Tropical Parasitology

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

Pulmonary cystic echinococcosis: A case report from tertiary care hospital


Sheetal Bankar1, Phudang Rebon Tokbipi2, Isha Ranwadkar3, Jayanthi Shastri4,  
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

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

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.



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;10:163-164


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 Apr 17 ];10:163-164
Available from: https://www.tropicalparasitology.org/text.asp?2020/10/2/163/307786


Full Text



 Introduction



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



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



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



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.

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