Junghanss et al proposed different therapeutic strategies for a patient with cystic echinococcosis based on available resources and disease status. The authors are from multiple university hospitals in Europe.
Parameters:
(1) WHO classification on imaging studies
(2) diameter of the cystic lesions in cm
|
WHO Classification |
Diameter in cm |
Therapeutic Plan |
|
CE1 |
>= 5 cm |
1 |
|
CE1 |
< 5 cm |
2 |
|
CE2 |
NA |
3 or 4 |
|
CE3a |
>= 5 cm |
1 |
|
CE3a |
< 5 cm |
2 |
|
CE3b |
NA |
3 or 4 |
|
CE4 |
NA |
5 |
|
CE5 |
NA |
5 |
|
Therapeutic Plan |
Elements |
|
1 |
PAIR and albendazole |
|
2 |
albendazole |
|
3 |
non-PAIR percutaneous therapy and albendazole |
|
4 |
surgery and albendazole (preferred) |
|
5 |
watch and wait; do not treat unless complicated |
where:
• PAIR = puncture, aspirate, inject scolicidal agent, reaspirate
• The injection of a scolicidal agent should only be considered if there is definite proof that no fistulas exist to the biliary tract or lung.
In resource-poor areas one or more modalities may not be available or may not be done properly. Management needs to be planned based on what is available.
Specialty: Infectious Diseases, Pharmacology, clinical, Gastroenterology
