Alveolar echinococcus
Clinical features
Early symptoms are usually non-specific and vague. The most common initial presentation is mild right upper quadrant pain. Tender hepatomegaly or a mass may be present. As the disease progresses, jaundice, ascites and hepatic insufficiency occur. In the early stages, a high index of suspicion in endemic areas is required. Differential diagnosis includes hepatoma, tuberculosis, hemangioma or focal nodular hyperplasia.
Alveolar echinococcus
Investigation
Radiological investigations such as ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) may provide additional information. Serology may be non-conclusive in the early stage of the disease; however, it may subsequently confirm the underlying process. Occasionally, laparoscopy and biopsy may be required. Even at operation, the accuracy of diagnosis is only 50%.
Treatment
The only known definitive cure for E. alveolaris is liver resection. Transplantation has been performed on selected cases but long-term outcome is uncertain. Albendazole, although unable to eliminate the parasite, may slow progression of the disease and should be administered on an indefinite basis in conjunction with surgery