ECHINOCOCCUS

GRANULOSUS
DOG TAPEWORM/HYDATID WORM
OBJECTIVES
• Introduction
• Morphology
• Epidemiology
• Life cycle
• Pathogenesis
• Clinical features
• Lab diagnosis
• Treatment and prophylaxis
INTRODUCTION
• Causes cystic echinococcosis/ hydatid disease
• Greek hydatis- means drop of water
• Acquired by ingestion of parasitic eggs excreted by tapeworm from an
infected animal.
• It is smaller than other cestodes
• Eggs are similar and indistinguishable from taenia eggs.
• Larval form is the hydatid cyst which develops inside various organs of
intermediate host
• Definitive host-dog or other canine carnivora(Wolf,fox) and intermediate
host is herbivorous animals(sheep,cattle)
• Humans are an accidental intermediate host.
MORPHOLOGY
Adult Worm
It is a small tapeworm measuring 3-6mm in length
It consists of a Scolex,short neck and a Strobila
Scolex is pyriform with four suckers and a prominent
rostellum with two circular rows of booklets
The neck is short than the rest of the worm
The Strobila is composed of three proglottids;
The anterior immature
The middle mature
The posterior gravid segment(it’s the longest and
widest segment and contains branched uterus filled
with eggs)
Morphology cont’d
• Eggs of E.granulossus are similar to those of taenia SPP
• It is ovoid in shape and brown in colour(bile stained)
• It contains embryo with three pairs of hooklets.
• LARVAL FORM *LIST OF ATTENDEES *1 : Titus Kimani 2 :Joyce Nzomo3 :Benita
Njeri4 :5 :
• It is found within the hydatid cyst, developing inside various
organs of the intermediate host.
• It represents the structure of the Scolex of the adult worm
and remains invaginated within a vesicular body
• Once in the definitive host,the scolex with suckers and
rostellar hooklets becomes exvaginated and develops into
adult worm.
EPIDEMIOLOGY
• The disease is most prevalent in most parts of the world,though it is most
extensive in the sheep and cattle raising areas of Australia,Africa,South
America.
• It is also common in Europe,China and Middle East
• It is a significant problem in India,it is seen more often in temperate than in
tropical regions
• Adult worm lives in the jejunum and duodenum of dogs and other canine
carnivora (Wolf and fox)
• The larval stage(hydatid cysts)is found in humans and herbivorous
animals(sheep,goat,cattle and horses)
KENYA is one of the higest CE endemic countries in the world.
LIFE CYCLE
Life cycle cont’d
• Adults reside in the SI of the definitive host
• The gravid proglottids release eggs into the faeces- immediately infectious
• Eggs hatch in the SI,release 6 hooked oncospheres which then penetrate
the wall of the Small intestine,migrate through the circulation to organs
esp liver and lungs
• Oncospheres develop into the thick walled hydatid cysts which enlarges
gradually producing protosclocises and daughter cysts that fill the cyst
interior
• Definitive host infected by ingesting the cyst contained in organs of the
intermediate host
• After ingestion the protoscolices evaginate attach to the intestinal mucosa
and develop into adults in 32 to 80 days.
Life cycle cont’d
• Man gets infection by:
• Direct contact with infected dog
• Allowing dogs to feed from the same dish-direct transmission of eggs
• Ingestion of raw vegetables and foods infected by dog faeces
• Ova ingested by man is liberated from the chitinous wall by gastric juice liberating the hexacanth
embryos(6hooked embryo)
• Hexacanth embryos hatch in the duodenum then penetrate the Small intestine and enter the
portal venules to reach organs like liver along portal circulation
• The embryos are trapped in hepatic sinusoids where they develop into hydatid cysts.The liver acts
as the first filter for embryo
• Some of the embryo which pass through the liver enter the right side of the heart and are caught
in pulmonary capillaries(forming pulmonary hydatid cysts)so that the lung acts as a second filter
• Embryos enter the systemic circulation to get lodged in other organs such as the
spleen,kidneys,eyes,brain or bones.
CONT’D
• Cellular reactions of monocytes,giant cells and eosinophils occurs
where embryo settles
• Hydatid cysts develop where embryo escapes destruction
• Cellular reactions cease and fibroblasts are deposited and new blood
vessels are fomed
• Pericyst formed-fibrous tissue enveloping growing embryo
• Hydatid cyst develop from growing embryo,the inner surface contains
brood capsules with numerous scolices.
Hydatid cyst development
• Animals serving as intermediate hosts their viscera may not be
disposed off properly and consumed by definitive hosts
• Dog has no access to hydatid cysts developed in man,life cycle of
parasite comes to a dead end
• Cyst grows slowly:symptoms develop in 5-20 years after cyst becomes
fully enlarged to cause obstruction
• Adult worms live from 6-30 months
 PATHOGENICITY
• At the site of deposition of embryo develop to a hydatid cyst,it enlarges slowly and
reaches a diameter of 0.5-1 cm in months.
• The growing cyst evokes host tissue reaction leading to the deposition of fibrous capsule
around it.
• The cyst wall secreted by the embryo has three indistinguishable layers;pericyst,ectocyst
and endocyst
• Ectocyst: intermediate white outer cuticle,acellular,laminated hyaline layer
• Endocyst:inner germinal layer,site of asexual reproduction.Gives rise to ectocyst and
brood capsules/scolices and secretes hydatid fluid
• Endogenous daughter cysts can develop from fragmentation of germinal layer plus
grandaughter cysts
• Hydatid fluid,clear acidic fluid(pH of 6.7).Contains salts(sodium chloride) and proteins.Its
antigenic-used for the Casoni test,toxic when spilled on body cavities and causes
anaphylactic shock and death
PATHOGENICITY CONT’D

