Cystic echinococcosis is a specific form of echinococcosis whose cause is a parasitic infection. The responsible pathogen is Echinococcus granulosus, which is classified as a tapeworm. The disease develops when the fins of the parasites form cystic structures in the intermediate host.
What is cystic echinococcosis?
Cystic echinococcosis is sometimes called echinococcal blister, bladderworm, and hydatid cyst. The cysts spread widely, causing displacement of adjacent organic tissue. In the majority of cases, humans are infected by the so-called dog tapeworm. Humans take the position of intermediate hosts for this tapeworm, while animal species such as dogs or wolves are potential final hosts. The German Infection Protection Act stipulates that all infections with the corresponding tapeworm must be reported to a doctor. In principle, Echinococcus granulosus is native to the whole world. However, it is particularly widespread in southern regions such as the Mediterranean area. Human infection usually occurs when affected individuals ingest the larvae of the tapeworm into the organism by the oral route.
Causes
Cystic echinococcosis develops after the larvae of the tapeworm enter the human body. Initially, the worm larvae hatch inside the intestine, from where they move to the liver. Later in the course of the infestation, they spread to other body organs if possible, preferring the lungs in particular. The incubation period is comparatively long, so that much time elapses before the first symptoms manifest. Typical of cysts of cystic echinococcosis are capsules of connective tissue surrounding the structures.
Symptoms, complaints, and signs
The symptoms and complaints of cystic echinococcosis cover a relatively wide spectrum. Basically, the course of the disease varies from patient to patient and depends primarily on the area of the body and the organs in which the cysts are located. The degree and strength of the immune response of the organism also affects the symptoms. In the majority of cases, the cysts are found in the lungs and liver. In most cases, the cysts grow slowly, so there are no symptoms for a long time. Symptoms develop mainly when the cysts take up too much space, displacing other organs. In addition, symptoms form when a superinfection caused by bacteria forms in the affected organism. Finally, the development of fistulas and anaphylactic effects also lead to the premature appearance of symptoms. Otherwise, infestation with the tapeworms and cystic echinococcosis remain undetected for a long time. Far less frequently than in the liver and lungs, the typical cysts also form in the heart, kidneys or bones. In turn, other symptoms occur. Basically, the incubation period is variable and extends over a period of several months to several years. The age of the affected patients also plays no role in the infestation with the tapeworms. However, observations indicate that cystic echinococcosis occurs more frequently in persons between the ages of 30 and 50. The fin of the dog tapeworm appears as a blister filled with a fluid. The human body’s response to this cyst is to build connective tissue around the blister. In this way, the so-called brood capsules are formed. In these, after some time, the tapeworms develop.
Diagnosis and course of the disease
Diagnosis of cystic echinococcosis occurs in numerous cases either by chance in the course of other examinations or relatively late, when the disease already causes considerable symptoms. As soon as the presence of cystic echinococcosis is suspected, the symptoms must be clarified by a physician. Here, a thorough medical history is first taken, and possible contacts with larval tapeworms are also discussed. On the basis of the patient’s descriptions, the attending physician already gains a large number of valuable clues that help him to establish the diagnosis. Later, clinical and, in particular, imaging techniques are used to diagnose cystic echinococcosis. During imaging, cysts and their localization are detectable.Laboratory analyses provide information about corresponding antibodies. CT and X-ray examinations are also suitable for diagnosing cystic echinococcosis. With regard to differential diagnosis, the physician excludes, for example, amebic abscesses or tumors.
Complications
As a rule, there are hardly any symptoms when infected with dog tapeworm. In rare cases, however, complications can even occur, some of them severe. Only when a large number of cysts have developed can they exert pressure on blood vessels and bile ducts. Feelings of tension, abdominal pain and, in some cases, jaundice then occur. The course of the disease varies, because in addition to the liver, the lungs, kidneys, heart or even the brain may be affected. However, usually only one organ is affected at a time. In severe cases, bleeding and irreversible organ damage can occur in the liver. Dead parasites leave behind random cavities in which bleeding can also occur. Then there is also a risk of bacterial superinfection, which can even lead to sepsis. If the lungs are affected, lung cysts may burst, causing hemorrhage, along with severe coughing and difficulty breathing. When the central nervous system and especially the brain are affected, various often irreversible neurological disorders occur. In some cases, the parasite cannot be completely eradicated with the help of drug and surgical treatment. However, in the context of a very dangerous complication, anaphylactic shock, even spontaneous recovery is possible in very rare cases due to a massive reaction of the immune system.
