Alveolar echinococcosis – a rare disease requiring a multidisciplinary approach
Authors:
D. Erhartová 1; J. Froněk 2; F. Stejskal 3,4,5; H. Skopcová 6; D. Kautznerová 7; J. Špičák 1; P. Trunečka 1
Authors‘ workplace:
Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
1; Klinika transplantační chirurgie, Transplantcentrum, IKEM, Praha
2; Klinika infekčních nemocí 2. LF UK a Nemocnice Na Bulovce, Praha
3; Infekční oddělení, Krajská nemocnice Liberec, a. s.
4; Ústav imunologie a mikrobiologie VFN v Praze a 1. LF UK
5; Pracoviště klinické a transplantační patologie, Transplantcentrum, IKEM, Praha
6; Pracoviště radiodiagnostiky a intervenční radiologie, Komplement, IKEM, Praha
7
Published in:
Gastroent Hepatol 2018; 72(4): 287-292
Category:
Clinical and Experimental Gastroenterology: Original Article
doi:
https://doi.org/10.14735/amg2018287
Overview
Alveolar echinoccocosis (AE) is a rare and potentially lethal zoonosis that primarily affects the liver and is caused by larvae of the tapeworm Echinococcus multilocularis, which occurs in the northern hemisphere. AE is an illness with tumor-like characteristics, such as infiltrative growth and metastatic potential. Diagnosis consists of imaging studies (ultrasonography, CT, and magnetic resonance) and serological tests. All patients are treated by long-term benzimidazoles therapy and if possible by radical surgery. In exceptional cases, a liver transplantation (LTx) can be performed. LTx is considered in patients with advanced, symptomatic and radically inoperable disease. Recurrence of AE has been linked with immunocompetence. The risk of recurrence is higher with post-transplant immunosuppressive treatment. Currently, non-surgical interventions, such as percutaneous drainage of bile ducts are preferred, which address most complications. The number of LTx due to AE is diminishing in Europe.
Key words:
Echinoccocosis – Echinococcus multilocularis – liver transplantation – benzimidazoles
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.
Submitted: 19. 6. 2018
Accepted: 3. 7. 2018
Sources
1. Stojkovic M, Mickan C, Weber TF et al. Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series. BMJ Open Gastroenterol 2015; 2 (1): e000036. doi: 10.1136/bmjgast-2015-000036.
2. 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. doi: 10.1016/j.actatropica.2009.11.001.
3. Deplazes P, Rinaldi L, Alvarez Rojas CA et al. Global Distribution of Alveolar and Cystic Echinococcosis. Adv Parasitol 2017; 95: 315–493. doi: 10.1016/bs.apar.2016.11.001.
4. Kolářová L, Matějů J, Hozáková L et al. Humánní alveolární echinokokokóza a přehled výskytu tasemnice Echinococcus multilocularis u zvířat v České republice. Epidemiol Mikrobiol Imunol 2017; 66 (4): 163–172.
5. Torgerson PR, Schweiger A, Deplazes P et al. Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analsysis in Switzerland over last 35 years. J Hepatol 2008; 49 (1): 72–77. doi: 10.1016/j.jhep.2008.03.023.
6. Akbulut S. Parietal complication of the hydatid disease: Comprehensive literature review. Medicine 2018; 97 (21): e10671. doi: 10.1097/ MD.0000000000010671.
7. Kolářová L. Laboratorní diagnostika tkáňových helmintóz. [online]. Available from: http: //uim.lf1.cuni.cz/file/5790/raabe-3el- cm-e3.pdf.
8. Kern P, Wen H, Sato N et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int 2006; 55 (Suppl): 283–287. doi: 10.1016/j.parint.2005.11.041.
9. Bresson-Hadni S, Koch S, Miguet JP et al. Indications and results of liver transplantation for Echinococcus alveolar infection: an overview. Langenbecks Arch Surg 2003; 388 (4): 231–238. doi: 10.1007/s00423-003-0394-2.
10. Bresson-Hadni S, Vuitton DA, Bartholomot B et al. A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France. Eur J Gastroenterol Hepatol 2000; 12 (3): 327–336.
11. Mihmanli M, Idiz UO, Kaya C et al. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8 (28): 1169–1181. doi: 10.4254/wjh.v8.i28.1169.
12. Vuitton DA, Azizi A, Richou C et al. Current interventional strategy for the treatment of hepatic alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 14 (12): 1179–1194. doi: 10.1080/14787210.2016.1240030.
13. Bresson-Hadni S, Laplante JJ, Lenys D et al. Seroepidemiologic screening of Echinococcus multilocularis infection in Europe area endemic for alveolar echinococcosis. Am J Trop Med Hyg 1994; 51 (6): 837–846.
14. Ozdemir F, Ince V, Barut B et al. Living donor liver transplantation for Echinococcus Alveolaris: single-center experience. Liver Transpl 2015; 21 (8): 1091–1095. doi: 10.1002/lt.24 170.
15. Moray G, Shahbazov R, Sevmis S et al. Liver transplantation in management of alveolar echinococcosis: two case reports. Transplant Proc 2009; 41 (7): 2936–2938. doi: 10.1016/j.transproceed.2009.07.022.
16. Aydinli B, Ozturk G, Arslan S et al. Liver transplantation for alveolar echinococcosis in an endemic region. Liver Transpl 2015; 21 (8): 1096–1102. doi: 10.1002/lt.24195.
17. Hand J, Huprikar S. Liver transplantation for alveolar echinococcosis: Acceptable when necessary but is it preventable? Liver Transpl 2015; 21 (8): 1013–1015. doi: 10.1002/lt.24 197.
18. Bresson-Hadni S, Blagosklonov O, Knapp J et al. Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study. Liver Transpl 2011; 17 (7): 855–865. doi: 10.1002/lt.22299.
19. Pang C, Chu YK. Recurrence of liver transplantation combined with lung and diaphragm resection for alveolar echinococcosis: a case report. Transplant Proc 2015; 47 (7): 2278–2281. doi: 10.1016/j.transproceed.2015.06.013.
20. Koch S, Bresson-Hadni S, Miguet JP et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation 2003; 75 (6): 856–863. doi: 10.1097/01.TP.0000054230.63568.79.
21. Bresson-Hadni S, Koch S, Beurton I et al. Primary disease recurrence after liver transplantation for alveolar echinococcosis: long-term evaluation in 15 patients. Hepatology 1999; 30 (4): 857–864. doi: 10.1002/hep.510300426.
22. Patkowski W, Kotulski M, Remiszewski P et al. Alveococcosis of the liver – strategy of surgical treatment with special focus on liver transplantation. Transpl Infect Dis 2016; 18 (5): 661–666. doi: 10.1111/tid.12574.
23. Yang X, Qiu Y, Huang B et al. Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases. Am J Transplant 2018; 18 (7): 1668–1679. doi: 10.1111/ajt.14621
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