Volume 84, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We report our experience with puncture, aspiration, injection, and reaspiration (PAIR) for the treatment of cystic echinococcosis in Bulgaria. PAIR was performed in 230 patients with 348 echinococcal cysts. At 12-month follow-up, 77.6% of the cysts, all cystic echinococcosis (CE) 1 and CE3a cysts according to the World Health Organization Informal Working Group classification, showed various degrees of obliteration. In 11.5% of cysts, all of which were > 10 cm-type CE1, a significant amount of fluid persisted, and they were punctured again. Of those, 16 (4.6%) contained protoscolices and were treated by a second PAIR. The remaining 24 (6.9%) cysts were treated by simple aspiration or drainage. No significant reduction in size and no changes in the structure were observed in 10.9% of cysts, all of which were classified as CE2 or CE3b. Complications developed in 25.2% of patients, including severe anaphylactic reaction in two (0.9%) patients. Our experience confirms that PAIR is a successful first-choice treatment when a stage-specific approach is taken.


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  1. Brunetti E, Kern P, Vuitton DA, , 2010. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 114: 116.[Crossref]
  2. Hosch W, Junghanss T, Stojkovic M, Brunetti E, Heye T, Kauffmann GW, Hull WE, , 2008. Metabolic viability assessment of cystic echinococcosis using high-field (1)H MRS of cyst contents. NMR Biomed 21: 734754.[Crossref]
  3. 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.
  4. Brunetti E, Junghanss T, , 2009. Update on cystic hydatid disease. Curr Opin Infect Dis 22: 497502.[Crossref]
  5. Brunetti E, Troia G, Garlaschelli AL, Gulizia R, Filice C, , 2004. Twenty years of percutaneous treatments for cystic echinococcosis: a preliminary assessment of their use and safety. Parassitologia 46: 367370.
  6. World Health Organization 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]
  7. Akhan O, Dincer A, Gokoz A, Sayek I, Havlioglu S, Abbasoglu O, Eryilmaz M, Besim A, Baris I, , 1993. Percutaneous treatment of abdominal hydatid cysts with hypertonic saline and alcohol. An experimental study in sheep. Invest Radiol 28: 121127.[Crossref]
  8. Todorov T, Boeva V, , 1999. Human echinococcosis in Bulgaria: a comparative epidemiological analysis. Bull World Health Organ 77: 110118.
  9. Todorov T, Boeva V, , 1997. Epidemiology of echinococcosis in Bulgaria—a comparative study. Arch Int Hidatid 32: 232233.
  10. Kurdova R, , 2001. New trends in parasitism in Bulgaria. Trends Parasitol 17: 314315.[Crossref]
  11. Kurdova R, Petrov P, Jordanova D, Rainova I, Harizanov R, Marinova Bikov I, Kaftandjiev I, , 2010. Parasitic morbidity in Bulgaria in the year 2007–2008. Status and prognosis. National Centre of Infectious and Parasitic Diseases Inform J 5: 530.
  12. Akhan O, Ozmen MN, Dincer A, Sayek I, Gocmen A, , 1996. Liver hydatid disease: long-term results of percutaneous treatment. Radiology 198: 259264.[Crossref]
  13. Ustunsoz B, Akhan O, Kamiloglu MA, Somuncu I, Ugurel MS, Cetiner S, , 1999. Percutaneous treatment of hydatid cysts of the liver: long-term results. AJR Am J Roentgenol 172: 9196.[Crossref]
  14. Todorov T, Mechkov G, Vutova K, Georgiev P, Lazarova I, Tonchev Z, Nedelkov G, , 1992. Factors influencing the response to chemotherapy in human cystic echinococcosis. Bull World Health Organ 70: 347358.
  15. Kabaalioglu A, Ceken K, Alimoglu E, Apaydin A, , 2006. Percutaneous imaging-guided treatment of hydatid liver cysts: do long-term results make it a first choice? Eur J Radiol 59: 6573.[Crossref]
  16. Men S, Yucesoy C, Edguer TR, Hekimoglu B, , 2006. Percutaneous treatment of giant abdominal hydatid cysts: long-term results. Surg Endosc 20: 16001606.[Crossref]

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  • Received : 31 May 2010
  • Accepted : 23 Oct 2010

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