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In vitro activities of benzimidazoles against Echinococcus multilocularis metacestodes.

Alveolar echinococcosis, caused by the larval (metacestode) stage of the tapeworm Echinococcus multilocularis, is a lethal parasitosis of the liver prevalent in the Northern Hemisphere. For chemotherapy the benzimidazole derivatives mebendazole and albendazole were introduced, and their use has resulted in a significant improvement in the survival rates. However, data from experiments with animals and clinical observations indicate that these drugs elicit only parasitostatic activity and in most cases are not able to completely eliminate the parasitic metacestode tissue. In the present study, we applied a culture system for the in vitro growth and proliferation of E. multilocularis metacestodes to analyze the parasitostatic and parasitocidal potential of mebendazole. Here, we demonstrate for the first time that at concentrations of >0.1 microM, i.e., at concentrations used for therapy of human alveolar echinococcosis, this antihelminth drug is parasitocidal in vitro. Viability assessment was performed by infection experiments with Meriones unguiculatus and mebendazole-treated metacestode tissue and by reverse transcription-PCR for the detection of E. multilocularis mRNA. The E. multilocularis in vitro model proved to be a valuable tool for the analysis of the potential of antihelminth drugs.

Animals↗

Diagnosis of the Echinococcus multilocularis infection in final hosts.

In view of the considerable public health significance of Echinococcus multilocularis, the causative agent of the highly lethal human alveolar echinococcosis, there is an urgent need for reliable and simple techniques for the diagnosis of the infection in populations of final hosts (foxes, dogs, cats) and also in individual dogs and cats. The standard technique presently used is parsitological examination of the small intestine at necropsy. This reliable technique requires high expenditure and special safety precautions. An alternative approach is coproantigen detection. Recently, in our laboratory an ELISA was evaluated using rabbit and chicken polyclonal antibodies against E. multilocularis antigens (affinity purified coproantigens and somatic adult worm antigens). The specificity of this test (evaluated in 20 foxes and 661 dogs with helmintic infections other than E. multilocularis) was very high (95%-99.5%). Average sensitivity in 35 foxes infected with E. multilocularis was 80%, but reached 93% in foxes with individual worm burdens over 55. A Polymerase Chain Reaction (PCR) was used for detecting DNA of E. multilocular is in faecal samples of foxes after the parasite eggs had been isolated by a sieving procedure. In a total of 55 foxes specificity was 100% and sensitivity 94%. For field application the coproantigen ELISA has the potential of replacing parasite detection at necropsy, and PCR is a valuable method for confirmation of positive coproantigen results and for diagnosis in individual animals. Detection of circulating anti-Em2 antibodies by ELISA may be useful for primary screening of fox populations but antibody prevalence rates do not correlate with prevalence rates of the intestinal infection with E. multilocularis.

Animals↗

Echinococcus multilocularis in red foxes (Vulpes vulpes) of the Italian Alpine region: is there a focus of autochthonous transmission?

Alveolar echinococcosis, caused by the metacestode of Echinococcus multilocularis, is a zoonosis with a wider distribution area than described in the past. Fox populations living in the Alpine regions of Italy had been considered free from this parasite until 2002, when two infected foxes (Vulpes vulpes) were detected in the Bolzano province (Trentino Alto Adige region) near the Austrian border. The aim of this work was to evaluate the prevalence of infection in red fox populations from five Italian regions. A modified nested PCR analysis was used to detect E. multilocularis DNA in faecal samples. Amplicons were confirmed by sequencing. Of 500 faecal samples from foxes shot in Valle d'Aosta (n=57), Liguria (n=44), Lombardy (n=102), Veneto (n=56), and Trentino Alto Adige (n=241) regions, 24 animals, all from the Trentino Alto Adige region, were found positive. Twenty-two positive animals originated from the Bolzano province and two positive animals from the Trento province. Several localities of the Bolzano province, in which positive foxes were detected, are the same as those where alveolar echinococcosis had been described in humans in the second half of the 19th century, suggesting an old endemicity for the investigated area, which is adjacent to endemic areas of Austria. Therefore, the question arises if we are observing an increase and expansion of foci, or if the new records are due to the more sensitive and specific methods used to detect the worm DNA.

