1- Echinococcosis & Hydatidosis

• What is Echinococcosis?
is the infection of canids’ small intestine with
adult tape worm:
• 1-Echinococcus granulosus
• 2- Echinococcus multilocularis
• 3- Echinococcus vogeli
 What is Cystic Echinococcosis ( Hydatidosis) ?

infection of tissue of man and intermediate host with the

larval stage of Echinococcus granulosus (hydatid cyst)
 What is Alveolar Echinococcosis?

• is the infection of tissue of man & other IH with

the larval stage of Echinococcus multilocularis
• A highly invasive disease and destructive form of
echinococcosis
• causes solid , tumor-like metastatic masses and is
commonly confused with hepatic cirrhosis or
carcinoma
What is polycystic echinococcosis (polycystic Hydatidosis)?

• Is the infection of tissue of man & other

intermediate hosts with the larval stage of
Echinococcus vogeli
• It has the characteristics of cystic and
alveolar disease.
 Aetiology

• Larva(metacestode) of :
• 1-Echinococcus granulosus
• 2- Echinococcus multilocularis
• 3- Echinococcus vogeli
 Hosts of: 1- Echinococcus granulosus

• It is the most common and the most

widespread species
• Definitive host: Adult (Dwarf dog tape worm 3-
7 mm) in the intestine of dingo- wolf-coyote-
jackals- domestic dogs.
• African lion is the only susceptible host among
feline spp.
• Intermediate host:*sheep, goat, pigs, water
buffalo, cattle, camels, cervids are IH.
Echinococcus granulosus
https://commons.wikimedia.org/wiki/File:Echinococcus_granulosus.JPG
Definitive hosts of Echinococcus granulosus

coyote
dingo

African lion

dog
jackal
Intermediate hosts of Echinococcus granulosus
Ecchinococcus granulosus stages
2- Hosts of Echinococcus multilocularis

• A ~1-4 millimeter long tapeworm found in

foxes, and can occur in domestic dogs, cats
(definitive hosts).
• It is more common in northern latitude
(Alaska)
• Small rodents are intermediate hosts for E.
multilocularis
Ingestion of
contaminated food
& water
2- Echinococcus multilocularis

Fox: Definitive host

Wild Rodent: IH

Rat infected with cyst of Echinococcus multilocularis

http://phil.cdc.gov
3- Hosts of :Echinococcus vogeli

• A 3.9-5.6 millimeter long tapeworm found in

wild and domestic dogs (definitive hosts).
• It occurs in Central and South America
• Wild rodents (Pacas and spiny rats) are
intermediate hosts for E. vogeli.
• Also, non human primates (Gorrilla and
Orangutan) are intermediate hosts
3- Intermediate host of Echinococcus vogeli

Spiny rat Pacas

3- Intermediate host of Echinococcus vogeli

• Gorrilla and Orangutan

 What is the role of man in
echinococcosis?
• Serves as intermediate host (dead end
host)
 Clinical signs

• When the intermediate host ingests the eggs of the

tapeworm, the hexacanth embryos are released , penetrate
intestinal wall and carried in blood or lymph to target organs
and the parasite develops into cysts.
• The incubation period of cystic echinococcosis is often
prolonged for several years and most cases of cystic
echinococcosis remain asymptomatic until the cysts become
large enough to cause dysfunction.
 Cystic Echinococcosis

• is the most common (2-3 million cases annually

worldwide), least severe and most treatable form of
disease.
• Diameter of cyst usually increase in length from <
1 cm to 5 cm each year.
• Diameter of cyst 7 cm, can reach up to 20 or 30
cm. Some cysts persist unchanged for years.
 Cystic Echinococcosis

• Size of cyst ranges from pin point to child’s head.

