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3. Indications and results of liver transplantation for Echinococcus alveolar infection: an overview

Author

Bresson-Hadni, Solange, Koch, Stéphane, Miguet, Jean-Philippe, Gillet, Michel, Mantion, Georges-André, Heyd, Bruno, Vuitton, Dominique-Angèle, Bresson-Hadni, Solange, Koch, Stéphane, Miguet, Jean-Philippe, Gillet, Michel, Mantion, Georges-André, Heyd, Bruno, and Vuitton, Dominique-Angèle

Abstract

Background: Alveolar echinococcosis (AE) of the liver, caused by the larval stage of the fox tapeworm Echinococcus multilocularis, has the characteristics of a slow-growing liver cancer. It is one of the rare parasitic diseases for which a parasitolytic drug is not yet available, and AE is lethal in the absence of appropriate therapeutic management. Complete surgical resection of the parasite at an early stage of infection provides favourable prospects for cure, but, due to a long clinical latency, many cases are diagnosed at an advanced stage, so that partial liver resection can be performed in only 35% of patients. Benzimidazole (BZM) treatment is given in inoperable cases but these compounds are only parasitostatic, and lifelong therapy is required. During the past 20 years some centres have considered liver transplantation (LT) for the treatment of incurable AE. Methods: Our review summarizes the results of this experience based on a series of 47 European patients who received transplants between 1985 and 2002, tries to specify the real place of LT for AE, and underlines the measures that could be undertaken in the future to improve the results. Results: Five-year survival was 71%. Five-year survival without recurrence was 58%. Major technical difficulties related either to previous laparotomies or to the loco-regional involvement were observed. The nine early deaths concerned AE patients with a long past-history of symptomatic AE (iterative cholangitis, secondary biliary cirrhosis). Five late deaths were directly related to ongoing AE, located in the brain in three cases, a very rare AE location that was not investigated before LT in these patients. Conclusions: In general, the pre-LT screening for distant AE metastases appeared insufficient in this series. Heavy immunosuppressive schemes, absence or delayed re-introduction of BZM after LT have clearly played a role in this unfavourable course. This unique experience indicates that, despite major technical diff

Published
2018

4. Echinococcoe alvéolaire

Author

Bresson-Hadni , Solange, Chauchet , Adrien, Vuitton , D.A., Frédéric , Grenouillet, Knapp , J., Richou , C., Delabrousse , Eric, Blagosklonov , Oleg, Koch , Stéphane, Mantion , Georges André, Heyd , Bruno, Millon , Laurence, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service d'hématologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté (UFC), Service d'oncologie chirurgicale, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -hopital Jean Minjoz, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), and Université de Franche-Comté ( UFC )

Subjects
[SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, échinococcose alvéolaire, résection chirurgicale, transplantation hépatique, infection opportuniste, benzimidazolés, ComputingMilieux_MISCELLANEOUS, [ SDV.EE.SANT ] Life Sciences [q-bio]/Ecology, environment/Health, radiologie et endoscopie interventionnelles, echinococcus multiloculoris
Abstract

International audience

Published
2010

5. L’échinococcose alvéolaire humaine en France en 2010 / Box – Human alveolarechinococcosis in France, update 2010

Author

Grenouillet, Frédéric, Knapp, J., Millon, Laurence, Raton, Vincent, Richou, Carine, Piarroux, Martine, Piarroux, Renaud, Mantion, Georges André, Vuitton, D.A., Bresson-Hadni, Solange, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ), Entente de lutte interdépartementale contre les zoonoses ( ELIZ ), Etablissement Public Interdépartemental, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale ( SESSTIM ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -ORS PACA-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université de la Méditerranée - Aix-Marseille 2, WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Entente de Lutte Interdépartementale contre les Zoonoses (ELIZ), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Franche-Comté (UFC), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Entente de lutte interdépartementale contre les zoonoses (ELIZ), and Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)

