无症状带虫者包虫病的流行病学、诊断、治疗和随访。

Epidemiology, diagnosis, treatment and follow-up of cystic echinococcosis in asymptomatic carriers.

机构信息

National University of Río Negro, Choele Choel, Argentina.

Hospital Artémides Zatti, Viedma.

出版信息

Trans R Soc Trop Med Hyg. 2019 Feb 1;113(2):74-80. doi: 10.1093/trstmh/try112.

DOI:10.1093/trstmh/try112

PMID:30412239

Abstract

BACKGROUND

Río Negro Province is endemic for cystic echinococcosis (CE). A CE control program includes early diagnosis in humans. During 1980-1996, screening was done with serology and surgery was the unique choice of treatment. Since 1997, ultrasound (US) has been the method of choice for screening, and new choices of treatment for asymptomatic carriers are discussed in the CE guidelines.

METHODS

Between 1997 and 2016, 42 734 abdominal USs were performed, 192 new asymptomatic cases were diagnosed and underwent a protocol according to the size, location and type of cyst. Treatment options included active surveillance (US monitoring, 83 [43.3%]), antiparasitic (albendazole, 92 [47.9%]) and surgery (17 [8.8%], including percutaneous treatment).

RESULTS

After 7.7 y of follow-up, of the cases under active surveillance, 28 (33.7%) had to change treatment: 5 (6%) to surgery and 22 (26.5%) to albendazole. Of the patients treated with albendazole, 3 (3.2%) were operated on and 13 (14%) were treated with a second cycle of albendazole.

CONCLUSION

As a result of the present study, resolution of CE in a non-surgical way with albendazole is confirmed to be effective in asymptomatic carriers with CE1 or CE3a cysts. An update eliminates the strategy of active surveillance in type CE1 cysts <3 cm and is replaced by treatment with antiparasitic in all asymptomatic cases with CE1 or CE3a cysts <10 cm. The update also limits follow-up to 12-18 months to evaluate those cases with non-response to antiparasitic and switch to a surgical option.

摘要

背景

内格罗河省是囊型包虫病（CE）的地方性流行区。CE 控制规划包括对人类的早期诊断。1980-1996 年期间，采用血清学方法进行筛查，手术是唯一的治疗选择。自 1997 年以来，超声（US）已成为筛查的首选方法，CE 指南中讨论了针对无症状感染者的新治疗选择。

方法

1997 年至 2016 年间，共进行了 42734 次腹部 US 检查，诊断出 192 例新的无症状病例，并根据囊肿的大小、位置和类型制定了方案。治疗选择包括主动监测（US 监测，83 例[43.3%]）、驱虫（阿苯达唑，92 例[47.9%]）和手术（17 例[8.8%]，包括经皮治疗）。

结果

在 7.7 年的随访中，主动监测组中有 28 例（33.7%）需要改变治疗方案：5 例（6%）手术，22 例（26.5%）阿苯达唑。接受阿苯达唑治疗的患者中，有 3 例（3.2%）接受手术，13 例（14%）接受阿苯达唑第二个疗程治疗。

结论

本研究证实，对于 CE1 或 CE3a 囊肿的无症状感染者，用阿苯达唑非手术方式治愈 CE 是有效的。更新后的方案消除了 CE1 型<3cm 囊肿的主动监测策略，代之以所有 CE1 或 CE3a 型<10cm 囊肿的无症状感染者用驱虫药物治疗。更新后的方案还将随访时间限制在 12-18 个月，以评估那些对抗寄生虫治疗无反应的病例，并转为手术治疗。