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PubMed1987

Sero-epidemiological survey for alveolar echinococcosis (by Em2-ELISA) of blood donors in an endemic area of Switzerland.

Sera from 17,166 blood donors living in 10 cantons of northern Switzerland in an area endemic for Echinococcus multilocularis were investigated by serological survey for alveolar echinococcosis (AE). A highly species-specific antigen (Em2) and a commonly used E. granulosus hydatid fluid antigen (EgHF) were compared for their suitability in seroepidemiology. EgHF showed a degree of nonspecificity which did not allow direct detection of AE cases. Antibody reaction with Em2 resulted in the detection of 2 asymptomatic clinical cases of AE (seroprevalence 0.01%) within this population of blood donors. A further 4 persons were positive in Em2-ELISA. These 4 persons had negative imaging studies and will be followed serologically and clinically.

Adult↗

PubMedDate not supplied

Em2-ELISA for the follow-up of alveolar echinococcosis after complete surgical resection of liver lesions.

Alveolar echinococcosis, a serious and often fatal human disease, can be efficiently cured only by complete surgical resection of the Echinococcus multilocularis lesion. The present study showed that the determination in patients who had undergone surgery of antibody activity directed against the antigen Em2 reliably reflected complete or incomplete surgical resection. From 9 patients with pre-operative positive results in the Em2 enzyme-linked immunosorbent assay (Em2-ELISA) and successful surgical resection, 6 converted to negative within one year and the remaining 3 patients within 4 years after surgery. Six of 7 additional patients who showed recurrences in an average of 6 years after surgery despite assumed complete surgical resection, were positive by Em2-ELISA at the time of recurrence. Discrimination was not possible between these 2 groups of patients when using an ELISA employing crude antigen obtained from E. granulosus hydatid cyst fluid.

Adolescent↗

PubMedDate not supplied

Computer tomography of liver in alveolar echinococcosis treated with albendazole.

Fourteen cases of alveolar echinococcosis were examined by computed tomographic (CT) scanning of the liver, including 3 cases before treatment and 11 cases 2.0-7.5 years after long-term continuous albendazole therapy. In 7 cases the hepatic lesions were almost completely calcified and cured, while in 3 cases incomplete calcification of the peripheral margin of the hepatic lesions was observed. CT scanning of the one uncured case and the 3 cases before treatment showed active lesions with heterogeneous hypodense areas in the liver without calcification on the peripheral margin. Long-term continuous albendazole therapy can result in parasitological cure with death of the parasite.

Adult↗

PubMedDate not supplied

Analysis of immunoglobulin G subclass in the serum antibody responses of alveolar echinococcosis patients after surgical treatment and chemotherapy as an aid to assessing the outcome.

Immunoglobulin G (IgG) subclass-specific antibody responses were evaluated for the follow-up of alveolar echinococcosis (AE) patients. Seventy-four sequentially collected sera from 25 Chinese and French AE cases who underwent surgery including hepatectomy, liver transplant and/or chemotherapy were analysed quantitatively and qualitatively during the clinical follow-up period. These AE patients were classified in 4 groups--cured, improved, stabilized, or aggravated. Serum antibody levels of the subclasses IgG1 and IgG4 were significantly higher in the AE patients than in healthy controls. IgG1 and IgG4 isotypes in AE patients were the most sensitive IgG antibody response in an enzyme-linked immunosorbent assay (ELISA) and in binding to antigens of 44kDa, 35kDa, 21kDa and 17.5kDa in an Echinococcus multilocularis protoscolex extract after Western blotting. In AE cases classed as cured or improved, IgG subclass antibody levels tended to decrease earlier than total IgG levels, especially IgG4 antibody levels which became negative within one year after successful treatment. IgG4 antibody levels also decreased in most of the improved cases. Increasing or unchanged levels of IgG4 and IgG1 antibodies were demonstrated in both stabilized and aggravated AE cases using both ELISA and immunoblot assays. Reappearance of specific IgG4 antibodies was a strong indication of recurrence, especially in liver transplant patients. Combined quantitative and qualitative assessment of IgG1 and IgG4 antibodies may be potentially useful for the serological follow-up of human AE.

Adult↗

PubMed1993

Prevalence of echinococcosis in pigs and sheep in the Slovak Republic.

