|Year : 2015 | Volume
| Issue : 2 | Page : 118-119
Pulmonary hydatidosis from Southern Argentina
Claudia Irene Menghi, Liliana Eugenia Arias, Carla Pia Puzzio, Claudia Liliana Gatta
Department of Clinical Biochemistry, Clinical Microbiology, Clinical Parasitology, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
|Date of Web Publication||10-Aug-2015|
Claudia Irene Menghi
Department of Clinical Biochemistry, Clinical Microbiology, Clinical Parasitology, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires
| Abstract|| |
Hydatidosis or cystic echinococcosis is a zoonosis caused by the larval stage of the cestode Echinococcus. Even though different measures are taken including the use of a vaccine in livestock to stop transmission, the continuous diagnoses of cases, mainly of liver and pulmonary hydatidosis, show the failure of the control programs for hydatidosis in our country. A clinical case of pulmonary hydatidosis in a patient from a rural endemic area in Southern Argentina is described.
Keywords: Argentina, cystic echinococcosis, hydatid cyst, pulmonary hydatidosis
|How to cite this article:|
Menghi CI, Arias LE, Puzzio CP, Gatta CL. Pulmonary hydatidosis from Southern Argentina. Trop Parasitol 2015;5:118-9
| Introduction|| |
Hydatidosis or cystic echinococcosis is a zoonosis caused by the larval stage of the cestode Echinococcus. Definitive hosts are dogs and other wild canids such as foxes or jackals where the adult stage develops. The larval stage develops in the intermediate hosts mainly sheep, goats, pigs and cattle. Man becomes infected upon ingesting eggs of Echinococcus spp. by means of contact with soil, water and contaminated vegetables, or by closed contact with parasitized dogs.  The liver and lungs are the most frequently involved organs of the disease. The incidence of simultaneous liver and lung involvement has been reported to be between 5.8% and 13.3%.  The frequency of detection of these cases in our country highlights the failure of the different control programs for hydatidosis.
In Argentina, cystic echinococcosis is widespread and some areas are considered endemic.  A clinical case of pulmonary hydatidosis in a patient from a rural endemic area in Southern Argentina is described.
| Case report|| |
A 59-year-old male patient, nonsmoker, working in a rural area in Rio Gallegos, province of Santa Cruz, attended the Emergency Department of a Hospital in Buenos Aires because of a localized pain on the right side of the thorax. A chest X-ray exam was performed and a 10 cm diameter right-side-mass partially occupying the mediastinum was observed. This mass extended towards the lung field and posterior mediastinum adjacent to the esophagus without a cleavage plane and displacing it towards the contralateral side. A cystic-like mass with internal solid components was observed. Based on these findings, a pulmonary cyst was diagnosed, a cystectomy was performed and treatment with albendazole 300 mg every 12 h was administered.
A computed tomography scanning with contrast of the chest, abdomen and pelvis was performed. In the paravertebral area of the right-upper side thorax, a lobulated 6.7 cm × 11.0 cm mass with internal vesicles was observed. Such features were compatible with the presence of a hydatid cyst. It presented a parietal calcification, and extended towards the medial mediastinum pressing and displacing the esophagus. A lysis area in the fourth posterior adjacent costal arc together with a mass that extended inside the vertebral column compressing the bone marrow was observed.
Based on the previous findings, a magnetic resonance imaging (MRI) scan was suggested. Three single cysts were observed in the liver, the biggest of them with a size of 2 cm × 2 cm.
An extra-pulmonary mass of paravertebral localization in the upper right thorax was confirmed by a chest MRI scan. Internal cystic vesicle-like images were observed.
The serologic techniques used detect anti-Echinococcus granulosus IgG. For the serologic diagnosis hydatid cyst fluid was used as the antigen. No antigen detection was performed.
Enzyme-linked immunosorbent assay (ELISA) with a two-graphic, receiver operator characteristic (TG-ROC) analysis was 0.498 with a positive Western Blotting. The ELISA with the TG-ROC method presents a sensitivity-specificity of 98.9%. The WB used has a sensitivity of 91.30% (90.17-92.44%) and specificity of 95.45% (94.86-96.05%). The microscopical examination of the fluid obtained by puncture of the extracted cyst showed the presence of the characteristic hooks and protoescolices of Echinococcus. Regarding the hook sizes (mean: 22.8 μm), a E. granulosus infection was diagnosed [Figure 1]. 
| Discussion|| |
Hydatidosis is a cosmopolitan infection and cases have been registered in every continent. The areas with greater prevalence are Europe and Asia (Mediterranean Region, Russia and China), North-East of Africa, Australia and South-America. In Argentina, Bolivia, Brazil, Peru and Uruguay, hydatidosis is a major public health problem. In Argentina, a great prevalence is observed in rural cattle-raising areas. One of the main reasons for the endemicity of hydatidosis in certain rural zones depends on the habit of feeding dogs with raw offal from dead animals. In order to control the spreading of the disease, a periodic deparasitation of dogs and the avoidance of feeding them with entrails from dead animals, is recommended. Other control guidelines include an appropriate cleaning of cattle-breeding places. Even though different measures are taken including the use of the EG95 vaccine as an important tool of control, the continuous diagnoses of cases, show the failure of the control programs for hydatidosis in our country. 
In the present case, the patient acquired the infection in an endemic rural zone with intense cattle-raising activity and in contact with infected dogs.
| References|| |
Schantz PM, Kern P, Brunetti E. Echinococcosis. In: Guerrant RL, Walker DH, Weller PF, editors. Tropical Infectious Diseases. Principles, Pathogens and Practice. 3 rd
ed. USA: Saunders, Elsevier; 2011. p. 824-38.
Tor M, Atasalihi A, Altuntas N, Sulu E, Senol T, Kir A, et al.
Review of cases with cystic hydatid lung disease in a tertiary referral hospital located in an endemic region: A 10 years' experience. Respiration 2000;67:539-42.
Dopchiz MC, Albani C, Riva E, Elissondo MC, Lavallen CM, Denegri G. Epidemiology and approach treatment of human cystic echinococcosis: Case series. Rev Ibero Latinoam Parasitol 2011;70:74-84.
D'Alessandro A, Rausch RL. New aspects of neotropical polycystic (Echinococcus vogeli
) and unicystic (Echinococcus oligarthrus
) echinococcosis. Clin Microbiol Rev 2008;21:380-401.
Lightowlers MW, Lawrence SB, Gauci CG, Young J, Ralston MJ, Maas D, et al.
Vaccination against hydatidosis using a defined recombinant antigen. Parasite Immunol 1996;18:457-62.