Echinococcosis medical therapy: Difference between revisions

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Latest revision as of 21:32, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Mahshid Mir, M.D. [2] ; Cafer Zorkun, M.D., Ph.D. [3]

Overview

Both cystic echinococcosis and alveolar echinococcosis are complicated to treat, sometimes requiring extensive surgery and/or prolonged drug therapy. There are 3 options for the treatment of cystic echinococcosis: anti-infective drug treatment, percutaneous treatment of the hydatid cysts with the PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique and surgery.^[1]

Medical Therapy

Cystic echinococcosis stage 1 of less than 5 cm

Preferred regimen: Albendazole 10 to 15 mg/kg per day q12
Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 1 of more than 5 cm

Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and Puncture, Aspiration, Injection, Re-aspiration (PAIR)
Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 2 of any size

Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 3 of any size

Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage ^[2]^[3]

Abbreviations: PAIR: puncture, aspiration, injection, reaspiration, CE: cystic echinococcus.

WHO stage	Description	Stage	Size	Preferred treatment	Alternate treatment
CE1	Unilocular unechoic cystic lesion with double line sign	Active	<5 cm	Albendazole alone	PAIR
CE1	Unilocular unechoic cystic lesion with double line sign	Active	>5 cm	Albendazole + PAIR	PAIR
CE2	Multiseptated, "rosette-like" "honeycomb" cyst	Active	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE3a	Cyst with detached membranes (water-lily sign)	Transitional	<5 cm	Albendazole alone	PAIR
CE3a	Cyst with detached membranes (water-lily sign)	Transitional	>5 cm	Albendazole + PAIR	PAIR
CE3b	Cyst with daughter cysts in solid matrix	Transitional	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE4	Cyst with heterogenous hypoechoic/hyperechoic contents; no daughter cysts	Inactive	Any	Observation	-
CE5	Solid plus calcified wall	Inactive	Any	Observation	-

References

↑ Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E (2016). "Current status of diagnosis and treatment of hepatic echinococcosis". World J Hepatol. 8 (28): 1169–1181. doi:10.4254/wjh.v8.i28.1169. PMC 5055586. PMID 27729953.
↑ Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E (2008). "Clinical management of cystic echinococcosis: state of the art, problems, and perspectives". Am. J. Trop. Med. Hyg. 79 (3): 301–11. PMID 18784219.
↑ Brunetti E, Kern P, Vuitton DA (2010). "Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans". Acta Trop. 114 (1): 1–16. doi:10.1016/j.actatropica.2009.11.001. PMID 19931502.

Template:WH Template:WS

[pmid27729953-1] Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E (2016). "Current status of diagnosis and treatment of hepatic echinococcosis". World J Hepatol. 8 (28): 1169–1181. doi:10.4254/wjh.v8.i28.1169. PMC 5055586. PMID 27729953.

[pmid18784219-2] Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E (2008). "Clinical management of cystic echinococcosis: state of the art, problems, and perspectives". Am. J. Trop. Med. Hyg. 79 (3): 301–11. PMID 18784219.

