Management of multiple echinococcosis in childhood with albendazole and surgery

• Published in: Journal of pediatric surgery 2008-11, Vol.43 (11), p.2024-2030
• Main Authors: Ben Brahim, Mohamed, Nouri, Abdellatif, Ksia, Amine, El Ezzi, Oumama, Krichene, Imed, Mekki, Mongi, Belghith, Mohsen
• Format: Article
• Language: English
• Subjects: Adolescent; Albendazole; Albendazole - therapeutic use; Anthelmintics - therapeutic use; Calcinosis - etiology; Calcinosis - parasitology; Child; Child, Preschool; Combined Modality Therapy; Echinococcosis - drug therapy; Echinococcosis - surgery; Echinococcosis - therapy; Echinococcosis, Hepatic - drug therapy; Echinococcosis, Hepatic - surgery; Echinococcosis, Hepatic - therapy; Echinococcosis, Pulmonary - drug therapy; Echinococcosis, Pulmonary - surgery; Echinococcosis, Pulmonary - therapy; Female; Hepatectomy - methods; Humans; Laparoscopy; Male; Multiple echinococcosis; Pediatrics; Pneumonectomy - methods; Prospective Studies; Recurrence; Surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2008.04.024

Abstract Background/Purpose Multiple echinococcosis (ME) is a severe disease in childhood inaccessible to an initial radical surgical treatment. The aim of this study was to evaluate the efficacy of Albendazole in ME and to discuss the role of surgery in this pathology. Methods Eleven patients were included in a prospective study between 1996 and 2004. ME was defined by the presence of 10 or more cysts in the same organ. Albendazole was given as 10 mg/kg daily continuously. Treatment outcome was defined as cure, improvement, stabilization or deterioration. Surgery was discussed after 1 year of treatment. Results Our patients totalized 296 cysts located essentially on the liver (178 cysts) and the lungs (78 cysts). With exclusive Albendazole therapy, 57.7% pulmonary cysts and 96% peritoneal cysts were considered as cured. This rate was only 31.5% in hepatic localization. After surgical therapy, 67.4% of hepatic cysts were cured. No productive biliary fistula was observed. Two patients were operated laparoscpically. The total treatment duration ranged between 1 and 5 years. Parasitologic examination of operated cysts showed that 30% of them were viable even after 3 years of treatment. Conclusion Albendazole has proven a strong efficacy in pulmonary and peritoneal localizations. A complementary surgical treatment is often necessary in hepatic localizations and it is facilitated with previous Albenazole therapy. Combination of ABZ and surgery seems to have encouraging results and must be applied for those patients. The high rate of viable cysts after medical therapy is problematic and must incite to develop new antihelminthic agents.