Treatment challenges associated with bone echinococcosis.
OBJECTIVE
In this literature review, we concentrate on epidemiology and therapy of osseous echinococcosis, with an emphasis on the recurrence risk.


METHODS
Literature review 1930-2012.


RESULTS
We retrieved 200 publications based upon single case reports or case series, mostly from resource-poor settings. Among the 721 rural patients (22% females; median age 37 years), 60% of all reported cases were from the Mediterranean region and almost all patients were immune competent. Echinococcus granulosus was identified as the most frequent species. Most infections involved a single bone (602/721; 83%) and often the spine (321 cases; 45%). In eight cases (8/702; 1%), a secondary bacterial surgical site infection was reported. Surgical intervention was performed in 702 cases (97%), with single intervention in 687 episodes (95%). Complete excision of the lesion was possible in only 117 episodes (16%). Albendazole was by far the most frequently used agent in monotherapy with various dosages, while mebendazole in monotherapy was less frequent (32 cases). The median duration of antihelminthic therapy was 6 months (range 0.7-144 months). There were 124 recurrences (17%) after a median delay of 2 years (range 0.4-17 years). In multivariate analysis, the presence of visceral organ involvement increased the odds of recurrence by 5.4 (95% CI 3.1-9.4), whereas the number of surgical interventions, the duration of antihelminthic therapy or the use of hypertonic saline did not influence recurrence.


CONCLUSIONS
Bone echinococcosis is a rare parasitic disease. While treatment modalities vary considerably, combined surgical and medical approaches are the standard of care with a 17% risk of recurrence.
Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Sylvain
S
Steinmetz
Guillaume
G
Racloz
Richard
R
Stern
Dennis
D
Dominguez
Mohamed
M
Al-Mayahi
Manuel
M
Schibler
Daniel
D
Lew
Pierre
P
Hoffmeyer
Ilker
I
Uçkay
D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D001847:Bone Diseases / Q000188:drug therapy* / Q000453:epidemiology* / Q000469:parasitology / Q000601:surgery; D003646:Debridement; D004443:Echinococcosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000469:parasitology / Q000601:surgery; D048209:Echinococcus granulosus / Q000302:isolation & purification*; D006801:Humans; D008463:Mebendazole / Q000627:therapeutic use; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D000871:Anthelmintics; D008463:Mebendazole; D015766:Albendazole
benzimidazoles; epidemiology; orthopaedic surgery; recurrence