Echinococcus Multilocularis Infectious Disease

Echinococcus multilocularis infectious disease is also called alveolar echinococcosis (AE) or alveolar hydatid disease. It happens when a person swallows microscopic eggs of the fox tapeworm Echinococcus multilocularis. Foxes, coyotes, and some dogs carry the adult tapeworm in their intestines and pass eggs in their stool. Small rodents carry the larval stage. People are accidental hosts when eggs on hands, food, water, fur, soil, or wild berries enter the mouth. Inside the body the eggs hatch, travel through the gut wall, and usually lodge in the liver. There they form many tiny, connected vesicles that grow and invade like a slow cancer. Over years this growth can block bile ducts, blood vessels, and spread to lungs, brain, and other organs. Without treatment, AE can be fatal. The mainstays of care are radical (“tumor-like”) surgery when possible and long-term benzimidazole medicines (usually albendazole) for years, sometimes lifelong. CDC+2World Health Organization+2

Echinococcus multilocularis is a tiny tapeworm that lives in the intestines of foxes and other canids. Its eggs pass out in the animal’s stool and can contaminate soil, water, wild berries, vegetables, and animal fur. People become infected when they swallow these eggs by accident. Inside the body, the eggs release larvae that travel mainly to the liver, where they grow slowly as many tiny vesicles that invade nearby tissue like a tumor. This condition is called alveolar echinococcosis (AE). It can spread to the lungs, brain, and other organs if not found and treated. AE is rare but serious and can be fatal without proper care. Diagnosis relies on imaging (ultrasound/CT/MRI), blood tests for antibodies, and sometimes tissue tests. ECDC+3CDC+3World Health Organization+3

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Other names

This disease is also known as: alveolar echinococcosis (AE), alveolar hydatid disease, multilocular echinococcosis, and fox tapeworm infection (because the adult worm commonly lives in foxes). Wikipedia

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Types

1. Hepatic (liver) AE – confined to the liver
   Most cases begin and stay in the liver for years. Lesions can be peripheral or central and may press on bile ducts or blood vessels. CDC

2. Hepatic AE with local spread
   The mass can invade nearby structures around the liver (e.g., bile ducts, diaphragm). Doctors describe this “local invasion” when planning treatment. PMC

3. AE with distant spread (metastasis)
   Fragments or extension can reach the lungs, brain, or bones, producing symptoms there. CDC

4. WHO-IWGE PNM staging
   Doctors often stage AE using the PNM system (P = size/position of the liver parasite, N = nearby organ involvement, M = distant spread). It is modeled on cancer staging and helps guide treatment choices. (Stages I–IV combine P, N, and M findings.) PubMed+1

By situation and spread

1. Liver-limited early AE (PNM stage I–II): small parasitic mass, no nearby organ invasion, no metastasis. Often suitable for radical resection plus albendazole. PubMed

2. Locally advanced hepatic AE (stage III): larger mass and/or invasion of neighboring structures (diaphragm, bile ducts, vessels). Often needs complex surgery or prolonged medical therapy. PubMed

3. Metastatic AE (stage IV): deposits in lungs, brain, bones, or elsewhere. Usually inoperable; long-term albendazole is the backbone of care, with procedures to relieve complications. PubMed

4. Post-resection AE (adjuvant phase): after curative-intent surgery, albendazole is continued (commonly for ≥2 years) and imaging/serology monitor for activity or relapse. PMC

5. Transplant-treated AE: rare; for end-stage liver disease or unresectable hilar disease. Requires lifelong benzimidazole and standard transplant immunosuppression. aasldpubs.onlinelibrary.wiley.com

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Causes

Each “cause” below is a simple way people can get exposed to E. multilocularis eggs. In all, the key event is swallowing microscopic eggs from contaminated environments.

