Farjam Mina, Changizi Faraz, Ebrahimzadeh Kaveh, Sabeti Shahram, Bidari Zerehpoush Farahnaz, Javandoust Gharehbagh Farid, Alavi Darazam Ilad
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Infect Dis. 2024 Dec 6;24(1):1392. doi: 10.1186/s12879-024-10286-3.
Hydatid cysts are caused by the larval stage of the tapeworm parasite Echinococcus granulosus, leading to a rare but significant zoonotic infection. This disease is primarily observed in regions with prevalent agricultural and livestock practices. While the liver, lungs, and brain are most affected, spinal involvement is notably rare. Hydatid cyst disease develops gradually and is usually asymptomatic in the early stages. Symptoms usually emerge when the cysts enlarge sufficiently to cause compression. Effective treatment typically combines surgical intervention with antiparasitic medication to reduce the risk of recurrence, highlighting the necessity of a comprehensive approach to treatment and follow-up.
A 17-year-old male from Afghanistan, now residing in Iran, presented with muscle weakness in his lower extremities, primarily in the right leg, back pain, and impaired balance. The patient had a history of previous surgical resection for a primary spinal hydatidosis in Afghanistan. Upon examination, he exhibited reduced muscle strength, sensory loss in the right lower limb, paresthesia in the left medial forearm, hyperactive deep tendon reflexes in both legs and a positive Babinski sign on the right. Imaging revealed signs of previous laminectomy at T2 and T3 and a well-defined cystic mass at the T2 level. Surgical intervention was performed to decompress and resect the cyst, and pathological examination confirmed it as a hydatid cyst. Post-surgery, the patient was prescribed chewable albendazole (400 mg twice daily) for six months to prevent recurrence. Routine follow-ups and physiotherapy sessions were recommended after.
Patients with spinal hydatidosis often exhibit spinal cord compression symptoms. When imaging modalities reveal multiple cysts and there is a history of residency in an endemic area, spinal hydatid cyst should be considered. Although rare, spinal hydatid cysts are difficult to treat completely. This case highlights the critical need for precise surgical removal, adequate postoperative medication, and long-term follow-up in managing of spinal hydatid cysts.
包虫囊肿由细粒棘球绦虫寄生虫的幼虫阶段引起，导致一种罕见但严重的人畜共患感染。这种疾病主要在农业和畜牧业盛行的地区观察到。虽然肝脏、肺和脑受影响最大，但脊柱受累明显罕见。包虫囊肿病逐渐发展，早期通常无症状。症状通常在囊肿充分增大引起压迫时出现。有效的治疗通常将手术干预与抗寄生虫药物相结合，以降低复发风险，突出了综合治疗和随访方法的必要性。
一名来自阿富汗、现居住在伊朗的17岁男性，出现下肢肌肉无力，主要是右腿，伴有背痛和平衡受损。该患者在阿富汗曾因原发性脊柱包虫病接受过手术切除。检查时，他表现出肌肉力量减弱、右下肢感觉丧失、左前臂内侧感觉异常、双下肢腱反射亢进以及右侧巴宾斯基征阳性。影像学检查显示T2和T3水平有既往椎板切除术的迹象，T2水平有一个边界清晰的囊性肿块。进行了手术干预以减压并切除囊肿，病理检查证实为包虫囊肿。术后，患者被开了可咀嚼的阿苯达唑（每日两次，每次400毫克），持续六个月以预防复发。之后建议进行常规随访和物理治疗。
脊柱包虫病患者常表现出脊髓压迫症状。当影像学检查发现多个囊肿且有疫区居住史时，应考虑脊柱包虫囊肿。虽然罕见，但脊柱包虫囊肿难以完全治愈。该病例突出了精确手术切除、术后充分用药以及脊柱包虫囊肿管理中长期随访的迫切需求。
