Editing Echinococcosis (section)

==Treatment==
===Cystic===
[[File:Vuitton et al - International consensus on terminology - parasite200043-fig3.png|thumb|left|International consensus on nomenclature framework for cystic echinococcosis surgery]]

A number of therapy options are presently available. Treatment with [[albendazole]], whether combined or not with [[praziquantel]], is useful for smaller, uncomplicated cysts (< 5&nbsp;cm).<ref name="Ferrer Inaebnit 35–41">{{Cite journal |last1=Ferrer Inaebnit |first1=Ester |last2=Molina Romero |first2=Francesc Xavier |last3=Segura Sampedro |first3=Juan José |last4=González Argenté |first4=Xavier |last5=Morón Canis |first5=José Miguel |date=January 2022 |title=A review of the diagnosis and management of liver hydatid cyst |journal=Revista Española de Enfermedades Digestivas |volume=114 |issue=1 |pages=35–41 |doi=10.17235/reed.2021.7896/2021 |pmid=34034501 |doi-access=free }}</ref> Only 30% of cysts disappear with medical treatment alone. Albendazole is preferred twice a day for 1–5 months.<ref name="DPDxTapeworm">{{cite web |date=20 July 2009 |title=The Medical Letter (Drugs for Parasitic Infections) |url=http://www.dpd.cdc.gov/dpdx/hTML/PDF_Files/MedLetter/TapewormInfection.pdf |url-status=live |archive-url=https://web.archive.org/web/20100304174546/http://www.dpd.cdc.gov/dpdx/HTML/PDF_Files/MedLetter/TapewormInfection.pdf |archive-date=4 March 2010 |publisher=DPDx, CDC}}</ref> An alternative to albendazole is [[mebendazole]] for at least 3 to 6 months.

Surgery is indicated for bigger liver cysts (> 10 cm), cysts at risk of rupture and/or complicated cysts. A [[Laparoscopy|laparoscopic]] approach provides excellent cure rates with minimal [[morbidity]] and [[death|mortality]].<ref>{{cite journal |author=Jani K |date=July 2014 |title=Spillage-free laparoscopic management of hepatic hydatid disease using the hydatid trocar canula |journal=J Minim Access Surg |volume=10 |issue=3 |pages=113–8 |doi=10.4103/0972-9941.134873 |pmc=4083542 |pmid=25013326 |doi-access=free }}</ref> The radical technique (total cystopericystectomy) is preferable because of its lower risk for postoperative abdominal infection, [[biliary fistula]], and overall morbidity. Conservative techniques are appropriate in [[Endemic (epidemiology)|endemic]] areas where surgery is performed by nonspecialist surgeons.<ref name="Ferrer Inaebnit 35–41"/>

[[PAIR (puncture-aspiration-injection-reaspiration)]]<ref name="Eckert04" /> is an innovative technique representing an alternative to surgery. PAIR is a [[minimally invasive procedure]] that involves three steps: puncture and needle aspiration of the cyst, injection of a [[scolicidal]] solution for 20–30 min, and cyst-re-aspiration and final irrigation. People who undergo PAIR typically take albendazole or mebendazole from 7 days before the procedure until 28 days after the procedure.<ref>{{Cite web |title=PAIR: Puncture, Aspiration, Injection, Re-aspiration An option for the treatment of cystic echinococcosis |url=https://www.who.int/publications-detail-redirect/WHO-CDS-CSR-APH-2001.6 |url-status=live |archive-url=https://web.archive.org/web/20220705123608/https://www.who.int/publications/i/item/WHO-CDS-CSR-APH-2001.6 |archive-date=5 July 2022 |access-date=5 July 2022 |website=www.who.int}}</ref> It is indicated for [[Operability|inoperable]] cases and/or patients who reject surgery, for recurrence after surgery, and lack of response to medical treatment.<ref name="Eckert04" /><ref name="Ferrer Inaebnit 35–41"/> There have been several studies that suggest that PAIR with medical therapy is more effective than surgery in terms of disease recurrence, and morbidity and mortality.<ref>{{cite journal |vauthors=Park KH, Jung SI, Jang HC, Shin JH |date=October 2009 |title=First successful puncture, aspiration, injection, and re-aspiration of hydatid cyst in the liver presenting with anaphylactic shock in Korea |journal=Yonsei Med. J. |volume=50 |issue=5 |pages=717–20 |doi=10.3349/ymj.2009.50.5.717 |pmc=2768250 |pmid=19881979}}</ref>

There is currently research and studies looking at new treatments involving [[percutaneous]] thermal ablation (PTA) of the germinal layer in the cyst using a [[radiofrequency ablation]] device. This form of treatment is still relatively new and requires much more testing before being widely used.<ref name="Eckert04" />

===Alveolar===
For alveolar echinococcosis, surgical removal of cysts combined with chemotherapy (using albendazole and/or mebendazole) for up to two years after surgery is the only sure way to completely cure the disease.<ref name=DPDxTapeworm/> However, in inoperable cases, chemotherapy by itself can also be used. In treatment using just chemotherapy, one could use either mebendazole in three doses or albendazole in two doses. Since chemotherapy on its own is not guaranteed to be completely rid of the disease, people are often kept on the drugs for extended periods (i.e. more than 6 months, years). In addition to surgery and chemotherapy, liver transplants are being looked into as a form of treatment for alveolar echinococcosis although it is seen as incredibly risky since it often leads to echinococcosis re-infection in the person afterwards.<ref name=Eckert04 />

===Polycystic===
Since polycystic echinococcosis is constrained to such a particular area of the world and is not well described or found in many people, treatment of polycystic echinococcosis is less defined than that of cystic and alveolar echinococcosis. While surgical removal of cysts was the treatment of choice for the previous two types of echinococcosis, chemotherapy is the recommended treatment approach for polycystic echinococcosis. While albendazole is the preferred drug, mebendazole can also be used if the treatment is to be for an extended period. Only if chemotherapy fails or if the lesions are very small is surgery advised.<ref name=Eckert04 />