Spectrum of severe presentations in Hydatid disease: A case series in an endemic area

Cystic Echinococcosis (CE) by larval form of the Echinococcus granulosus, is distributed worldwide; is asymptomatic many-a-times, predominantly affecting the liver. Due to active efforts of World Health Organization (WHO) and health authorities of different nation states through the ‘One Health’ approach involving veterinary and food safety measures the disease prevalence is steadily decreasing. However, life-threatening presentations of this disease still present to us occasionally. This report describes histopathology, fluid microscopy and radiological findings of eleven patients of symptomatic and life-threatening CE involving liver, kidney, spleen, peritoneum, common bile duct (CBD), and retroperitoneal involvement. Patients included those with multiple organ involvement (five patients), solitary cysts, multiple cysts or even calcified cysts but all eleven patients had severe clinical features requiring emergency admissions. Specifically, external obstruction on the caecum and colon, renal colic, fever with chills and rigor, anaemia, biliary obstruction, respiratory distress (acute or chronic progressive), cough and chest pain were prominent manifestations that were distinct from the common abdominal pain and liver related issues. The disease all of its epidemiological components (reservoir, definitive host, intermediate host, poor hygienic conditions, lack of awareness) which lead to infection is prevalent in West Bengal state of India. Public health education to improve hygiene and to block the life cycle of the parasite is need of the hour. Despite decreasing incidence due to concerted preventive measures by health authorities, clinicians should be aware of the occasional dramatic and life-threatening presentations which may come to fore in the out-patient department or emergency.