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Infection of man by Echinococcus multilocularis occurs relatively seldom, most commonly localizing in the liver in the manner of a malignant tumour. A case of alveolar hydatid disease is reported presenting with extensive biliary obstruction, and a large cavitation in the liver due to necrosis. A review of epidemiology, clinical and roentgenological findings is given.
A striking feature of the transmission ecology of Echinococcus multilocularis in China is the diversity of hosts that contribute to the parasite cycle. Considering the population dynamics of key reservoir intermediate hosts and the ratio of their preferred habitat in a landscape (ROMPA) is essential to understanding transmission, but the numerous communities in which the parasite cycles and the extent of those communities is currently far from being fully documented. On the Tibetan plateau grassland management influences intermediate host species populations and the sheer size of the area could be a major contributing factor to sustaining transmission in the region. In Southern Gansu and Southern Ningxia the processes of deforestation have temporarily provided optimal habitat for key reservoir intermediate hosts of E. multilocularis, resulting in high transmission and human disease, however currently the parasite may be extinct locally. Faced with this pattern of potentially transient transmission in a diversity of communities the question of the dispersal potential of the parasite arises. The reforestation program currently active across much of Western China has the potential to give rise to a massive increase in habitat favourable to suitable intermediate hosts and emergence or re-emergence of the zoonosis alveolar echinococcosis in many areas. This potential epidemic could be mitigated by both natural and human induced parasite dispersal mechanisms including fox migration and the sale of infected dogs originating from stable endemic foci on the Tibetan plateau. However, currently the degree of genetic exchange between discrete transmission foci is unknown and it is expected that genetic techniques could provide crucial information regarding this important question.
The study of purified alkaline phosphatase and crude extract antigen immunogenicity from Echinococcus multilocularis was carried out on BALB/c mice. The animals were immunized, then infected with E. multilocularis metacestode. The immune response against purified alkaline phosphatase was studied. Flow cytometry analysis of the CD4+ and CD8+ lymphocyte populations showed a predominance of CD4+ populations in infected immunized mice. The specific humoral response to purified alkaline phosphatase was analyzed by enzyme-linked immunosorbent assay method. We noted a stimulation of an immunoglobulin IgG response. The isotypic profile showed a prevalence of IgG1 and IgG3 in immunized infected mice compared to IgG2a and IgG2b. In addition, analysis of the profiles of the in vitro secreted cytokines, after stimulation of the splenocytes from immunized mice, was performed. The cytokine profile was a mix of Th1/Th2 types in the infected and uninfected immunized mice. The results of this study suggest a humoral mixed Th1/Th2 response, with a high predominance of Th2 response. A similar study was conducted in mice immunized with crude total antigen. The comparison of the immune response showed an important immune response in mice immunized with purified alkaline phosphatase compared to mice immunized with the crude total antigen.
Antigen B (AgB) initially found in hydatid cyst fluid of Echinococcus granulosus is a polymeric lipoprotein of 160 kDa, and is an aggregate of several different but homologous small proteins with approximately 8 kDa. Four genes encoding these 8-kDa-subunits have been identified from E. granulosus. In this study we isolated five genes encoding 8-kDa-subunits of AgB from Echinococcus multilocularis. Sequence comparison of isolated cDNA clones demonstrated that one of these five clones was completely identical to EmAgB8/1 which had been isolated previously by our group, and three of them were 94.5, 90.8, and 91.9% homologous to E. granulosus antigen B 8-kDa subunit genes, EgAgB8/2, EgAgB8/3, and EgAgB8/4, respectively. The remaining clone shared 51-58% homology with the nucleotide sequences of AgB genes. Gene-specific RT-PCR and Western blot analyses revealed that these genes were expressed in a developmentally regulated manner in E. multilocularis vesicles, protoscoleces, and immature adult worms. Possible functions of different expression manners are also discussed.