1. Eating unwashed wild berries or herbs gathered where foxes or dogs roam. Eggs stick to plant surfaces. CDC

2. Eating raw, unwashed vegetables from gardens contaminated by fox/dog feces. CDC

3. Drinking untreated surface water (streams/ditches) in endemic areas. CDC Stacks

4. Dirty hands after gardening or fieldwork in areas with fox activity. Soil can carry eggs. CDC

5. Handling foxes or their pelts and then touching your mouth without washing hands. Eggs can be on fur. CDC Stacks

6. Playing with or feeding wild foxes (habituated urban foxes) and poor hand hygiene afterward. CDC Stacks

7. Owning free-roaming dogs that hunt small rodents and can carry adult worms, shedding eggs at home surroundings. CDC

8. Owning outdoor cats that catch infected rodents and can be definitive hosts in some settings. CDC

9. Letting pets eat rodents or offal. This can infect the pet and raise contamination risk around the home. PMC

10. Cleaning dog kennels or litter areas without gloves and then eating/touching the face. CDC

11. Children’s hand-to-mouth behavior after playing in contaminated yards or sand. CDC

12. Living in or traveling to endemic regions (northern hemisphere zones with fox cycles). Wikipedia

13. Fox population increases near towns (urban foxes) which raise environmental egg contamination. CDC Stacks

14. Home slaughter or handling of wild game in endemic areas with poor hygiene. PMC

15. Poor access to safe water and sanitation in rural endemic zones. World Health Organization

16. Storing picked produce on the ground where animals pass. CDC

17. Eating raw, unpeeled produce while hiking or working outdoors. CDC

18. Not washing hands after touching pet fur (if pets have contaminated coats). CDC Stacks

19. Rodent infestations around homes/farms (supporting the parasite’s wildlife cycle). PMC

20. Lack of regular deworming for dogs/cats in endemic areas. Deworming reduces egg shedding risk. ECDC

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Symptoms

AE grows slowly, often for years, so early infection may be silent. When symptoms appear, they usually reflect liver disease and, if spread occurs, the affected organ.

1. Upper-right abdominal pain or discomfort from the growing liver mass. CDC

2. Unexplained weight loss due to chronic illness and poor appetite. CDC

3. Fatigue or weakness from long-standing disease. CDC

4. Enlarged liver (hepatomegaly) that a clinician can feel. CDC

5. Jaundice (yellow eyes/skin) when the mass blocks bile flow. CDC

6. Nausea or poor appetite from liver congestion or cholestasis. CDC

7. Fever if there is secondary infection or inflammation of the lesion. PMC

8. Itching and dark urine/pale stool from cholestasis. World Health Organization

9. Abdominal fullness or swelling from enlarged liver or ascites. World Health Organization

10. Portal-hypertension signs (e.g., enlarged spleen, fluid in the abdomen) in advanced disease. World Health Organization

11. Cough or chest pain if the disease has spread to the lungs. CDC

12. Coughing up blood (hemoptysis) with lung involvement (infrequent). World Health Organization

13. Headache, seizures, or neurological changes if the brain is affected. CDC

14. Bone pain or pathologic fractures if bone is involved (rare). World Health Organization

15. Symptoms that mimic liver cancer or cirrhosis, which often delays diagnosis. CDC

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Diagnostic tests

Doctors combine history, exam, imaging, and special laboratory tests. Imaging usually comes first; blood tests support the diagnosis; tissue tests are reserved for selected cases.

A) Physical examination

1. General inspection for weight loss and jaundice
   Long-standing illness causes weight loss. Yellow eyes/skin point to blocked bile flow from liver involvement. CDC

2. Abdominal palpation for liver enlargement and tenderness
   The liver may feel enlarged and firm; mild tenderness can occur over the right upper quadrant. CDC

3. Percussion to estimate liver span
   A larger-than-normal span supports hepatomegaly from a space-occupying lesion. World Health Organization

4. Look for ascites and edema
   Abdominal fluid and leg swelling suggest advanced liver disease or portal hypertension. World Health Organization

B) Manual bedside maneuvers

5. Shifting dullness / fluid wave
   Simple bedside checks for ascites, which may accompany complicated hepatic AE. World Health Organization

