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Hydatid Cysts Follow-up

  • Author: Imad S Dandan, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Aug 19, 2014
 

Further Outpatient Care

See the list below:

  • 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.
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Further Inpatient Care

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  • 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.
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Inpatient & Outpatient Medications

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  • 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.
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Transfer

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  • 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
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Deterrence/Prevention

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  • 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
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Complications

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  • 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
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Prognosis

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  • Prognosis mainly depends on the type of infestation (ie, whether it is CE or AE).
    • In CE, prognosis is generally good, and complete cure is possible 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%.
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Patient Education

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  • 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).
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Contributor Information and Disclosures
Author

Imad S Dandan, MD Chief of Trauma Section, Scripps Memorial Hospital La Jolla, California

Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, California Medical Association, American Trauma Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Assaad M Soweid, MD, FACG, FASGE Associate Professor of Clinical Medicine, Endosonography and Advanced Therapeutic Endoscopy, Director, Endoscopy-Bronchoscopy Unit, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Lebanon

Assaad M Soweid, MD, FACG, FASGE is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Firass Abiad, MD Fellow in Minimally Invasive Surgery, Department of Surgery, University of Tennessee

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Ann Ouyang, MBBS Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.

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