{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:47:27Z","timestamp":1760204847572},"reference-count":16,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,4,6]]},"abstract":"<jats:p>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 \u201cWatch-and-Wait\u201d 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\u2013CE5 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.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0620","type":"journal-article","created":{"date-parts":[[2016,2,2]],"date-time":"2016-02-02T04:23:39Z","timestamp":1454387019000},"page":"900-905","source":"Crossref","is-referenced-by-count":9,"title":["Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004\u20132013: Comparison of Current Practices with Expert Recommendations"],"prefix":"10.4269","volume":"94","author":[{"given":"Marin","family":"Muhtarov","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iskra","family":"Rainova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Tamarozzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1423","article-title":"Cystic echinococcosis in Bulgaria 1996\u20132013, with emphasis on childhood infections","volume":"34","author":"Jordanova","year":"2015"},{"key":"ref2","series-title":"Acta Trop","first-page":"1","article-title":"Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans","volume":"114","author":"Brunetti","year":"2010"},{"key":"ref3","series-title":"Radiology","first-page":"459","article-title":"Ultrasound examination of the hydatic liver","volume":"139","author":"Gharbi","year":"1981"},{"key":"ref4","series-title":"Acta Trop","first-page":"253","article-title":"International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings","volume":"85","author":"WHO Informal Working Group","year":"2003"},{"key":"ref5","series-title":"World J Hepatol","first-page":"293","article-title":"Cystic echinococcosis of the liver: a primer for hepatologists","volume":"6","author":"Rinaldi","year":"2014"},{"key":"ref6","series-title":"Gastroenterol Res Pract","article-title":"Human echinococcosis: a neglected disease","volume":"2010","author":"da Silva","year":"2010"},{"key":"ref7","series-title":"Am J Trop Med Hyg","first-page":"301","article-title":"Clinical management of cystic echinococcosis: state of the art, problems, and perspectives","volume":"79","author":"Junghanss","year":"2008"},{"key":"ref8","series-title":"NMR Biomed","first-page":"734","article-title":"Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents","volume":"21","author":"Hosch","year":"2008"},{"key":"ref9","series-title":"Am J Trop Med Hyg","first-page":"48","article-title":"Efficacy and safety of PAIR for cystic echinococcosis: experience on a large series of patients from Bulgaria","volume":"84","author":"Golemanov","year":"2011"},{"key":"ref10","series-title":"BMC Infect Dis","first-page":"492","article-title":"Medical treatment versus \u201cWatch and Wait\u201d in the clinical management of CE3b echinococcal cysts of the liver","volume":"14","author":"Rinaldi","year":"2014"},{"key":"ref11","series-title":"PLoS Negl Trop Dis","first-page":"e524","article-title":"Treatment response of cystic echinococcosis to benzimidazoles: a systematic review","volume":"3","author":"Stojkovic","year":"2009"},{"key":"ref12","series-title":"Cardiovasc Intervent Radiol","first-page":"419","article-title":"Diagnosis and percutaneous treatment of soft-tissue hydatid cysts","volume":"30","author":"Akhan","year":"2007"},{"year":"2001","series-title":"PAIR: Puncture, Aspiration, Injection, Re-aspiration. An Option for the Treatment of Cystic Echinococcosis","author":"WHO Informal Working Group on Echinococcosis","key":"ref13"},{"key":"ref14","series-title":"PLoS Negl Trop Dis","first-page":"e3057","article-title":"Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a \u201cwatch-and-wait\u201d approach","volume":"8","author":"Piccoli","year":"2014"},{"key":"ref15","series-title":"Clin Infect Dis","first-page":"721","article-title":"Current management of cystic echinococcosis: a survey of specialist practice","volume":"60","author":"Nabarro","year":"2015"},{"key":"ref16","series-title":"Curr Opin Infect Dis","first-page":"425","article-title":"Acceptance of standardized ultrasound classification, use of albendazole, and long-term follow-up in clinical management of cystic echinococcosis: a systematic review","volume":"27","author":"Tamarozzi","year":"2014"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/94\/4\/article-p900.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/94\/4\/article-p900.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/94\/4\/article-p900.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T22:08:02Z","timestamp":1723068482000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/94\/4\/article-p900.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,4,6]]},"references-count":16,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.15-0620","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2016,4,6]]}}}