Animal Diseases↗

[Characterization of surface and intracellular glycoconjugates in larval forms of Echinococcus multilocularis using lectins].

Carbohydrate moieties have been detected with nine fluorescent lectins in Echinococcus multilocularis cysts, developed in liver and lung of infested jirds. Tegument and glycocalyx, and two types of medullary cells were found to selectively and strongly bind lectins which are specifically adsorbed by N acetyl glucosamine, N acetyl galactosamine, galactose or mannose. The significance of these features in the host-parasite interaction are discussed.

Animals↗

The house mouse: a potential intermediate host for Echinococcus multilocularis in France.

An adult house mouse infected with an alveolar hydatid of Echinococcus multilocularis was trapped in the cellar of an inhabited house in a small village in Auvergne (France) where 3 human cases of alveolar hydatid disease had been diagnosed. The rodent harboured a young hepatic larval cyst. This indicated the presence of infective eggs of the parasite inside the house and outbuildings, an important observation concerning the circulation of the parasite in a domestic environment.

Animals↗

Detection of antibodies against glycolipids of Echinococcus multilocularis metacestodes in sera of patients with alveolar hydatid disease.

Glycosphingolipids extracted from Echinococcus multilocularis metacestodes were tested against sera from patients with alveolar hydatid disease (AHD). The tests were performed first by ELISA then by immunostaining on thin layer chromatography. A binding between the parasite glycolipids and antibodies of AHD human sera was observed by ELISA. The glycolipids related to this binding were specifically parasite neutral glycosphingolipids. No reaction was observed with parasite acid glycolipids nor with neutral glycolipid extracts from human or mongolian gerbil erythrocytes. Comparison between absorbance values of 25 AHD sera and 20 control sera showed significant differences. Similar results were obtained with sera from hydatid cyst patients. Sera from patients with other parasitoses (schistosomiasis, strongyloidosis or paludism) were also tested. The reactive fractions were identified by immunostaining on thin layer chromatography with AHD sera, they were neutral glycosphingolipids containing at least two carbohydrate residues. These results were compared with chromatograms obtained with hydatid cyst human sera and discussed.

Animals↗

Fine needle aspiration biopsy in hepatic Echinococcus multilocularis.

OBJECTIVE: To determine the fine needle aspiration biopsy (FNAB) findings in hepatic Echinococcus multilocularis. STUDY DESIGN: FNAB and tru-cut liver needle biopsy were applied in 14 hepatic E multilocularis cases. Cytologic smears were stained with May-Grünwald-Giemsa and periodic acid-Schiff (PAS) stain. Tissue sections were stained with hematoxylin-eosin (HE) and PAS stain. RESULTS: In tissue sections, homogeneous, thin, cystic structures of various dimensions strongly stained with PAS. Mucoid material was stained with PAS in the cystic structures. Wide, coagulative necrosis was observed in all cases. In some cases there were foreign body-type giant cells at the periphery of the lesion. In all the cytologic smears there were an intense necrotic ground, PAS-positive hyaline cuticular structures and mucoid globules; in some cases there were foreign body-type giant cells. CONCLUSION: The above cytologic characteristics are basic diagnostic criteria for FNAB of E multilocularis.

Biopsy↗

[Importance of epidemiology and control of the fox tapeworm, Echinococcus multilocularis, in Germany].

A review is given on the epidemiology and control of Echinococcus multilocularis with emphasis on the particular situation in Germany. Recent studies have demonstrated a comparatively frequent general occurrence of the parasite in fox populations in Germany apart from the traditional endemic areas in the Southwest. Final conclusions concerning a putative spread of the parasite from the highly endemic areas in the Southwest of Germany to the North and the East can not be drawn to date due to a lack of data. New and traditional diagnostic tools, as well as prophylactic and therapeutic measures are discussed.

