title: Structured treatment interruption in patients with alveolar echinococcosis.
abstract: In human alveolar echinococcosis (AE), benzimidazoles are given throughout life because they are only parasitostatic. It has been a longstanding goal to limit treatment, and recent reports suggest that, in selected cases, benzimidazoles may be parasitocidal. Previously, we showed that positron -emission tomography (PET) using [(18)F]fluoro-deoxyglucose discriminates active from inactive lesions in AE. We have now performed a 3-year prospective study in 23 patients and conducted a structured treatment interruption in those without signs of PET activity. Disease progression was further assessed by ultrasound, computerized tomography, laboratory parameters, and clinical examination. We found PET-negative lesions in 15 of 23 patients and benzimidazoles were discontinued in these patients. After 18 months, patients were reevaluated, and, of the 15 initially PET-negative patients, 8 showed either new activity on PET (n = 6) or signs of clinical progression (n = 2). Reinitiation of benzimidazoles halted parasite growth again. No further progression was detected after 36 months. PET had a sensitivity of 91% for the detection of active lesions. In conclusion, despite successful suppression of metabolic activity, in most cases benzimidazoles do not kill the parasite. PET is a reliable tool for assessing metabolic activity and for timely detection of relapses. Neither duration of treatment, kind of treatment, lesion size, calcifications, or regressive changes reliably indicate parasite death. We discourage the discontinuation of benzimidazoles in inoperable AE even after many years of treatment. However, patients with a poor compliance of benzimidazole intake or patients suffering from side effects to benzimidazoles might be assessed for PET negativity. If permanent discontinuation of benzimidazoles is attempted, the course of disease should be followed by PET.
authors.affiliation: Section of Infectious Diseases and Clinical Immunology, Department of Medicine III, University Hospital of Ulm, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Reuter
authors.forename: Andreas
authors.initials: A
authors.lastname: Buck
authors.forename: Burkhard
authors.initials: B
authors.lastname: Manfras
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kratzer
authors.forename: Hanns Martin
authors.initials: HM
authors.lastname: Seitz
authors.forename: Kassa
authors.initials: K
authors.lastname: Darge
authors.forename: Sven Norbert
authors.initials: SN
authors.lastname: Reske
authors.forename: Peter
authors.initials: P
authors.lastname: Kern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000871:Anthelmintics / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D004445:Echinococcosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000000981:diagnostic imaging / Q000469:parasitology / Q000473:pathology; D012008:Recurrence; D014055:Tomography, Emission-Computed
chemical_list: D000871:Anthelmintics; D001562:Benzimidazoles; D019788:Fluorodeoxyglucose F18; C031000:benzimidazole