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DIAGNOSIS, CONTINUED
b)
Serological Diagnosis:
General:
Eosinophilia
- frequently absent
- protection of lung cysts from host immune response
ELISA:
- not specific (cross-reactivity with helminths other than
Echinococcus, and in non-infectious conditions such as malignancy and
autoimmune diseases)
- positive in 90% with liver disease
- positive in 50% with lung cysts only
TREATMENT
a) Surgical:- lung-preserving resection is treatment of choice
- very high cure rate
- several techniques described
- intraoperative risk of spillage causing disseminated disease likely overstated, based upon a large case series that found that even cysts that ruptured pre-op had minimal recurrence
b) Medical:
- benzimidazole compounds (mebendazole and albendazole)
- may be sufficient for small pulmonary cysts
- also indicated if surgery not feasible
- no indication for pre-op treatment
- WHO recommendations are for treatment of inoperable disease or incomplete
surgery, or to prevent secondary echinococcus after spontaneous or traumatic
rupture
- some advocate post-op treatment, especially if spillage
- minimal evidence
Main risks:
- potential teratogenicity (in lab animals)
Side effects
are usually mild:
- GI disturbance, transaminase elevation, hair loss, sleeplessness,
leukopenia
PROGNOSIS AND OUTCOME
- pediatric series (n=33) from Austria- no operative deaths
- 2 patients had recurrence (mean f/u 4.8 yrs)
- large (n=405) series from Turkey
- 4 had recurrent cysts (3 had ruptured before surgery)
- f/u range 16 to 58 months
- prognosis generally excellent
