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Epidemiology and control of echinococcosis

Author
Pedro L Moro, MD, MPH
Section Editor
Peter F Weller, MD, FACP
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Echinococcal disease is caused by infection with the tapeworm Echinococcus. Four species of Echinococcus cause infection in humans. E. granulosus and E. multilocularis are the most common, causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. The two other species, E. vogeli and E. oligarthrus, cause polycystic echinococcosis and are less frequently associated with human infection (table 1) [1]. Two relatively new species have been identified: Echinococcus shiquicus in small mammals from the Tibetan plateau and Echinococcus felidis in African lions [2,3]; their transmission potential to humans is not known.

The geographic distribution and animal host species vary by Echinococcus species, and mixed infections involving more than one species have been reported. In addition, different strains within an Echinococcus species may have variable morphology, genetic characteristics, infectivity to humans, and pathogenicity [2,3].

The epidemiology and control of the echinococcal species will be reviewed here. The clinical manifestations, diagnosis, and treatment of cystic and alveolar echinococcosis are discussed separately. (See "Clinical manifestations and diagnosis of echinococcosis" and "Treatment of echinococcosis".)

ECHINOCOCCUS SPECIES

Echinococcus granulosus — E. granulosus causes cystic echinococcosis (CE).

Life cycle — The life cycle of echinococcus includes a definitive host (usually dogs or related species) and an intermediate host (such as sheep, goats, camels, cervids, horses, cattle, and swine) (figure 1). Humans are incidental hosts; they do not play a role in the transmission cycle. E. granulosus adult tapeworms are usually found in dogs or other canids.

             