6. Bedside scratch test (liver span)
   A gentle stethoscope “scratch” helps outline liver size when formal imaging is not immediately available. (A supportive exam tool; imaging still required.) World Health Organization

7. Targeted palpation for splenomegaly
   An enlarged spleen points toward portal hypertension from advanced hepatic involvement. World Health Organization

C) Laboratory & pathological tests

8. Liver function tests (ALT, AST, ALP, GGT, bilirubin, albumin)
   Obstruction often raises ALP/GGT and bilirubin; albumin may fall in chronic disease. These tests show impact, not the organism itself. World Health Organization

9. Complete blood count (CBC)
   May be normal or show mild eosinophilia or anemia of chronic disease; results are nonspecific but helpful for overall assessment. NCBI

10. Serology – Echinococcus Em2-based ELISA
    Antibodies against Em2 antigen are positive in most AE patients and help distinguish AE from cystic echinococcosis. CDC

11. Serology – Em18 ELISA for activity/monitoring
    Em18-based tests are useful for monitoring disease course and treatment response. ARUP Consult

12. Confirmatory immunoblot (Western blot)
    Used after ELISA to confirm and help differentiate AE vs CE when results are unclear. Some assays are available via reference/public health labs. ARUP Consult

13. Polymerase chain reaction (PCR) on tissue
    Detects parasite DNA and confirms species when histology is obtained, typically in expert centers. World Health Organization

14. Histopathology of lesion
    Biopsy or surgical specimens show a PAS-positive laminated layer; in humans, protoscoleces are rarely seen, so identifying the laminated layer is key. Immunohistology can support the diagnosis. (Performed with care in specialized centers.) PMC

D) Electrodiagnostic tests

15. No electrodiagnostic test has a role
    Studies like EEG/nerve conduction do not diagnose AE. If brain involvement is suspected, MRI/CT (imaging) is used instead. (Important to know what not to order.) World Health Organization

E) Imaging tests

16. Abdominal ultrasound (US)
    First-line test: shows irregular, infiltrative liver lesion(s), calcifications, or cyst-like areas. Helpful for screening and follow-up. World Health Organization

17. Contrast-enhanced CT scan
    Defines extent, calcifications, and relationship to vessels/bile ducts; key for surgical planning and staging. MDPI

18. MRI of the liver
    Adds soft-tissue detail and characteristic patterns; can show bile duct involvement and satellite lesions. Parasite Journal

19. MRCP (MR cholangiopancreatography)
    Noninvasive look at bile ducts when jaundice or cholestasis suggests obstruction. World Health Organization

20. FDG-PET/CT or PET/MR (selected cases)
    Assesses metabolic activity to help judge lesion activity and extrahepatic spread; sometimes used to guide therapy duration. BioMed Central

Treatment overview

• Surgery: early, radical “tumor-like” resection with clear margins is the only potential cure. Post-op albendazole is continued, commonly for ≥2 years. ScienceDirect

• Antiparasitic chemotherapy: albendazole (first-choice) or mebendazole (second-choice). These drugs are parasito-static against AE; they stop growth but rarely kill all larvae, so long-term or lifelong therapy is needed in inoperable disease. Monitor blood counts and liver tests. Take with fatty food to improve absorption. CDC+2Hopkins Guides+2

• Transplant: for end-stage liver disease or unresectable hilar invasion; must continue benzimidazole afterward. aasldpubs.onlinelibrary.wiley.com

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Non-pharmacological treatments (therapies & care practices)

1. Shared decision-making and staging review: discuss PNM stage, options, and goals so care is realistic and safe. PubMed

2. Regular imaging surveillance: ultrasound or MRI every 3–6 months at first, then yearly, tailored to stage and symptoms. PET may be used to judge activity. MDPI

3. Liver-protective lifestyle: avoid alcohol; keep healthy weight; control diabetes and lipids; these reduce extra stress on the liver.

4. Medication adherence coaching: pill boxes, phone reminders, caregiver support—critical because stopping benzimidazoles early risks relapse. PMC

5. Nutrition counseling: adequate calories and protein; small frequent meals in cholestasis; soluble fiber to ease pruritus and constipation.