Depending on location, some cysts can become very
large containing up to several liters of fluid.
• Signs differ according to the location of cyst;
• appear in liver, lung, the spleen, kidneys, heart,
bone, and central nervous system, including the
brain and eyes.
 Cystic Echinococcosis

• The cysts are mainly found in the liver (60-

70 %) and lungs (20-25%) but can also
appear in the spleen, kidneys, heart, bone, and
central nervous system, including the brain
and eyes.
 Cystic Echinococcosis

• 1- Liver: Abdominal pain, vomition, nausea,

indigestion, hepatomegaly, liver congestion,
ascitis.
• If cyst obstructs biliary system, it can mimic
gall stone and cause pain or cholestatic jaundice
 Cystic Echinococcosis

• Subcapsular cyst may grow upward and adhere to

diaphragm, cross it and open into thoracic cavity or
it may grow towards peritoneal cavity, where it can
adhere and empty into hollow abdominal viscera.
• These cysts do not metastasize, but they may be
disseminated by accidental spillage. Cyst rupture
is most frequently caused by trauma and may
cause mild to severe anaphylactic shock
 Hydatid cyst of liver

https://radiopaedia.org/cases/hydatid-cyst-of-liver-gross-pathology-1
 Cystic Echinococcosis

• 2- Lung: is usually located in one lung

leading to deformity of thorax, chest pain,
chronic cough, hemoptysis
 An oval-shaped, well-defined and rounded
homogeneous density mass is observed in left lung.

Case contributed by Dr Mohammad Taghi Niknejad

https://radiopaedia.org/cases/pulmonary-
hydatid-cyst-on-x-ray
 Cystic Echinococcosis

• 3- Brain or spinal cord: Seizure and blindness.

• 4-Bone: Spontaneous fracture.
• 5-Heart: Pericardial effusion, arrhythmia and
sudden death
 Alveolar echinococcosis

• Echinococcus multilocularis cyst is almost

always located in liver.
• Large tumors cause hepatomegaly, ascitis
and jaundice.
 Alveolar echinococcosis

• It is very dangerous , not enclosed within a

membrane, invade tissue by budding
outward(progressive and malignant)spread to
nearby organs, metastasize to brain, lung, and
other organs.
 Alveolar echinococcosis

• *Unlike E. granulosus, E. multilocularis

produces many small cysts that spread
throughout the internal organs of the infected
host.
• E. multilocularis cysts resemble tumors:
they are not contained within a capsule and
are very invasive.
 Alveolar echinococcosis

• Size of cyst from 1-3 mm, can reach up to

20-30 mm. It infiltrates the affected organ,
causes destruction of the internal organs
• The cysts can also metastasize to distant sites
such as the central nervous system (CNS), lungs
or bones
• The annual occurrence of cyst: 300 human
cases worldwide.
 Polycystic echinococcosis

• Cyst of E. vogeli:
• Tends to be in liver. Size: 5-6 cm
• Cysts are invasive and spread to nearby
organs and tissue.
• It is caused by formation of numerous
interconnected subdivisions produced by
endogenous proliferation of cystic membrane
 Geographic distribution
• Echinococcus granulosus is worldwide distributed.

• Echinococcus multilocularis is localized in

Northern hemisphere (East and Central Europe,
USSR, Iraq, Turkey, India, Some islands of Japan.
• Echinococcus vogeli is localized in South and
Central America
by Alfonso J. Rodriguez-Morales DOI: 10.5772/60731
 How can human contract hydatidosis?

• The most common mode of transmission to

humans is by the accidental consumption of soil,
water, or food that has been contaminated by the
fecal matter of an infected dog.
• *When dog licks human face
• Flies can disperse tapeworm eggs after they feed
on infected feces
 N.B

• No inter human transmission of hydatidosis

• No transmission between intermediate hosts.
• Eggs can remain viable in moist soil:
• 225 days at 6 ºC,
• 21 days at 30 ºC.

• Eggs have sticky wall that make them

adhere to fur of animals.
• Rapid deactivation of eggs upon dryness and
exposure to sunlight
 Destruction of eggs:

• The most destructive effect was produced by:

•lime-nitrogen (Ca CN2), Calcium cyanamide. This
chemical is used as fertilizer in which the eggs
survived only for 24 hours in the substance

• 10% sodium hypochlorite solution

 Prevention and Control of
echinococcosis & hydatidosis
Echinococcus granulosus
1- Health education 6- Elimination of stray dogs
2- Persons in contact with dogs
7- Elimination of infected dogs; if
should observe rules of personal
hygiene infected dogs are valuable, they
3- Dogs should be excluded should be isolated, treated (use
from slaughterhouse area
arecholine hydrobromide
4-Boiling of offals given to dogs
5- Condemnation of affected followed by praziquantel (but it
offals is not ovicidal) along with

hygienic disposal of feces.

