61 - Freie Mitteilung
HPB II & general oncology
16. Mai 2019, 13:45 - 15:15, Bellavista 5, 6. OG
Treatment of alveolar echinococcosis in immunocompromised and immunocompetent patients
A. Lachenmayer, D. Gebbers, D. Candinas, G. Beldi, Presenter: A. Lachenmayer (Bern)
Human alveolar echinococcosis (AE) is a zoonosis caused by metacestodes shed by feces of wild foxes. For this study we aimed to address the hypothesis that AE is an opportunistic disease by using epidemiological data.
Retrospective analysis of 131 patients with a median age of 54 years treated for AE between 1971 and 2017 at a swiss high-volume university center. Fifty-two % were females and 65 (49.6%) patients were diagnosed incidentally. Fourteen patients (15.9%) were operated laparoscopically. Overall median follow-up was 48 months.
A significant increase of new diagnoses in general and of coexisting immunosuppressive conditions in the past decade were observed (p ≤ 0.005). Fourty-one (31.3%) patients had co-existing or previous immunosuppressive conditions including 16 (36%) malignancies, 11 (31%) auto-immune diseases or immunosuppressive therapies, 5 (11%) infectious diseases, 4 (9%) chronic asthma conditions, 2 (4%) previous transplantations and 4 (9%) other immune compromising conditions. Serologies of EM18, EM2 and EgHF were not associated with mmunocompetentce at diagnosis, but significantly decreased after treatment with Benzimidazole (n=43) or surgery (n=88). Neoadjuvant (p=0.042), adjuvant therapy for ≥ 1 year (p=0.007) with benzimidazole and resection status (R0) (p=0.002) were significantly correlated with recurrence-free survival. Survival at 5 and 10 years after surgery was 97.3% and 94.2%, respectively, and after conservative treatment 91.2% and 73%, respectively. Surgical approach (p=0.014) and immunocompetence (p=0.048) were significantly correlated with overall survival.
The incidence of human AE is increasing over the last decades that may not only be explained by the urban and rural increase of fox populations. We have observed an association of immunosuppressive conditions with both incidence and survival of AE. Therefore human AE may be considered at least in part as an opportunistic disease.