ATLASLIVER, LUNG, CNS PARASITES
      CESTOIDEA Order: Cyclophyllidea

      ECHINOCOCCUS GRANULOSUS

      Hyd1-ic

      Echinococcus granulosus: life cycle.


      Hyd2-ic

      Echinococcus granulosus infection has a world-wide
      distribution with a higher prevalence in South-America (Argentina, Uruguay),
      Europe (mediterranean bassin), Northern Africa, Middle East,
      South-Central and East Asia.


      Hyd3-ic

      Echinococcus granulosus: hydatidosis is caused by the larval stage of E.granulosus.
      After ingestion of eggs the onchospheres penetrate the intestinal mucosa
      and reach host organs (mainly liver and lung) where they encyst within a week
      reaching 1 cm in diameter in about 5 months.


      Hyd4-ic

      Echinococcus granulosus: the cysts (2 to 30 cm) are constituted by an external
      acellular cuticule and an inner cellular "germinal" layer (10-25 µ) that produces
      the brood capsules containing 6-12 protoscolices or single protoscolices.
      (Germinal layer with a protoscolex).


      By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD
      Echino 02-400 Echino 03-250 Echino 04-400 Echino 06-400 Echino 07-1000
      By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD
      Echino 08-1000 Echino 09-1000 Idat 02 Echino 10-100 Echino 11-250

      Echinococcus granulosus: Cyst wall showing a laminated membrane
      (Echino 10 100; Echino 11 250)       and the germinal layer (Echino 03 250),
      with scolices in the brood capsules.
      Some scolices are invaginated (idat 02) and have a double row of hooklets
      (Echino 04 400; Echino 06 400).
      Double row of hooklets (Echino 09 1000) and free hooklets
      (Echino 07 1000; Echino 08 1000, Echino 02 400).

       Courtesy of M.Lisci MD and G.Cera MD:
      Pathology Unit, Ospedale di Mondově ASL 16 Mondově, Italy


      By M.Lisci MD and G.Cera MD By M.Lisci MD and G.Cera MD
      Liver 400x Liver 250x

      Echinococcus granulosus: E.granulosus protoscolex adjacent to liver parenchima
      H-E stain 1000 X oil immersion.

       Courtesy of M.Lisci MD and G.Cera MD:
      Pathology Unit, Ospedale di Mondově ASL 16 Mondově, Italy


      Hyd5-ic
      By Dott. Luis Toca Porraz

      echi_gran_pro-ic
      Echinococcus granulosus protoscolex

      Echinococcus granulosus: the larvae (scolices) develop from the germinal layer.
      The protoscolices are at first evaginated and measure 120-220 by 70-120 µ.

      Echinococcus granulosus: mature protoscolex.

      Echinococcus granulosus protoscolex:
      Courtesy of Dott. Luis Toca Porraz,
      Jefe del laboratorio de la UMF 4 - IMSS, Mexico


      Hyd6-ic

      Echinococcus granulosus: the mature protoscolices have 4 suckers and a rostellum
      with hooklets and can be observed in the hydatid fluid.


      Hyd6a-ic

      Echinococcus granulosus: detail of the rostellum.


      Hyd7-ic

      Echinococcus granulosus: the presence of isolated hooklets
      is diagnostic for hydatidosis.
      Hooklets can be observed in hydatid fluid and must be searched
      in sputum after a vomica .


      Hyd8-ic

      Echinococcus granulosus: the protoscolices then become invaginated and
      measure 90-140 by 70-120 µm.
      They can transform into daughter cysts.
      These cysts can proliferate both internally and externally giving exogenous cysts.
      Spontaneous or surgical rupture of the cyst can originate a secondary hydatidosis.


      Hyd9-ic

      Echinococcus granulosus: the liver is the most common site
      of development of cysts (50-75%).
      Lesions can be detected by CT scan or echography;
      a septate structure is a characteristic of active cysts.
      Treatment is based on surgical and/or medical therapy (albendazole)


      By the Editor Pietro Caramello, MD By the Editor Pietro Caramello, MD

      Hyd10-ic

      Hyd10b-ic

      Echinococcus granulosus: definitive diagnosis is obtained by means 
      of serologic tests (EIA, IHA, CIEP/Western Blot); 
      the last two are confirmatory tests
      and are useful for the follow-up of treated patients.

      Image:      Hyd10-ic Detail of liver lesion, CT-scan with septa. 
      Image:      Hyd10b-ic Western blot analysis: both Ag5 (55 and 65 Kd) 
      and       AgB (8, 16, 24 Kd) bands are present.

      By the Editor Pietro Caramello, MD


      Hyd11-ic

      Echinococcus granulosus: pulmonary infection is observed in about 20-30% of patients.
      Roengtenografic examination shows round mass lesions
      and CT scan demonstrates the fluid content of the lesion.
      Serology has a lower sensitivity in extrahepatic hydatidosis.


      By the Editor Pietro Caramello, MD By the Editor Pietro Caramello, MD By the Editor Pietro Caramello, MD

      Hyd12-ic

      Hyd12b-ic

      Hyd12c-ic

      Hyd12d-ic

      Echinococcus granulosus: any other organ can be affected: 
      nervous system, heart, bones, spleen eyes, muscles are the most common sites. 
      Multiple involvement is frequent.
      Symptoms and signs depend on the size, 
      the site and the pressure of the cyst on host structures.

      Image:       Hyd12-ic CT scan of a spleen cyst.
      Images:       Hyd12b-ic,Hyd12c-ic,Hyd12d-ic MRI scans of a muscular cyst.

      By the Editor Pietro Caramello, MD


      Hyd13-ic

      Echinococcus granulosus: medullary hydatidosis is a severe form of the infection.
      In this case the mechanical pressure of host tissues caused paraplegia.
      The surgical treatment allowed resolution of symptoms.
      The infection relapsed and responded partially to medical treatment.


      Hyd14-ic

      Echinococcus granulosus: MRI imaging can demonstrate the relationship
      between the cyst and the medulla on the longitudinal axis.
      The serology is often negative in infections in sites other than liver or lung.
      (Medullary hydatidosis).


      By Daniel Brito de Araujo, By Daniel Brito de Araujo, MD and Marcelo Rios Pinto de Britto, MD. By Daniel Brito de Araujo, MD and Marcelo Rios Pinto de Britto, MD.
      Cisto_Hidático03-ic Cisto_Hidático02-ic Cisto_Hidático01-ic

      Echinococcus granulosus: excision of pulmonary echinococcosis;
      TC, surgical intervention, cysts.

      Echinococcus granulosus.: Courtesy of Daniel Brito de Araujo, MD
       and Marcelo Rios Pinto de Britto, MD.
       Hospital Escola - Universidade Federal de Pelotas (Brasil - RS).


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