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Year : 2008  |  Volume : 51  |  Issue : 1  |  Page : 143-145
Morbidity pattern of hydatid disease (cystic echinococcosis) and lack of its knowledge in patients attending Mamata General Hospital, Khammam, Andhra Pradesh

Department of Microbiology, Mamata Medical College, Khammam, Andhra Pradesh, India

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There is hearsay that prevalence of hydatid disease in Khammam and Nalgonda districts of Andhra Pradesh is high. We report here a preliminary study conducted to determine the magnitude of the problem of hydatid disease and the morbidity associated with it in patients attending MGH, KMM, A.P. (rural hospital). Eleven cases were identified during the period from November 2005 to May 2006 (seven months). Pain in abdomen, mass per abdomen, loss of appetite, pregnancy complicated by cystic echinococcosis (CE), and jaundice were the main clinical symptoms and signs. Ultrasonography, detection and removal of the cysts on the operation table, microscopic examination of the aspirated hydatid fluid were confirmatory. Ziehl-Neelsen stain of the aspirated fluid revealed acid-fast scolices. Interrogation of the patients and their family members (50) revealed that there was a total lack of knowledge of dog-tapeworm-caused infection in humans. They knew 'rabies' as the only disease man gets from dogs, and tapeworms are from pork and beef.

Keywords: Acid-fast scolices, cystic echinococcosis, morbidity

How to cite this article:
Hemachander S S, Prasad C R, Jessica M. Morbidity pattern of hydatid disease (cystic echinococcosis) and lack of its knowledge in patients attending Mamata General Hospital, Khammam, Andhra Pradesh. Indian J Pathol Microbiol 2008;51:143-5

How to cite this URL:
Hemachander S S, Prasad C R, Jessica M. Morbidity pattern of hydatid disease (cystic echinococcosis) and lack of its knowledge in patients attending Mamata General Hospital, Khammam, Andhra Pradesh. Indian J Pathol Microbiol [serial online] 2008 [cited 2022 Jan 22];51:143-5. Available from: https://www.ijpmonline.org/text.asp?2008/51/1/143/40429

   Introduction Top

Human beings' association with dog is endearing, provided the dog does not carry tapeworms (Echinococcus granulosus) in its intestine.

Dog/wolf/jackal is the definitive host carrying adult worms (tens of thousands) in the small intestine. (The adult worm measures less than a centimeter). Eggs discharged in the feces are infective to sheep/pig/cattle/horse and humans. The larval stage is hydatid cyst. The hydatid disease has varied clinical manifestations in humans, depending on the location, number and size of the cysts.

Hydatid disease is presently called cystic echinococcosis (CE). [1]

Objective of the study

To determine the magnitude of the problem of CE and the morbidity associated with it in patients attending Mamata General Hospital (rural hospital) at Khammam in Andhra Pradesh.

   Materials and Methods Top

The study design was cross-sectional, including the cases attending the outpatient departments of surgery/obstetrics and gynecology. One hundred patients with pain in abdomen and/mass per abdomen were enrolled for this study and investigated by ultrasonography for a period of seven months during November 2005 to May 2006. The cases found to be with hydatid cysts were taken for surgery. On the operation table, the surgeon identified the cysts and aspirated the fluid. This fluid was examined microscopically, and a wet film to detect the hydatid sand and a smear stained by Ziehl-Neelsen stain to detect the acid-fast scolices were used. The cysts removed by the surgeon were preserved in formalin.

   Results Top

Of the 100 cases studied, 11 were identified to be cases of CE. Six cases were from Khammam District. Six out of the 11 cases were females. The presenting complaints of these 11 cases were pain in abdomen, mass per abdomen, loss of appetite and jaundice. One female had pregnancy complicated by a large hepatic hydatid cyst (about 20 cm) extending retroperitoneally and was admitted to the hospital for a safe institutional delivery. As the pregnancy was already reaching term, under close monitoring, normal vaginal delivery was conducted. The patient delivered a male child weighing 2.3 kg. Elective surgery was done and the big cyst was removed.

The distribution with respect to district, gender, and clinical signs and symptoms is given in [Table - 1].

Particulars of the cysts (anatomical location, number of cysts and size of the cysts) are given in [Table - 2].

   Discussion Top

CE is endemic in India. The annual incidence of CE per 100,000 persons varies from 1 to 200. [1] The cross-sectional study conducted over a brief period of seven months at MGH, Khammam, revealed 11 cases of CE associated with various clinical manifestations and immense morbidity. One case was that of hydatid cyst complicating pregnancy, and another was that of hydatid cyst causing obstructive jaundice.

Hydatid cysts can occur anywhere in the body; and cases of CE in orbit, [2] left ventricle of the heart, [3] muscle, [4] ovary [5] and intraosseous have all been reported. In the present study, as usual hepatic hydatid cyst is the commonest (nine cases). No cysts were found in lungs, probably because ultrasonography cannot detect them. [1] Presence of multiple cysts in four patients was an interesting finding (one case with cysts in kidney, liver and spleen; one with cysts in kidney and spleen; one with cysts in liver and omentum; and one with multiple cysts in right and left lobes of liver.) Multiple cysts in the same patient may indicate ingestion of many eggs of Echinococcus.

