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Hydatid Cyst - Signs, Symptoms, Diagnosis, and Treatment

Published on Aug 05, 2022 and last reviewed on Aug 08, 2022   -  5 min read

Abstract

Hydatid cysts are the most common cyst in the lungs and the liver. Read the article below to know more about them.

Introduction:

A cyst is an abnormal sac of membranous tissue filled with fluid, semi-solid substances, or air; mostly benign, sometimes cancerous, and causes pain. There are many different types of cysts; they can grow in any part of the body. Most cysts do not cause any problems and fade away on their own. Some do cause pain, turn cancerous, and get infected and inflamed.

What Is a Hydatid Cyst?

It is a disease that is transmitted to humans from animals, known as a zoonotic disease. Hydatid condition is a parasitic infestation by a tapeworm of the genus Echinococcus. This condition is also known as hydatidosis or echinococcosis. This condition is potentially serious and can sometimes be fatal, caused by hydatid cysts that contain the larval stages of the echinococcus granulosus tapeworm. Adult E. granulosus tapeworms are found in the feces of infected dogs and other canines, and the eggs of tapeworms are shed in the feces. The individuals get infected by ingesting these tapeworm eggs, which may occur through hand-to-mouth transfer after handling dogs or consuming contaminated food and water or objects which are contaminated.

Hydatid cysts usually affect the liver, around 50 to 70 %, and less frequently affect the lungs, spleen, bones, kidneys, and brain. Liver hydatidosis can cause dissemination or anaphylaxis after the rupture of a cyst into the peritoneum or biliary tract. This infection due to cysts can lead to the development of liver abscesses and local mechanical complications, like in bile ducts and vessels that can induce cholestasis (decrease bile flow due to obstruction), portal hypertension (increase in pressure in portal vein due to restricted blood flow), and Budd-Chiari syndrome (blocked and narrowing of hepatic veins).

How Is Hydatid Cyst Transmitted?

It is a zoonotic disease transmitted from animals to humans. It is transmitted from infected dogs and canine feces; they can survive in soil and gardens for several months. Animals like sheep, cattle, pigs, horses, goats, and kangaroos can be infected by eating contaminated grass with dog feces. Hydatid cysts may form in the meat of these animals, and when the dogs eat these infected animals’ uncooked meat, the cycle gets completed. Dogs start passing eggs in feces is about five to seven weeks after they are infected. The only way of infection in humans is by eating eggs or coming in contact with the contaminated eggs of infected dogs or canines. Hydatid cyst disease is not transmitted from human to human or by a person eating the meat of an infected animal.

Who Is at More Risk of Getting Infected with Hydatid Cyst?

This disease is mostly found in people who raise sheep and cattle. Young children are more at risk of getting infected with tapeworm eggs, but symptoms do not appear for many years.

What Are the Signs and Symptoms of Hydatid Cyst?

Hydatid cyst grow to the extent that triggers clinical signs. Some of them are:

How Is Hydatid Cyst Diagnosed?

The diagnosis of hydatid cyst done with the help of following investigations:

  • Ultrasonography is an imaging technique used for diagnosis that is usually complemented by a CT (computed tomography) scan or an MRI (magnetic resonance imaging).

  • Cysts can be incidentally discovered by radiography.

  • A serologicaltest is done to detect specific antibodies.

  • Early detection of E. granulosus and E. multilocularis infection can lower the risk of a hydatid cyst.

What Are the Complications of a Hydatid Cyst?

Hydatid cysts can cause complications in about 40 % of cases. The most common complications are:

  • Infection - It is the most common complication and is mostly asymptomatic. An infected hydatid cyst is usually latent, subacute, and clinically shown by pain in the right hypochondrium, fever, and hepatomegaly (enlarged liver).

  • Intrabiliary Rupture of Hydatid Cyst - Common complications that can occur in 10 to 37 % of cases. This rupture may lead to other biliary complications like cholangitis (inflammation of bile ducts), sclerosis oddities (potentially disabling disease of the brain and spinal cord), and hydatid lithiasis (hydatid cyst in the kidney).

  • Rupture of the Thorax - Intrathoracic rupture of hepatic hydatid cyst is rare but a severe complication causing lesions to pleura, lung parenchyma, and bronchi can occur.

  • Rupture of the Peritoneum - Rare and generally followed by anaphylactic reactions. This rupture may present acute abdominal pain, nausea, vomiting, and urticaria (hives, redness, and itchiness of the skin).

  • Other Complications - These include portal hypertension, vascular erosions, and acute abdominal pains with a sudden decrease in the volume of the cyst.

What Is the Treatment Provided For Hydatid Cyst?

Surgical Treatment is the best treatment provided for hydatid disease. The main aim of surgery is to inactivate the parasite and evacuate the cyst. It can be successfully performed in 90 % of cases. But, these surgeries can be impractical in patients with multiple cysts. Chemotherapy comes into the picture in such cases - the PAIR (puncture-aspiration-injection-respiration) technique is an alternative method.

The surgical techniques are widely divided as -

  1. Conservative Technique: It is safe and technically simple. Marsupialization is the most common procedure used here. The main disadvantage is the frequency of postoperative complications like bile leak, bilomas, and bile peritonitis.

  2. Radical Technique: This technique includes the following procedures -

  • Cystectomy: The procedure is simple and has a low recurrence rate. It involves the removal of a hydatid cyst, comprising the laminar germinal layer and cyst contents.

  • Pericystectomy: This is technically a more difficult procedure than cystectomy and has considerable blood loss. It involves non-anatomical resection of cysts and surrounding compressed liver. This can also be hazardous in the case of large, complicated cysts.

