American Family Nurse Practitioner saw a patient in the Emergency room and has a very serious warning. Don’t let your dog lick you on the mouth A patient came into the emergency and she looked extremely pregnant, like 8-9 months pregnant but the patient said she wasn’t pregnant After running all the tests everything kept coming back as normal and not pregnant But the belly was extremely distended and “if was clear that something was in there” it was also very “firm” Every test keeps coming back as normal “Nothing explains why it looks like she's immediately about to deliver. Then we ultrasound her abdomen, and we don't see a baby. Nope. Massive cystic structure taking up a huge portion of her abdominal cavity. Tumor? Massive hepatic cyst? Some bizarre congenital anomaly? Go to CT, and that's where we find enormous 25-centimeter lesion in the right lobe of her liver. So big that it's displacing her bowel and other organs in the same sense that a pregnancy might do. The cysts weren't empty. There were smaller pieces inside the cysts. Imagine this big ball filled with littler balls. It gets worse” “Radiology calls them daughter cysts, and this is where infectious diseases gets involved and we start drawing a bunch of labs and doing way more studies. Cystic echinococcosis.She has a hydatid cyst. What causes hydatid cyst? Echinococcosis granulosus. Parasitic tapeworm. Yes, I said tapeworm. Someone brilliantly asks, "Hey, do you have any dogs?" Which she replies, "Yeah, my dog is my life. He's my literal baby." The dog sleeps in her bed, licks her face, and kisses her on the mouth all the time. This is where it gets gross. Dogs and other canids can be definitive hosts for echinococcosis, the adult tapeworms, like the final form. The adult worms live in intestines and produce microscopic eggs that shed in feces. Humans accidentally ingest them through fecal-oral transmission. The eggs hatch, larvae penetrate the intestinal walls, they enter circulation. What's the first place that they meet in circulation? The liver. Once they're there, they slowly form these massive cysts that take up a ton of space. What's inside those cysts? More of the parasites. All of the tiny balls on the CT that we saw, the balls inside of balls inside of balls, those are literally more baby parasites that are gonna grow up into adult tapeworms and then penetrate the walls of the intestine, replicate, and make more parasites. One of the scary parts is that they can grow for years and not have anybody know. Another scary part is you don't just stick a needle in, suck it out, and be done with it. If you mess this up and you spill the contents of those cysts, there are tons of tiny baby parasite particles spread about the abdomen and make everything so much worse. They can invade other organs. They can do tons of damage. It's a mess. Not only that, spilling those contents can actually trigger anaphylactic reaction, so people can die from opening them up and spilling them. So infectious diseases and hepatobiliary get involved, and they end up performing a definitive surgery on this woman to make sure that they very, very carefully clear out her abdomen without spilling any of the contents anywhere else” She has to have surgery, is out on antiparasitics and that massive belly goes away “Please stop letting your animals lick your face. I don't care if you love them. Kiss them on the forehead, scratch their belly, tell them they are the best things on earth — Don't let the dog that just spent 10 minutes licking its booty hole lick the inside of your mouth” Globally there are around 200,000 cases of this per year If you get this and it’s large like with this patient it can actually be deadly if it ruptures