Treatment of Liver Echinococcosis in Germany
Best hospitals and doctors for liver echinococcosis treatment in Germany
Leading hospitals
Cost for treatment
Content
- Where does it originate from?
- Stages of cystic echinococcosis (hydatid disease)
- What happens in hydatid disease?
- Why is hydatid disease dangerous?
- Manifestations
- Making diagnosis of cystic echinococcosis
- Treatment of liver echinococcosis in Germany
- Types of surgical treatment
- How is the surgery carried out?
- Can you prevent the development of hydatid disease?
- Where to undergo liver echinococcosis treatment in Germany?
- How to start treatment of liver echinococcosis in Germany?
Human echinococcosis belongs to one of the most severe parasitic diseases, leading to disability. It develops during the invasion and growth of the tapeworm Echinococcus granulosus in various organs.
Where does it originate from?
The primary carriers of hydatid disease are dogs, wolves, foxes, etc. The geographical spread of the hydatid disease includes different countries with developed agriculture. There are many clinical cases of infection with echinococcus there.
Predators get hydatid disease by eating the organs of animals infected with echinococcus. Infected predators are a source of polluting pastures, water, premises for animals and human homes with eggs of echinococcus.
Stages of cystic echinococcosis (hydatid disease)
The clinical picture of cystic echinococcosis (hydatid disease) is determined by the localization, the size of the cysts, the growth rate, and the degree of compression of the surrounding organs and tissues. Cystic echinococcosis of the liver can be clinically divided into three types:
- Initial or asymptomatic cystic echinococcosis
- Uncomplicated cystic echinococcosis (onset of symptoms)
- Complicated cystic echinococcosis with severe pathological changes
The asymptomatic cystic echinococcosis is the period of hydatid disease when the cyst is still very small and is located inside the liver parenchyma. Asymptomatic cystic echinococcosis is detected accidentally, during ultrasound scan or radiography.
During uncomplicated cystic echinococcosis, an increase in the liver size is revealed due to the growth of a cyst. If liver damage is multiple or the cysts are very large, the liver size increases in all dimensions. During uncomplicated cystic echinococcosis, urticaria, eosinophilia and other allergic manifestations are sometimes observed.
What happens in hydatid disease?
Digestive juices help the egg to free itself from the membranes and it penetrates the gastrointestinal wall. Further, with the flow of blood, it travels to the internal organs, such as liver, lungs, kidneys, muscles. Having already settled in their tissues, it turns into a larva. By the end of two weeks, the parasite forms cysts. In 5 months, the resulting cysts are 5 mm in diameter. In the future, they reach a large size gradually.
Changes in patients’ condition are associated with mechanical pressure of the growing cystic echinococcosis on the organs. The intensity of symptoms that patients experience is associated with the localization of the echinococcus. So, for example, a cyst that develops in liver echinococcosis may not cause any signs for many years, but it ultimately compresses the hepatic biliary passages, i.e. causes jaundice, and compresses the portal vein, i.e. leads to the development of ascites.
Why is hydatid disease dangerous?
The parasite that causes cystic echinococcosis (hydatid disease) can invade any organ of the human body. Most often, lung, brain and liver echinococcosis are observed in patients. From the moment patients find out that they have cystic echinococcosis, their lives change dramatically.
The most dangerous complication in patients with hydatid disease is a cyst rupture that can occur for a reason or without one. Then cystic echinococcosis affects all tissues of the body, which is often fatal.
In the process of cyst growth, an abscess may also develop, which manifests itself with a rise in temperature, chills and other signs of acute inflammation. Patients almost carry the "time bomb", which, however, may never "explode". In the clinical studies, a clinical case is described when a detected cyst has existed in the human body for 75 years, not manifesting itself at all.
Manifestations
Clinical manifestations of cystic echinococcosis appear when a cyst reaches a significant size or, due to its location, suppresses the organ and leads to a violation of its function.
General symptoms of cystic echinococcosis that patients may experience are signs of an allergic reaction (urticaria, etc.). This is usually associated with the absorption of echinococcal fluid in case of the cyst membrane tears or as a result of surgery. Like other helminthic diseases, cystic echinococcosis is characterized by an increase in the level of eosinophils in the blood.
Cystic echinococcosis is usually detected when a tight-elastic tumor is felt, and damage of the lungs and bones is determined on X-ray in the form of cystic formations.
Making diagnosis of cystic echinococcosis
Often, patients seek medical help at the stage when the parasitic cyst reaches a significant size or complications arise. Early diagnosis of cystic echinococcosis is often a difficult task due to the lack of clear symptoms in patients, especially in the early period of cystic echinococcosis development, when the cyst is located deep in the organ.
