Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004–2013: Comparison of Current Practices with Expert Recommendations

Abstract

Abstract. Cystic echinococcosis (CE) is a clinically complex chronic parasitic disease, management options for which include surgery, percutaneous treatments, and treatment with albendazole (ABZ) for active cysts, and the "Watch-andWait" approach for uncomplicated, inactive cysts. We examined, retrospectively, the clinical management of 334 patients with hepatic CE from the southeastern Rhodope region of Bulgaria between 2004 and 2013. Cysts were reclassified according to the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) on the basis of ultrasound reports and images. The majority (62.3%) of uncomplicated cysts were CE1, 66% of which were treated surgically. Of all interventions, 5% were performed on inactive uncomplicated CE4-CE5 cysts. About half (47.6%) of these cysts were therefore treated inappropriately, exposing patients to unnecessary treatment-related risks and the health system to unnecessary costs. No management change was observed after the publication of the WHO-IWGE Expert Consensus recommendations in 2010. In Bulgaria, ABZ is still used in interrupted cycles as this is reimbursed, and peri-interventional chemoprophylaxis was not administered in the majority of surgical patients. Efforts are needed to introduce the WHO-IWGE classification and management recommendations and to encourage reception of state-of-the-art practices by public health regulatory bodies to improve patient quality of care and optimization of health resources.

Patients with cystic echinococcosis in the three national referral centers of Mongolia: A model for CE management assessment

“…Introducing PT into Mongolia should be considered because it carries less risks for the patients, reduces treatment cost and length of hospital stay. A study in Bulgaria showed similar deviations from best practices as recommended by WHO-IWGE expert consensus[ 43 ].…”

Evaluation of the efficacy of Zataria multiflora essential oil versus albendazole in patients infected with liver cystic echinococcosis: A nonrandomized clinical trial

“…According to the results of previous studies, the therapeutic effect of different drugs on hydatid disease decreases when the cysts are larger. [ 5 16 17 ]…”

“…Treatment options for hydatid disease include surgery, medical therapy, and PAIR (Puncture, Aspiration, Injection of scolicidal agent, Reaspiration), whereas the clinically silent and inactive cysts are commonly monitored by “Watch-and-Wait” approach. [ 3 5 ] Medical therapy may be the only treatment option for multiple, very small or inaccessible cysts and in old people as well as in those who do not accept surgery. Medical therapy may also be applied before surgery to reduce the cyst size and to decrease the recurrence rate after surgical operation.…”

Influence of hydatid disease on the pregnancy outcomes: An experimental study

“…Human infection usually occurs after ingestion of infective eggs passed in the feces from dogs via direct contact or through environmental contamination . CE is a chronic disease with complex nature and may be asymptomatic, severe or even a fatal infection in human beings . One hydatid cyst may grow as much as a cyst containing several liters of hydatid fluid …”