Home About us Editorial board Ahead of print Browse Articles Search Submit article Instructions Subscribe Contacts Login 
  • Users Online: 229
  • Home
  • Print this page
  • Email this page


 
Previous article Browse articles Next article 
LETTER TO EDITOR
J Res Med Sci 2016,  21:25

Hydatids everywhere: A 15-year experience of unusual locations of the disease in an endemic area


1 Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
2 Department of Cardiology, National Heart Institute, New Delhi, India
3 Department of Anaesthesiology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
4 Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India

Date of Web Publication08-Apr-2016

Correspondence Address:
Arif Hussain Sarmast
Dalipora Kawadara, Srinagar - 190 002, Jammu and Kashmir
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1735-1995.179894

Rights and Permissions

How to cite this article:
Sarmast AH, Showkat HI, Shah NF, Mujtaba B, Malik AA, Malik NK, Parray FQ. Hydatids everywhere: A 15-year experience of unusual locations of the disease in an endemic area. J Res Med Sci 2016;21:25

How to cite this URL:
Sarmast AH, Showkat HI, Shah NF, Mujtaba B, Malik AA, Malik NK, Parray FQ. Hydatids everywhere: A 15-year experience of unusual locations of the disease in an endemic area. J Res Med Sci [serial online] 2016 [cited 2019 Sep 21];21:25. Available from: http://www.jmsjournal.net/text.asp?2016/21/1/25/179894

Sir,

Hydatid disease is a parasitosis, and it is endemic in many sheep-rearing regions in the world, especially in the Middle East and Mediterranean countries. [1],[2],[3] The reported annual morbidity from the disease in humans is 1.04-2.4 per 1,000,000, while the actual rates are supposed to be more than twice, this difference is probably due to the underreporting of data. [4] The liver (65-75%) and lungs (10-25%) are the organs most commonly involved, followed by peritoneal cavity (8-18%), spleen (2-3%), kidneys (1-4%), uterus and adnexa (0.5-1%), retroperitoneum (0.5-1%), pancreas (0.5-0.8%), [5] subcutaneous tissue (1-2%), [6] mediastinum (0.1-0.5%), [7] gall bladder (≤1%), [8] brain (2%), [9] seminal vesicle, [10] spinal cord, [11] and others (0.1-3%). [5]

A 15-year retrospective study of the cases of hydatid disease treated between January 2000 and December 2014 was done at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India, and associated SKIMS Medical College, a tertiary care center. The main thrust of the study was to know the incidence of atypical forms and infrequent location of the disease and to evaluate diagnostic and therapeutic modalities. These atypical locations included the kidneys, spleen, pancreas, peritoneum, retroperitoneum with extension in the spinal medulla, gallbladder wall cyst, bone, brain, ovary, seminal vesicle, and muscle.

The diagnosis was established by the history, clinical examination, complete blood counts, liver and kidney function tests, serological tests (enzyme-linked immunosorbent assay and indirect hemagglutination test), chest x-ray, ultrasound and magnetic resonance imaging (MRI), or contrast enhanced computerized tomography (CECT). CT was applied in all of our patients as the diagnostic tool of choice [Figure 1],[Figure 2],[Figure 3] and [Figure 4].

The treatment for all the patients was surgical. All the patients received preoperative and postoperative albendazole chemotherapy. Out of 527 patients of hydatid disease studied over a period of 15 years, 38 (7.2%) patients had hydatid cyst present at atypical location, with their ages ranging from 17 years to 69 years (mean 36.2 years). Spleen was the most common organ involved when cases of liver [359 (68.1%)] and lung [106 (20.1%)] hydatids were excluded. There were 11 (2.08%) cases of hydatid spleen followed by cases involving pancreas 6 (1.13%); peritoneum 6 (1.13%); brain 4 (0.75%); spinal cord 2 (0.3%); subcutaneous tissue 2 (0.3%); and kidney, ovary, seminal vesicle, mediastinum, muscle, gall bladder, bone 1 (0.19%) case each.
Figure 1: CECT abdomen of the patient showing cystic lesion in spleen with a calcified wall that on operation proved to be hydatid cyst

