title: Increased incidence and characteristics of alveolar echinococcosis in patients with immunosuppression-associated conditions.
abstract: BACKGROUND
  An increased incidence of alveolar echinococcosis (AE) in patients with immunosuppression (IS) has been observed; our aim was to study this association and its characteristics.
  
  
  METHODS
  Fifty AE cases with IS-associated conditions (ISCs) before or at AE diagnosis were collected from the French AE registry (1982-2012, 509 cases). There were 30 cancers, 9 malignant hematological disorders, 14 chronic inflammatory diseases, 5 transplants, and 1 case of AIDS; 9 patients had ≥2 ISCs. Characteristics of the 42 IS/AE cases and the 187 non-IS/AE cases diagnosed during the period 2002-2012 were statistically compared.
  
  
  RESULTS
  There was a significant increase in IS/AE cases over time. Risk factors did not differ between IS/AE and non-IS/AE patients. However, AE was more frequently an incidental finding (78% vs 42%) and was diagnosed at earlier stages (41% vs 23%) in IS/AE than in non-IS/AE patients. Serology was more often negative (14% vs 1%) and treatment efficacy was better (51% regression after 1-year treatment vs 27%) in IS/AE patients. All IS/AE patients but 7 took IS drugs; 7 received biotherapeutic agents. When not concomitant, AE occurred in IS patients within a 48-month median time period. Atypical presentation and abscess-, hemangioma-, and metastasis-like images delayed AE diagnosis in 50% of IS/AE patients, resulting in inappropriate treatment. Liver images obtained for 15 patients 1-5 years before diagnosis showed no AE lesions. Albendazole efficacy was good, but 19 of 48 treated patients experienced side effects.
  
  
  CONCLUSIONS
  Patients with immunosuppression are at increased risk for occurrence, delayed diagnosis, and progression of AE.
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital Department of Hematology, University Hospital, Besançon.
authors.forename: Adrien
authors.initials: A
authors.lastname: Chauchet
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital UMR 6249 'Chrono-environment,'
authors.forename: Frédéric
authors.initials: F
authors.lastname: Grenouillet
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital UMR 6249 'Chrono-environment,'
authors.forename: Jenny
authors.initials: J
authors.lastname: Knapp
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital.
authors.forename: Carine
authors.initials: C
authors.lastname: Richou
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital.
authors.forename: Eric
authors.initials: E
authors.lastname: Delabrousse
authors.affiliation: Department of Internal Medicine, University Hospital, Grenoble.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Dentan
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital UMR 6249 'Chrono-environment,'
authors.forename: Laurence
authors.initials: L
authors.lastname: Millon
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital EA 4266 'Pathogens and inflammation,'
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.affiliation: Department of Pharmacy, Hospital of Belfort-Montbéliard, Belfort.
authors.forename: Remy
authors.initials: R
authors.lastname: Contreras
authors.affiliation: Department of Hematology, University Hospital, Besançon UMR 1098 'Graft-tumor-host interactions and cell and tissue engineering,'
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital EA 4662 'Nanomedicine, imagery, therapeutics,'
authors.forename: Oleg
authors.initials: O
authors.lastname: Blagosklonov
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital EA 3181 'Epithelial carcinogenesis; preventive and predictive factors,' Franche-Comté University, Besançon, France.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Vuitton
authors.affiliation: WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and French National Reference Centre on Alveolar Echinococcosis, Franche-Comté University and University Hospital UMR 6249 'Chrono-environment,'
authors.forename: Solange
authors.initials: S
authors.lastname: Bresson-Hadni
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis; D004443:Echinococcosis; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors
keywords: Echinococcus multilocularis; biotherapy; cancer; liver abscess; liver metastases