HUMAN CYSTIC ECHINOCOCCOSIS IN ENDEMIC REGIONS IN BULGARIA - ULTRASOUND SURVEILLANCE, TREATMENT AND FOLLOW-UP OF PATIENTS

Abstract

Introduction: Cystic echinococcosis (CE) is a chronic disease in humans, usually asymptomatic, but in some cases could be very severe with fatal outcomes. This parasitosis is a health and economic problem in many areas of the world. The actual spread among people with CE in endemic regions is not known. The purpose of prophylactic ultrasound examinations of people in some areas was to clarify the real prevalence of CE and to detect undiagnosed asymptomatic cases and recurrences. Materials and methods: An abdominal ultrasound survey in four endemic regions in Bulgaria with the highest rate of registered patients with CE in Bulgaria for the last five years was conducted. For every patient with CE an epidemiological and clinical history, abdominal ultrasound examination, blood tests and ELISA IgG test for CE were performed. Results: From all 8602 people examined, in seventeen persons (0.2%), liver hydatid cysts were found for the first time. Ssixty five (0.8%) reported a history of previous surgical treatment for CE, of which 54 (83.1%) had passed surgery because of liver CE and 11 (16.9%) had extrahepatic CE (pulmonary, cardiac, bone, spleen). In three (5.6%) patients, who were operated years before for liver CE, recurrences were discovered. In 11 (64.7%) patients devitalized CE4 cysts were observed without any data for previous treatment. Three of the discovered patients with CE were treated with surgery, one with puncture-aspiration-injection-reaspiration, four only with Albendazole. The patients were successfully treated and followed for a period of five years. Conclusions: During the prophylactic ultrasound examinations, a higher percentage of people infected with liver cystic echinococcosis was found compared to the official information. It should be noted that these results are found in areas with the highest incidence of this disease in the country. US screenings give the opportunity for early detection, timely treatment of infected people and to prevent severe complications in patient with CE disease.