The prevalence of echinococcosis in slaughtered animals has been monitored in the Slovak Republic between 1971 and 1990. In pigs, the prevalence dropped almost constantly from 3.85% to 0.13%, by as much as 15% per year. The dynamics of prevalence in sheep differs substantially from that in pigs. Significant 12 year, 6 year and 3 year periodicities predominate over a nonsignificant and slight decrease of prevalence by only 1% per year. Therefore, the prevalence fluctuates in the period of observations between 0.49 and 3.72%. No significant correlations or cross-correlations have been found between the prevalences in the two groups of animals.

Animals↗

PubMed2004

Ultrasonographic diagnosis and medical treatment of human cystic echinococcosis in asymptomatic school age carriers: 5 years of follow-up.

Hydatidosis or cystic echinococcosis (CE) caused by Echinococcus granulosus is endemic in the Province of Río Negro, Argentina. The objective of this investigation was to evaluate the results of a program carried out in endemic areas of the Province of Río Negro, Argentina, in the years 1997-2002. Abdominal ultrasonography was used, classifying the cases detected according to WHO guidelines. A treatment algorithm was defined which included observation, albendazol therapy, PAIR or surgery, according to cyst type and size. A total of 5745 schoolchildren were evaluated, detecting hydatid cyst carriers in 70 (1.2%). Of these; 40 (57.1%) were included in follow-up protocol, 25 (35.7%) in treatment protocol with albendazol, 2 (2.9%) with PAIR and 3 (4.3%) with conventional surgery. After a mean of 44 months, among 25 cases treated with albendazol, in 2 (8%) cysts underwent total involution, in 17 (68%) they presented positive changes, in one (4%) they remained unchanged and in 4 (16%) they progressed to type II, while 1 (4%) displayed negative evolutionary changes. Out of 39 cases under observation alone protocol, in 8 cases (21%) cysts underwent total involution, in 7 (18%) they presented positive changes, in 11 (28%) they remained unchanged, in 2 (5%) they progressed to Type II and in 11 (28%) they presented negative evolutionary changes and had to be included in the other protocol types. In this study, conventional surgery, was applied to 10% of detected cases. The combination of ultrasonographic screening and albendazol treatment showed promising results.

Abdomen↗

PubMedDate not supplied

Echinococcus granulosus cattle strain identification in an autochthonous case of cystic echinococcosis in central Mexico.

Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.

Adult↗

PubMed2004

A discrepancy between cystic echinococcosis confirmed by ultrasound and seropositivity in Turkish children.

In three randomly selected villages of Manisa, Turkey, 630 primary school children were examined for cystic echinococcosis (CE) by a portable ultrasound scanner (US) and chest microfilm. Sera samples of 483 (76.7%) children were tested for anti-E. granulosus antibodies by ELISA and indirect hemagglutination (IHA) tests. Hepatic CE were detected in two cases (0.3%) by US, while 43 (8.9%) and 49 (10.1%) cases were found to be positive for CE by ELISA and IHA, respectively. The high seropositivity levels could have been attributed to extra-abdominal or abortive Echinococcus infections, but probably most of them were false-positives. Due to the discrepancy in results, US should be selected as the primary test in field studies and serologic tests should be performed in all cases with suspected lesions. We could not find any reported community based study on CE in Turkey, in which US was applied; but our results suggest that extensive epidemiological studies are required.

Adolescent↗

PubMed2006

Post-survey follow-up for human cystic echinococcosis in northwest China.

In Hobukesar, Xinjiang Uygur Autonomous Region, (China), a mass-screening programme for human cystic echinococcosis (CE)was performed during 1995 and 1996. After the survey 51 cases were followed-up using ultrasound scan and serology for 1-8 years(1996-2003). These included 20 CE cases treated by surgery (endocystectomy), four CE cases treated by percutaneous drainage(PAIR), six untreated CE cases, five ultrasound 'query' cases, eight cases of isolated hepatic calcifications, four previous CE surgery cases whose ultrasound was now normal, and four seropositive cases who exhibited a normal hepatic ultrasound. Follow-up results indicated that in the untreated CE patients, one case exhibited a spontaneous cure within 4 years, another case changed from a hepatic hydatid cyst that contained a floating laminated membrane (type CE3) to a cyst that contained daughter cysts (type CE2)within 1 year of follow-up. In the 20 surgically treated cases, two recurrent CE cases occurred within 4 years, and five cases had had residual cavities for more than 4 or 8 years. Of the 4 PAIR treated cases, two recurrent cases of CE occurred within 4 or 8 years of follow-up. Serological follow-up data showed that specific IgG antibody levels were persistently positive in most CE cases, but exhibited a decreasing tendency in cases that were effectively treated by surgery; In contrast, serum IgG levels in the PAIR group or in the recurrent CE cases after surgery exhibited an increasing tendency. At least one persistent seropositive case with an isolated hepatic calcification was considered to be abortive CE.

