Orhun A, Müller-Stöver I, Holtfreter M C, Dedelen H, Häussinger D, Richter J
Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Germany.
Dtsch Med Wochenschr. 2012 May;137(20):1039-44. doi: 10.1055/s-0032-1304951. Epub 2012 May 8.
Cystic echinococcosis (CE) is a widespread zoonosis. Difficulties in patient care were investigated in order to improve the clinical management of CE patients.
65 patients with CE attending our service between 1999 and 2011 were interviewed for their history. Previous diagnostic findings were taken into account. Diagnosis, staging and therapy relied on laboratory and imaging findings.
56 patients were immigrants and nine of German origin. 55 of 59 evaluable patients had been living in rural areas for many years. 34 of 35 patients recalled dog contacts. Symptoms had indicated CE in 21 of 59 (36 %) cases only, whereas CE was mostly detected accidentally. Diagnosis was hampered by false negative serological results (IHA false negative in 11 of 60 cases [18 %], EIA in 8 of 53 [15 %]), the low frequency of eosinophilia (15/61 [25 %]) and of IgE increase (27/57 [47 %]). Percutaneous treatment or surgery was performed in active CE of the liver; disseminated CE was treated non-surgically. Inactive CE cases were monitored without any intervention. Relapses occurred in 7 of 51 (14 %) patients with follow-up: one after surgery, six after conservative treatment.
The diagnosis of CE is delayed by the paucity of characteristic symptoms and the inconsistency of serologic results. Assessment of cyst morphology and localisation are particularly important for diagnosis, staging and follow-up. CE requires an interdisciplinary management which should be coordinated by specialized infectious diseases centres.
