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Hydatid Disease — SCE Infectious Diseases MCQ

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ModerateTropical & Imported InfectionsHydatid DiseaseSCE Infectious Diseases

A 30-year-old man from India presents with multiple hepatic cysts on ultrasound, the largest measuring 12 cm. Echinococcus granulosus serology is strongly positive. CT shows no communication with the biliary tree and no daughter cysts. He is asymptomatic. What is the most appropriate initial management?

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Correct answer: C — Albendazole 400 mg BD for 1–3 months pre-operatively, followed by surgical excision or PAIR

Hepatic hydatid disease (cystic echinococcosis) with large cysts (>5 cm) is best managed with pre-operative Albendazole (to reduce cyst viability and risk of secondary echinococcosis from spillage) followed by definitive treatment: surgery (pericystectomy) or PAIR (puncture, aspiration, injection of scolicidal agent, re-aspiration). Albendazole alone may be considered for small, uncomplicated cysts or inoperable patients. Percutaneous drainage without antihelmintic cover risks anaphylaxis and secondary seeding.

Reference: WHO 2022 – Echinococcosis guidelines; NICE CKS 2024 – Hydatid disease