Albendazole↗

PubMedDate not supplied

[Long-term followup of patients with alveolar echinococcosis].

INTRODUCTION: Alveolar Echinicoccosis is a severe parasitic disease: its natural evolution is comparable to a slowly progressive malignant liver tumour. There is no definitive medical therapy. Surgery remains the only option to assure a cure. This report is our surgical experience for the care of this affection. PATIENTS AND METHOD: Between 1980 and 2002, 12 patients were operated for an hepatic alveolar echinococcosis. For 11 of them, the affection was primary. Lesions were located in the right liver lobe (n = 9), in the left lobe (n = 1), in both lobes (n = 1) and close to the hilar region (n = 1). Twice there was a diaphragmatic infiltration and once a pleural infiltration. Resections consisted in: segmentectomies in the right lobe (n = 4), right hepatectomy (n = 5, associated once with a partial I and IV segmentectomy), left hepatectomy (n = 1), one liver transplantation (n = 1), one drainage of a parasitic cavity (n = 1). One pleurectomy and a partial diaphragmatic resection were made. All patients were treated postoperatively with benzimidazole chemotherapy. RESULTS: Three patients presented some complications: segmental necrosis with biloma (n = 1), biliary fistula tract (n = 1), subdiaphragmatic hematoma (n = 1), cholangitis (n = 1). 10 patients are alive (median follow-up of 10 years). Two patients still present some parasitic lesions; the situation remains doubtful for one of them. Two patients died (one of them in the context of a disease progression). CONCLUSION: Surgical treatment, associated with medical therapy, assured a control of the parasitic lesions or a definitive cure in most cases. When the disease is limited to the liver with no possibility for partial hepatectomy, a transplantation is an option.

Adult↗

PubMed2004

Secondary and primary murine alveolar echinococcosis: combined albendazole/nitazoxanide chemotherapy exhibits profound anti-parasitic activity.

In this study, the efficacies of chemotherapy employing nitazoxanide (NTZ), albendazole (ABZ), and a NTZ/ABZ-combination against alveolar echinococcosis (AE) were investigated in an experimental murine model. Following secondary infection, meaning i.p. injection of 20 Echinococcus multilocularis metacestodes, the drugs were administered by intragastric inoculation on a daily bases for a period of 5 weeks. Treatment was started either immediately on the day of infection, or at 2 months p.i., respectively. Application of the NTZ/ABZ-combination starting at 2 months p.i. was proven to be most effective in terms of reducing parasite weight (from 4.42+/-1.03 to 1+/-0.05 g; P=0.01). Inspection of treated parasites by transmission electron microscopy showed that ABZ- and NTZ-treated metacestode tissues, respectively, were heterogeneous in that both largely intact parasites as well as severely altered metacestodes could be observed. NTZ/ABZ-combination treatment induced the most severe ultrastructural alterations, including massive reduction in length and number of microtriches, severely damaged tegumental architecture, and progressive loss of viability of the germinal layer, associated with encapsulation by host connective tissue. A comparative pharmacokinetic study in mice revealed that the application of ABZ and NTZ in combination resulted in a two- to four-fold increase of albendazole sulfoxide serum levels for the period of 4-8 h following drug uptake compared to application of ABZ alone. In a third experiment, mice were orally infected with E. multilocularis eggs, and treated with NTZ starting at 2 months p.i. This resulted in a significantly lower lesion number in treated versus untreated mice (P=0.01). This investigation indicates the potential value for NTZ and/or a combined ABZ/NTZ chemotherapy against AE.

Albendazole↗

PubMed2005

In a diagnostic test study the validity of three serodiagnostic test was compared in patients with liver echinococcosis.

