Internal Medicine, St. Joseph Medical Center, Stockton, California, USA.
Infectious Diseases, Touro University, Stockton, California, USA
BMJ Case Rep. 2023 Aug 4;16(8):e254876. doi: 10.1136/bcr-2023-254876.
Echinococcosis is primarily a disease of developing nations with poor medical infrastructure, where cohabitation with domesticated animals is common. These conditions, in conjunction with the inherent chronicity of the disease, lead to low rates of diagnosis and high morbidity. Robust surveillance is not readily available in communities with the highest disease burden.WHO classifications assist in diagnostic and treatment endeavours especially in countries where this disease is not commonly encountered. However, the understanding of the pathophysiology of echinococcosis and optimal treatment are still lacking in certain patient populations.We present the case of a female from Central Asia with an isolated pulmonary hydatid cyst. She was diagnosed several months after she had an uncomplicated pregnancy and gave birth to a healthy baby girl. Due to a delay in surgical intervention, our patient received a prolonged course of treatment which resulted in a significant reduction in the size of the cyst. Given her improvement, we questioned the current guidelines set by the WHO regarding surgical resection of pulmonary hydatid cysts, compared with an extended course with albendazole in patients with an unusual and protracted course of the disease. Furthermore, we discuss the possible role of pregnancy in exacerbating symptoms of underlying pulmonary hydatid disease.
包虫病主要发生在医疗基础设施较差的发展中国家,这些国家与家养动物共同生活。这些情况加上疾病固有的慢性特征,导致诊断率低、发病率高。在疾病负担最高的社区,无法进行有效的监测。世界卫生组织的分类有助于诊断和治疗工作,特别是在这种疾病不常见的国家。然而,在某些患者群体中,对包虫病的病理生理学和最佳治疗方法的理解仍然不足。我们报告了一位来自中亚的女性孤立性肺包虫囊肿病例。她在经历了一次无并发症的妊娠并生下一个健康的女婴几个月后被诊断出患有该病。由于手术干预的延迟,我们的患者接受了延长的治疗过程,导致囊肿大小显著缩小。鉴于她的病情改善,我们对世界卫生组织目前关于肺包虫囊肿手术切除的指南提出了质疑,与在疾病过程不寻常且持续时间较长的患者中使用阿苯达唑进行延长疗程治疗进行了比较。此外,我们还讨论了妊娠在加重潜在肺包虫病症状方面的可能作用。