Echinococcus granulosus protoscolex formation in natural infections

Echinococcus granulosus is a parasitic platyhelminth that is responsible for cystic hydatid disease. From the inner, germinal layer of hydatid cysts protoscoleces are generated, which are are the infective forms to the dog. Systematic studies on the cell biology of E. granulosus protoscolex formation in natural infections are scarce and incomplete. In the present report we describe seven steps in the development of protoscoleces. Cellular buds formed by a clustering of cells emerge from the germinal layer of hydatid cysts. The buds elongate and the cells at their bases seem to diminish in number. Very early on a furrow appears in the elongated buds, delimiting anterior (scolex) and caudal (body) regions. Hooks are the first fully-differentiated structures formed at the apical region of the nascent scolex. In a more advanced stage, the scolex shows circular projections and depressions that develop into suckers. A cone can later be seen at the center of the hooks, the body is expanded and a structured neck is evident between the scolex and the body. During protoscolex development this parasitic form remains attached to the germinative layer through a stalk. When fully differentiated, the stalk is cut off and the infective protoscolex is now free in the hydatid fluid.

Cytokine response and outcome of infection depends on the infective dose of parasites in experimental infection by Echinococcus granulosus

We here analysed whether the cytokine responses in early and late experimental infection with Echinococcus granulosus depend on the dose of parasites to which the host is exposed. To this purpose Balb/c mice were inoculated intraperitoneally (i.p.) with either 500 or 2000 protoscoleces. Splenocytes of mice were obtained at days 3, 7, 14 and 21 and also on week 37 post-infection and cultured in vitro with protoscolex antigens. Type-1 and type-2 cytokines were analysed in supernatants by ELISA. Results showed that the inoculation of 500 protoscoleces induced an early type-0 and a late type-2 cytokine response, whereas the inoculation of 2000 protoscoleces induced an early type-2 and a late type-0 cytokine response. Parasite growth was lower in the group inoculated with the low infective dose. These results indicate that the cytokine response during the infection by the helminth E. granulosus depends on the dose of parasites to which the host has been exposed.

Cestode parasites: application of in vivo and in vitro models for studies on the host-parasite relationship

Cestode worms, commonly also known as 'flat' worms or tapeworms, are an important class of endoparasitic organisms. In order to complete their life cycle, they infect intermediate and definitive hosts in succession, through oral ingestion of eggs or larvae, respectively. Serious disease in humans or other mammalian hosts is mostly caused by the larval stages. Echinococcus spp. and Taenia spp. have been extensively investigated in the laboratory due to the fact that they represent important veterinary medical challenges and also cause grave diseases in humans. In contrast, Hymenolepis spp. and Mesocestoides spp. infections are relatively rare in humans, but these parasites have been extensively studied because their life cycle stages can be easily cultured in vitro, and can also be conveniently maintained in laboratory animal hosts. Thus they are more easily experimentally accessible, and represent important models for investigating the various aspects of cestode biology. This review will focus on in vitro and in vivo models which have been developed for studies on the host-parasite relationship during infection with Echinococcus, Taenia, Hymenolepis, Mesocestoides and Spirometra, and will cover the use of these models to investigate the morphology and ultrastructure of respective genera, the immunological relationship with the host and the development of vaccination approaches, as well as applications of these models for studies on parasite metabolism, physiology and gene expression. In addition, the use of these models in the development of chemotherapeutic measures against cestode infections is reviewed.

In vitro culture of Echinococcus multilocularis and Echinococcus vogeli metacestodes: studies on the host-parasite interface

The larval stage of Echinococcus multilocularis causes alveolar echinococcosis (AE) in various mammalians including humans, while Echinococcus vogeli larvae cause a related disease which is also occasionally found in man. Traditionally, Echinococcus metacestodes have been maintained in the laboratory by serial transplantation passages into susceptible animals such as mice or gerbils, enabling the parasite to proliferate asexually. These experimental animal models have been used extensively to investigate host-parasite interactions and to study immunological events occurring at the host-parasite interface. However, with the use of laboratory animals it has always been difficult to investigate in more detail those factors modulating metacestode differentiation, and investigations on gene expression and respective regulation have been hampered by the complexity of the host-parasite interplay. There has been a need for an in vitro culture model which would enable researchers to dissect specific parasite compartments involved in the host-parasite relationship in more detail. This review summarises the studies leading to the development and application of a suitable in vitro culture model for the maintenance and proliferation of E. multilocularis and E. vogeli metacestodes, including the formation of protoscoleces, in a chemically defined medium devoid of host influence. These culture models have been used to study the basic parameters of metacestode in vitro proliferation and differentiation, and for the dissection of the ultrastructure and composition of the acellular laminated layer, the structure of which is predominantly involved in the physical interaction between the parasite and host immune and non-immune cells and tissues. For E. multilocularis, in vitro cultured parasites have been more extensively employed to study the localisation of several antigens, and to generate defined antigens for immunological studies. Although in vitro culture will not completely eliminate the need of animal experimentation, a wider application of this technique could significantly reduce the use of animals, and thus the costs and time required for respective experimental investigations.

Performance characteristics and quality control of community based ultrasound surveys for cystic and alveolar echinococcosis

The probability of disease given the results of a test, is called the predictive value of the test. The predictive value of a test is not a property of the test itself but will vary according to the prevalence of the disease in the studied population. The positive predictive value (PPV) is the probability that the subject tested has the disease given that a positive result is obtained. The negative predictive value (NPV) is the probability that the subject tested is normal given that a negative result is obtained. As the prevalence of a disease in a population approaches zero so does the PPV and most of the positive cases will be 'false positives'. Conversely the NPV will be very high at low prevalences and there will be few 'false negative' results. The sensitivity and specificity of a test are properties of the test and do not vary with prevalence. The higher the sensitivity and specificity of a particular test the greater the predictive values will be at any given prevalence of the disease. Ultrasound (US) is increasingly used for detecting lesions due to cystic and alveolar echinococcosis (CE and AE) and portable US scanners facilitate community based mass screening surveys in remote rural communities. Screening is justified with AE and CE in endemic areas as diagnosis at an early stage can lead to a better prognosis following treatment. The sensitivity and specificity of US has been reported to be between 88-98% and 95-100% respectively for CE and the sensitivity is a little higher for AE. Both species have pathognomonic signs on US and the technique is considered to be the 'gold standard' although it is still an imperfect test. Clinical, laboratory and epidemiological data also play an important role in the diagnosis of CE and AE. US results where possible, should be evaluated in relation to these findings. Suspected CE and AE images, may benefit from the use of other imaging techniques such as magnetic resonance imaging, computerised tomography and in the case of AE angiography or cholangiography. Immunological tests or molecular biological techniques also provide a useful back up, especially for AE. As sensitivity and specificity are properties of the US diagnostic test they should not vary if the case mix reported in different studies remains the same. The use of the WHO standardised US classifications for CE and AE should be used so that the properties of the test are standardised. Quality control of field based studies will depend on geographical variations in the case mix and the relative proportions of cyst types without pathognomonic signs. The latter will have the most bearing on variations in specificity, as would the use of different classifications. Inter- and intra-observer variability and differences in prevalence will affect the performance of US in different endemic settings. Community based surveys must adhere to the highest ethical standards and the outcome of surveys should result in appropriate treatment and follow-up strategies for all infected individuals and suspected cases found during the surveys.

