Shall we talk about Hydatid Disease, which causes cysts to form in the liver, today?

Today we are going to talk about a disease that grows inside our bodies, but we don't talk about it much. This is called hydatid disease. You may not have heard this name before. But knowing about it properly will help us and our families avoid a lot of trouble. So, let's talk about it in a little more detail, shall we?

Okay, first let's see what this hydatid disease is?

Simply put, hydatid disease is a disease caused by a parasite. A parasite is, think of it, a tiny creature that lives in our bodies, feeds on us, and makes us sick. Hydatid disease is caused by the eggs of a tapeworm . Yes, you heard that right, a tapeworm! These tapeworms usually live inside animals like sheep and goats and in the intestines of dogs.

So how do we get this? This disease occurs when we unknowingly ingest the eggs of these parasitic worms. When these eggs enter our bodies, the larvae that develop from them travel to organs like our liver, lungs, and brain and form cysts , which are like water bubbles. These cysts can gradually grow larger. This condition is also called `(Cystic Echinococcosis)` in medical science.

Do you know who is most likely to develop this disease? Who is most at risk?

This hydatid disease is most common in rural or somewhat difficult, poorly-sanitated areas. In particular, people who raise sheep or other livestock, as well as those who raise dogs, are at higher risk of developing this disease. Just think, sheep are the main host of this parasite. That means the parasite lives well in the body of sheep. Then, if a dog eats the meat of such a sick sheep, the dog will also be infected with this parasite.

You may be at increased risk of developing this disease due to things like:

• If you give deworming medication to infected dogs at home or if you constantly handle them.
• If you sit and eat in places where infected dogs hang out.
• If you live in an environment with poor cleanliness.
• If you slaughter and prepare sheep or other animals for food at home.

Think about it this way. In some of our villages, dogs are kept in homes. Sometimes these dogs walk outside and eat various things. These parasite eggs can be added to the environment with their feces. If we are not careful about it, there is a high chance that those eggs will somehow get into our mouths through our hands.

Is hydatid disease contagious from one person to another?

No, this is the most important point . Hydatid disease is not transmitted directly from one person to another. That means, you cannot get this disease just by touching someone who has this disease, just by being near them. For someone to get this disease, those parasite eggs that I mentioned earlier have to be ingested.

There are two types of echinococcosis, right? What are they?

Yes, there is another parasitic disease caused by tapeworms of the genus Echinococcosis. It is called Alveolar Echinococcosis (AE) . However, this type of Echinococcosis is usually transmitted to humans from animals such as foxes and jackals, not from sheep.

We are talking about `(Cystic Echinococcosis - CE)`, that is, `(AE)` is a slightly more serious condition than hydatid disease. `(AE)` can cause tumors to form in places like the liver, lungs, and brain. These tumors are not cancerous, but they spread at a rate similar to a cancer.

What is the difference between a hydatid cyst and a simple liver cyst?

This is also something that confuses many people. A hydatid cyst is the result of a parasitic infection. That is, it is something that develops when those tapeworm eggs enter the body.

However, simple liver cysts are usually present at birth. They rarely get very large or affect the functioning of the liver. However, hydatid cysts are not like that, and they can become large enough to interfere with the functioning of the liver. Also, the treatments for these two types of cysts are completely different.

How common is hydatid disease in the world and in our area?

This disease is not very common in developed countries like North America. However, it is a growing public health problem in poor and rural areas of Africa, parts of Europe, Asia, the Middle East, and Central and South America. Worldwide, about two to three million people develop this `(Echinococcal)` infection every year. Of these, 95% are the hydatid disease we are talking about, that is, `(Cystic Echinococcosis).` It is good to be aware of this in Sri Lanka, especially in areas where animals are kept.

What are the symptoms we experience when we develop this disease?

It can take years for symptoms of hydatid disease to appear . That's what makes it so scary. You may not notice anything until the cysts grow large in the liver, lungs, or other organs. However, as the cysts grow larger, you may experience symptoms such as:

• Blood in the stool.
• Cough.
• Feeling of discomfort or pain in the stomach or chest.
• Hives or skin rash.
• Yellowing of the eyes and skin (Jaundice).
• Feeling like a knot in the stomach area.
• Nausea and vomiting.
• Difficulty breathing.
• Being thin for no reason.

Don't be afraid of this disease just because you have one or two of these symptoms. But if these things persist, it's wise to see a doctor.

What are the dangerous complications that can occur due to hydatid disease?

If these cysts become large enough, they can cause the affected organ (such as the liver or lungs) to not function properly. Even more dangerous, these cysts can suddenly burst (rupture) . If this happens, life-threatening complications may occur. Symptoms of a ruptured hydatid cyst may include:

• Anaphylaxis is a severe allergic reaction that can cause sudden difficulty breathing, low blood pressure, and even loss of consciousness.
• Severe stomach pain.
• Even sudden death can occur.

