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PubMed1994

Seroepidemiologic screening of Echinococcus multilocularis infection in a European area endemic for alveolar echinococcosis.

In a serologic survey for Echinococcus multilocularis infection, we screened sera from 7,884 subjects from the Doubs Departement in France, an area endemic for alveolar echinococcosis (AE) of the liver. An enzyme-linked immunosorbent assay (ELISA) with a highly species-specific antigen (Em2) and an E. multilocularis crude antigen (Emc) was used for screening. An evaluation of the cost/benefit relationship of this screening, followed by therapeutic management of patients, was made and compared with the actual cost of the follow-up and treatment of the disease in symptomatic cases in this endemic area. Antibody reactions to Em2 and/or Emc made possible the detection of eight asymptomatic clinical cases (seroprevalence averaging 1/1,000), with typical lesions of active AE revealed by abdominal ultrasonography and computed tomography. All were seropositive using the Emc ELISA but two were seronegative using the Em2 ELISA. In five additional seropositive cases, the radiologic investigations revealed small calcified lesions similar to the lesions of abortive AE previously found in Alaska. The cost of this serologic screening program per screened subject and per diagnosed case averaged 50.00 French Francs (FF) (U.S. $8.60) and 60,000.00 FF (U.S. $10,909.00), respectively. The cost of diagnosis, follow-up and treatment of the patients was 5,086.00 FF (U.S. $929.00) per patient per month in the case of diseases diagnosed by the screening program and 7,086.00 FF (U.S. $1,288.00) per patient per month for patients with symptomatic AE. This survey indicates a high prevalence of AE in the target area; it confirms the long latency period of the larval growth in human AE and shows that abortive AE is present in Europe. The use of both the Emc and Em2 ELISAs seems to be better than using the Em2 ELISA alone. The cost of the hospitalization and treatment of the eight screened patients would appear to be relatively high. Even though two of them were asymptomatic, they had very severe forms of the disease. In fact, the total cost was much lower than the actual cost of the disease when diagnosed from clinical symptoms.

Adolescent↗
PubMed1995

Imported echinococcosis in southern California.

A retrospective chart review conducted at two teaching hospitals in Los Angeles County identified 28 patients with infection due to Echinococcus granulosus diagnosed by positive echinococcal serology and/or tissue biopsy between January 1981 and December 1990. Of these patients, 25 (89%) were foreign born and 19 (68%) were immigrants from the Middle East or central Asia. Only 12 of 22 immigrants questioned about epidemiologic risk factors described a history of rural residence or direct exposure to dogs in their native country. Single cysts of liver, lung, and soft tissue were present in six of 28 patients; multiple cysts in the 22 remaining patients were exclusively hepatic in 13 patients, exclusively pulmonary in two patients, and involved mixed sites including liver, lung, abdomen, central nervous system, and bone in seven patients. Natives of middle eastern countries currently constitute a major risk group for imported infection due to E. granulosus in the United States. Since their epidemiologic risk factors may be absent and clinical presentations varied, a high index of suspicion for echinococcosis is warranted in this population based solely on the presence of a cystic mass in liver, lung, or another organ site.

Adult↗
PubMed1998

Risk factors associated with human cystic echinococcosis in Florida, Uruguay: results of a mass screening study using ultrasound and serology.

Sonographic evidence of asymptomatic Echinococcus granulosus lesions in the liver was found in 156 of 9,515 persons in the Department of Florida, Uruguay. The sensitivity of ELISA and latex agglutination serology compared with ultrasound was 47.6% and 28.1%, respectively, and specificity was > 85%. There was a significant positive association between positive sonography and a personal history of previous but treated Echinococcus infection while those that were seropositive but ultrasound-negative were significantly more likely to have a personal history of infection or a history of infection in their family. Prevalence of infection increased significantly with age. There was no correlation between echinococcosis and dog ownership or home slaughter of sheep but offal disposal was important, with an increased prevalence of infection of 3.2%, 2.8%, and 3.1%, respectively, in persons feeding offal to dogs or burying or burning it compared with a prevalence of 0.8-1.5% in those using other methods of disposal. Almost half the population, when questioned, seemed to have sound knowledge about E. granulosus and described correct treatment of E. granulosus in dogs but this did not affect prevalence. There was a significant positive association between infection and the presence of a fenced fruit/vegetable garden and use of rural waters, particularly the cachimba (a small dam) and the aljibe (a cistern or tank) that collect rainwater from the ground surface and roofs, respectively.

