title: Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004-2013: Comparison of Current Practices with Expert Recommendations.
abstract: Cystic echinococcosis (CE) is a clinically complex chronic parasitic disease, management options for which include surgery, percutaneous treatments, and treatment with albendazole (ABZ) for active cysts, and the "Watch-and-Wait" approach for uncomplicated, inactive cysts. We examined, retrospectively, the clinical management of 334 patients with hepatic CE from the southeastern Rhodope region of Bulgaria between 2004 and 2013. Cysts were reclassified according to the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) on the basis of ultrasound reports and images. The majority (62.3%) of uncomplicated cysts were CE1, 66% of which were treated surgically. Of all interventions, 5% were performed on inactive uncomplicated CE4-CE5 cysts. About half (47.6%) of these cysts were therefore treated inappropriately, exposing patients to unnecessary treatment-related risks and the health system to unnecessary costs. No management change was observed after the publication of the WHO-IWGE Expert Consensus recommendations in 2010. In Bulgaria, ABZ is still used in interrupted cycles as this is reimbursed, and peri-interventional chemoprophylaxis was not administered in the majority of surgical patients. Efforts are needed to introduce the WHO-IWGE classification and management recommendations and to encourage reception of state-of-the-art practices by public health regulatory bodies to improve patient quality of care and optimization of health resources.
authors.affiliation: Gastroenterology Ward, Multi-Profile Hospital for Active Treatment "Kardzhali," Kardzhali, Bulgaria; Department of Parasitology and Tropical Medicine, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy mukhtarov@abv.bg.
authors.forename: Marin
authors.initials: M
authors.lastname: Muhtarov
authors.affiliation: Gastroenterology Ward, Multi-Profile Hospital for Active Treatment "Kardzhali," Kardzhali, Bulgaria; Department of Parasitology and Tropical Medicine, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy.
authors.forename: Iskra
authors.initials: I
authors.lastname: Rainova
authors.affiliation: Gastroenterology Ward, Multi-Profile Hospital for Active Treatment "Kardzhali," Kardzhali, Bulgaria; Department of Parasitology and Tropical Medicine, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Tamarozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015766:Albendazole / Q000627:therapeutic use; D000923:Anticestodal Agents / Q000627:therapeutic use; D002031:Bulgaria; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004444:Echinococcosis, Hepatic / Q000145:classification / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D057832:Watchful Waiting / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000923:Anticestodal Agents; D015766:Albendazole
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