eMedicine Specialties > Infectious Diseases > Parasitic Infections

Echinococcosis Hydatid Cyst: Follow-up

Author: Enrico Brunetti, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious and Tropical Diseases, University of Pavia School of Medicine, Italy
Coauthor(s): Carlo Filice, MD, Chief of Ultrasound Unit, Adjunct Professor, Department of Internal Medicine, Division of Infectious and Tropical Diseases, IRCCS S Matteo Hospital, University of Pavia, Italy
Contributor Information and Disclosures

Updated: Mar 28, 2008

Follow-up

Further Inpatient Care

  • Reevaluate patients for symptom resolution and determination of cure.

Further Outpatient Care

  • During treatment of patients discharged on benzimidazoles, monitor aminotransferases, WBC, RBC, and hemoglobin monthly.
  • Evaluate patients for ultrasonographic appearance modifications and changes in serology titers after 3 months of treatment and then for several years (at least 5).

Deterrence/Prevention

  • In endemic areas, distribution of educational material in elementary schools regarding modes of transmission of the disease is helpful to increase knowledge about the nature and transmissibility of cystic echinococcosis.
  • Educational material should include information about proper disposal of sheep viscera in abattoirs and proximity to dogs and sources of transmission.

Complications

  • The cysts may rupture, and the cyst content may be released into biliary or bronchial systems. This may cause infection of the cyst and an obstruction of the biliary or bronchial tree with severe clinical consequences (eg, pneumonitis, pleural effusion, pneumothorax, secondary echinococcosis of the pleural and peritoneal cavity).

Prognosis

  • Prognosis is generally good and depends on the cyst location. For instance, neither surgery nor medical therapy is generally effective for bone, especially spinal, echinococcosis. Surgery to treat cardiac cysts can be risky, and there is very little experience with the use of albendazole in this site.
  • Sometimes after removal of a cyst, one or more new cysts may develop at a different site. A hypothesis for this is that the growth of some cysts may be inhibited by the presence of the cyst that has been removed.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the possible echinococcal nature of a cyst found on an imaging examination and subsequent percutaneous puncture may lead to anaphylactic shock and possible death.
    • Always consider the possibility of an echinococcal cyst, especially with patients coming from endemic areas, and try to exclude it with serology.
    • If serology is inconclusive, diagnostic puncture may be indicated with the presence of an anesthesiologist; however, cases in which echinococcal cysts were misdiagnosed as simple cysts and punctured with no adverse effects are listed in the literature.

Special Concerns

  • Consider PAIR in pregnant patients with large liver cysts that are at risk of rupture because of increased intra-abdominal pressure during labor.
 


More on Echinococcosis Hydatid Cyst

Overview: Echinococcosis Hydatid Cyst
Differential Diagnoses & Workup: Echinococcosis Hydatid Cyst
Treatment & Medication: Echinococcosis Hydatid Cyst
Follow-up: Echinococcosis Hydatid Cyst
Multimedia: Echinococcosis Hydatid Cyst
References
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Further Reading

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Keywords

hydatid cyst, cystic echinococcosis, hydatidosis, CE, echinococcal cysts, taeniid-type tapeworm, Echinococcus granulosus, E granulosus, Echinococcus multilocularis, E multilocularis parasites, protoscolices, alveolar echinococcosis, Echinococcus species, primary echinococcosis, secondary echinococcosis, liver echinococcosis, lung echinococcosis, heart echinococcosis

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Contributor Information and Disclosures

Author

Enrico Brunetti, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious and Tropical Diseases, University of Pavia School of Medicine, Italy
Enrico Brunetti, MD is a member of the following medical societies: American Society of Tropical Medicine and Hygiene
Disclosure: Nothing to disclose.

Coauthor(s)

Carlo Filice, MD, Chief of Ultrasound Unit, Adjunct Professor, Department of Internal Medicine, Division of Infectious and Tropical Diseases, IRCCS S Matteo Hospital, University of Pavia, Italy
Disclosure: Nothing to disclose.

Medical Editor

Mark R Wallace, MD, FACP, FIDSA, Clinical Professor of Medicine, Florida State University College of Medicine; Infectious Disease Fellowship Director, Orlando Regional Medical Center
Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

John W King, MD, Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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