Predictive values and quality control of techniques for the diagnosis of Echinococcus multilocularis in definitive hosts

By the end of the 1980s the only reliable technique for diagnosing the intestinal Echinococcus multilocularis infection of definitive hosts was parasite detection at necropsy. Currently, several techniques for the post mortem and in vivo diagnosis are available, including classical and modern methods. The sedimentation and counting technique (SCT) is used for the exact determination of the worm burden in the intestine after necropsy. The SCT has high sensitivity and specificity values (both close to 100%) and can be regarded as 'gold standard'. The principle of the intestinal scraping technique (IST) is the stereomicroscopic examination of at least 15 intestinal thick smears. This technique has a sensitivity of 78% and a specificity approximating 100%. In recent years, the IST has been successfully used in large post mortem surveys of foxes for E. multilocularis. The newer techniques for detecting coproantigens by ELISA (CA-ELISA) exhibit rather high sensitivities between 84 and 95%, combined with very high specificities of >96%, the latter regarding non-Echinococcus cestodes and other parasites. However, cross-reactivity may occur with E. granulosus. Copro-DNA detection by PCR is also highly sensitive (89-94%) and specific (100%). With the SCT, IST and Copro-PCR one person can only examine about 10-20 animals per day, whereas the CA-ELISA allows the examination of 200 samples. Therefore, the latter test is suited for mass-screening of definitive host populations. Both the CA-ELISA and the Copro-PCR allow the examination of materials from dead and living animals, including faecal samples collected in the field. Quite often diagnostic techniques have been used without adequate quality control and proper definition of their performance characteristics, including diagnostic sensitivity, specificity, predictive values and some other parameters. Examples are presented with the aim to demonstrate the need and the value of calculating the predictive values for assays used to diagnose the E. multilocularis infection in individual animals and in definitive host populations.

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.

Pro-inflammatory (IL-1beta, IL-18) cytokines and IL-8 chemokine release by PBMC in response to Echinococcus multilocularis metacestode vesicles

In humans infected with Echinococcus multilocularis, larval metacestodes will develop, proliferate and progressively infiltrate the surrounding host tissues by exogenous budding of parasitic microvesicles or cell lines which detach from the original tumour and thus become transported through blood or lymph vessels into other organs. Cellular effector mechanisms constitute the most effective means to restrict parasite persistence and proliferation, and here we demonstrate that E. multilocularis vesicle antigens will induce pro-inflammatory, regulatory and chemokine release by PBMC from patients. The pro-inflammatory cytokines IL-1beta and IL-18 were reduced in echinococcosis patients, regulatory IL-10 was similar, but parasite vesicle-induced IL-8 was dominant and clearly elevated in patients. Such selective and opposite dynamics of inflammatory cytokines and chemokine release may prevent overwhelming and pathogenic inflammation, and constitute an appropriate response for attraction of effector cells into the periparasitic tissues with the capacity to limit E. multilocularis metacestode proliferation and dissemination.

Effect of amphotericin B on larval growth of Echinococcus multilocularis

Alveolar echinococcosis is caused by the parasitic cestode Echinococcus multilocularis. Benzimidazoles, namely, mebendazole and albendazole, are the only drugs available for the treatment of inoperable alveolar echinococcosis. At present, no therapeutic alternative is available for patients with progressive disease under treatment or for patients who are unable to tolerate the side effects of the benzimidazoles. In addition, benzimidazoles are only parasitostatic for E. multilocularis. Thus, new therapeutic options are of paramount importance. In the present study we examined the in vitro effect of amphotericin B on E. multilocularis larvae. E. multilocularis metacestodes grown in the peritoneal cavities of Mongolian gerbils were transferred into a culture system. Vesicles budded from the tissue blocks and increased in number and size during the first 5 weeks. After 6 weeks drugs were added and deleterious effects on the vesicles were observed macroscopically and microscopically. By use of this in vitro tissue culture model we demonstrated that amphotericin B effectively inhibits the growth of E. multilocularis metacestodes. This destructive effect was significantly more rapid with amphotericin B than with the benzimidazoles. Cyclic treatment was effective in suppressing parasite growth. However, amphotericin B appears to be parasitostatic for E. multilocularis larvae, and regrowth occurs even after extended periods. In summary, amphotericin B constitutes the first promising alternative for the treatment of alveolar echinococcosis in cases of intolerance or resistance to benzimidazoles. It holds promise as an effective treatment option for otherwise fatal courses of disease.

Public health education/importance and experience from the field. Educational impact of community-based ultrasound screening surveys

The public health educational impact of community-based ultrasound (US) surveys for cystic echinococcosis (CE) can form an important part of the development about the awareness of the importance of the disease in an endemic area. In addition to identifying asymptomatic carriers and thereby facilitating early diagnosis and treatment, such surveys can be used to impart important educational messages at the individual, household, community, regional and national levels. US surveys are usually appealing to rural communities where such services are not available but where the technique is generally appreciated by its application in a wide field of medical applications. The qualities of the test (painless, non-invasive and gives instant recordable results) are also attractive to participants during such surveys and the majority of the population in a selected study area choose to be screened. Two such surveys were carried out amongst the Berber people of the mid-Atlas mountains in central Morocco in May 2000 and 2001. Over 11,000 people were screened in the two 10-day surveys. Informed consent had been obtained through community meetings and with the chiefs of villages prior to the surveys being conducted. Individuals who volunteered to be screened entered the study and as far as is known there were no refusals. The concept of voluntary participation, the explanation of the life cycle and clinical manifestations of the disease and its prevention are all-important educational messages. The occurrence of CE is almost always known in an endemic community but is usually very poorly understood leading in many cases to a fear of the disease, especially amongst families with an infected individual who has previously undergone surgery. During the US survey considerable attention was paid to provide educational input before, during and after the survey. Information was provided at the start of the survey to local leaders, doctors, veterinarians and school teachers on the aims of the study and to obtain informed consent. At the start of the study everyone was individually schooled about the route of transmission of the parasite and how this may be best prevented. The knowledge level of those screened was assessed by showing hydatid cysts, either freshly obtained from the abattoir of from photographs. Animal cysts were recognised by almost everyone but its transmission and link to human disease was invariably unknown. Patients found to be infected with CE were always confidentially counselled and followed up for treatment, if required. Treatment options were explained to the individual or to parents in the case of a child. Local physicians participated in discussions on the WHO guidelines for the treatment of CE and all cases were fully discussed providing an educational element for the local doctors. The 1% US prevalence found sent an important message to the local politicians and the perceived importance of the disease had an impact at the leadership level. Local leaders made calls for a control programme. The long term educational impact remains to be evaluated as does the role such surveys play in the future collaboration of communities with the implementation of a control programme.

