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Sections Echinococcosis Hydatid Cyst
Overview
Presentation
- History
- Physical
- Causes
- Complications
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Treatment
Medication
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References

Medication

Medication Summary

Albendazole and mebendazole are the only anthelmintics effective against cystic echinococcosis. Albendazole is the drug of choice against this disease because its degree of systemic absorption and penetration into hydatid cysts is superior to that of mebendazole. Albendazole in combination with percutaneous aspiration or PAIR therapy can lead to a reduction in cyst size, and, in one study, it improved efficacy over albendazole alone against hepatic hydatid cysts.^[42]When surgery cannot be avoided, presurgical use of albendazole in echinococcus infestations reduced risk of recurrence and/or facilitated surgery by reducing intracystic pressure.

Treatment of echinococcosis for patients weighing more than 60 kg is albendazole administered PO with meals in a dose of 400 mg twice daily for 28 days. A dose of 15 mg/kg of body weight daily in 2 divided doses (not to exceed total daily dose of 800 mg) has been suggested for patients weighing less than 60 kg. For cystic echinococcosis, the 28-day course may be repeated after 14 days without treatment to a total of 3 treatment cycles.

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Albendazole (Albenza)

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Decreases ATP production in worm, causing energy depletion, immobilization, and, finally, death. To avoid inflammatory response in CNS, patient must also take anticonvulsants and high-dose glucocorticoids.

Mebendazole (Vermox)

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Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.

