Cystic Echinococcosis: Stages & Treatment

One of the complex, chronic and often neglected parasite condition known as cystic echinococcosis affects people all over the world. Its clinical spectrum in humans ranges from asymptomatic infection to serious, perhaps lethal illness. Cystic echinococcosis can remain undiagnosed for an extended period of time because of the slow growth and development of cysts and the host's immune system resistance. The liver is the most frequent location of parasitic cysts. Therefore, while making a differential diagnosis for liver cystic lesions, Cystic echinococcosis should always be considered.

Because of the variety of clinical factors, diagnosis and clinical management can be challenging. Clinical care involves four approaches: surgery, medication treatment and percutaneous procedures for active cysts, and watch and wait for inactive cysts. Patients should be assigned to various treatments according to the stage, location and size of the cyst as well as any concomitant conditions and available clinical knowledge.

The most beneficial guidelines for the diagnosis and management of human cystic and alveolar echinococcosis were given by the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) Expert consensus and the International categorization of ultrasonography imaging in Cystic echinococcosis. Based on the classification, chemotherapy can be used alone or in conjunction with a PAIR strategy to treat simple active cysts. The "watch-and-wait" approach can be used to treat simple, dormant cysts and surgery is necessary for complex cysts that affect the biliary system structurally.

Although hydatid disease is not contagious, but untreated cases can be lethal. Cysts can grow to such a size that they entirely stop the affected organ from functioning and in rare instances, they can result in a potentially fatal allergic reaction.

References:

1. Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch S, Tamarozzi F. Cystic echinococcosis of the liver: A primer for hepatologists. World J Hepatol. 2014 May 27;6(5):293-305.

2. Pakala T, Molina M, Wu GY. Hepatic Echinococcal Cysts: A Review. J Clin Transl Hepatol. 2016 Mar 28;4(1):39-46. 

3. WHO Informal Group on Echinococcosis. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003; 85:253–61.

4. Brunetti E, Kern P, Vuitton DA, WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114:1–16.

5. Laura Eve Nabarro, Zahir Amin, Peter L. Chiodini, Current Management of Cystic Echinococcosis: A Survey of Specialist Practice. Clinical Infectious Diseases 2015;60(5):721–728.