1. Pulmonary Echinococcus

2. Definition
Hydatid disease, which is caused by the echinococcus granulous tapeworm and is known as echinococcis or hydatidosis, has been acknowledged as a clinical disease since ancient times.

3. Review
History
Epidemiology
Etiology
The life cycle

4. History
Hydatid disease, known in the times of Galen, was described by Thebessius in the 17th century.
Rudolph(1808)first used the term “hydatid cyst” for the description of the echinococcis in man.

5. Epidemiology
Echinococcosis is a disease frequently encountered in the sheep and cattle raising-regions of the world.

6. Australia, New Zealand, South Africa, South America, and the Mediterranean countries of Europe, and Asia.

7. Ganshu,Ningxia, Qinhai, Xinjiang Shanxi, Neimengu Xizhang,Sichuan, etc.

8. Human Echinococcosis in major Endemic Regions in China
Years
Hospital
cases
Screening cases*
population patients
Xinjiang
Gansu
Qinghai
Ningxia
Sichuan
Qinghai &.
1951—90
1900
1991
1998
1990—98
1985
1989
1993—94
1997—98
16663
(20 hospitals)
2913
(AE 143)
1106
>2000
10682
26528
1275
32402
8799
1253(chengduo)
2389
5488
3999
6298
Tibetans (1251)
(2.0%)
(1.00%)
65 AE (5.1%)
(0.82%)
345 (3.92%, ae22)
141 AE (5.9&)
225 (4.1%)
161 (4.03%,CE85,AE 76
CE 260 (4.03), AE 94
(1.49%)
*Based on data and materials from China Hydatid Provention and Policy Symposium.

9. Etiology

10. The primary hosts of hadatid disease:
Dogs wolves coyotes

11. The Intermediate hosts of hadatid disease:
sheep, goats, cattle, hogs, deer, moose reindeer, elk

12. The life cycle of echinococcus granulosus

13. a parasitic worm
a scolex, neck, and three proglottids -segments.

14. The life cycle of echinococcus granulosus
In its adult stage, the parasite lives in the intestinal track of carnivores.
The last-proglottid contains 400 to 800 ova(eggs).
After being eliminated with the feces, the eggs contaminated fields, irrigated land and wells.

15. The life cycle of echinococcus granulosus
Herbivores ingest the eggs, which develop into larvae, or hydatids, within the viscera of these animals.
The cycle is completed with the ingestion of the infected viscera by carnivores

16. Humans contract the disease

17. The life cycle of echinococcus granulosus
Humans contract the disease from water or food or by direct contract with dogs
the eggs reach the stomach
the hexacanth embryos are released
Attaches to and penetrates the mucosa of the duodenum and jejunum
enters the tributary vein and proceed to the portal vein
the embryo enters the live and develop into a cyst.

18. If they overcome the hepatic obstacle, they may become lodge in the lung, where they would also be transformed into hydatids.
If they advance beyond the lung, they may remain in any organ to which they carried by the bloodstream.

19. the hexacanth

20. A hydatid cyst The wall The laminated membrane
The germinative membrane
the pericyst
The hydatid fluid

21. The hydatid fluid Colorless Odorless and resembles crystal-clear water
The specific gravity to 1.015
The PH to 7.2

22. The incidence of the hydatid disease
The liver % to 60% or 70% to 80%.
The lungs % to 15%.

23. The most common areas of involvement of pulmonary echinococcosis are the right lung and both of the lower lobes.

24. The Prevalence of the Various Locations in Humans

25. ThePrevalence of the Various Locations in Humans
Organ %
Liver
55.6
kindey
2.1
lung 25
brain
1.4
muscles and connective tissue
6.8
heart
1.2
spleen
others(thyoid gland,bones,breast,pancres,eyes)
4.2

