EchiNam: multicenter retrospective study on the experience, challenges, and pitfalls in the diagnosis and treatment of alveolar echinococcosis in Belgium

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Abstract

Objectives

The aim of this retrospective study was to collect epidemiological, clinical, laboratory, imaging, management, and follow-up data on cases of alveolar echinococcosis (AE) diagnosed and/or followed up within the Namur Hospital Network (NHN) in order to gather information on the challenges, pitfalls, and overall experience in the diagnosis and treatment of AE.

Methods

EchiNam was a multicenter retrospective study. Patients diagnosed and/or treated for probable or confirmed AE in the NHN between 2002 and 2023 were included in the study. Patient selection was based on diagnosis codes, laboratory results, and albendazole (ABZ) dispensing.

Results

A total of 22 AE cases were retrieved, of which four were classified as probable and 18 as confirmed cases. Nine patients were either asymptomatic or had symptoms attributed to another disease. Clinical examination yielded pathologic findings in 10 patients. The median duration from the first AE-suggestive laboratory abnormalities to diagnosis was 176 days, and the median duration from the first AE-related imaging abnormalities to diagnosis was 133 days. Overall, 12 patients underwent surgical resection, with only four achieving complete lesion resection. Nine patients experienced ABZ-related adverse effects, with temporary ABZ discontinuation in five.

Conclusion

Due to various factors such as a long incubation period and a lack of awareness among Belgian physicians, AE is often diagnosed at advanced disease stages. Treatment then becomes more complex or even suboptimal, resulting in prolonged therapy, higher risk of adverse effects, significantly impaired quality of life, poor prognosis, and higher mortality rates. Measures should be taken to achieve early diagnosis in endemic areas.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10096-024-04996-4.

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Most cited references 3

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WHO classification of alveolar echinococcosis: principles and application.

Peter Kern, Hao Wen, Naoki Sato … (2006)

Alveolar echinococcosis is caused by the larval stage of the fox tapeworm (Echinococcus multilocularis) and is frequently diagnosed as a space occupying lesion in the liver. The growth pattern resembles that of a malignant tumor with infiltration throughout the liver, spreading into neighbouring organs and metastases formation in distant organs. Thus, one of the prevailing differential diagnoses is liver cancer. Guided by the Tumor-Node-Metastasis (TNM) system of liver cancer, the European Network for Concerted Surveillance of Alveolar Echinococcosis and the WHO Informal Working Group on Echinococcosis proposed a clinical classification for alveolar echinococcosis. It was designated as PNM system (P = parasitic mass in the liver, N = involvement of neighbouring organs, and M = metastasis). As for TNM in oncology, single PNM categories were combined into four stages, I to IV. The system was developed by a retrospective analysis of 97 patients' records from two treatment centers (Besançon/France and Ulm/Germany). Recently, this WHO classification was applied to 222 patients in 4 clinical centers around the world (Besançon/France, n = 26; Urumqi/China, n = 46; Sapporo/Japan, n = 58; and Ulm/Germany, n = 92). All patients could be classified who had been diagnosed in the period from January 1998 to June 2005. The stage grouping indicated center differences, but appeared to segregate patients according to various treatment regimens. The WHO classification not only serves as a tool for the international standardization of disease manifestation but also aids to evaluate the outcome of a chosen diagnostic and treatment procedure in different treatment centers in Europe and Asia.

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Threat of alveolar echinococcosis to public health--a challenge for Europe.

Bruno Gottstein, Marija Stojkovic, Dominique A. Vuitton … (2015)

Alveolar echinococcosis (AE) is a neglected 'malignant' parasitic disease. The European endemic area of Echinococcus multilocularis in foxes is larger than previously anticipated, and there is new evidence that both fox populations and the prevalence of E. multilocularis have increased in many areas, indicating increased pressure for infection with E. multilocularis eggs in intermediate and accidental hosts, including humans. This may result in more human AE cases within the next decades. Current numbers of both immunocompetent and immunocompromised AE patients, and the anticipated future increase, call for scaling-up research to rapidly improve the development and implementation of prevention measures, early diagnosis, and curative treatment of human AE.

