Follow-up
Further Inpatient Care
- Inpatient care for individuals who have had surgical resection of their hydatid cyst(s) is similar to that for any other surgical procedure on the affected organ.
- Special consideration must be made for patients with hepatic CE who were found to have biliary communication. These patients must be observed for signs and symptoms of either biliary obstruction or fistula formation. If either of these complications occurs, the patient must be treated by percutaneous or endoscopic stenting of the biliary tree with or without sphincteroplasty.
- Postoperatively, treatment with benzimidazoles is continued for approximately 1 month, although the exact duration has not been determined.
Further Outpatient Care
- Outpatient care is directed towards the following end points:
- Chemotherapy: Postoperative treatment with benzimidazoles is continued for 1 month in patients with CE who have undergone complete resection or PAIR successfully. The treatment is continued for 3-6 months for patients with resected AE, incompletely resected CE, spillage during surgery or PAIR, and metastatic lesions. Chemotherapy is needed for 3-10 years for patients with partially resected AE, unresectable AE, or liver transplant for AE.
- Laboratory tests: Patients on benzimidazoles should have a CBC count and liver enzyme evaluation performed at biweekly intervals for 3 months and then every 4 weeks to monitor for toxicity. ELISA or indirect hemagglutination tests are usually performed at 3-, 6-, 12-, and 24-month intervals as screening for recurrence of resected disease or aggravation of existing disease.
- Imaging: Ultrasonography and/or CT scan are used in follow-up at the same intervals as the laboratory tests or as clinically indicated.
Inpatient & Outpatient Medications
- Antibiotics are used prophylactically for surgery as indicated in patients with a cystobiliary fistula, for treatment of infected cysts, and for treatment of associated infections.
- Benzimidazoles are continued after discharge.
Transfer
- Several criteria must be met in medical centers in order for patients to be treated appropriately. The lack of any of the following criteria should lead to patient transfer.
- Medical staff experienced in the treatment of echinococcosis (eg, surgeons, radiologists, infectious disease consultants)
- Medical centers that are able to provide the services for treatment (eg, well-equipped intensive care unit and surgical ward, well-equipped operating room, diagnostic radiology and laboratory facilities)
- Availability of scolicidal agents
Deterrence/Prevention
- Because human infection with Echinococcus results from fecal-oral contamination, prevention requires the following steps:
- Education on proper hygiene
- Proper cleansing of uncooked food and avoidance when possible
- Dietary regulation of pet dogs (stop the habit of feeding viscera of intermediate hosts, such as sheep, to pet dogs)
- Regulate pet dog activity to prevent ingestion of sheep material
- Avoidance of unregulated dogs
- Treatment of pet dogs in endemic areas for intestinal echinococcosis with praziquantel (5 mg/kg) periodically
- Control of the dog population
- Regulation of livestock butchering
Complications
- All the usual complications related to the surgical procedure and anesthesia
- Related to the parasite
- Recurrence
- Metastasis
- Infection
- Spillage and seeding (secondary echinococcosis) - Allergic reaction or anaphylactic shock
- Related to the medical treatment
- Hepatotoxicity
- Anemia
- Thrombocytopenia
- Alopecia
- Embryotoxicity
- Teratogenicity
- Spillage and seeding (secondary echinococcosis)
- Related to PAIR
- Hemorrhage
- Mechanical damage to other tissue
- Infections
- Allergic reaction or anaphylactic shock
- Persistence of daughter cysts
- Sudden intracystic decompression leading to biliary fistulas
- Related to scolicidal agents - Chemical sclerosing cholangitis
Prognosis
- Prognosis mainly depends on the type of infestation (ie, whether it is CE or AE).
- In CE, prognosis is generally good, with complete cure with total surgical excision without spillage. Spillage occurs in 2-25% of cases (depends on location and surgeon's experience), and the operative mortality rate varies from 0.5-4% for the same reasons.
- In AE, prognosis is much worse. Cure is only possible with early detection and complete surgical excision. In patients in whom the latter is not possible, the addition of long-term chemotherapy has decreased 10-year mortality rates from 94% to 10%.
Patient Education
- Education is aimed at teaching the population at risk about the disease, its methods of transmission, its hosts, and the methods of prevention (see Deterrence/Prevention).
Miscellaneous
Medicolegal Pitfalls
- Medicolegal pitfalls lie mainly in misdiagnosis, lack of experience, and a hospital's lack of preparation.
- In most cases, signs and symptoms from echinococcal infestation are nonspecific and can lead to an error in diagnosis. This usually results in an error in management and, sometimes, in catastrophic results in which major spillage occurs secondary to a poorly planned and executed percutaneous puncture or rupture during surgery.
- Once the diagnosis is made, the surgeon's experience plays a large role in the outcome. Not only is experience with the infestation important, but also experience in the surgical procedure. This lack of experience adds up to an increase in mortality and morbidity rates related to spillage and incomplete resections.
- The hospital where a patient is treated should be well equipped with the proper equipment and laboratory facilities and diagnostic and interventional radiology, pharmacy, and medical specialists. Deficiency in any of these should prompt transfer of the patient to an appropriate facility.
More on Hydatid Cysts |
| Overview: Hydatid Cysts |
| Differential Diagnoses & Workup: Hydatid Cysts |
| Treatment & Medication: Hydatid Cysts |
 Follow-up: Hydatid Cysts |
| References |
| « Previous Page |
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Further Reading
Keywords
echinococcosis, Echinococcus infestation, hydatid disease, parasitic infestation, tapeworm, zoonotic infection, parasite, Echinococcus granulosus, E granulosus, Echinococcus multilocularis, E multilocularis, Echinococcus vogeli, E vogeli, cystic echinococcosis, CE, alveolar echinococcosis, AE, echinococcal cyst, echinococcal worms, larval cestodes, Platyhelminthes
