Échinococcose alvéolaire : épidémiologie, surveillance et prise en charge

Human alveolar echinococcosis (AE) is a parasitic zoonosis with intermediate (rodents and lagomorphs) and final hosts (carnivores, mainly fox but also dogs). The latter can transmit the parasite to humans, by their feces, which are contaminated by the oncospheres of Echinococcus multilocularis, the larvae of which develop in the liver like a slow cancer. This chronically progressive disease may involve adjacent tissues and organs. Distant metastases may also be observed. Infected patient are frequently detected at earlier asymptomatic stage. Increasing fox populations, their invasion of the cities and the detection of the parasite in foxes from previously parasite-free areas seem to currently modify the epidemiology of AE. Patients' management must be multidisciplinary and includes (i) radical liver resection whenever possible, (ii) avoidance of palliative surgical procedures, (iii) use of interventional radiology or endoscopy to treat biliary and vascular complications whenever possible, (iv) indication of liver transplantation only in patients with life-threatening complications, (v) treatment of all patients without exception by albendazole for at least two years after radical surgery and long-term (at least several years) in non operated cases, (vi) use of positron-emission tomography combined with computed tomography (PET-CT) and specific serological tools to assess the functional activity of the lesions and monitor treatment, (vii) regular monitoring of albendazole plasmatic levels. Patients' survival and quality of life have improved very substantially, due to optimized care strategy.