Latex agglutination test (LAT) for antigen detection in the cystic fluid for the diagnosis of cystic echinococcosis

Latex agglutination test (LAT) was standardized and evaluated to detect hydatid antigen in fluid samples aspirated from 6 surgically proved human cases of cystic echinococcosis (CE), 4 suspected human cases of CE (2 cases of cysts in the liver which were not confirmed surgically and 2 cases of pelvic cysts later confirmed as abscesses) and 7 cases of hydatid cysts of liver in cattle. Echinococcus granulosus scolices and hook lets were seen in aspirated fluid by microscopy and the characteristic germinal layer of the cyst wall was demonstrated by histopathology in 6 human hydatid cysts operated and removed by surgery. In case of cattle hydatid liver cysts no scolices or hook lets were seen in aspirated fluid as they were sterile cysts but characteristic laminated layer of the cyst wall was demonstrated by histopathology of these cysts. The LAT could detect antigen in fluid samples collected from all 6 human cases of surgically proved CE and 7 cases of hydatid cyst liver in cattle, thus showing sensitivity of 100%. The LAT could detect antigen in fluid samples collected from 2 suspected cases of CE liver in humans, which were not operated. The LAT was found to be specific. No cross reactivity was observed. The results of the study showed that LAT could be employed as a simple and rapid diagnostic procedure, as an alternate to microscopy, to confirm the hydatid etiology of a suspected cyst.

Hydatid cyst of the liver-criteria for the selection of appropriate treatment

The appropriate treatment of hydatid cysts of the liver is determined by several factors, namely the patient, the cyst, the therapeutic resources and the physician. Characteristics of cysts, can be described by ultrasonography (US). Based on US images, we can classify hydatid cysts, according the evolutionary phase of the larval parasite and to choose the most appropriate therapeutic approach. US is also important to evaluate the efficacy of the treatment. Concerning the therapeutic methods, surgery had long been the only treatment available for the hydatid cyst of the liver. Beginning the 1970s benzimidazoles, Mebendazole and Albendazole, have been used for the treatment of the hydatid disease and in the early 1980s, with the development of diagnostic US, the deliberate puncture of abdominal cysts, particularly those in the liver, was evaluated this lead to puncture/aspiration, followed by injection of a scolicide which became a therapeutic method known as puncture, aspiration, injection and re-aspiration (PAIR). So, according to the cyst's characteristics based on US evaluation we can establish a therapeutic strategy: cysts type 1 and 3 may be treated by chemotherapy. Alternative treatment should be PAIR but only if the cysts cannot be treated with benzimidazoles. If there are contraindications for PAIR and chemotherapy the treatment should be surgical. Type 2 hydatid cysts can be treated by PAIR following initial treatment with benzimidazoles. If PAIR is not feasible or there is no evidence of degenerative changes after chemotherapy, surgery is indicated. Type 4 cysts are usually inactive and, in these cases, treatment is not indicated. If there is evidence that the cysts contents are still viable PAIR may be indicate. If PAIR is not possible, surgery is the method of choice. Cysts type 5 do not require treatment.

[Cystic echinococcosis (CE) in the Poznan region in the years 1990-2000]

The results of multidisciplinary studies on cystic echinococcosis (CE) in Poznan region, Poland carried out in 1990-2000, in co-operation with CDC, Atlanta GA, USA, are summarised as follows. The distinct focality of Echinococcus granulosus (Eg) infections has been demonstrated on some private farms rearing pigs (refs 12, 13). A reduction in Eg prevalence rates in pigs has been achieved, from 13.0% in 1989 down to 0.5% in 1998. This was an effect of various factors, including free treatment of all dogs in the Eg foci, i.e. farms, supplying infected pigs (ref. 13). The experimental studies confirmed, that pig's strain of Eg has some distinct characteristics, in comparison with the other Eg strains (ref. 8). It also had a separate genotype, classified as G7 (G9) (refs 9, 10). It has been demonstrated, that pig's strain was the only one found in 16 patients with CE, hospitalised in the Clinic of Parasitic and Tropical Diseases in Poznan, Poland (refs 9, 10) The same genotype in pigs was found in Slovakia and Ukraine (ref. 10). In clinical research the fine needle aspiration biopsy (FNAB) has been introduced in the doubtful cases and confirmed to be a safe and useful diagnostic technique (ref. 11). The FNAB material was examined for Eg protoscolices as well as for the presence of antigen 5 (ref. 24). Studies with intradermal Multiest suggested, that development of Eg cysts depend much on immune system, especially a switch between Th1 and Th2 (ref. 19). It has been observed that FNAB may have a beneficial effect on treatment of CE with albendazole, which can be reduced to 1 month only in the patients treated after FNAB (refs 11, 25, 26). The studies carried out were a basis for one habilitation (ref. 11) and 3 MD dissertations (13, 19, 23).

Echinococcosis: disease, detection and transmission

Echinococcosis is one of the world's most geographically widespread parasitic zoonoses, with transmission occurring in tropical, temperate and arctic biomes. Most human infections are due to Echinococcus granulosus transmitted between domestic dogs and livestock, but this cosmopolitan species also cycles between wild carnivores (principally canids) and wild ungulates. The other species with significant zoonotic potential is E. multilocularis that occurs naturally in fox definitive hosts and small mammal intermediate hosts. These two species cause human cystic or alveolar echinococcosis respectively, which may be considered serious public health problems in several regions including developed countries. This review provides an introductory overview to the Supplement and summarises the biology and epidemiology of these two related cestodes with an emphasis on applied aspects relating to detection, diagnosis and surveillance in animal and human populations, and includes aspects of transmission ecology, and also considers aspects of community epidemiology and potential for control.

