Annals of Clinical Cytology and Pathology

Hepatic Hydatid Disease in 21st Century New Zealand: Is there Still a Problem?

Research Article | Open Access

  • 1. Department of Surgery, North Shore Hospital, New Zealand
+ Show More - Show Less
Corresponding Authors
Jonathan Koea, Hepatobiliary Surgeon, Upper Gastrointestinal Unit, North Shore Hospital, Private Bag 93505, Takapuna, Auckland, New Zealand, Tel: 649-486-8900; Fax: 649- 488-4621

Background: This investigation reviews the contemporary characteristics of hepatic hydatid disease in New Zealand presenting for treatment.

Methods: A prospectively maintained clinical database containing demographic, patient and treatment data of patients presenting with hepatic hydatid disease between 1998 and 2015 was reviewed.

Results: Twelve patients (six male) were identified with a median age at presentation of 61 yr (range 34-78 yrs). Eight patients were New Zealand European, three Maori and one Indian migrant. Abdominal pain (7 patients) and malaise (3 patients) were the most common presenting symptoms. Hydatid serology was positive in all patients with the diagnosis confirmed by typical appearance on cross -sectional imaging. Ten patients had a past history of hydatid disease, 3 patients presented with biliary fistulae and 4 patients had extensive intra-abdominal disease. All patients were managed with pre and post-operative anthelmintic medication prior to surgery (two lobectomies and 10 treated with scolicidal instillation and cyst excision). There were no in-hospital deaths following treatment and 11 patients remain alive and well off treatment with a median follow up of 67 months (range 12-210 months).

Conclusion: Hepatic hydatid disease is now rare and largely comprises patients with recurrent disease rather than new presentations.


Bowman MJ, Koea J (2016) Hepatic Hydatid Disease in 21st Century New Zealand: Is there Still a Problem?. Ann Clin Cytol Pathol 2(2): 1023.


•    Echinococcus granulosis
•    Hepatectomy
•    Cystectomy
•    Extrahepatic disease


Hydatid disease due to infection with Echinococcus granulosis was first described in New Zealand in 1881 by Thomas [1] who reviewed 54 admissions to New Zealand’s public hospitals. However the disease was made notifiable in 1873 [2] implying that it was recognised prior to Thomas’s report. In 1976 Burridge et al [3] summarised the state of hydatid disease between 1878 and 1972 highlighting a decline in the incidence and mortality after 1955 when community based initiatives driven by the a national agricultural organization eliminated the feeding of uncooked sheep offal to dogs and later introduced mandatory canine dosing of arecholine. These local initiatives were reinforced by the passing of the Hydatids Act (1959) and the formation of the National Hydatids Council to implement control measures on a national scale [4]. By 1972 the prevalence rate of hydatid disease had had fallen from 28.7/1000,000 in 1878 to unrecordable levels while the annual incidence had fallen from 68.2/1000,000 in 1935, when the first reliable figures became available, to 11 .9/1000,000 in 1972. These investigators also highlighted that, even in 1972, New Zealand Maori had five times the incidence of non-Maori, and that between 1961 and 1970 the incidence rate of hepatic hydatid disease fell only in children, consistent with an effective primary prevention program.

Since 1972 the overall incidence of hydatids has continued to decline in New Zealand with the last recorded case in a slaughtered animal in 1996 and the National Hydatids Council was disbanded in 1991. Sporadic clinical reports from the 1980s and 1990s highlight a decreasing surgical workload made up of patients with primarily recurrent disease [5-7] and an increasing role for anthelmintic therapy as a primary treatment with surgical resection reserved for those patients with surgically curable disease, those presenting acutely with complications and those with manageable levels of comorbidity [5,6]. New Zealand was declared provisionally hydatids free in 2002 [8] however hydatids remains a notifiable disease with between one and seven cases reported annually to the New Zealand Ministry of Health over the last 10 years.5 Importantly it remains part of the syllabus for specialist training in surgery and internal medicine, continues to be included in the differential for all patients presenting with cystic liver lesions, and it has been suggested that it remains a significant health problem in Australasia [9]. There have been no investigations reporting the status of hydatid disease in New Zealand in the 21st century although Burridge et al [3] suggest that by now new cases should be rare and most, if not all, presentations will comprise patients with long-standing infections.

This investigation was undertaken to define the number and characteristics of hepatic hydatid cases requiring surgical intervention in the last 16 years and to determine whether it remains a significant part of hepatobiliary practice in New Zealand.