6. Pregnancy planning and contraception counseling: albendazole is teratogenic; plan therapy timing with specialists. CDC

7. Vaccination against hepatitis A and B: protects the liver if exposed; discuss with your clinician.

8. Hand-washing training: after handling pets/soil and before food prep to protect patient and family. CDC

9. Pet hygiene measures: keep dogs on leash, prevent hunting of rodents, clean up feces promptly, routine vet care. CDC

10. Kitchen food safety: wash produce, especially wild-foraged foods; avoid untreated surface water. CFSPH

11. Mental health support: counseling for the stress of long therapy and imaging follow-ups.

12. Exercise plan: light-to-moderate activity as tolerated to preserve muscle and energy.

13. Sun and skin care when on prolonged therapy (some drugs and cholestasis increase itch and sensitivity).

14. Itch self-care: cool showers, moisturizers, loose cotton clothing; medical treatment if severe.

15. Sleep hygiene: routines to manage fatigue from chronic illness.

16. ERCP-based biliary drainage (procedure without new long-term meds): stenting to relieve jaundice and cholangitis when ducts are compressed.

17. Interventional radiology support: image-guided drainage of infected collections if present.

18. Specialist referral pathways: hepatobiliary surgery, infectious diseases, interventional radiology, transplant center.

19. Community/registry follow-up: centers with AE expertise improve consistency of care. ClinicalTrials.gov

20. Household risk reduction: pet deworming schedule and avoiding wildlife attractants around home. Companion Animal Parasite Council

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Drug treatments

⚠️ Always use these under specialist supervision. Doses are typical adult ranges; adjust for weight, kidney/liver function, interactions, and pregnancy.

1. Albendazole (benzimidazole anthelmintic). Dose: 10–15 mg/kg/day PO in 2 doses (commonly 400 mg twice daily) with fatty meals; max 800 mg/day. Time: continuous for years; at least 2 years after curative surgery; lifelong if inoperable. Purpose: stop parasite growth. Mechanism: blocks microtubules and glucose uptake in larval cells. Side effects: liver enzyme rise, abdominal pain, hair loss, low WBC; teratogenic—avoid in pregnancy. CDC+1

2. Mebendazole (alternative benzimidazole). Dose: 40–50 mg/kg/day PO in divided doses. Time: long-term/continuous. Notes: use when albendazole is not tolerated/available. Side effects: similar hepatic and GI effects. CDC

3. Praziquantel (adjunct/peri-operative). Role: sometimes added short-term around surgery or procedures in expert centers; not effective alone for AE. Mechanism: alters calcium flux in cestodes. Caution: drug interactions; benefit for AE is limited. World Health Organization

4. Broad-spectrum antibiotics (e.g., piperacillin-tazobactam or ceftriaxone + metronidazole) for acute cholangitis. Purpose: treat secondary bile infection due to obstruction.

5. Ursodeoxycholic acid for cholestasis-related symptoms; Mechanism: improves bile flow; Dose: commonly 10–15 mg/kg/day PO.

6. Cholestyramine for itch from cholestasis; Dose: 4–16 g/day; Mechanism: binds bile acids in the gut.

7. Rifampicin for refractory pruritus; Caution: strong inducer—can lower albendazole levels; use only with specialist guidance.

8. Vitamin K for coagulopathy from obstructive jaundice (e.g., 10 mg IV/PO as directed).

9. Analgesics (e.g., acetaminophen within safe hepatic dosing; avoid or limit NSAIDs in advanced liver disease).

10. Antiemetics (ondansetron or similar) to maintain nutrition and medication adherence.

11. Proton pump inhibitor when NSAIDs or steroids are unavoidable peri-op.

12. Albendazole+fat co-administration strategy: not a new drug, but a prescribing technique that raises absorption and improves exposure. Hopkins Guides

13. Immunosuppressants after liver transplant (e.g., tacrolimus, mycophenolate, steroids) plus continued albendazole to prevent regrowth; doses per transplant protocol. aasldpubs.onlinelibrary.wiley.com

14. G-CSF (filgrastim) if severe albendazole-induced neutropenia occurs; specialist-directed rescue.

15. Antifungals/antibiotics for secondary abscess if lesions become superinfected.

16. Diuretics (spironolactone ± furosemide) for ascites from advanced portal hypertension.

17. Non-selective beta-blockers (propranolol/carvedilol) for esophageal variceal prophylaxis if portal hypertension develops.