A modified sedimentation technique (the "shaking in a vessel" technique; SVT) to examine intestines for smaller helminths such as Echinococcus multilocularis is described and compared with the intestinal scraping technique (IST). Out of 356 foxes, 26 were E. multilocularis positive, 19 using IST (sensitivity 73.1%) and 25 with SVT (sensitivity 96.2%) after IST. Especially low infection intensities went undetected with IST. The result is comparable to the established sedimentation and counting technique (SCT). SVT is recommended for the routine examination of fox intestines as an alternative to SCT.
Echinococcus multilocularis causes alveolar echinococcosis, one of the most lethal helminthic (accidental) infections in humans, as the life cycle predominantly includes wildlife rodents as intermediate hosts. The physical barrier between the proliferating parasitic metacestode and the host tissue is the acellular laminated layer (LL), which is characterized by its rich high-molecular-weight polysaccharide composition. Conversely to a crude protein-rich vesicular fluid antigen, a major carbohydrate antigen of the LL--the Em2(G11) antigen--did not stimulate murine T-cell proliferation in vitro. In fact, the persistent metacestode growth and antigenic stimulation induced a Th2 shift in vivo following conventional infection by intraperitoneal inoculation of 100 metacestode vesicles into C57/BL6 mice. Concurrently, the expression of Th1 cytokines (interleukin-2 and gamma interferon) remained persistently low until the late stage of chronic infection. In comparison to a recombinant proteinic II/3 antigen, the specific immunoglobulin G (IgG) response against the Em2(G11) antigen (including all IgG isotypes) maintained persistently low avidity. Furthermore, the Em2(G11) antigen induced a specific IgM and IgG response in T-cell-deficient athymic nude, TCRbeta(-/-), major histocompatibility complex class II (MHCII)(-/-)(CD4-deficient), and CD40(-/-) mice. The Em2(G11)-specific IgG synthesized in nude TCRbeta(-/-) and MHCII(-/-) mice was predominantly of the IgG3 and IgG2a isotypes and of the IgG3 and IgG2b isotypes in CD40(-/-) mice. This finding suggested that in vivo, the IgG response to major carbohydrate antigen Em2(G11) of E. multilocularis could take place independently of alphabeta+ CD4+ T cells and in the absence of CD40-CD40 ligand interactions; thus, the Em2(G11) antigen of the acellular LL represents a T-cell-independent antigen. Functionally, the encapsulating LL, and especially its major carbohydrate antigen, Em2(G11), seems to be one of the key factors in the parasite's survival strategy and acts by modulating the host immune response by virtue of its T-cell-independent nature.
Gangliosides, glycosphingolipids with sialic acid, were found in metacestodes of Echinococcus multilocularis in low quantities. All gangliosides were resolved after preparative high-performance thin layer chromatography into four fractions. Cholera toxin was specifically bound to the major ganglioside, allowing the identification of it as a GM1. Precise structure of the four fractions was determined by sequential degradation by exoglycosidases, gas chromatography, electron impact mass spectrometry and liquid secondary ion-mass spectrometry. Beside GM1, the other fractions were GM3, GD1a and, at a lesser percentage, GM2, all belonging to the same a-ganglio-series. The ceramide part of these parasite gangliosides contained sphingosine associated to unsaturated n24, saturated n24 and n16 fatty acids.
Free ceramides were isolated and purified from the metacestodes of Echinococcus multilocularis. Two different fractions were obtained by preparative thin-layer chromatography. Their structure was determined by gas chromatography and electron impact mass spectrometry of trimethylsilylated derivatives. The ceramide with the higher thin-layer chromatographic migration rate contained exclusively erythro-sphinganine associated with saturated C16, C18 and very-long-chain fatty acids (up to C30) and unsaturated C24 fatty acid. The second ceramide contained 90.3% sphingosine and 9.7% sphinganine associated with saturated C16 and C24 and unsaturated C18 and C24 fatty acids. These findings were discussed with regard to the structure and metabolic pathway of neutral and acid glycosphingolipids found in the metacestodes.