Epidemiology of alveolar echinococcosis with particular reference to China and Europe

Human alveolar echinococcosis (AE), caused by the metacestode of the fox tapeworm Echinococcus multilocularis, is the most pathogenic zoonosis in temperate and arctic regions of the northern hemisphere. Prospective collection of human cases in some areas and mass screenings using ultrasound imaging and confirmation with serological techniques have markedly improved our knowledge of the epidemiology of the disease in humans during the past two decades. Transmission occurs when eggs of the tapeworm, excreted by the final hosts (usually foxes but also dogs, wolves and cats), are ingested accidentally by humans or during normal feeding by a variety of rodents and small lagomorphs. However, the species of host animals differ according to regional changes in mammalian fauna. This review mostly focuses on epidemiology of alveolar echinococcosis in those parts of the world where new and more accurate epidemiological data are now available, i.e. China and Europe, as well as on new epidemiological trends that can be suspected from recent case reports and/or from recent changes in animal epidemiology of E. multilocularis infection. The People's Republic of China (PRC) is a newly recognized focus on AE in Asia. Human AE cases were firstly recognized in Xinjiang Uygur Autonomous Region and Qinghai Provinces at the end of 1950s and infected animals were first reported from Ningxia in central China and northeast of Inner Mongolia in the 1980s. E. multilocularis (and human cases of AE) appears to occur in three areas: (1) Northeastern China (northeast focus): including Inner Mongolia Autonomous region and Heliongjiang Province (2) Central China (central focus): including Gansu Province, Ningxia Hui Autonomous Region, Sichuan Province, Qinghai Province and Tibet Autonomous Region and (3) Northwestern China: including Xinjiang Uygur Autonomous Region, bordered with Mongolia, Russia, Kazakhstan and Kyrgyzstan. The highest prevalence of the disease, up to 15 per cent of the population in some villages, is reached in China. In Europe, data from the European Echinococcosis Registry (EurEchinoReg: 1982-2000) show 53 autochthonous cases of AE in Austria, 3 in Belgium, 235 in France, 126 in Germany, 1 in Greece, and 112 in Switzerland, and 15 'imported' cases, especially from central Asia; 14 cases were collected in Poland, a country not previously considered endemic for AE. Improved diagnostic technology, as well as a real increase in the infection rate and an extension to new areas, can explain that more than 500 cases have been reported for these 2 decades while less than 900 cases were published for the previous 7 decades. New epidemiological trends are related to an unprecedented increase in the fox population in Europe, to the unexpected development of urban foxes in Japan and in Europe, and to changes in the environmental situation in many countries worldwide due to climatic or anthropic factors which might influence the host-predator relationship in the animal reservoir and/or the behavioural characteristics of the populations in the endemic areas.

A gene family from Echinococcus granulosus differentially expressed in mature adult worms

Differences in mRNA expression between immature adult worms (IAW) and mature adult worms (MAW) of Echinococcus granulosus were determined using polymerase chain reaction-based differential display (DDRT-PCR). Twenty-eight putative differential cDNA fragments were isolated, cloned and sequenced. mRNAs from IAW and MAW were probed with the labelled fragments. Six cDNA fragments (coded as egM12, egM13, egM22, egM26, egM30 and egM34) were putatively determined to be specific to MAW by Northern hybridisation. The stage-specificity of egM12, egM13 and egM34 was confirmed by RT-PCR. RNAs of IAW, MAW, protoscoleces and oncospheres, probed with egM13 and egM30, showed that the mRNAs were expressed exclusively in MAW, which implied involvement in the regulation of egg development. Using the labelled fragments to screen a cDNA library of MAW, 99 clones were identified and analysed. An alignment of selected clones showed that the MAW-specific mRNAs belonged to a family. Examination of the deduced amino acid sequence of three of the corresponding cDNAs (egM4, egM9 and egM123) indicated they were cysteine-rich and contained a 24 amino acid repeat sequence, repeated four to six times. The repeat regions were predominantly alpha helical in nature with interspersed turns, forming alternating zones of positive and negative charge. The functional significance of each of the cDNAs identified is unclear as none had significant sequence similarity to genes of known function. However, polypeptides encoded by egM4 and egM123 were recognised by antibodies in a serum pool from dogs experimentally infected with E. granulosus, suggesting they could prove of value in serodiagnosis of definitive hosts.

Short report: Echinococcus granulosus from Xinjiang, PR China: cDNAS encoding the EG95 vaccine antigen are expressed in different life cycle stages and are conserved in the oncosphere

The EG95-based vaccine protects sheep from infection with the dog tapeworm Echinococcus granulosus. The EG95 encoding gene is a member of a multigene family, several members of which are expressed in the oncosphere, believed to be the target of immunity induced by the vaccine. E. granulosus exhibits extensive intraspecific (strain) variation, and variability of the eg95 gene in different isolates of E. granulosus may directly impact the effectiveness of the EG95-based vaccine. We analyzed the eg95 gene from E. granulosus collected in Xinjiang, in northwest China, where hydatid disease is hyperendemic. The gene is expressed in oncospheres, protoscoleces, and immature and mature adult worms, and the eg95 gene family was shown to comprise two basic sequence types. Very limited sequence variation was evident in the EG95 protein from oncospheres. This high degree of sequence conservation predicts that the vaccine will continue to be effective in China and elsewhere.

Perspective on control options for Echinococcus multilocularis with particular reference to Japan

Following a brief introduction of recent advances in molecular and immunological technology for detection of persons and animals infected with Echinococcus multilocularis and an overview of the current situation of alveolar echinococcosis (AE) in Japan, perspectives on control options are discussed with reference to different epidemiological situations. AE is considered the most serious parasitic zoonosis in temperate and arctic regions of the northern hemisphere. The number of human cases differs drastically among regions. While high numbers of patients are apparently associated with high E. multilocularis prevalence in domestic dogs, e.g. in parts of Alaska and western China, the number of cases is moderate or low in areas where the parasite is mainly transmitted by wild canid species (e.g. in central Europe or temperate North America). However, the severity of the disease, the absence of curative treatment for most cases, the high cost of long-term chemotherapy and the anxiety caused for the population in highly endemic areas call for the development of preventive strategies even in regions where human AE is rare. Furthermore, in view of (1) drastically increasing numbers and infection rates of foxes involved in transmission of E. multilocularis, and (2) increasingly close contact between humans and foxes e.g. in Europe and Japan, there is considerable concern that AE incidences may in future increase in these regions. Control options depend on a variety of factors including the species of canid principally responsible for transmission and the socio-economic situation in the region. Where domestic dogs (stray or owned) are the principal hosts for E. multilocularis, control options can include those applicable to E. granulosus, i.e. reduction of the number of stray dogs, registration and regular preventive chemotherapy of owned dogs, and information campaigns for the population promoting low-risk behaviour for man and dogs. Where E. multilocularis is mainly transmitted by wild canids, the situation is far more difficult with preventive strategies still being in trial stage. Integrated control measures could include prevention information campaigns, restricting access of pet animals (dogs and cats) to rodents, chemotherapy of foxes on local or regional scales, and strategies to minimize contacts between people and foxes.

