Internal Medicine

P1: RLJ/OZN P2: PSB

0521779407-D-02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:9

Echinococcosis 519

➣Needle aspiration: for larger cysts where needle can pass through

liver to cyst. Hypertonic saline then injected to kill remaining

organisms.

➣Surgical resection: for larger hepatic cysts, cysts elsewhere. Give

albendazole during and 1 month after aspiration or surgery to

prevent new disease in case of leakage.

■E. multilocularis:

➣Primary resection of cyst when possible is treatment of choice.

Liver transplant occasionally done.

➣Albendazole long-term (years), or:

➣Mebendazole long-term. Albendazole gives higher blood and

cyst levels.

Side Effects & Complications

■Surgery: rupture and leakage of cyst, other surgical complications

■Albendazole: Hepatic toxicity, such as jaundice, elevated enzymes.

Also alopecia, leukopenia, fever.

■Mebendazole: same

■Contraindications to treatment: absolute:

➣E. granulosis: dead cysts

➣E. multilocularis: none

■Contraindications to treatment: relative:

➣E. granulosis: Very small deep cysts. Elderly or debilitated

patients.

➣E. multilocularis: relative contraindications are same as in a

patient with a malignancy.

follow-up

During Treatment

■Follow liver function, CBC, and ultrasound or CT. In E. multilocularis,

serology follow-up is useful.

Routine

■Continued ultrasound follow-up

complications and prognosis

■E. granulosis: Rupture of cyst can produce new cysts in area of rup-

ture, or anaphylaxis. Covering with chemotherapy can usually pre-

vent this. Otherwise good prognosis.

■E. multilocularis: Behaves somewhat like a malignancy. If resected,

curative. If chemotherapy used, some regress well, some progress to

fatal outcome, but 10-year survival rate on therapy is 90%.