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PubMed1984

Cost-effectiveness analysis of echinococcosis-hydatidosis eradication project in Sardinia.

In this study we attempt to evaluate the convenience of a campaign to eradicate the echinococcosis in Sardinia vs a 'do-nothing' or do-very-little policy adopted at this time. The main conditions which have to be met in setting up the eradication programme are identified as follows: (a) precise knowledge of the real diffusion of the parasitosis in man and animals; (b) eradication project control (action research); (c) health education; (d) reduction of stray canine population; (e) anthelmintics distribution and permanent health control to registered dogs. In Italy, echinococcosis-hydatidosis is present in many regions but in none has reached the diffusion rate present in Sardinia where over 200 patients per year are surgically treated, with a prevalence rate of 13.32 per 100,000 inhabitants. The disease does not spare any social or age group. The economic aspects of hydatidosis involve losses due both to human and to livestock resources, evaluated in monetary or non-monetary terms, according to circumstances. As a method to evaluate the human life has been assumed the years gained related to the Potential Years of Life Lost (PYLL). Several Net Present Values (NPV) have been calculated under alternative discount rates inclusive of the Internal Rate of Return (IRR).

Animals↗

PubMed2005

Treatment options for hepatic cystic echinococcosis.

A number of surgical and non-surgical options exist to treat cystic echinococcosis of the liver. For decades, surgical excision via a conservative or radical approach was the recommended approach for hepatic hydatid cysts. The availability of chemotherapeutic agents with significant activity against Echinococcus granulosis has made it possible to undertake ultrasound- or computed tomography-guided transhepatic percutaneous drainage (termed puncture, aspiration, injection, and re-aspiration (PAIR)) of hydatid cysts. Pre- and post-intervention chemotherapy with albendazole or mebendazole offers the advantage of reducing the risk of disease recurrence and intraperitoneal seeding of infection that may develop via cyst rupture and spillage occurring spontaneously or during surgery or needle drainage. PAIR appears to have greater clinical efficacy (i.e. a higher incidence of cure), lower rates of major and minor complications, mortality, and disease recurrence, and fewer days of hospitalization compared to patients treated surgically. For patients who fail drug therapy alone, PAIR is a safe and effective procedure of choice for patients with hepatic echinococcosis, and perhaps other anatomic sites of infection such as lung, peritoneum, kidney, and other viscera. Surgery should be reserved for patients with hydatid cysts refractory to PAIR because of secondary bacterial infection or for those with difficult-to-manage cyst-biliary communication or obstruction.

Albendazole↗

PubMed2005

Recombinant antigens for serodiagnosis of cysticercosis and echinococcosis.

Diagnosis of cysticercosis/echinococcosis is primarily based on imaging techniques. These imaging techniques are sometimes limited by the small size of visualized lesions and atypical images, which are difficult to be distinguished from abscesses or neoplasms. Therefore, efforts have been directed toward identification and characterization of specific antigens of parasites for development of serodiagnostic method that can detect specific antibody. For cysticercosis, glycoproteins of 10-26 kDa in cyst fluid of Taenia solium have been widely accepted for serodiagnosis purpose. The glycoproteins consist of a very closely related family of 8-kDa proteins. We identified four genes (designated Ag1, Ag1V1, Ag2 and Ag2V1) encoding the 7- and 10-kDa polypeptides. Based on the antigenicities of these clones, Ag1V1 and Ag2 were chosen as ELISA antigens and the Ag1V1/Ag2 chimeric protein was expressed. The Ag1V1/Ag2 chimeric protein showed the similar sensitivity and specificity as the native glycoproteins. For alveolar echinococcosis, the 65-kDa protein of Echinococcus multilocularis protoscolices and Em18 has been considered as serodiagnostic antigens. The sensitivity and specificity of Em18 are very compatible to those of the recombinant 65-kDa protein. Recently, we demonstrated that Em18 was the proteolytic product of the 65-kDa protein following the action by cysteine proteinases. From the information of N-terminal amino acid sequences, molecular size and isoelectric point of Em18, recombinant Em18 ((349)K to (508)K of the 65-kDa protein, RecEm18) was expressed and evaluated for serodiagnostic value. RecEm18 has the potential for use in the differential serodiagnosis of alveolar echinococcosis.

Animals↗

PubMed2005

Taeniasis, cysticercosis and echinococcosis in Thailand.

