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Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans.
Acta Trop. 2010 Apr; 114(1):1-16.AT

Abstract

The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance -Echinococcus granulosus and Echinococcus multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE. The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update.

Authors+Show Affiliations

Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S.Matteo Hospital Foundation, WHO Collaborating Center for Clinical Management of Cystic Echinococcosis, 27100 Pavia, Italy. selim@unipv.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19931502

Citation

Brunetti, Enrico, et al. "Expert Consensus for the Diagnosis and Treatment of Cystic and Alveolar Echinococcosis in Humans." Acta Tropica, vol. 114, no. 1, 2010, pp. 1-16.
Brunetti E, Kern P, Vuitton DA, et al. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114(1):1-16.
Brunetti, E., Kern, P., & Vuitton, D. A. (2010). Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Tropica, 114(1), 1-16. https://doi.org/10.1016/j.actatropica.2009.11.001
Brunetti E, et al. Expert Consensus for the Diagnosis and Treatment of Cystic and Alveolar Echinococcosis in Humans. Acta Trop. 2010;114(1):1-16. PubMed PMID: 19931502.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. AU - Brunetti,Enrico, AU - Kern,Peter, AU - Vuitton,Dominique Angèle, AU - ,, Y1 - 2009/11/30/ PY - 2009/08/23/received PY - 2009/11/02/revised PY - 2009/11/04/accepted PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2010/5/11/medline SP - 1 EP - 16 JF - Acta tropica JO - Acta Trop. VL - 114 IS - 1 N2 - The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance -Echinococcus granulosus and Echinococcus multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE. The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update. SN - 1873-6254 UR - https://www.unboundmedicine.com/medline/citation/19931502/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0001-706X(09)00358-1 DB - PRIME DP - Unbound Medicine ER -