1921
Volume 94, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Cystic echinococcosis (CE) is a clinically complex chronic parasitic disease, management options for which include surgery, percutaneous treatments, and treatment with albendazole (ABZ) for active cysts, and the “Watch-and-Wait” approach for uncomplicated, inactive cysts. We examined, retrospectively, the clinical management of 334 patients with hepatic CE from the southeastern Rhodope region of Bulgaria between 2004 and 2013. Cysts were reclassified according to the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) on the basis of ultrasound reports and images. The majority (62.3%) of uncomplicated cysts were CE1, 66% of which were treated surgically. Of all interventions, 5% were performed on inactive uncomplicated CE4–CE5 cysts. About half (47.6%) of these cysts were therefore treated inappropriately, exposing patients to unnecessary treatment-related risks and the health system to unnecessary costs. No management change was observed after the publication of the WHO-IWGE Expert Consensus recommendations in 2010. In Bulgaria, ABZ is still used in interrupted cycles as this is reimbursed, and peri-interventional chemoprophylaxis was not administered in the majority of surgical patients. Efforts are needed to introduce the WHO-IWGE classification and management recommendations and to encourage reception of state-of-the-art practices by public health regulatory bodies to improve patient quality of care and optimization of health resources.

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2016-04-06
2017-09-22
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References

  1. Jordanova DP, Harizanov RN, Kaftandjiev IT, Rainova IG, Kantardjiev TV, , 2015. Cystic echinococcosis in Bulgaria 1996–2013, with emphasis on childhood infections. Eur J Clin Microbiol Infect Dis 34: 14231428.[Crossref]
  2. Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO-IWGE; , 2010. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 114: 116.[Crossref]
  3. Gharbi HA, Hassine W, Brauner MW, Dupuch K, , 1981. Ultrasound examination of the hydatic liver. Radiology 139: 459463.[Crossref]
  4. WHO Informal Working Group, 2003. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 85: 253261.[Crossref]
  5. Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch S, Tamarozzi F, , 2014. Cystic echinococcosis of the liver: a primer for hepatologists. World J Hepatol 6: 293305.[Crossref]
  6. da Silva AM, , 2010. Human echinococcosis: a neglected disease. Gastroenterol Res Pract 2010: pii.583297.[Crossref]
  7. Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E, , 2008. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 79: 301311.
  8. Hosch W, Junghanss T, Stojkovic M, Brunetti E, Heye T, Kauffmann GW, Hull WE, , 2008. Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents. NMR Biomed 21: 734754.[Crossref]
  9. Golemanov B, Grigorov N, Mitova R, Genov J, Vuchev D, Tamarozzi F, Brunetti E, , 2011. Efficacy and safety of PAIR for cystic echinococcosis: experience on a large series of patients from Bulgaria. Am J Trop Med Hyg 84: 4851.[Crossref]
  10. Rinaldi F, De Silvestri A, Tamarozzi F, Cattaneo F, Lissandrin R, Brunetti E, , 2014. Medical treatment versus “Watch and Wait” in the clinical management of CE3b echinococcal cysts of the liver. BMC Infect Dis 14: 492.[Crossref]
  11. Stojkovic M, Zwahlen M, Teggi A, Vutova K, Cretu CM, Virdone R, Nicolaidou P, Cobanoglu N, Junghanss T, , 2009. Treatment response of cystic echinococcosis to benzimidazoles: a systematic review. PLoS Negl Trop Dis 3: e524.[Crossref]
  12. Akhan O, Gumus B, Akinci D, Karcaaltincaba M, Ozmen M, , 2007. Diagnosis and percutaneous treatment of soft-tissue hydatid cysts. Cardiovasc Intervent Radiol 30: 419425.[Crossref]
  13. WHO Informal Working Group on Echinococcosis, 2001. PAIR: Puncture, Aspiration, Injection, Re-aspiration. An Option for the Treatment of Cystic Echinococcosis. WHO/CDS/CSR/APH/2001.6. Geneva, Switzerland: World Health Organization.
  14. Piccoli L, Tamarozzi F, Cattaneo F, Mariconti M, Filice C, Bruno A, Brunetti E, , 2014. Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a “watch-and-wait” approach. PLoS Negl Trop Dis 8: e3057.[Crossref]
  15. Nabarro LE, Amin Z, Chiodini PL, , 2015. Current management of cystic echinococcosis: a survey of specialist practice. Clin Infect Dis 60: 721728.[Crossref]
  16. Tamarozzi F, Nicoletti GJ, Neumayr A, Brunetti E, , 2014. Acceptance of standardized ultrasound classification, use of albendazole, and long-term follow-up in clinical management of cystic echinococcosis: a systematic review. Curr Opin Infect Dis 27: 425431.[Crossref]
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  • Received : 24 Aug 2015
  • Accepted : 09 Dec 2015

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