Multi-scale spatial analysis of human alveolar echinococcosis risk in China

Risk factors for the transmission of Echinococcus multilocularis to humans operate at a range of spatial scales. Over a large area, such as China, regional scale risk is correlated with variation in climatic conditions because of its effect on the spatial distribution of landscapes that can support E. multilocularis transmission in wildlife hosts and the probability of egg survival. At a local scale of a few kilometres, or tens of kilometres, transmission risk is related to the spatial proximity of human populations and landscapes with active transmission. At the patch scale, when considering individual villages or households, human behavioural factors are important and for individuals genetic and immunological factors play a role. Satellite remote sensing can provide landscape information at a range of spatial scales and provide a spatial framework within which to examine transmission patterns. This paper reviews the application of remotely sensed data and spatial data analysis to develop a better understanding of disease transmission and shows how such data have been used to examine human alveolar echinococcosis infection patterns, at a range of spatial scales, in an endemic area in central China.

Morphological variability and degenerative evolution of human hepatic hydatid cysts

The findings are presented of a macro and microscopic investigation of 89 hydatid hepatic cysts removed intact from 59 patients by total pericystectomy. Detailed analysis revealed significant morphostructural variability and cysts grouped into 10 types were characterized, providing useful clinical indications. Only 30 cysts resulted fertile (33.7%), probably due to mean age of sample; 7 of these were "classic" cysts, 1 "septated" and 22 "multivesicular" packed with daughter cysts (DC), of varying turgidity or collapsed. Among the remaining 59 sterile cysts, 52 were degenerated and classified as "hyperlaminated" cysts due to the presence of large convoluted sheets of laminar tissue (SLT) surrounded by varying amounts of caseous (40 specimens), granular (6) or gelatinous (6) matrix. Moreover, "multivesicular", "acephalocyst", "caseous" and "serous" cysts were also recovered among the sterile specimens. Some "multivesicular" cysts (14) appeared as "transitional forms" towards the various types of "hyperlaminated" cysts containing all different forms of DC and large SLT intermingled with a variously degenerated matrix. The comprehensive study allows to hypothesize the train of events leading, over the years, to the gradual transformation and degeneration of the larval form Echinococcus granulosus in the human liver.

Characterization of the immune response induced by a carbohydrate enriched fraction from Echinococcus granulosus protoscoleces in patients with cystic hydatid disease

The serological and cellular immune response against a carbohydrate-enriched fraction of Echinococcus granulosus (E4+) was studied in a group of patients with cystic hydatid disease (CHD). The profile of IgG subclass against E4+ and the native non-enriched extract (protoscolex somatic antigen, PSA) were compared. A relatively higher ratio of IgG2:IgG4 was induced by E4+ than by PSA (12.4 vs 3.6 respectively). Serological data were associated with clinical parameters dealing with the outcome of disease. The expression of IgG1 and IgG4 subclasses against both of the antigens was associated with the progression of the disease. Interestingly, anti-PSA IgG4 was the only variable that was specifically associated with the stage of cysts (P < 0.04). Similar levels of IL-13 were evoked by peripheral blood mononuclear cells from patients with CHD when incubated with either of the antigens, while higher levels of IL-10 were obtained in supernatants from cells stimulated with E4+ (P < 0.029) than from those stimulated by PSA. Considerable amounts of IL-10 (median 60 pg/ml) were obtained in the supernatants of cells from healthy individuals incubated with E4+. Our results suggest a putative role for E4+ in immunoregulation during the course of infection with E. granulosus in humans.

Culture of Echinococcus multilocularis metacestodes: an alternative to animal use

This article reviews the use of an in vitro culture model for the maintenance and proliferation of Echinococcus multilocularis metacestodes and the formation of protoscoleces. This model has been used to identify and characterize parasite molecules involved in host-parasite interactions, and is a suitable tool to perform in vitro drug-screening assays. The development of a simple and easy-to-handle assay to determine the effects of drugs on parasite viability, without the need for time-consuming animal experimentation, has opened the way for larger-scale in vitro drug screening.

[Comparative observation on experimental infection with Echinococcus multilocularis in Cricetulus Migratorius and Meriones meridianus]

AIM

To search for an animal model with higher susceptibility to Echinococcus multilocularis and shorter experimental period.

METHODS

Cricetulus migratorius, Meriones meridianus and NIH mice were experimentally infected with protoscolices of E. multilocularis and were autopsed at different times after their infection. The development of E. multilocularis in these three species of rodents was observed and compared.

RESULTS

The average wet cyst weight and the ratio of cyst weight to body weight on the 91st day after infection were 15.0 +/- 2.1 g and 32.3% for C. migratorius, 3.3 +/- 1.1 g and 6.9% for M. meridianus, 0.6 +/- 0.6 g and 2.4% for NIH mice; and the corresponding figures on the 188th day after infection were 11.8 +/- 2.7 g and 21.7% for C. migratorius, 8.1 +/- 5.1 g and 15.4% for M. meridianus and 8.4 +/- 8.3 g and 26.7% for NIH mice, respectively. On the 91st day, matured protoscolices were found in C. migratorius and M. meridianus, whereas NIH mice had matured protoscolices on the 188th day after infection.

CONCLUSION

C. migratorius has higher sensitivity to E. multilocularis infection than the other two species of animals as manifested by high infection rate, well-developed vesicles and rapid growth speed. C. migratorius proved to be an ideal experimental animal for E. multilocularis.

Fertility assessment of hydatid cyst by proton MR spectroscopy

BACKGROUND

Hydatid cysts, the larvae of the parasite Echinococcus granulosus, may lodge in any organ of intermediate hosts, namely, man and sheep. Complete cyst removal is the treatment of choice; however, spillage of fertile cysts during surgery leads to disease recurrence that may be prevented by preoperative detection of the fertility status of the cyst. With this perspective, ex vivo proton (1H) MR spectroscopy of hydatid fluid of human and sheep origin was performed to differentiate fertile from sterile cysts on the basis of their metabolite pattern.

