PubMed · 14249671
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S S KULIUKIN. [SPLENIC ECHINOCOCCCOSIS].. https://pubmed.ncbi.nlm.nih.gov/14249671/
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BACKGROUND: The aim of this retrospective study was to evaluate clinical presentation and long-term outcome of patients treated surgically for complicated liver hydatid cysts. PATIENTS AND METHODS: Eighty-four patients with liver hydatid cysts underwent an operation at the Geneva University Hospital between 1980 and 1999. Clinical presentation, postoperative morbidity, mortality, and long-term recurrence rate were evaluated. RESULTS: Among the 84 patients with liver hydatid disease, 35 patients (41%) presented complicated cysts (ie, cysts that had developed a fistula into adjacent structures or organs). In most patients, the fistula communicated with the biliary tree (n = 25), but we also observed communication with the right lung (n = 3), the right diaphragm (n = 2), liver parenchyma (n = 1), and peritoneal cavity (n = 1). Complete removal of the cystic disease was possible in 24 of 35 patients (70%). In 11 patients, fragments of cysts were not removed because of their location adjacent to main vessels. Postoperatively, 8 patients (23%) developed a severe complication (grade II and III). There were no postoperative deaths, and no recurrences of hydatid disease were observed with a median follow-up of 8.6 years (complete follow-up was obtained in 69% of patients). CONCLUSIONS: Complicated liver hydatid disease is frequent and was observed in almost half of patients operated for liver hydatid cysts at our center. Using a surgical strategy aimed at complete removal of cystic and pericystic tissue with simultaneous treatment of the fistulous tract, we observed 23% postoperative morbidity, no mortality, and no recurrence of disease with a median follow-up of >8 years.
Two species of the genus Echinococcus occur sympatrically in central Europe, namely Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE), and E. granulosus, resulting in cystic echinococcosis (CE) in humans. The endemic area of Europe demonstrates an annual incidence of 0.02 to 1.4 new AE cases per 100000 inhabitants. The importance of the disease refers primarily to the high lethality observed in untreated cases. Therapeutically, radical surgical resection of hepatic lesions followed by continuous benzimidazole-therapy is anticipated. Recently, the strategic control of cystic echinococcosis in humans has considerably been improved by the development of an effective and efficient vaccine that will indirectly prevent humans from infection. The vaccine protects animal intermediate hosts (mainly farm ruminants), thus the lack of hydatid cysts in these animals will prevent dogs to become infected. This on the long-term will result in an abrogation of infection sources (Echinococcus eggs) for humans (and other intermediate hosts). Principally, it has been shown that a similar vaccination is also possible for E. multilocularis. Thus, a 14-3-3 and another Em95-vaccine have successfully been tested in the experimental murine model. As the parasite development mainly focuses on a wildlife cycle (wild rodents), a practical application of the vaccine can hardly be implemented. Nevertheless, AE is a very severe disease in humans, therefore one should discuss about the feasibility and the health-economic impact of large-scale vaccination of humans living in areas of high endemicity and thus being at high infection risk.