This document summarizes information about hydatid disease (echinococcosis), which is caused by the larval stage of the tapeworm Echinococcus. It is most prevalent in rural areas where older animals are slaughtered. The life cycle involves canines as the definitive host and sheep as the intermediate host. Humans can become accidentally infected through contact with infected animal feces. Clinically, hydatid cysts most commonly form in the liver and lungs, though any organ can be affected. Diagnosis involves imaging like ultrasound or CT scan along with serological tests. Treatment options include surgery, anthelmintic drugs like albendazole, and percutaneous drainage of cysts. Follow up involves monitoring for

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in Botswana
(AFRICA)
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HYDATID DISEASE
Presented by :

3. Hydated Disease  Echinococcosis
• Neglected tropical diseases; family Taeniidae; Zoonosis
• Nearly one million affected worldwide at any one time
• Incidence 10% in certain areas of South America, Africa,
& Central Asia
• Highest prevalence in rural areas where older animals slaughtere
• Antartica is the only continent that is free from Echinococcosis
• Three billion USD is the economic cost of the disease
• Usually asymptomatic, detected incidentally or until quite late

5. HISTORICAL
PERSPECTIVE
Disease was known even during pre-biblical times.
Talmud.

6. Man is an
accidental
host
Totally
unaware
BATSMA
NDefinite host
Intermediate host
Eg: A game
of cricket
LIFE CYCLE

7. DOG /
CANINES
EXCRETA
(carrying eggs
of
Echinocoocus)
POO
GRAZING
GROUND
Infested
carcass
of
herbivores &
small
mammals
INPUT

8. DEFINITE HOSTS
INTERMEDIATE HOSTS
POO
MAN
ACCIDENTAL HOST
Echinococcus
egg
DOG
SHEEP
FO
X CA
T
WOLF Other
Canines
Small
rhodent
s
Granulosus
Multilocularis
Cam
el
Buffal
o
Goat
YAK
Horse
Swine
Kangaroo
Wombat
s

9. Larval / hydatid cyst :
EGG
HYDATID CYST *Grows to about 5–10 cm in 1 year
* Can survive within organs for years
* Cysts may contain several liters of fluid
& many daughter cysts.

10. Hydatid cyst has three layers
(Pericyst, ectocyst, & endocyst)
May contain a few daughter cysts
Hydatid sand
Hydatid cyst
Echinococcus
Terminal segment
(gravid)
Scolex (25 -50
hooks), neck, &
suckers (4)
Immature
proglottid
Mature
proglotti
d

11. MODE OF INFECTION

12. Humans infected by
• hand-to-mouth transfer of Echinococcus eggs
after handling dog
• close contact with an infected animal, petting,
kissing, licking
• consuming contaminated food or water
MODE OF INFECTION

13.  Hydatid disease NOT transmitted from person to
person
 NOT spread by person eating the meat of an
infected animal
 Incubation period in humans is indefinite; range
from months to years

14. E. Granulosus
CE
E. Multilocularis
AE
E. Vogeli
Polycystic
E. Oligarthrus
Unicystic
Definitive hosts
Family of wild cats
Domestic
dogs,
wolves,
coyotes,
foxes, jackals,
dingoes, etc.
Fox, dogs,
other canidae,
& cats
Wild dogs &
domesticated
dogs
Sheep, goats, cattle, buffalo,
pigs,
camel, kangaroos, &
other wild herbivores
Small rodents
(small mammals)
Rodents
Small rodents
Intermediate hostsTYPES
Central
&
South
America
W
O
R
L
D
W
I
D
E
Central Asia
Russia
Central & Northern
Europe
North central USA
Alaska, NW Canada

15. Zhu GQ1, Li L, Yan HB, Wu YT, Li WH, Fu BQ, Jia WZ.
[Advances in research on echinococcus shiquicus tapeworm]. Zhonghua Yu Fang
Yi Xue Za Zhi. 2019 Jan 6;53(1):112-117. doi: 10.3760/cma.j.issn.0253-
9624.2019.01.017.
Echinococcus shiquicus found in Tibet,
Echinococcus felidis in African lions are the other
species which have no zoonotic transmission potential.
Other sub
types

