Echinococcus granulosus - Revision history

Aidan: /* Medication */

2024-01-24T14:24:19Z

Medication

← Older revision		Revision as of 14:24, 24 January 2024
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	**For simple cysts, usually start the [[albendazole]] only 1-3 days before the procedure		**For simple cysts, usually start the [[albendazole]] only 1-3 days before the procedure
	**Continued for 4 weeks post-procedurally		**Continued for 4 weeks post-procedurally
			*If treating with medical management alone, duration of 1 to 3 months is likely appropriate, possibly up to 6 months
	*[[Albendazole]] 10-15 mg/kg/day in two divided doses (adult dose 400 mg twice daily), taken with a fat-rich meal		*[[Albendazole]] 10-15 mg/kg/day in two divided doses (adult dose 400 mg twice daily), taken with a fat-rich meal
	**30% cure at 3-6 months when medical management alone is used		**30% cure at 3-6 months when medical management alone is used

Aidan at 18:04, 30 August 2023

2023-08-30T18:04:17Z

← Older revision		Revision as of 18:04, 30 August 2023
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	**Most common single sites are the liver (80%) and lungs (20%)		**Most common single sites are the liver (80%) and lungs (20%)
	**''E. canadensis'' may be more likely to go to brain		**''E. canadensis'' may be more likely to go to brain
	**Other sites include pleural cavity, kidney, spleen, bone, brain, eye, ovary, testis, and pancreas		**Other sites include pleural cavity, kidney, [[Splenic hydatid cyst\|spleen]], bone, brain, eye, ovary, testis, and pancreas
	*Cysts grow by 1 to 50 mm annually, and can spontaneously rupture		*Cysts grow by 1 to 50 mm annually, and can spontaneously rupture
	*Symptoms are caused by compression of nearby structures or by rupture		*Symptoms are caused by compression of nearby structures or by rupture

Aidan: /* Medication */

2023-07-14T04:31:20Z

Medication

← Older revision		Revision as of 04:31, 14 July 2023
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	===Medication===		===Medication===

	*May be used in combination with ~~surgerical~~ resection or PAIR, to prevent secondary seeding		*May be used in combination with surgical resection or PAIR, to prevent secondary seeding
	**Shouldn't be ~~done~~ too soon before procedure due to potential for becoming more fragile and therefore more likely to rupture		**Shouldn't be started too soon before procedure (4 to 30 days before) due to potential for becoming more fragile and therefore more likely to rupture
	**For simple cysts, usually start the [[albendazole]] only 1-3 days before the procedure		**For simple cysts, usually start the [[albendazole]] only 1-3 days before the procedure
	**Continued for 4 weeks post-procedurally		**Continued for 4 weeks post-procedurally
	*[[Albendazole]] 10-15 mg/kg/day in two divided doses, taken with a fat-rich meal		*[[Albendazole]] 10-15 mg/kg/day in two divided doses (adult dose 400 mg twice daily), taken with a fat-rich meal
	**30% cure at 3-6 months when medical management alone is used		**30% cure at 3-6 months when medical management alone is used
	**Contraindicated with risk of rupture and in early pregnancy, and are not effective with cysts >10 cm		**Contraindicated with risk of rupture and in early pregnancy, and are not effective with cysts >10 cm

Aidan: /* Serology */

2023-07-14T04:14:23Z

Serology

← Older revision		Revision as of 04:14, 14 July 2023
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	*Detection of antibodies in serum using indirect hemagglutination, ELISA, or latex agglutination		*Detection of antibodies in serum using indirect hemagglutination, ELISA, or latex agglutination
	**Sensitivity 85-98% for liver cysts, 50-60% for lung cysts, and 90-100% for cysts in multiple organs		**Sensitivity 85-98% for liver cysts, 50-60% for lung cysts, and 90-100% for cysts in multiple organs
	**Lower sensitivity in early disease (~~i.e.~~ CE1)		**Lower sensitivity in early disease (CE1 and CE2) and late disease (CE4 and CE5)
	**Cross reacts with other cestodes, including [[Echinococcus multilocularis]], [[Taenia solium]], [[Fasciola hepatica]], [[filariasis]], malignancies, liver cirrhosis, and anti-P1 antibodies		**Cross reacts with other cestodes, including [[Echinococcus multilocularis]], [[Taenia solium]], [[Fasciola hepatica]], [[filariasis]], malignancies, liver cirrhosis, and anti-P1 antibodies
	*Positive screening serology should be confirmed with imunoblot assays, IgG subclasses, or arc 5 precipitation testing		*Positive screening serology should be confirmed with imunoblot assays, IgG subclasses, or arc 5 precipitation testing
	**Still cross-reacts with [[Echinococcus multilocularis]] and [[Taenia solium]], though less		**Still cross-reacts with [[Echinococcus multilocularis]] and [[Taenia solium]], though less
			*Not useful in following response to treatment or monitoring for relapse

