Case Report: Amphotericin B and Mefloquine as a Salvage Treatment of Alveolar Echinococcosis

Karlo Jelicic University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia;

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Neven Papic University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia;
School of Medicine, University of Zagreb, Zagreb, Croatia;

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Klaudija Viskovic University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia;
Faculty of Health Studies, University of Rijeka, Rijeka, Croatia

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Adriana Vince University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia;
School of Medicine, University of Zagreb, Zagreb, Croatia;

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ABSTRACT.

Alveolar echinococcosis is an emerging zoonotic disease caused by the parasite Echinococcus multilocularis. Most patients are diagnosed at a late stage, when lifelong treatment with benzimidazoles is required to stop disease progression. However, for patients who do not tolerate benzimidazole therapy, there are no alternatives. Here, we present a patient with advanced alveolar echinococcosis who was successfully treated with amphotericin B deoxycholate and mefloquine as a rescue therapy after he developed albendazole intolerance.

Author Notes

Address correspondence to Neven Papic, University Hospital for Infectious Diseases Zagreb, Mirogojska 8, 10000 Zagreb, Croatia. E-mail: npapic@bfm.hr

Authors’ Addresses: Karlo Jelicic, University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia, E-mail: kjelicic@bfm.hr. Neven Papic and Adriana Vince, University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia, and School of Medicine, University of Zagreb, Zagreb, Croatia, E-mails: npapic@bfm.hr and avince@bfm.hr. Klaudija Viskovic, University Hospital for Infectious Diseases Zagreb, Zagreb, Croatia, and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia, E-mail: kviskovic@bfm.hr.

  • 1.

    Moro P , Schantz PM , 2009. Echinococcosis: A review. Int J Infect Dis 13: 125–133.

  • 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: 1–16.

    • Search Google Scholar
    • Export Citation
  • 3.

    Kadry Z , Renner EC , Bachmann LM , Attigah N , Renner EL , Ammann RW , Clavien PA , 2005. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg 92: 1110–1116.

    • Search Google Scholar
    • Export Citation
  • 4.

    Wen H , Vuitton L , Tuxun T , Li J , Vuitton DA , Zhang W , McManus DP , 2019. Echinococcosis: Advances in the 21st century. Clin Microbiol Rev 32: e00075-18.

    • Search Google Scholar
    • Export Citation
  • 5.

    Torgerson PR , Schweiger A , Deplazes P , Pohar M , Reichen J , Ammann RW , Tarr PE , Halkic N , Mullhaupt B , 2008. Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years. J Hepatol 49: 72–77.

    • Search Google Scholar
    • Export Citation
  • 6.

    Siles-Lucas M , Casulli A , Cirilli R , Carmena D , 2018. Progress in the pharmacological treatment of human cystic and alveolar echinococcosis: Compounds and therapeutic targets. PLoS Negl Trop Dis 12: e0006422.

    • Search Google Scholar
    • Export Citation
  • 7.

    Dusek D , Vince A , Kurelac I , Papic N , Viskovic K , Deplazes P , Beck R , 2020. Human alveolar echinococcosis, Croatia. Emerg Infect Dis 26: 364–366.

    • Search Google Scholar
    • Export Citation
  • 8.

    Hemphill A , Stadelmann B , Rufener R , Spiliotis M , Boubaker G , Muller J , Muller N , Gorgas D , Gottstein B , 2014. Treatment of echinococcosis: Albendazole and mebendazole–what else? Parasite 21: 70.

    • Search Google Scholar
    • Export Citation
  • 9.

    Lundstrom-Stadelmann B , Rufener R , Hemphill A , 2020. Drug repurposing applied: activity of the anti-malarial mefloquine against Echinococcus multilocularis. Int J Parasitol Drugs Drug Resist 13: 121–129.

    • Search Google Scholar
    • Export Citation
  • 10.

    Reuter S , Buck A , Grebe O , Nussle-Kugele K , Kern P , Manfras BJ , 2003. Salvage treatment with amphotericin B in progressive human alveolar echinococcosis. Antimicrob Agents Chemother 47: 3586–3591.

    • Search Google Scholar
    • Export Citation
  • 11.

    Tappe D , Muller A , Frosch M , Stich A , 2009. Limitations of amphotericin B and nitazoxanide in the treatment of alveolar echinococcosis. Ann Trop Med Parasitol 103: 177–181.

    • Search Google Scholar
    • Export Citation
  • 12.

    Reuter S , Merkle M , Brehm K , Kern P , Manfras B , 2003. Effect of amphotericin B on larval growth of Echinococcus multilocularis. Antimicrob Agents Chemother 47: 620–625.

    • Search Google Scholar
    • Export Citation
  • 13.

    Burkert S , Peters L , Bloehdorn J , Grüner B , 2022. Salvage therapy for alveolar echinococcosis – A case series. Pathogens 11: 333.

  • 14.

    Reuter S , Buck A , Manfras B , Kratzer W , Seitz HM , Darge K , Reske SN , Kern P , 2004. Structured treatment interruption in patients with alveolar echinococcosis. Hepatology 39: 509–517.

    • Search Google Scholar
    • Export Citation
  • 15.

    Deibel A , Stocker D , Meyer Zu Schwabedissen C , Husmann L , Kronenberg PA , Grimm F , Deplazes P , Reiner CS , Mullhaupt B , 2022. Evaluation of a structured treatment discontinuation in patients with inoperable alveolar echinococcosis on long-term benzimidazole therapy: A retrospective cohort study. PLoS Negl Trop Dis 16: e0010146.

    • Search Google Scholar
    • Export Citation
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