Internal Medicine

P1: RLJ/OZN P2: PSB

0521779407-D-02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:9

Dyspnea Echinococcosis 517

General Measures

■Additional tests based on clinical suspicion, pulmonary function

testing

specific therapy

■Aimed at treatable etiologies (see specific diseases)

■Severe dyspnea (eg, end-stage lung disease) may require oxygen,

noninvasive ventilation (BiPAP), and opiates

follow-up

■Careful coordination of care may be needed during extensive work-

up

complications and prognosis

■Depends on underlying cause

Echinococcosis......................................

J. GORDON FRIERSON, MD

history & physical

History

■Disease due toEchinococcus granulosisandEchinococcus multiloc-

ularis

➣Life cycle:E. granulosis: eggs shed by sheep dog are ingested by

sheep or man, develop into larval cysts, mainly in the liver; cysts

are eaten by dogs and larvae develop into tapeworm, which gives

off eggs

E. multilocularis: same cycle except hosts are foxes, wolves,

other carnivores, and intermediate hosts are voles, shrews,

mice. Arctic and alpine disease.

■Exposure: ingestion of eggs of either cestode through dirty hands,

food

Signs & Symptoms

■E. granulosis: usually silent until cyst in liver reaches 5 or more cm.

Then RUQ pain, or pain elsewhere, depending on where cyst is (most

are in liver or lung). Rupture or leak causes allergic reactions, occa-

sionally anaphylaxis.

■E. multilocularis: grows rapidly, pain is more frequent, generally in

liver