Cystic echinococcosis in a rural Peruvian family

Abstract

The prevalence of human infection with was not painful, surgery was recommended and a subcutaneous cyst, measuring 5 cm Echinococcus granulosus, the cause of cystic echinococcosis (CE), is particularly high in diameter, was subsequently removed. As CE was conŽ rmed when this neck cyst where the Andes pass through central and southern Peru (Otarola, 1966). That infection was examined, the girl’s abdomen was then checked with ultrasound (US) and three is common in this area is largely the result of high levels of human–dog contact (dogs further cysts — two (measuring 10 and 4 cm in diameter) in the right lobe of the liver being the parasite’s main deŽ nitive host) and inadequate disposal of the viscera of infected and another (5 cm) in the left lobe — were revealed. A chest X-ray appeared normal. livestock (Moro et al., 1994, 1997). Given the epidemiology of the disease, it is perhaps Like the neck cyst, all the liver cysts were surgically removed and pathological examnot surprising that clusters of human infection are sometimes observed in areas where CE ination conŽ rmed them to be of Echinococcus. The girl’s post-operative recovery was is common. One such cluster, in a Peruvian family of seven members, six of whom uneventful. In April 1989, one of the boy’s in the underwent surgical treatment for CE over a 6-year period (1986–1992), is described family, then 16 years old, was admitted to hospital complaining that he had had a cough below. All members of this family (a man and woman and their Ž ve children) were and mild haemoptysis since August 1987 (he had been previously diagnosed, at another born in Huarochiri, a small rural town, 3000 m above sea level, in the department medical centre, as a case of pulmonary tuberculosis but had shown no improvement of Lima. The family raised sheep and cattle and usually kept three sheep dogs to help on treatment for this condition). A chest X-ray then showed a small round shadow manage the farm animals. The children, both boys and girls, were allowed to have (2×2 cm) on the upper lobe of the right lung, and an abdominal scan with US revealed close contact with the dogs. The livestock were slaughtered, when necessary, by the cysts in both lobes of the boy’s liver. The lung infection was checked Ž rst, by surgery; adults, close to their house, and the adults reported feeding raw viscera, from livestock multiple small cysts were found in the upper lobe of the right lung and a lobectomy was known to have the cysts of CE, to their dogs on several occasions. performed. At a subsequent laparotomy, three cysts (measuring 12, 12 and 4 cm in In August 1986, one of the girls, then aged 5 years, complained of a swelling on diameter) were found in the right lobe of the liver and another 12-cm cyst, with a Ž stula the back of her neck. This swelling gradually increased in size until, 9 months after the into the biliary tract, was found in the left lobe. Crystal-clear  uid was aspirated from swelling had Ž rst been noticed, the girl’s parents sought medical advice. A general each of these cysts which were then washed internally with hypertonic saline to remove examination then revealed hepatomegaly (3 cm below the costal margin) and a large any daughter cysts. All the daughter cysts removed were conŽ rmed to be those of CE. (8×6 cm) swelling on the left side of the back of the girl’s neck. Although the swelling The boy recovered without complication.