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Conservative Management of Liver Echinococcal Cysts in Pregnant Women: Single Center Experience in Pavia, Italy

Raffaella LissandrinDepartment of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;
Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Ambra VolaUnit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Mara MaricontiUnit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Carlo FiliceUnit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Tommaso ManciulliDepartment of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;
Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy;

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Francesca TamarozziDepartment of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy

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

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ABSTRACT.

Human cystic echinococcosis (CE) in pregnancy is rarely reported, with approximately one case of CE for every 20,000 to 30,000 pregnant women in endemic areas. Little information on its management is available. We report our experience with a watch and wait approach in this group of patients. We retrieved clinical data from pregnant patients with hepatic CE seen at our clinic from 1989 to 2021. All patients had at least one hepatic CE cyst and received no treatment during pregnancy. Ultrasound was used to monitor cyst evolution; outcome and complications of pregnancy and echinococcal infection were evaluated. Twelve patients with 15 pregnancies were included in this study. At the time of pregnancy, nine patients had a single cyst and two patients had multiple hepatic CE cysts. Cysts were in stage CE3a, CE3b, CE4, and CE5, according to the WHO Informal Working Group on Echinococcosis classification. All cysts except one remained stable in stage and size during and after pregnancy. In one patient with a history of multiple treatments with albendazole and with a CE4 cyst at the start of pregnancy, reactivation of the cyst during pregnancy was observed. All pregnancies except three had eutocic delivery. Cesarean sections were performed for reasons unrelated to CE. In our experience, “watch and wait” in pregnant women with uncomplicated transitional and inactive CE of the liver was a safe option in a small cohort of patients. Pooled data from other referral centers, including cases with CE1 and CE2 cysts, are needed to confirm the safety of this approach.

Author Notes

Address correspondence to Tommaso Manciulli, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Brambilla 54, 27100, Pavia, Italy. E-mail: tommaso.manciulli01@ateneopv.it

Financial support: This study was supported in part by an FP7-HEALTH-2013-INNOVATION-1 grant, “Human Cystic Echinococcosis in Central and Eastern Societies—HERACLES” to E. B.

Authors’ addresses: Raffaella Lissandrin, Tommaso Manciulli, and Enrico Brunetti, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, and Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mails: raffaella.lissandrin@unipv.it, tommaso.manciulli01@universitadipavia.it, and selim@unipv.it. Ambra Vola, Mara Mariconti, and Carlo Filice, Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mails: ambra.vola@gmail.com, maramariconti@libero.it, and carlo.filice@unipv.it. Francesca Tamarozzi, Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy, E-mail: f_tamarozzi@yahoo.com.

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