Adult↗

Detection of Echinococcus multilocularis in foxes: evaluation of a protocol of the intestinal scraping technique.

The intestinal scraping technique (IST) is widely used for the detection of definitive hosts infected with Echinococcus multilocularis. The sensitivity of the method has been questioned in recent years. Several variations of the technique are used that may differ in their performance. We therefore estimated the diagnostic sensitivity and specificity of the IST protocol used in our lab by examining the small intestines of 210 E. multilocularis-infected foxes and 294 foxes that had tested negative for this parasite. To this end, IST was first performed on 48 and 294 intestines from infected and uninfected foxes respectively, followed by an examination of the entire remaining mucosa of the small intestine to discover any infections with E. multilocularis that had not been detected by IST. The point estimate for diagnostic sensitivity was 100%. Five different classes of infection intensities were formed. The lower limits of the 95% confidence intervals ranged between 76.8% and 92.6% depending on the number of samples analysed per class. When the small intestines of another 162 infected foxes were examined by IST and the results recorded separately for the anterior, middle and posterior third of the small intestine, a strong preference of E. multilocularis for the posterior third was observed. For epidemiological purposes, it may thus be possible to restrict routine investigations to the posterior portion of the small intestine. By contrast, a reduction of the number of slides examined per infected animal may lead to a considerable loss in sensitivity in animals with a low intensity of infection.

Animals↗

Comparison of the antigenicity of protoscoleces and microvesicles of Echinococcus multilocularis prepared from rats.

Rats are known to be relatively resistant to infection with Echinococcus multilocularis. However, when rats are inoculated with the parasite tissues, E. multilocularis proliferates slowly at first but after 6 months the cysts increase in size considerably and contain large numbers of protoscoleces. As rats survive for 18 months or longer, approximately 100 ml of packed protoscoleces can be produced from each rat. A comparison of the antigenicity of the protoscoleces and microvesicles by immunoblot methods showed that both Em18 and Em16 are shared components between both protoscoleces and microvesicles, although the latter have some additional antigenic components. In antigens prepared from protoscoleces, the banding patterns around Em18 were much simpler than those from microvesicles. Therefore, for serodiagnosis of E. multilocularis, antigens should be carefully prepared from protoscoleces rather than microvesicles from the rat.

Animals↗

A monoclonal antibody against Echinococcus multilocularis Em2 antigen.

A monoclonal antibody (MAb G11) species-specific to the Em2 antigen of Echinococcus multilocularis was generated for (i) further biological characterization of the Em2 antigen, (ii) easy affinity-purification of Em2 antigen for immunodiagnostic and immunological investigations and (iii) development of a sandwich-ELISA for the detection of Em2 antigen in diagnostic samples and thus species-specific identification of E. multilocularis metacestode material. The MAb G11 was used in an antibody sandwich-ELISA to detect soluble Em2 antigen with a methodical sensitivity of 80 ng E. multilocularis antigen/ml of solution. MAb G11 specifically detected Em2 antigen in all of 15 E. multilocularis-isolates originating from various geographical areas and in none of other helminth isolates (e.g. Echinococcus granulosus, E. vogeli, and others). Further biological analysis by FITC-labelled MAb G11 demonstrated unique binding activity to the laminated layer of the metacestode. Also, oncospheres were binding FITC-labelled MAb G11 on an outer layer synthesized during cultivation in vitro for 13 days after hatching. Application of the MAb G11 antibody sandwich-ELISA for investigation of solubilized oncospheres confirmed the in vitro synthesis of Em2 antigen by oncospheres on day 13 p.i. Adult stages (somatic antigens) and freshly hatched oncospheres were always MAb G11 negative. Solid-phase MAb G11 was used for purification of the corresponding Em2 antigen by affinity chromatography. A preliminary serological evaluation of the Em2(G11) antigen by ELISA revealed identical immunodiagnostic characteristics, compared to Em2 obtained by classical means, thus suggesting the presented method for future isolation of large-scale Em2 antigen.

Animals↗

Pasture types and Echinococcus multilocularis, Tibetan communities.