26. The Prevalence of the Various Locations in thorax
Organ
cases %
Lung
1169
81.75
Right
up lobe
Middle lobe
Lower lobe
234
135
337 20
11.5
28.8
Left
215
248
18.5
21.2
The upper of the liver
168
11.75
The thoracic cavity 78
5.45
The thoracic wall 8
0.56
Diaphragm 3
0.21
Pericardium 4
0.28
In all
1430
100

27. The Prevalence of the Various Locations in thorax10 8
234
215 4
135
337 78
248
168 3

28. The pathway of the parasites entrance into the lungs

29. the gastro-intestinal system.
the lymphatic vessels.
the bronchi (Jerray et al, 1992)

30. Clinical manifestations Intact or simple hydatid cysts

31. Most of the patients are asymptomatic,
a nonproductive cough
blood-streaked sputum
a dull aching pain

32. Clinical manifestations Rupture of the hydatid cysts

33. vigorous coughing
a large amount of salty tasting sputum,
generalized rash, high fever,
pulmonary congestion, severe dyspnea
severe bronchospasm. shock, and even death

34. Diagnosis

35. 1. The history
The patient who lived in or went to an endemic area has the history to contact the sheep and dogs.

36. 2.Chest radiography or CT.
An intact Echinococcus cyst appears as a smoothly outlined, dense spherical or oval opacity in frontal chest roentgenogram or CT.

37. Rupture of the hydatid A “moon” sign or “crescent” sign
A “double-dome arch” sign
A “water-lily” sign
A “bulla ” sign

38. A “moon” sign Barrett and Tomas (1952).
This sign has been attributed to the air that enters the perivesicular space .

39. A “double-dome arch” sign
This sign may be observed when a relatively small amount of air further enter the hydatid vesicle.

40. A “water-lily” sign
The air into the cyst and the perivesicle space, following the complete rupture of the laminated membrane, displaces the fluid, This sign produced by the floating membrane of the cyst.

42. A “bulla ” sign
the complete rupture of the laminated membrane, displaces the all fluid,
The air into the cyst

43. 3.B-supersonic examination
shows that there is cystoid lesion in the lungs.

44. 4.clinical laboratory tests :
The Casoni’s intradermal test,
The Weinberg complement fixation test,
The indirect hemagglutination test.

45. Treatment

46. The current treatment of the hydatid cyst of the lung is complete excision of the disease process with maximum preservation of the lung tissue.

47. Removal of the intact cyst after needle aspiration
Segmental resection
Lobectomy
pneumonectomy

48. The types of the operation
Removal of the intact cyst after needle aspiration
Segmental resection
Lobectomy
pneumonectomy

49. The types of the operation
cases %
Removal of the intact cyst after needle aspiration
resection by enucleation of the cyst without needle aspiration
Lobectomy
Segmental resection
wedge pulmonary resection
Pneumonectomy
Limited Pericardial resection
Liquid nitrogon
VATS
681
294
109 17 46 4 2 5 11
58.2
25.1
9.32
1.45
3.93
0.3
0.15
0.43
0.94
In all
1169
100

51. B A
A: Removal of the intact cyst after needle aspiration B: resection by enucleation of the cyst without needle aspiration

52. POSITION

53. Large hydatid cyst

54. The lung containing the hydatid cyst
The lung containing the hydatid cyst. Note the grayish white surface of lung where the cyst is located.

55. Residual pericystic cavity after the hydatid cyst has been removed

56. Residual pericystic cavity after the hydatid cyst has been removed

57. Residual pericystic cavity after the hydatid cyst has been removed

58. drugs
At present, there are no special drugs to cope with the hydatid disease.
But there are some medicine may have certain effect, such as

59. Prevention/control pattern for hydatid diaseas(CE、AE)
Education for Hydatid Prevention and Control
Herdsman
Drugs
Albendazole
Fast serology
Human
Imaging
Combination
Patients
Surgery
Local residents
PAIR
livestock
Serology, imaging,
Fecal Exam,
Anatomy
Hosts
Drugs
Praziquantel
Ecology study
Slaughter
Wild Animals