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Those Dog-Gone Cysts

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

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  1. Those Dog-Gone Cysts A Case Study about Echinococcus granulosus by Sarah Wycoff

  2. 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

  3. 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?

  4. Echinococcus Species • 3 known species of Echinococcus are medically important • Echinococcus granulosus • Echinococcus multiocularis • Echinococcus vogeli

  5. 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

  6. 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.

  7. Life Cycle

  8. 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.

  9. Adult Tapeworm • Body is separated into 3 sections • Scolex with nonretractable rostellum armed with double crown of 28-50 hooks

  10. Infective stage: Egg • Found in dog feces • Resembles Taenia eggs

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. Treatment • Surgery • Risks of operative morbidity, recurrence of cyst, anaphylaxis or dissemination of the infection • Drugs • Albendazole, mebendazole or praziquantal

  18. 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

  19. 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

  20. 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.

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