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World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage

World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage
WHO stage Description Stage Size Preferred treatment Alternate treatment
CE1 Unilocular unechoic cystic lesion with double line sign Active <5 cm Albendazole alone PAIR
>5 cm Albendazole + PAIR PAIR
CE2 Multiseptated, "rosette-like" "honeycomb" cyst Active Any Albendazole + either modified catheterization or surgery Modified catheterization
CE3a Cyst with detached membranes (water-lily sign) Transitional <5 cm Albendazole alone PAIR
>5 cm Albendazole + PAIR PAIR
CE3b Cyst with daughter cysts in solid matrix Transitional Any Albendazole + either modified catheterization or surgery Modified catheterization
CE4 Cyst with heterogenous hypoechoic/hyperechoic contents; no daughter cysts Inactive Any Observation -
CE5 Solid plus calcified wall Inactive Any Observation -
Albendazole is dosed 10 to 15 mg/kg per day in two divided doses; the usual dose for adults is 400 mg twice daily. Duration of therapy is discussed in the text.
WHO: World Health Organization; CE: cystic echinocococcis; PAIR: puncture, aspiration, injection, reaspiration.
Data from:
  1. Junghanss T, da Silva AM, Horton J, et al. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008; 79:301.
  2. Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114:1.
Graphic 71806 Version 6.0

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