18. Lactulose for encephalopathy in end-stage liver disease.

19. Peri-operative anticoagulation as indicated after major hepatic surgery—per surgeon/hepatologist.

20. Vaccines (Hepatitis A & B)—not “drugs” treating AE, but essential preventive medicines that protect a vulnerable liver.

Evidence notes: Albendazole and mebendazole dosing and long-term strategy come from CDC/WHO-IWGE guidance and large reviews; benzimidazoles are parasito-static, so therapy is prolonged and sometimes lifelong. CDC+2ScienceDirect+2

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Dietary, molecular, and supportive supplements

1. Standard multivitamin at RDA to cover gaps during long therapy.

2. Vitamin D (e.g., 800–1,000 IU/day) if deficient; supports bone and immune health.

3. Calcium (1,000–1,200 mg/day split doses) if intake is low, especially with vitamin D.

4. Omega-3 fish oil (~1 g/day EPA+DHA) for cardiometabolic health; avoid high doses before surgery.

5. Vitamin K-rich foods (dietary) if not contraindicated; supports clotting in cholestasis.

6. Soluble fiber (psyllium, oats) 5–10 g/day to help pruritus and bowel regularity.

7. Probiotics (evidence for liver disease symptoms is mixed; may help gut tolerance of meds).

8. Protein supplements (whey/plant) to maintain lean mass if intake is poor.

9. Branched-chain amino acids in advanced cirrhosis for encephalopathy support (specialist advice).

10. Coffee (2–3 cups/day if tolerated) is associated with liver-protective effects in observational studies (general liver health point).
    Avoid “liver detox” herbs like kava or comfrey—they can injure the liver.

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Immunity booster / regenerative / stem-cell drugs

There are no approved immune-booster or regenerative/stem-cell drugs that treat AE. Some liver-regeneration or stem-cell approaches are experimental and not standard of care. If you see such claims online, be cautious. What specialists actually use is:

1. Hepatitis A & B vaccines to protect the liver;

2. Nutritional optimization;

3. Manage neutropenia with G-CSF when needed;

4. Standard post-transplant immunosuppressants (not boosters) when a transplant is performed;

5. N-acetylcysteine only for specific toxic injuries (not routine AE);

6. Clinical trials in expert centers if available.
   This honest approach keeps you safe and aligned with evidence-based care. aasldpubs.onlinelibrary.wiley.com

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Surgeries and procedures

1. Radical liver resection (segmentectomy/lobectomy) with clear margins: removes all visible parasite tissue; followed by albendazole to reduce microscopic relapse. Why: potential cure at early stage. ScienceDirect

2. Complex hepatic resection with vascular/biliary reconstruction: for lesions near major vessels or bile ducts. Why: achieve radicality while preserving function. ScienceDirect

3. ERCP with biliary stenting: endoscopic relief of obstructed bile ducts. Why: treats jaundice and cholangitis; bridges to surgery or long-term control.