BACKGROUND AND OBJECTIVE: To determine the efficacy of immunoprecipitation (DD5), enzyme immunoanalysis (ELISA-IgG), and immunoelectrotransference or Western blot (WB) in patients with liver echinococcosis (LE) used separately, in parallel and in series. METHODS: Diagnostic test study. DD5, ELISA-IgG, and WB were applied in 75 patients with LE and 75 with cholelithiasis. Surgery was considered a reference standard. The sample size was calculated assuming a 99% confidence interval (99% CI), expected sensitivity (S) of 90% and a worst result of 80%; expected specificity (SP) of 95% and a worst result of 85%. S, SP, and predictive values (PPV and NPV) were calculated. RESULTS: The best S was verified with ELISA-IgG and WB (82.7%) and the best SP with DD5 (94.7%). DD5 presented a better PPV (92.9%) and WB a better NPV (83.5%). When applying the tests in parallel, the best S was obtained from the combination of DD5 and WB (82.7%); and the best SP, PPV and NPV with ELISA-IgG and WB (88.0%, 87.3%, and 83.5%, respectively). CONCLUSIONS: DD5 appears as the most specific test and as having greater PPV; ELISA-IgG and WB are more sensitive. The combined use of these tests does not improve diagnosis validity.

Adolescent↗

PubMed2004

Observations on clinical efficacy of albendazole emulsion in 264 cases of hepatic cystic echinococcosis.

Two regimens of albendazole emulsion (AbzE), a novel formulation, were used in the treatment of 264 cases of hepatic cystic echinococcosis. AbzE 10 mg/kg per day (calculated by albendazole base) was administered orally to 71 cases for 6 months to over 1 year. Imaging evaluation at the end of courses showed overall efficacy in 97.2%, (cure rate 60.6%, and inefficacy rate 2.8%); The follow-up study on 62 cases 3-4 years post therapeutic courses showed overall efficacy in 92.0% (cure rate 83.9%, ineffective rate 1.5% and recurrence rate 6.5%); Abz 12.5 mg/kg per day was administered orally to 193 cases for 3 months to over 1 year, resulting in an overall efficacy of 97.9%, (cure rate 75.1% and inefficacy rate 2.1%). The follow-up study in 139 cases 2-4 years post treatment demonstrated efficacy in 89.2%, (cure rate 84.2% and recurrence rate 10.8%); Mild reversible adverse reactions were observed in 14.4% of the patients. Retreatment of recurrent hydatidosis patients with AbzE provided promising results. AbzE is considered to be superior to the albendazole tablet or capsule formulations currently used in treatment of liver cystic hydatid disease.

Adolescent↗

PubMed2005

Coproantigens in taeniasis and echinococcosis.

The application of modern immunodiagnostic or molecular diagnostic techniques has improved the diagnosis of the taeniid cestode infections, echinococcosis and taeniasis. One particularly promising approach is the detection of parasite-specific antigens in faeces (coproantigens). This approach has been applied to both Echinoccocus and Taenia species and it has gained increasingly widespread use. Taeniid coproantigen tests are based on either monoclonal or polyclonal antibodies raised against adult tapeworm antigens. These tests have the following common characteristics; they are largely genus-specific, specificity is high (>95%), parasite antigen can be detected in faeces weeks prior to patency, levels of coproantigen are independent of egg output, coproantigen is stable for days at a range of temperatures (-80 degrees C to 35 degrees C), for several months in formalin-fixed faecal samples, and coproantigen levels drop rapidly (1-5 days) following successful treatment. In the genus Taenia, most work has been done on Taenia solium and coproantigen tests have reliably detected many more tapeworm carriers than microscopy. For Echinococcus species, there is a broad positive correlation between test sensitivity and worm burden with a reliable threshold level for the test of >50 worms. Characterisation of taeniid coproantigens in order to further improve the tests is ongoing. Studies indicate taeniid coproantigens to include high molecular weight (>150 kDa), heavily glycosylated molecules with carbohydrate moieties contributing substantially to the levels of antigen detected in faeces. Application of the existing coproantigen tests in epidemiological and control programmes for Echinococcus and Taenia species infection has begun to contribute to an improved understanding of transmission and of surveillance of these important zoonotic cestodes.

Animals↗

PubMed2005

Usefulness of severe combined immunodeficiency (scid) and inbred mice for studies of cysticercosis and echinococcosis.

