Hydatid cyst of the lung: diagnosis and treatment

Pulmonary Hydatid : Diagnosis and Response to Hypertonic Saline Irrigation and Albendazole

BACKGROUND

Pulmonary hydatid is caused by larval stage of parasite Echinococcus granulosus. Although surgery still remains the definitive therapy, various workers have tried albendazole and sterilization of cysts with varying result.

METHODS

32 patients(21 males, 11 females) of pulmonary hydatid disease with average age 32.5 years(21-51 years) treated by us between Jan 97 to Apr 2001 were analysed. Diagnosis was established clinically, radiologically and by serological testing. 16 patients who had simple cyst were treated with 20 ml percutaneous hypertonic(20%) saline irrigation of the cyst along with albendazole (400 mg twice a day, 6 cycles of 4 weeks with 2 weeks drug free period between the cycles). 13 patients of complicated cysts were treated with 6 cycles of albendazole. All cases were followed up for one year. 16 patients including three fresh cases were subjected to surgical resection.

RESULTS

Pleural involvement was noted in 10 patients. On chest radiography 19 patients had homogenous oval or circular cysts, 6 patients had crescent sign and 10 had water lily sign. After percutaneous hypertonic saline irrigation all patients showed initial regression in size and developed complicated cysts with water lily sign but subsequently there was no regression. Of 13 patients treated with albendazole, 3 patients showed complete resolution and 2 patients showed regression of cyst. All these 5 patients had shown regression during first cycle of albendazole. 16 patients were subjected to surgery (6 after saline irrigation, 7 after albendazole course and 3 fresh cases). No difference was noted in these groups on histopathological examination.

CONCLUSION

From this study it was evident that those patients who demonstrate regression in size during first cycle of albendazole are likely to benefit and improve with further cycles of it. Those who do not respond should be subjected to surgery. Result of percutaneous hypertonicsaline irrigation as scolicidal was not encouraging.

[Primary heterotopic pleural hydatid cyst presenting as a pneumothorax]

INTRODUCTION

Hydatid cyst is a parasitic disease that is endemic in many countries. Pneumothorax may be a presentation of this disease that presents urgent problems of diagnosis and treatment.

CASE REPORT

We report the case of a 23-year-old woman, amenorrheic for 22 weeks, who presented with chest pain and dyspnoea. Chest x-ray revealed a right-sided tension pneumothorax. A check x-ray after drainage showed a homogeneous opacity of water density occupying the lower 2/3 of the right hemithorax. Thoracic ultrasound suggested an uncomplicated hydatid cyst at the right base. Surgical exploration revealed a hydatid cyst 14cm in diameter in the pleural space, and a cavity in the right lower lobe with two bronchial fistulae. Treatment consisted of removal of the cyst intact, closure of the bronchial fistulae and capitonnage of the residual cavity. The postoperative course was uncomplicated.

CONCLUSION

Primary heterotopic pleural hydatid cyst is an exceptional cause of pneumothorax that should considered in countries where hydatid disease is endemic. Treatment is surgical following drainage of the pneumothorax.

[Multiple pulmonary hydatid disease with cardiovascular localisation]

Multiple thoracic hydatid disease is rare. Cardiovascular localisation is exceptional. Clinical, radiological and even electrocardiographic signs are not specific. The diagnosis is often difficult. We report a case of multiple pulmonary hydatid disease associated to a hydatid cyst of the infundibulum of the pulmonary artery. This is presented in a young man, aged 21 years, in good physical health, with recurrent minimal haemoptysis dating back two years ago. The authors emphasise, throughout this case history, the difficulties of diagnosis and treatment of multiple hydatid cysts especially with cardiovascular localisation.