16. Man is an
accidental
host
Totally
unaware
BATSMA
NDefinite host
Intermediate host
Eg: A game
of cricket
PATHOGENESIS

17. Man
Lung
s Spleen
Kidney
Liver
Brain
Bone
s
Pancrea
s
Muscul
oskelet
al
Orbit
Forearm
Peritoneum
Heart
Pelvis
Solitary hydatid cyst in the forearm: A case report.
Alatassi R, Koaban S, Alshayie M, Almogbil I.
Int J Surg Case Rep. 2018;51:419-424. doi: 10.1016/j.ijscr.2018.09.038. Epub 2018 Sep 27.
Unusual locations of hydatid
disease: A 10-year experience
from a tertiary reference center
in Western Turkey.
Gun E, Etit D, Buyuktalanci DO,
Cakalagaoglu F.
Ann Diagn Pathol. 2017 Aug;29
:37-40. doi: 10.1016/j.anndiag
path.2017.01.011. Epub 2017 Apr
29.

18. Eggs from definite host
Eggs of Intermediate
host X
Hydatid cyst
Hakuni
matata

19. Solitary cyst 70 %
Right lobe
Hyperechoic centre
&
non-homogeneous
scar
Bilateral 17%
Left lobe 16%

20. E. granulosus (Cystic echinococcosis)
• more common 70%
• one or more hydatid cysts, most often in the liver and lungs
• less frequently in bones, kidneys, spleen, muscles & CNS

21. Echinococcus multilocularis (Alveolar echinococcosis)
• affects liver
• slow growing, destructive tumor, & biliary obstruction
• DD liver cancer.
• rarely, metastatic lesions  lungs, spleen, brain
• untreated infections have a high fatality rate.
Echinococcus vogeli affects liver; acting as a slow growing
tumor; secondary cystic development is common
E. oligarthrus too few cases reported for characterization of
its clinical presentation.

22. Seeding : Following erosion or rupture
Cysts can rupture easily, with even a blunt
trauma
Hematogenous Lung
Spleen
Brain
Lymphatic spread Muscle
Peritoneum
Kidney
Bones

23. Clinical features 
• More in male
• USUALLY ASYMPTOMATIC
•Depend on the organ involved
•Single organ involved in 80%
•Weight loss, anorexia, pain abdomen, dyspepsia,
vomiting, growing palpable mass, jaundice
Liver Rt lobe 70% (solitary cyst) Hydatid thrill +
Left lobe 17 % Both lobes 16 %
Lungs - cough, dyspnea, occasionally stridor
Brain  fits, disturbances in vision, memory, balance

24. Water lily sign (Camellotte sign)
Lump
Hydatid thrill (3-finger test)
Incidental findings

25. Pulmonary hydatidosis
Cysts > greater than 5 cm in diameter  bronchial
compression.
Cyst rupture
Sudden onset of chest pain
Cough
Urticaria
Wheezing  anaphylaxis
Hemoptysis
Pneumothorax
Secondary infection
Fever
Occasionally a salty taste in the mouth

26. (a) USG
(b) CT scan
(c) MRI
(d) X-ray - incidental detection of calcified cyst with fluid
(e) Serology  Lung cysts  50% negative
 Liver cysts  90% accuracy (IHA, ELISA )
(f) Biopsy & histopathology
• well defined cysts with thick or thin walls
• cyst wall calcification
• hydated sand
• fluid layer
• presence of daughter cysts within the larger
cyst
• eggshell or mural calcification in CT scan
 differentiates from carcinoma , amoebic
liver abscess, hemangioma, etc
Investigations

27. Investigations (contd):
• FDG-PET  18F-fluoro-desoxyglucose positron
emission tomography (FDG-PET) is also being
used in reference laboratories. Larval metabolic
activity enhances FDG enrichment of AE lesions
• Immunodiagnosis with standard commercial
tests, ELISA, IHA etc. Specific antibodies are
detected by different serological tests by
immunodiffusion and immunoelectrophoresis
(Arc 5)
• Eosinophilia detected in 25 % cases

28. Distinguishing feature (USG) :
 Accuracy 90%. Usually hypoechoic lesions
 Free floating hydatid sand  changes position
Typically an absence of halo phenomenon,
distinguishing them from metastasis /
malignancy
Cyst show hyperechoic centre with non-

