Watch and Wait Approach for Inactive Echinococcal Cyst of the Liver: An Update

Abstract

Human cystic echinococcosis (CE) is a chronic, complex and neglected infection causing severe disease in humans. Hepatic CE cysts are detected and classified mainly by using ultrasound. Expert opinion and published data suggest that uncomplicated inactive liver cysts do not require treatment and only need to be monitored over time ("Watch and Wait"). Here we update our findings as published in 2014 on the "Watch and Wait" approach applied to inactive, asymptomatic cysts of the liver to keep the medical community informed. Clinical data of patients who accessed the World Health Organization Collaborating Center for CE at the University of Pavia-San Matteo Hospital Foundation from January 1991 to October 2017 were analyzed. Inclusion criteria were presence of one or more inactive uncomplicated cysts in the liver (CE4 or CE5), without any history of previous treatment, and an ultrasound-based follow-up of at least 24 months. Fifty-three patients with 66 inactive cysts fulfilled the inclusion criteria. Of these, 11 patients are newly described here; 37 were part of our previously described cohort and the follow-up for 17 of them was further extended; and five were excluded from the previously published analysis as their follow-up was too short, but could be included now. Without the need for treatment and without development of complications, 98.5% of cysts remained inactive over time. In only one patient (1.9% of patients), a reactivation of one cyst (1.5% of cysts) was observed.

Cystic Echinococcosis: Clinical, Immunological, and Biomolecular Evaluation of Patients from Sardinia (Italy)

“…This study is based on the diagnostic evaluation of 13 patients that presented different complications and needed the surgical removal of the cysts by total pericystectomy [52]. The choice of the diagnostic method depends on the phase of the infection and the cyst stadiation [53,54].…”

Treatment of a giant hepatic echinococcal cyst with percutaneous drainage and in vivo assessment of the protoscolicidal effect of praziquantel

“…In terms of treatment, the stage-matched approach to liver cysts allows a rational choice that avoids ineffective (ABZ or PAIR for CE2 and CE3b cysts) or unnecessary over-treatment. Any surgery on uncomplicated inactive cysts is potentially dangerous and a waste of medical resources [ 1 , 4 , 23 , 28 ].…”

Proteomic analysis of plasma exosomes from Cystic Echinococcosis patients provides in vivo support for distinct immune response profiles in active vs inactive infection and suggests potential biomarkers

“…In patients with inactive cysts who had received prior albendazole treatment (n = 12/43), the last administration was 3 years before or longer (median 7 years, range 3-15 years). As the majority of reactivations after albendazole treatment-induced inactivation occur within 2 years from inactivation, and that spontaneously-inactivated CE reactivates extremely rarely [37][38][39], the inactive CE group could be considered composed of stably inactive cysts. Control samples were from participants to the HERACLES screening campaigns with no lesions on US examination, who voluntarily donated their blood for research purposes.…”