Emerging and established parasitic lung infestations

Many lung infestations from established and newly emerging parasites have been reported as a result of the emergence of HIV/AIDS, the increasing use of immunosuppressive drugs, increasing organ transplantations, the increase in global travel, and climate change. A renewed interest in parasitic lung infections has been observed recently because many protozoal and helminthic parasites cause clinically significant lung diseases. The diseases caused by these parasites may mimic common and complicated lung diseases ranging from asymptomatic disease to acute respiratory distress syndrome requiring critical care management. The availability of new molecular diagnostic methods and antiparasitic drugs enables early diagnosis and prompt treatment to avoid the morbidity and mortality associated with these infestations. Good hygiene practices, improvement in socioeconomic conditions, vector control measures, and consumption of hygienically prepared and properly cooked food are essential to reduce the occurrence of parasitic infestations.

Preparation, characterization, and in vitro release study of albendazole-encapsulated nanosize liposomes

The purpose of the present study was to formulate effective and controlled release albendazole liposomal formulations. Albendazole, a hydrophobic drug used for the treatment of hydatid cysts, was encapsulated in nanosize liposomes. Rapid evaporation method was used for the preparation of albendazole-encapsulated conventional and PEGylated liposomes consisting of egg phosphatidylcholine (PC) and cholesterol (CH) in the molar ratios of (6:4) and PC:CH: polyethylene glycol (PEG) (5:4:1), respectively. In this study, PEGylated and conventional liposomes containing albendazole were prepared and their characteristics, such as particle size, encapsulation efficiency, and in vitro drug release were investigated. The drug encapsulation efficiency of PEGylated and conventional liposomes was 81% and 72%, respectively. The biophysical characterization of both conventional and PEG-coated liposomes were done by transmission electron microscopy and UV-vis spectrophotometry. Efforts were made to study in vitro release of albendazole. The drug release rate showed decrease in albendazole release in descending order: free albendazole, albendazole-loaded conventional liposomes, and least with albendazole-loaded PEG-liposomes. Biologically relevant vesicles were prepared and in vitro release of liposome-entrapped albendazole was determined.

[Complicated hydatid cysts of the lung]

BACKGROUND

Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options.

METHODS

A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia.

RESULTS

52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism.

CONCLUSION

Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.

Evaluation of two ELISA and two indirect hemagglutination tests for serodiagnosis of pulmonary hydatid disease

To establish a definite diagnosis for pulmonary hydatid disease, combination of radiology and serology is useful. In this study, 19 preoperative sera from patients with surgically confirmed pulmonary hydatidosis, 40 sera from patients with other parasitosis and pulmonary diseases, and 20 sera from healthy donors were evaluated using 4 different serological tests, i.e., the commercial ELISA (ELISA-kit) test, the ELISA (ELISA-lab) test prepared in our laboratory, the commercial indirect hemagglutination assay kit (IHA-kit) test, and the IHA test using sensitized sheep red blood cells with tannic acid (IHA-TA). The ELISA-kit was the most sensitive (84.2%) and the most specific test (100.0%). The ELISA-kit also demonstrated the highest positive (100.0%) and negative (95.2%) predictive values. The sensitivity of the ELISA-lab test, that we prepared, was found to be 73.6%, whereas the IHA-kit test and the IHA-TA test were found to be 73.6% and 68.4%, respectively. The specificity of these tests was 96.6%, 98.3%, and 83.3%, respectively. When all 4 tests were assessed together, it was found that the sensitivity had risen to 94.7%. When the ELISA-kit was assessed with the IHA-kit and IHA-TA together, it was found that the sensitivity was 89.5% and 84.2%, respectively. Likewise, the combination of the ELISA-lab and IHA-kit or IHA-TA allowed us to achieve a sensitivity of 84.2% in cases of pulmonary echinococcosis. In conclusion, the diagnosis would be imminent if least 2 tests were applied together.

Use of albendazole sulfoxide, albendazole sulfone, and combined solutions as scolicidal agents on hydatid cysts (in vitro study)

AIM: To establish which scolicidal agents are superior and more suitable for regular use.

