Hepatic echinococcosis: Clinical and therapeutic aspects

Giuseppe Nunnari, Marilia R. Pinzone, Salvatore Gruttadauria, Benedetto M. Celesia, Giordano Madeddu, Giulia Malaguarnera, Piero Pavone, Alessandro Cappellani, Bruno Cacopardo

Research output: Contribution to journalArticle

Abstract

Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumorlike, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-todate review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

Original languageEnglish
Pages (from-to)1448-1458
Number of pages11
JournalWorld Journal of Gastroenterology
Volume18
Issue number13
DOIs
Publication statusPublished - Apr 7 2012

Keywords

  • Albendazole
  • Alveolar echinococcosis
  • Cystic echinococcosis
  • Diagnosis
  • Hydatidosis
  • Liver
  • PAIR
  • Treatment

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Nunnari, G., Pinzone, M. R., Gruttadauria, S., Celesia, B. M., Madeddu, G., Malaguarnera, G., Pavone, P., Cappellani, A., & Cacopardo, B. (2012). Hepatic echinococcosis: Clinical and therapeutic aspects. World Journal of Gastroenterology, 18(13), 1448-1458. https://doi.org/10.3748/wjg.v18.i13.1448