41 COTD

Tom Doherty 21/09/18

41.1 COTD One

37 yr woman, originally from albania. In UK for 7 years.

Ovarian cyst removed in Albania 14 yrs earlier.

Presented with fever/pain in RUQ

Tender abdominal mass and fever.

Hydatid cyst seen in liver. clear edge, no inflammation around it(seen in bacterial), no invasian into tissue around it (seen in amoebic), calcified (only seen in hydatid)

Eosinophilia, and obstructive picture.

Eosinophilia = leaking

Massive CRP a few days later = secondary bacterial infection

Treated with praziwuantel for protoscolices

Treated with albendazole for germinal membrane.

Surgical removal.

41.2 COTD 2

26 yr turkish man, in the UK for 5 years.

Complaining of abdominal pain for two weeks.

Large abdominal mass,

Had PAIR

Don’t give albendazole for lung cysts - it works on germinal layer and weakens it to the point of bursting in the lung!

41.3 Cotd 3

Student with week of headache, fever, neck stiffness. Originally from Ecuador. Lived with family in UK for 2 years

41.3.1 DDx

Meningococcal meningitis
Meningococcal meningitis!
Meningococcal meningitis!!
Viral Meningitis

Pyrexial. All else normal. Slightly elevated CRP.

41.4 Investigation

You want to LP, when would you want to CT first?

Immunosuppression
Focal Neurology
Depressed GCS
Papilloedema

IN SSA SETTING, WITHOUT FOCAL NEUROLOGY, DOING CT BEFORE LP IS REALLY NOT USEFUL, AND RISKS DELAYING EFFECTIVE TREATMENT

41.4.1 CT

Multiple cysts in head, Taenia solium!

If you eat eggs you get cysts. If you eat cysts you get a worm!

Remember you can be either intermediate or definitve host.

Meets criteria for neurocysticercosis.

Remember disease happens from degenerating cyst.

Fear is of basal disease causing hydrocephalus.

You’ll give steroids.

Do you give anti parasite drugs? Well you’ve got multiple cysts, might as well kill in a nice controlled fashion whilst they’re on steroids.

Treated with albendazole and dex.

41.4.2 Day 4

Becomes drowsy and confused. GCS 11/15.

CT shows early findings of hydrocephalus)

Opening pressure 37, closing 16 WCC 250 (99% lymphocytes) High protein. Low Glucose.

Think TB Meningitis!!!

The classic CSF findings of neurocystericosis is absolutely fine. Normally wouldn’t see any abnormality

2 months of intensive phase treatment. Then 10 more months of 2 more drugs.

Continue steroids? Yes seems to improve outcomes in TB meningitis.

Don’t get led astray by the fact that cysts exist in the head. He’s come from a high prevalence setting, of course he has cysts.

40% of adult onset epilepst in Peru is secondary to neurocystericosis. It’s v common in equador (25% of asymptomatic lesion)