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Genus Echinococcus

Genus Echinococcus

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Published by: dhainey on Mar 02, 2009
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Genus Echinococcus
Belong to family TaeniidaeContains 3 species for which humans are host tothe larval stage (hydatids)
o
E. granulosus
o
E. multilocularis
o
E. vogeliShare the same Life cycle, Diagnosis, Treatmentand Prevention & ControlEpidemiology:
o
primarily involves parasitizedmembers of the canine family
o
most important specie producinghuman disease
o
infection of this parasite is very rarein the Phil
Hydatids or hydatid cysts
 
o
larval stage / Infective stage
o
are large, roughly spherical, fluidfilledhollow bladders
o
cyst wall consists of:
outer laminate hyaline wall,supporting the wholecyst
Inner germinal layer studdedwithdeveloping broodcapsules
o
the protoscolices are formed withinthe brood capsules, which mayrupture to give off freeprotoscolices in the fluid filled cyst
o
 Thousands of protoscolices can fillthe hydatid
o
Hydatid cyst usually grow slowlybut steadily (1-5 cm per year)producing protoscolices anddaughter cysts that fill the cystinterior, they are usually welltolerated until their size becomes aproblem or they rupture
o
Cyst rupture or leakage can resultin allergic reactions andmetastasis
Hydatid sand
 
o
From the inside surface of the fluidfilled cystgrow hundred of protoscoliceswhich bud off and fall to the bottom of the cysts,forming
hydatid sand
 
o
a granular material, consisting of free
protoscolices, daughtercysts, and amorphousmaterials which is found inolder cysts
o
sometimes aspirated for diagnosticpurposes
3 forms hydatid cyst :
o
Unilocular hydatid cyst 
Unilocular hydatid disease( E. granulosus)
o
Multilocular/alveolar hydatid cyst 
Multilocular/alveolar hydatiddisease (E. multilocularis)
o
Polycystic hydatid cyst 
Polycystic hydatid disease (E.vogeli)
Echinococcus granulosus
Syn: Dog tapeworm, Hydatid wormDisease:
Unilocular Echinococcosis,Unilocular Hydatid Disease
Intermediate host : sheep, goat, ,ox
Definite host: dog
 
Humans: accidental intermediate host
Hydatid disease in man is causedprincipally by infection with the larvalstageGeog. Dist:
o
Worldwide
o
Chiefly Russia, Siberia, Bavaria, Tyrol
o
heavy infection occurs in sheepraising areas of the world, SouthAmerica, Iceland, Tasmania, Africa,Asia
Adult
measures 0.25cm – o.9cm (ave 0.6cm)
o
Only 3 proglottods: 1 immature, 1mature and 1 gravid proglottidsScolex
 