Adolescent↗
PubMed1998

Short report: An imported case of cystic echinococcosis in Japan diagnosed by imaging and serology with confirmation of Echinococcus granulosus-specific DNA sequences.

We report one case of cystic echinococcosis (CE) in Japan in a native of Nepal. Ultrasonography and computed tomography scan of the liver revealed unique cystic lesions with or without daughter cysts of Echinococcus granulosus. Immunoblot analysis using crude antigens of E. multilocularis and cyst fluid of E. granulosus, without reference to these image analyses, strongly suggested this was a case of CE. We found protoscoleces in surgically removed hepatic lesions and analyzed the mitochondrial cytochrome c oxidase subunit I (COI) gene by the polymerase chain reaction. Based on the similarity in DNA sequences of the COI gene of this Echinococcus spp. with that of previously reported sheep-dog strain (GI), the parasite was considered to be the so-called common sheep strain of E. granulosus.

Adult↗
PubMed1998

Human cystic echinococcosis in a Uruguayan community: a sonographic, serologic, and epidemiologic study.

A prevalence and transmission study of human cystic echinococcosis (CE), due to infection with the dog tapeworm Echinococcus granulosus, was undertaken in the village of La Paloma in central Uruguay. The human population was registered and screened for CE by abdominal ultrasound scan as well as a number of serologic tests. Dogs were screened for E. granulosus infection by arecoline purgation as well as specific coproantigen testing. The total prevalence of human CE (new cases and those with a previous history) was 5.6% (64 of 1,149); 3.6% (40) of the cases were new ultrasound detected asymptomatic cases (mean age = 45 years). Age prevalence increased from 1.1% in the 4-6-year-old group to > 11% in the > 60-year-old group; the 20-29-year-old group had a significantly higher CE rate of 7.4%, compared with younger and older age groups, and there was no difference between sexes. A CE rate of 3.9% (20 of 514) was also recorded by ultrasound for new cases in the population residing outside the village. Most of the hydatid cysts were located in the liver presenting as either univesicular cysts or a solid mass, and of those 71% and 63%, respectively, with such cyst presentations were seropositive against E. granulosus cyst fluid antigens. Two of eight individuals who were filter paper blood spot seropositive, but ultrasound scan negative, were subsequently diagnosed respectively with pulmonary hydatidosis after radiography, and hepatic hydatidosis after computed tomography scan. Of 36 households with a CE patient, 32 were single cases while four households each harbored two CE cases. This did not represent a clustered distribution within families (23 of 117). Almost 20% of the dogs from La Paloma were found infected with E. granulosus after purge examination, with a mean worm number of 67 (range = 1-1,020). An additional eight dogs that were purge negative were Echinococcus coproantigen positive. The study showed that human CE is highly endemic in Uruguay, with one of the highest local prevalence rates in the world. Transmission appears to occur readily within well-developed towns, as well as on rural sheep ranches. Mass screening by ultrasound scanning with confirmatory serologic testing is an effective approach to case detection at the community level.

Adolescent↗
PubMed1999

An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya.