Clinical examination methods for cystic echinococcosis are non-specific and provide only auxiliary information to clarify the diagnosis.
Different medical studies detect an increase in the number of leukocytes and total blood plasma protein that is typical for patients with cystic echinococcosis. Immunological methods in the diagnosis of cystic echinococcosis are of great importance.
At the stage of planning treatment of liver echinococcosis, possible connections of the cyst with the bile tree should be excluded by the measures of visualizing diagnosis before the treatment start.
Treatment of liver echinococcosis in Germany
Treatment of liver echinococcosis in Germany involves stage specific approach. In most cases, treatment of liver echinococcosis can only be effective with surgery. Although, chemotherapy is also used, as some medical studies have demonstrated that liver echinococcosis can be eliminated by exposure to chemical agents.
The radicality of surgery depends on the size and location of the cyst. One of the options for surgical intervention is removal of the cyst without damaging its shell. If it is impossible to carry out surgery in this way, doctors remove a part of the organ (liver, lung) together with the cyst.
Basically, traditional surgery options are still considered the "gold standard" for the treatment of liver echinococcosis. Most often, various types of echinococcectomies, extensive or partial ones, are used.
However, there are still many supporters of resection of the organ or its removal along with the cyst in the medical community. One should not forget about the parasitic nature of the hydatid disease and the re-infection risk for patients.
Types of surgical treatment
Considering that surgery is the main treatment method for liver echinococcosis, several surgery options are overviewed in clinical studies for treatment of liver echinococcosis. The most widespread treatment technique is complete or partial removal of the cyst.
The first place is occupied by minimally invasive surgery. The main tasks that the clinical practitioners have solved in the studies for development of minimally invasive options of surgery are the prevention of fluid entry into the abdominal cavity and antiparasitic treatment with guaranteed death of all embryonic elements of liver echinococcosis.
Often, radical methods of surgery (complete pericystectomy or liver resection) are recommended to patients with liver echinococcosis. Patients can also receive sparing therapy in the form of percutaneous drainage. More radical treatments carry more significant intraoperative risks, but smaller risks of relapses. By adding pre- or postoperative chemotherapy, the radical treatments become less aggressive. If surgery is mandatory, the use of drugs before surgery reduces the possibility of re-infection and makes surgery easier by decreasing intracystic pressure.
Percutaneous puncture in the treatment of liver echinococcosis ensures the safety of treatment of liver echinococcosis due to implementation of ultrasound monitoring during medical procedure.
The supervision of an anesthesiologist during the treatment of liver echinococcosis is mandatory.
How is the surgery carried out?
In surgical treatment of liver echinococcosis, the introduction of the instrument into the cyst cavity is carried out first. After aspiration, cyst is filled with glycerin.
To remove the membrane of the cyst, the puncture canal is expanded using special instruments. The control of the completeness of the treatment is carried out radiographically. If there is a suspicion of incomplete removal of the liver echinococcosis, an endoscope is inserted into the cyst cavity, under the control of which the remaining cells are removed.
The treatment of liver echinococcosis is completed by leaving a thin drainage in the cyst.
Can you prevent the development of hydatid disease?
The main measures of anti-infective prophylaxis for liver echinococcosis are compliance with the rules of personal hygiene when keeping dogs and caring for them, washing hands after collecting greens, fruits, working on the land, and thorough washing of greens, vegetables, fruits, and berries that are consumed raw.
Where to undergo liver echinococcosis treatment in Germany?
Patients from all over the world undergo treatment in Germany due to the high level of medical service and modern technologies. With treatment in Germany, patients will also be able to avoid the long waiting list, which is typical for many other countries. German physicians undergo rigorous and intensive training before starting clinical practice.
The leading medical institutions for treatment of liver echinococcosis in Germany are:
- Academic Hospital Nuremberg
- Hospital Kassel
- Academic Hospital Garmisch-Partenkirchen
- Sana Hospital Duisburg
- Hospital Bogenhausen Munich
The cost of treatment in German hospitals is based on the prices for procedures chosen for the treatment of liver echinococcosis.
The cost of treatment in Germany with extensive liver resection starts at 18,031 EUR. The cost of treatment in Germany with partial liver resection starts at 15,482 EUR. The cost of treatment in Germany with percutaneous aspiration echinococcotomy starts at 8,650 EUR. The minimal price of diagnosis in the overall cost of treatment is 3,128 EUR.
How to start treatment of liver echinococcosis in Germany?
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Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed