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Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 163-164  

Pulmonary cystic echinococcosis: A case report from tertiary care hospital


1 Department of Microbiology, Orchid Medical Centre, Ranchi, Jharkhand, India
2 Department of Microbiology, GNRC, Dispur, Guwahati, India
3 Department of Microbiology, Topiwala National Medical College, Mumbai, Maharashtra, India
4 Department of Microbiology, Topiwala National Medical College and B.Y.L. Nair Ch. Hospital, Mumbai, Maharashtra, India

Date of Submission04-Jan-2020
Date of Decision11-Feb-2020
Date of Acceptance23-Mar-2020
Date of Web Publication23-Jan-2021

Correspondence Address:
Phudang Rebon Tokbipi
Flat No. 301, Rajdhani Apartment, Christian Basti, Near Dispur Baptist Church, Guwahati - 781 005, Assam
India
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DOI: 10.4103/tp.TP_3_20

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   Abstract 


Human echinococcosis is a zoonotic infection transmitted by dogs in livestock-raising areas. We present a case of a 30-year-old female with respiratory symptoms.

Keywords: Brood capsule, Echinococcus, hydatid disease, scolex


How to cite this article:
Bankar S, Tokbipi PR, Ranwadkar I, Shastri J. Pulmonary cystic echinococcosis: A case report from tertiary care hospital. Trop Parasitol 2020;10:163-4

How to cite this URL:
Bankar S, Tokbipi PR, Ranwadkar I, Shastri J. Pulmonary cystic echinococcosis: A case report from tertiary care hospital. Trop Parasitol [serial online] 2020 [cited 2021 May 14];10:163-4. Available from: https://www.tropicalparasitology.org/text.asp?2020/10/2/163/307786




   Introduction Top


Human echinococcosis is caused by larval forms (metacestodes) of the tapeworm of the genus Echinococcus. Human infection is acquired from ingestion of the parasite eggs from infected animals. Echinococcus granulosus causes cystic echinococcosis in humans. This relatively benign parasitic disease is characterized by slowly growing cysts most commonly in the liver (accounting for 50%–70% of cases), followed by the lungs (20%–30%), and less frequently the spleen, kidneys, heart, bones, central nervous system, and other organs.[1] In India, the highest prevalence is reported in Andhra Pradesh and Tamil Nadu than in other parts of the country.[2] Since there is a scarcity of reports on pulmonary echinococcosis from the Western part of the country, this case report is presented.


   Case Report Top


A 30-year-old female presented with cough and mucous expectoration, mild fever, and dyspnea on exertion for 2 months in June 2015. On clinical examination, chest movements and breath sounds were decreased on the right side. Chest X-ray revealed homogenous opacity in the right mid and lower zone. Computed tomography (CT) scan of the chest showed a thick-walled, unilocular, fluid-filled cystic lesion in the superior part of the right lower lobe of dimension 5.8 cm × 6.5 cm × 7.1 cm with heterogeneous contents, compressing the right lower lobe bronchus. IgG antibodies for Echinococcus granulosus were positive. Bronchoscopy showed a sign of white glistening membrane-like structures in the superior segment of the right lower lobe which was aspirated and sent to microbiology laboratory. The specimen was processed in the parasitology division of the department of microbiology. A wet mount of the aspirated fluid showed brood capsules of E. granulosus with scolices [Figure 1]. The cyst was removed surgically, and the patient was started on albendazole (ABZ) 400 mg daily for 6 months.{Figure 1}


   Discussion Top


Majority of the Echinococcus cysts are seen in the liver. Those bypassing the liver are likely to travel through the right side of the heart or lymphatic vessels or bronchi to the lungs.[3]

Clinical presentation of pulmonary hydatid cysts depends on the size of the cyst and whether the cyst is intact or ruptured. The cysts grow at the rate of 1–1.5 cm/year.[4] It may be symptomless for 10–20 years until they become large enough to produce symptoms.[5] In this case, the patient might have acquired the infection in her childhood as she was born in a farmer's family and was in contact with the animals at her native place. As the cysts are slow growing, symptoms developed in adulthood.

