Personalized management of patients with inoperable alveolar echinococcosis undergoing treatment with albendazole: usefulness of positron-emission-tomography combined with serological and computed tomography follow-up

Abstract

The present study aimed to identify a sub-group of inoperable alveolar echinococcosis (AE) patients undergoing long-term treatment with benzimidazole (BZM) who presented with an evolution suggestive of a parasitocidal effect. An evolution compatible with parasite death was observed in five patients.

The Role of Delayed 18F-FDG PET Imaging in the Follow-up of Patients with Alveolar Echinococcosis

“…Previous studies have demonstrated the value of standard 18 F-FDG PET in the follow-up of patients with AE, and this imaging procedure is currently considered the best surrogate marker of parasite viability. It has especially been proposed for the detection of patients in whom the parasite had become inactive and in whom treatment interruption could be programmed (7,8,(10)(11)(12)22,23).…”

“…Moreover, according to WHO IWGE expert consensus (5), all patients underwent a separate ultrasound examination as a routine imaging technique, as well as multiphase CT or MR imaging, as a part of combined follow-up (22,23) when other tests suggested that disease-or treatment-related complications were present. However, as stated by the WHO IWGE expert consensus, the results of CT or MR imaging were not taken into consideration when decisions on treatment interruption were being made (5).…”

Multimodality imaging in diagnosis and management of alveolar echinococcosis: an update

“…Benzimidazoles (mebendazole and albendazole) are parasitostatic drugs that can be used against parasitic metacestodes (2,12,16). Although benzimidazoles are widely regarded as parasitostatic, it has been reported that they may, in some cases, exert parasiticidal effect and thus the treatment may be safely terminated after some time (37,40). On the other hand, these drugs have some side effects and are potentially teratogenic.…”

“…In contrast, 18F-fluorodeoxyglucose (FDG)-PET is suggested to show the viability and metabolic activity in AE lesions (16,36,37). An increased FDG uptake is observed in neoplastic and inflammatory-infectious lesions.…”

“…It is also debated how long the treatment should be continued, and a reliable parameter showing the effectiveness of chemotherapy is lacking. The basic reason for this is the difficulty in detecting the viability of the parasites in vivo (37). In a recent study, the combined use of FDG-PET and antibody levels against the recombinant EmII/3-10 antigen was reported as a promising method for assessing disease activity (48).…”