A prevalence study of abdominal cystic echinococcosis (CE) was undertaken in the northwest, north-central, and northeast regions of Libya. A total of 36 villages along the coast were included, in which 20,220 people were screened by portable ultrasound. Three hundred thirty-nine (1.7%) were diagnosed with CE. There was no significant difference between CE prevalence rates in the three regions of Libya (mean = 1.6%); however, intervillage rates were variable, ranging from 0% to 4.5%. The prevalence of CE increased significantly with age (P < 0.0001) and females were significantly more affected (2%) than males (1.3%) (P < 0.0001). Cases of CE were distributed among 3.2% of housewives, 2.6% of farmers, 2.3% of male civil servants, 1.3% of female students, and 1.1% of male students. Housewives (P < 0.0001) and students (P < 0.0001) were significantly more at risk for CE. A statistically significant proportion (62% [210 of 339]) of CE cases kept dogs (P < 0.0001). Of the ultrasound-positive CE cases 69% (233 of 339) were antibody seropositive by ELISA using Echinococcus granulosus hydatid cyst fluid antigen B. Blood samples (n = 10,096) collected onto filter papers were taken randomly from ultrasound-negative people who entered the study, of which 11.2% were found to be seropositive. Seropositivity increased with age (P < 0.0001), with females exhibiting higher seroprevalence than males for all age groups (P < 0.0001). Seroprevalence was distributed occupationally among 17.3% of female students, 11.2% of male students, 8.3% of housewives, 7.3% of farmers, and 6.4% of male civil servants. Housewives and students were more likely to be seropositive (P < 0.0001). Forty-seven percent (526) of the seroreactors kept dogs. All liver hydatid cysts detected by ultrasound during community screening were classified according to morphology and size into six types. Type I (17.5% of all cases) were small univesicular cysts less than 50 mm in diameter with no laminations or daughter cysts. Type II (34%) were univesicular cysts with only laminations. Type IIIa (8.5%) were univesicular cysts with the appearance of laminations and daughter cysts. Type IIIb (13%) were univesicular with laminations and less prominent daughter cysts. Type IV (5.6%) presented as a solid mass. Type V were degenerated calcified or partially calcified cysts (13.2%). Type VI presented as multiple cysts (8% of all cases). The CE cases that exhibited Types II, IIIa, IIIb, IV or VI cysts showed the highest seropositivity (86%, 96%, 95%, 100%, and 96%, respectively), while Types I and V were the least seroreactive (38% and 22%, respectively). Cases of CE occurred in 311 families, with 93% having only one member as a CE case while 7% of the families had two or more cases. However, 25% of the ultrasound-negative persons belonging to families with an index CE case were seropositive for antibodies to Echinococcus. These results confirm the importance of human CE in Libya. They also confirm the usefulness of ultrasound combined with serology as a mass screening approach for CE in north African communities.

Abdomen↗
PubMed1999

Water vole (Arvicola terrestris scherman) density as risk factor for human alveolar echinococcosis.

Concern is growing in Europe about alveolar echinococcosis (AE) with the increase in grassland rodent and red fox populations, intermediate and definitive hosts for Echinococcus multilocularis, respectively. The objective of this study was to assess the influence of rodent densities on human AE distribution. Spatial Poisson regression analyses were performed with geomorphologic features, landscape composition, climatic characteristics, and water vole density as independent variables. The outcome consisted of AE cases diagnosed over the period 1980-1992. High vole density yielded a 10-fold risk (relative risk [RR] = 10.34, 95% confidence interval [CI] = 2.78-38.39), and the first plateau (400-700 m altitude) compared with the plain (200-400 m) was associated with a large increase in risk (RR = 7.10, 95% CI = 1.30-38.63). These results confirm that human AE is strongly influenced by the densities of arvicolid species. Foxes feeding almost exclusively on grassland rodents when the latter expand could mediate this relation.

Altitude↗
PubMed1999

An epidemiologic survey of human alveolar echinococcosis in southwestern Germany. Römerstein Study Group.

The inhabitants of a rural community in southwestern Germany were examined for alveolar echinococcosis (AE). The study was prompted by the recent increase of the prevalence of the parasite in foxes and the increase of fox populations: in the study area, 75% of the foxes carried Echinococcus multilocularis. The human population was screened using hepatic ultrasound and serology. All participants were interviewed for demographic and potential risk factors. Of 2,560 participants, one was identified with active AE, while 3 others had suspicious liver lesions. Another 9 participants were seropositive for specific antibodies without detectable lesions. Demographic and behavioral factors were not correlated with active or suspected cases nor with seropositivity. If the prevalence of 40/100,000 (95% confidence interval = 15-295/100,000) for active cases would be representative for the rural population in high endemicity areas, the current number of AE cases in southwestern Germany is considerably higher than previously suspected.

Adolescent↗
PubMed2002

Combined ultrasound and serologic screening for hepatic alveolar echinococcosis in central China.

