Epidemiological studies have demonstrated that most humans infected with Echinococcus spp. exhibit resistance to disease. When infection leads to disease, the parasite is partially controlled by host immunity: in case of immunocompetence, the normal alveolar echinococcosis (AE) or cystic echinococcosis (CE) situation, the metacestode grows slowly, and first clinical signs appear years after infection; in case of impaired immunity (AIDS; other immunodeficiencies), uncontrolled proliferation of the metacestode leads to rapidly progressing disease. Assessing Echinococcus multilocularis viability in vivo following therapeutic interventions in AE patients may be of tremendous benefit when compared with the invasive procedures used to perform biopsies. Current options are F18-fluorodeoxyglucose-positron emission tomography (FDG-PET), which visualizes periparasitic inflammation due to the metabolic activity of the metacestode, and measurement of antibodies against recEm18, a viability-associated protein, that rapidly regresses upon metacestode inactivation. For Echinococcus granulosus, similar prognosis-associated follow-up parameters are still lacking but a few candidates may be listed. Other possible markers include functional and diffusion-weighted Magnetic Resonance Imaging (MRI), and measurement of products from the parasite (circulating antigens or DNA), and from the host (inflammation markers, cytokines, or chemokines). Even though some of them have been promising in pilot studies, none has been properly validated in an appropriate number of patients until now to be recommended for further use in clinical settings. There is therefore still a need to develop reliable tools for improved viability assessment to provide the sufficient information needed to reliably withdraw anti-parasite benzimidazole chemotherapy, and a basis for the development of new alternative therapeutic tools.

/pdf/echinococcus-metacestode-in-search-of-viability-markers-4pv1eirpnt.pdf

Echinococcus metacestode: in search of viability markers

Resume L’echinococcose alveolaire (EA) humaine est une zoonose parasitaire. Son cycle repose sur des hotes intermediaires (rongeurs, lagomorphes) et definitif (carnivores : renards essentiellement, chiens). L’hote definitif transmet le parasite a l’homme via ses feces, contaminees par les oncospheres d’Echinococcus multilocularis, dont la larve va se developper au niveau hepatique a la maniere d’un cancer a marche lente. L’echinococcose alveolaire peut progressivement s’etendre aux structures biliaires et vasculaires, aux tissus et organes voisins, et s’accompagner de metastases a distance. Les patients infectes sont actuellement detectes frequemment a un stade precoce, asymptomatique. L’augmentation des populations de renards, leur implantation croissante dans les villes et l’extension de la zone d’endemie du parasite chez les renards modifient l’epidemiologie de la maladie. La prise en charge des patients doit etre multidisciplinaire et repose sur des points cles : chirurgie radicale si realisable ; pas de gestes chirurgicaux palliatifs ; si possible radiologie interventionnelle ou endoscopie pour traiter les complications biliaires ou vasculaires ; transplantation hepatique indiquee uniquement chez les patients avec complications majeures, en impasse therapeutique ; traitement medical de tous les patients sans exception par albendazole en continu, au moins deux ans apres une chirurgie radicale et au long cours chez les patients non operes ; tomographie par emission de positons couplee a la tomodensitometrie (TEP-TDM) et serologie specifique pour evaluer l’activite fonctionnelle parasitaire et monitorer le traitement ; suivi regulier des taux plasmatiques d’albendazole. La survie et la qualite de vie des patients se sont considerablement ameliorees grâce a l’optimisation de cette prise en charge.

Échinococcose alvéolaire : épidémiologie, surveillance et prise en charge

Echinococcosis

https://www.parasite-journal.org/articles/parasite/pdf/2014/01/parasite140024-s.pdf

Proceedings of the international symposium - innovation for the management of echinococcosis besançon, march 27-29, 2014.

Introduction: Care management of patients with alveolar echinococcosis (AE), a rare, severe and orphan parasitic disease, is essentially based on expert consensus. Treatment strategies and recommendations have regularly been updated by the WHO-Informal Working Group on Echinococcosis, based upon the 35 years’ experience, research and published papers from the main reference centers in Europe, Japan and China. Areas covered: This expert opinion covers the basics of benzimidazole chemotherapy and interventions used in the care management of patients with AE, and it summarizes the current status of potentially ‘candidate’ drugs. It closely follows and updates the statements of the last ‘expert consensus’ published in 2010, which includes radical resection of liver lesions whenever possible, and continuous and prolonged treatment with albendazole (ABZ) or mebendazole (MBZ) in all patients. It discusses the modalities of patient’s follow-up and of a possible benzimidazole withdrawal in selected patients. Exper...

Alveolar echinococcosis: evaluation of therapeutic strategies

https://www.journal-of-hepatology.eu/article/S0168-8278(13)60925-3/pdf

923 emergence of a new opportunistic infection in europe: hepatic alveolar echinococcosis. a fifty-case report

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923 emergence of a new opportunistic infection in europe: hepatic alveolar echinococcosis. a fifty-case report