcosis (C0013502)

Definition (NCI) A parasitic infection caused by tapeworm larvae of Echinococcus. It affects livestock and humans. It is characterized by the formation of hydatid cysts mainly in the liver, lungs, spleen, and kidneys. Rupture of the cysts may lead to shock.
Definition (MSH) An infection caused by the infestation of the larval form of tapeworms of the genus Echinococcus. The liver, lungs, and kidney are the most common areas of infestation.
Concepts Disease or Syndrome (T047)
MSH D004443
ICD9 122
ICD10 B67 , B67.90
SnomedCT 187143006, 154414008, 74942003
LNC LP14823-6
English Cysts, Hydatid, Echinococcoses, Echinococcosis, Hydatid Cyst, Hydatid Cysts, Hydatidoses, Hydatidosis, Cyst, Hydatid, Echinococcus NOS, Tenia echinococcus infection, echinococcus infection (diagnosis), echinococcus infection, Taenia echinococcus infection, hydatidosis, Echinococcosis NOS, Echinococcosis, unspecified, Echinococcosis [Disease/Finding], Disease;hydatid, echinococciasis, disease hydatid, cyst hydatid, echinococcus disease, hydatid cyst, Echinococcus NOS (disorder), Echinococciasis, Hydatid disease, Echinococcosis (disorder), Echinococcus disease, Echinococcus, hydatid; disorder, hydatid disease, echinococcosis, Echinoccosis, Hydatid cyst
Dutch hydatidecyste, Taenia echinococcus-infectie, hydatideziekte, hydatide; aandoening, echinococcose, Cyste, hydatide-, Echinokokkose, Hydatidecyste, Hydatidosis
French Infection à Taenia echinococcus, Échinococcose larvaire, Hydatidose kystique, Maladie hydatique, Echinococcose, Échinococcose alvéolaire, Échinococcose, Échinococcose hydatique, Hydatidose, Kyste hydatique, Kyste multiloculaire, Kyste uniloculaire
German Hydatidenerkrankung, Taenia echinococcus Infektion, Echinokokkose, Hydatidenzyste, Hydatidose, Zysten, Hydatiden-
Italian Infezione da echinococco, Malattia idatidea, Cisti idatidea, Idatidosi, Echinococcosi
Portuguese Doença hidátide, Infecção por Taenia echinococcus, Quisto hidático, Cistos Hidáticos, Cisto Hidatídico, Cistos Hidatídicos, Equinococose, Cisto Hidático, Hidatidose
Spanish Quiste hidatídico, Infección por tenia echinococcus, Enfermedad hidatídica, Quistes Hidatídicos, Echinococcus, SAI, Echinococcus, SAI (trastorno), enfermedad hidatídica (trastorno), enfermedad hidatídica, equinococosis, hidatidosis, Equinococosis, Hidatidosis, Quiste Hidatídico
Japanese 包条虫感染, ホウチュウショウ, ホウジョウチュウカンセン, ホウチュウノウホウ, 包虫症, エキノコックス症, 包虫嚢胞, 包虫嚢腫, 嚢胞-包虫, 嚢腫-包虫
Swedish Blåsmasksjuka
Czech echinokokóza, Hydatidózní cysta, Hydatidosis, Echinokokóza, Hydatidóza, Infekce měchožilem zhoubným, hydatidóza, cystická hydatidóza, nemoc hydatid, alveokokóza
Finnish Ekinokokkoosi
Korean 포충증
Polish Bąblowica, Echinokokoza
Hungarian Echinococcosis, echinococcosis, Echinococcus cysta, Taenia echinococcus fertőzés, hydatidosis
Norwegian Not Translated[Echinococcosis]