Alveolar echinococcosis: evaluation of therapeutic strategies

Introduction: Care management of patients with alveolar echinococcosis (AE), a rare, severe and orphan parasitic disease, is essentially based on expert consensus. Treatment strategies and recommendations have regularly been updated by the WHO-Informal Working Group on Echinococcosis, based upon the 35 years' experience, research and published papers from the main reference centers in Europe, Japan and China. Areas covered: This expert opinion covers the basics of benzimidazole chemotherapy and interventions used in the care management of patients with AE, and it summarizes the current status of potentially 'candidate' drugs. It closely follows and updates the statements of the last 'expert consensus' published in 2010, which includes radical resection of liver lesions whenever possible, and continuous and prolonged treatment with albendazole (ABZ) or mebendazole (MBZ) in all patients. It discusses the modalities of patient's follow-up and of a possible benzimidazole withdrawal in selected patients. Expert opinion: The authors of this review are convinced that for such a disease, organization of care management and involvement of the patient in his/her own care are as important as technical skills and drug efficacy. It is why they propose networking and multidisciplinary approach as a basis for progress. This should allow the constitution of well-characterized multicenter cohorts of patients and the implementation of prospective controlled studies. They also provide some practical recommendations that reflect the current practice in their reference center, especially regarding treatment initiation and follow-up, and the management of ABZ adverse effects.