Alveolar echinococcosis (AE), caused by Echinococcus multilocularis, is a zoonotic helminthic disease that can mimic malignancy. In the 1970s, foci of the disease were found in central China. The aim of the present study was to estimate the prevalence of AE in humans in 2 districts of south Gansu Province, China, by use of ultrasound and Echinococcus serology. After answering an epidemiological questionnaire, 2,482 volunteers from 28 villages underwent ultrasound. Serology via enzyme-linked immunosorbent assay for antibody activity was performed on whole blood collected on filter paper in all subjects; on serum from subjects with an abnormal ultrasound image; and on randomly chosen subjects that either had no lesions or had atypical lesions. At least one (25.3%) abnormal ultrasound image was observed in 630 of the subjects screened. A typical lesion of progressive AE was found in 84 subjects (3.4%). Serologies were positive in 77 (96%) of 80 of patients who had lesions typical of progressive AE. Ultrasound is useful for screening for AE in endemic regions.

Adolescent↗
PubMedDate not supplied

Surgical and chemotherapeutic treatment of alveolar echinococcosis in a dog.

Surgical removal of macroscopically detectable metacestode tissue followed by postoperative chemotherapy according to established human protocols resulted in complete clinical remission and immediate normalization of hyperglobulinemia in a dog with alveolar echinococcosis (AE). The disease is caused by the metacestode stage of the cestode, Echinococcus multilocularis. In endemic areas, AE should be included in the differential diagnosis of polycystic liver masses, especially if concomitant hyperglobulinemia is present. However, the importance of AE is not only the disease of the single dog itself but also the potential risk of infection for humans in an endemic area.

Albendazole↗
PubMed1995

Human alveolar echinococcosis seroprevalence assessed by western blotting in Hokkaido.

To investigate the recent prevalence of human alveolar echinococcosis in Hokkaido, we took advantage of Western blotting analysis capable of classifying persons infected with Echinococcus multilocularis into two groups: the complete and incomplete types. From the geographic distribution, the residents with the complete type appeared for the first time in 1992 in the Oshima district (western Hokkaido). The age distribution indicated that persons with the complete type increased, since 1990, in the age groups younger than 30 years old.

Adolescent↗
PubMedDate not supplied

[Experimentally inoculated human echinococcosis in piglets and a trial of the therapeutic preparation SK-1].

Experiments were made on 26-month-old piglets divided into 4 groups: Groups 1 and 4 included 5 piglets and Groups 2 and 3 comprised 8 animals. The piglets from Groups 1, 2, and 3 were peritoneally inoculated with 5000 protoscolices and acephalocysts of Echinococcus from patients with echinococcosis who had been operated on. On postinoculation day 60, Group 1 piglets were killed to measure the baseline weight of parasitic larvocysts (PL) developed by that time. On postinoculation day 61, Group 3 piglets continuously received feed in combination with CK-1 within 3 weeks. The mean daily doses of the agent were 0.05, 0.10, 0.25 g/kg, respectively. On day 91 following inoculation, all the animals were killed and dissected. The studies were made by using the procedures and formulas [9]. The growth suppression index for PL was 94.50, 92.39, and 96 for Groups 1, 2, and 3, respectively. Significant destruction of embryonic elements was revealed in 75-85% of PL in each treated animals. There was a tendency for blood indices to become normal in the treated animals. The acute toxicity of CK-1 was examined in outbred white mice, albino rats, chickens, piglets. The maximum non-lethal dose of CK-1 was 19 g/kg for white mice. The agent showed a low toxicity.

Animals↗
PubMedDate not supplied

[Experimental echinococcosis in piglets infected by the inoculation of the embryonic elements of the cysts from human patients].

Twenty six piglets aged 25 days divided into 4 groups (Groups 1 and 4 included 5 piglets and Groups 2 and 3 comprised 8 ones) were selected. The piglets from Groups 1, 2, and 3 were peritoneally inoculated with 5000 protoscolices and acephalocysts from the cyst of human Echinococcus granulosus by the procedure [4]. Group 4 piglets were not inoculated they served as a control group. Prior to infection, the animals were weighed and their blood was analyzed by the conventional procedure. On day 90 following inoculation, the piglets were killed. All the infected piglets developed Echinococci which grew rapidly, some larvocysts measured as high as 34 mm in diameter and contained alive protoscolices. The Echinococcus-infected animals were found to have changes in blood composition, impaired protein-amino acid metabolism, lower living mass as compared to the controls. The inoculation of embryonic elements of echinococcosis from ill humans to pigs is a model of this disease, which is promising for medical studies.

Animals↗
PubMed1999

[Swiss study of chemotherapy of alveolar echinococcosis--review of a 20-year clinical research project].