Subjects
[SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, ComputingMilieux_MISCELLANEOUS, [ SDV.EE.SANT ] Life Sciences [q-bio]/Ecology, environment/Health
Abstract

International audience

Published
2010

6. Diagnosis and treatment of alveolar echinococcosis of the liver in immunocompromised patients

Author

Chauchet , Adrien, Richou , C., Grenouillet , Frédéric, Vuitton , Dominique Angèle, Blagosklonov , Oleg, Dupond , Jean-Louis, Delabrousse , Eric, Di Martino , Vincent, Deconinck , Eric, Millon , Laurence, Mantion , Georges André, Bresson-Hadni , Solange, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Dept. of Nucl. Med., Jean Minjoz Univ. Hosp., Besancon, Agents pathogènes et inflammation - UFC (EA 4266) ( API ), Service greffe de moelle osseuse, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Service de Médecine nucléaire, biophysique, isotopes [CHRU Besançon], Agents pathogènes et inflammation - UFC (EA 4266) (API), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)

Subjects
[SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, ComputingMilieux_MISCELLANEOUS, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology
Abstract

International audience

Published
2010

7. Em+ Elisa: a serological test able to predict long term outcome in inoperable alveolar echinococcosis patients under benzimidazole therapy

Author

Richou, Carine, Grenouillet, Frédéric, Delabrousse, Eric, Blagosklonov, Oleg, Ma, Shu Mei, Millon, Laurence, Mantion, Georges André, Di Martino, Vincent, Bresson-Hadni, Solange, WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Service de Médecine nucléaire, biophysique, isotopes [CHRU Besançon], Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté ( UFC ), Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Dept. of Nucl. Med., Jean Minjoz Univ. Hosp., Besancon, and Agents pathogènes et inflammation - UFC (EA 4266) ( API )

Subjects
[ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, ComputingMilieux_MISCELLANEOUS, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology
Abstract

International audience

Published
2009

8. Survival strategy of Echinococcus multilocularis in the human host

Author

Vuitton, Dominique-Angèle, Zhang, S.-L., Yang, Y., Godot, Véronique, Beurton, Isabelle, Mantion, Georges André, Bresson-Hadni, Solange, WHO Collaborating Center on Prevention and Treatment of Human Echinococcosis, Université de Franche-Comté ( UFC ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), and Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)

Subjects
[SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology
Abstract

International audience; As exemplified by "aborted" calcified liver lesions commonly found in patients from endemic areas, Echinococcus multilocularis metacestodes develop only in a minority of individuals exposed to infection with the papasite. Clinical research has disclosed some aspects of the survival strategy of E. multilocularis in human hosts. Clinical observations in liver transplantation and AIDS suggest that suppression of cellular/Th1-related immunity increases disease severity. Most of the studies have stressed a role for CD8+ T cells and for Interleukin-10 in the development of tolerance. A spontaneous secretion of IL-10 by the PBMC seems to be the immunological hallmark of patients with progressive forms of alveolar echinococcosis (AE). IL-10-induced inhibition of effector macrophages, but also of antigen-presenting dendritic cells, may be operating and allowing parasite growth and survival. The genetic correlates of susceptibility to infection with E. multilocularis are clearer in humans than in the mouse model. A significant link between MHC polymorphism and clinical presentation of AE has been shown, and the spontaneous secretion of IL-10 in patients with a progressive AE is higher in patients with the HLA DR3+, DQ2+ haplotype. Clustering of cases in certain families, in communities otherwise exposed to similar risk factors, also points to immuno-genetic predisposition factors that may allow the larva to escape host immunity more easily. The first stage of larval development may be crucial in producing "danger signals" stimulating the initial production of cytokines. Therapeutic use of Interferon alpha is an attempt to foil the survival strategy of E. multilocularis.

