Ultrasonographic diagnosis and medical treatment of human cystic echinococcosis in asymptomatic school age carriers: 5 years of follow-up

Larrieu, Edmundo; Carpio, Mario Del; Salvitti, Juan Carlos; Mercapide, Carlos; Sustersic, José; Panomarenko, Héctor; Costa, María Teresa; Bigatti, Ricardo; Labanchi, José Luis; Herrero, Eduardo; Cantoni, Gustavo; Pérez, Alícia; Odriozola, Martı́n

doi:10.1016/j.actatropica.2004.02.006

Cited by 51 publications

(22 citation statements)

References 12 publications

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“…By 2009, follow-up by general practitioners of cases first diagnosed in 1998–1999 reached 100% of cases at 5 years and 64% at 10 years from diagnosis [11], [12]. Follow-up of patients first diagnosed in 2000–2008 reached 88.5% of cases by June 2010.…”

Section: Resultsmentioning

confidence: 99%

“…The algorithm for treatment according to cyst stage (WHO IWGE classification) and size is based on the “Clinical Guidelines for Diagnosis, Treatment of Human Hydatidosis” [11], [12], [13] updated by Resolution 3541/09 of the Ministry of Health of Rio Negro Province. Treatments were chosen by the general practitioners in the rural hospital, after consultation with the Heads of Surgery in the tertiary care hospitals and only the cases with a clear indication to surgery were referred to the surgeons.…”

Section: Methodsmentioning

confidence: 99%

“…Monitoring of treatment was carried out by the local health network (30 days after diagnosis or start of treatment, 60 days and thereafter every 3 months until completion of the first year and re-scanning patients once a year up to 10 years afterwards as indicated in the Guidelines) [12]–[13].…”

Section: Methodsmentioning

confidence: 99%

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

Carpio¹,

Mercapide²,

Salvitti³

et al. 2012

PLoS Negl Trop Dis

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Carpio¹,

Mercapide²,

Salvitti³

et al. 2012

PLoS Negl Trop Dis

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“…Although published studies based on ultrasound surveys support the use of watchful monitoring of asymptomatic inactive CE [16], [17], to date, no data on the safety and effectiveness of the watch-and-wait approach have been published from a clinical setting in clinically well-defined patients. To start filling this gap, we report our experience with long-term sonographic and serological monitoring of a well-defined group of patients with uncomplicated hepatic inactive cysts that were in the inactive stage at the time of first diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Long-term Sonographic and Serological Follow-up of Inactive Echinococcal Cysts of the Liver: Hints for a “Watch-and-Wait” Approach

et al. 2014

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Human cystic echinococcosis is a chronic, complex and neglected infection. Its clinical management has evolved over decades without adequate evaluation of efficacy. Recent expert opinion recommends that uncomplicated inactive cysts of the liver should be left untreated and solely monitored over time (“watch-and-wait” approach). However, clinical data supporting this approach are still scant and published mostly as conference proceedings. In this study, we report our experience with long-term sonographic and serological follow-up of inactive cysts of the liver. From March 1994 to October 2013, 38 patients with 47 liver cysts, diagnosed as inactive without any previous treatment history, were followed with ultrasound and serology at 6–12 months intervals for a period of at least 24 months (median follow-up 51.95 months) in our outpatient clinic. In 97.4% of patients, the cysts remained inactive over time and in only one case was reactivation of the cyst detected. No complications occurred during the time of monitoring. During follow-up, serology tests for CE were negative at diagnosis or became negative in 74.1% and were positive or became positive in 25.9% of cases. Patients with inactive cysts on ultrasound but positive serological tests were also investigated by CT scan (chest and abdomen) to rule out extra-hepatic cyst localization. This study confirms the importance of a stage-specific approach to the management of cystic echinococcosis and supports the use of a monitoring-only approach to inactive, uncomplicated cysts of the liver. It also confirms that serology plays only an ancillary role in the clinical management of these patients, compared to ultrasound and other imaging techniques. The implications of these findings for clinical management and natural history of cystic echinococcosis are discussed.

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“…However, its efficiency may be overestimated as ABZ only resulted in an apparent cure in up to 30% of cases [4–6]. Besides, cyst degeneration occurs in up to 20% of patients [7]. Therefore, it is urgent to develop new drugs for treating CE.…”

Section: Introductionmentioning

confidence: 99%

CT Scanning in Identification of Sheep Cystic Echinococcosis

Mao

Pei

et al. 2017

BioMed Research International

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Objective We aim to determine the efficiency of CT in identification of cystic echinococcosis in sheep. Methods Fifty-three sheep with liver cysts confirmed by ultrasonography were subject to CT scan to evaluate the number, size, and type of the cysts in liver and lung, confirmed using necropsy. The correlation of numbers between liver cysts and lung cysts was calculated using Pearson analysis. Results Necropsy indicated a 98% consensus on size, location, number, and activity compared with CT scan. The viable cysts were 53.1% and 50.6% in the liver and lung, respectively. Among the cysts in liver, 35.5%, 9.5%, 5.7%, 10.2%, and 39.1% were Types CE1, CE2, CE3, CE4, and CE5, respectively. The cysts in the lungs, 17.4%, 26.9%, 12.1%, 11.6%, and 32.1%, were Types CE1, CE2, CE3, CE4, and CE5, respectively. A significant correlation was noticed between the number of cysts in liver and those in lung (R = 0.770, P < 0.001). Conclusions CT scan is a suitable tool in determining the size and type of cystic hydatid cysts in both liver and lung of sheep. A significant correlation was noticed between the numbers in liver and lung, indicating that lung infection was likely due to the expansion of liver cyst burden pressure.

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Ultrasonographic diagnosis and medical treatment of human cystic echinococcosis in asymptomatic school age carriers: 5 years of follow-up

Cited by 51 publications

References 12 publications

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

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

Long-term Sonographic and Serological Follow-up of Inactive Echinococcal Cysts of the Liver: Hints for a “Watch-and-Wait” Approach

CT Scanning in Identification of Sheep Cystic Echinococcosis

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