Alveolar echinococcosis (A. E.), caused by Echinococcus multilocularis, behaves biologically like a malignant tumour of the liver which is best treated by radical surgery. However, radical surgery can be performed only in about 20-30% of A. E. cases. The efficacy of chemotherapy with benzimidazole derivatives for inoperable cases is debated. The results of a prospective Swiss chemotherapy trial, which started in 1976, are reviewed. In the last 20 years a total of 110 patients has been included in our protocol and 74 of these patients had inoperable or palliatively operated A. E. (average observation time 12.8 years). The efficacy of long-term chemotherapy was documented by increase of 10-year survival compared to historical (untreated) A. E. cases (80 vs 6%) and by reduction or stabilisation of the liver lesions in 83% of cases during long-term chemotherapy. Several relevant problems remain to be clarified, e.g. optimal duration of chemotherapy, the controversy as to whether chemotherapy is parasitostatic or parasitocidal, the establishment of reliable routine methods for short-term assessment of therapeutic efficacy, and comparative studies between mebendazole and albendazole. Furthermore, additional studies are necessary in collaboration with basic science, for example on the impact of the increasing fox population, with invasion of large agglomerations, on infection risk in the Swiss population, and the importance of individual immune competence for susceptibility or resistance to A. E.

Albendazole↗
PubMed1998

Alveolar echinococcosis in China.

DATA SOURCES: All reference data originated from related Chinese- or English-language literature in Chinese journals. STUDY SELECTION: Twenty-three original articles published in 1992-1996 were selected according to the stated purpose and 9 of them were written by myself. DATA EXTRACTION: The present paper dealt with 5 subtopics, i.e. epidemiology, parasitology, pathology, diagnosis, treatment and prognosis. RESULTS: Five hundred and eighty-four patients with alveolar echinococcosis (AE) have been reported from 7 provinces or autonomous regions. Human infection rate was 19.2% or 2.8%, and the morbidity was 2.4%-5.0%. The intermediate hosts of Echinococcus multilocularis included 7 species of rodents and 3 species of livestocks, and the final hosts of that were fox, dog or wolf. Diagnosis of AE was chiefly based on imaging examination (ultrasound and CT) and immunological test. The operative resection rate for liver AE was only 10.5% (27/258). Albendazole was a certain remedy for the chemotherapy of AE, and TCM "Xiao-Bao" pill may be a hopeful drug. CONCLUSIONS: In the past 30 years, a lot of work concerning basic and clinical studies has been done in China and some achievements have been achieved. However, some important problems such as how to conduct further research on molecular biology, how to make early diagnosis, how to improve the chemotherapeutic effect, and how to control the prevalence of AE, need to be studied more deeply in the 21st century.

Animals↗
PubMedDate not supplied

[The experimental chemotherapy of larval alveolar echinococcosis. The search for an optimal regimen of albendazole use].

The antiechinococcal activity of albendazole resynthesized at the E. I. Martsinovskiĭ Institute of Medical Parasitology and Tropical Medicine was studied on infection models in rats and mouse in different experimental modifications. The efficiency of the therapy was determined in relation to the dose of the drug and its routes administrations, to the single or intermittent daily dose, to the presence or absence of intervals in the treatment regimen, to dosage forms. The trials indicated that albendazole was most active against larval alveolar echinococcosis of mice or cotton rats when it was used with their feed, i.e. through the gastrointestinal tract.

Administration, Oral↗
PubMed1999

Our experience in operative treatment of secondary and recurrent echinococcosis.

The frequency rate of echinococcis has recently increased rapidly and so has the number of the relapses of the disease. The aim of the present retrospective study was to summarise our experience in the surgical treatment of secondary and recurrent echinococcosis. We discuss the most effective methods for operative treatment in which the intervention spares organs and combines with further antiparasytic treatment.

Animals↗
PubMed1999

Recent epidemiologic trends in alveolar echinococcosis prevalence in humans and animals in Hokkaido.

We investigated chronological and geographical changes of alveolar echinococcosis (AE) prevalence in 14 administrative districts of Hokkaido based on the data of our epizootiologic and seroepidemiologic surveys. The results suggest that the chronological transitions of the enzootic state of AE in Hokkaido markedly reflect those of human AE prevalence, and that new prevalence of human AE has been emerging from central and western Hokkaido.

Animals↗