Uncomplicated Hydatid Cysts of the Liver: Clinical Presentation, Diagnosis and Treatment

Abstract

Hydatid cyst of the liver is zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus and is still endemic in the South European regions, Asia, South America, North Africa, Australia, New Zealand and several Asian and European countries. The diagnosis of non complicated hydatid cyst of the liver depends on clinical suspicion. They appear in two ways as general (systemic) symptoms, and local symptoms based on the site and organ on which larva settles. While cysts sometimes recover spontaneously, more severe clinical presentations are observed in immunosuppressive individuals. Ultrasonography is the gold standard diagnostic tool and E. Granulosus antigen 5 (Ag5) and antigen B (Ag B) obtained from cyst fluid are used as a serologic diagnostic method in combination with the imaging method. The current treatment of hydatid cyst of the liver varies from surgical intervention to minimally invasive treatments (percutaneous drainage) or medical therapies. Surgery is still the best treatment tool. Percutaneous drainage and treatment of the cyst is a good option to surgery in selected cases. Multiple, superficial single cysts are the most suitable ones for surgical treatment. Also for complicated infected cysts pressing biliary tree and vital organs, surgery should be the first choice of treatment coming to mind. We believe that the laparoscopic approach should be safe to uncomplicated cysts. The purpose of our article is to provide a current review of clinical, diagnostic, and therapeutic features of hydrated cyst diseases.

Hydatid disease: a 2 years retrospective study in a tertiary care center in South India

“…The life cycle of Echinococcus granulosus was first described by Haubner. [2][3][4] It is an important zoonotic and parasitic infection of humans, following ingestion of tapeworm eggs excreted in the faeces of infected dogs. 3 Echinococcosis is endemic in developing countries like South America, Middle East, Australia, India and Mediterranean countries where flocks of sheep and cattle are raised with dogs and hence more common in the rural population and with also the people involved in animal husbandry.…”

“…3 Echinococcosis is endemic in developing countries like South America, Middle East, Australia, India and Mediterranean countries where flocks of sheep and cattle are raised with dogs and hence more common in the rural population and with also the people involved in animal husbandry. 2,4,5 In India the highest prevalence is reported in Andhra Pradesh, Tamil Nadu, and Jammu and Kashmir…”

“…The sites of occurrence in descending order are liver (50-93%), lungs (18-35%), peritoneal cavity (10-16%), spleen (2-3%), kidney (1-4%), and retroperitoneum (0.5-1.5%). [2][3][4]6 After infection with Echinococcus granulosus, humans are usually asymptomatic for a long time. The growth of the cyst in the liver is variable, ranging from 1 mm to 5 mm in diameter per year.…”

“…They may show a "spoke wheel" pattern or a water lily sign typical eggshell-like appearance is seen in completely calcified cysts. 4,5,10 Treatment of HD Small, calcified cysts do not require treatment but should be monitored. 1 Treatment options can be divided into chemotherapy (benzimidazolic drugs) and surgery, which consist of PAIR (Puncture, Aspiration, Injection, Respiration), PPDC (Percutaneous Puncture with Drainage and Curettage), conservative surgery (open cystectomy with or without omentoplasty), and radical surgery (total pericystectomy or partial hepatectomy).…”

“…In the case of alternative medical therapy using chemotherapy alone, albendazole is used with an adult dosage of 400mg orally, twice a day for 1-5 months and a pediatric dosage of 15 mg/kg/day (maximum of 800mg) for 1-6 months. 1,4,5,10,11 Study by Gourgiotis S and collegues on 169 patients of hydatid cysts in a 12 years period showed that surgical procedures combined with antiscolicidal agents like albendazole were more effective in treatment of hepatic hydatid cysts.…”