[pmid19931502-3] Brunetti E, Kern P, Vuitton DA (2010). "Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans". Acta Trop. 114 (1): 1–16. doi:10.1016/j.actatropica.2009.11.001. PMID 19931502.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Echinococcosis}}
-{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}
+{{CMG}} '''Associate Editor-In-Chief:''' {{MIR}} ; {{CZ}}
 ==Overview==
-Both cystic echinococcosis and alveolar echinococcosis are complicated to treat, sometimes requiring extensive surgery and/or prolonged drug therapy. There are 3 options for the treatment of cystic echinococcosis:
+Both [[cystic echinococcosis]] and [[alveolar echinococcosis]] are complicated to treat, sometimes requiring extensive [[surgery]] and/or prolonged [[drug therapy]]. There are 3 options for the treatment of [[cystic]] [[echinococcosis]]: anti-infective [[drug]] treatment, [[percutaneous]] treatment of the [[Hydatid cyst|hydatid cysts]] with the PAIR (Puncture, Aspiration, [[Injection (medicine)|Injection]], Re-aspiration) technique and surgery.<ref name="pmid27729953">{{cite journal |vauthors=Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E |title=Current status of diagnosis and treatment of hepatic echinococcosis |journal=World J Hepatol |volume=8 |issue=28 |pages=1169–1181 |year=2016 |pmid=27729953 |pmc=5055586 |doi=10.4254/wjh.v8.i28.1169 |url=}}</ref>
-*Anti-infective drug treatment
-*Percutaneous treatment of the hydatid cysts with the PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique;
-*Surgery
 ==Medical Therapy==
-'''Cystic echinococcosis stage 1 of less than 5 cm'''
+'''[[Cystic]] [[echinococcosis]] stage 1 of less than 5 cm'''
-*Preferred regimen: Albendazole 10 to 15 mg/kg per day q12
+*Preferred regimen: [[Albendazole]] 10 to 15 mg/kg per day q12
-*Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)
+*Alternative regimen: Puncture, [[Aspiration]], [[Injection]], Re-aspiration (PAIR)
-'''Cystic echinococcosis  stage 1 of more than 5 cm'''
+'''[[Cystic]] [[echinococcosis]]  stage 1 of more than 5 cm'''
-*Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 '''and''' Puncture, Aspiration, Injection, Re-aspiration (PAIR)
+*Preferred regimen: [[Albendazole]] 10 to 15 mg/kg per day q12 '''and''' Puncture, Aspiration, Injection, Re-aspiration (PAIR)
-*Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)
+*Alternative regimen: Puncture, [[Aspiration]], [[Injection]], Re-aspiration (PAIR)
-'''Cystic echinococcosis stage 2 of any size'''
+'''[[Cystic]] [[echinococcosis]] stage 2 of any size'''
-*Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 '''and''' either modified catheterization or surgery
+*Preferred regimen: [[Albendazole]] 10 to 15 mg/kg per day q12 '''and''' either modified [[catheterization]] or surgery
-*Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)
+*Alternative regimen: Puncture, [[Aspiration]], [[Injection]], Re-aspiration (PAIR)
-'''Cystic echinococcosis stage 3 of any size'''
+'''[[Cystic]] [[echinococcosis]] stage 3 of any size'''
-*Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 '''and''' either modified catheterization or surgery
+*Preferred regimen: [[Albendazole]] 10 to 15 mg/kg per day q12 '''and''' either modified [[catheterization]] or surgery
-*Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)
+*Alternative regimen: Puncture, [[Aspiration]], [[Injection]], Re-aspiration (PAIR)
+==== World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage <ref name="pmid18784219">{{cite journal |vauthors=Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E |title=Clinical management of cystic echinococcosis: state of the art, problems, and perspectives |journal=Am. J. Trop. Med. Hyg. |volume=79 |issue=3 |pages=301–11 |year=2008 |pmid=18784219 |doi= |url=}}</ref><ref name="pmid19931502">{{cite journal |vauthors=Brunetti E, Kern P, Vuitton DA |title=Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans |journal=Acta Trop. |volume=114 |issue=1 |pages=1–16 |year=2010 |pmid=19931502 |doi=10.1016/j.actatropica.2009.11.001 |url=}}</ref>====
+:
+<span style="font-size:85%">'''Abbreviations:'''
+'''PAIR:''' puncture, aspiration, injection, reaspiration, '''CE:''' cystic echinococcus.
+</span>
+{| class="wikitable"
+! style="background: #4479BA; color: #FFFFFF; " |WHO stage
+! style="background: #4479BA; color: #FFFFFF; " |Description
+! style="background: #4479BA; color: #FFFFFF; " |Stage
+! style="background: #4479BA; color: #FFFFFF; " |Size
+! style="background: #4479BA; color: #FFFFFF; " |Preferred treatment
+! style="background: #4479BA; color: #FFFFFF; " |Alternate treatment
+|-
+! rowspan="2" style="background: #DCDCDC; " |CE1
+| rowspan="2" |Unilocular unechoic [[Cystic|cystic lesion]] with double line sign
+| rowspan="2" |Active
+|<5 cm
+|[[Albendazole]] alone
+|PAIR
+|-
+|>5 cm
+|[[Albendazole]] + PAIR
+|PAIR
+|-
+! style="background: #DCDCDC; " |CE2
+|Multiseptated, "rosette-like" "honeycomb" [[cyst]]
+|Active
+|Any
+|[[Albendazole]] + either modified catheterization or surgery
+|Modified [[catheterization]]
+|-
+! rowspan="2" style="background: #DCDCDC; " |CE3a
+| rowspan="2" |[[Cyst]] with detached membranes (water-lily sign)
+| rowspan="2" |Transitional
+|<5 cm
+|[[Albendazole]] alone
+|PAIR
+|-
+|>5 cm
+|[[Albendazole]] + PAIR
+|PAIR
+|-
+! style="background: #DCDCDC; " |CE3b
+|[[Cyst]] with daughter cysts in solid [[matrix]]
+|Transitional
+|Any
+|[[Albendazole]] + either modified catheterization or surgery
+|Modified [[catheterization]]
+|-
+! style="background: #DCDCDC; " |CE4
+|[[Cyst]] with heterogenous hypoechoic/hyperechoic contents; no daughter cysts
+|Inactive
+|Any
+|Observation
+| -
+|-
+! style="background: #DCDCDC; " |CE5
+|Solid plus calcified wall
+|Inactive
+|Any
+|Observation
+| -
+|}
 == References ==
 {{reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Parasitic diseases]]
-[[Category:Infectious disease]]
 [[Category:Needs content]]
 [[Category:Disease]]
 [[Category:Needs overview]]
-{{WH}}
+[[Category:Emergency medicine]]
-{{WS}}
+[[Category:Up-To-Date]]
+[[Category:Infectious disease]]
+[[Category:Hepatology]]
+[[Category:Gastroenterology]]
+[[Category:Surgery]]

Echinococcosis medical therapy: Difference between revisions

Latest revision as of 21:32, 29 July 2020

Overview

Medical Therapy

World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage [2][3]

References

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World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage ^[2]^[3]