Albendazole Treatment of Alveolar Echinococcosis in a Trial Based on a Cross Sectional Ultrasound Study in Kyrgyzstan.

BACKGROUND: Human alveolar echinococcosis (AE) is a potentially fatal parasitic disease. In the low-resource country of Kyrgyzstan, it is essential to develop protocols to manage the large number of AE cases being diagnosed. METHODS: A randomised trial was undertaken to explore the hypothesis that subjects with small AE lesions, detected by ultrasound, a wait and see approach could be adopted. Alternatively, subjects could be managed by albendazole and avoid invasive surgical treatment. One group of subjects with small P1N0M0 lesions was treated with albendazole. A second group remained untreated. A third group, with larger lesions, was either treated with albendazole or referred for surgical intervention. Patients were monitored for up to 2.5 years by ultrasound every 3-4 months. Subjects in the wait and watch group were switched to albendazole treatment if their lesions progressed. The study was registered at clinicaltrials.com. Registration number NCT07182305. RESULTS: Of the 97 subjects initially assigned to the wait and watch group, 22 had signs of lesion progression and were placed on albendazole therapy. Subjects on continuous albendazole therapy demonstrated a reduction in the mean lesion size during the course of the study. CONCLUSION: In hyperendemic areas of AE, wait and see for small lesions or combined with albendazole therapy is a realistic approach to the management of AE cases. Frequent follow up with imaging every 3-4 months is essential to monitor any disease progression.