Echinococcosis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Echinococcosis}} | {{Echinococcosis}} | ||
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}} '''Associate Editor-In-Chief:''' {{MIR}} ; {{CZ}} | ||
==Overview== | ==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 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> | 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> | ||
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==== 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>==== | ==== 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>==== | ||
PAIR: puncture, aspiration, injection, reaspiration | : | ||
<span style="font-size:85%">'''Abbreviations:''' | |||
'''PAIR:''' puncture, aspiration, injection, reaspiration, '''CE:''' cystic echinococcus. | |||
</span> | |||
{| class="wikitable" | {| class="wikitable" | ||
!WHO stage | ! style="background: #4479BA; color: #FFFFFF; " |WHO stage | ||
!Description | ! style="background: #4479BA; color: #FFFFFF; " |Description | ||
!Stage | ! style="background: #4479BA; color: #FFFFFF; " |Stage | ||
!Size | ! style="background: #4479BA; color: #FFFFFF; " |Size | ||
!Preferred treatment | ! style="background: #4479BA; color: #FFFFFF; " |Preferred treatment | ||
!Alternate treatment | ! style="background: #4479BA; color: #FFFFFF; " |Alternate treatment | ||
|- | |- | ||
! rowspan="2" |CE1 | ! rowspan="2" style="background: #DCDCDC; " |CE1 | ||
| rowspan="2" |Unilocular unechoic [[Cystic|cystic lesion]] with double line sign | | rowspan="2" |Unilocular unechoic [[Cystic|cystic lesion]] with double line sign | ||
| rowspan="2" |Active | | rowspan="2" |Active | ||
| Line 40: | Line 43: | ||
|PAIR | |PAIR | ||
|- | |- | ||
!CE2 | ! style="background: #DCDCDC; " |CE2 | ||
|Multiseptated, "rosette-like" "honeycomb" [[cyst]] | |Multiseptated, "rosette-like" "honeycomb" [[cyst]] | ||
|Active | |Active | ||
| Line 47: | Line 50: | ||
|Modified [[catheterization]] | |Modified [[catheterization]] | ||
|- | |- | ||
! rowspan="2" |CE3a | ! rowspan="2" style="background: #DCDCDC; " |CE3a | ||
| rowspan="2" |[[Cyst]] with detached membranes (water-lily sign) | | rowspan="2" |[[Cyst]] with detached membranes (water-lily sign) | ||
| rowspan="2" |Transitional | | rowspan="2" |Transitional | ||
| Line 58: | Line 61: | ||
|PAIR | |PAIR | ||
|- | |- | ||
!CE3b | ! style="background: #DCDCDC; " |CE3b | ||
|[[Cyst]] with daughter cysts in solid [[matrix]] | |[[Cyst]] with daughter cysts in solid [[matrix]] | ||
|Transitional | |Transitional | ||
| Line 65: | Line 68: | ||
|Modified [[catheterization]] | |Modified [[catheterization]] | ||
|- | |- | ||
!CE4 | ! style="background: #DCDCDC; " |CE4 | ||
|[[Cyst]] with heterogenous hypoechoic/hyperechoic contents; no daughter cysts | |[[Cyst]] with heterogenous hypoechoic/hyperechoic contents; no daughter cysts | ||
|Inactive | |Inactive | ||
| Line 72: | Line 75: | ||
| - | | - | ||
|- | |- | ||
!CE5 | ! style="background: #DCDCDC; " |CE5 | ||
|Solid plus calcified wall | |Solid plus calcified wall | ||
|Inactive | |Inactive | ||
| Line 82: | Line 85: | ||
== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Parasitic diseases]] | [[Category:Parasitic diseases]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Hepatology]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 21:32, 29 July 2020
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Echinococcosis medical therapy On the Web |
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Risk calculators and risk factors for Echinococcosis medical therapy |
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 |
| >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 |
| >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.