Early Diagnosis, Treatment and Follow-Up of Cystic Echinococcosis in Remote Rural Areas in Patagonia: Impact of Ultrasound Training of Non-Specialists

Abstract

Cystic echinococcosis (CE) is a chronic, complex and neglected disease caused by the larval stage of Echinococcus granulosus. The effects of this neglect have a stronger impact in remote rural areas whose inhabitants have no chances of being diagnosed and treated properly without leaving their jobs and travelling long distances, sometimes taking days to reach the closest referral center.BackgroundIn 1980 our group set up a control program in endemic regions with CE in rural sections of Rio Negro, Argentina. Since 1997, we have used abdominopelvic ultrasound (US) as a screening method of CE in school children and determined an algorithm of treatment.ObjectivesTo describe the training system of general practitioners in early diagnosis and treatment of CE and to evaluate the impact of the implementation of the field program.Materials and MethodsIn 2000, to overcome the shortage of radiologists in the area, we set up a short training course on Focused Assessment with Sonography for Echinococcosis (FASE) for general practitioners with no previous experience with US. After the course, the trainees were able to carry out autonomous ultrasound surveys under the supervision of the course faculty. From 2000 to 2008, trainees carried out 22,793 ultrasound scans in children from 6 to 14 years of age, and diagnosed 87 (0.4%) new cases of CE. Forty-nine (56.4%) were treated with albendazole, 29 (33.3%) were monitored expectantly and 9 (10.3%) were treated with surgery.DiscussionThe introduction of a FASE course for general practitioners allowed for the screening of CE in a large population of individuals in remote endemic areas with persistent levels of transmission, thus overcoming the barrier of the great distance from tertiary care facilities. The ability of local practitioners to screen for CE using US saved the local residents costly travel time and missed work and proved to be an efficacious and least expensive intervention tool for both the community and health care system.

Global Distribution of Alveolar and Cystic Echinococcosis

“…Argentina has been a pioneer in South America implementing population ultrasound screenings as a tool to diagnose CE and also to assess the success of control programs. For example, in the Argentinean Patagonia, 87 (0.4%) cases were diagnosed after 22,793 ultrasound scans were performed in children from 6 to 14 years of age from 2000 to (Del Carpio et al, 2012. In Rio Negro, the overall prevalence of CE based on ultrasound was 7.1% (40/ 560) in 2009 (Bingham et al, 2014).…”

The Economic Impact of Cystic Echinococcosis in Rio Negro Province, Argentina

“…The hospitals located in Bariloche and Viedma were classified as tertiary care facilities, whereas the hospital located in Ingeniero Jacobacci was classified as a rural hospital. 27 Besides the hospitals included in this study, Rio Negro Province has one additional tertiary care public hospital and nine additional rural public hospitals. However, the hospitals included in this study were selected because they had CE specialists on staff, and represented both local and regional healthcare facilities.…”

Echinococcosis

“…Ultrasonography (US) is the cornerstone of abdominal CE screening, diagnosis, staging, and follow-up (Stojkovic et al 2012;Del Carpio et al 2012;Giordani et al 2012;Macpherson and Milner 2003;Eckert et al 2001;Torgerson and Deplazes 2009) and is the current screening method of choice for diagnosis and regular follow-up imaging in AE (Bresson-Hadni et al 2006;Bartholomot et al 2002;Yang et al 2006a;Kantarci et al 2012), while computed tomography (CT) and magnetic resonance imaging (MRI) techniques are needed for an accurate staging of the disease .…”