Taeniasis is one of the major food-borne parasitic zoonoses in Thailand. During the years 1957-1997, the prevalence was low in most parts of the country. Recent (2000-2005) country prevalence was lower than 1%. A high prevalence (5.9%) was found among 1450 villagers from 30 villages in the North, and among 1233 stool samples from 19 provinces in the Northeast (2.8%). Taenia saginata was the dominant species. Cysticercosis in Thailand is somewhat under-reported/recorded. During the period 1965-2005, diagnosis was based on techniques other than serodiagnosis, giving a total of cysticercosis cases of less than 500. However, an immunoblot technique using delipidized cyst antigen showed 314 positive cases out of 754 samples tested in 2000-2005. Reports of neurocysticercosis appeared more often than cutaneous cysticercosis. A total of 24 cases of echinococcosis, mostly hydatid cysts (only 2 cases of alveolar cysts), were recorded during 1936-2005. These records included 3 cases of foreigners seeking surgery in hospitals in Bangkok. Most Thai patients were migrant workers from the Middle East, and only a few cases were indigenous. The prevalence of cysticercosis and echinococcosis is increasing resulting from sensitive modern diagnostic tests. Taeniasis will persist in Thailand as the consumption of raw/half-cooked meat dishes is still a normal practice for Thai people.

Adolescent↗

PubMed2005

Veterinary public health activities at FAO: cysticercosis and echinococcosis.

In many developing and transition countries, parasitic zoonoses such as cysticercosis and echinococcosis cause serious human suffering and considerable losses in agricultural and human productivity, thus posing a significant hindrance to their development. Although, effective and reliable tools for the diagnosis, prevention and control of parasitic zoonoses are now available, their implementation has not always been successful in many countries. This is primarily due to the lack of awareness on the presence or impact of the causing parasites (Taenia saginata, Taenia solium and Echinococcus spp.). In addition, often the needed intersectorial cooperation, resource management and political commitment for their control are (also) absent. FAO's regular programme has established a global network of professionals directly involved in zoonotic and food-borne diseases. The network provides a basic framework for the spread of information related to the diagnosis, prevention and control of major zoonotic diseases including cysticercosis and echinococcosis.

Animals↗

PubMed2005

Methods for assessing the burden of parasitic zoonoses: echinococcosis and cysticercosis.

Cysticercosis and echinococcosis cause illness and productivity losses in human and agricultural animal populations. Recent studies suggest that these diseases have large societal impacts on endemic areas. Estimates of burden provide essential, evidence-based data for conducting cost-benefit and cost-utility analyses that will secure political will, and financial and technical resources. To evaluate the burden, the monetary and non-monetary impacts of these zoonoses on human health, agriculture and society must be considered comprehensively. In this article, we review the framework used to assess the burden of cysticercosis and echinococcosis, and the data needed to estimate the extent of the problem for societies.

Animals↗

PubMed2006

Successful outcome of hepatic polycystic echinococcosis managed with surgery and chemotherapy.

Echinococcus vogeli has been reported to cause human polycystic echinococcosis. A 43-year-old Brazilian woman was admitted to hospital complaining of mild epigastric discomfort. Computed tomography (CT) revealed multiple cystic lesions with calcified edges in several hepatic segments. At exploratory laparotomy, polycystic lesions were excised from the liver, omentum and peritoneum. No remaining cysts were observed on a post-surgery CT scan. The patient was asymptomatic when discharged on Day 19 post-operatively. She was prescribed albendazole therapy for 6 months. Follow-up CT performed 11 months later revealed no evidence of recurrence. Surgery combined with chemotherapy may improve the quality of life of patients with polycystic echinococcosis.

Adult↗

PubMed2003

National prevalence of larval echinococcosis in sheep in slaughtering plants Ovis aries as an indicator in control programmes in Uruguay.