METHODS: Echinococcus granulosus protoscoleces were obtained from 25 patients with liver hydatid cysts. Various concentrations of albendazole sulfone, albendazole sulfoxide, and albendazole sulfone and albendazole sulfoxide mixed together in concentrations of 50 &mgr;g/mL, and H₂O₂ in a concentration of 4%, NaCl 20%, and 1.5% cetrimide-0.15% chlorhexidine (10% Savlon-Turkey) were used to determine the scolicidal effects. Albendazole (ABZ) derivatives and other scolicidal agents were applied to a minimum of 100 scoleces for 5 and 10 min. The degree of viability was calculated according to the number of living scolices per field from a total of 100 scolices observed under the microscope.

RESULTS: After 5 min, ABZ sulfone was 97.3% effective, ABZ sulfoxide was 98.4% effective, and the combined solution was 98.6% effective. When sulfone, sulfoxide and the combined solutions were compared, the combined solution seemed more effective than sulfone. However, there was no difference when the combined solution was compared with sulfoxide. After 10 min, hypertonic salt water, sulfone, sulfoxide, and the combined solution compared to other solutions looked more effective and this was statistically significant on an advanced level. When sulfone, sulfoxide, and the combined solutions were compared with each other, the combined solution appeared more effective than sulfone. When the combined solution was compared with sulfoxide, there was no difference.

CONCLUSION: Despite being active, ABZ metabolites did not provide a marked advantage over 20% hypertonic saline. According to these results, we think creating a newly improved and more active preparation is necessary for hydatid cyst treatment.

Evaluation of pulmonary hydatid cyst cases

BACKGROUND

The incidence of pulmonary hydatid cyst has been high in developing countries such as Turkey.

OBJECTIVE

The aim of this study was to evaluate the clinical presentation, treatment and outcomes of pulmonary hydatid cyst disease at a tertiary centre.

METHODS

A total of 138 patients, aged between 9 and 72 years with pulmonary hydatid cyst were diagnosed between 2000 and 2008 in 2nd thoracic surgery clinic at our hospital. Clinical characteristics of patients, epidemiological features, cyst diameters and localizations, laboratory findings, surgical approaches were recorded and analyzed.

RESULTS

The most frequent symptoms of pulmonary hydatid cyst were chest pain and cough (44.9%, 37.6%). According to cyst size, there was no difference between younger than twenty and older age groups (p>0.05). Twenty-two patients had complicated cyst cases. Most of them were symptomatic (90.9%). Association of complicated cyst with hepato-pulmonary involvement was significantly higher as compared with single hydatid cyst (p=0.01). Cystectomy was performed in 84.05% of patients and post-operative mortality was seen in only one patient due to pulmonary embolism.

CONCLUSION

Association of lung and liver hydatid cyst increased the risk of occurrence of a complicated pulmonary hydatid cyst. Choice of surgical approach had satisfactory results and post-operative mortality was low.

One-stage procedure for lung and liver hydatid cysts

Concomitant pulmonary and liver hydatid cysts occur in 4% 25% of patients with echinococcosis. To evaluate the safety of a single-stage operation, experience with this procedure between 1992 and 2005 was reviewed. Of 152 patients who underwent surgery for pulmonary hydatid cyst, 30 had an additional hepatic cyst that was located on the upper dome of the liver in all cases. Pulmonary cysts were excised first via a posterolateral thoracotomy. After phrenotomy, the hepatic hydatid cyst was evacuated without capitonnage, and a Folly catheter was left in the cavity. Postoperative complications in the 30 patients with cysts in both locations included empyema in 2, bronchopleural fistula in 1, excessive biliary discharge in 3 and hemorrhage in 1. Hepatic hydatid cysts recurred in 2 patients. There was no hospital death. A single-stage posterolateral thoracotomy for extraction of pulmonary and liver hydatid cyst is an effective and safe surgical technique with few complications.

Diagnosis and treatment of pulmonary cystic hydatidosis

OBJECTIVE

Hydatidosis is a parasitic infection that is still an important public health problem in Turkey. In the present study, it was planned to review the diagnostic and treatment options.

