Skip to main content
PMC home page
Bulletin of the World Health Organization logoLink to Bulletin of the World Health Organization
. 1996;74(3):231–242.

Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis.

PMCID: PMC2486920  PMID: 8789923

Abstract

Summarized in this article are recent experiences in the treatment of human cystic echinococcosis (CE) and alveolar echinococcosis (AE) of the liver caused by the metacestode stages of Echinococcus granulosus and E. multilocularis, respectively. For CE, surgery remains the first choice for treatment with the potential to remove totally the parasite and completely cure the patient. However, chemotherapy with benzimidazole compounds (albendazole or mebendazole) and the recently developed PAIR procedure (puncture-aspiration-injection-re-aspiration) with concomitant chemotherapy offer further options for treatment of CE cases. Chemotherapy is not yet satisfactory: cure can be expected in about 30% of patients and improvement in 30-50%, after 12 months' follow-up. AE is generally a severe disease, with over 90% mortality in untreated patients. Radical surgery is recommended in all operable cases but has to be followed by chemotherapy for at least 2 years. Inoperable cases and patients who have undergone nonradical resection or liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival, even for inoperable patients with severe AE. Liver transplantation may be indicated as a life-saving measure for patients with severe liver dysfunction, but is associated with a relatively high risk of proliferation of intraoperatively undetected parasite remnants. Details of indications, contraindications, treatment schedules and other aspects are discussed.

Full text

PDF
231

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ben Amor N., Kchouk H., Ayachi K., Ben Chehida F., Golvan Y. J., Gargouri M., Ben Cheikh M., Gharbi H. A. A propos du traitement d'un cas de kyste hydatique pariétal par ponction. J Belge Radiol. 1987;70(4):333–336. [PubMed] [Google Scholar]
  2. Bresson-Hadni S., Franza A., Miguet J. P., Vuitton D. A., Lenys D., Monnet E., Landecy G., Paintaud G., Rohmer P., Becker M. C. Orthotopic liver transplantation for incurable alveolar echinococcosis of the liver: report of 17 cases. Hepatology. 1991 Jun;13(6):1061–1070. [PubMed] [Google Scholar]
  3. Bresson-Hadni S., Miguet J. P., Lenys D., Vuitton D. A., Viennet G., Becker M. C., Rohmer P., Mantion G., Gillet M. Recurrence of alveolar echinococcosis in the liver graft after liver transplantation. Hepatology. 1992 Jul;16(1):279–280. doi: 10.1002/hep.1840160146. [DOI] [PubMed] [Google Scholar]
  4. Davis A., Dixon H., Pawlowski Z. S. Multicentre clinical trials of benzimidazole-carbamates in human cystic echinococcosis (phase 2). Bull World Health Organ. 1989;67(5):503–508. [PMC free article] [PubMed] [Google Scholar]
  5. Filice C., Pirola F., Brunetti E., Dughetti S., Strosselli M., Foglieni C. S. A new therapeutic approach for hydatid liver cysts. Aspiration and alcohol injection under sonographic guidance. Gastroenterology. 1990 May;98(5 Pt 1):1366–1368. doi: 10.1016/0016-5085(90)90358-8. [DOI] [PubMed] [Google Scholar]
  6. Gargouri M., Ben Amor N., Ben Chehida F., Hammou A., Gharbi H. A., Ben Cheikh M., Kchouk H., Ayachi K., Golvan J. Y. Percutaneous treatment of hydatid cysts (Echinococcus granulosus). Cardiovasc Intervent Radiol. 1990 Jun-Jul;13(3):169–173. doi: 10.1007/BF02575469. [DOI] [PubMed] [Google Scholar]
  7. Gharbi H. A., Hassine W., Brauner M. W., Dupuch K. Ultrasound examination of the hydatic liver. Radiology. 1981 May;139(2):459–463. doi: 10.1148/radiology.139.2.7220891. [DOI] [PubMed] [Google Scholar]
  8. Kammerer W. S., Schantz P. M. Echinococcal disease. Infect Dis Clin North Am. 1993 Sep;7(3):605–618. [PubMed] [Google Scholar]
  9. Teggi A., Lastilla M. G., De Rosa F. Therapy of human hydatid disease with mebendazole and albendazole. Antimicrob Agents Chemother. 1993 Aug;37(8):1679–1684. doi: 10.1128/aac.37.8.1679. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Todorov T., Vutova K., Mechkov G., Georgiev P., Petkov D., Tonchev Z., Nedelkov G. Chemotherapy of human cystic echinococcosis: comparative efficacy of mebendazole and albendazole. Ann Trop Med Parasitol. 1992 Feb;86(1):59–66. doi: 10.1080/00034983.1992.11812631. [DOI] [PubMed] [Google Scholar]
  11. Wang X., Li Y., Feng S. [Clinical treatment of hepatic and abdominal hydatid cyst by percutaneous puncture, drainage and curettage]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 1994;12(4):285–287. [PubMed] [Google Scholar]
  12. Wilson J. F., Rausch R. L., McMahon B. J., Schantz P. M. Parasiticidal effect of chemotherapy in alveolar hydatid disease: review of experience with mebendazole and albendazole in Alaskan Eskimos. Clin Infect Dis. 1992 Aug;15(2):234–249. doi: 10.1093/clinids/15.2.234. [DOI] [PubMed] [Google Scholar]

Articles from Bulletin of the World Health Organization are provided here courtesy of World Health Organization

RESOURCES