Click here to view
Figure 2: MRI brain showing cystic mass in left occipital region with mass effect and midline shift

Click here to view
Figure 3: Intraoperative picture of removal of hydatid brain

Click here to view
Figure 4: Plain CT scan head of the patient after removal of hydatid cyst showing residual cavity

Click here to view


Nonspecific abdominal pain and a nontender palpable abdominal lump were the most predominant symptoms; other symptoms varied according to the localization of the cyst. Palpable lump was also a presenting symptom in the patients with subcutaneous and muscle cysts. Seven patients with atypical locations were asymptomatic, which included three cases with peritoneal hydatid, three cases of isolated splenic hydatid, and one case of renal hydatid. The patients with brain and spinal hydatid presented with neurological symptoms, while the one with seminal vesicle hydatid presented with lower urinary tract symptoms (LUTS). Eosinophilia was observed in 24 out of 38 patients. Medical treatment (albendazole 10 mg/kg) was given preoperatively followed by definitive surgical treatment followed by postoperative chemotherapy for 3 months. None of the patients with hydatid disease at atypical location had a recurrence after the treatment.

Atypical localization of hydatid disease usually poses a diagnostic dilemma. It is well known that specific local or general symptoms and signs of hydatid disease do not exist. The majority of cases are diagnosed following incidental findings at imaging examinations done for some unrelated complaints. The uncommon localization frequently causes diagnostic problems, and specific diagnostic tests do not have 100% reliability in these cases. [10] Surgery is the treatment of choice when location of the cyst is atypical, conservative approaches are used less often.

We conclude that a differential diagnosis of hydatid cyst should be considered whenever a cystic lesion is encountered anywhere in the body depending upon the level of endemicity of the disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dhaliwal RS, Kalkat MS. One-stage surgical procedure for bilateral lung and liver hydatid cysts. Ann Thorac Surg 1997;64:338-41.  Back to cited text no. 1
    
2.
Topçu S, Kurul IC, Taºtepe I, Bozkurt D, Gülhan E, Cetin G. Surgical treatment of pulmonary hydatid cysts in children. J Thorac Cardiovasc Surg 2000;120:1097-101.  Back to cited text no. 2
    
3.
Sayek I, Yalin R, Sanaç Y. Surgical treatment of hydatid disease of the liver. Arch Surg 1980;115:847-50.  Back to cited text no. 3
    
4.
Arambulo P 3 rd . Public health importance of cystic echinococcosis in Latin America. Acta Trop 1997;67:113-24.  Back to cited text no. 4
    
5.
Palanivelu C. Laparoscopic management of hydatid cysts of liver. In: Palanivelu C, editor. Art of Laparoscopic Surgery: Textbook and Atlas. Jaypee Publishers; 2007. p. 757-83.  Back to cited text no. 5
    
6.
Zulfikaroglu B, Koc M, Ozalp N, Ozmen MM. A rare primary location of echinococcal disease: Report of a case. Ups J Med Sci 2005;110:167-71.  Back to cited text no. 6
    
7.
Kabiri el H, Zidane A, Atoini F, Arsalane A, Bellamari H. Primary hydatid cyst of the posterior mediastinum. Asian Cardiovasc Thorac Ann 2007;15:e60-2.   Back to cited text no. 7
    
8.
Raza MH, Harris SH, Khan R. Hydatid cyst of gall bladder. Indian J Gastroenterol 2003;22:67-8.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Greenberg SM. Handbook of Neurosurgery. 1 st ed. New York: Thieme Medical Publisher; 2001. p. 238-9.  Back to cited text no. 9
    
10.
Safioleas M, Stamatakos M, Zervas A, Agapitos E. Hydatid disease of the seminal vesicle: A rare presentation of hydatid cyst. Int Urol Nephrol 2006;38:287-9.   Back to cited text no. 10
    
11.
Drimousis PG, Stamou KM, Koutras A, Tsekouras DK, Zografos G. Unusual site of recurrent musculoskeletal hydatid cyst: Case report and brief review of the literature. World J Gastroenterol 2006;12:5577-8.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Previous article  Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed1003    
    Printed10    
    Emailed0    
    PDF Downloaded86    
    Comments [Add]    

Recommend this journal