All patients that had undergone surgical treatment for hepatic hydatid disease at Auckland City Hospital or North Shore Hospital between October 1998 and December 2015 were identified from a prospectively maintained clinical database. Patients were identified by their National Health Index number and the relevant demographic, radiological, serological, operative and pathological data collected electronically from the hospitals’ database and review of paper records with approval from Awhina Research and Knowledge, Waitemata District Health Board and the Northern Regional Ethics Committee.



Twelve patients (six male) were identified from the clinical database with a median age at presentation of 61 yr (range 34- 78 yrs). Eight patients were New Zealand European, three New Zealand Maori and one Indian migrant, while five patients lived in the Auckland/Northland area, four in Canterbury, two in Otago and one in the Manawatu.


Details of presentation and past history of hydatid treatment are presented in table 1. In one patient a calcified hydatid cyst was an incidental finding on plain abdominal film taken for mild blunt trauma. One patient presented with fevers and rigors due to lobar pneumonia and was found to have a cystobronchial fistula. Ten patients had a past history of hydatid disease, two having been treated for pulmonary disease 20-40 years prior to presentation and eight treated for intra-abdominal disease between 10 and 30 years prior to presentation. Two patients presented with newly diagnosed disease, one a 58-year-old New Zealand farmer and a 34 year old immigrant from India. Of the 12 patients, four had extra hepatic disease present in the spleen, peritoneum, pleura and pelvis at presentation with hepatic disease. The hepatic disease was present in the right lobe of the liver in three patients, bilobar in eight and in the left lobe in one patient.


Details of pre-operative, intra-operative and post-operative management are presented in table 2. Two of the 11 patients managed with pre-operative albendazole developed pancytopenia and were changed to praziquatal after 12 and 16 days of therapy respectively. Intra-operatively betadine and silver nitrate were used as scolicidal agents in the first two patients and thereafter hypertonic saline was used in a further 10 patients.


There were no in hospital deaths following treatment. One patient died 4 years post-operation of cardiac failure. The median hospital post-operative stay was 8 days (range 5-23 days). Three patients developed a significant post-operative complication (peri-operative myocardial infarction, symptomatic intra-abdominal collection requiring percutaneous drainage in two patients). Three patients with known biliary fistulae treated with pre-operative ERCP and operative closure of the fistula had prolonged bile drainage of bile into a surgical drain and these drains were removed in outpatient clinic between 18 and 36 days post-operation. All surviving 11 patients have no signs of active hydatid disease and remain well off treatment with a median follow up of 67 months (range 12-210 months).

Table 1: Summary of presenting symptoms, abdominal examination findings and pre

Abdominal pain                                             7
Malaise                                                         3
Fever/rigors                                                  1
Incidental                                                      1
Examination Findings
Abdominal mass                                              7
Jaundice                                                          3
Normal abdominal examination                       2
Hydatid haemagluttination positive               12/12
Hydatid complement fixation positive            2/2
CT Scan                                                        12/12
MRI                                                                 2/2
ERCP                                                              3/3

Table 2: Summary of pre, intra and post-operative management.

Pre-operative Treatment Number Patients
11 (2)
1 (3)
Post-operative Treatment  
Intra-operative Treatment  
Hepatic lobectomy
Hydatid cystectomy
Additional Procedures
Pulmonary resection
Common bile duct exploration



Hydatid disease has a long history in New Zealand dating from the 1860s and was a major health issue for New Zealanders and a significant part of the clinical workload for New Zealand surgeons for most of the 20th century. Between 1951 and 1970 New Zealand had an average annual incidence of new hydatid cases of 68 of which 32 were hepatic.3 This investigation has shown that 12 patients presented with hepatic hydatids between1998-2015. Over the same time period in the Northern region over 1000 hepatic resections have been performed for indications including trauma, cancer and pre-malignant lesions as well as inflammatory conditions such as hepatolithiasis. Hydatids is now only rarely seen and treated by surgeons. Current New Zealand Ministry of Health data show that there are between one and seven notifications annually [10] and, based on this report most represent chronic disease rather than presentations of newly acquired disease since 10 of our patients had previously been treated for hydatids. Of these eight had previously had abdominal disease and their representation may signify incompletely treated disease or the results of spillage at their initially procedure. However two of our patients did present with newly diagnosed disease. Importantly one was a migrant from India and others have documented the phenomenon of new diagnoses in migrants from endemic areas to countries where hydatids is rare [11].

