Alveolar hydatid disease. A review of clinical features of 33 indigenous cases of Echinococcus multilocularis infection in Alaskan Eskimos

Abstract

The clinical features of 33 cases of alveolar hydatid disease (AHD) in Alaskan Eskimos and a review of the surgical experience with this disease are presented. Among untreated patients, progression of the disease to a fatal outcome was observed in 70%. The primary hepatic lesion resembles cancer, and errors in diagnosis by both the surgeon and pathologist are common. Although surgical resection of the entire primary hepatic lesion offers the only proven curative treatment, only 26% of those explored were resectable. All seven patients resected for cure are alive 6-27 years post-operatively (average survival, 14.7 years). A 5-year experience with continuous mebendazole therapy in the management of five nonresectable cases of AHD indicates that a favorable effect of this drug is being observed. It now appears that Echinococcus infections are no longer the sole province of the surgeon. Although the role of medical therapy is not yet clearly defined, it must be considered in the management of all cases of AHD. The first reported locally-acquired case of AHD in the conterminous United States, and the widespread occurrence and expanding range of E. multilocularis in the north-central United States and south-central Canada, point to the increasing public health importance of alveolar hydatid disease.