29. Sonologically identified patterns :
• Hailstorm
• Pseudocystic
• Ossification patterns
• Hemangioma-like pattern

30. CE  Unilocular cyst
CE 1  Unilocular cyst + fine echoes representing hydatid
sand
CE 2  Single mother cyst + honeycomb appearance
(active)
CE 3  Unilocular cyst + daughter cysts (water lily sign)
CE 4  Hypo & hyper-echoic contents and no daughter cysts
(degenerative)
CE 5  Arch like, partially or completely calcified cyst wall
Steering Group of the WHO Informal
Working Group categorization based
on USG

31. Steering Group of the WHO Informal
Working Group on Echinococcosis (WHO-
IWGE) met in Algiers, Algeria, on 06 Oct 2017
Turk J Gastroenterol. 2014 Aug;25(4):398-404. doi: 10.5152/tjg.2014.7112.
Diagnostics in cystic echinococcosis: serology versus ultrasonography.
Wuestenberg J1, Gruener B, Oeztuerk S, Mason RA, Haenle MM, Graeter T, Akinli AS, Kern
P, Kratzer W.

32. Based on
USG

33. Classification according to the WHO-IWGE criteria
:
 based on clinical presentation, epidemiology, imaging findings &
serology
!. “Possible” (clinical presentation AND epidemiological history AND imaging
findings
OR serology positive for AE)
2. “Probable” (clinical presentation AND epidemiological history AND imaging
findings
AND serology positive for AE)
2. “Confirmed” (the above AND histopathology compatible with AE
AND/OR
E. multilocularis-nucleic acid sequences in a clinical specimen)
Modified TNM classification

35. Differential Diagnosis (Liver)
1. Metastasis (colorectal, breast, or metastases of malignant
melanomas)
2. Hepatic adenomas
3. Biliary cystadenoma or cystadenocarcinoma
4. Primary hepatoma
5. Hemangioma
6. Hematoma
7. Pyogenic or amoebic abscess
8. Regenerative nodules
9. Cystadenoma
10. Angiomyolipomas, etc

36.  Health education
Limiting stray dogs and wild carnivores
Avoid access to raw carcass of cattle  bury / incinerate
Slaughterhouse hygiene
Vaccines for sheep
 Avoid pet dogs to lick your face or body
 Avoid dogs to poo in children parks and kitchen gardens
Using gloves for gardening, manuring, and working with soil
Periodic deworming of pet dogs with Praziquantal / Ivermectin
Wash fruits and raw vegetables before eating.
Wash hands after handling dogs & after contact with items that are likely to be
soiled with dog faeces.

37.  Treatment has historically been reserved
for
symptomatic individuals
 Screening family members can be
considered
MANAGEMENT

38. Available management options
(1) PAIR  Percutaneous treatment
(Puncture, Aspiration, Injection, Re-aspiration)
(2) Surgery
(3) Anti-infective drug treatment
(Albendazole /Mebendazole)
(4) “Watch and wait”.
Acta Trop. 2010 Apr;114(1):1-16. doi: 10.1016/j.actatropica.2009.11.001. Epub 2009
Nov 30.
Expert consensus for the diagnosis and treatment of cystic and alveolar
echinococcosis in humans. Brunetti E1, Kern P, Vuitton DA; Writing Panel for the
WHO-IWGE.

39. Choice guided by :
1. USG staging
2. Condition of the patient
3. Available infrastructure & expertise
• Confined lesion  radical surgery can be curative
• Otherwise palliative
• Albendazole may have to be continued for indefinite period
• Relapses are frequent
Rx

40. Courtesy
Dr. Arun Prasad
Courtesy
Dr. Arun Prasad
LIVER
BRAIN
LUNG
LUNG
Laproscopic surgery is
now well accepted with
good results.