Diagnostic surveys carried out on ovine larval echinococcosis in slaughtering plants at a national level in 1998 made it possible to meet several objectives, i.e. to estimate the existing levels of prevalence, to evaluate the effectiveness of the control actions applied by the Programme against Hydatidosis and to contribute to the improvement of the health information systems for epidemiological surveillance. The work included sheep (Ovis aries), both lambs (2-4 teeth) and adults (6-8 teeth). A random sample was performed among sheep from the plants that slaughter the majority of animals in the country. The sample included 22 animals per herd, and it involved removing their offal (liver, lungs and heart) and processing serial sections at the laboratory. The histopathological studies were performed on the lesions that could not be adequately identified at gross examination, and those that were so small that had to be submitted for confirmation of the diagnosis. Of the 2035 animals that were examined, 1019 were lambs (2-4 teeth) and 1016 were adults (6-8 teeth). The prevalence of larval echinococcosis was 7.7% in lambs and 18.0% in adults. The overall prevalence in the liver was 8.5 and 8.0% in the lungs. As to the characteristics of the morphologic structures of the larvae, in younger animals 29% of the lesions were calcified, and 71.0% were hyaline, while in older animals the proportions were 34.4% calcified versus 65.6% hyaline. Other conditions found in the liver parenchyma included: white stain (0.8%), caseous lymphadenitis (3.0%), abscess (0.4%), larvae of Taenia hydatigena (5.1%), Fasciola hepatica (3.9%). And 1.7% of the animals presented larvae of Taenia ovis in the cardiac muscle. Previous surveys carried out in 1994 using the same methodology showed a prevalence of 15.2% in 2-4 teethed animals and 33.9% in 6-8 teethed animals, thus confirming that rates have decreased by 49.6 and 47.0%, respectively. The data obtained reflect the reduction of areas contaminated with eggs of Echinococcus granulosus, which would cause a loss in immunity against this parasite after a certain time. Prevalence of larvae T. hydatigena and T. ovis could change if more sites were considered, a fact that was confirmed in studies carried out in our country. The species O. aries must be used as an indicator in the control programmes, especially in the category of 2-4 teethed lambs. The fact they are not as frequent in our market must be considered; in 1998 they accounted for only 3.0% of the total numbers of animals.

Abattoirs↗

PubMed2003

An update on immunodiagnosis of cystic echinococcosis.

Immunological parameters are increasingly investigated as possible markers for the development of cystic echinococcosis. Among the newer immunologic tests for assessing the host-parasite relationship, assay of immunoglobulin isotypes with the use of distinct parasite antigens and detection of Th1/Th2 cytokine expression are an interesting new approach. The findings upon which we have constructed our immunological hypothesis of the host-parasite relationship are: (1) immunoglobulin isotype profiles differ in patients with distinct clinical outcomes of the disease; in particular, antigen B is the antigen of choice to detect specific IgG4, which is the immunoglobulin isotype most clearly associated with the progression of the disease; (2) the isolation and characterisation of recombinant parasite proteins that behave as molecular markers of allergic reactions associated with cystic echinococcosis; (3) Th1/Th2 cell activation is involved in the clinical outcome of Echinococcus granulosus infection and, in particular Th2 response, is associated with susceptibility to the disease, whereas a Th1 response is associated with protective immunity.

Animals↗

PubMed2003

Economic effects of echinococcosis.

Cystic echinococcosis (CE) has a number of important economic effects. The most tangible of these is the cost of expensive medical treatment for human cases. Each confirmed case of CE can cost the health services or individual several thousand dollars. In addition to these costs, the additional cost of loss of edible offal from agricultural animals is well known. This may result in the entire loss of an infected organ or at least the trimming and downgrading of that organ, depending on local legislature. However, these losses may only be a relatively small percentage of the economic losses attributed to CE. Recent evidence suggests, through quality of life surveys, that patients treated for CE never fully recover and have a significant and permanent decreased quality of life. This has yet to be translated into monetary terms, but it almost certainly will result in the loss of income, possibly through a lower paid job, and/or the additional expense of increased ill health. Furthermore, in most reports, between 1 and 2% of CE cases are fatal. The death of these individuals results in the loss of the potential lifetime's economic output of these individuals. With alveolar echinococcosis the mortality rate is much higher and such consequences more severe. There is also a considerable amount of Soviet literature, and small amounts published elsewhere which suggests that CE also significantly affects animal productivity. Thus, infected sheep tend to give birth to fewer lambs, have lower levels of food conversion, produce less milk and have poorer quality fleeces then non-infected sheep. The total cost of the disease is the sum of the various costs to the health services, costs of morbidity and losses in animal productivity. Due to the uncertainty of many of these costs, it is appropriate to model these losses using techniques that can give a range of cost estimates. By using analytical techniques such as Monte-Carlo analysis, on parameters that are difficult to determine accurately, all such variables can be randomly varied simultaneously along likely frequency distributions. The results of this give a useful sensitivity analysis of economic costs. In addition, the purchasing power of money in the local economy must also be taken into account. One US $ buys much more in a developing country than in an industrialized economy. Consequently, each lost $ will be more acutely felt in poor countries. Estimates of the financial burden of disease are beneficial in deciding priorities for control. They are also potentially useful tools to lobby donors or non-governmental organizations to fund control programs in poor countries.

Animals↗

PubMed2003

The ambiguous role of immunity in echinococcosis: protection of the host or of the parasite?