METHODS

The study was conducted in pediatric pulmonary chest ward of Izmir Chest Diseases and Surgery Training Hospital, a referral tertiary hospital for pulmonary diseases in Western Turkey. Cases were evaluated in clinical presentations, radiological, histopathologic and serological features retrospectively.

RESULTS

Consecutive 17 (11 male and 6 female; mean age 11.29 + 2.44) pediatric cases between 1996 and 2001 were evaluated. Liver involvement was found in 8 (47%) cases. Casoni skin test and IHA test were found positive in 7 (63.6%) and 8 (72.7%) out of 11 cases, respectively. Surgical treatment was performed only in 7 (41.1%) cases as well as surgical plus medical treatment was given in 3 (17.6%) cases. Seven (41.1%) cases were treated just medically.

CONCLUSION

Hydatidosis should be considered in the existence of appropriate clinical and radiological findings as a probable diagnosis in all children in our region. Surgery should be the first choice for treatment but, medical therapy was considered as effective for treatment complicated and/or nonsurgical pediatric cases.

Possible anaphylactic reaction due to pulmonary hydatid cyst rupture following blunt chest trauma: a case report and review of the literature

A hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. It is endemic in many areas, including New Zealand, Australia, and the Mediterranean region. Pulmonary hydatid disease can be diagnosed incidentally in asymptomatic patients or may cause symptoms such as cough, chest pain, dyspnea, fever, and hemoptysis both in patients with ruptured and nonruptured cysts. Anaphylactic reaction is a rare presentation of pulmonary hydatid cyst disease. In this case report, we report an unusual anaphylactic reaction following pulmonary hydatid cyst rupture secondary to blunt chest trauma.

Local complications of hydatid disease involving thoracic cavity: imaging findings

Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although it can involve almost every organ of the body, lung involvement follows in frequency the hepatic infestation in adults and is the predominating site in children. Radiologically, hydatidosis usually demonstrates typical findings, but many patients are at risk of developing various complications of hydatid disease with atypical imaging findings and these are rarely described in the literature. In this pictorial review, the imaging features of local complications of hydatid disease involving the thorax including intrapulmonary or pleural rupture, infection of the ruptured cysts, reactions of the adjacent tissues, thoracic wall invasion and iatrogenic involvement of pleura are described. Additionally, imaging characteristics of transdiaphragmatic thoracic involvement of hepatic hydatid disease are presented. To prevent the development of subsequent catastrophic results, all radiologists need to be aware of the atypical imaging appearances of complications of pulmonary hydatid disease.

Unusual imaging characteristics of complicated hydatid disease

Hydatid disease, a worldwide zoonosis, is caused by the larval stage of the Echinococcus tapeworm. Although the liver and the lungs are the most frequently involved organs in the body, hydatid cysts of other organs are unusual. Radiologically, they usually demonstrate typical imaging findings, but unusual imaging characteristics of complicated cyst of hydatid disease, associated with high morbidity and mortality, are rarely described in the literature. The purpose of this study is to review the general features of hydatidosis and to discuss atypical imaging characteristics of the complicated hydatid disease in the human, with an emphasis on structure and rupture of the cystic lesion as well as ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) features of the disease. In our study, the available literature and images of the cases with complicated hydatidosis involving liver, lung, brain, spine and orbit were reviewed retrospectively. In hydatid disease, there are many potential local and systemic complications due to secondary involvement in almost any anatomic location in humans. Radiologically, in addition to the presence of atypical findings such as perifocal edema, non-homogenous contrast enhancement, multiplicity or septations and calcification, various unusual manifestations due to rupture or infection of the cyst have been observed in our cases with complicated hydatid disease. To prevent subsequent acute catastrophic results and the development of recurrences in various organs, it should be kept in mind that complicated hydatid cysts can cause unusual USG, CT, and MRI findings, in addition to typical ones, in endemic areas. Therefore, familiarity with atypical radiological appearances of complicated hydatid disease may be valuable in making a correct diagnosis and treatment.