PATIENTS AND MATERIALS

Cysts of sheep and human origin were used as source of hydatid fluid. A fraction of this fluid was tested for cyst fertility and the rest was used for ex vivo1H spectroscopy. Histopathology of the cyst wall was done as a gold standard for this study.

RESULTS

Of 10 sheep samples, 7 were fertile and 3 were sterile, while among 6 human samples, 5 were fertile and 1 was sterile. Spectroscopic and histopathological results corroborated each other. The fluid from microbiologically proven fertile cysts contained malate and fumarate along with other resonances and the histopathology of the fertile cyst wall demonstrated germinal lining and protoscoleces.

CONCLUSIONS

The ex vivo spectroscopic differentiation of fertile and sterile cysts may be a stepping-stone for their in vivo separation in future and thus help in framing strategies for percutaneous/surgical management.

Molecular cloning of a vaccine antigen against infection with the larval stage of Echinococcus multilocularis

Alveolar and cystic hydatidosis are caused by infection with the larval stages of Echinococcus multilocularis and Echinococcus granulosus, respectively. A host-protective antigen has been identified in E. granulosus. Here we identify the presence of a closely related protein in E. multilocularis, characterize and express a cDNA encoding the antigen (designated EM95), determine the structure of the em95 gene, and demonstrate that the EM95 recombinant protein can be used to induce significant levels of protection against challenge infection with E. multilocularis eggs in mice.

Could ivermectin have a synergic effect with albendazole in hydatidosis therapy?

The efficacy of a combination of ivermectin (IVM) and albendazole (ABZ) used as a chemoprophylactic treatment and as treatment of secondary hydatidosis is described for the first time. IVM treatment alone was not effective against Echinococcus granulosus, either when the protoscolices were recently inoculated or when they had developed to the metacestode stage. However, the efficacy of IVM and ABZ when used in combination as a prophylactic treatment was 95.72% and 87% with respect to the number and the wet weight of cysts, respectively. These results were higher than in the treatment of secondary hydatidosis, which were 44.8% and 45.26%, respectively. The ultrastructural changes in the germinal layer of the cysts after the treatments are also described.

myo-Inositol hexakisphosphate is a major component of an extracellular structure in the parasitic cestode Echinococcus granulosus

myo-Inositol hexakisphosphate (IP(6)) is an abundant intracellular component of animal cells. In this study we describe the presence of extracellular IP(6) in the hydatid cyst wall (HCW) of the larval stage of the cestode parasite Echinococcus granulosus. The HCW comprises an inner cellular layer and an outer, acellular (laminated) layer up to 2 mm in thickness that protects the parasite from host immune cells. A compound, subsequently identified as IP(6), was detected in and purified from an HCW extract on the basis of its capacity to inhibit complement activation. The identification of the isolated compound was carried out by a combination of NMR, MS and TLC. The majority of IP(6) in the HCW was found in the acellular layer, with only a small fraction of the compound being extracted from cells. In the laminated layer, IP(6) was present in association with calcium, and accounted for up to 15% of the total dry mass of the HCW. IP(6) was not detected in any other structures or stages of the parasite. Our results imply that IP(6) is secreted by the larval stage of the parasite in a polarized fashion towards the interface with the host. This is the first report of the secretion of IP(6), and the possible implications beyond the biology of E. granulosus are discussed.

Control of Echinococcus granulosus in Uruguay: evaluation of different treatment intervals for dogs

This study attempted control of transmission of Echinococcus granulosus from dogs to sheep in different areas in the Department of Florida, Uruguay, by treating dogs with praziquantel at intervals of 6, 12 and 16 weeks. The 6-week interval was based on the prepatent period of infection with E. granulosus, the 12- and 16-week intervals were based on the rate of reinfection with tapeworms in dogs in the area. Dogs had become reinfected with E. granulosus between 2 and 4 months after treatment, whereas they became reinfected with the Taenia spp. tapeworms within 2 months of treatment. One year after the start of treatments sentinel lambs were born and grazed the farms in the three treatment areas. Approximately, 15 months later when the sentinel lambs were killed and examined for parasites the six weekly treatments had stopped the transmission of E. granulosus to the sentinel lambs. Treatment of dogs at 12- and 16-week intervals failed to stop transmission of E. granulosus but both the numbers of farms and the numbers of sheep infected with E. granulosus were lower where dogs received 12 weekly treatments compared with dogs receiving 16 weekly treatments and a fourth area where dogs had received no treatments (chi(2)P=0.002). Lambs continued to become infected with the Taenia spp. tapeworms in all the areas. Control was complicated by large changes in the dog population. From a starting population of 1164 dogs in the three treated areas, 832 new dogs, most of these adult hunting dogs, entered the population and 793 dogs were lost from the population.

Could ivermectin have a synergic effect with albendazole in hydatidosis therapy?

The efficacy of ivermectin (IVM) alone, albendazole (ABZ) alone and a combination of both (IVM + ABZ) against Echinococcus granulosus protoscolices was studied by means of in vitro incubation. The maximum protoscolicidal effect was detected when we used IVM+ABZ in combination. In this case, protoscolex viability dropped to 35% in comparison with 50% for IVM alone and 82.5% with ABZ alone 18 days post-incubation. Only the protoscolices incubated with IVM + ABZ did not develop into cysts following their inoculation into mice. The changes in ultrastructure induced in the protoscolices after the different drug incubations are also described. The incubation of cysts with IVM and IVM + ABZ shows that IVM + ABZ in combination is more effective than IVM alone as only when we incubated the cysts with IVM + ABZ did they completely lose their infectivity to mice. This occurred after only 10 days post-incubation. Cellular alterations were also more marked with IVM+ABZ incubations with: (1) the presence of residual bodies, (2) numerous lipids droplets and (3) vacuoles in the cytoplasm of cytons. However, the truncated microtriches and the nuclei remained unaltered after 10 days.

Combined ultrasound and serologic screening for hepatic alveolar echinococcosis in central China

Alveolar echinococcosis (AE), caused by Echinococcus multilocularis, is a zoonotic helminthic disease that can mimic malignancy. In the 1970s, foci of the disease were found in central China. The aim of the present study was to estimate the prevalence of AE in humans in 2 districts of south Gansu Province, China, by use of ultrasound and Echinococcus serology. After answering an epidemiological questionnaire, 2,482 volunteers from 28 villages underwent ultrasound. Serology via enzyme-linked immunosorbent assay for antibody activity was performed on whole blood collected on filter paper in all subjects; on serum from subjects with an abnormal ultrasound image; and on randomly chosen subjects that either had no lesions or had atypical lesions. At least one (25.3%) abnormal ultrasound image was observed in 630 of the subjects screened. A typical lesion of progressive AE was found in 84 subjects (3.4%). Serologies were positive in 77 (96%) of 80 of patients who had lesions typical of progressive AE. Ultrasound is useful for screening for AE in endemic regions.

