Past: surgery for accessible cysts, done with great care to avoid spillage of cyst fluid.
Now: per-cutaneous aspiration under ultrasound or PAIR (Puncture, Aspiration, Injection, Re-aspiration).
Surgery candidates should receive Albendazole +/- Praziquantel for 1-3 months covering the procedure. PAIR should be followed by 8 weeks of Albendazole.
Inoperable patients: 3 to 12 cycles of Albendazole (one cycle = 28 days).
Reference: Lecture Notes Tropical Medicine, Geoff Gill & Nick Beeching, 6th edition.
Humans can pick up the infection directly from infected dogs. People, especially children, become infected by ingesting eggs through hand to mouth transfer of eggs after contact with the faeces or contaminated fur of infected dogs. Eggs may also be passed when dogs lick people. It may also occur following ingestion of food, water or soil which has been contaminated by infected dog faeces. Eliminated segments of the tapeworm present in dog faeces have been reported to migrate some distance over grass or garden vegetables before expelling eggs that subsequently adhere to the vegetation. Humans are intermediate hosts; they do not play a role in the biological cycle although they may act as agents in perpetuating the infection by feeding dogs with infected meat and viscera.
Please open this link:
http://www.wales.nhs.uk/sites3/Documents/457/RS%20modified%20QA%20Andrew%2014%20September%20V3.pdf
In general, human disease is treated by surgical removal of the cyst with supplementary chemotherapy (mebendazole or albendazole). Surgical removal may not prevent other cysts growing and causing further problems.
Treatment differs for cystic echinococcosis and alveolar echinococcosis.
Polycystic echinococcosis is treated as for cystic echinococcosis.
Mebendazole and albendazole are well tolerated and show definite efficacy against cystic echinococcosis. Concomitant use of praziquantel is sometimes advised.
Surgery remains the mainstay of treatment. Less invasive methods and combinations with chemotherapy are being developed.
Long-term follow-up is recommended.
In cystic echinococcosis, risks versus benefits, indications, and contra-indications for each individual must be considered before deciding on type and timing of surgery.
In alveolar echinococcosis, more radical surgical excision is coupled with chemotherapy (mebendazole or albendazole) in operable cases but, if the cyst can only be partially resected, or is inoperable, long-term aggressive chemotherapy is employed, and improves survival.
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