When should you go to the doctor?
Characteristic of the disease is a gradual and steady increase in various health impairments. These manifest themselves individually in each patient and should be presented to a physician as soon as they are consciously noticed by the affected person. General dysfunction, a feeling of illness, and inner weakness indicate the presence of a health disorder. If there is a feeling of tightness in the organism, if the affected person complains of a sensitivity to pressure or if a sensory disturbance appears, the observations should be examined by a physician. Irregularities in digestion, changes in the appearance of the skin and a decrease in the general resilience of the organism are indications that should be investigated. A visit to the doctor is necessary so that a clarification of the complaints can take place. In case of pain, a noise during digestion or irregularities in respiratory activity, a medical examination is needed. If there are abnormalities in the heart rhythm, changes in blood pressure, restrictions in mobility and a decrease in physical performance, a doctor should be consulted. Headaches, inner restlessness and tiredness should also be examined. Sleep disturbances and fatigue are other health irregularities that indicate the presence of a disease. As soon as the complaints persist, they should be presented to a doctor. If changes in habitual behavior are evident, mood swings are present, or internal irritability is present, these irregularities should also be investigated.
Treatment and therapy
Cystic echinococcosis is treated when it causes symptoms. However, drug therapy is usually used even for cysts that do not cause any symptoms. The active substance albendazole is the preferred treatment. In addition to treatment with various drugs, it is also possible to perform surgical procedures. The aim of such procedures is to remove cysts in the liver. After removal, the area is cleaned with a solution of saline. Also, a sterilizing mixture may be injected. The drug albendazole is also used in such cases.
Prevention
Cystic echinococcosis can be prevented by avoiding infestation of the organism with the larvae of the dog tapeworm. This can be achieved primarily by maintaining hygienic standards.
Aftercare
In most cases of echinococcosis, the measures of direct follow-up are significantly limited.They are sometimes not even available to the affected person, so that in the case of this disease a doctor should be consulted very early in the first place, so that other complications and complaints do not arise. The sooner a doctor is consulted, the better the further course of the disease usually is. In the case of echinococcosis, the affected persons themselves are usually dependent on taking various medications. Regular intake and the correct dosage should always be observed in order to counteract the symptoms properly and permanently. Furthermore, regular checks and examinations by a doctor are also very important. Thereby further damages can be detected. If echinococcosis is treated by surgery, patients are advised to take it easy and rest after the procedure. Stressful activities or strenuous movements should be avoided. The disease itself usually does not reduce the life expectancy of the affected person if it is treated properly. However, the further course also depends very much on the time of diagnosis of the disease.
What you can do yourself
By the time it comes to this diagnosis, a lot of time has usually passed and the patient is already receiving medical treatment. Depending on what the doctor advises, the patient will be given medication or even have to undergo surgical procedures. As with all surgeries, good compliance is important here to avoid unnecessary pre- or post-operative complications. This includes, among other things, informing the attending physicians and surgeons of all medications taken and any known pre-existing conditions to minimize the risk of anesthesia. To support the course of recovery, patients should ensure that they are in good general health before and after surgery. Those who abstain from stimulants such as nicotine or alcohol and instead eat well, avoid stress, keep regular sleeping hours and make sure to exercise regularly activate and support their body’s immune system and can thus make a decisive contribution to recovering quickly from cystic echinococcosis. In particular, exercise in the fresh air, preferably in the countryside or in the forest, activates the cardiovascular system and thus also the immune system. Especially if in the run-up patients have complained of a drop in performance, headaches, fatigue and sleep disturbances, daily, extended walks in the forest, for example, are a good way to regain one’s strength.