The demographic profile of the current series is consistent with that of Burridge et al [3] in that Maori made up one third of our patients yet comprise only 15% of our population. Burridge et al [3] showed that hydatids had a higher incidence in Maori and also a higher prevalence particularly in Maori from the East Coast of New Zealand. A recent publication from Waikato Hospital describes 14 patients with hydatid disease treated over a 10 year period from this district [12]. While historically patients with hydatid disease were managed at local hospitals [7] the conditions increasing rarity and the often comorbid status of the patients means that most are now treated in tertiary upper gastrointestinal units. We believe that, taken together, the report of Reid et al [12] and the current report are an accurate reflection of the current status of hydatid disease in New Zealand with a small number of operative procedures performed annually in tertiary institutions with the remainder of patients treated primarily with anthelmintic agents [5,6].

In this series presentation with hydatid disease tended to be non-specific with abdominal pain and malaise most common presenting symptoms. Examination findings were also nonspecific but serological tests and appearance on cross sectional imaging allowed definitive diagnosis. Consistent with long standing disease the majority of our patients presented with complex liver disease with biliary fistulae or extra hepatic disease and required complex surgical resections. However two patients with localised disease required hepatic lobectomy and most were managed with conservative hydatid surgery treating the disease with an anthelmintic preoperatively, intraoperative treatment of cysts with a scolicidal agent followed by cyst excision [13]. Post-surgical therapy with anthelmintics was also employed in all patients. With this surgical policy only 3 patients developed significant post-operative complications and all patients had their disease eradicated. No patients were managed with percutaneous aspiration because of concerns over precipitating anaphylaxis [14].

Consequently, hydatid disease is a now a rare part of hepatobiliary surgery in New Zealand but there remains a reservoir of patients in the community with disease dating from last century prior to the introduction of widespread control measures and immigration will also contribute new presentations of the disease. The ability to diagnose, image and treat the disease has improved greatly and the development of effective anthelmintic therapies has ensured that primary medical therapy is possible and that all surgical patients can receive perioperative treatment.


1. Thomas JD. The statistics of hydatid disease in the Australasian colonies. Aust Med J. 1881; 3: 344-348.

2. Gemmell MA. Cestode problems of domestic animals and man in the South Island of New Zealand. NZ Med J. 1958; 57: 442-458.

3. Burridge MJ, Schwabe CW, Fraser J. Hydatid disease in New Zealand: Changing patterns in human infection, 1878-1972. NZ Med J. 1976; 85: 173-177.

4. Begg NC. The campaign against hydatid disease: an experiment in social medicine. NZ Med J 1961; 60: 229-234.

5. Lynch AC, Stubbs RS. Hydatid disease in New Zealand. What remains and how should we treat it. NZ Med J. 199; 112: 131-134.

6. Isaacs RD, Beeching NG, Ellis-Pegler RB. Cystic hydatid disease in Auckland, New Zealand 1967-82. Trans R Soc Trop Med Hyg.1987; 81: 794-798.

7. Civil ID, Dempsey EF. Hydatid disease at a peripheral hospital: a review of 25 years experience. NZ Med J 1981; 94: 447- 448.

8. Kline K, McCarthy JS, Pearson M, Loukas A, Hotez PJ. Neglected tropical diseases of Oceania: Review of their prevalence, distribution and opportunities for control. PLOS Neglected Tropical Diseases. 2013; 7: e1755-1764.

9. Richmond R. Human disease from tapeworm still a threat in Australia. Aust Vet Journal 2014; 92:18.

10. www.surv.esr.cri.nz. 2016.

11. Chrieki M. Echinococcosis – an emerging parasite in the immigrant population. Am Family Physician 2002; 66: 817-820.

12. Reid R. Hydatid disease at Waikato hospital 2004-2014. Presented at the Annual Scientific Meeting of the ANZHPBA, Cairns, Australia. 2016.

13. Morris DL. Echinococcus of the liver. Gut 1994; 35: 1517-1518.

14. Safioleas MC, Misiakos EP, Kouvaraki M, Stomatakos MK, Manti CP, Felekouras ES. Hydatid disease of the liver. A continuing surgical problem. Arch Surg 2006; 141: 1101-1108.

Received : 02 Mar 2016
Accepted : 06 Apr 2016
Published : 25 Apr 2016
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X