Our study showed that open pastures had more small mammal burrows than fenced pastures in Tibetan pastoralist communities in 2003. This characteristic was linked to a higher prevalence of Echinococcus multilocularis in dogs and indicates that pasture type may affect E. multilocularis transmission.

Animals↗

The production of eggs by Echinococcus multilocularis in the laboratory following in vivo and in vitro development.

Adult worms of Echinococcus multilocularis produced eggs in vitro following partial development in the definitive host for 20-21 days and maturation for 8 days in a monophasic or diphasic medium. The technique was shown to be reproducible with morphologically normal eggs produced in two separate experiments. The onset of egg production in vitro was identical to that in vivo although the number of eggs produced by each worm was less in vitro.

Animals↗

Echinococcus multilocularis (Cestoda), the causative agent of alveolar echinococcosis in humans: first record in Poland.

Echinococcus multilocularis, the causative agent of human alveolar echinococcosis, was found for the first time in Poland in 2 of 20 red foxes (Vulpes vulpes), originating from the area of Gdansk (northern Poland). This finding supports the hypothesis that the endemic area of this parasite in central Europe (Belgium, France, Luxembourg, Switzerland, Liechtenstein, Germany, and Austria) is not an isolated focus as previously anticipated but is connected with the large endemic zone in Russia.

Animals↗

Base line prevalence and spatial distribution of Echinococcus multilocularis in a newly recognized endemic area in the Netherlands.

The base line prevalence of Echinococcus multilocularis in foxes was determined in the eastern part of the province of Groningen in the Netherlands adjacent to the German border. This region has been identified in a previous study in 1998 as one of the westernmost border areas of E. multilocularis. Base line prevalence data are important for a better insight in the possible spread of the parasite and its changes in time. As fox feces containing E. multilocularis eggs are an important source for human exposure this base line prevalence is also an indicator for the potential risk for public health. The base line prevalence was estimated at 9.4% (95% CI: 5.2-16.5%). These results confirm previous findings of E. multilocularis in the same region. The spatial distribution of the infected foxes has been analyzed as a spatial gradient using a logistic model. The prevalence appeared to change strongest in east-western direction and was highest near the German border, adjacent to a German endemic area. These results suggest that the border areas in the Netherlands are the most margin of E. multilocularis territory.

Animals↗

Alkaline phosphatase from Echinococcus multilocularis: purification and characterization.

1. Kinetic and physical parameters of purified alkaline phosphatase from Echinococcus multilocularis metacestodes, livers of infected gerbils and control animals were determined. 2. Km value for p-nitrophenyl phosphate was about 0.05 +/- 0.02 mM for the three enzymes. 3. Vmax values were 357 +/- 67 nmol/min/mg proteins for metacestode enzyme, and 6.7 +/- 1.1 and 6.7 +/- 0.8 nmol/min/mg proteins for liver enzyme of infected and control animals, respectively. 4. Mr and pI were different for the parasite and hepatic enzyme. 5. The parasite enzyme was less sensitive to the elevation of temperature than hepatic enzyme. 6. The isatin inhibition was a competitive inhibition type for parasite and uncompetitive type for host liver enzyme.

Alkaline Phosphatase↗

Milbemycin oxime in a new formulation, combined with praziquantel, does not reduce the efficacy of praziquantel against Echinococcus multilocularis in cats.

Twenty European domestic cats were each infected with 15,000 protoscoleces of Echinococcus multilocularis extracted from metacestodes grown in experimentally infected common voles (Microtus arvalis). Sixteen days after infection, ten cats were treated with a broad-spectrum anthelmintic and acaricide comprising praziquantel and milbemycin oxime. Five days later treated and untreated cats were euthanized and the intestine examined for E. multilocularis. Five of ten untreated cats were infected with E. multilocularis with worm burdens ranging from 235 to 1920 worms per cat. No E. multilocularis were recovered from any of the treated cats. This study has demonstrated that this new combination broad spectrum anthelmintic and acaricide for cats is highly efficacious against E. multilocularis and the relevance of this is discussed.

Animals↗