Abstract
BackgroundCystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence.MethodsA descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122–0 to 122–9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015.ResultsAmong the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence’s diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1–7.1; p < 0.05] when the cyst was located in organs other than liver and lung, 22.6% (7/31) vs 14.2% (31/217) in the cohort. We detected a chance of recurrence [OR = 2.3; 95% CI, 1.4–6.5; p > 0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%).ConclusionsDespite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management.
Highlights
Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease
The purpose of this study was to determine the frequency of CE recurrence, the clinical setting and the risk factors involved in recurrence
We reviewed all patients diagnosed with CE according to ICD-9 criteria admitted at Complejo Asistencial Universitario de Salamanca (CAUSA) between January 1998 and December 2015
Summary
In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence. The recurrence of disease may present with major complications including pyogenic infection, intrabiliary rupture, or anaphylaxis. It is usually initially asymptomatic, and regular long-term follow-up should be routine after primary treatment [9, 10]. The absence of protocols and clinical guidelines of the “best” management for echinococcal cysts is a clear factor underlying recurrent CE [11]. The purpose of this study was to determine the frequency of CE recurrence, the clinical setting and the risk factors involved in recurrence. We studied the treatment applied to these patients and their mortality
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