Increased Incidence and Characteristics of Alveolar Echinococcosis in Patients With Immunosuppression-Associated Conditions
Increased Incidence and Characteristics of Alveolar Echinococcosis in Patients With Immunosuppression-Associated Conditions
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DOI：
10.1093/cid/ciu520
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发表时间：
2014-10-15
影响因子：
11.8
通讯作者：
Bresson-Hadni, Solange
中科院分区：
文献类型：
--
作者：
Chauchet, Adrien;Grenouillet, Frederic;Bresson-Hadni, Solange
背景在免疫抑制（IS）患者中，观察到泡状棘球蚴病（AE）的发病率增加;我们的目的是研究这种相关性及其特征。从法国AE登记研究（1982-2012年，509例病例）中收集了50例在AE诊断前或诊断时发生IS相关疾病（ISC）的AE病例。有30例癌症，9例恶性血液病，14例慢性炎症性疾病，5例移植，1例艾滋病; 9例患者有≥ 2个ISC。对2002-2012年确诊的42例IS/AE病例和187例非IS/AE病例的特征进行统计学比较。随着时间的推移，IS/AE病例显著增加。IS/AE和非IS/AE患者的风险因素无差异。然而，与非IS/AE患者相比，IS/AE患者中AE更常见于偶发结果（78% vs 42%），并且在早期阶段（41% vs 23%）被诊断。IS/AE患者的血清学阴性率更高（14% vs 1%），治疗疗效更好（治疗1年后51% vs 27%消退）。除7例患者外，所有IS/AE患者均服用IS药物; 7例患者接受生物制剂治疗。如果不是伴随治疗，IS患者在48个月的中位时间段内发生AE。50%的IS/AE患者的非典型表现和脓肿、血管瘤和转移样图像延迟了AE诊断，导致治疗不当。1- 5例患者在诊断前1-5年获得的肝脏图像显示无AE病变。阿苯达唑疗效较好，但有19例出现不良反应。免疫抑制患者发生AE、延迟诊断和进展的风险增加。
Background. An increased incidence of alveolar echinococcosis (AE) in patients with immunosuppression (IS) has been observed; our aim was to study this association and its characteristics.Methods. Fifty AE cases with IS-associated conditions (ISCs) before or at AE diagnosis were collected from the French AE registry (1982-2012, 509 cases). There were 30 cancers, 9 malignant hematological disorders, 14 chronic inflammatory diseases, 5 transplants, and 1 case of AIDS; 9 patients had >= 2 ISCs. Characteristics of the 42 IS/AE cases and the 187 non-IS/AE cases diagnosed during the period 2002-2012 were statistically compared.Results. There was a significant increase in IS/AE cases over time. Risk factors did not differ between IS/AE and non-IS/AE patients. However, AE was more frequently an incidental finding (78% vs 42%) and was diagnosed at earlier stages (41% vs 23%) in IS/AE than in non-IS/AE patients. Serology was more often negative (14% vs 1%) and treatment efficacy was better (51% regression after 1-year treatment vs 27%) in IS/AE patients. All IS/AE patients but 7 took IS drugs; 7 received biotherapeutic agents. When not concomitant, AE occurred in IS patients within a 48-month median time period. Atypical presentation and abscess-, hemangioma-, and metastasis-like images delayed AE diagnosis in 50% of IS/AE patients, resulting in inappropriate treatment. Liver images obtained for 15 patients 1-5 years before diagnosis showed no AE lesions. Albendazole efficacy was good, but 19 of 48 treated patients experienced side effects.Conclusions. Patients with immunosuppression are at increased risk for occurrence, delayed diagnosis, and progression of AE.