Is lobectomy necessary in the treatment of pulmonary hydatid cysts?

BACKGROUND

Hydatidosis is endemic in Turkey and many other areas of the world. The definitive treatment for pulmonary hydatidosis is surgical. The purpose of this study was the review of surgical therapy of our patients with pulmonary hydatid disease and the necessity of lobectomy.

METHODS

We reviewed 107 patients: 26 of whom were women and 81 were men. The median age was 30 years (range, 7-57 years). Chest roentgenogram, abdominal ultrasound and computed tomography of the chest and upper abdomen were carried out as diagnostic study. All patients underwent thoracotomy and cystotomy with or without capitonnage.

RESULTS

Four patients had two cysts in the same lobe and one patient had three cysts (one perforated and two intact) in the left lower lobe (4.6%). In nine patients, the cysts were >10 cm in diameter (8.4%). In 18 patients, the cysts were suppurative (16.8%). None of the patients required lobectomy. Of the 107 patients, prolonged air leaks (n = 8), atelectasis (n = 3) and empyema (n = 3; two had empyema preoperatively because of pleural perforation of cysts and the other had prolonged air leak) were observed in the postoperative period. There was no death.

CONCLUSION

The effective treatment of hydatid cysts in the lung is the complete excision of the cyst with maximum preservation of lung parenchyma. We believe that the decision of lobectomy must be taken very carefully, even in the case of infected hydatid cysts, atelectasis, giant cysts and multiple cysts in the same lobe.

Subcutaneous extension of a large diaphragmatic hydatid cyst

A 53-year-old male patient with a large hydatid cyst of the left hemidiaphragm and smaller secondary cysts located in the left thoracic cavity and upper left abdominal quadrant presented with two progressively enlarging lipoma-like masses in the left hypochondrium and under the left scapulae respectively. Total excision of all the cysts was performed through a bilateral subcostal incision, with the left hemidiaphragm near totally excised and replaced by a synthetic bilayer mesh.

A rare cause of parotid swelling: Primary hydatid cyst

Hydatid disease is a zoonotic infection caused by Echinococcus species. Cystic form of this infection mostly involves liver and lung. Hydatid disease of the parotid gland is a very rare entity that may be easily overlooked in daily practice. On the other hand, rupture of the cyst during surgery may give rise to serious complications. We present a case of hydatid cyst of the parotid and discuss the differential diagnosis of this rare condition.

One-stage transthoracic operation for the treatment of right lung and liver hydatid cysts

In this study we reviewed our experience of hydatid disease of the lung and the liver and discussed the safety and the follow-up results of the one-stage operation. Between 1990 and 2004, 142 patients with pulmonary hydatid disease underwent operation in our clinic. Of these, 27 (19%) patients had cysts located on the dome of the liver, treated with phrenotomy through a right thoracotomy. Hydatid cysts located in the lungs were managed by means of cystotomy. For liver cysts, cystotomy and the inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. The pulmonary cysts of 12 (8.4%) patients were bilateral and 5 (3.5%) patients had prior surgical treatment of hepatic (n = 1) or pulmonary (n = 4) hydatid cysts. The liver cysts were approached transdiaphragmatically after the lung cysts were excised in 27 (19%) patients. In patients with pulmonary cysts, cystotomy, with or without capitonnage was performed on 123 (86.6%) patients, and wedge resection was performed on 11 (7.7%), segmentectomy was performed on 6 patients (4.2%), and lobectomy was performed on 2 (1.4%) patients. There was no mortality, and only a small number of complications were encountered: empyema in 3, excessive biliary drainage in 2, and bronchopleural fistula in only 1. We suggest that the extraction of pulmonary and hepatic cysts simultaneously through the transthoracic route is a useful and safe surgical technique. This technique also prevents the need for a second operation.

Methods of surgical therapy in pulmonary hydatid disease: is capitonnage advantageous?

