Albendazolesulphoxide concentrations in plasma and hydatid cyst and prediction of parasitological and clinical outcomes in patients with liver hydatidosis caused by Echinococcus granulosus

Abstract

AimTo investigate the relationship between plasma and cyst concentrations of albendazolesulphoxide (ASO) and their effects on parasitological findings and disease recurrence in patients with liver hydatidosis.MethodsThe study was conducted at the University Hospital for Infectious Diseases “Dr. Fran Mihaljević,” Zagreb, Croatia, between August 2006 and January 2011. Consecutive patients (N = 48, age 6-77 years) were treated with albendazole (3 × 5 mg/kg/d) over 28 days before surgical cyst removal (n = 34) or percutaneous evacuation (PAIR) (n = 14). Plasma ASO was determined on days 10 and 28 of treatment and cyst concentrations at surgery/PAIR.ResultsDisease recurred in 3 surgically treated patients. Variability of ASO concentrations was substantial. Plasma concentrations on day 10 were higher than on day 28 (geometric means ratio [GMR] 2.00; 95%CI 1.38-2.91, P < 0.001) and higher than cyst concentrations at the time of treatment (GMR = 1.58, 1.01-2.34, P = 0.045). Higher cyst (but not plasma) concentrations were independently associated with lower odds of protoscolex motility (OR = 0.23, 0.01-0.70, P < 0.001) and higher odds of protoscolex destruction (OR = 1.17, 1.04-1.46, P < 0.001). With adjustment for age and protoscolex motility, higher day 10 plasma concentrations (but not cyst concentrations) were associated with lower odds of disease recurrence (OR = 0.49, 0.09-0.97, P = 0.035). Plasma concentrations did not predict cyst concentrations.ConclusionViability of protoscolices progressively decreased with increasing ASO concentrations in the cyst. Data strongly suggested that higher plasma concentrations reduced the risk of disease recurrence.

Research Note. One minute, intraoperative assessment of the viability of hydatid cysts using a simple reagent strip test

“…Other organs may be affected as primary sites, or as a result of leakage if such serious cystic lesions are not properly managed (Nunnari et al, 2012). Surgical interventions are frequently used to manage this parasitic infection while, medical treatment by albendazole is typically recommended as an adjunctive treatment to avoid dissemination of scolices to secondary sites (Skuhala et al, 2014). In general, there is a high risk of disease recurrence which is certainly increased if the cyst is not managed properly.…”

“…In general, there is a high risk of disease recurrence which is certainly increased if the cyst is not managed properly. One of the most important factors controlling this issue is the viability of the protoscolices (PSs) which by a way or another should be inactivated (Stankovi, et al 2005;Skuhala et al, 2014). Cyst viability and fertility are mainly determined by the presence of free protoscolices in the hydatid fl uid and of growing protoscolices attached to the germinal layer (Galindo et al, 2002).…”

Case Report: Ivermectin and Albendazole Plasma Concentrations in a Patient with Disseminated Strongyloidiasis on Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

“…Albendazole concentrations have instead been described in the treatment of neurocysticercosis, hydatid disease, and lymphatic filariasis. [18][19][20] In neurocysticercosis, the concentrations of ABZ's active metabolite, ABZ-OX, vary considerably. 21,22 Taenia solium activity was inhibited at an ABZ-OX concentration of 50 ng/mL.…”

Repeated Percutaneous Treatment of Massive Hepatic Cystic Echinococcosis in a Child

“…Parasitological examination of the aspirated cyst fluid revealed wellpreserved E granulosus elements before the procedure and destructed E granulosus elements after the procedure. In the postprocedure samples after incubation with sodium taurocholate in Hanks' buffer for 48 hours at 37°C ("stimulation"), 11 protoscolices revealed no signs of viability, and 75% of them showed signs of destruction.…”