Treatment of liver hydatidosis: how to treat an asymptomatic carrier?

February 24, 2013 at 9:03 pm

World J Gastroenterol. 2010 Sep 7;16(33):4123-9.

Frider B, Larrieu E.

Bernardo Frider, Department of Medicine-Hepatology, Argerich Hospital, University of Buenos Aires, Maimonides University, Salguero 2601, 1425 Buenos Aires, Argentina

Edmundo Larrieu, Department of Zoonosis, Ministry of Health of Rio Negro Province, Laprida 240, 8500 Viedma, Argentina; University of La Pampa, Calle 5 y 116, 6360 General Pico, Argentina

Abstract

Liver hydatidosis is the most common clinical presentation of cystic echinococcosis (CE). Ultrasonographic mass surveys have demonstrated the true prevalence, including the asymptomatic characteristic of the majority of cases, providing new insight into the natural history of the disease. This raises the question of whether to treat or not to treat these patients, due to the high and unsuspected prevalence of CE. The high rate of liver/lung frequencies of cyst localization, the autopsy findings, and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion. The decision to treat an asymptomatic patient by surgery, albendazole, or puncture aspiration injection and re-aspiration or to wait and watch, is based on conflicting reports in the literature, the lack of complications in untreated patients over time, and the spontaneous disappearance and involution of cysts. All these points contribute to difficulties of individual clinical decisions. The patients should be informed of the reasons and the risks of watchful/waiting without treatment, the possibility of complications, and the risks of the other options. As more information on the natural history of liver hydatidosis is acquired, selection of the best treatment will be come easier. Without this knowledge it would be very difficult to establish definitive rules of treatment. At present, it is possible to manage these patients over time and to wait for the best moment for treatment. Follow-up studies must be conducted to achieve this objective.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2932914/pdf/WJG-16-4123.pdf

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Entry filed under: Antiparasitarios, Infecciones intraabdominales, Infecciones parasitarias, Metodos diagnosticos.

Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Biomarkers in community-acquired pneumonia: A state-of-the-art review.


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