Hydatidosis

Echinococcosis is a neglected zoonotic helminthic disease caused by the metacestodes stage of Echinococcus granulosus, E. multilocularis, E. vogeli, and E. oligarthrus. According to the involved species, the disease will be defined as cystic echinococcosis or alveolar echinococcosis, each with different clinical features. Cystic echinococcosis, caused by Echinococcus granulosus sensu lato, has global distribution, an annual incidence ranging from 1 to 200 per 100,000 and a mortality rate of 2–4% if treated. Alveolar echinococcosis, caused by Echinococcus multilocularis, has an annual prevalence from 0.03 to 1.2 per 100,000 with a mortality up to 90% within 10–15 years from diagnosis. Humans are the parasite dead-end hosts through a hand-to-mouth and food-borne or water-borne transmission. After ingestion, the parasite’s eggs release larvae, which can reach more frequently the hepatic sinusoids or lungs, but potentially any organ, where they develop in the form of cysts. The progressive growth of Echinococcus cysts might cause compression symptoms or be complicated by cysts rupture or superinfections. Occasionally, in case reports and series, the involvement of the cardiovascular system was described in patients with echinococcosis. Vascular involvement can occur through the development of a primary intramural form of the hydatid cyst in the vessel’s wall; the spontaneous or surgical rupture of a hydatid cyst into an adjacent vessel; the erosion of the arterial wall of the aorta by scolex passing into the vasa vasorum through an intimal defect. The clinical presentation can be acute, with bleeding, neurological symptoms and limb ischemia described at presentation, but also subacute or chronic. Chronic presentation was usually characterized by compressive symptoms or effects of vertebral erosion. In surgical patients, pre-operative serology tests for Echinococcus spp should be performed when patients are from known endemic areas, integrated by ultrasound investigations. Both open and endovascular approaches to the arterial lesions were described, but the endovascular treatment has the limit of not allowing a radical removal of the parasite cysts, thus potentially leading to both parasitic and vascular lesion recurrence. The endovascular treatment can be a useful too as a bridge treatment before open surgical approach or as a palliative treatment in those patients unfit for open intervention. A long-term antiparasitic treatment with albendazole can usefully integrate the surgical correction of the aneurysm and the removal of the parasite’s cyst. More studies are needed to better understand the exact epidemiology, the features and outcome of patients and layout specific guidelines for the management of the cardiovascular involvement in this parasitic disease.