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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 22 00:00:00 GMT 2015.
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References
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  1. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004; 17:107.
  2. Xiao N, Qiu J, Nakao M, et al. Echinococcus shiquicus, a new species from the Qinghai-Tibet plateau region of China: discovery and epidemiological implications. Parasitol Int 2006; 55 Suppl:S233.
  3. Hüttner M, Nakao M, Wassermann T, et al. Genetic characterization and phylogenetic position of Echinococcus felidis (Cestoda: Taeniidae) from the African lion. Int J Parasitol 2008; 38:861.
  4. Eckert J, Gotstein B, Heath D, Liu FJ. Prevention of echinococcosis in humans and safety precautions. In: WHO/OIE Manual on Echinococcosis in Humans and Animals, Eckert J, Gemmell MA, Meslin FX, Pawlowski Z. (Eds), Office International des E 'pizooties, Paris 2001. p.96.
  5. Jenkins DJ, Romig T, Thompson RC. Emergence/re-emergence of Echinococcus spp.--a global update. Int J Parasitol 2005; 35:1205.
  6. Romig T, Dinkel A, Mackenstedt U. The present situation of echinococcosis in Europe. Parasitol Int 2006; 55 Suppl:S187.
  7. Moro P, Schantz PM. Cystic echinococcosis in the Americas. Parasitol Int 2006; 55 Suppl:S181.
  8. Moro PL, Bonifacio N, Gilman RH, et al. Field diagnosis of Echinococcus granulosus infection among intermediate and definitive hosts in an endemic focus of human cystic echinococcosis. Trans R Soc Trop Med Hyg 1999; 93:611.
  9. Gavidia CM, Gonzalez AE, Zhang W, et al. Diagnosis of cystic echinococcosis, central Peruvian Highlands. Emerg Infect Dis 2008; 14:260.
  10. Tiaoying L, Jiamin Q, Wen Y, et al. Echinococcosis in Tibetan populations, western Sichuan Province, China. Emerg Infect Dis 2005; 11:1866.
  11. Chai JJ, Jiao W, Yisilayin W, et al. An epidemiological survey of current status of cystic echinococcosis in northern Xinjiang. J Trop Dis Parasitol 2004; 2:139.
  12. Nuerguli A, Azhener Z, Buerliesi S. The current epidemiological status of hydatid disease in Tuoli County, Xinjiang. Chin Foreign Med Res 2010; 8:109.
  13. Wang GZ, Feng XH, Chu XD, et al. Epidemiological study on human echinococcosis in Hobukesar Mongolian autonomous county of Xinjiang. Chin J Endemiol 2009; 28:214.
  14. Cohen H, Paolillo E, Bonifacino R, et al. Human cystic echinococcosis in a Uruguayan community: a sonographic, serologic, and epidemiologic study. Am J Trop Med Hyg 1998; 59:620.
  15. Moro PL, Schantz PM. Echinococcosis: historical landmarks and progress in research and control. Ann Trop Med Parasitol 2006; 100:703.
  16. MacPherson CN, Romig T, Zeyhle E, et al. Portable ultrasound scanner versus serology in screening for hydatid cysts in a nomadic population. Lancet 1987; 2:259.
  17. Schantz PM, Kern P, Brunetti E. Echinococcosis. In: Tropical Infectious Diseases: Principles, Pathogens and Practice, 3rd ed, Guerrant R, Walker DH, Weller PF (Eds), Saunders Elsevier, Philadelphia 2011. p.824.
  18. Riganò R, Profumo E, Ioppolo S, et al. Immunological markers indicating the effectiveness of pharmacological treatment in human hydatid disease. Clin Exp Immunol 1995; 102:281.
  19. Schweiger A, Ammann RW, Candinas D, et al. Human alveolar echinococcosis after fox population increase, Switzerland. Emerg Infect Dis 2007; 13:878.
  20. Vuitton DA, Zhou H, Bresson-Hadni S, et al. Epidemiology of alveolar echinococcosis with particular reference to China and Europe. Parasitology 2003; 127 Suppl:S87.
  21. Hozáková-Lukácová L, Kolárová L, Roznovský L, et al. [Alveolar echinococcosis--a new emerging disease?]. Cas Lek Cesk 2009; 148:132.
  22. Landen S, Van de Sande J, Berger P, et al. Alveolar echinococcosis in a Belgian urban dweller. Acta Gastroenterol Belg 2013; 76:317.
  23. Gottstein B, Stojkovic M, Vuitton DA, et al. Threat of alveolar echinococcosis to public health--a challenge for Europe. Trends Parasitol 2015; 31:407.
  24. Wilson JF, Rausch RL. Alveolar hydatid disease. A review of clinical features of 33 indigenous cases of Echinococcus multilocularis infection in Alaskan Eskimos. Am J Trop Med Hyg 1980; 29:1340.
  25. Kern P, Ammon A, Kron M, et al. Risk factors for alveolar echinococcosis in humans. Emerg Infect Dis 2004; 10:2088.
  26. Kapel CM, Torgerson PR, Thompson RC, Deplazes P. Reproductive potential of Echinococcus multilocularis in experimentally infected foxes, dogs, raccoon dogs and cats. Int J Parasitol 2006; 36:79.
  27. Chauchet A, Grenouillet F, Knapp J, et al. Increased incidence and characteristics of alveolar echinococcosis in patients with immunosuppression-associated conditions. Clin Infect Dis 2014; 59:1095.
  28. Brunetti E, White AC Jr. Cestode infestations: hydatid disease and cysticercosis. Infect Dis Clin North Am 2012; 26:421.
  29. Rausch RL, Wilson JF, Schantz PM, McMahon BJ. Spontaneous death of Echinococcus multilocularis: cases diagnosed serologically (by Em2 ELISA) and clinical significance. Am J Trop Med Hyg 1987; 36:576.
  30. Sturm D, Menzel J, Gottstein B, Kern P. Interleukin-5 is the predominant cytokine produced by peripheral blood mononuclear cells in alveolar echinococcosis. Infect Immun 1995; 63:1688.
  31. Gottstein B, Bettens F. Association between HLA-DR13 and susceptibility to alveolar echinococcosis. J Infect Dis 1994; 169:1416.
  32. Mayor P, Baquedano LE, Sanchez E, et al. Polycystic echinococcosis in Pacas, Amazon region, Peru. Emerg Infect Dis 2015; 21:456.
  33. Tappe D, Stich A, Frosch M. Emergence of polycystic neotropical echinococcosis. Emerg Infect Dis 2008; 14:292.
  34. D'Alessandro A. Polycystic echinococcosis in tropical America: Echinococcus vogeli and E. oligarthrus. Acta Trop 1997; 67:43.
  35. Gottstein B, D'Alessandro A, Rausch RL. Immunodiagnosis of polycystic hydatid disease/polycystic echinococcosis due to Echinococcus vogeli. Am J Trop Med Hyg 1995; 53:558.
  36. Craig PS. Echinococcus granulosus: immunodiagnosis and vaccination, a perspective. Parassitologia 1997; 39:345.
  37. Craig PS, Larrieu E. Control of cystic echinococcosis/hydatidosis: 1863-2002. Adv Parasitol 2006; 61:443.
  38. Heath DD, Holcman B. Vaccination against echinococcus in perspective. Acta Trop 1997; 67:37.
  39. Lightowlers MW, Lawrence SB, Gauci CG, et al. Vaccination against hydatidosis using a defined recombinant antigen. Parasite Immunol 1996; 18:457.
  40. Heath DD, Jensen O, Lightowlers MW. Progress in control of hydatidosis using vaccination--a review of formulation and delivery of the vaccine and recommendations for practical use in control programmes. Acta Trop 2003; 85:133.
  41. Lightowlers MW, Jensen O, Fernandez E, et al. Vaccination trials in Australia and Argentina confirm the effectiveness of the EG95 hydatid vaccine in sheep. Int J Parasitol 1999; 29:531.
  42. Heath DD, Robinson C, Shakes T, et al. Vaccination of bovines against Echinococcus granulosus (cystic echinococcosis). Vaccine 2012; 30:3076.
  43. Nonaka N, Hirokawa H, Inoue T, et al. The first instance of a cat excreting Echinococcus multilocularis eggs in Japan. Parasitol Int 2008; 57:519.
  44. Dyachenko V, Pantchev N, Gawlowska S, et al. Echinococcus multilocularis infections in domestic dogs and cats from Germany and other European countries. Vet Parasitol 2008; 157:244.
  45. Rausch RL, Wilson JF, Schantz PM. A programme to reduce the risk of infection by Echinococcus multilocularis: the use of praziquantel to control the cestode in a village in the hyperendemic region of Alaska. Ann Trop Med Parasitol 1990; 84:239.
  46. McManus DP, Zhang W, Li J, Bartley PB. Echinococcosis. Lancet 2003; 362:1295.