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Those Dog-Gone Cysts. A Case Study about Echinococcus granulosus by Sarah Wycoff. Patient History. 53-year-old Middle-Eastern female Presented to the hospital Prompt Care Clinic with a severe cough and chest pains Surgeon at another hospital had removed a cyst from her lungs and liver.

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those dog gone cysts

Those Dog-Gone Cysts

A Case Study about Echinococcus granulosus by Sarah Wycoff

patient history
Patient History
  • 53-year-old Middle-Eastern female
  • Presented to the hospital Prompt Care Clinic with a severe cough and chest pains
  • Surgeon at another hospital had removed a cyst from her lungs and liver
questions to consider
Questions to Consider
  • What caused the cysts that were removed?
  • How is this parasite transmitted to humans?
  • How does the lab help in the diagnosis of this parasite?
  • What is the treatment for this parasite?
echinococcus species
Echinococcus Species
  • 3 known species of Echinococcus are medically important
    • Echinococcus granulosus
    • Echinococcus multiocularis
    • Echinococcus vogeli
echinococcus granulosus
Echinococcus granulosus
  • A zoonotic infestation by a tapeworm causing hydatid disease
  • Very rare disease in the continental US (less than 1 case per 1 million inhabitants)
  • Endemic areas include Mediterranean counties, the Middle East, Iceland, Australia, New Zealand
life cycle
Life Cycle
  • Dogs are the definitive hosts
    • Adult worm develops in the small intestine
    • Eggs are voided in the feces of the dogs
  • Sheep are intermediate hosts
  • Humans are accidental intermediate hosts
    • Larval form develops mainly in the liver and lungs
  • The cycle is completed when a dog eats a cyst-infested liver or lungs.
infected dogs
Infected Dogs
  • Small intestine of a dog infected with Echinococcus granulosus
  •  Adult tapeworms are small (2 mm) but they can be very numerous

F. Rochette, 1999, Dog Parasites and Their Control, Janssen Animal Health, B.V.B.A.

adult tapeworm
Adult Tapeworm
  • Body is separated into 3 sections
  • Scolex with nonretractable rostellum armed with double crown of 28-50 hooks
infective stage egg
Infective stage: Egg
  • Found in dog feces
  • Resembles Taenia eggs
metacestode cyst
Metacestode (cyst)
  • Unilocular
  • Sub spherical in shape
  • Fluid-filled
  • Pulmonary cyst are commonly found in the lower lobe on the right side

http://www.biosci.ohio-state.edu/~parasite/echinococcus.html

human host
Human Host
  • Each egg contains an embryo (oncosphere)
  • Eggs hatch in the human stomach and release the oncosphere
  • The oncosphere penetrate the intestinal lining and enter the blood stream
  • Travel to any organ, usually lung and liver, and a cyst develops
cyst stage in humans
Cyst stage in Humans

The cyst consists of a thick outer layer (*), several thinner internal layers, and many protoscolices. The protoscolices are often called "hydatid sand."

A single protoscolex.

“Hooks” can be seen that will form the hooks associated with the adult worm's rostellum

http://www.biosci.ohio-state.edu/~parasite/echinococcus.html

symptoms
Symptoms
  • Vary by size and site of cyst
  • Usually no symptoms until cyst becomes enlarged
  • Liver: jaundice, portal hypertension, pain
  • Lung: coughing, shortness of breath, chest pain
  • Brain: seizures, paralysis
  • Rupture of cyst: anaphylactic shock, spread of scolices, death
diagnosis
Diagnosis
  • Radiographic images of lungs and liver
  • Examination of sputum or bronchial washes
    • Protoscolices
    • Membranes
    • Hooklets
  • Serologic test
    • Increase sensitivity if liver and lungs are infected
morbidity
Morbidity
  • Free rupture of echinococcal cyst (with or without anaphylaxis)
  • Infection of the cyst
  • Dysfunction of the affected organs
    • Biliary obstruction
    • Cirrhosis
    • Bronchial obstruction
    • Renal outflow obstruction
treatment
Treatment
  • Surgery
    • Risks of operative morbidity, recurrence of cyst, anaphylaxis or dissemination of the infection
  • Drugs
    • Albendazole, mebendazole or praziquantal
summary
Summary
  • Patient has hydatid disease caused by Echinococcus granulosus
  • Patient continuing with oral treatments of albendazole
  • Patient is seen every 3 months by her physician
  • Periodic CT scans are performed on her chest and liver
references
References
  • Dandan, Imad MD. “Hydatid Cyst” November 22, 2002. http://www.emedicine.com/med/topic1046.htm
  • Brunetti, Enrico MD. “Cystic Echinococcosis” March 5, 2004

http://www.emedicine.com/med/topic629.htm

  • http://www.biosci.ohiostate.edu/~parasite/echinococcus.html
credits
Credits

This case study was

prepared by

Sarah Wycoff, MT(ASCP)

while she was a

Medical Technology student in the

2004 Medical Technology Class at

William Beaumont Hospital in

Royal Oak, MI.