A complicated cyst ruptures into a bronchus, pleural cavity, or biliary tree and presents with expectoration of cystic contents, productive cough, repetitive hemoptysis, fever, or anaphylactic shock.[6] Most of the times, only one lobe is involved in 72% of cases, usually at the base of the lung.[7] In this case, the right lower lobe was affected. The primary diagnosis is obtained by X-ray, ultrasonography, and CT scan. Apart from routine tests, serological tests available are ELISA as a screening test and immunoelectrophoresis (IE) as a confirmatory test. An antibody titer >1:160 is usually considered positive. Diagnosis is established if both ELISA and IE are positive. Serology may be negative in 10%–15% of cases, especially in well-encapsulated cysts. The sensitivity of serological tests for liver cysts is 80%–90% and specificity is 88%–96%. For pulmonary cysts, sensitivity is only 50%–60%. IgG4 response is more pronounced than that of IgG1.[8]

The mainstay of the treatment is surgery. In our case, a complete excision of the cyst was performed. According to the WHO guidelines, benzimidazole is the preferred treatment when surgery is not available. Medical treatment includes long courses of ABZ given 400 mg twice a day.[9]

In order to minimize the transmission of disease, it is important to educate population in endemic areas about careful washing of hands and foods. The feeding of livestock entrails to dogs is a common starting point for the tapeworm life cycle and should be avoided.[10]


   Conclusion Top


Farmers commonly come in contact with animals and might acquire a zoonotic disease. Environmental contamination of soil by dogs' feces might be an important route of transmission in rural community. This case report signifies that pulmonary echinococcosis needs consideration in the differential diagnosis, especially when a patient presents with respiratory symptoms. Such diseases can be prevented by simple hygienic practices such as handwashing and proper washing of food. Educational programs should be initiated early because, presumably, most infections are acquired in childhood.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kammerer WS, Schantz PM. Echinococcal disease. Infect Dis Clin North Am 1993;7:605-18.  Back to cited text no. 1
    
2.
Reddy CR, Narasiah IL, Parvathi G, Rao MS. Epidemiology of hydatid disease in Kurnool. Indian J Med Res 1968;56:1205-20.  Back to cited text no. 2
    
3.
Torgerson PR, Oguljahan B, Muminov AE, Karaeva RR, Kuttubaev OT, Aminjanov M, et al. Present situation of cystic echinococcosis in Central Asia. Parasitol Int 2006;55 Suppl: S207-12.  Back to cited text no. 3
    
4.
Brunetti E. Echinococcosis Hydatid cyst. Available from: http://emedicine.medscape.com/article/216432- overview#a0104. [Last accessed 31 Dec 2019; Last updated on 2018 Dec 05].  Back to cited text no. 4
    
5.
Chrieki M. Echinococcosis – An emerging parasite in the immigrant population. Am Fam Physician 2002;66:817-20.  Back to cited text no. 5
    
6.
Alloubi I. Thoracic Hydatid Cyst: Clinical Presentation, Radiological Features and Surgical Treatment. Available from: https://www.intechopen.com/books/principles-and-practice-of-cardiothoracic-surgery/. [Last accessed 31 Dec 2019; Last updated on 2013 Jun 12].  Back to cited text no. 6
    
7.
Harlaftis NN, Aletras HA, Symbas PN. Hydatid disease of the lung. In: Shields TW. General Thoracic Surgery. Vol 1. 6th edition. Philadelphia, PA: Lippincott Williams and Wilkins; 2005.p. 1298-308.  Back to cited text no. 7
    
8.
Wen H, Craig PS. Immunoglobulin G subclass responses in human cystic and alveolar echinococcosis. Am J Trop Med Hyg 1994;51:741-8.  Back to cited text no. 8
    
9.
Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-6.  Back to cited text no. 9
    
10.
Garcia LS, Bruckner DA. Tissue cestodes: Larval forms. In: Diagnostic Medical Parasitology. 4th ed. Washington, D.C: ASM Press; 2001. p. 387-403.  Back to cited text no. 10
    


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