Echinoccocus granulosus infection (Echinococcosis)

Notes
  • Canines such as dogs are the definitive hosts while herbivores and human beings are the intermediate hosts.
  • Globally, Kenya has among the highest reported incidence of human hydatid disease with about 30% of cattle, 15% of goats and 13% of sheep harbouring the infection. Turkana in Kenya is an endemic area for the disease.
  • Other forms of echinococcus:

_alveolar echinococcosis (E. multilocularis infection)

_Polycystic echinococcosis (E. vogeli infection)

_Unicystic echinococcosis (E. oligarthrus infection)

  • Statistics: Global prevalence - I million.
  1. Transmission
  • The Life-cycle;

_Adult worms in the small intestines of canines

_Embryonated eggs in canines’ feces

_Eggs ingested by the intermediate host (that may be human, sheep, goat, pig etc).

_Oncophere hatches, penetrates intestinal wall into the blood circulation.

_Oncophere moves to varius organs such as lung, liver and to a lesser extent brains.

_Oncophere develops into hydatid cyst.

_Hydatid cyst enlarges slowly with protoscolices and daughter cysts forming within the large cyst.

_A canine ingests cyst-containing tissue of the intermediate host.

_Protoscolices evaginates and attach to the intestinal mucosa as scolex. 

Symptoms
  • Mainly asymptomatic for so many years
  • Tumour-like palpable mass in the liver, lungs, bones, muscles, spleens, eyes and brain
  • Abdominal pain
  • Vomiting
  • Jaundice
  • Ruptured organs
  • Fever
  • Anaphylactic shock
  • Urticaria
  • Chronic cough
  • Chest pain
  • Shortness of breath
Diagnosis
  • Physical examination
  • MRI
  • CT scan
  • Ultrasound (most preferred)
  • Immunoassays
  • Full blood Count (any eosinophilia??)
Management
  • Surgery
  • Percutaneous treatment with the Puncture, Aspiration, Injection, Re-aspiration (PAIR) technique.
  • “Watch and Wait”
  • Tabs Albendazole 400mg BID x 1/12 to 6/12. For  children: 7.5mg/kg  BID x  1/12 to  6/12. (Cure rate: 30 - 40%)
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