Treatment of Liver Echinococcosis
Best hospitals and doctors for liver echinococcosis treatment abroad
Leading hospitals
Cost for treatment
Content
- Overview
- Sources of echinococcosis
- How does liver echinococcosis manifest?
- Diagnosis
- Treatment regimen
- Treatment methods
- Preventative measures
- Hospitals for the treatment of liver echinococcosis
- Prices for treatment of liver echinococcosis
- Undergoing treatment of liver echinococcosis abroad
Echinococcosis (hydatid disease) is the infection with a tapeworm – echinococcus, which is in the larval stage at the time of the invasion. Unlike other tapeworms, echinococcus invades the liver, lungs, and even the brain. Constantly growing echinococcal cysts cause compression of internal organs and soft tissues, which impairs their function.
Overview
Echinococcosis is a common parasitic disease in humans.
Echinococcus can affect any organ, but in most cases, it’s the liver or lungs. The incubation period of the hydatid disease can vary from 2-4 months to 5-15 years. From the moment of infection, the disease goes through three stages of development. Each of them has different symptoms. There are several forms of the disease. Most often, alveolar echinococcosis and cystic echinococcosis develop, less often echinococcosis of the kidneys, brain, and intestines develops. Cystic echinococcosis often affects the liver, alveolar echinococcosis affects the lungs mainly.
Sources of echinococcosis
The main cause of echinococcosis is infection with the tapeworm Echinococcus granulosus. In the human body, it goes through the larval stage of its development. Humans and herbivores, domestic and wild, are intermediate hosts for the parasite.
The size of an adult echinococcus is small, no more than a centimeter. Its eggs leave the body of the final host during bowel movements and remain in the soil for several months. When it enters the human body, the larva penetrates the intestinal wall. From there it goes into the bloodstream, which delivers it to the organ on which it will parasitize.
A cyst begins to develop in the tissues, growing by about 1 mm per month. Their total number can exceed a thousand. In case of a cyst breakthrough, a person develops purulent tissue inflammation, which, in the absence of medical care, can lead to death. In some cases, the parasite dies spontaneously and the cyst resolves.
Domestic animals are the main source of human infection. In cats and dogs, the parasite develops from the larval to the adult stage, and then a person can become infected by contact with the feces of their pets.
With insufficient heat processing of animal food products, the larvae remain viable and enter the human intestine with food, travelling later into the liver or other organs.
The most common source of infection with echinococcus is getting it into the body through unwashed hands or with foods that have been into contact with contaminated soil.
How does liver echinococcosis manifest?
Symptoms of liver echinococcosis (liver hydatid disease) correlate with the stage of the pathology and the localization of the echinococcal cyst. The latency period can last for several years without symptoms. When the process enters the stage of progressive growth, patients experience pain at the site of the cyst, general weakness, and may complain of urticaria and itching. The pathological process can be complicated by the rupture of the cyst, and, as a consequence, the development of peritonitis (inflammation of the peritoneum) or pleurisy (inflammation of the pleura).
Patients with liver echinococcosis usually complain of nausea, lack of appetite, loose stools, pain in the right hypochondrium. During palpation of the liver through the abdominal wall the doctor can detect liver echinococcosis. If the cyst has grown so much that it compresses the bile ducts, obstructive jaundice develops. Deformation of the portal vein by a growing cyst can lead to portal hypertension (increased blood pressure in the portal vein system) and accumulation of fluid in the abdominal cavity. With the addition of secondary infection, medical treatment becomes more complicated.
Diagnosis
At the first stage of diagnosis making the doctor needs to find out when the symptoms began. It is important whether the person had contact with animals, whether the patient ate unwashed fruits or vegetables, insufficiently processed the food, or drank unfiltered water.
Blood tests help in making the diagnosis of liver echinococcosis. A complete blood count will show an increased blood level of eosinophils (cells that contribute to the development of an allergic reaction in the body). Biochemical blood tests will reveal dysproteinemia (violation of the ratio of blood protein fractions), a decrease in albumin (a simple protein soluble in water), prothrombin (an indicator of blood coagulation), and an increase in gamma globulins (antibodies). All this is evidence of a violation of the protein synthesis in the liver.
Immunological research methods include the indirect hemagglutination reaction – a method for detecting viruses in the body.
Among the instrumental methods of making the diagnosis, ultrasound scan of the abdomen is highly effective.
Due to the high information content and simplicity, ultrasound scan has become one of the main methods for diagnosing liver echinococcosis. It allows obtaining reliable information about the localization and nature of the cyst in the liver. Given the absence of a harmful effect of the diagnostic ultrasound scan on the human body, there is a possibility of re-examination. Postoperative ultrasound diagnostic control is also carried out in order to assess the effectiveness of the operation.
