eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Echinococcosis: Differential Diagnoses & Workup

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 22, 2009

Differential Diagnoses

Liver Tumors
Neurocysticercosis
Taenia Infection
Teratomas and Other Germ Cell Tumors

Other Problems to Be Considered

Hepatic abscess
Liver cancer
Cirrhosis

Workup

Laboratory Studies

Chest radiography, CT scanning, ultrasonography, or MRI findings usually suggest the diagnosis of echinococcosis, especially in patients with epidemiological risk factors. Serologic tests are then typically used to help confirm the diagnosis. If radiologic studies and epidemiology suggest echinococcosis, consider further evaluation when serology test results are negative.

  • Serologic testing
    • The Centers for Disease Control and Prevention in Atlanta, Georgia provides the following 3 types of serologic tests:
      • Indirect hemagglutination
      • Indirect fluorescent antibody
      • Enzyme immunoassay/enzyme-linked immunosorbent assay
    • Sensitivities range from 60-95%. Liver cysts are more likely to yield positive results than pulmonary cysts. Positive test results are less likely with calcified or dead cysts and more likely with ruptured cysts.
    • False-positive serologic test results may occur in patients with other parasitic infections (especially cysticercosis) and in patients with cancer or an immune dysfunction.
  • Antigen testing may be helpful if antibody test results are negative, although this modality is not available in the United States.
  • Stool evaluation is generally not useful for diagnosis.

Imaging Studies

  • Chest radiography may reveal cysts of 1-20 cm in any location. These cysts do not calcify, nor do they have daughter cysts. Approximately one third of patients with a positive finding on chest radiography have definable cysts in the liver.
  • Liver cysts may be diagnosed based on findings of CT scanning, ultrasonography, or MRI. Most liver cysts are in the right lobe and may sometimes be difficult to differentiate from abscesses or neoplasms. Liver cysts may be single or multiple.
  • Ultrasonography may reveal irregular, heterogeneous, hypoechoic lesions, some with calcifications. Ultrasonography is a simple and noninvasive method to ascertain cyst size.

More on Echinococcosis

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

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Further Reading

See Image 25 and Image 60 at the McGill Faculty of Medicine Web site and The Gorgas Courses in Clinical Tropical Medicine for interesting images and cases.

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Keywords

echinococcosis, abdominal pain, alveolar hydatid echinococcosis, anaphylaxis, asthma, biliary obstruction, cystic echinococcosis, Echinococcus infection, Echinococcus granulosus, E granulosus, Echinococcus multilocularis, E multilocularis, Echinococcus vogeli, E vogeli, hydatid disease, hydatidosis, polycystic echinococcosis, urticaria

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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