• Acephalocytes-some cysts are sterile and may never produce brood

capsules,while some brood capsules may not produce scolices.(So no
infection does not occur when ingested by man)
• Scolices may escape from the cyst and transported elsewhere which
may initiate secondary hydatid cysts
• Dense osseous tissue in bone doesn’t allow proper development of
the laminated layer.Parasite migrates along bony canals causing
erosion.
Clinical features
• Cysts affect liver (50-70%) or lungs(20-30%) but may affect any body
organ.
• Often asymptomatic,found incidentally on radiological imaging.
• Symtoms-result of expansion or rupture into adjacent organs
• Liver cysts:hepatomegaly,pressure on both bile ducts and blood
vessels and cause pain and biliary rupture
• Primary hydatid cysts occur in the liver mostly in the right lobe
Abscess if superinfected;cyst rupture causing allergic reactions I.e skin
rash,anaphylactic shock or death
CLINICAL FEATURES CONT’D
• Lung cyst-cough, shortness of breath, chest pain, rupture leading to pneumothorax,
Emphysema, allergic reactions, shock
• Lung cysts are common in the lower right lobe of the lung.
• Bone-erosion of the marrow cavity and the bone itself, leading to pathological fractures
• Other sites: spleen(3-5%), CNS, heart, kidneys, bones, muscles, eyes(visible swelling and
pressure effects )
• In the kidney,hydatid cysts cause pain and hematuria.
• Cyst rupture leads to the dissemination of infection from the release of thousands of
protoscolices.
• Hypersensitivity to the echinococcal antigen -urticarial-minute amounts of hydatid fluid
seeping out through the capsule)
• If a hydatid cyst ruptures spontaneously during surgical interference, massive release of
hydatid fluid may cause severe even fatal anaphylaxis
LABORATORY DIAGNOSIS
a)imaging-radiological examination techniques such as ultrasonography,CT
scan and MRI reveal the diagnosis in most cases of cystic echinococcus
b)Examination of cyst fluid-examination of aspirated cyst fluid under
microscope after trichome staining reveals scolices,brood capsules and
hooklets.
c)Casoni’s intradermal test-it is on immediate hypersensitivity(type1)skin test
using fresh sterile hydatid fluid.The test is almost abandoned now due to non
specificity and has been supplemented by serological tests.
May produce false positive results with other cestode infections
d)Serology;antibody detection-detection of serum antibodies using specific
antigens from hydatid fluid are frequently used to support the clinical
diagnosis of cystic echinococcosis.The test include indirect
hemagglutination(IHA),indirect immunofluorescence and ELISA.
LAB DIAGNOSIS CONT’D
• Blood examination-it may reveal generalized eosinophilia
• Excretion of the scolices-into the sputum or urine may be revealed in
pulmonary and renal cyst respectively and can be demonstrated by
acid-fast staining or lactophenal cotton blue
• Specific molecular diagnostic- methods have been developed using
DNA probes and PCR but application limited by their technical
complexity
• Histological examination of cysts
TREATMENT
• Asymptomatic cysts-monitor
• Surgery-previously considered the best prognosis,but it is nowadays only
recommended for cysts which communicate with biliary tract and in cysts
where PAIR is impossible
• PAIR(puncture,apiration,injection and reaspiration)-widely used in the early
stages of the disease.Basic steps involved in PAIR include:
• Ultrasound or CT guided puncture of the cyst
• Aspiration of cyst fluid
• Infusion of scolicidal agent usually(95% ethanol,alternatively hypertonic
saline)
• Reaspiration of the fluid after 5 minutes
Treatment cont’d
• Perioperative antihelminthic agents-albendazole or mebendazole
with care to prevent cyst rupture or spillage during surgery
• If inoperable because of the cysts location-consider high dose
albendazole or mebendazole or praziquantel.Given for years,cure
rate-29%
Other new treatment modalities include laparoscopic hydatid liver
surgery and percutaneous thermal ablation of the germinal layer of the
cyst using radiofrequency ablation device
Nb-chemotherapy with benzimidazole agents are restricted to
residual,post surgical and inoperable cysts.
PROPHYLAXIS
• E.granulossus infection can be prevented by;
• Ensuring animal pets do not eat animal carcasses
• Periodical deworming of pet dogs
• Destruction of stray and infected dogs
• Maintaining personal hygiene such as washing hands after touching
dogs and avoidance of kissing pet dogs
• Education regarding the transmission of infection
HYDATIDOSIS IN TURKANA MAN
Hydatid cysts in the liver and brain