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PubMed1997

[A patient with alveolar echinococcosis (Echinococcus multilocularis infection].

In a 45-year-old Swiss male, who had been living in the Netherlands for 20 years, alveolar echinococcosis was diagnosed. He had probably been infected during his youth in Switzerland. His illness became symptomatic more than 20 years later. The diagnosis was reached by microscopic examination of material obtained from a necrotic mass in the liver. Imaging revealed that the disease had spread diffusely throughout the liver, spleen and abdomen. Curative resection was impossible. Percutaneous drainage of the hepatic necrotic mass was complicated by a bacterial infection for which he was treated with antibiotics. Treatment with high doses of albendazole resulted in considerable improvement. The patient represents the first case of Echinococcus multilocularis infection diagnosed in the Netherlands.

Albendazole↗
PubMed1997

[Infestation of water voles (Arvicola terrestris) with metacestodes of Echinococcus multilocularis in the canton Freiburg (Switzerland)].

The results of an investigation on Echinococcus multilocularis-metacestodes in European water voles (Arvicola terrestris) are shown. The investigation materials were 28 water voles captured in Schermann-traps on a meadow in the canton of Fribourg and subsequently maintained in laboratory cages. The animals were patho-anatomically and histo-pathologically examined, a part of them additionally with an E. multilocularis-specific direct immunofluorescence-assay and/or a polymerase-chain-reaction. Radiographs were obtained from one animal, showing typical calcifications as they often occur with alveolar echinococcosis. Altogether 11 out of 28 (39%) animals proved to be infected with E. multilocularis. As far as we know this represents the highest percentage of infested intermediate hosts ascertained in Europe. However, fertile, i.e. able to infect, protoscolices were detected in only two cases. In spite of this small number of protoscolices it can be shown that A. terrestris is able to maintain the lifecycle of this cestode at least spatially and temporally limited. In conclusion the possible measures for reducing the infection risk of the people in the affected community are shortly discussed.

Animals↗
PubMed1997

[Prevalence of Echinococcus multilocularis and other metacestodes and cestodes in the muskrat (Ondatra zibethicus LINK 1795) in Lower Saxony].

Aim of the study was to examine the prevalence and regional distribution of Echinococcus multilocularis and other metacestodes and cestodes in muskrats in Lower Saxony, Germany. A total of 991 muskrats with similar numbers from all districts of the country were examined between January and December 1995. E. multilocularis metacestodes were found in 4.1% of the muskrats in the liver and other organs of the abdominal cavity. The majority of the E. multilocularis positive animals came from the south of Lower Saxony, where E. multilocularis is endemic, and single animals from the middle or the northern part of the country. All metacestodes found were fertile. Additionally, metacestodes from T. taeniaeformis were found in the livers of 42.3% of the muskrats, metacestodes from T. crassiceps were present in the abdominal cavity of 2.7%, T. polyacantha in 0.4% and T. martis in 3.4% of the animals. Adult cestodes of the family of the Anoplocephalidae were found in the small intestine of 1.5% of the muskrats. Due to autolysis a species differentiation of the latter was not possible.

Abdomen↗
PubMed1997

[Occurrence of Echinococcus multilocularis Leuckart, 1863, in foxes (Vulpes vulpes) in the Czech Republic].

During the period between December 1994 and December 1996 the authors examined, using the method of helminthological dissection of the intestinal tract in 15 districts of four regions in the Czech Republic a total of 824 foxes from 350 land registers. Echinococcus multilocularis was found in the following regions: South Bohemian (districts Jindrichův Hradec, Ceský Krumlov, Prachatice and Strakonice), Central Bohemian (Benesov district) and North Bohemian (district Teplice and Chomutov). There were 87 positive (10.6%) foxes in 56 places (16%). In some areas of the South Bohemian region examinations of foxes were repeated. It was found that there are places where the prevalence of E. multilocularis varied between 28.6 and 75% (mean 53.7%) but also areas which were repeatedly negative. In 1996 after one-week intervals foxes from the Prachatice district (South Bohemian region) were sent for parasitological examination. During different months of the year the prevalence of E. multilocularis varied between 2.6 and 33.3%. A similar investigation was made during May to October 1996 (except September) also in the district of Ceský Krumlov (South Bohemian region). Tapeworms were found in 7.14 to 66.7% of foxes.

Animals↗
PubMed1998

Factors influencing the development and carbohydrate metabolism of Echinococcus granulosus in dogs.

