背景:囊性包虫病(CE)是一种被认为被忽视的慢性疾病。囊性包虫病是乌拉圭和该地区的地方病。手术,使用各种技术方法,具有安全地去除囊肿的潜力,并导致在大量具有简单形式的CE的患者中完全治愈。然而,在几个器官有多个囊肿的患者中,手术可能是不切实际的,手术风险高,或以前多次手术的患者。在这些情况下,单独使用苯并咪唑类药物阿苯达唑(ABZ)或与吡喹酮(PZQ)联合使用的药物治疗,一直有希望成为实现改善或治愈的最佳选择。
方法:在本研究中,我们分析了2003年至2020年间43例诊断为CE的患者的抗寄生虫治疗结果.在手术之前和/或之后用ABZ或ABZ/PZQ组合治疗患者。手术前抗寄生虫药物治疗的标准化方案为7天,15天或1个月,取决于外科手术的紧迫性和可用性。所有涉及肺部确认位置的病例都进行了立即手术,并在可能的情况下进行了最少的预处理。手术后,抗寄生虫药物治疗的标准化方案包括6个周期,每个周期30天,间隔15天.在所有情况下都使用ABZ,口服给药,每天两次,总剂量为15mg/kg/天,用脂肪含量高的食物改善吸收。根据WHO-IWGE指南进行了5年的随访。
结果:在43例患者中,有14例≤15岁,并接受了不同的术前治疗。从≥16岁开始,36人完成了治疗和5年的随访。四个病人改变了地理位置,没有转发联系人,术后治疗后。研究期间没有患者死亡。在完成研究的36名患者中,32例患者仅接受ABZ治疗;93.75%的患者通过改善或治愈获得治疗成功,6.25%的治疗失败,由无变化或恶化确定。最后4例患者接受ABZ/PZQ联合治疗,治疗成功率达到100%。
结论:药物治疗不仅是姑息治疗,而且是潜在治愈的良好选择。其使用的主要相关性是在先前多次手术或由于囊肿的数量和位置以及并发合并症而具有潜在危及生命的并发症的手术的情况下。建议至少5年的随访,以确保缓解和控制传播。需要更多的随机试验来为CE的不同药物治疗提供明确的临床证据。
BACKGROUND: Cystic echinococcosis (CE) is a chronic disease considered a neglected one. Cystic echinococcosis is endemic in Uruguay and the region. Surgery, using various technical approaches, has the potential to safely remove the cyst(s) and lead to a complete cure in a high number of patients with simple forms of CE. However, surgery may be impractical in patients with multiple cysts in several organs, high surgical risk, or in patients with previous multiple surgeries. In these cases, the pharmacological treatment with the benzimidazolic drug Albendazole (ABZ) alone or combined with Praziquantel (PZQ), has been promising as the best choice to achieve improvement or cure.
METHODS: In this study, we analyze the results obtained on the anti-parasitic treatment of 43 patients diagnosed with CE between the years 2003 and 2020. Patients were treated before and/or after surgery with ABZ or the combination ABZ/PZQ. The standardize protocol of the anti-parasitic drug treatment before surgery was 7 days, 15 days or 1 month depending on the urgency and availability of the surgical procedure. All cases that involved confirmed locations on lungs underwent immediate surgery with minimal pre-treatment when possible. After surgery, the standardize protocol of anti-parasitic drug treatment consisted of six cycles of 30 days each and resting intervals of 15 days in between. ABZ was used in all cases, administered orally, twice daily, at a total dosage of 15 mg/kg/day, with food high in fat content for improved absorption. The follow up was carried out according to WHO-IWGE guidelines for 5 years.
RESULTS: Of the 43 patients fourteen were ≤ 15 years of age and had a differentiated pre-surgical treatment. From the ≥ 16 years of age, 36 completed the treatments and the 5 years follow up. Four patients changed geographical locations, without a forwarding contact, after the post-surgery treatment. No patient died during the study. Of the 36 patients that completed the study, 32 were treated only with ABZ; 93.75% achieved treatment success as determined by improvement or cure, and 6.25% treatment failure determined by no change or worsening. The last four patients received the ABZ/PZQ combination therapy and achieved 100% treatment success.
CONCLUSIONS: The pharmacological treatment resulted in a good option not only as palliative but also as potentially curative. The main relevance of its use was in cases with previous multiple surgeries or surgeries with potential life-threatening complications due to the number and location of cysts and concurrent comorbidities. A follow-up of at least 5 years would be recommended to assure remission and control of the transmission. More randomized trials are needed to provide clear clinical evidence of different pharmacological treatments for CE.