The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE)
for the treatment of human echinococcosis have had considerable impact in different
settings worldwide, but the last major revision was published more than 10 years ago.
Advances in classification and treatment of echinococcosis prompted experts from different
continents to review the current literature, discuss recent achievements and provide
a consensus on diagnosis, treatment and follow-up. Among the recognized species, two
are of medical importance -Echinococcus granulosus and Echinococcus multilocularis
- causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively.
For CE, consensus has been obtained on an image-based, stage-specific approach, which
is helpful for choosing one of the following options: (1) percutaneous treatment,
(2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making
depends also on setting-specific aspects. The usage of an imaging-based classification
system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery
followed by anti-infective prophylaxis with albendazole remains one of the key elements.
However, most patients with AE are diagnosed at a later stage, when radical surgery
(distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE
treatment remains the continuous medical treatment with albendazole, and if necessary,
individualized interventional measures. With this approach, the prognosis can be improved
for the majority of patients with AE. The consensus of experts under the aegis of
the WHO-IWGE will help promote studies that provide missing evidence to be included
in the next update.
Copyright 2009 Elsevier B.V. All rights reserved.