In Echinococcus infection, at the metacestode stage, studies of the immune responses in the experimental murine model as well as in humans have shown that (1) cellular immunity induced by a Th1-type cytokine secretion was able to successfully kill the metacestode at the initial stages of development; (2) antigenic proteins and carbohydrates (and perhaps non-antigenic, mitogenic components) of the oncosphere/metacestode were able to interfere with antigen presentation and cell activation so that host lymphocytes and other immune cells could produce cytokines (especially IL-10) and other mediators able to inhibit the effector phase of cellular immune reaction; and (3) immunogenetic characteristics of the host were essential to this parasite-induced deviation of the immune response. In E. multilocularis infection, a combined Th1 and Th2 cytokine profile appears crucial for prolonged metacestode growth and survival. It may be hypothesized that Th1 cytokines promote the initial cell recruitment around the metacestode and are involved in the chronicity of the cell infiltrate leading to a fully organized periparasitic granuloma and its consequences, fibrosis and necrosis. The Th2 cytokines, on the other hand, could be responsible for the inhibition of a successful parasite killing especially because of the 'anti-inflammatory' potency of IL-10. This combination of various arms of the immune response results in a partial protection of both Echinococcus metacestode and host. However, it may also be considered responsible for several complications of the disease. The Th2-related IgE synthesis and mast cell activation, well known to be responsible for anaphylactic reactions in cystic echinococcosis, are more rarely involved in 'allergic' complications in alveolar echinococcosis (AE). However, the partial but chronic effects of the efficient Th1-related cellular immune response are responsible for cytotoxic events which both help metacestode growth and dissemination and lead to the central necrosis of the lesions and clinical complications of AE. Moreover, the Th-1 response is responsible for the major and irreversible fibrosis which leads to bile duct and vessel obstruction. In addition, the peri-parasitic fibrosis may be one of the reasons for the relative lack of efficacy of antiparasitic drugs. Modulation of the host immune response, by using Interferon alpha for instance, may be a new tool to generate an effective immune response against the parasite and to prevent AE and its complications.

Animals↗

PubMed1997

IgG1 and IgG4 serum antibody responses in asymptomatic and clinically expressed cystic echinococcosis patients.

IgG1 and IgG4 subclass antibody responses were investigated in two clinically different groups of hepatic cystic echinococcosis (CE) patients. One group consisted of surgically proven CE cases (clinically expressed hospitalized cases) and a second group comprised asymptomatic CE patients (first time community detected cases) diagnosed by portable ultrasound and serology in four different endemic communities. Fifty eight sera from surgically proven CE patients and 133 sera from asymptomatic ultrasound diagnosed CE cases were screened by ELISA using purified human hydatid cyst fluid antigen B for total specific IgG, IgG1 and IgG4 antibodies. Fifty sera from healthy individuals from within endemic regions were used as control negatives. Compared to control negatives total IgG antibody levels were elevated in both surgically proven (85%) and asymptomatic CE cases (77%) but there was no significant difference between the two groups. IgG1 subclass antibody levels were also elevated in both surgically proven (55%) and asymptomatic cases (58%) compared to endemic controls and similarly the difference in this response was not significant between these two groups. In contrast the prevalence of IgG4 antibodies in surgically confirmed chronic CE patients was greater (71%) than the respective IgG1 antibody levels (55%). The greatest difference in specific antibody response, between advanced surgically confirmed CE patients and ultrasound detected asymptomatic CE cases, was observed for IgG4 antibody levels which were detected in 71% of symptomatic compared to only 23% of asymptomatic patients (P < 0.0001). These observations confirm that IgG4 is an important diagnostic parameter for clinically expressed cystic echinococcosis in humans and suggest that a switch from a predominant IgG1 response to IgG4 might occur in CE patients as the disease progresses.

Animals↗

PubMed1997

Polycystic echinococcosis in tropical America: Echinococcus vogeli and E. oligarthrus.