BACKGROUND

Hydatid disease of the lungs is still a serious health problem for some Mediterranean countries. The best surgical therapy for the treatment of this disease is still unclear. In this clinical retrospective study, we aimed to investigate whether capitonnage is an effective therapy method for a pulmonary hydatid cyst or not.

METHODS

Between 1990 and 2004, 89 patients (49 male and 40 female) each with a pulmonary hydatid cyst were treated surgically. The patients were divided into two groups based on whether capitonnage was carried out (group 1, n = 44) or not (group 2, n = 45). Cystotomy and the closure of the bronchial openings were carried out in both groups. The results were assessed in two groups during a 1 year follow-up period. The groups were comparable with regards to their clinical, operative and demographic characteristics.

RESULTS

There was no mortality, and no significant difference in hospitalisation time between the two groups. It was 8.2 +/- 3.2 days for group 1 and 8 +/- 3.1 days for group 2 (P = 0.89). The most serious complications were restricted bronchopleural fistula (only one patient in group 2), empyema (only one patient in group 1 and two patients in group 2), and prolonged air leak (five patients in group 1 and six patients in group 2). These results were not valuable statistically (P = 1.00, P = 1.00 and P = 0.78, respectively).

CONCLUSIONS

We conclude that it is not an advantage to carry out capitonnage when treating pulmonary hydatid cysts.

Comparison of pulmonary hydatid cysts in children and adults

BACKGROUND

The purpose of the present study was to compare the clinical features and the surgical approaches of the pulmonary hydatid cysts in children and adults.

METHODS

One hundred and thirty-four patients, operated on for pulmonary hydatid cysts over the last 10 years were retrospectively evaluated in two groups: 39 children who were younger than 18 years old (29%) and 95 adults (71%). The patients in each group were analysed according to their clinical, radiological and surgical findings.

RESULTS

The frequency of pulmonary hydatid cysts in children was significantly higher in boys (74%) than in girls (26%). However, there was no sex tendency in adults (52% in male vs 48% in women). The sex difference in hydatid cyst frequencies between adults and children was significant (P < 0.05). Among preoperative pleural complications, pneumothorax (15.5%) in children and empyema (11%) in adults were more frequent. The frequency of concomitant hepatic cysts was less in children than in adults (33%vs 79%). Huge pulmonary cysts (=10 cm) were more common in children (31%) than in adults (22%). Cystotomy with capitonnage was the most frequently preferred method in both groups. Postoperative complications developed in six children (16%) and 19 adults (19%), and were more frequent in patients with huge cysts (27%vs 16%). No recurrence was observed in both groups.

CONCLUSIONS

Isolated pulmonary cysts are more common in children than adults. The cysts also tend to be bigger in children than adults. The frequency of concomitant hepatic cysts is less in children. Because of higher lung expansion ability and improvement capacity in children, resection should be avoided and lung saving surgical procedures should be performed. In spite of differences observed in the clinical features it does not change the treatment of pulmonary hydatid cysts in children.

Complicated hydatid cysts of the lung: clinical and therapeutic issues

BACKGROUND

The clinical presentation and the preoperative and postoperative complications associated with pulmonary hydatid cysts depend on whether the cyst is intact or ruptured. The aim of this study was to review the problems encountered in treating ruptured pulmonary hydatid cysts and to highlight the risks associated with chemotherapy and the delay of surgical treatment in pulmonary hydatid disease.

METHODS

The medical records for 67 patients of pulmonary hydatidosis were retrospectively investigated. The patients were divided into two groups based on whether the pulmonary cyst was intact (group 1, n = 34) or complicated (group 2, n = 33). A complicated cyst was defined as one that had ruptured into a bronchus or into the pleural cavity. All patients were treated surgically. Data related to symptoms, preoperative complications, surgical procedures performed, postoperative morbidity, hospitalization time, and cyst recurrence were collected from each individual's records, and the group findings were compared.