8-Treatment of infected persons

 Drug Adult Dosage Pediatric
Dosage
• *
Albendazole 400 mg orally 10-15
twice a day for mg/kg/day
1-6 months (max 800 mg)
orally in two
doses for 1-6
months
Backbone in most treatment strategies is chemotherapy with the
anthelmintic drug albendazole.

Chemotherapy is effective in early stages of uncomplicated CE

and in reducing the risk of recurrence.

Albendazole is administered several weeks to months

Adverse effects of long-term albendazole use are usually

relatively mild, however, in some cases, severe hepatotoxicity
occurs, prompting premature treatment cessation.

In more advanced disease, unfortunately, as is the case in many

patients at the time of diagnosis, albendazole alone is ineffective
in curing or even preventing disease progression.
For some patients, chemotherapy with benzimidazoles is
the preferred treatment.

Effective treatment involves benzimidazoles administered

continuously for at least 2 years.

*Patient monitoring for 10 years or more since recurrence

is possible.

Liver transplant is required in cases of alveolar

echinococcosis
Therefore, additional treatment options have been developed over the
years.

The surgical approach has long been the gold standard in treatment of
CE.

There are various surgical options: laproscopic, PAIR

A percutaneous treatment option is PAIR

(puncture–aspiration–injection–reaspiration). PAIR is generally indicated in

younger cysts

This technique utilizes ultrasound or tomography (CT) to guide puncture of the

cyst using fine needle, destruction of the germinal layer with protoscolices using

a scolicidal agent ( 10% formalin or hypertonic glucose solution50%), and

reaspiration of this fluid after 15–20 min.

This is repeated until the return is clear.

 Summary of the life cycle of Echinococcus granulosus

1- Disease: unilocular echinococcosis, cystic echinococcosis

2- Aetiology: larva (metacestode) of Echinococcus granulosus
3-Final host: Adult cestode lives in intestine of dogs, wild canid
4- Intermediate host: sheep, goat, pig, camel, cattle, cervid
5- Role of human: IH (dead end host)
6- Source of human infection: feces of dogs
7- Infective stage: Egg (ova) of Echinococcus granulosus
8- Mode of transmission: ingestion of food and water contaminated
with feces of dogs
9- Site of inhabitation: larva in tissues of man
10- Main clinical signs: Larva in liver, lung, other organs
11-Type of zoonoses according to maintenance cycle: Cyclozoonoses
 Summary of the life cycle of Echinococcus multilocularis

1- Disease: alveolar echinococcosis

2- Aetiology: larva (metacestode) of Echinococcus multilocularis
3-Final host: Adult cestode lives in intestine of foxes, dogs, cats
4- Intermediate host: wild rodents
5- Role of human: IH (dead end host)
6- Source of human infection: feces of foxes, dogs, cats
7- Infective stage: egg (ova) of Echinococcus multilocularis
8- Mode of transmission: ingestion of food and water
contaminated with feces of foxes, dogs,cats.
9- Site of inhabitation: larva located mainly in liver of man
10- Main clinical signs: Larva in liver, other organs( malignancy in
behaviour)
11-Type of zoonoses according to maintenance cycle:
Cyclozoonoses
 Summary of the life cycle of Echinococcus vogeli

1- Disease: Poly cystic echinococcosis

2- Aetiology: larva (metacestode) of Echinococcus vogeli
3-Final host: Adult cestode lives in intestine of dogs, wild canids
4- Intermediate host: wild rodents, non human primates
5- Role of human: IH (dead end host)
6- Source of human infection: feces of dogs, wild canids
7- Infective stage: egg (ova) of Echinococcus vogeli
8- Mode of transmission: ingestion of food and water
contaminated with feces dogs and wild canids.
9- Site of inhabitation: larva located mainly in liver
10- Main clinical signs: Larva mainly in liver
11-Type of zoonoses according to maintenance cycle:
Cyclozoonoses