Case study:

Hydatidosis

STUDENT: PANI ANAMARIA VALETA

MG II, D, 23
TEACHER: STAICU SIMONA NICOLETA
Hydatidosis

Hydatidosis or cystic echinococcosis is parasitic

infection caused by a tapeworm larva called
echinococci (Echinococcus granulosus). The type and
severity of symptoms is determined by the location
of the infestation - the most common site for the
larval cysts is the liver. The most common symptoms
are due to compression of nearby organs or blood
vessels due to increasing size of the cyst. The larva
may incubate for months or even years.
In the human manifestation of the disease, E.
granulosus, are localized in the liver (in 75% of cases), the
lungs (in 5-15% of cases) and other organs in the body such
as the spleen, brain, heart and kidneys (in 10-20% of
cases).
In the patients who are infected with E. granulosus and
therefore have cystic echinococcosis, the disease develops
as a slow-growing mass in the body. These slow-growing
masses, often called cysts, are also found in patients that
are infected with alveolar and polycystic echinococcosis.
The cysts found in those with cystic echinococcosis are
usually filled with a clear fluid called hydatid fluid, are
spherical and typically consist of one compartment and are
usually only found in one area of the body.
Depending on the location of the cyst in the body, the patient
could be asymptomatic even though the cysts have grown to be
very large or be symptomatic even if the cysts are absolutely tiny.
If the patient is symptomatic, the symptoms that an infected
patient exhibits will also depend largely on where the cysts are
located. For instance, if the patient has cysts in the lungs and is
symptomatic, they will have a cough, shortness of breath and/or
pain in the chest.
On the other hand, if the patient has cysts in the liver and is
symptomatic, they will suffer from abdominal pain, abnormal
abdominal tenderness, hepatomegaly with an abdominal mass,
jaundice, fever and/or anaphylactic reaction. In addition, if the
cysts were to rupture while in the body, whether during
surgical extraction of the cysts or by some kind of trauma to the
body, the patient would most likely go into anaphylactic shock
and suffer from high fever, pruritus (itching), edema (swelling)
of the lips and eyelids, dyspnea, stridor and rhinorrhea.
CT scan of liver with
polycystic
echinococcosis
Transmission

All disease-causing species of Echinococcus are

transmitted to intermediate hosts via the ingestion of
eggs and are transmitted to definitive hosts by means
of eating infected, cyst-containing organs. Humans
are accidental intermediate hosts that become
infected by handling soil, dirt or animal hair that
contains eggs.
Treatment

For simple cases of cystic echinococcosis, the most common form

of treatment is surgical removal of the cysts combined with
chemotherapy using albendazole and/or mebendazole before
and after surgery. However, if there are cysts in multiple organs
or tissues, or the cysts are in risky locations, surgery becomes
impractical. For inoperable cases such as these, chemotherapy
and/or PAIR (puncture-aspiration-injection-reaspiration)
become alternative options of treatment. In the case of
alternative treatment using just chemotherapy, albendazole is
preferred with an adult dosage of 400 mg orally, twice a day for
15 months and a pediatric dosage of 15 mg/kg/day (max. of
800 mg) for 16 months.
 Personal details

First Name: Amellie

Last Name: Petrosky
Address: Timisoara, Timis, RO
Phone number: 0764321987
Sex: Female
Age: 56
Date of birth: 12/15/1955
Occupation: nurse
Marital status: married
Height: 1,67 m (3.28 ft)
Weight: 75 kg (154 lbs)
 Main Complaint

The patient presents:

pain in the right hypochondria
abdominal tenderness
hepatomegaly with and unindentified mass
fatigue.
 Introduction

Dr.: Hello! My name is Doctor Barney Stinson.

Patient: Hello doctor! My name is Amellie Petrosky.
Dr.: Nice to meet you Mrs. Amellie! First, can you tell
me your age, please?
Pat.: Yes, of course! I am 56 years old.
Dr.: Ok, are you married?
Pat.: Yes, I am married.
Dr.: And what do you do for a living?
Pat.: I am a nurse at a private office.
Dr.: Good.
 Present Complaint

Dr.: Now, tell me what seems to be the problem?

Pat.: Well, doctor, I feel an unusual pain on the right side of the abdomen,
just below the rib cage, tenderness and fatigue.
Dr.: Ok, what kind of pain is it?
Pat.: It is constant, sometimes pulsating, and it makes it hard for me to
sleep on my right side.
Dr.: When have you acknowledged this pain?
Pat.: Ive been having it for a few months now.
Dr.: Have you done any tests, seen other doctors?
Pat.: Yes, my family doctor sent me to a specialist and I had an
ultrasound.
Dr.: And what were the results?
Pat.: They said I have hepatomegaly with an unidentified mass on the
liver.
Dr.: Ok, that is useful.
 Past Medical History

Dr.: Mrs. Petrosky, I have a few more questions about your medical history.
Pat.: Yes, please!
Dr.: How would you describe your general state of health?
Pat.: I am good, but I have been better.
Dr.: What past illnesses do you remember having?
Pat.: I think I had all the usual childhood illnesses: measles, rubella, chickenpox,
and I had hepatitis A as a teenager too.
Dr.: Hospitalization? Surgery?
Pat.: With the hepatitis, the three births I gave, and I had surgery for some stretch
marks on my calves.
Dr.: Ok. Injuries of any kind?
Pat.: No.
Dr.: Allergies?
Pat.: No.
Dr.: Current medications?
Pat.: Yes, I am on Preductal for hypertension, Aspenter for heart palpitations, when
needed, and antiinflammatory drugs for pain in my keens.
 Family History

Dr.: Do you have any siblings Mrs. Petrosky?