RESULTS

In most cases of intact pulmonary hydatid cysts, the lesions were either incidental findings or the patient had presented with cough, dyspnea and chest pain. In addition to these symptoms, the patients with complicated cyst had presented with problems such as expectoration of cystic contents, repetitive hemoptysis, productive sputum, and fever. The differences between the groups with respect to the rates of preoperative complications and postoperative morbidity, frequency of decortication, and hospital stay were statistically significant (p < 0.05).

CONCLUSIONS

Surgery is the primary mode of treatment for patients with pulmonary hydatid disease. Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases. This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis.

[Seroprevalence of infection due to Echinococcus granulosus in the population of Castilla and León (Spain)]

INTRODUCTION

Human hydatidosis is a prevalent zoonotic disease in the Castilla y León region of Spain. The aim of this study is to investigate the seroprevalence of Echinococcus granulosus infection in this region.

METHODS

We studied 4824 serum samples from a random, representative population of healthy individuals from each province of Castilla y León, obtained over one year. An indirect enzyme-immunoassay developed in our laboratory was used to determine the presence of IgG antibodies against Echinococcus granulosus in these samples.

RESULTS

IgG antibodies against Echinococcus granulosus were detected in 3.4% (164/4824) of samples studied, with a range of 1.26% to 7.10%, depending on the province. Antibody seroprevalence increased significantly with age, but there was no significant sex-related difference (3.66% men vs. 3.14% women).

CONCLUSION

The seroprevalence of Echinococcus granulosus infection in Castilla y León is still high. These data contribute to hydatidosis surveillance within the control program for this disease.

Preauricular hydatid cyst: an unusual location for echinoccosis

Hydatid disease is an important medical problem in countries of the temperate zones. A 21-year-old female patient was admitted to our outpatient clinics with a complaint of a progressive swelling in the left preauricular region. The case of the patient with hydatid disease that developed in the left preauricular region is presented in detail. Hydatid cyst in this location is rare.

Echinococcus granulosus infection: clinical presentation, medical treatment and outcome

BACKGROUND

Chemotherapy of cystic echinococcosis became a treatment option 25 years ago, when new anthelminthic drugs were introduced. Benzimidazole carbamates were shown to kill the entire metacestode stage of the parasite, and praziquantel exhibited an effect on protoscoleces. Continuous or intermittent treatment with albendazole is recommended for a period of up to 6 months, and praziquantel may enhance the effect, in particular in the case of cyst spillage. Degenerative changes in the cysts occur in approximately 75% of the patients by the end of the treatment period. Benzimidazoles have to be applied in high daily doses, and adverse effects are observed, such as leucopenia, elevation of liver transaminases, and alopecia. Unfortunately, prospective randomized trials on the efficacy of chemotherapy versus surgery are not available. New treatment methods, such as percutaneous puncture, aspiration, injection of scolicidal agents and re-aspiration (PAIR) or modified PAIR-based techniques, have received much attention, and in experienced hands these approaches yield rates of cure and relapse equivalent to those following surgery. Adjunct treatment with benzimidazoles is the cornerstone of the interdisciplinary approach in cystic echinococcosis.

CONCLUSION

The recent ultrasound WHO consensus classification of hepatic cysts is a major achievement, since on the basis of this classification prospective clinical trials can be initiated. The results of such studies may provide the basis for a stage-specific appropriate medical, interventional or surgical therapy, or even guide the clinicians to opt for 'watch and wait' by close observation without specific treatment.

Single-stage transthoracic approach for right lung and liver hydatid disease

OBJECTIVE

Human echinococcosis remains a serious health problem for the Mediterranean countries. Synchronous pulmonary and hepatic hydatid disease may occur in 4% to 25% of cases. Our experience on simultaneous surgical treatment of right lung and liver hydatid disease in patients was reviewed.

METHODS

Between 1990 and 2000, 48 patients (33 female patients and 15 male patients) with synchronous right lung and liver dome hydatid cysts were operated with a 1-stage procedure.

