WHO guidelines for the treatment of patients with cystic echinococcosis

Overview

The purpose of these guidelines is to provide guidance on the choice of treatment so that patients (adults and children) with CE cysts can be offered and receive appropriate and equitable treatment. The aim is to ensure that patients receive the most appropriate and affordable management in the context of infrastructure and expertise sufficient to ensure its safety, and without unnecessary invasive procedures or treatment, to avoid iatrogenic complications by using invasive interventions.

For complicated CE liver cysts, surgery is usually the treatment of choice, based on best medical practice as conveyed by the WHO-IWGE. These guidelines are focused on the different choices for uncomplicated liver cysts. Pulmonary CE is usually managed by surgical intervention, but these guidelines evaluate the option of using ALB alone to treat small pulmonary cysts.

For uncomplicated inactive cysts, there are no recommendations in these guidelines since current best medical practice is follow-up with imaging (ultrasonography, CT or MRI), also known as the “watch and wait” approach. Surgery should be avoided as far as possible unless the inactive cyst is causing complications (e.g. cyst causing portal hypertension).

These guidelines were developed for clinicians, health facility managers and health practitioners practising at all levels of health services (primary, secondary and tertiary health care) and at all resource levels (low, middle-and high-income countries) that provide care for patients with CE. They were also developed to inform health care policy-makers, health system administrators, insurance companies and NTD programme implementors.