Pat.: Yes, doctor. I have two brothers and two sisters.
Dr.: Do any of them have any illnesses?
Pat.: Well one of my brothers has Parkinson disease and one of
my sister has diabetes, but the rest are healthy.
Dr.: What about your parents? Are they still alive?
Pat.: No, they both passed away.
Dr.: Were they sick when they passed away?
Pat.: My father was, he passed away because of a bad case of
pneumonia, but my mother passed away of old age, she had
some health problems, but none in particular life threatning.
Dr.: Ok.
 Social and personal history

Dr.: Do you live in the city or in the country?

Pat.: I live here, in the city, but we have a house in the country too, and I
like to spend time there as well, gardening, talking walks.
Dr.: Do you live with your family?
Pat.: I live with my husband and my youngest daughter, the older ones are
married.
Dr.: You said you are a nurse, is your job stressful?
Pat.: Yes, you could say that. Its a lot of work and a lot of patients everyday.
I often feel exhausted at the end of the day.
Dr.: Ok. Do you smoke?
Pat.: No.
Dr.: Do you drink alcohol?
Pat.: No.
Dr.: Do you exercise?
Pat.: Not really, but I do talk walks with my nephew and niece.
Dr.: Ok.
 Other complaints

Dr.: So, Mrs. Petrosky, besides the pain in your

abdomen and fatigue, does anything else bother you?
Headaches, muscle pains, anything?
Pat.: I dont think so, I might get headaches at work,
but I get them from the computer, my keens hurt some
times because of my rehumatism.
Dr.: So nothing else?
Pat.: No.
 Continuing invastigation

Dr.: Now, from what you have told me I would like you to do some
more tests. I will do another abdominal ultrasound and I would want
you to take a blood test and then come back with the results.
Pat.: Ok, I will do everything necessary.
Dr.: Here you have everything you have to do. Come back in a week
please.
Pat.: Of course. Thank you dr. Stinson. Good bye.
Dr.: Good bye.

Dr.: Hello again, Mrs. Petrosky! How are you feeling today?
Pat.: Hello doctor, Im fine.
Dr.: Good. We have the results of the tests you have done, and I will
like to discuss them with you.
Pat.: Ok.
 Explaining diagnosis and management

Dr.: You have hydatidosis.

Pat.: What is that doctor?
Dr.: It is a suffering given by a parasite called Echinococcus granulosus, which produces
cysts. These cysts will form in an organ, in your case, the liver. I confirmed this diagnosis
by the ultrasound I did, discovering four masses on the liver, as well as the blood test
you took, the ELISA Igg Echinococcus granulosus.
Pat.: Is it curable?
Dr.: Yes, it is. We have two options: treatment or surgery, but in your case I would chose
surgery, because its more efficient.
Pat.: Surgery?
Dr.: Yes, liver surgery. We will cut out the cysts and then drain the fluid that will form
there. I will operate on you with my team. I will make the appointment as soon as
possible. I want to let you know that your liver will regenerate in about 6 months, and
the antibodies that were formed to fight the parasites will be back to normal in a year or
so. Do you have any questions?
Pat.: No, I understand why I have to undergo surgery. What about the medication I have
to take?
Dr.: Your treatment: Albendazole, Liv. 5.2, Essentiale, Immunocal, to fight the parasites
and to help your liver to recover after surgery. You will take it before and after surgery
as well.
 Explaining diagnosis and management

Dr.: And after surgery you will go on a limited diet, light foods, starting with
cottage cheese, light yogurt, rice, grains, no fatty foods, no potatoes, no whole
bread.
Pat.: I will do everything I need to do.
Dr.: Very well. After surgery you will come back for a check up in a month, then
three months and so on.
Pat.: Sure.
Dr.: Any other questions?
Pat.: Not for now I guess.
Dr.: Fine, Mrs. Petrosky, but if you have any questions, please call me, Im glad to
help.
Pat.: Ok, I will do that.
Dr.: We will see each other in 3 days for surgery. My nurse will tell you everything
you have to know, so you will come prepared for the surgery.
Pat.: Ok, thank you so much doctor.
Dr.: Youre welcome. See you soon. Good-bye.
Pat.: Good-bye.
 Bibliography

http://en.wikipedia.org/wiki/Echinococcosis

http://www.rightdiagnosis.com/h/hydatidosis/intro.htm

http://www.spc.int/lrd/ext/Disease_Manual_Final/b053__echinococcosishydatid
osis.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381596/