Ultrasonography is of special importance. Ultrasonography is considered expedient in all cases of suspicion of echinococcal disease. Diagnosis of patients often begins with an ultrasound scan.
The use of ultrasonography made it possible to obtain high-quality images, and thus determine cysts localization not only by lobes but also by segments. This is important for planning the medical treatment and assessing the volume of surgical intervention. The radicality of manipulations during treatment of liver echinococcosis depends on the choice of the operative access and surgical technique.
Magnetic resonance imaging or computed tomography also helps to detect pathological cysts. Radiography can also be used in diagnosis making. To determine the etiology of formations, the method of liver biopsy is used.
Treatment regimen
Conservative and surgical treatment of liver echinococcosis is used in modern medicine, as well as general recommendations, including diet therapy – a diet high in protein, vitamins, minerals, and restriction of animal protein.
Conservative treatment is symptomatic and/or anti-relapse, so the main method of treatment of liver echinococcosis is surgery. During treatment, pain relievers and antiemetic drugs are used to eliminate symptoms, hepatoprotectors are prescribed to protect and normalize liver function. Antiparasitic drugs for liver echinococcosis are ineffective. They are used to prevent infection of other organs before and after the operation.
Treatment methods
There are different types of operations for the treatment of liver echinococcosis.
Getting rid of the parasite is extremely difficult. The most effective is the surgical treatment of echinococcosis, but it is not possible in all cases. There are currently four main treatments: surgical (radical and partial), percutaneous, and conservative.
Radical surgery completely eliminates the cause of the disease. In this case, the infected part of the organ or cyst is removed. Partial resection, or removal of part of the cyst and antiparasitic treatment of the affected area, eliminates the cause of the disease, but in this case there is a risk of recurrence.
In some cases, surgical treatment is impossible, and the conservative antiparasitic treatment, which can last from several months to two years is applied.
Percutaneous methods, usually involving techniques of percutaneous aspiration, percutaneous puncture, percutaneous drainage with further administration of drugs are widely used for the management of cystic echinococcosis.
All percutaneous procedures are performed under anesthesia with ultrasound guidance of patients throughout treatment. In percutaneous procedures, ultrasound is vital as it determines the location of the cysts and the position of the patient during the treatment.
For small cysts, percutaneous aspiration is usually used, and for bigger ones – percutaneous drainage. In percutaneous aspiration, the cyst is punctured and most of the cyst's content is aspirated. Then the cyst is filled with drugs that help to eliminate the cyst content completely.
With percutaneous drainage, the manipulations for percutaneous aspiration are repeated and the remaining fluid is drained from the cyst through the catheter.
After recovery, the patient undergoes follow-up examinations for 10 years.
Preventative measures
Secondary prevention of liver echinococcosis includes follow-up examinations of patients who have undergone therapy. At least once a year, they have a blood test, urine test, tests for antibody-serological reactions (based on the determination of antibodies), X-ray and ultrasound examinations.
It is obligatory to register veterinary services and carry out regular examinations of domestic animals for parasites, especially in regions with a high incidence of echinococcosis. Control over proper cooking is of high importance as well.
Hospitals for the treatment of liver echinococcosis
Today, the healthcare systems are best developed in Western Europe (in particular in Germany), in the United States, and Israel and Turkey. If you decide to undergo treatment of liver echinococcosis abroad, we recommend that you choose from the following hospitals:
- University Hospital of Ludwig Maximilian University of Munich, Germany
- University Hospital Duesseldorf, Germany
- University Hospital Jena, Germany
- Memorial Sisli Hospital Istanbul, Turkey
- Primus Super Speciality Hospital New Delhi, India
- Tel Aviv Sourasky Medical Center, Israel
You are welcome to check out the profiles of the hospitals on the Booking Health website for more information.
Prices for treatment of liver echinococcosis
The cost of treatment with extensive liver resection in Germany starts at 18,031 EUR, in Israel – at 26,643 EUR, and in Turkey – at 12,105 EUR.
The cost of treatment with partial liver resection in Germany starts at 15,482 EUR, in Israel – at 21,434 EUR, and in Turkey – at 9,720 EUR.
The cost of treatment with percutaneous aspiration echinococcotomy in Germany starts at 8,650 EUR, in Israel – at 11,000 EUR, and in Turkey – at 4,948 EUR.
Undergoing treatment of liver echinococcosis abroad
The benefits of undergoing treatment in hospitals abroad are enormous. The favorable prices, individual approach, modern technologies, and professionalism of foreign doctors are the main ones.
You can easily receive all of the above with the medical tourism operator Booking Health. With Booking Health, you don’t have to worry about where to start with treatment arrangement. You can enjoy having the support instead.
Leave a request on the Booking Health website to get to know how the diagnosis and treatment arrangement works.
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed