Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
PLoS Negl Trop Dis. 2022 Jan 28;16(1):e0010146. doi: 10.1371/journal.pntd.0010146. eCollection 2022 Jan.
Alveolar echinococcosis (AE) is an orphan zoonosis of increasing concern in endemic areas, including Europe. It frequently presents in an advanced, inoperable stage, that requires life-long parasitostatic benzimidazole therapy. In some patients, long-term therapy leads to negative anti-Em18 antibody ELISA and PET. It is disputed, whether these patients are truly cured and treatment can be safely discontinued. Our aim was to retrospectively assess long-term outcome of 34 patients with inoperable AE who participated in a previous study to determine feasibility of benzimidazole treatment cessation.
Retrospective analysis of medical charts was undertaken in all 34 AE patients who participated in our previous study. Of particular interest were AE recurrence or other reasons for re-treatment in patients who stopped benzimidazole therapy and whether baseline clinical and laboratory parameters help identify of patients that might qualifiy for treatment cessation. Additionally, volumetric measurement of AE lesions on contrast-enhanced cross-sectional imaging was performed at baseline and last follow-up in order to quantify treatment response.
12 of 34 patients stopped benzimidazole therapy for a median of 131 months. 11 of these patients showed stable or regressive AE lesions as determined by volumetric measurement. One patient developed progressive lesions with persistently negative anti-Em18 antibody ELISA but slight FDG-uptake in repeated PET imaging. At baseline, patients who met criteria for treatment cessation demonstrated higher lymphocyte count and lower total IgE.
Treatment cessation is feasible in inoperable AE patients, who demonstrate negative anti-Em18 antibody ELISA and PET on follow-up. Close monitoring including sectional imaging is strongly advised.
泡型包虫病（AE）是一种日益受到关注的孤儿性动物源性疾病，在流行地区包括欧洲。它常处于晚期、不可手术阶段，需要终身使用苯并咪唑类药物进行寄生虫抑制治疗。在一些患者中，长期治疗会导致 Em18 抗体 ELISA 和 PET 检测呈阴性。这些患者是否真正治愈以及能否安全停止治疗存在争议。我们的目的是回顾性评估 34 例参加过先前研究的不可手术 AE 患者的长期结局，以确定停止苯并咪唑治疗的可行性。
对 34 例参加过我们先前研究的 AE 患者的病历进行回顾性分析。特别关注的是停止苯并咪唑治疗的患者中 AE 复发或其他需要重新治疗的原因，以及基线临床和实验室参数是否有助于识别可能适合停止治疗的患者。此外，在基线和最后一次随访时对增强型横断面成像上的 AE 病变进行容积测量，以量化治疗反应。
34 例患者中有 12 例停止苯并咪唑治疗，中位时间为 131 个月。其中 11 例患者的 AE 病变通过容积测量显示稳定或退行性改变。1 例患者的病变进展，尽管抗 Em18 抗体 ELISA 持续阴性，但重复 PET 成像显示 FDG 摄取略有增加。在基线时，符合治疗停止标准的患者表现出更高的淋巴细胞计数和更低的总 IgE。
在不可手术的 AE 患者中，当他们在随访中表现出阴性的抗 Em18 抗体 ELISA 和 PET 时，可以停止治疗。强烈建议进行密切监测，包括影像学检查。
