Velasco-Tirado Virginia, Romero-Alegría Ángela, Belhassen-García Moncef, Alonso-Sardón Montserrat, Esteban-Velasco Carmen, López-Bernús Amparo, Carpio-Perez Adela, Jimenez López Marcelo Fernando, Muñoz Bellido Juan Luis, Muro Antonio, Cordero-Sanchez Miguel, Pardo-Lledias Javier, Muñoz-Bellvis Luis
Servicio de Dermatologia Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Paseo San Vicente, Salamanca, Spain.
Servicio de Medicina Interna, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente, 58-182, 37007, Salamanca, Spain.
BMC Infect Dis. 2017 Jun 27;17(1):455. doi: 10.1186/s12879-017-2556-9.
Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence.
A descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122-0 to 122-9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015.
Among the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence's diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1-7.1; p < 0.05] when the cyst was located in organs other than liver and lung, 22.6% (7/31) vs 14.2% (31/217) in the cohort. We detected a chance of recurrence [OR = 2.3; 95% CI, 1.4-6.5; p > 0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%).
Despite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management.
囊型包虫病（CE）是一种慢性、复杂且被忽视的人畜共患病。囊型包虫病在全球范围内均有发生。在人类中，它可能导致广泛的临床表现，从无症状感染到致命疾病。临床管理程序在数十年间不断演变，但未得到充分评估。尽管手术技术和化疗的应用取得了进展，但复发仍然是包虫病管理中的主要问题之一。本研究的目的是确定囊型包虫病复发的频率以及复发所涉及的危险因素。
设计了一项描述性纵向回顾性研究。我们回顾了1998年1月至2015年12月期间在西班牙萨拉曼卡大学综合医院根据国际疾病分类第九版（ICD - 9，编码122 - 0至122 - 9）标准确诊为囊型包虫病的所有患者。
在研究的217例患者中，25例（11.5%）在接受根治性治疗后出现包虫复发。复发诊断的中位时间为12.35年（标准差：±9.31）。当囊肿位于肝脏和肺以外的器官时，复发的可能性更高[比值比（OR）= 2.7；95%置信区间（CI），1.1 - 7.1；P < 0.05]，该队列中分别为22.6%（7/31）和14.2%（31/217）。我们发现接受抗蠕虫治疗与手术干预联合治疗的患者（20/141，14.2%）复发几率[OR = 2.3；95% CI，1.4 - 6.5；P > 0.05]是仅接受手术干预患者（5/76，6.6%）的两倍。
尽管包虫病的诊断和治疗技术取得了进展，但复发仍然是包虫病管理中的主要问题之一。目前对复发的管理和治疗在很大程度上仍基于专家意见且证据质量中等到较差。因此，需要开展大型前瞻性多中心研究，以便为其临床管理提供明确的建议。