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Echinococcus multilocularis in Europe--state of the art.

T Romig (2009)

New information has become available on the epidemiological situation of Echinococcus multilocularis in Europe. Additional endemic areas have been identified, and, in some areas, prevalences in foxes have drastically increased. In addition, some neozootic mammals may by now be involved in the lifecycle. The parasite is now widespread in urban and suburban areas in central Europe. The number of human cases of alveolar echinococcosis is small, but still underreported, and is likely to increase in the near future. Trials to counteract the spread of this parasite have been performed by application of anthelmintics to foxes via baits, and gave encouraging results on different spatial scales.

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Author and article information

Contributors

Pierre-Emmanuel Plum:

ORCID: http://orcid.org/0009-0007-1914-8637

pierreemmanuelplum@gmail.com

Journal

Journal ID (nlm-ta): Eur J Clin Microbiol Infect Dis

Journal ID (iso-abbrev): Eur J Clin Microbiol Infect Dis

Title: European Journal of Clinical Microbiology & Infectious Diseases

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0934-9723

ISSN (Electronic): 1435-4373

Publication date (Electronic): 25 November 2024

Publication date PMC-release: 25 November 2024

Publication date (Print): 2025

Volume: 44

Issue: 2

Pages: 263-275

Affiliations

[1 ]Department of Infectious Diseases, CHU UCL Namur (Site Godinne), Université catholique de Louvain, ( https://ror.org/02495e989) Avenue Dr Gaston Thérasse 1, Yvoir, 5530 Belgium

[2 ]Department of Infectious Diseases, CHU UCL Namur (Site Namur), Université catholique de Louvain, ( https://ror.org/02495e989) Namur, Belgium

[3 ]Department of Infectious Diseases, Centre Hospitalier Régional de Namur (Site Namur), ( https://ror.org/00kc2sb72) Namur, Belgium

[4 ]Department of Clinical Microbiology, Centre Hospitalier Régional de Namur (Site Namur), ( https://ror.org/00kc2sb72) Namur, Belgium

[5 ]HPB Surgery Unit, CHU UCL Namur (Site Godinne), Université catholique de Louvain, ( https://ror.org/02495e989) Yvoir, Belgium

[6 ]National Reference Laboratory for Echinococcosis, Department of Clinical Microbiology, University Hospital of Liège (CHU Liège), ( https://ror.org/044s61914) Liège, Belgium

[7 ]Department of Abdominal Surgery and Transplantation, University Hospital of Liège (CHU Liège), ( https://ror.org/044s61914) Liège, Belgium

[8 ]Department of Infectious Diseases, University Hospital of Liège (CHU Liège), ( https://ror.org/044s61914) Liège, Belgium

[9 ]Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles, ( https://ror.org/01r9htc13) Brussels, Belgium

[10 ]Department of Clinical Microbiology, CHU UCL Namur (Site Godinne), Université catholique de Louvain, ( https://ror.org/02495e989) Yvoir, Belgium

Author information

Pierre-Emmanuel Plum http://orcid.org/0009-0007-1914-8637

Article

Publisher ID: 4996

DOI: 10.1007/s10096-024-04996-4

PMC ID: 11754326

PubMed ID: 39585582

SO-VID: 79044eea-0f39-4e6e-bc67-df06ac157198

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 27 July 2024

Date accepted : 17 November 2024

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: alveolar echinococcosis,challenges,pitfalls,diagnosis,treatment,belgium

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: alveolar echinococcosis, challenges, pitfalls, diagnosis, treatment, belgium

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EchiNam: multicenter retrospective study on the experience, challenges, and pitfalls in the diagnosis and treatment of alveolar echinococcosis in Belgium

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Abstract

Objectives

Methods

Results

Conclusion

Supplementary Information

Related collections

Zoonoses

Most cited references 3

WHO classification of alveolar echinococcosis: principles and application.

Threat of alveolar echinococcosis to public health--a challenge for Europe.

Echinococcus multilocularis in Europe--state of the art.

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Contributors

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