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      Uncommon Locations and Presentations of Hydatid Cyst

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          Abstract

          Background:

          Hydatid disease (HD) is an ancient disease and even was known to Hippocrates. This disease involves all human parts and most common affected organs are liver and lungs. Incidence of unusual site is about 8-10%. The clinical picture depends upon the involved organs, its effects on adjacent structures, complications due to secondary infection, rupture, and anaphylaxis caused by hydatid cysts.

          Aim:

          The aim of this study was to find out incidence of unusual location of hydatid cyst in the human body.

          Materials and Methods:

          A retrospective study of HD was carried in a medical college between July 2007 and June 2012. A total 79 cases of HD were treated during this period. Information on clinical presentation and management were reviewed, and results presented as summary statistics.

          Results:

          Sixty one cases were of liver HD, and 11 were with hydatid lung disease. Fifty cases were with right lobe involvement, and rest 11 were with both lobe involvement. Out of 11 lung hydatid only one case was with bilateral lung involvement. Only eight cases of HD of uncommon locations and presentations were encountered during this period. First case presented with left hypochondriac mass as splenic HD, second with pelvic HD along with obstructive uropathy, third with non-functioning right kidney with bilateral psoas muscles HD, fourth with HD involving mesentery, fifth with pelvic pain due to right ovary HD, sixth with simultaneous involvement of the liver and right subdiaphragmatic region, seventh with HD of right inguinal region, and eighth with hydatid cyst of the left kidney. Even though, there was no mortality found in these patients, there was high morbidity.

          Conclusion:

          We conclude that Echinococcus granulosus can affect any organ in the body from head to toe, and a high suspicion of this disease is justified in endemic regions. Moreover, medical treatment should be given in the pre-operative period as well as in the post-operative period for 4-6 weeks.

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          Most cited references33

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          Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern.

          Echinococcosis in humans is a zoonotic infection caused by larval stages (metacestodes) of cestode species of the genus Echinococcus. Cystic echinococcosis (CE) is caused by Echinococcus granulosus, alveolar echinococcosis (AE) is caused by E. multilocularis, and polycystic forms are caused by either E. vogeli or E. oligarthrus. In untreated cases, AE has a high mortality rate. Although control is essentially feasible, CE remains a considerable health problem in many regions of the northern and southern hemispheres. AE is restricted to the northern hemisphere regions of North America and Eurasia. Recent studies have shown that E. multilocularis, the causative agent of AE, is more widely distributed than previously thought. There are also some hints of an increasing significance of polycystic forms of the disease, which are restricted to Central and South America. Various aspects of human echinococcosis are discussed in this review, including data on the infectivity of genetic variants of E. granulosus to humans, the increasing invasion of cities in Europe and Japan by red foxes, the main definitive hosts of E. multilocularis, and the first demonstration of urban cycles of the parasite. Examples of emergence or reemergence of CE are presented, and the question of potential spreading of E. multilocularis is critically assessed. Furthermore, information is presented on new and improved tools for diagnosing the infection in final hosts (dogs, foxes, and cats) by coproantigen or DNA detection and the application of molecular techniques to epidemiological studies. In the clinical field, the available methods for diagnosing human CE and AE are described and the treatment options are summarized. The development of new chemotherapeutic options for all forms of human echinococcosis remains an urgent requirement. A new option for the control of E. granulosus in the intermediate host population (mainly sheep and cattle) is vaccination. Attempts are made to reduce the prevalence of E. multilocualaris in fox populations by regular baiting with an anthelmintic (praziquantel). Recent data have shown that this control option may be used in restricted areas, for example in cities, with the aim of reducing the infection risk for humans.
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            Handbook of Neurosurgery

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              Atypical Localizations of Hydatid Disease: Experience from a Single Institute

              Introduction: The hydatid disease most often involves the liver and the lungs. The disease can involve any part of the body except the hair, teeth and nails. Primary extrahepatico-pulmonary hydatid cysts are rare and only a few sporadic cases have been reported. Materials and Methods: Two hundred and forty-four patients with hydatid cysts managed surgically from January 2005 to December 2009 were evaluated retrospectively. Fourteen (5.7%) patients had isolated involvement of the atypical sites, while six (2.4%) also had a primary involvement of liver. Results: The cysts were present in gall bladder (0.4%), peritoneum (1.6%), spleen (1.6%), ovary (0.4%), subcutaneous (0.8%), seminal vesicle (0.4%), spinal (0.4%), pancreas (0.4%), kidney (0.4%), mediastinal (0.4%), muscle (0.4%), and brain (0.8%). Discussion and Conclusions: Involvement of sites other than liver and lungs by hydatid disease is rare. Symptoms are related to size, location or possible complication of the cyst. It should be strongly suspected in differential diagnosis of all abdominal cysts especially in an endemic area. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.
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                Author and article information

                Journal
                Ann Med Health Sci Res
                Ann Med Health Sci Res
                AMHSR
                Annals of Medical and Health Sciences Research
                Medknow Publications & Media Pvt Ltd (India )
                2141-9248
                2277-9205
                May-Jun 2014
                : 4
                : 3
                : 447-452
                Affiliations
                [1] Department of Radio-Diagnosis and Imaging, Muzaffarnagar Medical College, Begrajpur, Muzaffarnagar, Uttar Pradesh, India
                [1 ] Department of Surgery, Muzaffarnagar Medical College, Begrajpur, Muzaffarnagar, Uttar Pradesh, India
                [2 ] Department of Pathology, Dr. Ram Manohar Lohia Postgraduate Institute of Medical Sciences, New Delhi, India
                [3 ] Department of Surgery, MM Institute of Medical Sciences and Research, Mulana, Haryana, India
                Author notes
                Address for correspondence: Dr. Sunder Goyal, Department of Surgery, Muzaffarnagar Medical College, Begrajpur, Opposite Industrial Area, Delhi-Meerut Highway, Muzaffarnagar, Uttar Pradesh, India. E-mail: goyal.sunder@ 123456yahoo.in
                Article
                AMHSR-4-447
                10.4103/2141-9248.133476
                4071749
                24971224
                40ca7906-21dd-4b85-bb42-68018cf4ee7d
                Copyright: © Annals of Medical and Health Sciences Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Medicine
                hydatid disease,ovary,psoas muscle,renal,spleen,unusual locations
                Medicine
                hydatid disease, ovary, psoas muscle, renal, spleen, unusual locations

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