o
globular shape with 4 prominentcup-shaped suckers
o
rostellum - armed with 2 circularrows of 28-50 large and smallhookletsMature proglottids-more elongated, and contains fullydeveloped reproductive organs w/c consist of pyriform testes, 45-65 in number, and locatedanterior to cirrous sac-Bilobed ovary at the posterior portion
o
Club –shaped uterus
Gravid proglottids
longer than wide; Biggest segmentof the strobila
Uterus at median, gives rise to 12-15 lateral uterine pouches filled witheggs
Egg
spherical shaped, with radiallystriated embryophore
Cannot be distinguished from thoseof Taenia spp.
 This genus compensate their veryminute size by producing thousandsof eggs
MOT :
o
Accidental ingestion of tapewormeggs excreted in the feces of infected dogs
o
Intimate association with dogs
o
Contaminated fingers and food
o
2° seeding from ruptured cyst
Pathogenesis:
o
disease will vary in theirseriousness depending on where inthe body the hydatid develops, andhow large it growsSometimes the infection is asymptomatic, theonly evidence of infection being the presence of calcified cysts on autopsy after death due to anunrelated cause:
o
the major pathology is due to thesizeof the cyst, giving rise to pressurerelated injury by expanding
o
of hydatid cyst
cysts can grow to be the sizeof a
o
softball or basketball, and may
o
contain several smaller "balloons"
o
inside the main cyst
Pressure effects can causelocaltissue damage andobstruction-Leakage of hydatid fluid synsitizes the patientand elicit eosinophilia-a complication may arise if the cyst is ruptured,possibly due to blows to the body, muscularstrain, or during operation-the hydatid cyst fluid is highly allergenic andcyst rupture may-result in severe allergic manifestations,anaphylactic shock and rapid death
o
deadliest tapeworm parasitizinghumans
Diagnosis:
o
Stool exam – charac. Ova & gravidsegments
o
X-ray, CT scan, Ultrasound –demonstate hydatid cyst
o
serological – Indirect HAI, ELISA, CF
o
Liver puncture
o
Blood smear – eosinophilia
 Therapeutic Modalities:
o
Surgery: leaking cysts, infectedcysts, multiple daughter cysts
o
Chemotherapy: Albendazole -inoperable, in-aspiratable
Praziquantel – active protoscolicidal agent
o
Ivermectin – injected directly intocysts was found to killprotoscolices in experimentalanimals
o
Observation: extreme age, muchcalcification, well padded smallcysts
o
Percutaneous aspiration & drainageof hydatid cyst of the liver & lungs
Prevention & Control:
o
Avoid fondling of infected dogs
o
Strict personal hygiene
o
Avoid eating contaminated foods
 
o
Dogs should be dewormedperiodically with Praziquantel every6 wks
Echinococcus multilocularis
Syn: Dog tapeworm, Hydatid wormDisease: Multilocular Echinococcosis
Multilocular / alveolar hydatiddiseaserecognized as distinct specie from E.granulosus
definitive hosts: primarily foxes and to a lesser extent dogs, cats, coyotes and wolves
intermediate host: rodents, mice
Man is an accidental host by the ingestionof eggsmore adaptations for colder climates
Adults
o
 
very similar to
E. granulosus
, witha maximum length of approximately 4mm, and consistingof 4-5 proglottids
Larvae
o
the 'cyst' grows invasively byexternal budding, to proliferate inany direction, forming a diffusegrowth through the infected organreplacing that organ tissues
 
-
minor morphologic difference between hydatid cyst and alveolar cyst 
Multilocular / Alveolar Hydatid Disease
Adults
o
 
As with
E. granulolsus
the adulttapeworm is usually
o
non-pathogenic to its canine hosts
Larvae
o
MOT
eating foods contaminatedwith feces of the hosts
hunters can be infected whilehandling foxes & wolves
o
common site of development: livernext lung and other organ-Growth in the vena cava or portal vein may leadto metastases, usually to the lungs or brain andother body organs-Prognosis is poor and depends on extend of organ involvement
the multilocular cyst is highly pathogenicdue to its fast growth rate and invasivenature, in extreme cases completelyreplacing liver tissue thus simulatinghepatocellular carcinoma with localpressure effects and allergy
Echinococcus vogeli
Syn: Dog tapeworm, Hydatid worm
Disease: Polycystic Echinococcosis,Polycystic hydatid disease
-found in Central and Northern South America
definitive hosts: bush dogs
Intermediate host: large rodents (pacas andspiny rats)
Larvae -
Similar to that of 
E. granulosus
 
Adults -
Similar to
E. granulosus
, butrather smaller; non-pathogenic-The germinal membrane of the hydatidsproliferates both inward, in the original cyst,forming septa that divide it in many sectionsand outwards to form new multi-chamberedE.multilocularisE. granulosuslimitingmembranethinThick &laminatedgerminalepitheliumGrowsexternally, toproliferate inany directionand act like aneoplasm withlocalinfiltration oreven tometastasizeGrows to theinternal cavityof the cystappearanceAlveolar orMultilocular cystUnilocularcystAmountof fluidlessmore

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