Echinococcus granulosus adult worms, 35 days postinfection, were measured for dispersion in the intestines of 10 dogs, a range of morphological characters, and the excreted end products of carbohydrate catabolism following 4 hr incubation in vitro. Most worms were found in the proximal sections of the small intestine, but the pattern of dispersion differed between dogs. Worm development varied both between dogs and between different regions of the small intestine of individual dogs. Overall there was a high level of variability with no simple patterns. Worm metabolism was related to worm development and, also independently, to local population density within the intestine. Larger, more mature worms produced less lactate and, at higher densities, worms tended to produce more acetate and succinate (pathways with a higher energy yield than lactate) and less ethanol. Thus, both more developed worms and high population density are associated with a shift from cytosolic to mitochondrial metabolism. The variation between worm populations along the small intestine along with the observed variation between worm populations from sibling dogs infected with genetically identical parasites suggests that the local host environment has a significant effect on parasite development.

Acetates↗
PubMed1997

Immune response to Echinococcus infection: parasite avoidance and host protection.

The life cycles of Echinococcus spp, involve two phases that have quite different immunological relationships with the host--the parenteral metacestode and the enteral adult. Immune control of the metacestode (at least of E. granulosus) by vaccination is now a real possibility, but there seems little prospect of similar control of the adult worms. Vaccination against metacestodes must not only induce effective responses but also prevent the parasite modulating these in such a way as to render them ineffective. This requires a much fuller understanding of the basis of parasite avoidance mechanisms, in particular an understanding of the balance of parasite- and host-protective mechanisms that involve the activity of T lymphocyte subsets. Protective responses against adult worms in the intestine appear weak and ineffective, although it is clear that the worms are immunogenic and there is some evidence that the host can become immune. Again, a more complete insight into the nature of the worm's association with the mucosal immune system is required, and a fuller understanding of the variables that influence this association; host genetic variation may prove to be an important factor that determines the outcome of adult worm infections.

Animals↗
PubMed1998

Use of sentinel lambs to survey the effect of an education programme on control of transmission of Echinococcus granulosus in South Powys, Wales.

In this article the effects of an education programme (area II) on transmission of Echinococcus granulosus from dogs to sheep in Wales and of substitution of the education programme by a 6-weekly anthelmintic control programme (area I) are compared with the situation in an area where no control interventions had occurred (area III). The education programme failed to prevent transmission of E. granulosus to sentinel lambs examined at 15 months of age, 6%, 4%, and 10% of which were infected in areas I, II, and III, respectively. Educational efforts did, however, show some positive effects; for example, significantly more farmers (87-98%) in areas I, II, and III used praziquantel to treat their dogs compared with 39% of farmers in a lowland area in the east of England where E. granulosus is absent. In particular, the interval between treatments of dogs was significantly shorter in areas targeted with education programmes, and 38% of farmers in area I treated dogs at a 4-6 week interval, as did 17% in area II and 10% in area III, compared with only 3% in the lowland area. Also, more dogs in Wales (65-88%) were treated at an interval of < or = 3 months, whereas most of the dogs in the lowland area (64%) were treated at intervals of > or = 6 months. The shorter treatment intervals with praziquantel may account for the significantly fewer positive coproantigen tests among dogs in area I (6.3%) and area II (5.6%) compared with area III (23.9%).

Adolescent↗
PubMed1976

[On the effect of mebendazole on metacestodes of Mesocestoides corti and Echinococcus multilocularis (author's transl)].

Mebendazole (5-benzoyl-2-methoxycarbonylaminobenzimidazole) was highly effective against tetrathydridia of Mesocestoides corti in the peritoneal cavity, liver and in the subcutis of mice when administered orally in the food (450 or 465 ppm) from days 7 or 40/50 post infectionem (p.i.) for 10 or 20 days in total doses of approximately 660-1660 mg/kg body weight (b.w.). All tetrathyridia were killed when treatment began at day 7 p.i., and only some survived when medication was started on days 40/50 p.i. A treatment of 5 days was only partially effective. In experiments with Echinococcus multilocularis laboratory animals were intraperitoneally infected with metacestode tissue transplants. Beginning on days 4-7 p.i. or on day 40 p.i. the animals were treated for 5, 10 or 20/21 days with mebendazole medicated food. In mice a treatment for 10 or 20/21 days with total mebendazole doses of approximately 660-2180 mg/kg b.w. caused an average reduction on metacestode weight of 61-89%. An average reduction between 58 and 84% was achieved in Meriones after a treatment for 20/21 days with total doses of approximately 650/530 mg/kg b.w. However, histological examinations and transplantation experiments revealed that in most of the treated animals metacestode tissue survived and retained its capability for budding. On the other hand, indications for a partial destruction of the parasite tissue were found in some of the treated animals. The oral mebendazole treatment was well tolerated. After intraperitoneal injection of 3 X 150 mg/kg b.w. mebendazole - as applied by Campbell et al. (1975) - all of 36 mice or Meriones died.