Relationship between the efficacy of praziquantel treatment and the cystic differentiation in vivo of Echinococcus granulosus metacestode

The cyst differentiation of protoscolices inoculated in NMRI mice was studied in detail. Although the laminated layer began its formation at 21 days post-infection (p.i.), we could not identify this structure in all parasites until 34 days p.i.. At 34 days p.i., all protoscolices were transformed into the metacestode stage. Subsequently, the efficacy of praziquantel (PZ) was studied in different stages of development of the parasite. We have found a different PZ susceptibility in both earlier stages and well-developed cyst. PZ treatment exhibited a high efficacy at the beginning of cyst differentiation and a zero efficacy in the mature metacestode when the cystic layers were totally developed. The relationship between the tegumental ultrastructural changes occurring during the vesicular evolution of protoscolices in NMRI mice and the efficacy of PZ treatment is discussed in the present study.

Meriones meridianus and Lagurus lagurus as alternative definitive hosts of Echinococcus multilocularis and E. granulosus

The utilization of Meriones meridianus and Lagurus lagurus as alternative definitive hosts for Echinococcus multilocularis and E. granulosus was investingated. Tapeworm stage development of E. multilocularis was observed and their recovery rate was determined in the small intestine of M. meridianus and L. lagurus. These were compared with those in golden hamsters, which are known as alternative definitive hosts. The animals were treated with PTBA (prednisolone tertiary butylacetate) and PA (prednisolone acetate), after which M. meridianus showed the highest recovery rate, whereas L. lagurus had few or no worms. The recovery rate of worms from golden hamsters was between those of M. meridianus and L. lagurus. On day 20 post-infection, developing tapeworms with mature segments were collected from M. meridianus treated with PA. The worms were mostly from the proximal and medial small intestine. The three species of animals infected orally with E. granulosus were divided into two groups, PTBA-treated and non-treated control groups. PTBA promoted/enhanced the recovery rate of the worms until 5 days, but none or only a few worms were found in PTBA treated animals thereafter. The highest recovery rate was obtained from M. meridianus treated with PTBA on day 5 post-infection. Some worm developments were observed on days 5 and 10 post-infection. These results demonstrate that M. meridianus could be useful as an alternative definitive host of Echinococcus.

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.

[Comparison observation on the mature alveolar of Echinococcus sibiricensis and Echinococcus multilocularis in the experimentally infected white mice]

The alveolar echinococcus is one of the most dangerous worm parasites in man. Rausch and Schiller reported a new species, Echinococcus sibiricensis n. sp. from arctic fox, Alpex logopus, on St. Lawrence Island of Alaska, USA. According to the view of Vogel, the sibiricensis form is only a geographical race or subspecies of Europe Echinococcus multilocularis. So far, the two names, Echinococcus multiocularis multilocularis and Echinococcus multilocularis sibiricensis, existed in many references and text books. We have found the adults of Echinococcus sibiricensis and Echinococcus multilocularis from sand foxes, Vulpes corsac and their larval stages (alveolar echinococcus) from field voles, Microtus brandti in the Hulunbeier Pasture of Inner Mongolia, northeastern China in 1985 and 1998-1999. Two types of metacestodes with quite different styles of early development of E. sibiricensis and E. multilocularis were found from field voles and laboratory experimental white mice. As one characteristic of alveolar E. multilocularis, the capsules are produced by the exogenous budding of germinal cell layer together with cyst wall. The protoscoleces grow from germinal cells on germinal cell layer. The peduncles of early protoscoleces attached to the germinal cell layer on the inner surface of capsule wall(Plate I, Figs. 1-2). Some protoscoleces in reticular structure were linked with the inner surface of capsule wall (Plate I, Fig. 3) in livers of mice in 9.5th month postinfection. In 14th month old alveolar multilocularis, large number of mature protoscoleces in reticular structure were still linked to the inner surface of capsule wall (Plate I, Figs. 4-8). The cavities of some capsules were filled with protoscoleces in meshes of reticular structure which were also linked around with the inner surface of capsule wall (Plate I, Fig. 9). The superficial surface of livers of positive field voles and experimental mice never showed any hyperemic phenomenon. The superficial surfaces of livers and lungs of positive field voles and experimental mice infected with alveolar E. sibiricensis were highly hyperemic. The metacestodes of E. sibiricensis composed of mother cyst, undifferentiated embryonic cysts and small brood capsules. Cavities of all cysts were fully filled with germinal cell masses. Host reaction appeared to be very strong, all cysts were surrounded by thick connective tissue and dense leukocytes (Plate II, Fig. 10). All alveolar vesicles were found located in lungs tissue of experimental mice. Large germinal cell masses metastasized out from undifferentiated embryonic cysts into host lung tissue, where germinal cell masses developed into accumulation of early protoscoleces (Plate II, Figs. 11-12). Early protoscoleces of alveolar E. sibiricensis were seen earliest in mice lung tissues on 101-104th days after infection. Many small capsules in different sizes and different shapes containing mature protoscoleces and reticular structure (Plate II, Figs. 13-15) were found in lungs of mice in 9th month after infection. Only in one experimental mouse infected with alveolar E. sibiricensis in 8.5th month postinfection, both its lung and liver existed alveolar cysts; the capsules in liver were surrounded by very thick connective tissue of the host, and there were some protoscoleces in their cavities (Plate II, Figs. 16-18).

A gene family expressing a host-protective antigen of Echinococcus granulosus

Echinococcus granulosus causes cystic hydatidosis in humans. A recombinant antigen vaccine has been developed, for use in the parasite's natural animal intermediate hosts, that may provide a new tool for control of hydatid disease transmission. The antigen, designated EG95, is encoded by a cDNA the features of which indicate it to be an incomplete copy of the associated mRNA. Characterisation of the gene(s) encoding the antigen was undertaken in order to enable subsequent study of genetic variability in the gene and associated protein in different parasite isolates. Southern hybridisation studies of E. granulosus genomic DNA probed with the eg95 cDNA revealed that the gene belonged to a gene family. DNA sequence analysis of cloned genomic fragments indicated that the gene family consists of at least seven members, one of which is a pseudogene. The gene having identity with the eg95 cDNA was cloned and sequenced, and the full length mRNA characterised. Genomic sequence and structure of the eg95 gene family members are highly conserved with respect to the gene encoding EG95. Four eg95-related genes are predicted to express an identical EG95 protein and all four were shown to be expressed in the oncosphere life-cycle stage. The full length EG95 protein has a predicted molecular mass of 16.9 kDa, secretory signal sequence, carboxy-terminal glycosylphosphatidylinositol hydrophobic anchor motif and a fibronectin type III domain. PCR amplification conditions were established which allow gene-specific characterisation of the eg95 gene in E. granulosus isolates from different host species and geographical locations.