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Tutar N, Cakir B, Geyik E, Tarhan NC, Niron EA. Hydatid cysts in breast: mammography and ultrasound findings. Br J Radiol. 2006 Oct. 79(946):e114-6. [QxMD MEDLINE Link].
Türkmen C, Unal SN, Berberoglu K, Genchellac H, Unal Z, Cantez S. Acute pulmonary embolism due to hydatid cyst. Clin Nucl Med. 2004 Nov. 29(11):760-1. [QxMD MEDLINE Link].
Yuksel BC, Ozel H, Akin T, Avsar FM, Hengirmen S. Primary hydatid cyst of the breast with elevated CA 19-9 level. Am J Trop Med Hyg. 2005 Aug. 73(2):368-70. [QxMD MEDLINE Link].
Pamir MN, Ozduman K, Elmaci I. Spinal hydatid disease. Spinal Cord. 2002 Apr. 40(4):153-60. [QxMD MEDLINE Link].
Bulman W, Coyle CM, Brentjens TE, et al. Severe pulmonary hypertension due to chronic echinococcal pulmonary emboli treated with targeted pulmonary vascular therapy and hepatic resection. Chest. 2007 Oct. 132(4):1356-8. [QxMD MEDLINE Link].
Bron JL, van Kemenade FJ, Verhoof OJ, Wuisman PI. Long term follow-up of a patient with disseminated spinal hydatidosis. Acta Orthop Belg. 2007 Oct. 73(5):678-82. [QxMD MEDLINE Link].
Nagpal V, Kohli K, Chowdhary A, Kumar A, Andley M, Ravi B. Breast lump as a presentation of a hydatid disease. Trop Doct. 2006 Jan. 36(1):57-8. [QxMD MEDLINE Link].
Santivanez S, Garcia HH. Pulmonary cystic echinococcosis. Curr Opin Pulm Med. 2010 May. 16(3):257-61. [QxMD MEDLINE Link].
[Guideline] Brunetti E, Kern P, Vuitton DA,. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010 Apr. 114(1):1-16. [QxMD MEDLINE Link].
Neumayr A, Troia G, de Bernardis C, et al. Justified concern or exaggerated fear: the risk of anaphylaxis in percutaneous treatment of cystic echinococcosis-a systematic literature review. PLoS Negl Trop Dis. 2011 Jun. 5(6):e1154. [QxMD MEDLINE Link]. [Full Text].
Macpherson CN, Bartholomot B, Frider B. Application of ultrasound in diagnosis, treatment, epidemiology, public health and control of Echinococcus granulosus and E. multilocularis. Parasitology. 2003. 127 Suppl:S21-35. [QxMD MEDLINE Link].
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Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg. 2008 Sep. 79(3):301-11. [QxMD MEDLINE Link].
Brunetti E, Junghanss T. Update on cystic hydatid disease. Curr Opin Infect Dis. 2009 Oct. 22(5):497-502. [QxMD MEDLINE Link].
Hosch W, Junghanss T, Stojkovic M, et al. Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents. NMR Biomed. 2008 Aug. 21(7):734-54. [QxMD MEDLINE Link].
Hosch W, Stojkovic M, Janisch T, Kauffmann GW, Junghanss T. The role of calcification for staging cystic echinococcosis (CE). Eur Radiol. 2007 Oct. 17(10):2538-45. [QxMD MEDLINE Link].
Dursun M, Terzibasioglu E, Yilmaz R, et al. Cardiac hydatid disease: CT and MRI findings. AJR Am J Roentgenol. 2008 Jan. 190(1):226-32. [QxMD MEDLINE Link].
Hosch W, Stojkovic M, Janisch T, et al. MR imaging for diagnosing cysto-biliary fistulas in cystic echinococcosis. Eur J Radiol. 2008 May. 66(2):262-7. [QxMD MEDLINE Link].
Stojkovic M, Rosenberger K, Kauczor HU, Junghanss T, Hosch W. Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound?. PLoS Negl Trop Dis. 2012. 6(10):e1880. [QxMD MEDLINE Link]. [Full Text].
Stojkovic M, Rosenberger KD, Steudle F, Junghanss T. Watch and Wait Management of Inactive Cystic Echinococcosis - Does the Path to Inactivity Matter - Analysis of a Prospective Patient Cohort. PLoS Negl Trop Dis. 2016 Feb 24. [QxMD MEDLINE Link]. [Full Text].
Piccoli L, Tamarozzi F, Cattaneo F, Mariconti M, Filice C, Bruno A, et al. Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a "watch-and-wait" approach. PLoS Negl Trop Dis. 2014 Aug. 8 (8):e3057. [QxMD MEDLINE Link]. [Full Text].
Lissandrin R, Tamarozzi F, Mariconti M, Manciulli T, Brunetti E, Vola A. Watch and Wait Approach for Inactive Echinococcal Cyst of the Liver: An Update. Am J Trop Med Hyg. 2018 Aug. 99 (2):375-379. [QxMD MEDLINE Link].
Saidi F, Habibzadeh F. The Non-operative Management of Asymptomatic Liver Hydatids: Ending Echinococcophobia. J Gastrointest Surg. 2018 Mar. 22 (3):486-495. [QxMD MEDLINE Link].
Larrieu E, Uchiumi L, Salvitti JC, Sobrino M, Panomarenko O, Tissot H, et al. Epidemiology, diagnosis, treatment and follow-up of cystic echinococcosis in asymptomatic carriers. Trans R Soc Trop Med Hyg. 2018 Nov 9. [QxMD MEDLINE Link].
Stojkovic M, Zwahlen M, Teggi A, et al. Treatment response of cystic echinococcosis to benzimidazoles: a systematic review. PLoS Negl Trop Dis. 2009 Sep 29. 3(9):e524. [QxMD MEDLINE Link]. [Full Text].
