Abstract
The lack of knowledge regarding polycystic hydatid disease results in delayed or even incorrect diagnosis. The lack of systematic information regarding treatment also makes it difficult to assess the results and prognosis in patients with peritoneal and hepatic lesions caused by Echinococcus vogeli. Here we describe the clinical features of patients, propose a radiological classification protocol and describe a therapeutic option for the treatment of hydatid disease that previously had only been used for cases of cystic echinococcosis (Echinococcus granulosus). A prospective cohort study was initiated in 1999 and by 2009 the study included 60 patients. These patients were classified according to the PNM classification (parasite lesion, neighbouring organ invasion and metastases) and placed in one of three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10 mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts via puncture, aspiration, injection and re-aspiration (PAIR). The results were stratified according to therapeutic outcome: "cure", "clinical improvement", "no improvement", "death" or "no information". The PNM classification was useful in indicating the appropriate therapy in cases of polycystic hydatid disease. In conclusion, surgical therapy produced the best clinical results of all the therapies studied based on "cure" and "clinical improvement" outcomes. The use of PAIR for treatment requires additional study.
Highlights
Echinococcosis is a zoonosis caused by parasites of the genus Echinococcus
The adult parasite is a tapeworm measuring from 3.9-5.6 mm that naturally infects the bush dog (Speothos venaticus), which is one of the lowland paca’s (Cuniculus paca) natural predators (Raush et al 1981)
Diagnosis is confirmed according to the criteria of D’Alessandro (1997), who proposed an algorithm for the diagnosis of polycystic echinococcosis combining physical examination, epidemiology, imaging methods, serology and parasitological diagnosis in a non-systematic review of cases published in South America
Summary
Echinococcosis is a zoonosis caused by parasites of the genus Echinococcus. There are four Echinococcus species of medical interest: Echinococcus granulosus, Echinococcus multilocularis, Echinococcus oligarthrus and Echinococcus vogeli (Acha & Szyfres 1989). Rausch and Bernstein (1972) described E. vogeli, which is responsible for the polycystic form of echinococcosis and occurs exclusively in the New World (D’Alessandro 1997, D’Alessandro & Raush 2008). The adult parasite is a tapeworm measuring from 3.9-5.6 mm that naturally infects the bush dog (Speothos venaticus), which is one of the lowland paca’s (Cuniculus paca) natural predators (Raush et al 1981). Lowland pacas are infected while feeding on eggs excreted by the bush dog, which completing the life cycle of the parasite (Raush & D’Alessandro 1999). The hydatid cyst is the morphological expression of the larval form of the disease both in intermediate (lowland paca) and accidental (man) hosts (Acha & Szyfres 1989). The aim of the current study was to evaluate the prognosis and systematise treatment indications in a cohort of patients with hepatic and peritoneal lesions online | memorias.ioc.fiocruz.br
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