Alveolar echinococcosis in immunocompromised hosts.
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BORIS DOI
Date of Publication
May 2023
Publication Type
Article
Division/Institute
Contributor
Autier, Brice | |
Millon, Laurence | |
Ramharter, Michael | |
Gruener, Beate | |
Bresson-Hadni, Solange | |
Dion, Sarah | |
Robert-Gangneux, Florence |
Series
Clinical microbiology and infection
ISSN or ISBN (if monograph)
1469-0691
Publisher
Elsevier
Language
English
Publisher DOI
PubMed ID
36528295
Uncontrolled Keywords
Description
BACKGROUND
Alveolar echinococcosis (AE) results of an infection with the larval stage of Echinococcus multilocularis. It has been increasingly described in individuals with impaired immune responsiveness.
OBJECTIVES
This narrative review aims at describing the presentation of AE according to the type of immune impairment, based on retrospective cohorts and case reports. Implications for patient management and future research are proposed accordingly.
SOURCES
Targeted search was conducted in PubMed using ((alveolar echinococcosis) OR (multilocularis)) AND ((immunosuppressive) OR (immunodeficiency) OR (AIDS) OR (solid organ transplant) OR (autoimmunity) OR (immune deficiency)). Only publications in English were considered.
CONTENT
Seventeen publications were found, including 13 reports of 55 AE in immunocompromised patients (AE/IS) and 4 retrospective studies of 755 AE immunocompetent patients (AE/IC) and 115 AE/IS (13%). The cohorts included 9 (1%) solid organ transplantation (SOT) recipients, 2 (0.2%) HIV patients, 41 (4.7%) with chronic inflammatory/autoimmune diseases (I/AID) and 72 (8.3%) with malignancies. SOT, I/AID and malignancies, but not HIV infection, were significantly associated with AE (odds ratios of 10.8, 1.6, 5.9 and 1.3, respectively). Compared to AE/IC, AE/IS was associated with earlier diagnosis (PNM stages I-II: 49/85 (58%) vs 137/348 (39%), p<0.001), higher rate of atypical imaging (24/50 (48%) vs 106/375 (28%), p<0.01) and lower sensitivity of serology (19/77 (25%) vs 265/329 (81%), p<0.001). Unusually extensive or disseminated infections were described in SOT and I/AID patients.
IMPLICATIONS
Patients who live in endemic areas should benefit from serology before onset of a long-term immunosuppressive therapy, even if the cost-benefit ratio has to be evaluated. Physicians should explain AE to immunocompromised patients and think about AE when finding a liver lesion. Further research should address gaps in knowledge of AE/IS. Especially, extensive and accurate records of AE cases have to be collected by multinational registries.
Alveolar echinococcosis (AE) results of an infection with the larval stage of Echinococcus multilocularis. It has been increasingly described in individuals with impaired immune responsiveness.
OBJECTIVES
This narrative review aims at describing the presentation of AE according to the type of immune impairment, based on retrospective cohorts and case reports. Implications for patient management and future research are proposed accordingly.
SOURCES
Targeted search was conducted in PubMed using ((alveolar echinococcosis) OR (multilocularis)) AND ((immunosuppressive) OR (immunodeficiency) OR (AIDS) OR (solid organ transplant) OR (autoimmunity) OR (immune deficiency)). Only publications in English were considered.
CONTENT
Seventeen publications were found, including 13 reports of 55 AE in immunocompromised patients (AE/IS) and 4 retrospective studies of 755 AE immunocompetent patients (AE/IC) and 115 AE/IS (13%). The cohorts included 9 (1%) solid organ transplantation (SOT) recipients, 2 (0.2%) HIV patients, 41 (4.7%) with chronic inflammatory/autoimmune diseases (I/AID) and 72 (8.3%) with malignancies. SOT, I/AID and malignancies, but not HIV infection, were significantly associated with AE (odds ratios of 10.8, 1.6, 5.9 and 1.3, respectively). Compared to AE/IC, AE/IS was associated with earlier diagnosis (PNM stages I-II: 49/85 (58%) vs 137/348 (39%), p<0.001), higher rate of atypical imaging (24/50 (48%) vs 106/375 (28%), p<0.01) and lower sensitivity of serology (19/77 (25%) vs 265/329 (81%), p<0.001). Unusually extensive or disseminated infections were described in SOT and I/AID patients.
IMPLICATIONS
Patients who live in endemic areas should benefit from serology before onset of a long-term immunosuppressive therapy, even if the cost-benefit ratio has to be evaluated. Physicians should explain AE to immunocompromised patients and think about AE when finding a liver lesion. Further research should address gaps in knowledge of AE/IS. Especially, extensive and accurate records of AE cases have to be collected by multinational registries.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| 1-s2.0-S1198743X22006309-main.pdf | text | Adobe PDF | 1.19 MB | accepted |