ECHINOCOCCUS GRANULOSUS

Four species of Echinococcus can produce infection in

humans, the two most common being E. granulosus,
causing cystic echinococcosis, and E. multilocularis, causing
alveolar echinococcosis.
Majority are due to sheep strain of E. granulosus:
Definitive hosts: dogs and other canids
Intermediate hosts: sheep. Humans are dead end accidental
hosts
Transmission: common in areas where sheep are raised and
transmission occurs when dogs living in close
proximity to humans are fed with home- slaughtered animal
viscera. Humans contract it by intimate and close
contact with dogs
Infectious eggs excreted by dogs in feces are consumed by
humans and other animals. After ingestion of eggs
by humans, onchospheres are hatched and penetrate the bowel wall
disseminating hemtogenously to various
visceral organs, leading to formation of hydatid cysts. Liver,
followed by lungs are the most frequently involved
viscera, although any viscera can be involved. Hydtaid cyst is
fluid filled cyst with inner germinal and outer
acellular laminated membrane. Germinal layer gives rise to various
secondary daughter cysts.
Can cause unilocular lesion in any organ (e.g liver, lungs,
muscle, bone); small daughter cysts may be present.
Multiple lesions can be caused by E. multilocularis.
Diagnosis: Usually diagnosed incidentally. Can cause
compression of surrounding tissue. 􀁨ltrasound has
excellent sensitivity (~95%) and typically shows a large,
smooth hepatic cyst often with daughter cysts (internal
septations). Positive serology for E granulosus lgG
corroborates the diagnosis (sensitivity ~95%) and usually
obviates the need for percutaneous biopsy. Eggshell calcification
of liver cyst on CT is highly suggestive of
hydatid cyst.
Treatment: Surgical resection under the cover of albendazole.
In some cases, aspiration of cyst may be
performed but there is risk of anaphylactic shock due to
spillage of cyst content. Small cysts (<5 cm) are
typically treated with albendazole.
􀃆Amebic liver abscess may occur within weeks of intestinal
amebiasis and present with fever and RUQ pain.
Eggshell calcifications are unusual.