EJMS

Abstract

Hydatid disease of bone is a rare disease. It usually occurs in the vertebrae, ilium, long bones, skull and ribs. The vertebral column is involved in about half of cases. Skeletal infection of Echinococcus granulosus occurs by hematogenous seeding. The diagnosis of the disease is usually late because of its slow progression and absence of specific symptoms. Therefore, Parasitologists and orthopaedic surgeons should be aware of this disease, especially in endemic areas and in subjects who live in or travel to sheep-raising areas or when there is a history of visceral hydatid disease. Serological and immunological tests are usually negative especially in case of primary bone cysts. Moreover, diagnostic aspiration of the suspected cyst should never be undertaken due to the risk of anaphylaxis, sensitization and dissemination. Radiographic findings can be helpful. The most important differential diagnosis of the disease is infections, mainly chronic osteomyelitis, and tuberculosis and giant cell tumor, osteosarcoma, brown tumor, lymphoma, metastasis, bone cysts and fibrous dysplasia. Radical resection of the involved bone is the treatment of choice for the disease, except in areas such as the spine and pelvis, which is technically impossible. Curettage and irrigation with scolicidal solutions is another procedure but with high local recurrence rate. Adjuvant medical therapy as benzimidazole derivatives and mebendazole can control the disease, prevent recurrence and avoid systematic spread. Follow up and sometimes lifelong treatment may be recommended. Phrases in bold letters represent our comments particularly on bold expressions in the text.