Management of Echinococcus multilocularis in pregnancy: A case report

Background

Alveolar echinococcus (AE) is a zoonosis caused by the Echinococcus multilocularis parasitic tapeworm, associated with substantial morbidity and mortality. Management of AE in pregnant people presents many challenges including the risk of disease progression due to the immunologic changes in pregnancy and potential teratogenicity of antihelminthic drugs. Currently, there is limited guidance on the perinatal management of AE. Therefore, we present a case of AE in a pregnant person highlighting some of the challenges around antepartum, intrapartum and postpartum care with this serious infection.

Case

A 20-year-old female became pregnant ten months after the initial diagnosis of AE with peritoneal dissemination. After discussion of risks and benefits of continuing with the pregnancy, the decision was made to closely monitor the patient with monthly liver ultrasound exams. Due to potential risk for teratogenicity, she was advised to hold albendazole treatment during first trimester with the understanding that she would restart if lesions formed or enlarged. The patient chose to continue abstaining from albendazole for the entire pregnancy. During the albendazole-free period, no new cystic growths or enlargement of existing cysts were observed in close follow-up. She had an uncomplicated delivery at 39.5 weeks via Cesarean section. Albendazole was restarted following delivery, and due to concerns about infant albendazole exposure, formula feeding was preferred over breastfeeding.

Conclusion

AE poses many management challenges in pregnant people. Effectively managing these challenges requires in-depth discussion about potential risks of withholding or continuing treatment, a shared decision-making approach, and close disease monitoring throughout the pregnancy.