title: Management of serology negative human hepatic hydatidosis (caused by Echinococcus granulosus) in a young woman from Bangladesh in a resource-rich setting: A case report.
abstract: Human cystic echinococcosis (hydatidosis) is a parasitic zoonosis with almost complete worldwide distribution. Echinococcus granulosus, the dog tapeworm, causes hydatidosis which accounts for 95% of human echinococcosis. Although this tapeworm is found in dogs as a definitive host and a number of intermediate hosts, humans are often infected from close contact with infected dogs. Humans are not part of the parasitic lifecycle and serve as accidental hosts. Hydatidosis is an important consideration in the differential diagnosis of hepatic cysts in individuals from endemic areas. Clinicians should be aware of the long incubation period, the high frequency of negative serological tests, and the possibility of intraoperative evaluations of the cyst aspirate being non-diagnostic. We describe a case of serology negative hydatidosis that came to medical attention as an incidental finding in a young woman from Bangladesh. The patient underwent imaging and was then started on albendazole. After several weeks of albendazole, the cyst was punctured, aspirated, injected with hypertonic saline, re-aspirated, and then fully excised. Diagnosis was confirmed by microscopic evaluation of the cyst aspirate. Serological tests for hydatidosis may be negative in patients with early disease and thus should not be used to rule out this disease. Consideration of this diagnosis allows clinicians to avoid the catastrophic spillage of cystic contents risking an anaphylactic reaction, which might prove fatal. Despite World Health Organization hydatidosis staging being based on ultrasound, radiologists in resource-rich setting may prefer MRI in the management and staging of cystic echinococcosis.
authors.affiliation: The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA; Department of Infectious Disease, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA; Department of Infectious Disease, NorthShore-LIJ Health System, Manhasset, NY 11030, USA.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Griffin
authors.affiliation: Department of Infectious Disease, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA; Department of Infectious Disease, NorthShore-LIJ Health System, Manhasset, NY 11030, USA.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Donaghy
authors.affiliation: Department of Infectious Disease, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY 11030, USA; Department of Infectious Disease, NorthShore-LIJ Health System, Manhasset, NY 11030, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Edwards
references.citation: Eur Rev Med Pharmacol Sci. 2012 Oct;16(11):1513-8
references.pmid: 23111963
references.citation: Clin Infect Dis. 1999 Oct;29(4):807-12
references.pmid: 10589894
references.citation: J Hepatol. 1999 Feb;30(2):228-31
references.pmid: 10068100
references.citation: PLoS Negl Trop Dis. 2008 Jan 16;2(1):e125
references.pmid: 18235847
references.citation: PLoS Negl Trop Dis. 2012;6(10 ):e1880
references.pmid: 23145199
references.citation: Int J Parasitol. 1994 Nov;24(7):929-35
references.pmid: 7883443
references.citation: Clin Vaccine Immunol. 2010 Mar;17(3):470-5
references.pmid: 20042519
references.citation: Parasitol Int. 2006;55 Suppl:S181-6
references.pmid: 16376604
references.citation: Adv Parasitol. 2006;61:443-508
references.pmid: 16735171
references.citation: PLoS Negl Trop Dis. 2012;6(2):e1524
references.pmid: 22347516
references.citation: FEMS Immunol Med Microbiol. 2006 Jun;47(1):24-41
references.pmid: 16706785
references.citation: Emerg Infect Dis. 2006 Feb;12(2):296-303
references.pmid: 16494758
references.citation: MMWR Morb Mortal Wkly Rep. 2013 Sep 13;62(36):747-51
references.pmid: 24025757
references.citation: Radiology. 1981 May;139(2):459-63
references.pmid: 7220891
references.citation: Int J Parasitol. 1994 Aug;24(5):623-35
references.pmid: 7928063
references.citation: J Clin Microbiol. 1999 May;37(5):1561-3
references.pmid: 10203521
references.citation: Exp Parasitol. 2012 May;131(1):85-91
references.pmid: 22446351
references.citation: Diagn Microbiol Infect Dis. 1999 Dec;35(4):255-62
references.pmid: 10668582
references.citation: Acta Trop. 2010 Apr;114(1):1-16
references.pmid: 19931502
references.citation: World J Gastroenterol. 2012 Apr 7;18(13):1448-58
references.pmid: 22509076
references.citation: Trends Parasitol. 2008 Sep;24(9):419-24
references.pmid: 18678528
references.citation: Int J Parasitol. 1989 Sep;19(6):621-9
references.pmid: 2807718
references.citation: J Clin Microbiol. 2008 May;46(5):1631-40
references.pmid: 18367566
references.citation: PLoS Negl Trop Dis. 2010 Aug 03;4(8):e771
references.pmid: 20689813
references.citation: J Commun Dis. 1996 Dec;28(4):221-30
references.pmid: 9057445
references.citation: J Clin Microbiol. 2000 Nov;38(11):3979-83
references.pmid: 11060055
references.citation: Diagn Microbiol Infect Dis. 2003 Feb;45(2):123-6
references.pmid: 12614983
references.citation: Clin Infect Dis. 1992 Sep;15(3):473-80
references.pmid: 1520796