Cystic Echinococcosis of the Bone: A European Multicenter Study

Letizia Cattaneo Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy;

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Tommaso Manciulli Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy;
PhD School of Experimental Medicine, University of Pavia, Pavia, Italy;

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Carmen-Michaela Cretu Parasitology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania;

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Maria Teresa Giordani Division of Infectious and Tropical Diseases, San Bortolo Hospital, Vicenza, Italy;

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Andrea Angheben Centre for Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore-Don Calabria Hospital, Verona, Italy;

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Alessandro Bartoloni Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy;

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Lorenzo Zammarchi Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy;

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Filippo Bartalesi Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy;

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Joachim Richter Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin, Berlin, Germany;

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Peter Chiodini Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom;

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Gauri Godbole Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom;

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Thomas Junghanss Section of Clinical Tropical Medicine, University Hospital, Heidelberg, Germany;

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Marija Stojkovic Section of Clinical Tropical Medicine, University Hospital, Heidelberg, Germany;

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Luigi Sammarchi Division of Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Roberto Dore Department of Radiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy;

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Alessandro Vercelli Department of Radiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy;

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Francesco Benazzo Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy;
Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Fabrizio Cuzzocrea Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Francesca Tamarozzi Centre for Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore-Don Calabria Hospital, Verona, Italy;

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Enrico Brunetti Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy;
Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy

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Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus. In humans, the infection induces the formation of parasitic cysts mostly in the liver and lungs, but virtually any organ can be affected. CE of the bone is one of the rarest forms of the disease, yet it is also extremely debilitating for patients and hard to manage for clinicians. Unlike abdominal CE, there is currently no expert consensus on the management of bone CE. In this study, we conducted a survey of the clinical records of seven European referral centers for the management of patients with CE and retrieved data on the clinical management of 32 patients with a diagnosis of bone CE. Our survey confirmed that the patients endured chronic debilitating disease with a high rate of complications (84%). We also found that diagnostic approaches were highly heterogeneous. Surgery was extensively used to treat these patients, as well as albendazole, occasionally combined with praziquantel or nitaxozanide. Treatment was curative only for two patients, with one requiring amputation of the involved bone. Our survey highlights the need to conduct systematic studies on bone CE, both retrospectively and prospectively.

Author Notes

Address correspondence to Enrico Brunetti, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 74, Pavia 27100, Italy or Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Viale Taramelli 5, Pavia 27100, Italy. E-mail: enrico.brunetti@unipv.it

Authors’ addresses: Letizia Cattaneo, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, E-mail: letizia.cattaneo01@ateneopv.it. Tommaso Manciulli, PhD School of Experimental Medicine, Universita degli Studi di Pavia, Pavia, Italy, and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Universita degli Studi di Pavia, Pavia, Italy, E-mail: tommaso.manciulli01@ateneopv.it. Carmen-Michaela Cretu, Parasitology Department, Colentina Clinical Hospital, University of Medicine and Pharmacy, Bucharest, Romania, and Parasitology Department, Bucharest, Romania, E-mail: michaelacarmen.cretu@gmail.com. Maria Teresa Giordani, Infectious and Tropical Diseases Unit, San Bortolo Hospital, Vicenza, Italy, E-mail: giordanimt@libero.it. Andrea Angheben, Centre of Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Verona, Italy, E-mail: andrea.angheben@sacrocuore.it. Alessandro Bartoloni, Infectious and Tropical Diseases, University of Florence, Florence, Italy, E-mail: alessandro.bartoloni@unifi.it. Lorenzo Zammarchi, Dipartimento di Medicina Sperimentale e Clinica, Clinica Malattie Infettive, Università di Firenze, Florence, Italy, E-mail: lorenzo.zammarchi@unifi.it. Filippo Bartalesi, SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy, E-mail: bartalesif@aou-careggi.toscana.it. Joachim Richter, Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin, Berlin, Germany, E-mail: joachim.richter@charite.de. Peter Chiodini and Gauri Godbole, Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom, E-mails: peter.chiodini@uclh.nhs.uk and gauri.godbole@phe.gov.uk. Thomas Junghanss, Section of Clinical Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany, E-mail: thomas.junghanss@urz.uni-heidelberg.de. Marija Stojkovic, Clinical tropical medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany, E-mail: marija.stojkovic@med.uni-heidelberg.de. Luigi Sammarchi, Department of Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mail: sammarchi@smatteo.pv.it. Roberto Dore and Alessandro Vercelli, Department of Radiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy, E-mail: r.dore@smatteo.pv.it and aleverce@gmail.com. Francesco Benazzo, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Universita degli Studi di Pavia, Pavia, Italy, and Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mail: francesco.benazzo@unipv.it. Fabrizio Cuzzocrea, Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mail: f.cuzzocrea@smatteo.pv.it. Francesca Tamarozzi, Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital - Negrar (Verona), Italy, and WHO collaborating centre for clinical management of cystic echinococcosis, Pavia, Italy, E-mail: f_tamarozzi@yahoo.com. Enrico Brunetti, Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy, and Division of Infectious and Tropical Diseases, IRCCS S Matteo Hospital Foundation, Univeristy of Pavia, Pavia, Italy, E-mail: enrico.brunetti@unipv.it.

These authors contributed equally to this work.

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