{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T13:31:47Z","timestamp":1775050307304,"version":"3.50.1"},"reference-count":19,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,2]]},"abstract":"<jats:p>Human cystic echinococcosis (CE) is a chronic, complex and neglected infection causing severe disease in humans. Hepatic CE cysts are detected and classified mainly by using ultrasound. Expert opinion and published data suggest that uncomplicated inactive liver cysts do not require treatment and only need to be monitored over time (\u201cWatch and Wait\u201d). Here we update our findings as published in 2014 on the \u201cWatch and Wait\u201d approach applied to inactive, asymptomatic cysts of the liver to keep the medical community informed. Clinical data of patients who accessed the World Health Organization Collaborating Center for CE at the University of Pavia-San Matteo Hospital Foundation from January 1991 to October 2017 were analyzed. Inclusion criteria were presence of one or more inactive uncomplicated cysts in the liver (CE4 or CE5), without any history of previous treatment, and an ultrasound-based follow-up of at least 24 months. Fifty-three patients with 66 inactive cysts fulfilled the inclusion criteria. Of these, 11 patients are newly described here; 37 were part of our previously described cohort and the follow-up for 17 of them was further extended; and five were excluded from the previously published analysis as their follow-up was too short, but could be included now. Without the need for treatment and without development of complications, 98.5% of cysts remained inactive over time. In only one patient (1.9% of patients), a reactivation of one cyst (1.5% of cysts) was observed.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0164","type":"journal-article","created":{"date-parts":[[2018,6,5]],"date-time":"2018-06-05T07:00:51Z","timestamp":1528182051000},"page":"375-379","source":"Crossref","is-referenced-by-count":42,"title":["Watch and Wait Approach for Inactive Echinococcal Cyst of the Liver: An Update"],"prefix":"10.4269","volume":"99","author":[{"given":"Raffaella","family":"Lissandrin","sequence":"first","affiliation":[{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;"},{"name":"Unit of Infectious and Tropical Diseases, Istituto di Ricerca e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Tamarozzi","sequence":"additional","affiliation":[{"name":"Centre for Tropical Disease, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara","family":"Mariconti","sequence":"additional","affiliation":[{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Manciulli","sequence":"additional","affiliation":[{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;"},{"name":"PhD School of Experimental Medicine, University of Pavia, Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Brunetti","sequence":"additional","affiliation":[{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy;"},{"name":"Unit of Infectious and Tropical Diseases, Istituto di Ricerca e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambra","family":"Vola","sequence":"additional","affiliation":[{"name":"Unit of Infectious and Tropical Diseases, Istituto di Ricerca e Cura a Carattere Scientifico San Matteo Hospital Foundation, Pavia, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","author":"WHO Echinococcosis WHO\/OIE Manual on Echinococcosis","year":"2001"},{"key":"b2","series-title":"Trop Med Health","first-page":"283","article-title":"Human echinococcosis: a neglected disease?","volume":"35","author":"Craig","year":"2007"},{"key":"b3","series-title":"Radiographics","first-page":"475","article-title":"Hydatid disease from head to toe","volume":"23","author":"Polat","year":"2003"},{"key":"b4","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":"b5","series-title":"PLoS Negl Trop Dis","first-page":"e1880","article-title":"Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound?","volume":"6","author":"Stojkovic","year":"2012"},{"key":"b6","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":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0005243","article-title":"Watch and wait management of inactive cystic echinococcosis\u2013does the path to inactivity matter\u2013analysis of a prospective patient cohort","volume":"10","author":"Stojkovic","year":"2016"},{"key":"b8","series-title":"Acta Trop","first-page":"52","article-title":"The natural history of cystic echinococcosis in untreated and albendazole-treated patients","volume":"171","author":"Solomon","year":"2017"},{"key":"b9","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":"b10","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":"b11","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":"b12","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":"b13","series-title":"Acta Trop","first-page":"1","article-title":"Programme for ultrasound diagnoses and treatment with albendazole of cystic echinococcosis in asymptomatic carriers: 10 years of follow-up of cases","volume":"117","author":"Larrieu","year":"2011"},{"key":"b14","series-title":"Acta Trop","first-page":"182","article-title":"Cystic echinococcosis in Turkana, Kenya: 30 years of imaging in an endemic region","volume":"178","author":"Solomon","year":"2018"},{"key":"b15","series-title":"Am J Trop Med Hyg","first-page":"1472","article-title":"Prevalence and risk factors for human cystic echinococcosis in the Cusco region of the Peruvian highlands diagnosed using focused abdominal ultrasound","volume":"96","author":"Tamarozzi","year":"2017"},{"key":"b16","series-title":"PLoS Negl Trop Dis","first-page":"e0005384","article-title":"Human cystic echinococcosis in Morocco: ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership","volume":"11","author":"Chebli","year":"2017"},{"key":"b17","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":"b18","series-title":"Parasite Immunol","first-page":"549","article-title":"The immunology of parasite infections in immunocompromised hosts","volume":"28","author":"Evering","year":"2006"},{"key":"b19","series-title":"Parasit Vectors","first-page":"243","article-title":"The first meeting of the European Register of Cystic Echinococcosis (ERCE)","volume":"9","author":"Rossi","year":"2016"}],"container-title":["The American Journal of Tropical Medicine and 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