Epidemiology, diagnosis, treatment and follow-up of cystic echinococcosis in asymptomatic carriers

Larrieu, Edmundo; Uchiumi, Leonardo; Salvitti, Juan Carlos; Sobrino, Mariano; Panomarenko, Oscar; Tissot, Hebe; Mercapide, Carlos; Sustercic, José; Arezo, Marcos; Mujica, Guillermo; Herrero, Eduardo; Labanchi, José Luis; Grizmado, Claudia; Araya, Daniel; Talmón, Gabriel; Galván, José María Moreno; Sepúlveda, Luís; Seleiman, Marcos; Cornejo, Tamara; Echenique, Horacio; Carpio, Mario Del

doi:10.1093/trstmh/try112

Cited by 30 publications

(40 citation statements)

References 19 publications

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“…Regarding to the farms, 94.7% had at least one positive animal by necropsy in 2009, whereas only 23.5% of them were positive in 2015 (Larrieu et al, ). Using coproELISA for diagnosis of infection in dogs, the differences were statistically significant ( p value = .04) between baseline (2009) and impact (2017) studies in the proportion of positive samples, and in relation to the farms, the differences were not significant among producers with farms with active transmission (by the presence of an infected dog; p value = .1) (Larrieu, Mujica, et al, ; Larrieu, Uchiumi, et al, ).…”

Section: General Principles For Controlmentioning

confidence: 99%

“…Full vaccination was considered to involve two immunizations in lambs and one additional vaccination when the animals were approximately 1 year of age. This being the case, three immunizations at a compliance rate of 80%–85% for each vaccination represents an effective vaccination compliance of 57.3% (Larrieu, Mujica, et al, ; Larrieu, Uchiumi, et al, ).…”

Section: General Principles For Controlmentioning

confidence: 99%

“…Although the EG95 vaccine has demonstrated a high efficacy, there have been few studies that have evaluated the effectiveness of the vaccine under field conditions (Larrieu, Mujica, et al, ; Larrieu et al, ; Larrieu, Uchiumi, et al, ). Additional studies of vaccination are required; for example, it is necessary to look for different vaccination schemes (only lamb vaccination, whole sheep population vaccination); also, animal species involved in the vaccination programme (bovine, goats, pigs and camelids) considering costs of the vaccine and the costs of its placement in the field.…”

Section: General Principles For Controlmentioning

confidence: 99%

“…While echinococcosis is primarily a human health problem, it is necessary to establish vigilance systems of the infection in man, especially in children (between 0/10 years old) or schoolchildren (between 6 and 14 years old), which can be efficiently carried out by using ultrasound (US) screenings (Frider et al, 2000;Larrieu et al, 2011;Perez et al, 2006). Early detection of CE children might facilitate the beginning of albendazole treatment (Brunetti et al, 2011;Frider & Larrieu, 2010;Larrieu, Mujica, et al, 2019;Larrieu, Uchiumi, et al, 2019;Zanini, Suárez, Pérez, & Elissondo, 2009).…”

Section: Surveillance In Humansmentioning

confidence: 99%

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Control of cystic echinococcosis: Background and prospects

Larrieu

Gavidia

Lightowlers

2019

Zoonoses and Public Health

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Cystic echinococcosis (CE), caused by Echinococcus granulosus, is a chronic and debilitating zoonotic larval cestode infection in humans, which is principally transmitted between dogs and domestic livestock, particularly sheep. Human CE occurs in almost all pastoral communities and rangeland areas of the underdeveloped and developed world. Control programmes against CE have been implemented in several endemic countries to reduce or eliminate the disease. New Zealand and Tasmania are examples of some of the first programmes to be undertaken (in insular territories) and which were very successful in the elimination of CE. The advent and proven effectiveness of praziquantel, plus the experience of insular models, produced high expectations for rapid advances in a second generation of control programmes undertaken in continental areas (Argentina, Uruguay and Chile). Nevertheless, only moderate gains in CE control have been made and the impact on prevalence among humans has been slight. A major impediment to the adoption of procedures that were successful in New Zealand and Tasmania has been the requirement to administer praziquantel to dogs in rural areas eight times per year over numerous years. In addition, there have been clear technological improvements made in the diagnosis of canine echinococcosis for surveillance, the genetic characterization of parasite strains and in vaccination against CE infection in livestock. In order to establish new paradigms and appropriate combinations of control strategies, we have carried out a review and discussion of the available control tools and control models. Control strategies must be suitable and sustainable to benefit the Echinococcosis–endemic areas primarily, which at the same time are the poorest regions of the world.

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Section: General Principles For Controlmentioning

confidence: 99%

Section: General Principles For Controlmentioning

confidence: 99%

Section: General Principles For Controlmentioning

confidence: 99%

Section: Surveillance In Humansmentioning

confidence: 99%

See 2 more Smart Citations

Control of cystic echinococcosis: Background and prospects

Larrieu

Gavidia

Lightowlers

2019

Zoonoses and Public Health

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“…Over the same period, Franchi and colleagues [ 19 ], using continuous 3- to 6-month ABZ administration, reported that, at the end of treatment, 82% of cysts had degenerative changes. More recently, Salinas and colleagues [ 20 ] used an interrupted treatment schedule on 64 active and transitional cysts, reporting a long-term success of 34%, while Larrieu and colleagues [ 21 ] used a continuous schedule and reported a long-term success of 96%. Despite the impossibility of rigorously comparing these studies due to the differences (and nonhomogeneous description) of the populations, cyst characteristics, and overall length of therapy, these results suggest a better efficacy of the continuous administration for the treatment of CE.…”

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confidence: 99%

A case for adoption of continuous albendazole treatment regimen for human echinococcal infections

et al. 2020

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Cystic (CE) and alveolar (AE) echinococcosis are chronic, neglected parasitic diseases burdened by high morbidity and, for AE, by high mortality, if left untreated. CE and AE have a widespread distribution, including Europe. Albendazole (ABZ), a broad-spectrum benzimidazole drug widely used to treat parasitic infections, is the drug of choice for the management of CE and AE, and is parasitostatic on echinococcal metacestodes. In Europe, ABZ is licensed for interrupted “cyclic” treatment, for a maximum of 3 cycles. However, better efficacy with no increased side effects has been shown when the drug is administered continuously and for longer periods. Current international recommendations, on the basis of clinical, pharmacological, and biological studies, recommend continuous administration of ABZ for months to years for the treatment of CE and AE, and this schedule has been widely in use for the past 20 years. However, in Europe this internationally recommended schedule, with the exception of France, is technically “off-label”, and, as such, requires an informed consent by the patient and, in some countries, even precludes the reimbursement of the drug cost. Adding to the very high cost of the drug, frequent “out-of-stock” situation, and packaging format impractical for long therapies, these conditions put patients with CE and AE regularly at risk of treatment discontinuation and disease progression. European regulations envisage variations to marketing authorization, but postauthorization studies should be carried out by the holder of the license of the drug, in the form of randomized controlled trials. While such studies do not seem feasible and would probably not be ethically justified for CE and AE, European regulations envisage other possibilities in particular situations, which apply to CE and AE, but there is limited interest to invest in this perspective. We urge a coordination between stakeholders to find effective and feasible ways to take action to revise the benzimidazole dosage regimens for CE and AE and to ensure a fair, regular, and easy access to the appropriate treatment to those suffering from these serious diseases.

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