Zasady rozpoznawania i leczenia bąblowicy wątroby wywoływanej przez Echinococcus multilocularis

Recent epidemiological reports have shown an increasing incidence of Echinococcus multilocularis infection among red foxes and inhabitants from Pomorskie, Warmińsko−Mazurskie and Podkarpackie Districts of Poland. The study describes the actual recommendations for a proper diagnosis and optimal treatment in patients infected with E. multilocularis in order to standardize diagnostic and therapeutic procedures for this severe parasitic disease by reference centres. Liver lesions caused by the parasite were visualised by ultrasonography and computerized tomography scan. The clinical diagnosis based on typical imaging findings was completed by Em2plus ELISA and Em16 and Em18 Western blot immunodiagnostic tests using specific antigens, and confirmed by positive histopathological and/or molecular examinations. Since 1992, forty−five cases of alveolar echinococcosis were registered in Poland. Professions related to forestry or picking−up mushrooms and blueberries were potential risk factors for an occurrence of the infection, especially in the northern region of the country. In the imaging techniques, the liver lesions were characterized by heterogenous, irregular masses with necrotic cavities, and clausters of calcifications located in the peripheral parts. The final diagnosis of alveococcosis was based on PAS−positive staining of lesions in histopathology and/or the detection of the parasite's DNA in liver sections by PCR. The patients were treated by radical surgery with concomitant long−term intensive chemotherapy with albendazole. Conclusions: Collaboration with physicians of various medical specialities is crucial for an early and more effective detection of alveococcosis in Poland. E. multilocularis infection should always be considered in the differential diagnosis of space−occupying lesions in the liver characterized by irregular heterogenous masses, suggesting slow tumor growth.