infectious diseases
Echinococcosis
Treatment of Echinococcosis
For hepatic echinococcosis, surgical resection Percutaneous aspiration followed by instillation of a scolicidal agent and reaspiration (PAIR) Albendazolealone or in combination with surgical resection or aspiration Observation only For alveolar echinococcus, surgical resection, if possible, plusalbendazole Treatment of cystic (hydatid) echinococcosis varies depending on the type, location, and number of cysts and whether imaging results indicate the cysts are active, transitional, or inactive ( Treatment references ). is typically given one week before, during, and at least 4 weeks (up to 6 months depending on clinical and imaging response) after surgery or PAIR ( Treatment references ). alone for several months' duration, resulting in about a 30% cure rate ( Treatment references ). Observation only is an option for asymptomatic cysts that are naturally inactivated (not inactivated by drug treatment). Liver transplantation has been lifesaving in a few patients. Take care to avoid leakage of echinococcal cyst contents during aspiration or surgery because metastatic infection can occur. Patients with alveolar echinococcosis due toE. multilocularisshould receivealbendazole(in the above daily dosing used for cystic echinococcosis) for ≥ 1 week followed by surgical resection, if feasible, which depends on the extent, location, and manifestations of the lesion. The prognosis is poor unless the entire larval mass can be removed.Albendazoleis administered continuously for at least 2 years and patients are monitored for recurrence for 10 years or more thereafter. Prolonged, high dosealbendazoletherapy can cause bone marrow suppression, liver toxicity, and temporary hair loss. It is important to monitor the complete blood count and liver enzymes during use. 1.Nabarro LE, Amin Z, Chiodini PL: Current management of cystic echinococcosis: a survey of specialist practice. Clin Infect Dis. 60(5):721-8, 2015. doi: 10.1093/cid/ciu931. 2.Bildik N, Cevik A, Altintaş M, Ekinci H, Canberk M, Gülmen M: Efficacy of preoperativealbendazoleuse according to months in hydatid cyst of the liver.J Clin Gastroenterol41(3):312-316, 2007. doi:10.1097/01.mcg.0000225572.50514.e6 3.Horton RJ:Albendazolein treatment of human cystic echinococcosis: 12 years of experience.Acta Trop64(1-2):79-93, 1997. doi:10.1016/s0001-706x(96)00640-7 