Hepatic echinococcosis: Clinical and therapeutic aspects

Abstract

Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

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

“…Hepatic localization is observed in about 75 % of infected cases. 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).…”

Clinical and serological outcomes with different surgical approaches for human hepatic hydatidosis

“…The cysts are usually localized in the liver (75% of cases), although other organs may be affected. The signs and symptoms of liver hydatidosis include hepatomegaly, right/epigastric pain, nausea and vomiting (4) .…”

Uncomplicated Hydatid Cysts of the Liver: Clinical Presentation, Diagnosis and Treatment

“…85-90% of the cases have single organ involvement, and more than 70% of patients have a single cyst. Based on the organ in which the cyst settles and the environment they affect, they may show various clinical manifestations changing from cholangitis with biliary ruptures, portal hypertension, biliary obstruction and fistules, and ascites to abscess formation [15].…”