Treatment challenges associated with bone echinococcosis

J Antimicrob Chemother. 2014 Mar;69(3):821-6. doi: 10.1093/jac/dkt429. Epub 2013 Nov 11.


Objectives: In this literature review, we concentrate on epidemiology and therapy of osseous echinococcosis, with an emphasis on the recurrence risk.

Methods: Literature review 1930-2012.

Results: We retrieved 200 publications based upon single case reports or case series, mostly from resource-poor settings. Among the 721 rural patients (22% females; median age 37 years), 60% of all reported cases were from the Mediterranean region and almost all patients were immune competent. Echinococcus granulosus was identified as the most frequent species. Most infections involved a single bone (602/721; 83%) and often the spine (321 cases; 45%). In eight cases (8/702; 1%), a secondary bacterial surgical site infection was reported. Surgical intervention was performed in 702 cases (97%), with single intervention in 687 episodes (95%). Complete excision of the lesion was possible in only 117 episodes (16%). Albendazole was by far the most frequently used agent in monotherapy with various dosages, while mebendazole in monotherapy was less frequent (32 cases). The median duration of antihelminthic therapy was 6 months (range 0.7-144 months). There were 124 recurrences (17%) after a median delay of 2 years (range 0.4-17 years). In multivariate analysis, the presence of visceral organ involvement increased the odds of recurrence by 5.4 (95% CI 3.1-9.4), whereas the number of surgical interventions, the duration of antihelminthic therapy or the use of hypertonic saline did not influence recurrence.

Conclusions: Bone echinococcosis is a rare parasitic disease. While treatment modalities vary considerably, combined surgical and medical approaches are the standard of care with a 17% risk of recurrence.

Keywords: benzimidazoles; epidemiology; orthopaedic surgery; recurrence.

Publication types

  • Review

MeSH terms

  • Albendazole / therapeutic use
  • Animals
  • Anthelmintics / therapeutic use
  • Bone Diseases / drug therapy*
  • Bone Diseases / epidemiology*
  • Bone Diseases / parasitology
  • Bone Diseases / surgery
  • Debridement
  • Echinococcosis / drug therapy*
  • Echinococcosis / epidemiology*
  • Echinococcosis / parasitology
  • Echinococcosis / surgery
  • Echinococcus granulosus / isolation & purification*
  • Humans
  • Mebendazole / therapeutic use
  • Recurrence
  • Time Factors
  • Treatment Outcome


  • Anthelmintics
  • Mebendazole
  • Albendazole