The topics in this review are the usefulness of immunodeficient and inbred mice for studies of developmental biology, drug efficacy and host specificity in cysticercosis and echinococcosis. In non-obese diabetic severe combined immunodeficiency (NOD/Shi-scid) mice of both sexes, in vitro hatched oncospheres of all three human taeniid species (Taenia solium, Taenia saginata and Taenia asiatica) developed into cysticerci comparable to or bigger than those developed in their known intermediate host animals, whereas only females were susceptible to these infections in other scid mice of BALB/c, C57BL or C.B-17 inbred strains. Detailed morphological observation from post-oncospheral to cysticercus developmental stages is expected to be easy when we use NOD/Shi-scid mice experimentally inoculated with in vitro hatched oncospheres. Metacestocidal effect of oxfendazole was evaluated in NOD/Shi-scid mice experimentally inoculated with oncospheres of T. solium. In Echinococcus multilocularis infection, larval tissue proliferated without induction of inflammatory host responses in scid mice, thus facilitating isolation of the larval vesicles and protoscoleces for biochemical and molecular biological studies. Trans portal inoculation of metacestode tissues resulted in proliferation of secondary echinococcal foci localized exclusively in the liver without metastasis to other tissues or organs. The advantages of a mouse model for Echinococcus granulosus are also described.

Animals↗

PubMed2006

Epidemiology and control of echinococcosis in sub-Saharan Africa.

Cystic echinococcosis (CE) is highly endemic among the nomadic pastoral tribes of East Africa, but is rare amongst the agriculturally based communities. Echinococcus granulosus infections are common in dogs from all countries in sub-Saharan Africa where they have been examined. Transmission of E. granulosus to humans is affected by such factors as prevalence of the parasite in domestic dogs, behaviors of humans towards dogs, and heterogenicity of the parasite and susceptibility of humans to infection. Sheep and goats appear to be the most common domestic intermediate hosts, but recent studies suggest that camels are equally important intermediate host, especially in Sudan and Turkana. At least five of ten E. granulosus genotypes are infective to humans in sub-Saharan African. Most human cases of CE are caused by the sheep strain (GI) and camel strain (G6) of E. granulosus. Other strains occurring in the area may include a lion strain, the horse strain (G4 or Echinococcus equinus) and the cattle strain (G5 or Echinococcus ortleppi).

Africa South of the Sahara↗

PubMed2005

Present situation of cystic echinococcosis in Central Asia.

Cystic echinococcosis (CE) caused by Echinococcus granulosus has always been an endemic disease in central Asia. During the period of Soviet Administration up to 1991, human surgical incidence rates tended to be relatively low with perhaps at most 1-5 cases per 100,000 per year. Following the collapse of the Soviet Union and the emergence of the New Independent States there has been profound economic and social changes. Associated with this has been a serious epidemic of CE throughout the region. In many areas figures suggest the surgical incidence is now greater than 10 cases per 100,000. Furthermore, official government figures are believed to substantially under report the extent of the problem. For example, official figures in Uzbekistan reported 819 cases of CE surgically treated in 2001. However, a detailed analysis of hospital records suggests that the true figure was 4089, more than 4 fold higher. The latter figure represents an annual surgical incidence rate of nearly 25 cases/100,000 per year. Similarly high endemic areas are seen in southern Kazakhstan, Kyrgystan and Tadjikistan with incidence rates of up to 13 cases/100,000, 20 cases/100,000 and 27 cases/100,000 respectively. A disproportionate number of cases are in children and the unemployed. The rates of infection have also increased in major livestock species such as sheep with a doubling of reported prevalence in some areas. In the dog population, independent studies in Uzbekistan and Kazakhstan have demonstrated that the rural dog population, closely associated with the sheep industry, is highly infected, with prevalences approaching 25%. Village and urban dogs have a considerably lower prevalence.

Adolescent↗

PubMed2005

Mathematical models for the control of cystic echinococcosis.

Cystic echinococcosis (CE) caused by Echinococcus granulosus is a global public health problem. In many areas the disease is being diagnosed in increasing numbers, whilst in other areas it is re-emerging due to the collapse of public health programmes associated with socio-economic changes. Mathematical models of the transmission dynamics between animals can have an important role to play in developing control options. In particular the parasite is highly endemic in many lower income countries where resources to undertake an intensive control programme that has been successful in wealthy countries, such as New Zealand, are not available. Data from dogs and livestock have been collected and modelled from a number of different countries and regions. In Australia and New Zealand transmission modelling was first developed and these models have been refined using data from the Middle East and central Asia. The model indicates that relatively intense anthelmintic treatment of the dog population will result in a substantial decrease in the parasite population over time and has been supported by the results of control programmes. However, if the newly developed sheep vaccine is included in the control programme, then it should be possible to treat dogs less frequently to achieve the same result. This is due to the potentiating effects of attacking the parasite at two places in its life cycle. This should result in considerable cost savings over the use intensive anthelmintic treatment as the sole method of control.

Animals↗