Animals↗
PubMed1998

Some studies on the growth and development of Echinococcus granulosus, camel origin in experimentally infected dogs.

Development of Echinococcus granulosus of camel subspecies in 35 experimentally infected dogs was performed at 3, 7, 10, 13, 18, 23, 35 and 56 days post-infection (d.p.i.). Morphological characters of each developmental stage was studied and discussed. Generally, the results indicate that the segmentation firstly appeared at 18 d.p.i. Also, male and female genitalia could be detected at the same period. However, completely developed of genitalia appeared at 56 d.p.i. Histological examination of small intestine of experimentally infected dogs revealed that the parasites were found in distended and thin wall crypts of Liberkuhn at 3, 7, & 10 d.p.i, while the parasite scolices were found embedded in the mucosa at 13, 18 & 23 d.p.i. No significant pathological changes were encountered in both infected and control dogs. This is the first report of strobilar development of E. granulosus of camel origin in experimentally infected dogs.

Animals↗
PubMed1987

Intraocular Echinococcus multilocularis.

Alveolar hydatid disease, caused by the organism Echinococcus multilocularis, is a potentially lethal helminthic infection. After initial hepatic infestation, the organism may spread locally and hematogenously to distant sites. Death occurs secondary to hepatic failure, local extension into vital structures, or metastasis to the brain or lungs. A 67-year-old male Alaskan Eskimo developed decreased visual acuity secondary to a choroidal mass in the right eye eight years after an initial diagnosis of alveolar hydatid disease and four years before the development of symptomatic cerebral metastasis. A pathologic examination disclosed characteristic parasitic membranes involving the posterior pole of the right eye. To our knowledge, this is the first report of ocular involvement in alveolar hydatid disease.

Aged↗
PubMed2003

Pelvic echinococcus mimicking multicystic ovary.

An unusual case of pelvic echinococcus cyst is presented, appearing initially on transvaginal ultrasound as a pelvic mass mimicking a multicystic ovary. A similar mass in the liver raised preoperatively the suspicion of echinococcosis, making an open surgical procedure preferable to laparoscopy. Diagnosis was confirmed pathologically after removal of the cyst. Though their location in the pelvis is rare, echinococcal cysts should be considered in the differential diagnosis of pelvic masses, especially in patients from endemic areas. Evaluation of previous medical history and current symptoms, together with the ultrasonographic findings, is important for correct diagnosis and appropriate management.

Adult↗
PubMed1995

Echinococcus granulosus: interactions with host complement in secondary infection in mice.

Complement has been shown to lyse protoscoleces of Echinococcus granulosus, but products from this parasite are able to consume complement, and this has been proposed as an evasion mechanism. The murine secondary hydatidosis model, with intraperitoneal inoculation, is used in this work to assess the occurrence in vivo of complement consumption by the parasite as well as the role of complement during the establishment of infection. Although the measurement of systemic levels of C3 activation, total C3, and hemolytic complement in challenged mice yielded no evidence of complement consumption, the relevance of local consumption at the site of infection cannot be ruled out. The role of complement during establishment of infection was assessed by comparing parasite burdens in normal and complement-depleted mice. Complement depletion by treatment with cobra venom factor caused a 79% reduction in cyst numbers (P < 0.05). Possible explanations of this unexpected result are discussed. The results presented suggest that lysis or opsonization by host complement are not effective against the establishing parasite in this model. They also indicate the significance of complement activation by the parasite needs to be studied at a local level.

Animals↗
PubMed1978

Pathological changes in the lymphoreticular tissues of Swiss mice infected with Echinococcus granulosus cysts.

Swiss mice infected intraperitoneally with approximately 1,500 protoscolices of Echinococcus granulosus and sacrificed at three and 13 months post infection yielded both viable and degenerated hydatid cysts. The mean cyst weights in the three and 13 months post infected mice were 0.13 and 2.1 g, respectively. Sections of spleens and lymph nodes in the three months post infected mice showed hyperplastic follicles and blastoid cells in thymus dependent areas. At 13 months post infection T cells from paracortex and periarterial areas were replaced by plasma cells and confluent sheets of histiocytes; follicles had retained germinal centres and medullary areas showed intense plasmacytosis and sinus histiocytosis. Failure of mice to control the histogenesis of hydatid cyst with reference to numerical reduction in T cells is discussed.

Animals↗
PubMed1990

Chemotherapy of experimental Echinococcus multilocularis in jirds.