41.  WHO recommends radical hepatic excision,
especially in alveolar echinococcosis (AE)
 In combination with medical anthelmintic treatment,
a safe distance of at least 1 mm is permissible in this procedure.
 Liver transplantation + adjuvant Albendazole indicated for patients
with end-stage AE
 ex-vivo liver resection & auto-transplantation for end-stage AE

42. Stage Size First-option treatment Alternative treatment
Refusal of intervention or contraindications
for invasive treatment
ABZ (6 months)
CE1, CE3a Small Only ABZ (6 months) PAIR + ABZ (1
month)
Medium Surgical treatment +
ABZ (1–6 months)
PAIR + ABZ (month)
Large Surgical treatment +
ABZ (1–6 months)
MoCaT + ABZ (1
month)
CE2, CE3b Small Only ABZ (6 months) MoCaT + ABZ (1
month)
Medium Surgical treatment +
ABZ (1–6 months)
MoCaT + ABZ (1
month)
Large Surgical treatment +
ABZ (1–6 months)
MoCaT + ABZ (1
month)
CE4, CE5 Any diameter “Watch-and-Wait”
attitude
“Watch-and-Wait”
attitude
Complicated cysts,
no matter what stage
Any diameter Surgical treatment
(+/- interventional
endoscopy in case of
rupture into the
biliary tract)+ ABZ (6
months)
Surgical treatment in
case of rupture;
Percutaneous
drainage in case of
infection
+ ABZ (1 month)
Botezatu C, Mastalier B, Patrascu T. Hepatic hydatid cyst - diagnose and treatment algorithm
[published correction appears in J Med Life. 2018 Oct-Dec;11(4):394]. J Med Life.
2018;11(3):203–209. doi:10.25122/jml-2018-0045
Modified Catheterisation Technique (MoCaT)

43. Follow up :
• Liver enzyme levels
• Ultrasonography
• ELISA / indirect hemagglutination tests

44. JAI
HIND

45. J Assoc Physicians India. 2017
Feb;65(2):98-99.
Asymptomatic Presentation of Large
Cardiac Hydatid.
Beedkar A1, Parikh R1, Deshmukh P2.

46. Indian Heart J. 2016 Sep;68 Suppl
2:S118-S120. doi:
10.1016/j.ihj.2016.04.011. Epub
2016 Apr 28.
A giant cardiac hydatid cyst
presenting with chest pain and
ventricular tachycardia in a
pregnant woman undergoing
cesarean section.
Yaman M1, Ates AH2, Arslan
U2, Ozturk H3, Aksakal A2.

47. Albendazole
•10 to 15 mg / kg body weight in two divided doses
•Or 400 mg twice daily
•28 days cycle with two weeks interval
•Inoperable cases = 3 cycles or more
•Pre and post op cycles (3 each)
X Pregnancy
Honeycomb cyst
Infected cyst
Calcified cyst
*Large cyst

48. ‘PAIR’ best suited for
• Surgically unfit
• Unwilling for surgery
• Active stages (CL, CE1, CE 2, and CE 3)
• Cases of relapse after surgery
• Pregnancy
• Infected cysts
Puncture, aspiration, injection, reaspiration
Complication
s
•Infection
•Recurrence
•Anaphylaxis

49. Surgery :
•Deroofing
•Drainage of cyst
•Omentoplasty
•Marsupilization
•Interoflexon
•Capitonage
• Adequate precautions against spillage of cyst’s contents
 Anaphylaxis, local spread , recurrence, biliary leakage, etc
• Isolate the area, coloured mops, reduce pressure, use scolicidals
(90% alcohol, 15 – 20 % saline)
 Pre & post op prophylaxis

50. Histopathological changes associated with E.
granulosus echinococcosis in food producing animals in
Punjab (India)
B. B. Singh, R. Sharma, J. K. Sharma, V. Mahajan, J. P. S. Gill
J Parasit Dis. 2016 Sep; 40(3): 997–1000. Published online 2014 Dec
20. doi: 10.1007/s12639-014-0622-4
The symptoms of lung infestation lead to sudden onset of chest pain, cough,
fever, and hemoptysis after a cyst rupture.
Rawat S, Kumar R, Raja J, Singh RS, Thingnam SKS. Pulmonary hydatid cyst:
Review of literature. J Family Med Prim Care. 2019;8(9):2774–2778. Published
2019 Sep 30. doi:10.4103/jfmpc.jfmpc_624_19
Hydatid Cyst of the Liver Causing Inferior Vena
Caval Obstruction
K Nagarajan*, D Sekar**, J Vijaya Babu**, Ashwini Kamath***
*Professor of Medicine, **Assistant Professor of Medicine,
***Post Graduate, Department of Internal Medicine, Thanjavur Medical College
Hospital, Thanjavur - 4, Tamil Nadu.