CE in females

The number of cases (six), size of the cysts (10 to 20 cm), the duration and morbidity (jaundice, pregnancy-complicating cases, etc.) were more in females. One case was a 23-year-old pregnant woman. Another was also 23 years old with a hepatic cyst containing 30-40 daughter cysts inside. The cyst in a 50-year-old woman was large (18 cm), with daughter and granddaughter cysts [Figure - 1] weighing about 1 kg. A 32-year-old woman with obstructive jaundice of one months' duration was a case of recurrent CE. She underwent surgery for the removal of a hepatic cyst five years ago. The size of the cyst in females appears to be relatively larger in comparison to that in males. Three cases with cyst size of 10-18 cm (two cases) and 20 cm (one case) were females. The females carried the cyst in their body for a duration that was 5 to 10 years longer than did males as the symptoms and signs of CE mimic those of menstrual cycles or as the females are used to bear the pain/discomfort, etc., or as no ultrasound examination is done on their visits to their local medical practitioners.

Despite of a large number of publications on CE in human beings, the information on CE associated with pregnancy is very scarce. The incidence of CE in pregnancy is as low as 1 in 20,000 to 30,000. [6] Because of its rarity and size of the hepatic cyst being large (20 cm), filled with fluid >500 ml, extending retroperitoneally, our single case of CE complicating pregnancy became noteworthy. Review of literature on CE in pregnancy revealed that hydatid cysts may grow bigger due to decreased cell-mediated immunity and humoral effects of placental steroids. (In our study, the largest was in the pregnant woman.) [7],[8],[9]

Lack of awareness of CE

On interrogation of the patients and their family members (total 50 persons), the following information was obtained: 1. All of them had the knowledge of tapeworm infections from beef and pork, and they knew rabies as the only infection man gets from dogs. 2. All of them had no knowledge of dog-tapeworm and hydatid cysts occurring in humans due to ingestion of food contaminated with the feces of infected dogs.

   Conclusions Top

  1. Hydatid cysts are associated with great morbidity in people of Khammam and Nalgonda districts of Andhra Pradesh. Well-established sources of infection seem to be present in these areas.
  2. All the patients and their families had no knowledge about Echinococcus infection, its source or modes of infection.
  3. Morbidity due to hydatid cyst is more and of longer duration in females when compared to males, probably due to their life style and/or neglect with respect to health care.

   Recommendations Top

This study points towards the need to maintain personal hygiene and also to generate awareness in the community.

   Acknowledgments Top

The authors gratefully acknowledge the help of their professional colleagues from the departments of Surgery, Obstetrics and Gynecology, Radiology and Preventive and Social Medicine, Mamata Medical College and General Hospital, Khammam, Andhra Pradesh. Our special thanks to Prof. R. K. Gupta, Department of Community Medicine, Mamata Medical College, Khammam.

   References Top

1.Parija SC. A textbook of medical parasitology: 2 nd ed. All India Publishers and Distributors: Madras; 2004. p. 220-9.  Back to cited text no. 1    
2.Kulkarni D, Kulkarni H, Deshpande AA, Karyakarte R. Hydatid of the orbit: A case report. Indian J Pathol Microbiol 2002;45:177-8.  Back to cited text no. 2    
3.Umesan CV, Kurian VM, Verghese S, Sivaraman A, Cherian KM. Hydatid cyst of the left ventricle of the heart. Indian J Med Microbiol 2003;21:139-40.  Back to cited text no. 3    
4.Mittal S, Mansgwana S. Primary diagnosis of soft tissue Echinococcosis by aspiration cytology. Indian J Pathol Microbiol 1993;36:298-303.  Back to cited text no. 4    
5.Rathod VS, Rathod SB, Suvernakar SV. Multiple Hydatid cyst of ovary and spleen: A case report. Indian J Pathol Microbiol 2006;49:1.  Back to cited text no. 5    
6.Bu-Eshy S, Elamin Ali M. Hydatid cyst associated with pregnancy: A case report and review of the literature. Ann Saudi Med 1999;19:2.  Back to cited text no. 6    
7.Jasper P, Peedicayil A, Nasir S, George RK. Hydatid cyst obstructing labor: A case report. J Trop Med Hyg 1989;92:393-5.  Back to cited text no. 7    
8.Golaszewskil T, Susani M, Golaszewski S, Shultz G, Bisghof G, Auer H. A large cyst of the liver in pregnancy. Arch Gynecol Obstet 1995;256:43-7.  Back to cited text no. 8    
9.Rahaman MS, Rahaman J, Lysikiewiez A. Obstetric and gynecological presentations of Hydatid disease. Br J Obstet Gynaecol 1982;89:665-70.  Back to cited text no. 9    

Correspondence Address:
S Suguna Hemachander
Department of Microbiology, Mamata Medical College, Khammam, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.40429

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  [Figure - 1]

  [Table - 1], [Table - 2]

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