ADVANCING THE CLINICAL MANAGEMENT OF CYSTIC ECHINOCOCCOSIS PATIENTS: THREE YEARS OF CLINICAL AND EPIDEMIOLOGICAL RESEARCH

The thesis illustrates the results of three years of clinical research in the field of Cystic Echinococcosis (CE). During these three years my work as a PhD student has mainly focused on three different aspects of CE-related research: CE epidemiology, clinical management, and studies on CE diagnosis with particular regard to serology and new molecular tools for the diagnosis of CE. The first presented publication analyzed the state of the art on CE-related research in the Mediterranean area and showed that much was left to be done about the three topics I focused on during my PhD. The studies conducted in these three years have shown that CE is often misdiagnosed, especially in its rarer forms such as bone CE. Our group headed a multicenter study on the clinical management of this severely debilitating form of the disease to start building a consensus on the treatment and management of these patients. We also showed the safety of the “watch and wait” approach for the management of inactive cysts of the liver by updating previously published data. Another publication addresses our experience with the clinical management of cysts close to the Inferior Vena Cava (IVC), showing that the rate of IVC-related complications in our center was zero if patients were adequately treated, and that a stage-specific approach is also valid for this particular localization. Regarding the epidemiology of CE, I have worked with Kazakh colleagues to publish data on the disease from the National Kazakh registry of CE, a publication that hopefully will serve to orient public health efforts in the country in the future. Another publication deals with the public health implications of Albendazole shortages in the treatment of CE – a problem which is not only restricted to Italy. On serology, two publications are presented: one on the field use of Rapid Diagnostic Tests as confirmatory tests for the diagnosis of CE – a study that was never before carried out. The other on the different performance of diagnostic tests used for the serological diagnosis of CE. Finally, a preliminary study on the alterations of miRNA expression levels in patients with CE is also included.