Topic Highlight
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 7, 2012; 18(13): 1448-1458
Published online Apr 7, 2012. doi: 10.3748/wjg.v18.i13.1448
Hepatic echinococcosis: Clinical and therapeutic aspects
Giuseppe Nunnari, Marilia R Pinzone, Salvatore Gruttadauria, Benedetto M Celesia, Giordano Madeddu, Giulia Malaguarnera, Piero Pavone, Alessandro Cappellani, Bruno Cacopardo
Giuseppe Nunnari, Marilia R Pinzone, Benedetto M Celesia, Bruno Cacopardo, Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, 95125 Catania, Italy
Giuseppe Nunnari, Department of Microbiology and Immunology, Jefferson Medical College, Thomas Jefferson University, 19107 Philadelphia, United States
Salvatore Gruttadauria, Department of Surgery, University of Catania, 95100 Catania, Italy
Giordano Madeddu, Department of Clinical, Experimental and Oncological Medicine, Division of Infectious Diseases, University of Sassari, 07100 Sassari, Italy
Giulia Malaguarnera, Department of Biomedical Sciences, University of Catania, 95100 Catania, Italy
Piero Pavone, Department of Pediatrics and Pediatric Neurology, Azienda Ospedaliera Universitaria OVE-Policlinico, University of Catania, 95100 Catania, Italy
Alessandro Cappellani, Department of Surgery, General Surgery and Senology Unit, University of Catania, 95100 Catania, Italy
Author contributions: Nunnari G, Pinzone MR, Celesia BM and Cacopardo B contributed to the article design, drafting and revision; Gruttadauria S, Madeddu G, Malaguarnera G, Pavone P and Cappellani A contributed to the literature research, writing and revision; Nunnari G, Pinzone MR and Cacopardo B wrote, revised and formatted the paper. All authors approved the version to be published.
Correspondence to: Giuseppe Nunnari, MD, PhD, MPH, Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Via Palermo 636, 95125ARNAS Garibaldi Nesima, 95125 Catania, Italy. gnunnari@hotmail.com
Telephone: +39-095-7598443 Fax: +39-095-7598666
Received: July 2, 2011
Revised: September 20, 2011
Accepted: January 22, 2012
Published online: April 7, 2012
Abstract

Echinococcosis or hydatid disease (HD) is a zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoccus multilocularis (E. multilocularis) and Echinococcus granulosus (E. granulosus) infection, respectively. Cystic echinococcosis (CE) has a worldwide distribution, while hepatic alveolar echinococcosis (AE) is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the pericyst; old cysts typically present internal septations and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration (PAIR)] and more effective drugs (such as benzoimidazoles) have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

Keywords: Hydatidosis; Cystic echinococcosis; Alveolar echinococcosis; Liver; PAIR; Albendazole; Treatment; Diagnosis