The validity of a coproantigen ELISA for Echinococcus multilocularis was evaluated by comparison of three diagnostic methods; autopsy, egg examination and the ELISA. Of 71 foxes, 39 were found to be infected with the cestode at autopsy. The overall mean of worm burdens was 3,451, but the number varied (1-34,522). The ELISA could detect 94.9% (37/39) of the worm positives and there were no false-positives. Two false-negatives were infected with 1 and 4 cestodes, whereas 3 cases with similar worm burdens (2, 4 and 6 worms) were diagnosed as positives. This indicates the detection limit of the assay may be equivalent to less than 10 (in the worm burden). On the other hand, egg examination showed low sensitivity (43.6%, 17/39). These results suggest the ELISA has a potential to replace for the conventional methods.
When protoscoleces of Echinococcus multilocularis were cultured in vitro, under axenic conditions in either monophasic or diphasic media, segmentation was suppressed in most organisms, some 70-80% of which developed into unsegmented, monozoic forms with a complete set of sexually mature male and female genitalia. The most striking feature of monozoic worms was the large lateral swelling produced by the cirrus sac the effect being to produce organisms with an unusual asymmetric shape. Worms which did not become monozoic either (a) underwent some somatic growth, developed two sets of genitalia and became 'pseudo-segmented', i.e. with the inter-proglottid membranes absent or poorly defined, or (b) became vesicular or abnormal. The mechanisms which could be involved in the suppression of somatic growth and the induction of the monozoic condition, are examined in terms of cell lineage. The possible significance of these results in understanding the evolution of the cestodes is discussed.
The metacestode stage of Echinococcus multilocularis was cultured in vitro. Sensitivity of protoscoleces to the presence of albendazole sulphoxide, praziquantel and methanol was assessed. 10 micrograms/litre of praziquantel or 500 micrograms/litre of albendazole sulphoxide significantly reduced protoscolex viability. The presence of methanol (at 0.25%) had no significant effect. In vitro culture of E. multilocularis can be used to assess possible chemotherapeutic agents.
The 13,738 bp mitochondrial DNA from the cestode Echinococcus multilocularis has been sequenced. It contains two major noncoding regions and 36 genes (12 for proteins involved in oxidative phosphorylation, two for rRNAs and 22 for tRNAs) but a gene for ATPase subunit 8 is missing. All genes are transcribed in the same direction. Putative secondary structures of tRNAs indicate that most of them are conventional clover leaves but the dihydrouridine arm is unpaired in tRNA(Ser(AGN)), tRNA(Ser(UCN)), tRNA(Arg) and tRNA(Cys). The base composition at the wobble positions of fourfold degenerate codon families is highly biased toward U and against C.
There are two foci of alveolar echinococcosis (AE) caused by Echinococcus multilocularis in Japan. The first focus is on Rebun Island where AE patients were found from 1937, and the second is in eastern Hokkaido where patients have been found since the 1960s. The origin of the second focus is unknown. To further investigate AE in eastern Hokkaido, wild rodents (Muridae) were captured and examined for infection on Kunashiri Island, which is located 15 km off the northeastern coast of Hokkaido. Metacestodes of E. multilocularis were isolated from two of 31 voles, all of which were identified to be Clethrionomys rufocanus. Mitochondrial DNA sequencing data of recovered cestodes showed total identity with the cestode reported from Hokkaido. These results suggest that E. multilocularis may have been introduced to Hokkaido from Kunashiri Island during or after 1965.
A high prevalence of larval Echinococcus multilocularis (Em) infection was found in zoo primates in Hokkaido, Japan. In October 1997, a Japanese monkey (Macaca fuscata) died and histopathologically diagnosed as alveolar hydatidosis. Serum samples were collected from the remaining Japanese monkeys and examined for antibodies against Em by enzyme-linked immunosorbent assay and western blotting. Serological tests showed 12 more animals of the remaining 57 monkeys were possibly infected. Ultrasonography revealed that nine of these 12 animals had a cystic lesion in the liver. The band patterns of western blotting in the monkeys were very similar to those in human.