The paper reports available data on 72 known human cases of polycystic echinococcosis (PE) caused by Echinococcus vogeli (Ev) or E. oligarthrus (Eo). The patients' ages ranged from 6 to 78 years (median 44); one third were younger than 22 years and had severe lesions, demonstrating the aggressiveness of PE. There were no differences in occurrence between sexes. In 80% of the cases the lesions were in the liver alone or in combination with other organs; the rest were located in the lung or other single sites. The diagnosis of PE was based on the demonstration of polycystic larval cestode lesions by radiological imaging (X-ray, US, CT scan) in patients born in tropical sylvatic areas of America where wild carnivores (canids, felids) and rodents (pacas and other species) were present. Serologic tests often, but not always, supported the diagnosis. Species identification of Ev or Eo were based on morphological characteristics of rostellar hooks from protoscoleces. The most common clinical presentation was abdominal; hard, round masses in or connected with the liver, hepatomegaly, increased abdominal size, pain, marked weight-loss and fever. Signs of portal hypertension were also present in 25% of cases, all of whom died of the disease or surgical complications following biliary drainage or partial hepatectomy. Ten percent were in asymptomatic persons. Albendazole treatment resulted in clinical improvement and disappearance or reduction of the size of lesions in some patients observed up to 24 months. The author believes that albendazole treatment should be tried before any other treatment is implemented. Human PE was reported from 11 countries, from Nicaragua to Argentina, 31 case were due to E. vogeli, three to E. oligarthrus (two orbital from Venezuela and Surinam and one cardiac from Brazil) and 38 were due to Echinococcus sp. (no rostellar hooks were available). PE reported from Nicaragua, Costa Rica, Chile, Argentina and Uruguay, countries outside the geographical range of the bush dog (only natural host of Ev) may have been due to Eo rather than to Ev. Several felids are known to serve as final host of Eo, and they are present in those areas. Epidemiological field studies of autochthonous human populations in tropical areas may contribute to early detection and make possible greater success in treatment of polycystic echinococcosis.

Adult↗

PubMed1997

Public health importance of cystic echinococcosis in Latin America.

Human cystic echinococcosis (CE) caused by larval Echinococcus granulosus is a zoonosis of major public health importance throughout Latin America. The Andean and South Cone regions have been recognized as endemic areas of cystic echinococcosis. This paper reviews prevalence in Argentina, Chile, Uruguay, Brazil and Peru.

Argentina↗

PubMed1997

Fine needle aspiration biopsy in the differential diagnosis of the liver cystic echinococcosis.

Liver cystic echinococcosis (CE) in non-endemic areas poses several problems in the differential diagnosis of various space occupying lesions detected by US examination. Fine needle aspiration biopsy (FNAB) using teflon covered needles with a US visible marker may be very useful for the definitive diagnosis. In the Clinic of Parasitic and Tropical Diseases in Poznan, FNAB were performed in 121 patients with liver space occupying lesions, with an addition of an anthelmintic cover of albendazole. The biopsy material was examined parasitologically, cytologically, bacteriologically and immunologically. E. granulosus infection has been confirmed in 25 patients (20.6%), in 16 cases by finding parasite protoscoleces or hooks and in nine cases by detection of an antigen specific for E. granulosus, antigen 5 (Ag5). Additionally nine cases of malignancy (7.4%), four of angioma (3.3%) and three bacterial abscesses (2.5%) were diagnosed. There were no complications related to FNAB puncture. The algorithm of the clinical management of space occupying lesions suspected for CE was proposed. FNAB is a very important technique in the differential diagnosis of cystic echinococcosis.

Biopsy, Needle↗

PubMed1999

Cardiac echinococcosis causing coronary artery disease.

We report a case of cardiac echinococcosis in a patient who had sustained an acute myocardial infarction 1 month previously. The coronary angiographic study revealed an isolated complete intrinsic obstruction of the left anterior descending coronary artery in the area of the cyst. The cyst was surgically removed. Coronary artery bypass grafting was not performed because of distal myocardial scarring. Coronary arteriography should routinely be performed in all patients with cardiac echinococcosis.

Aged↗

PubMed1997

Alveolar echinococcosis of the liver in a six-year-old girl with acquired immunodeficiency syndrome.

A 6-year-old girl with acquired immunodeficiency syndrome (AIDS) had extensive alveolar echinococcosis. Diagnosis was proved by needle biopsy of a specimen from affected liver tissue. The case was characterized by the unusually young age of the patient and more specifically by the absence of any detectable parasite-specific humoral and cellular immune response at diagnosis or later. Thus the present case indicates that a marked immunodeficiency caused by AIDS may substantially contribute to the rapid proliferation and early manifestation of the disease. In patients with pediatric AIDS and living in areas endemic for Echinococcus multilocularis, alveolar echinococcosis should be considered in intrahepatic tumor-like lesions even if the result of immunodiagnostic testing is negative.

AIDS-Related Opportunistic Infections↗

PubMed1990

Alveolar echinococcosis with involvement of the ureter and testis.

Alveolar echinococcosis is a rare disease of the liver, and occasionally of the lungs and brain, that is endemic across areas of Central Europe, the Soviet Union and Alaska. We describe a case of alveolar echinococcosis with involvement of the ureter and testis overshadowing the liver manifestation. The unusual presentation and nondemonstrable exposure to the organism caused misinterpretation of the histological findings and an initial misdiagnosis of tuberculosis.

Adult↗