Editing Echinococcosis (section)

==Treatment==

===Cystic===
[[File:Vuitton et al - International consensus on terminology - parasite200043-fig3.png|thumb|left|International consensus on nomenclature framework for cystic echinococcosis surgery]]

For simple cases of cystic echinococcosis, the most common form of treatment is open surgical removal of the cysts combined with chemotherapy using [[albendazole]] and/or [[mebendazole]] before and after surgery. However, if there are cysts in multiple organs or tissues, or the cysts are in risky locations, surgery becomes impractical. For inoperable cases such as these, chemotherapy and/or [[PAIR (puncture-aspiration-injection-reaspiration)]] become alternative options of treatment.<ref name=Eckert04 /> In the case of alternative treatment using just chemotherapy, albendazole is preferred twice a day for 1–5 months.<ref name=DPDxTapeworm>{{cite web |title=The Medical Letter (Drugs for Parasitic Infections) |date=20 July 2009 |publisher=DPDx, CDC |url=http://www.dpd.cdc.gov/dpdx/hTML/PDF_Files/MedLetter/TapewormInfection.pdf |url-status=live |archive-url=https://web.archive.org/web/20100304174546/http://www.dpd.cdc.gov/dpdx/HTML/PDF_Files/MedLetter/TapewormInfection.pdf |archive-date=4 March 2010  }}</ref> An alternative to albendazole is mebendazole for at least 3 to 6 months. The other alternative to surgery is PAIR with chemotherapy. PAIR is a minimally invasive procedure that involves three steps: puncture and needle aspiration of the cyst, injection of a [[scolicidal]] solution for 20–30 min, and cyst-re-aspiration and final irrigation. People who undergo PAIR typically take albendazole or mebendazole from 7 days before the procedure until 28 days after the procedure.{{cn|date=May 2021}}

While open surgery still remains as the standard for cystic echinococcosis treatment, there have been a number of studies that suggest that PAIR with chemotherapy is more effective than surgery in terms of disease recurrence, and morbidity and mortality.<ref>{{cite journal |vauthors=Park KH, Jung SI, Jang HC, Shin JH |title=First successful puncture, aspiration, injection, and re-aspiration of hydatid cyst in the liver presenting with anaphylactic shock in Korea |journal=Yonsei Med. J. |volume=50 |issue=5 |pages=717–20 |date=October 2009 |pmid=19881979 |pmc=2768250 |doi=10.3349/ymj.2009.50.5.717 }}</ref> In addition to the three above mentioned treatments, there is currently research and studies looking at new treatment involving percutaneous thermal ablation (PTA) of the germinal layer in the cyst by means of a radiofrequency ablation device. This form of treatment is still relatively new and requires much more testing before being widely used.<ref name=Eckert04 /> An alternative to open surgery is laparoscopic surgery, which provides excellent cure rates with minimal morbidity and mortality.<ref>{{cite journal |author=Jani K |title=Spillage-free laparoscopic management of hepatic hydatid disease using the hydatid trocar canula |journal=J Minim Access Surg |volume=10 |issue=3 |pages=113–8 |date=July 2014 |pmid=25013326 |pmc=4083542 |doi=10.4103/0972-9941.134873 }}</ref>

===Alveolar===
For alveolar echinococcosis, surgical removal of cysts combined with chemotherapy (using albendazole and/or mebendazole) for up to two years after surgery is the only sure way to completely cure the disease.<ref name=DPDxTapeworm/> However, in inoperable cases, chemotherapy by itself can also be used. In treatment using just chemotherapy, one could use either mebendazole in three doses or albendazole in two doses. Since chemotherapy on its own is not guaranteed to completely rid of the disease, people are often kept on the drugs for extended periods of times (i.e. more than 6 months, years). In addition to surgery and chemotherapy, liver transplants are being looked into as a form of treatment for alveolar echinococcosis although it is seen as incredibly risky since it often leads to echinococcosis re-infection in the person afterwards.<ref name=Eckert04 />

===Polycystic===
Since polycystic echinococcosis is constrained to such a particular area of the world and is not well described or found in many people, treatment of polycystic echinococcosis is less defined than that of cystic and alveolar echinococcosis. While surgical removal of cysts was the treatment of choice for the previous two types of echinococcosis, chemotherapy is the recommended treatment approach for polycystic echinococcosis. While albendazole is the preferred drug, mebendazole can also be used if the treatment is to be for an extended period of time. Only if chemotherapy fails or if the lesions are very small is surgery advised.<ref name=Eckert04 />