Surgery for parasitic lung infestations: roles in diagnosis and treatment

Abstract

Pulmonary parasitic infestations are a worldwide problem associated with significant morbidity and socioeconomic impact. They are known to have varied clinical presentations and radiological appearances. Prevention of parasite transmission and medical treatment of cases form the two pillars of control of these diseases. The role of surgery is limited to the diagnosis and definitive treatment of the minority of pulmonary parasitic afflictions, most notably hydatidosis. Despite surgery being established as the treatment of choice in pulmonary hydatid cysts (PHCs) for over half a century, variations and unresolved controversies persist regarding the best surgical technique. Complications brought on by cyst rupture, multiplicity and multi-organ involvement add complexity to treatment decisions. The development of videoassisted thoracoscopic surgery (VATS) brings the promise of reduced peri-operative morbidity but is yet to be universally accepted as a safe technique. In this review, we endeavor to discuss the common pulmonary infestations focusing on the current trends and controversies surrounding surgery for PHC.

Surgical management of pulmonary hydatid cysts in children in KwaZulu-Natal Province, South Africa

“…Patients with intact cysts are usually asymptomatic; however, some do develop symptoms such as cough, dyspnoea, fever and chest pain. [4] A chest radiograph is the first radiological analysis that is performed for all patients with pulmonary hydatid disease and its diagnostic value for intact cysts is very high. [8] A contrast-enhanced CT scan of the chest and upper abdomen should be performed to confirm the diagnosis, identify liver and splenic cysts and help with the planning of the necessary surgical procedure.…”

“…Children have more elastic lung tissues, tend to have larger cysts and delayed presentation. [4] Furthermore, they may present with so-called giant cysts (≥10 cm in size). [4] In a study of 1 055 patients in Turkey, [11] most cysts were found in the lower lobes compared with upper lobes and in the right lung compared with the left lung.…”

“…[4] Furthermore, they may present with so-called giant cysts (≥10 cm in size). [4] In a study of 1 055 patients in Turkey, [11] most cysts were found in the lower lobes compared with upper lobes and in the right lung compared with the left lung. Studies have reported that ~30% of patients with PHCs can have multiple cysts while about 20% have bilateral cysts.…”

“…Dogs and other canines are the definitive hosts while livestock, including cattle, sheep, goats and pigs, are the intermediate hosts. [2,4] Four species of Echinococcus have been identified (recent literature states six species are recognised); however, E. granulosus and E. multilocularis are the most important species that are infective to humans and cause cystic and alveolar echinococcosis, respectively. [1,5] The World Health Organization estimates that >1 million people become infected with Echinococcus spp.…”

“…[1,3,7] Symptoms of pulmonary hydatid disease include cough, chest pains, fever, dyspnoea and rarely expectoration of salty material. [3][4][5] However, the rupture of the cyst into either the airways or pleural space may result in haemoptysis or pleural effusion, which usually complicates into an empyema. Chest radiography and computed tomography (CT) scan of the chest and upper abdomen are usually the imaging modalities used to achieve the diagnosis of pulmonary hydatidosis.…”