On the basis of high prevalences of Echinococcus multilocularis in the growing fox populations in Central Europe, its total biomass may have increased significantly in the past 20 years. E. multilocularis is now also found in areas outside the known endemic area in Central Europe. Therefore, E. multilocularis, the causative agent of a serious parasitic zoonosis, might be of major concern for public health and a challenge to control. Some experimental field trials to control E. multilocularis using an anti-worm drug reduced parasite burden in a contaminated region during the control campaign, but failed to eradicate the parasite completely. It was our aim to develop a mathematical model describing the biomass of egg, larval, and adult worm stages of the E. multilocularis life-cycle, and simulate a hypothetical control campaign. Additionally, we derived the reproduction number of this parasite and explored conditions for the persistence of the parasite's life-cycle. Our model shows that while control campaigns rapidly reduce the worm burden in the definitive host, and consequently eggs in the environment, the pool of larvae in the intermediate host remains large. The parasite's life-cycle persists in a region where prevalence in the intermediate host is low (approximately 1%). Therefore, we conclude that the parasite is likely to re-emerge if control is discontinued on the basis of reduced worm population. Continued treatment of the definitive host is required to eradicate the larval stage of the parasite from the intermediate host population.
The present study aimed to search for and characterize parasite molecules, whose expression levels correlate with the viability and growth activity of Echinococcus multilocularis metacestodes. We focused on the expression profiles of 2 parasite-derived genes, 14-3-3 and II/3-10, as putative molecular markers for viability and growth activity of the larval parasite. In experiments in vivo, gene expression levels of 14-3-3 and II/3-10 were relatively quantified by real-time reverse transcription-PCR using a housekeeping gene, beta-actin, as a reference reaction. All three reactions were compared with growth activity of the parasite developing in permissive nu/nu and in non-permissive wild type BALB/c mice. At 2 months p.i., the transcription level of 14-3-3 was significantly higher in parasites actively proliferating in nu/nu mice compared to parasites moderately growing in wild type mice. Immunoblotting experiments confirmed at the protein level that 14-3-3 was over-expressed in parasites derived from nu/nu mice at 2 months p.i. In vitro treatment of E. multilocularis with an anti-echinococcal drug nitazoxanide resulted in a significant decrease of both 14-3-3 and II/3-10 transcription levels found after 8 days of treatment, which correlated with the kinetics of a housekeeping gene, beta-actin. The conclusion is that 14-3-3, combined with II/3-10, exhibits good potential as a molecular marker to assess viability and growth activity of the parasite.
A cDNA expression library representing the metacestode developmental stage of the tapeworm Echinococcus multilocularis was immunoscreened with monospecific antibodies affinity purified following differential immunoblot analysis. Using this procedure, a metacestode-specific clone was isolated representing a 14-3-3 gene of the parasite, which is present as a single copy in the parasite genome. The identity of this clone was demonstrated by cross-reactivity of the recombinant E. multilocularis 14-3-3 protein with antibodies raised against a heterologous 14-3-3 protein from Saccharomyces cerevisiae. In addition, expression of the E. multilocularis 14-3-3 gene in the mutant S. cerevisiae strain, DS9-22, resulted in complementation of the phenotypic deficiency of this strain, thus demonstrating the functionality of the respective gene product. By reverse transcription-polymerase chain reaction (RT-PCR) we showed that the E. multilocularis 14-3-3 protein is about 10-fold overexpressed in the metacestode stage compared with the expression level in the adult stage. Immunolocalization of the 14-3-3 protein in E. multilocularis metacestodes revealed its predominant presence in the germinal layer of the parasite. The results of this study, taken together with the current knowledge on the 14-3-3 protein family, suggest that this parasite molecule may contribute to the promotion of the progressive, potentially unlimited growth behaviour of the E. multilocularis metacestode within the host tissue.
Intratracheal inoculation of Echinococcus multilocularis protoscoleces was performed in prednisolone tertiary-butylacetate(PTBA)-treated and untreated golden hamsters and AKR/J mice. Repeated PTBA treatments prior to the day of inoculation prevented the influx of neutrophils against the cestode. More than 1 month after infection, living immature adult forms of E. multilocularis, showing some somatic prolongation, were recovered from the pulmonary alveolar space of PTBA-treated golden hamsters, in the absence of any cystic development.