4. Percutaneous drainage of infected collections (IR-guided). Why: control sepsis when cavities are superinfected.

5. Liver transplantation (selected cases): for unresectable hilar invasion or end-stage disease; requires lifelong albendazole afterward. Why: restores liver function when other options fail. aasldpubs.onlinelibrary.wiley.com

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Prevention tips

1. Wash hands after handling dogs/cats and before eating/cooking. CDC

2. Do not touch foxes/coyotes (alive or dead) without gloves. CDC

3. Keep pets from hunting rodents; leash outdoors. CDC

4. Regularly deworm pets in endemic areas (praziquantel schedules from your vet). Ottawa Public Health+1

5. Wash or cook foraged berries, herbs, and mushrooms; avoid untreated water. CFSPH

6. Do not feed wildlife; secure trash to deter wild canids near homes. Kentucky Department of Fish & Wildlife

7. Wear gloves when gardening or handling animal feces. CDC

8. Hygienic slaughtering/offal disposal in livestock settings; never feed raw offal to dogs. World Health Organization

9. Community fox-baiting programs with praziquantel where authorities offer them—shown to reduce environmental contamination. CDC Stacks

10. Teach children pet-hygiene habits early. CDC

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When to see a doctor

• You live in or traveled to an endemic area and have unexplained right-upper-abdominal pain, jaundice, or weight loss.

• You had high-risk exposure (handled wild canids, foraged unwashed foods) and now feel unwell.

• You have abnormal liver tests or a liver mass on ultrasound/CT/MRI and AE is a possibility.

• You have AE and develop fever/chills, worsening itch/jaundice, confusion, or bleeding.

• You are pregnant or planning pregnancy while on albendazole—specialist advice is essential. CDC

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What to eat” and “what to avoid

Eat more of:

• Balanced, liver-friendly meals: lean proteins (fish, poultry, legumes), whole grains, fruits and cooked vegetables.

• Healthy fats (olive oil, nuts) and a small fatty snack with albendazole to aid absorption (e.g., yogurt, nut butter). Hopkins Guides

• Soluble fiber (oats, barley, psyllium) to help cholestatic itch and bowel regularity.

• Plenty of fluids (safe water) to prevent dehydration.

• Calcium and vitamin D sources if intake is low.

Avoid or limit:

• Alcohol—it adds liver stress.

• Unwashed wild-foraged produce; wash or cook thoroughly. CFSPH

• Herbal “detox” products with known liver toxicity (kava, comfrey, some bodybuilding supplements).

• Very high-fat fast foods if they worsen symptoms (use moderate, healthy fats instead).

• Excess salt if you have ascites or swelling—follow your clinician’s sodium plan.

• Raw or undercooked meats from wild game.

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Frequently asked questions

1. Is AE contagious person-to-person? No. You must swallow parasite eggs from the environment to get infected. CDC

2. Can I get AE from my dog? Only if your dog carries eggs on its fur or feces contaminate hands/food; regular deworming and hygiene reduce risk. Ottawa Public Health

3. Do albendazole or mebendazole cure AE? They usually control the parasite, not kill it. Many patients need long-term or lifelong therapy. PubMed

4. Why take albendazole with fatty food? It improves absorption and drug levels. Hopkins Guides

5. How long is treatment? After curative surgery, often ≥2 years; if inoperable, therapy may be lifelong with regular monitoring. PMC

6. How do doctors decide treatment? They use PNM staging, imaging, serology, and your overall health to plan surgery, medicines, or both. PubMed

7. What tests follow activity? Ultrasound/MRI for structure and FDG-PET and Em18 serology can help judge activity over time. MDPI+1

8. Is biopsy always needed? No. Imaging plus serology often suffice. Biopsy is for uncertain cases in expert centers.

9. Can AE spread beyond the liver? Yes, to lungs, brain, and other organs in advanced disease. CDC

10. What if I’m pregnant? Avoid benzimidazoles in the first trimester; coordinate closely with specialists. CDC

11. Do probiotics or vitamins cure AE? No. They may support health but do not kill the parasite.

12. Can I stop medicine if I feel fine? Don’t. Stopping early risks relapse or progression. Always follow your specialist’s plan. PMC

13. When is transplant considered? For end-stage liver failure or unresectable hilar invasion; albendazole continues afterward. aasldpubs.onlinelibrary.wiley.com

14. How can my family stay safe? Hand-washing, pet deworming, and keeping pets from hunting rodents are the key steps. CDC

15. Are community programs helpful? Yes—praziquantel fox-baiting reduced environmental contamination in several studies. CDC Stacks

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: September 14, 2025.