	==Management==		==Management==

Aidan: added table of ultrasound features

2023-07-14T03:59:34Z

added table of ultrasound features

@@ Line 68: / Line 68: @@
 **Transitional disease (CE3): cysts are starting to degenerate but the protoscolices are still viable
 **Inactive disease (CE4-CE5): cysts are fully degenerated and are now calcifying
 *Pathognomonic features include:
 **Unilocular anechoic lesion that are round or oval with a clear, well-defined wall, and souble line sign

Aidan: /* Medication */

2022-05-04T16:46:21Z

Medication

← Older revision		Revision as of 16:46, 4 May 2022
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	*May be used in combination with surgerical resection or PAIR, to prevent secondary seeding		*May be used in combination with surgerical resection or PAIR, to prevent secondary seeding
	**Shouldn't be done too soon before procedure due to potential for becoming more fragile and therefore more likely to rupture		**Shouldn't be done too soon before procedure due to potential for becoming more fragile and therefore more likely to rupture
	**For simple cysts, usually start the [[albendazole]] only a ~~day or so~~ before the procedure		**For simple cysts, usually start the [[albendazole]] only 1-3 days before the procedure
			**Continued for 4 weeks post-procedurally
	*[[Albendazole]] 10-15 mg/kg/day in two divided doses, taken with a fat-rich meal		*[[Albendazole]] 10-15 mg/kg/day in two divided doses, taken with a fat-rich meal
	**30% cure at 3-6 months when medical management alone is used		**30% cure at 3-6 months when medical management alone is used

Aidan: /* Percutaneous Treatments */

2022-05-04T16:28:43Z

Percutaneous Treatments

← Older revision		Revision as of 16:28, 4 May 2022
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	*Large-bore catheters + cutting devices + aspiration		*Large-bore catheters + cutting devices + aspiration
	**Goal is removal of entire endocyst and daughter cysts from the mother cyst		**Goal is removal of entire endocyst and daughter cysts from the mother cyst
			*Risk of anaphylaxis is quite low, about 1%[[CiteRef::brooker2011ju]]

	===Medication===		===Medication===

Aidan: /* Medication */

2022-05-04T16:26:31Z

Medication

← Older revision		Revision as of 16:26, 4 May 2022
Line 157:		Line 157:
	**For simple cysts, usually start the [[albendazole]] only a day or so before the procedure		**For simple cysts, usually start the [[albendazole]] only a day or so before the procedure
	*[[Albendazole]] 10-15 mg/kg/day in two divided doses, taken with a fat-rich meal		*[[Albendazole]] 10-15 mg/kg/day in two divided doses, taken with a fat-rich meal
	**30% cure at 3-6 months		**30% cure at 3-6 months when medical management alone is used
	**Contraindicated with risk of rupture and in early pregnancy, and are not effective with cysts >10 cm		**Contraindicated with risk of rupture and in early pregnancy, and are not effective with cysts >10 cm
	**Monitor for hepatotoxicity, leukopenia, and thrombocytopenia		**Monitor for hepatotoxicity, leukopenia, and thrombocytopenia

Aidan: /* Management */

2022-05-04T16:25:05Z

Management

← Older revision		Revision as of 16:25, 4 May 2022
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	==Management==		==Management==

⚫	*Medical management alone with [[albendazole]] is ~~not~~ effective
	*The WHO-recommended approach is stage-specific[[CiteRef::brunetti2010ex]]		*The WHO-recommended approach is stage-specific[[CiteRef::brunetti2010ex]]
	*Options include surgery, percutaneous therapy, and medical therapy (with [[Is treated by::albendazole]])		*Options include surgery, percutaneous therapy, and medical therapy (with [[Is treated by::albendazole]])
	**Surgery is first-line for complicated cysts		**Surgery is first-line for complicated cysts
		⚫	**Medical management alone with [[albendazole]] is rarely effective
	**In resource-poor setting, forgo the [[albendazole]]		**In resource-poor setting, forgo the [[albendazole]]

Aidan: /* Medication */

2022-05-04T16:24:19Z

Medication

← Older revision		Revision as of 16:24, 4 May 2022
Line 154:		Line 154:
	*May be used in combination with surgerical resection or PAIR, to prevent secondary seeding		*May be used in combination with surgerical resection or PAIR, to prevent secondary seeding
	**Shouldn't be done too soon before procedure due to potential for becoming more fragile and therefore more likely to rupture		**Shouldn't be done too soon before procedure due to potential for becoming more fragile and therefore more likely to rupture
			**For simple cysts, usually start the [[albendazole]] only a day or so before the procedure
	*[[Albendazole]] 10-15 mg/kg/day in two divided doses, taken with a fat-rich meal		*[[Albendazole]] 10-15 mg/kg/day in two divided doses, taken with a fat-rich meal
	**30% cure at 3-6 months		**30% cure at 3-6 months