Another alternative in the treatment of hepatic cystic echinococcosis (Part three)

The recurrence cases have been high (14 – 25%), but in general, they have been sensitive to a second treatment (Todorov, 1997).

Horton has treated 665 cysts with albendazole with a daily dose of 10-15 mg/Kg (Divided into two daily doses) and has noticed a 48% disappearance of the cysts and a 24% reduction in their volume. (10)

Treatment with chemotherapeutic agents is a non-invasive treatment that can be used in patients of all ages and should continue for 3-6 months with unpredictable results that vary from individual to individual. The treatment should be limited in pregnant women. (11)

The medication Praziquantel (PZQ) has been recommended as an adjunctive medication to be given once a week with a dose of 40 mg/kg, during treatment with benzimidazole. (12).

New cysts respond much better to treatment, probably as a result of a thinner pericystic membrane as well as a more active metabolism. (13)

All patients under treatment should be under periodic control, especially for the leukocyte formula (every 2 weeks in the first trimester), because leukopenia, not always reversible, may occur during the early stages of treatment. (14)

Ultrasonographic Follow-up of a case treated with PAIR:

Fig. 9. Right subcostal oblique section. Hydatid cyst in the 4th segment treated with percutaneous ethanol injection under ultrasound guidance. a. Presence of the catheter inside the cyst. b. Ethanol injection after aspiration of the cystic fluid. c. Shriveling of the membrane. d. Hardening of the cyst. Ultrasonographic management of hydatid cysts M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani** * Infectious Diseases Unit - S. Donato Hospital - Arezzo; ** Hematology Section - S. Donato Hospital – Arezzo. Page 147

Ultrasonographic Follow-up of a case treated with PAIR:

Fig. 10. Hydatid cyst of the 5th segment of the liver. a. Hydatid cyst before treatment. b. After 48 hours, the wall becomes thicker with artifacts reflecting and giving hypoechoic shadows. c. After a few days, the hypoechoic shadow is even more evident, with disappearance of the liquid component and appearance of echogenic material inside. d. After 3 months, the lesion is completely hardened. Ultrasonographic management of hydatid cysts M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani** * Infectious Diseases Unit - S. Donato Hospital - Arezzo; ** Hematology Section - S. Donato Hospital – Arezzo. Page 148.

CONCLUSION

* Ultrasound is a good method for diagnosis, treatment, and follow-up after therapy, in hydatid cysts.

* In cystic echinococcosis, ultrasound and interventional ultrasound have changed the natural history of this pathology, allowing for a quicker diagnosis with high sensitivity and specificity, improving treatment and achieving complete, sustainable improvements with much less risk and minor complications. (15)

* Within a few years, the PAIR technique has undoubtedly gained one of the top spots in Italy for the treatment of hepatic cystic echinococcosis, as its efficacy has been confirmed with long-term Check-Ups. (C. Filice., E. Brunetti).

* For developing countries, PAIR represents not only an alternative but also a first-rate diagnostic and therapeutic solution in the treatment of human cystic echinococcosis. (16)