Abstract
Five patients with hepatic (3), pelvic (1) or spinal (1) hydatid cysts received 10 mg/kg/d albendazole for 1–3 months prior to surgery. Daughter cysts were present in the spinal hydatid and in one patient with hepatic disease. Electron microscope examination of the cyst tissue of the pelvic and the 2 hepatic cysts lacking daughter cysts showed no evidence of germinal layer, and the protoscoleces were dead. The primary cyst of the hepatic hydatid with daughter cysts (1 month therapy) was also judged dead but some pieces of the daughter cyst germinal layer appeared normal and had unaffected protoscoleces. The daughter cyst tissue of the spinal hydatid (3 month therapy) appeared normal and the protoscoleces viable. In view of the undetermined viability of human hydatids before chemotherapy, treatment of longer than 1 month is advocated for hepatic cysts, particularly if daughter cysts are present, and longer therapy is indicated for spinal disease.
Highlights
Surgery remains the primary treatment for human hydatid disease, there is a growing interest in medical treatment, where resection is contraindicated due to disseminated disease, the condition of the patient or in an adjuvant setting.Mebendazole was the first drug shown to have an effect albeit inconsistent[2,3,4] and more encouraging results have been achieved using albendazole[5,6,7].Efficacy is generally judged clinically or monitored radiographically to determine cyst regression
When chemotherapy has been followed by surgery, the viability of the protoscoleces within the cyst has been assessed, but less often has the germinal layer of the hydatid been examined histologically, and reports of the ultrastructure of this layer after therapy have been more rare
Verheyen compared human untreated and mebendazole-treated hydatid germinal layer using electron microscopy, and AIDabagh et al.[9] and Gemmell et al reported the effect of mebendazole on the ultrastructure of sheep hydatids
Summary
Surgery remains the primary treatment for human hydatid disease, there is a growing interest in medical treatment, where resection is contraindicated due to disseminated disease, the condition of the patient or in an adjuvant setting.Mebendazole was the first drug shown to have an effect albeit inconsistent[2,3,4] and more encouraging results have been achieved using albendazole[5,6,7].Efficacy is generally judged clinically or monitored radiographically to determine cyst regression. When chemotherapy has been followed by surgery, the viability of the protoscoleces within the cyst has been assessed, but less often has the germinal layer of the hydatid been examined histologically, and reports of the ultrastructure of this layer after therapy have been more rare. Verheyen compared human untreated and mebendazole-treated hydatid germinal layer using electron microscopy, and AIDabagh et al.[9] and Gemmell et al reported the effect of mebendazole on the ultrastructure of sheep hydatids. Morris et al included an ultrastructural study in their report on albendazole treatment of pulmonary hydatid cysts in naturally infected sheep. Rahemtulla et al 2 used histology and electron microscopy to examine a resected human hydatid after albendazole therapy, but no ultrastructural details of the germinal layer were given
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