Watch and Wait Approach for Inactive Echinococcal Cyst of the Liver: An Update

Raffaella Lissandrin Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;
Unit of Infectious and Tropical Diseases, Istituto di Ricerca e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;

Search for other papers by Raffaella Lissandrin in
Current site
Google Scholar
PubMed
Close
,
Francesca Tamarozzi Centre for Tropical Disease, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy;

Search for other papers by Francesca Tamarozzi in
Current site
Google Scholar
PubMed
Close
,
Mara Mariconti Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;

Search for other papers by Mara Mariconti in
Current site
Google Scholar
PubMed
Close
,
Tommaso Manciulli Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;
PhD School of Experimental Medicine, University of Pavia, Pavia, Italy

Search for other papers by Tommaso Manciulli in
Current site
Google Scholar
PubMed
Close
,
Enrico Brunetti Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;
Unit of Infectious and Tropical Diseases, Istituto di Ricerca e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;

Search for other papers by Enrico Brunetti in
Current site
Google Scholar
PubMed
Close
, and
Ambra Vola Unit of Infectious and Tropical Diseases, Istituto di Ricerca e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;

Search for other papers by Ambra Vola in
Current site
Google Scholar
PubMed
Close
Restricted access

Human cystic echinococcosis (CE) is a chronic, complex and neglected infection causing severe disease in humans. Hepatic CE cysts are detected and classified mainly by using ultrasound. Expert opinion and published data suggest that uncomplicated inactive liver cysts do not require treatment and only need to be monitored over time (“Watch and Wait”). Here we update our findings as published in 2014 on the “Watch and Wait” approach applied to inactive, asymptomatic cysts of the liver to keep the medical community informed. Clinical data of patients who accessed the World Health Organization Collaborating Center for CE at the University of Pavia-San Matteo Hospital Foundation from January 1991 to October 2017 were analyzed. Inclusion criteria were presence of one or more inactive uncomplicated cysts in the liver (CE4 or CE5), without any history of previous treatment, and an ultrasound-based follow-up of at least 24 months. Fifty-three patients with 66 inactive cysts fulfilled the inclusion criteria. Of these, 11 patients are newly described here; 37 were part of our previously described cohort and the follow-up for 17 of them was further extended; and five were excluded from the previously published analysis as their follow-up was too short, but could be included now. Without the need for treatment and without development of complications, 98.5% of cysts remained inactive over time. In only one patient (1.9% of patients), a reactivation of one cyst (1.5% of cysts) was observed.

Author Notes

Address correspondence to Raffaella Lissandrin, Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Viale Taramelli 5, Pavia 27100, Italy. E-mail: raffaella.lissandrin@unipv.it

Financial support: This work was partially funded by the EU Project HERACLES–(Human cystic Echinococcosis ReseArch in CentraL and Eastern Societies), FP7-HEALTH-2013-INNOVATION-1 PN 602051 (to E. B.).

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

  • 1.

    WHO Echinococcosis WHO/OIE Manual on Echinococcosis, 2001. Echinococcosis in Humans and Animals: A Public Health Problem of Global Concern. World Organization for Animal Health (Office International des Epizooties) and World Health Organization. Available at: http://www.who.int/echinococcosis/resources/929044522X/en/. Accessed January 10, 2018.

    • PubMed
    • Export Citation
  • 2.

    Craig PS, Budke CM, Schantz PM, Li T, Qiu J, Yang Y, Zeyhle E, Rogan MT, Ito A, 2007. Human echinococcosis: a neglected disease? Trop Med Health 35: 283292.

  • 3.

    Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A, 2003. Hydatid disease from head to toe. Radiographics 23: 475494.

  • 4.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Stojkovic M, Rosenberger K, Kauczor HU, Junghanss T, Hosch W, 2012. Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound? PLoS Negl Trop Dis 6: e1880.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Stojkovic M, Rosenberger KD, Steudle F, Junghanss T, 2016. Watch and wait management of inactive cystic echinococcosis–does the path to inactivity matter–analysis of a prospective patient cohort. PLoS Negl Trop Dis 10: e0005243.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Solomon N, Kachani M, Zeyhle E, Macpherson CNL, 2017. The natural history of cystic echinococcosis in untreated and albendazole-treated patients. Acta Trop 171: 5257.

  • 9.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Larrieu E et al. 2011. Programme for ultrasound diagnoses and treatment with albendazole of cystic echinococcosis in asymptomatic carriers: 10 years of follow-up of cases. Acta Trop 117: 15.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Solomon N et al. 2018. Cystic echinococcosis in Turkana, Kenya: 30 years of imaging in an endemic region. Acta Trop 178: 182189.

  • 15.

    Tamarozzi F et al. 2017. Prevalence and risk factors for human cystic echinococcosis in the Cusco region of the Peruvian highlands diagnosed using focused abdominal ultrasound. Am J Trop Med Hyg 96: 14721477.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Chebli H et al. 2017. Human cystic echinococcosis in Morocco: ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership. PLoS Negl Trop Dis 11: e0005384.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Evering T, Weiss LM, 2006. The immunology of parasite infections in immunocompromised hosts. Parasite Immunol 28: 549565.

  • 19.

    Rossi P et al. 2016. The first meeting of the European Register of Cystic Echinococcosis (ERCE). Parasit Vectors 9: 243.

Past two years Past Year Past 30 Days
Abstract Views 138 138 12
Full Text Views 1470 17 0
PDF Downloads 223 14 0
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save