Echinococcosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Mahshid Mir, M.D. [2] ; Cafer Zorkun, M.D., Ph.D. [3]

Overview

Both cystic echinococcosis and alveolar echinococcosis are complicated to treat, sometimes requiring extensive surgery and/or prolonged drug therapy. There are 3 options for the treatment of cystic echinococcosis: anti-infective drug treatment, percutaneous treatment of the hydatid cysts with the PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique and surgery.^[1]

Cystic echinococcosis stage 1 of less than 5 cm

Cystic echinococcosis stage 1 of more than 5 cm

Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and Puncture, Aspiration, Injection, Re-aspiration (PAIR)
Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 2 of any size

Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 3 of any size

Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Abbreviations: PAIR: puncture, aspiration, injection, reaspiration, CE: cystic echinococcus.

WHO stage	Description	Stage	Size	Preferred treatment	Alternate treatment
CE1	Unilocular unechoic cystic lesion with double line sign	Active	<5 cm	Albendazole alone	PAIR
CE1	Unilocular unechoic cystic lesion with double line sign	Active	>5 cm	Albendazole + PAIR	PAIR
CE2	Multiseptated, “rosette-like” “honeycomb” cyst	Active	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE3a	Cyst with detached membranes (water-lily sign)	Transitional	<5 cm	Albendazole alone	PAIR
CE3a	Cyst with detached membranes (water-lily sign)	Transitional	>5 cm	Albendazole + PAIR	PAIR
CE3b	Cyst with daughter cysts in solid matrix	Transitional	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE4	Cyst with heterogenous hypoechoic/hyperechoic contents; no daughter cysts	Inactive	Any	Observation	–
CE5	Solid plus calcified wall	Inactive	Any	Observation	–

↑ Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E (2016). “Current status of diagnosis and treatment of hepatic echinococcosis”. World J Hepatol. 8 (28): 1169–1181. doi:10.4254/wjh.v8.i28.1169. PMC 5055586. PMID 27729953.
↑ 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 (3): 301–11. PMID 18784219.
↑ Brunetti E, Kern P, Vuitton DA (2010). “Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans”. Acta Trop. 114 (1): 1–16. doi:10.1016/j.actatropica.2009.11.001. PMID 19931502.