Published
2006

11. Indications and results of liver transplantation for Echinococcus alveolar infection: an overview

Author

Bresson-Hadni, Solange, Koch, Stéphane, Miguet, Jean-Philippe, Gillet, Michel, Mantion, Georges-André, Heyd, Bruno, Vuitton, Dominique-Angèle, Bresson-Hadni, Solange, Koch, Stéphane, Miguet, Jean-Philippe, Gillet, Michel, Mantion, Georges-André, Heyd, Bruno, and Vuitton, Dominique-Angèle

Abstract

Background: Alveolar echinococcosis (AE) of the liver, caused by the larval stage of the fox tapeworm Echinococcus multilocularis, has the characteristics of a slow-growing liver cancer. It is one of the rare parasitic diseases for which a parasitolytic drug is not yet available, and AE is lethal in the absence of appropriate therapeutic management. Complete surgical resection of the parasite at an early stage of infection provides favourable prospects for cure, but, due to a long clinical latency, many cases are diagnosed at an advanced stage, so that partial liver resection can be performed in only 35% of patients. Benzimidazole (BZM) treatment is given in inoperable cases but these compounds are only parasitostatic, and lifelong therapy is required. During the past 20 years some centres have considered liver transplantation (LT) for the treatment of incurable AE. Methods: Our review summarizes the results of this experience based on a series of 47 European patients who received transplants between 1985 and 2002, tries to specify the real place of LT for AE, and underlines the measures that could be undertaken in the future to improve the results. Results: Five-year survival was 71%. Five-year survival without recurrence was 58%. Major technical difficulties related either to previous laparotomies or to the loco-regional involvement were observed. The nine early deaths concerned AE patients with a long past-history of symptomatic AE (iterative cholangitis, secondary biliary cirrhosis). Five late deaths were directly related to ongoing AE, located in the brain in three cases, a very rare AE location that was not investigated before LT in these patients. Conclusions: In general, the pre-LT screening for distant AE metastases appeared insufficient in this series. Heavy immunosuppressive schemes, absence or delayed re-introduction of BZM after LT have clearly played a role in this unfavourable course. This unique experience indicates that, despite major technical diff

12. Imaging aspects and non-surgical interventional treatment in human alveolar echinococcosis.

Author

Bresson-Hadni S, Delabrousse E, Blagosklonov O, Bartholomot B, Koch S, Miguet JP, Mantion GA, and Vuitton DA

Subjects
Animals, Humans, Magnetic Resonance Imaging, Positron-Emission Tomography, Tomography, X-Ray Computed instrumentation, Ultrasonography, Echinococcosis, Hepatic diagnostic imaging, Echinococcosis, Hepatic therapy
Abstract

Alveolar echinococcosis (AE) of the liver caused by the metacestode of the fox tapeworm Echinococcus multilocularis is characterized by a multivesicular structure surrounded by an extensive fibro-inflammatory host reaction. The lesions behave like a slow-growing liver cancer, without sharp limits between the parasitic tissue and the liver parenchyma. Invasion of biliary and vascular walls is another hallmark of this severe disease. Moreover, the poor vascularization of the parasitic mass often leads to necrosis in the central part of the lesion. This explains why liver abscess due to superimposed bacterial infection of the necrotic area may occur in this disease. Currently, a range of imaging techniques can be used at the different stages of management of AE. For diagnosis, ultrasonography remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computerized tomography, Magnetic Resonance (MR) imaging, including cholangio-MR imaging are of importance, providing useful complementary information. More recently, Positive-Emission Tomography using [18F] fluoro-deoxyglucose has been developed for the follow-up of inoperable AE patients under long-term benzimidazoles therapy. This approach seems very promising to assess inflammatory activity and thereby to indirectly depict parasitic activity. Non-surgical interventional procedures, mainly percutaneous biliary and/or centro-parasitic abscesses drainages, are currently a major aspect in the care of incurable AE patients and have largely contributed to the improvement of survival in this situation during the past 20 years. They may also be used as a bridge before a curative surgical procedure in symptomatic patients presenting a life-threatening bacterial and/or fungal infection. It is also very useful in inoperable patients to overcome similar infectious episodes.

Published
2006
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