That's why we say it's so important to be aware of these symptoms and seek treatment quickly.

How does this parasite enter our bodies? Let's learn about the ways in which the disease is transmitted.

The main reason people get hydatid disease is through contact with dog poop, which contains parasite eggs . Over time, these parasites grow inside the body and form cysts. The disease can be transmitted in the following ways:

• Drinking water contaminated with parasite eggs.
• You can get it by unknowingly ingesting soil contaminated with parasite eggs, which can be found in things like vegetables, herbs, or berries. (That's why it's important to wash your vegetables and fruits thoroughly before eating!)
• By petting or touching an infected dog (and then eating food without washing your hands properly).

How do doctors accurately diagnose this disease? (Diagnosis)

Imaging exams and blood tests are the main methods used to diagnose hydatid disease. Blood tests can check for elevated levels of antibodies against the Echinococcal infection. Imaging tests can show the size, shape, and location of the cysts.

Your doctor may use an X-ray, CT scan, or ultrasound to examine the cyst. Hydatid cysts have several features that are different from those of a normal liver cyst. For example:

• What looks like another collapsed tumor inside the tumor wall.
• The wall of the fruit is made up of several layers.
• The wall of the cyst is thickened and possibly calcified.

What are the treatments for hydatid disease? How do we recover?

Treatment for hydatid disease depends on the size of the cysts and their location . The most commonly used treatments are:

Are there any medications?

Yes, if the cysts are small, superficial, and only in one area, they can be treated with anti-parasitic medications called benzimidazoles . These medications kill the parasites and cause the cysts to shrink. Sometimes, your doctor may also decide to perform a procedure to drain the cyst or perform surgery to remove fluid from the cyst.

Is the PAIR method a special treatment?

Yes, `PAIR` (Puncture, Aspiration, Injection, Re-aspiration) is a special method. In this, the fluid inside the cyst is gradually drained using a needle or a small tube (catheter). Then, a chemical substance that works against parasites is injected into the cyst. Then the fluid is drained again. This process is repeated several times until the cyst is completely empty. This is usually done under the guidance of a scan such as an ultrasound.

Does everyone have to have surgery?

Large, deep-seated tumors may need to be removed surgically. This may involve removing all or part of the tumor, or even part of the liver. However, there is a risk that the parasites inside the tumor will spread to other parts of the abdominal cavity. Therefore, only a well-experienced doctor should perform this type of surgery.

How can we protect ourselves from this dangerous hydatid disease? (Prevention)

The only way to control hydatid disease is to stop the spread of these parasites. People at risk of developing this disease should be very careful about the following:

• Do not consume any food or drink that may have come into contact with dog feces.
• If you are giving your dog deworming medication, do not do it yourself at home, but have it done by a trained veterinarian .
• Avoid close contact with dogs that you think may be infected.
• Do not slaughter sheep or other livestock for food at home and prepare them for consumption (it is best to obtain them from a professional butcher shop).
• Prevent dogs from eating infected sheep meat.
• Wash fruits and vegetables thoroughly before eating.
• Wash your hands thoroughly with soap and water often, especially before preparing food and after handling dogs. This is a very simple thing, but it is a great safety measure.

What happens if you get hydatid disease? Can it be cured? (Prognosis/Outlook)

If left untreated, hydatid disease can be fatal . The cysts can grow large and cause organ failure. Also, if the cysts burst, a life-threatening allergic reaction called ``Anaphylaxis'' can occur. Therefore, it is important to diagnose the disease early and get proper treatment. If you do, your chances of recovery are high.

When should we see a doctor about these symptoms?

If you have any symptoms that you think may be signs of hydatid disease (for example, persistent abdominal pain, yellowing of the eyes, difficulty breathing), see a doctor immediately . Also tell your doctor if you have been in a high-risk environment (for example, working with sheep or dogs) where hydatid disease is common. This information will help your doctor distinguish between a hydatid cyst and a normal cyst.

Remember, early diagnosis and treatment can greatly reduce the risk of developing serious health problems or death.

So, the most important things to remember from all this talk (Take-Home Message)

Okay, we've talked a lot about hydatid disease. In short, it's a parasitic disease caused by tapeworm eggs . The disease occurs when these eggs, which are found in dog feces, enter our bodies unknowingly. This causes cysts to form in organs like our liver.

• Cleanliness is very important! Don't forget to wash your hands thoroughly and wash fruits and vegetables before eating.
• If you have dogs, take care of their health. Give them deworming medication properly, as directed by a veterinarian.
• If you are involved in animal husbandry, especially working with sheep, be extra careful.
• If symptoms appear, see a doctor without delay.

I hope this information is useful to you. Stay healthy!

` Hydatid Disease, Parasitic Infections, Liver Cysts, Tapeworm, Dog-borne Diseases, Animal Health