Alveolar echinococcosis
TL;DR
Treatment options for alveolar echinococcosis have not changed in decades and Benzimidazole intolerance dramatically worsens prognosis, as parasitic growth cannot be suppressed in inoperable patients.
Abstract
Purpose of review Alveolar echinococcosis is a wildlife zoonotic disease. Clinically and radiologically, it presents in a manner similar to hepatic malignancy. The aim of our review is to summarize the current standard of clinical management of alveolar echinococcosis. We also want to raise awareness and promote an integrated approach for this neglected tropical disease (NTD). Recent findings Data suggest increased prevalence of alveolar echinococcosis in some parts of the world. This may be due to intensified surveillance, spread of the disease, decreasing control efforts or a combination of these. Development of new diagnostics and treatment modalities is very slow, constrained by lack of investment into research. Summary Treatment options for alveolar echinococcosis have not changed in decades. Cure is only available for early and limited hepatic disease amenable to R0-surgical resection. Advanced disease, ineligible for surgery, is treated with benzimidazoles with a parasitostatic effect on Echinococcus multilocularis. The prognosis of alveolar echinococcosis ranges from excellent to poor depending mainly on the extent of hepatopathy induced by irreversible damage to the biliary and vascular system of the liver. Benzimidazole intolerance dramatically worsens prognosis, as parasitic growth cannot be suppressed in inoperable patients.