Speeding Up the Diagnosis of Pancreatic Echinococcosis

Correctly diagnosing pancreatic echinococcosis (PE) earlier can occur with a combination of CT or MRI scans, epidemiological history, and positive echinococcosis serology, according to a paper published in Open Forum Infectious Diseases.

Investigators from China retrospectively analyzed 19 patients with PE in order to track their clinical manifestations, laboratory tests, radiological findings, and treatment. The patients were treated in 2 hospitals between January 2006 and December 2018. The study authors followed up with the patients for at least 1 year.

The study authors said that the incidence of PE in China is increasing, but the imaging characteristics of PE are similar to cystic diseases such as cyst, tuberculosis, or tumor. This leaves PE often misdiagnosed and mistreated as it only effects about 0.14% to 2% of patients with hydatidosis.

The diagnostic features of PE include: the characteristic epidemiological setting, history of liver and lung echinococcosis, daughter cysts and typical eggshell cyst wall calcification on abdominal CT, the internal cyst wall dissection and imaging presented ribbon sign, or positive echinococcosis serology, the study authors wrote.

The patients were admitted to the hospital, provided a medical history, and underwent clinical examination and lab tests for PE. This included CT scans and 7 patients also underwent MRI examination, the study authors reported. Sixteen of the patients underwent contrast-enhanced CT scans, while 7 patients were used in MR Short-TI-RI (STIR) cans, and 2 patients underwent magnetic resonance cholangiopancreatography (MRCP) testing. After CT or MRI examinations, patients were hospitalized for a week.

The investigators wrote that 6 of their patients were male and 13 were female, with ages ranging from 13 to 67 years, with a median age of 38 years. Their occupations were farmers (9 patients), herdsman (9 patients) and 1 student. All of the patients lived in rural areas of Xinjiang, the study authors added.

The authors also noted that close contact with a dog or sheep was counted as having a dog or sheep at home. This is relevant due to the zoonotic nature of PE, most frequently impacting the liver and lungs. Fourteen of the patients had a history of close contact with dogs or sheep and the study authors documented 7 cases of surgical history of hepatic hydatid.

The patients had a list of symptoms, including 10 cases of cholestatic jaundice, 7 cases of abdominal mass, 6 cases of nausea, 5 cases of abdominal pain, 3 cases of swelling. However, 3 cases had no clinical symptoms.

Of the 7 cases with a complete MRI exam, 3 cases were located in the pancreatic head, 3 in the body and 1 in the body/tail, the study authors reported. MRCP imaging for defining the lesion was performed in 2 patients, where the investigators found 2 cases of head lesions with the bile ducts dilated.

The patients were all treated with 400 mg albendazole daily for a month prior to surgery. After the surgeries, all patients were treated with albendazole and praziquantel and nitazoxanide (10 mg/kg body weight/day) for 6 months, the study authors said.

“This study presents the most significant number of cases with PE in China,” the study authors concluded. “For the patients with the cystic lesion CT and/or MRI diagnosis combined with epidemiological history and positive echinococcosis serology, the doctors can correctly diagnose PE earlier. The surgical treatment combined with drugs can reduce the mortality of PE, leading to a better prognosis.”