Polycystic Echinococcosis
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Image of the Month Polycystic Echinococcosis ARTURO ZEGARRA,* JAIME CÁCERES, ‡ and ALEJANDRO PISCOYA* *Division of Gastroenterology and ‡ Department of Pathology, Hospital Cayetano Heredia, Lima, Peru A 43-year-old man from a jungle in Peru, who worked as a farmer and hunted wild animals, presented with a 4-month history of tenderness in the right upper quadrant of the abdomen and moderate weight loss. Physical examination revealed a painful hepatomegaly. Computed tomography of the abdomen (Figure A) showed multiple cystic lesions with thick walls that replaced most of the right hepatic parenchyma. Western blot was positive for hydatid cyst. With this diagno- sis the patient was scheduled for partial hepatectomy. During surgery, there was massive bleeding causing hemodynamic in- stability and death in a matter of hours. Despite the bleeding, part of the liver with the cystic lesion was excised (Figure B), showing multiple cysts. Histology examination revealed cyst layers and hooks from protoscoleces (Figure C). The diagnosis of Echinococcus vogeli was performed because of the size of the hooks. 3 Polycystic echinococcosis is a zoonosis, 1,2 present in the tropic areas of South America. 3 The agent is a parasite known as E vogeli. The life cycle of this parasite includes the bush dog and some wild mammals as definitive hosts; human beings are incidental hosts. The largest series published was of 59 patients with polycystic echinococcosis, 3 with the liver as the most frequently involved organ. The diagnosis is performed by en- zyme-linked immunosorbent assay (high sensitivity) and West- ern blot (high specificity). 3 It can be distinguished from other species for the size and shape of the hooks of protoscolex. In some species such as E granulosus the longest hook size is up to 20 m, but in E vogeli it is almost twice as big. 3 The manage- ment is controversial; there are reports of mortality of around 22% with surgical management and a survival rate of only 40% with albendazole at 1.5 years. 3 Unfortunately for our patient, the severe liver involvement contributed to the poor prognosis. References 1. Tappe D, Stich A, Frosch M. Emergence of polycystic neotropical echinococcosis. Emerg Infect Dis 2008;14:292–297. 2. Craig PS, McManus DP, Lightowlers MW, et al. Prevention and control of cystic echinococcosis. Lancet Infect Dis 2007;7:385–394. 3. D’Alessandro A, Rausch RL. New aspects of Neotropical Polycystic (E. vogeli) and unicystic (E. oligarthrus) echinococcosis. Clin Mi- crobiol Rev 2008;21:380 – 401. Conflicts of interest The authors disclose no conflicts. © 2010 by the AGA Institute 1542-3565/$36.00 doi:10.1016/j.cgh.2010.03.018 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:e106
Transcript of Polycystic Echinococcosis
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mage of the Month
olycystic Echinococcosis
RTURO ZEGARRA,* JAIME CÁCERES,‡ and ALEJANDRO PISCOYA*
Division of Gastroenterology and ‡Department of Pathology, Hospital Cayetano Heredia, Lima, Peru
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43-year-old man from a jungle in Peru, who worked as afarmer and hunted wild animals, presented with a
-month history of tenderness in the right upper quadrant ofhe abdomen and moderate weight loss. Physical examinationevealed a painful hepatomegaly. Computed tomography of thebdomen (Figure A) showed multiple cystic lesions with thickalls that replaced most of the right hepatic parenchyma.Western blot was positive for hydatid cyst. With this diagno-
is the patient was scheduled for partial hepatectomy. Duringurgery, there was massive bleeding causing hemodynamic in-tability and death in a matter of hours. Despite the bleeding,art of the liver with the cystic lesion was excised (Figure B),howing multiple cysts. Histology examination revealed cystayers and hooks from protoscoleces (Figure C). The diagnosisf Echinococcus vogeli was performed because of the size of theooks.3
Polycystic echinococcosis is a zoonosis,1,2 present in theropic areas of South America.3 The agent is a parasite knowns E vogeli. The life cycle of this parasite includes the bush dognd some wild mammals as definitive hosts; human beings arencidental hosts. The largest series published was of 59 patientsith polycystic echinococcosis,3 with the liver as the most
requently involved organ. The diagnosis is performed by en-yme-linked immunosorbent assay (high sensitivity) and West-rn blot (high specificity).3 It can be distinguished from otherpecies for the size and shape of the hooks of protoscolex. Inome species such as E granulosus the longest hook size is up to0 �m, but in E vogeli it is almost twice as big.3 The manage-ent is controversial; there are reports of mortality of around
2% with surgical management and a survival rate of only 40%ith albendazole at 1.5 years.3 Unfortunately for our patient,
he severe liver involvement contributed to the poor prognosis.
References. Tappe D, Stich A, Frosch M. Emergence of polycystic neotropical
echinococcosis. Emerg Infect Dis 2008;14:292–297.
. Craig PS, McManus DP, Lightowlers MW, et al. Prevention and controlof cystic echinococcosis. Lancet Infect Dis 2007;7:385–394.
. D’Alessandro A, Rausch RL. New aspects of Neotropical Polycystic(E. vogeli) and unicystic (E. oligarthrus) echinococcosis. Clin Mi-crobiol Rev 2008;21:380–401.
onflicts of interestThe authors disclose no conflicts.
© 2010 by the AGA Institute1542-3565/$36.00
doi:10.1016/j.cgh.2010.03.018
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:e106
