Be Careful While Eating From a Roadside Open Food Stalls

These days, quite often you would have heard people talking about a word ‘Cyst”. Somebody had had a problem of epilepsy and the treating doctor had told him about a cyst in the brain. Quite often you would have heard your aquantenance complaining about pain in right upper side of abdomen and jaundice and it was found later that a cyst in his liver was the cause of it.

Also you would have heard or seen your relative suffering from severe dry cough along with chest pain and coughing out blood. When on a doctor’s advice chest X-ray was done, a cyst was found in the lung. Sometimes you do not have any problem and when you get routine medical check-up for job placement or for going abroad, you will be surprised to see a large round white shadow of cyst in chest X-ray on one side or both sides. You would have also heard that so and so got operated for lung cyst removal and later on after some time, again a cyst was formed after surgery.

After all this cyst or tumour of worms is all about?

In medical terms, a cyst in the body is called “Hydatid Cyst” that is actually an egg with a special worm inside surrounded by a protected covering. When this cyst reaches inside a human body, it starts enlarging in size gradually. For a cyst to reside in a human body, the most favourite organs is either lung or liver. This hydatid cyst is also found in other organs of human body such as brain, heart and muscles of hand or foot and sometimes even in the body bones. The worm that gives birth to cysts or eggs is only 5-millimetre-long and is called in medical terms as Echinococcus Granulosus. You will be surprised to know this worm prefers living only in the intestine of a dog instead of living in a human body and the total life span of this worm is only between 5 months to approximately 2 years. Within this short span of life, this worm would have spread lakhs of eggs to earth soil, through excreta (shit) of a dog in whose intestine it resides.

How does this cyst enter the human body?

In our country, there is abundance of filth, dirt and a network of open drains. A lot of garbage, shit and urine

are lying in open air untreated, either waiting for or left without disposal. The stray dogs infested with cysts empty out their stools in these very spots leading to pollution of not only ground soil but air as well. In other words, soil, water and air become contaminated with cysts or eggs. In close proximity to these contaminated sites along the roads, you will find open stalls of Indian fast foods like “Chaat”, “Bhelpuri” and fruit juice vendors. It is quite obvious that eatables being sold in these open air food stalls will be definitely laced with these cysts and eggs. Whenever you and your family members go for evening outings, it is very difficult to avoid temptation of tasting these open- air well- displayed Indian fast foods. As soon as you eat theses cyst- infested fast food, not only food alone but eggs too will enter your intestine and you just cannot notice these cysts as they are too tiny to be seen with your naked eyes. 

How does this cyst reaches lung?

After reaching the intestine, worm inside the cyst breaks out the covering and roam freely. It then punctures the wall of the intestine and enters the adjacent blood pipes and then blood circulation. It then through these blood pipes reaches various parts of the body especially liver and lung where it makes its permanent abode. After settling down in any of these favourite places, it stars growing in size and construct for itself an outer covering for safety and gives birth to hydatid cyst which gradually start increasing in size. When cyst attains adequate size, the worm feels safe inside the cyst and the start giving birth to new worms who repeat the same process to become cysts and are now called daughter cysts whose number slowly increases.

Who are the victims of disease of cyst in the lung?

If you happen to live in such a locality where rearing and selling of sheep or goats is done or you or your children play with stray dogs or your pet dog inside your home is neither vaccinated regularly nor his proper hygiene is maintained, or your pet spends most part of daytime outside the house specially near open dirty drains rather than inside the house, you and possibly your children can become victim of cysts.

 If you and your children do not wash hands with soap before eating or after touching earth and soil and then without washing their hands with soap straightway go for dinner/lunch or If you and your children have dirty long uncut nails having dirt underneath or If you and your family members are very fond of roadside open air food stalls where cut fruits, chaat and other fast foods are not covered, you and your children are most likely to be infested with lung or liver cysts.

If you are in the habit of eating meat in nonstandard roadside food stalls (called Dhaaba in local language), chances are you can ingest cyst-laden meat. If such a person suffers from incessant cough with phlegm, chest pain and eosinophilia and sometimes he coughs out blood, it raises the possibility of cysts in the chest.

If a person who does not maintain proper hygiene before eating or after playing with stray or unvaccinated dogs feels pain in the right side of abdomen and feels a solid tumour like thing on touching with your hand, the possibility of cyst in the liver cannot be ruled out.

What will happen if no treatment is done for cyst of lung

If you refuse to get treated for lung cyst, sooner or later you will lose life. Because of enormous space available inside the chest, lung cyst has an ample opportunity to enlarge rapidly and becomes gigantic in size in a very short time. If ever such a patient coughs severely or receives a strong blow on the chest or sustain a chest injury, the enlarged hydatid cyst of lung gets ruptured. With the result, the liquid coming out of ruptured cyst harms in two ways, firstly spilled liquid may cause severe life-threatening reactions and secondly, the liquid containing multiple small daughter cysts reaches other organs like brain, stomach,

muscles of hand and feet and the whole human body thus gets infested with cysts. If the cyst happens to burst into wind pipe, the liquid coming out of burst cyst will choke the wind pipe and subsequently the lung, with the result a life threatening condition develops. If the cyst staying in the lower part of the lung bursts downward, the liquid content of ruptured cyst goes to abdomen resulting into severe abdominal complications.

If you have a cyst in the lung, where to go?

A person suffering from lung cyst should consult a Thoracic or a chest surgeon and start treatment under his guidance as early as possible to avoid cyst getting burst and resulting serious complications. A chest X-ray is the simplest, cheapest and foremost investigation in present scenario for diagnosing a cyst in the lung. Besides this, other investigations like CT chest and MRI chest are required to assess the size and exact location of cyst in various parts of lung and to decide the treatment modality. Therefore, always go to a hospital where all these investigatory facilities are available and make sure whether there is an availability of a full time thoracic or a cardiothoracic surgeon in that hospital. Some special blood investigations are also required.

What is the correct treatment of lung cyst?

To decide the treatment of lung cyst, you have to take into account some factors like size of the cyst, location of cyst and other associated medical conditions of the patient. Surgery is an ideal and the best treatment of lung cyst. A person suffering from a cyst in the lung must get it removed surgically as early as possible, otherwise it will lead to life threatening complications if cyst gets ruptured. Sometimes, during surgery, a part of lung is also removed along with cyst. During this surgery a special technique is used to avoid pilferage of daughter cysts inside the chest, otherwise chances of birth of new generation cysts are there.

Sometimes, instead of surgery the fluid is aspirated from cyst through a syringe needle and a medicine is injected into the cyst. But this treatment is not durable and above all there is always a danger of spillage of cyst fluid and subsequent spread of daughter cysts in other organs. Therefore, this injection treatment is only recommended in special circumstances in those patients where surgery is not possible due to medical non fitness.

Dr. K.K. Pandey is Senior Thoracic & Cardiovascular Surgeon, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi