Pediatric Echinococcosis Treatment & Management

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Medical Care

Preoperative and postoperative albendazole therapy may be beneficial in patients with echinococcosis. As an alternative to surgical management, a randomized controlled study of albendazole in uncomplicated hepatic hydatid disease in adults concluded that 10 mg/kg/d for 3 months without rest periods was effective and could be tried before surgical intervention. In children, the dose is 15 mg/kg/d for 28 days and is repeated, as necessary.

The World Health Organization (WHO) recommends postoperative chemotherapy for 2.5 years after radical surgery for alveolar hydatid disease.

Inoperable cases can be treated with albendazole or mebendazole.[7] An overall response rate of 55-79% has been documented, with cure in 29% of cases. Albendazole is the drug of choice because of its greater absorption from the GI tract with higher plasma levels. Mebendazole is poorly absorbed and must be taken at higher doses for several months for a therapeutic effect. Albendazole is administered in 3 or more cycles of 400-800 mg twice daily for 4 weeks (adult dose), followed by a 2-week period of rest. If response to 3 cycles is not evident, subsequent courses are unlikely to be beneficial. Response to therapy is best monitored by serial imaging studies. Another treatment option for disseminated disease that fails to respond to standard treatment regimens is nitazoxanide with albendazole (with or without praziquantel) for salvage therapy.[8]

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Surgical Care

Surgery is the treatment of choice for most cases of cystic echinococcosis and is usually successful. Alveolar echinococcosis is less amenable to surgery and medical therapy may be useful.

Liver surgery options include the following:

  • Partial hepatic resection
  • Pericystectomy
  • Cystectomy

In 20% of cases, disease recurs despite surgery.

Some clinicians have inactivated the fertile cyst with formalin or 30% saline in combination with resection. Sclerosing cholangitis may occur as a complication of this procedure.

An alternative to surgery is the PAIR method (ie, puncture the cyst, aspirate fluid, introduce a protoscolicidal agent, then reaspirate), which requires ultrasonographic guidance.[9] Extreme care is essential to prevent spilling hydatid fluid into a body cavity because this may lead to anaphylactic shock. Albendazole therapy may be combined with PAIR from 10 days before to 30 days after the procedure. PAIR is a promising technique, and early large-scale clinical trials have been reassuring.[10]

Some severe cases of alveolar hydatid disease have led to liver transplantation.

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Consultations

Recommended consultations for echinococcosis include surgeons and infectious diseases specialists with experience in diagnosis and treatment of the disease.

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Diet

To prevent repeat infections, instruct patients to wash fruits and vegetables thoroughly and to consume only well-cooked meats.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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Diagram of the Echinococcus life cycle, provided by the Centers for Disease Control and Prevention.
 
 
 
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