A total of 50 jirds (Meriones unguiculatus) were infected by intraperitoneal implantation of 0.20 g metacestode tissue of Echinococcus multilocularis. The feed of 4 groups of 10 animals each was treated for 35 days with 500 ppm albendazole, flubendazole, mebendazole or praziquantel; 1 group of 10 jirds served as unmedicated controls. At autopsy 2 weeks after the end of medication, the transplants had increased in size and weight, reaching a total weight of 78.11 g in the control group, 21.60 g in the albendazole-treated group, 3.63 g in the flubendazole-treated group, 7.00 g in the mebendazole-treated group and 68.91 g in the praziquantel-treated group. The percentage in reduction of parasitic tissue weight as compared with control values was 72%, 95%, 91% and 12%, respectively. The calculated daily drug intake was approximately 48 mg/kg body weight. Drug-related side effects were not observed.

Albendazole↗
PubMed1983

[Hepatic resection for tumors, trauma and Echinococcus].

52 patients with hepatic resection due to liver tumor, metastases, Echinococcus or liver trauma are reported. Hepatic resection represents a relatively harmless procedure in case of benign liver tumor; however, in case of a malignant disease, the prognosis after hepatic resection is impaired by the difficulty to predict the regeneration capability of the liver. The indication for the different operative procedures is being discussed. It is suggested to perform hepatic resection in the border lines of the liver lobes without extensive preparation of the liver hilus and to clamp the liver hilus during resection. If the liver hilus was occluded after steroid pretreatment, 40 min of hepatic ischemia were well tolerated without any consequences and intraoperative bloodloss could be reduced significantly.

Echinococcosis, Hepatic↗
PubMed1995

Changes in T-cell subpopulations in mice during prolonged experimental secondary infection with Echinococcus granulosus.

Balb/c mice were infected intraperitoneally with protoscoleces of Echinococcus granulosus. After 15 months of infection, and by means of flow cytometry, the expression of T-cell markers CD3, CD4, and CD8 on T cells from peripheral blood, spleen, and thymus was analyzed and compared with that of age-matched controls. Infected mice had higher percentages of CD3+, and CD4+ cells in peripheral blood, and higher percentages of CD8+ cells in the spleen, when compared with control mice. CD4+ and CD8+ cells in peripheral blood and CD8+ cells in thymus also showed higher percentages of expression of interleukin-2 receptor. The results infer a role for interleukin-2 in experimental secondary echinococcosis.

Animals↗
PubMed2003

Indications and results of liver transplantation for Echinococcus alveolar infection: an overview.

BACKGROUND: Alveolar echinococcosis (AE) of the liver, caused by the larval stage of the fox tapeworm Echinococcus multilocularis, has the characteristics of a slow-growing liver cancer. It is one of the rare parasitic diseases for which a parasitolytic drug is not yet available, and AE is lethal in the absence of appropriate therapeutic management. Complete surgical resection of the parasite at an early stage of infection provides favourable prospects for cure, but, due to a long clinical latency, many cases are diagnosed at an advanced stage, so that partial liver resection can be performed in only 35% of patients. Benzimidazole (BZM) treatment is given in inoperable cases but these compounds are only parasitostatic, and lifelong therapy is required. During the past 20 years some centres have considered liver transplantation (LT) for the treatment of incurable AE. METHODS: Our review summarizes the results of this experience based on a series of 47 European patients who received transplants between 1985 and 2002, tries to specify the real place of LT for AE, and underlines the measures that could be undertaken in the future to improve the results. RESULTS: Five-year survival was 71%. Five-year survival without recurrence was 58%. Major technical difficulties related either to previous laparotomies or to the loco-regional involvement were observed. The nine early deaths concerned AE patients with a long past-history of symptomatic AE (iterative cholangitis, secondary biliary cirrhosis). Five late deaths were directly related to ongoing AE, located in the brain in three cases, a very rare AE location that was not investigated before LT in these patients. CONCLUSIONS: In general, the pre-LT screening for distant AE metastases appeared insufficient in this series. Heavy immunosuppressive schemes, absence or delayed re-introduction of BZM after LT have clearly played a role in this unfavourable course. This unique experience indicates that, despite major technical difficulties, LT for incurable AE is feasible and could be discussed in very symptomatic cases. Before LT, interventional radiology should be preferred to repeated laparotomies. Pre-LT and post-LT BZM treatment is mandatory. A careful evaluation of possible distant metastases should be done before the decision for LT is made. After LT, the possibility of an ongoing AE must be permanently kept in mind. This could be reduced by lightening the immunosuppressants, carefully following the specific circulating antibodies, and applying a systematic radiological evaluation, not only to the graft but also to the lungs and the brain.

Adolescent↗