Internal Medicine

P1: RLJ/OZN P2: PSB

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

518 Echinococcosis

tests

■Basic tests: blood: sometimes eosinophilia (both diseases)

■Basic tests: urine: normal

■Specific tests:

➣E. granulosis: ultrasound and/or CT scan locates cysts and

is sometimes diagnostic, depending on internal morphology.

Serology, using immunoelectrotransfer blot (EITB, done at CDC),

is sensitive and specific. Double diffusion test (a gel diffusion

test) also very good. Lung cysts often have negative serology (any

method).

➣E. multilocularis: Ultrasound and CT scans locate cysts and sug-

gest diagnosis. Serology, using the em2 ELISA, is sensitive and

specific.

■Other tests: Chest X-ray locates lung cysts but is not usually diag-

nostic. CT scanning locates cysts in bone, brain, etc. Antigen tests

available, but only present in 50% cases. PCR currently research only.

differential diagnosis

■E. granulosis: simple liver cysts, amebic abscess, other abscesses in

liver. In lung: tuberculosis, abscess, bronchogenic cysts, tumors.

■E. multilocularis: carcinoma or sarcoma in liver

management

What to Do First

■E. granulosis: assess entire patient for cysts, and their size. If possible,

an estimate of age of cyst(s).

■E. multilocularis: assess for possibility of resection.

General Measures

■Instructions on how to avoid rupture. Screen others in area suspect

for disease, using serology and/or ultrasound.

specific therapy

Indications

■Both diseases: All patients with viable or possibly viable cysts

Treatment Options

■E. granulosis:

➣Chemotherapy: for nonresectable disease or small hepatic cysts

(<7 cm). Use albendazole for 3–6 months.