  • Hepatic resections: This is the primary modality of the treatment.

Laparoscopic Management: Surgery using a minimally invasive approach is done. A special instrument perforator-grinder-aspirator apparatus is used for the removal of the hydatid cyst with a laparoscope. The laparoscopic technique has some more advantages than open surgery. It gives better visual control of cysts under magnification and better detection of biliary fistula. It provides a shorter stay in the hospital and faster surgery completion.

Endoscopic Management of Hydatid Cyst: This is useful in the presence of intra-biliary rupture. During this biliary tree, it is cleared of any hydatid cyst and fluid with a balloon catheter. The endoscopic sphincterotomy is performed to facilitate drainage of the common bile duct.

Chemotherapy: Medical treatment of this cyst primarily was induced by benzimidazole carbamates like Mebendazole and Albendazole. This was mainly used in inoperable cases or combined with surgery to prevent post-operative occurrence.

What Are the Preventive Measures Taken to Prevent Hydatid Cyst?

The preventive measures taken to prevent hydatid cyst are:

  • Wash hands before eating or consuming anything orally, like smoking.

  • Wash hands thoroughly after handling dogs, soil, or places that may be infected by dog feces.

  • Do not encourage the dog to lick your face or kiss your dog.

  • Prevent dogs from littering around farm areas and cattle grazing areas, and children's parks.

  • Keep a check on the dog's eating habits, and avoid giving uncooked meat.

  • Take advice from the veteran to avoid infections in dogs and get your pets a timely vaccination and check on any change or infection.

  • Focus on deworming the dogs regularly.

Conclusion:

Hydatid disease is an endemic disease in many countries. It is most common in grazing countries. It is a serious but treatable infection in some cases. The liver is most commonly affected by this cyst (75 %), lungs (15 %), spleen around 5 %, and other organs around 5 %. Though surgery remains a gold-mark treatment in the case of hydatid disease, PAIR is a valuable alternative surgery for selected patients. Drugs that kill tapeworms are also used. In some cases, they are used by injecting the drug into the cyst. No treatment is needed in a few cases; the infected individual needs to be monitored by the physician at regular intervals.

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Frequently Asked Questions


1.

What Symptoms Does Hydatid Cyst Possess?

Hydatid cysts present with:
Bloody stools.
Discomfort in the abdomen and chest.
Jaundice.
Coughing.
Lump in the midsection of the body.
Skin rashes.
Nausea and vomiting.
Sudden weight loss.
Breathing difficulties.

2.

How Do People Get Hydatid Disease?

Humans get infected with hydatid when they swallow tapeworm eggs. This can happen by touching a dog and then placing that unwashed hand into a person's mouth, through contact with contaminated soil, by kissing a dog, or by consuming water or food contaminated with dog feces containing tapeworm eggs.

3.

What Happens if Hydatid Cysts Rupture?

If a hydatid cyst ruptures into the peritoneal cavity, it can lead to several complications, including urticaria, abdominal pain, anaphylaxis, and sudden death. So, hydatid cyst rupture needs emergency surgery and cautious postoperative care.

4.

What Are the Possible Locations of Hydatid Cysts in Humans?

Hydatid cysts commonly form in the liver and lungs. However, they may also occur in other organs, muscles, and bones. These cysts can increase in size to 5 to 10 cm or more and can survive for decades in the human body.

5.

How Long Does It Take for the Formation of Hydatid Cysts?

After ingestion, the protoscolices (parasite larvae that develop into adult worms) get attached to the intestinal mucosa and mature and form into a cyst in 32 to 80 days.

6.

What Is Known as the Hydatid Cyst of the Liver?

The hydatid disease is caused by the larvae of Echinococcus granulosus. It is a serious disease that can even cause death. These parasites can form cysts anywhere in the body, mainly found in the liver (about 75% of the cases), and remain asymptomatic in most cases.

7.

How Do Hydatid Cysts Develop in Humans?

Hydatid disease, also called hydatidosis or cystic echinococcosis, causes the development of cysts in the liver or other organs. These cysts can lead to serious health complications if proper treatment is not provided.

8.

Which Parasite Causes Hydatid Disease?

Hydatid disease is a parasitic disease that occurs when infected by tiny tapeworms of the genus Echinococcus.

9.

How Does a Person Get a Hydatid Cyst?

Hydatid cysts spread when a human gets in contact with dog feces infected with tapeworm eggs. This can lead to cysts formation in vital organs such as the lungs and liver.

10.

Which Is the Most Effective Drug for Hydatid Cysts?

Benzimidazole carbamates are effective against parasites that cause hydatid disease. However, Mebendazole has shown some beneficial effects in selective patients. Albendazole, a recently developed benzimidazole, is more effective than Mebendazole.

11.

Which Surgical Procedure Is Performed for Hydatid Disease?

Total or partial pericystectomy and hepatic resection surgery are recommended for hydatid disease. Surgical therapy in hydatid disease is indicated for large cysts, superficially located liver cysts that have a risk of rupture, and complicated cysts such as infection, compression, or obstruction in the cyst. However, surgical therapy has a high risk of mortality and recurrence.

12.

What Are the Complications of Hydatid Disease?

The cysts can grow large and prevent the affected organs from working properly. They can also rupture, leading to life-threatening complications. The signs of ruptured hydatid cysts are anaphylaxis, severe abdominal pain, and sudden death.

13.

What Is the Common Therapy for Hydatid Disease Treatment?

Percutaneous drainage with Albendazole therapy is a commonly used treatment against hydatid cysts. It is a safe and effective alternative treatment for hydatid cysts of the liver.

Last reviewed at:
08 Aug 2022  -  5 min read

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