RESULTS

Six patients had previous surgical treatment of hepatic (n = 2) or pulmonary (n = 4) hydatid cyst. The pulmonary cysts were diagnosed with radiography in 18 patients and thoracic computed tomography scan in 30. The pulmonary cysts of 9 patients were bilateral. Seventy-five pulmonary cysts were seen in radiological examinations. The diagnosis of hepatic cysts was established with ultrasonography in 18 patients and upper abdominal computed tomography in 30. The total number of hepatic cysts was 48. In cases with pulmonary cysts, cystotomy and capitonnage were performed in 32 patients, only cystotomy was done in 14 patients, and wedge resection was performed in 2. Liver cysts were approached to transdiaphragmatically after the lung cysts had been dealt with and were managed with evacuation of the cysts. In the remaining cases, marsupialization (n = 2), pericystectomy (n = 1), and enucleation (n = 1) were performed. Major postoperative complications were hemorrhage (n = 1) and biliocutaneous fistula (n = 1). Hepatic recurrence was seen in 3 patients (6.2%) and pulmonary recurrence in 1 (2.1%).

CONCLUSION

Transthoracic approach is a useful and a safe surgical management of both pulmonary and upper surface of hepatic hydatid cysts.

Chest wall hydatidosis as the unique location of the disease: Case report and review of the literature

The chest wall is a rare location of secondary hydatidosis, but secondary hydatidosis may occur from the rupture of a lung cyst, from a liver cyst invading the diaphragm into the pleural cavity, following previous thoracic surgery for hydatidosis, or by hematogenous spread. This report describes a case of chest wall hydatidosis, which was the primary disease site in the patient, who had no previous history or current disease (hydatidosis) at other sites. The cyst invaded and partially destroyed the 9th and 10th ribs and the 10th thoracic vertebra, and protruded outside the pleural cavity through the 9th intercostal space. Preoperative albendazole administration for 10 days, surgical resection of the disease through a posterolateral thoracotomy incision, and postoperative albendazole treatment resulted in a cure with no evidence of local recurrence or disease at other sites in four years of follow-up.

Endemic infectious diseases of Afghanistan

The current crisis in Afghanistan has resulted in an influx of Western military personnel, peacekeepers, humanitarian workers, and journalists. At the same time, unprecedented numbers of internally displaced persons and refugees have overwhelmed much of the already fragile infrastructure, setting the stage for outbreaks of infectious diseases among both foreigners and local populations. This review surveys the literature concerning the infectious diseases of Afghanistan and south-central Asia, with particular emphasis on diseases not typically seen in the Western world.

Hydatid lung disease (echinococcosis/hydatidosis)

Two Echinococcus species may exhibit medical relevance as causative agents of pulmonary forms of echinococcosis. Most importantly, infections with Echinococcus granulosus result in "cystic hydatid disease" or "cystic echinococcosis," which affects the lungs in a considerable ratio of cases. Echinococcus multilocularis, which causes "alveolar echinococcosis," affects the lungs relatively rarely and then usually upon metastasizing from primary hepatic lesions. Cystic echinococcus and alveolar echinococcus differ pathologically and clinically so greatly that they are considered separately in this article, although alveolar echinococcus is covered minimally because of its minor importance regarding lung infections.

Pulmonary hydatid and other lung parasitic infections

The lung may be infested by a great number of parasites. Hydatidosis is the most frequent parasitic lung disease. Diagnosis of lung hydatidosis is usually easy on chest radiography, ultrasonography, and CT scan, and immunodiagnosis may help in dubious cases. Surgery is necessary in most cases, but it must be conservative. Complex forms, such as disseminated disease and secondary lung hydatidosis (metastatic or bronchogenic) are difficult to treat and may be considered malignant. Medical treatment may be helpful in complex forms, in poor surgical risk patients, and in cases of preoperative spillage of hydatic fluid. Prevention programs are necessary in endemic areas, and research must be directed toward vaccination against the parasite. Other parasitic diseases are reported less frequently in the literature, and the majority of published articles are either case reports or only report a small number of cases. Clinical presentation is variable according to the great variety of parasites that may involve the lungs.