Liu Y, Wang X, Wu J. Continuous long-term albendazole therapy in intraabdominal cystic echinococcosis. Chin Med J (Engl). 2000 Sep. 113(9):827-32. [QxMD MEDLINE Link].
Bygott JM, Chiodini PL. Praziquantel: neglected drug? Ineffective treatment? Or therapeutic choice in cystic hydatid disease?. Acta Trop. 2009 Aug. 111(2):95-101. [QxMD MEDLINE Link].
Ulger S, Barut H, Tunc M, Aydin E, Aydinkarahaliloglu E, Gokcek A. Radiation therapy for resistant sternal hydatid disease. Strahlenther Onkol. 2013 Jun. 189(6):508-509. [QxMD MEDLINE Link].
Neumayr A. Radiotherapy of osseous echinococcosis: where is the evidence?. Int J Infect Dis. 2015 Jan 10. 33:75-78. [QxMD MEDLINE Link].
El Malki HO, El Mejdoubi Y, Souadka A, et al. Predictive factors of deep abdominal complications after operation for hydatid cyst of the liver: 15 years of experience with 672 patients. J Am Coll Surg. 2008 Apr. 206(4):629-37. [QxMD MEDLINE Link].
Bagheri R, Haghi SZ, Amini M, Fattahi AS, Noorshafiee S. Pulmonary hydatid cyst: analysis of 1024 cases. Gen Thorac Cardiovasc Surg. 2011 Feb. 59(2):105-9. [QxMD MEDLINE Link].
Neumayr A, Tamarozzi F, Goblirsch S, Blum J, Brunetti E. Spinal cystic echinococcosis--a systematic analysis and review of the literature: part 2. Treatment, follow-up and outcome. PLoS Negl Trop Dis. 2013. 7(9):e2458. [QxMD MEDLINE Link].
Li Y, Zheng H, Cao X, Liu Z, Chen L. Demographic and clinical characteristics of patients with anaphylactic shock after surgery for cystic echinococcosis. Am J Trop Med Hyg. 2011 Sep. 85(3):452-5. [QxMD MEDLINE Link]. [Full Text].
Filice C, Pirola F, Brunetti E, Dughetti S, Strosselli M, Foglieni CS. A new therapeutic approach for hydatid liver cysts. Aspiration and alcohol injection under sonographic guidance. Gastroenterology. 1990 May. 98(5 Pt 1):1366-8. [QxMD MEDLINE Link].
Paksoy Y, Odev K, Sahin M, Arslan A, Koç O. Percutaneous treatment of liver hydatid cysts: comparison of direct injection of albendazole and hypertonic saline solution. AJR Am J Roentgenol. 2005 Sep. 185(3):727-34. [QxMD MEDLINE Link].
Paksoy Y, Odev K, Sahin M, Dik B, Ergül R, Arslan A. Percutaneous sonographically guided treatment of hydatid cysts in sheep: direct injection of mebendazole and albendazole. J Ultrasound Med. 2003 Aug. 22(8):797-803. [QxMD MEDLINE Link].
Smego RA Jr, Bhatti S, Khaliq AA, Beg MA. Percutaneous aspiration-injection-reaspiration drainage plus albendazole or mebendazole for hepatic cystic echinococcosis: a meta-analysis. Clin Infect Dis. 2003 Oct 15. 37(8):1073-83. [QxMD MEDLINE Link].
Kabaalioglu A, Ceken K, Alimoglu E, Apaydin A. Percutaneous imaging-guided treatment of hydatid liver cysts: do long-term results make it a first choice?. Eur J Radiol. 2006 Jul. 59(1):65-73. [QxMD MEDLINE Link].
Khuroo MS, Wani NA, Javid G, et al. Percutaneous drainage compared with surgery for hepatic hydatid cysts. N Engl J Med. 1997 Sep 25. 337(13):881-7. [QxMD MEDLINE Link].
Men S, Yucesoy C, Edguer TR, Hekimoglu B. Percutaneous treatment of giant abdominal hydatid cysts: long-term results. Surg Endosc. 2006 Oct. 20(10):1600-6. [QxMD MEDLINE Link].
Schipper HG, Laméris JS, van Delden OM, Rauws EA, Kager PA. Percutaneous evacuation (PEVAC) of multivesicular echinococcal cysts with or without cystobiliary fistulas which contain non-drainable material: first results of a modified PAIR method. Gut. 2002 May. 50(5):718-23. [QxMD MEDLINE Link].
Ustunsoz B, Ugurel MS, Uzar AI, Duru NK. Percutaneous treatment of hepatic hydatid cyst in pregnancy: long-term results. Arch Gynecol Obstet. 2008 Jun. 277(6):547-50. [QxMD MEDLINE Link].
Golemanov B, Grigorov N, Mitova R, et al. Efficacy and safety of PAIR for cystic echinococcosis: experience on a large series of patients from Bulgaria. Am J Trop Med Hyg. 2011 Jan. 84(1):48-51. [QxMD MEDLINE Link]. [Full Text].
Mohan S, Garg SK, Kathuria M, Baijal SS. Mechanical suction through wide bore catheters for nonsurgical management of Gharbi type III hepatic hydatid cysts. Trop Gastroenterol. 2011 Jul-Sep. 32(3):189-95. [QxMD MEDLINE Link].
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Brunetti E, Filice C, Meroni V. Comment on percutaneous treatment of liver hydatid cysts. AJR Am J Roentgenol. 2006 Apr. 186(4):1198-9; author reply 1199-200. [QxMD MEDLINE Link].
Brunetti E, Gulizia R, Garlaschelli AL, Filice C. Cystic echinococcosis of the liver associated with repeated international travels to endemic areas. J Travel Med. 2005 Jul-Aug. 12(4):225-8. [QxMD MEDLINE Link].
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Media Gallery

