Cystic Echinococcosis: Chronic, Complex and Still Neglected

Cystic echinococcosis is a most clinically neglected
parasitic disease that urgently needs attention.
A valuable tool for diagnosing,
staging, and following up patients, ultrasound,
is readily available. Four management
procedures, surgery, percutaneous
sterilization techniques, anti-parasitic
treatment, and watch & wait, have
‘‘evolved’’ over decades, and been recently
summarized, but without adequate
comparative evaluation of efficacy, effectiveness,
rate of adverse events, relapse
rates, and cost. Clinical decision making is
on even shakier ground for extrahepatic
and extrapulmonary locations, which are
rarer and numbers needed to build
comparative trials hard to come by. There
is an obligation to put at least what we
have on an appropriate evidence base by
conducting comparative clinical trials at
the scale and quality that allow answering
these important questions. As one of the
expected results, clear criteria for the
watch & wait option alone might already
save a substantial proportion of patients
from unnecessary interventions and save
health services money. Difficult chronic
diseases clustering in poor rural areas need
intelligent, creative approaches, and this
one urgently needs operational research
incorporating the particularities of resource-
poor settings into consideration.