WHO Informal Working Group on Echinococcosis standardized ultrasound classification of echinococcal cysts. Image courtesy of World Health Organization (WHO).
CE1 cyst in the right segments of the liver in a young Albanian boy
CE3a echinococcal cyst of the liver. Note the folding endocyst ("waterlily sign") typical of CE3a cysts.
CE3b cyst in the right lobe of the liver. The cyst is predominantly solid with a few daughter cysts
CE4 cyst in the liver. The cyst is completely solid and inactive.
CE3b cyst in the muscles of posterior thigh (scanned with a convex ultrasound probe).
CE4 cysts in the peritoneum in a patient with disseminated echinococcosis (longitudinal scan).
Viable scolices (note rostellar hooklets).
CT scan of peritoneal, disseminated echinococcosis
MR scan of echinococcal cyst in the right psoas muscle, infiltrating the adjacent vertebral body
Ultrasound scan of a CE3b subcutaneous cyst located in the lumbar area. The cyst was the subcutaneous extension of a cyst located in the spine that had been previously operated on.
MR of the spine showing CE involvement of CE3,CE4,CE5 vertebral bodies, spinous processes and subcutaneous tissue (same patient as # )
CT scan showing CE infiltration of vertebral bodies and destruction of left peduncles

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Author

Enrico Brunetti, MD Associate Professor, Department of Infectious Diseases, Division of Infectious and Tropical Diseases, University of Pavia, Italy; Staff Physician, Department of Infectious Diseases, IRCCS S Matteo Hospital Foundation, Pavia, Italy

Enrico Brunetti, MD is a member of the following medical societies: American Society of Tropical Medicine and Hygiene, European Society of Clinical Microbiology and Infectious Diseases

Disclosure: Nothing to disclose.

Coauthor(s)

Carlo Filice, MD Chief of Ultrasound Unit, Adjunct Professor, Department of Internal Medicine, Division of Infectious and Tropical Diseases, IRCCS S Matteo Hospital, University of Pavia, Italy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University School of Medicine in Shreveport; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Mark R Wallace, MD, FACP, FIDSA Infectious Disease Physician, Skagit Valley Hospital, Skagit Regional Health

Disclosure: Nothing to disclose.

Sections Echinococcosis Hydatid Cyst
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Medication
Media Gallery
References

Echinococcosis Hydatid Cyst Medication

Medication Summary

Anthelmintics

Class Summary

Albendazole (Albenza)

Albendazole (Albenza)

Mebendazole (Vermox)

Mebendazole (Vermox)

Echinococcosis Hydatid Cyst Medication

Medication Summary

Anthelmintics

Class Summary

Albendazole (Albenza)

Albendazole (Albenza)

Mebendazole (Vermox)

Mebendazole (Vermox)

References

Tables

Contributor Information and Disclosures

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