Veterinary aspects of alveolar echinococcosis--a zoonosis of public health significance

Human alveolar echinococcosis (AE), caused by the metacestode stage of Echinococcus multilocularis, is a serious zoonosis which caused up to 100% lethality in untreated patients before the 1970s, when modern methods of treatment were not yet established. AE occurs in large areas of the northern hemisphere mostly with low country-wide prevalences, but high prevalences of up to 4% have been reported from small population groups in highly endemic foci, e.g. from China. AE includes many veterinary aspects which are the topic of this review. Recent studies have shown that E. multilocularis has a wider geographic range than previously anticipated. There is evidence for growing populations of red foxes (Vulpes vulpes) in some areas, for increasing invasion of cities by foxes and also for establishment of the parasite cycle in urban areas. These and other factors may lead to an increased infection risk for humans. Significant progress has been made in the development of sensitive and specific new techniques for the intra vitam and post mortem diagnosis of intestinal E. multilocularis infection in definitive hosts, notably the detection of coproantigen by enzyme-linked immunosorbent assay and of copro-DNA by PCR. Both tests can also be used for the identification of E. multilocularis in faecal samples collected in the environment. Recommendations are given for chemotherapy and chemoprophylaxis of the intestinal infection in definitive hosts. In recent years, infections with the metacestode stage of E. multilocularis have not only been diagnosed in humans in several regions, including at least eight countries in central Europe, but also in animal species which do not play a role in the transmission cycle (wild and domestic pigs, dogs etc.). From 1987 to 2000 our group in Zurich has diagnosed 10 cases of AE in dogs and 15 in captive monkeys. In 2 dogs, concurrent infections of the intestine and of the liver with adult and larval stages of E. multilocularis, respectively, were observed for the first time. Clinical data are presented, and methods of diagnosis and treatment (surgery, chemotherapy) are described. Furthermore, small liver lesions caused by E. multilocularis were diagnosed in 10% of 90 slaughter pigs, and 2.9% of 522 breeding sows had specific serum antibodies against parasite antigens. In view of the unpredictable epidemiological situation, all possible measures for preventing E. multilocularis infections in humans and in domestic animals should be initiated by the veterinary and health authorities.

[Increase in the prevalence of Echinococcus multilocularis infection in red foxes in Lower Saxony]

Echinococcus multilocularis is a tapeworm having carnivores as final hosts, the red fox in particular, dog and cat less frequent. Its two host life cycle consists of a larval cycle which predominantly takes place in the liver of rodents such as mice but it can also develop in musk rats as intermediate hosts. Man can also be infected and serves as a wrong intermediate host. He develops an alveolar echinococcosis which usually ends lethal without medical treatment. The prevalence of E. multilocularis among 5.365 red foxes in Lower Saxony was monitored from 1991 to 1997. The data were analysed using spatial epidemiological methods. This evaluation is based on a significance test which was applied to the parameters of spatial autoregressive regression models (CAR) fitting to the data of two successive sampling periods from 1991-1994 and 1994-1997. The mean prevalence (spatial median) increased from 6% to 11%. The results of this epidemiological study which was restricted to Lower Saxony support for the first time the earlier reported assumption that the prevalence of foxes infected with E. multilocularis has risen in Europe in the last decade. The reasons for this development are still unknown.

Mitosis and differentiation in T-cells under cytotoxic action of Echinococcus granulosus hydatid fluid

In the T-cell line, D10, thymidine uptake was used to measure the proportion of cells in S-phase, and the MTT assay to measure the number of viable cells. The effect of Echinococcus granulosus hydatid fluid (HF) on the lymphocytes was assayed in 3-day cultures of the T-cell line, D10, in increasing concentrations of HF. Apparent cytotoxic effects of HF were recorded as a log-linear decline in S-phase activity, which was reduced by the presence of IL-1, IL-2, or a combination of the two. In the presence of IL-2, however, mitogenic treatment with concanavalin A increased the cytotoxic effect in 3-day cultures, while in day-2 cultures, HF itself showed mitogenic effect. HF-induced decline in S-phase activity was not matched by a parallel decline in viable cells, suggesting that the apparent cytotoxicity of HF could result from cell-cycle arrest. Depending on its origin, HF enhanced membrane expression of CD25 and CD38 on human peripheral blood lymphoblasts, and diminished that of CD28. Taken together, these changes suggest that HF can induce T-cell mitosis and reduce co-stimulation with subsequent T-cell anergy or apoptosis.

Praziquantel and albendazole in the combined treatment of experimental hydatid disease

The combination of praziquantel and albendazole (PZ + ABZ) used in the present study demonstrated an efficacy of 100% when used as chemoprophylactic treatment because no viable hydatid cysts developed after mice had been injected with protoscolices. However, when the PZ + ABZ combination was used for the treatment of 4-month secondary experimental hydatidosis, no significant difference was found between the control and treated mice, although severe damage to the cyst ultrastructure of the treated mice was observed.

Characterization of the laminated layer of in vitro cultivated Echinococcus vogeli metacestodes

The metacestode (larval) stages of the cestode parasites Echinococcus vogeli and E. multilocularis were isolated from the peritoneal cavity of experimentally infected C57BL/6 mice and were cultured in vitro for a period of up to 4 mo under conditions normally applied for the in vitro cultivation of E. multilocularis metacestodes. In contrast to E. multilocularis, E. vogeli did not exhibit extensive exogenous budding and proliferation but increased in size with a final diameter of up to 10 mm. Most metacestodes contained protoscoleces, singly or in groups, either associated with brood capsules or growing directly out of the germinal layer. Each individual metacestode was covered by an acellular translucent laminated layer that was considerably thicker than the laminated layer of E. multilocularis metacestodes. The ultrastructural characteristics, protein content, and carbohydrate composition of the laminated layer of in vitro cultivated E. vogeli and E. multilocularis were assessed using transmission electron microscopy, lectin fluorescence labeling, and lectin blotting assays. The laminated layer of E. vogeli is, as previously described for E. multilocularis metacestodes, largely composed of N-acetyl-beta-D-galactosaminyl residues and alpha- and beta-D-galactosyl residues, as well as of the core structure of O-linked carbohydrate chains, N-acetylgalactosamine-beta-1,3-galactose. However, in contrast to E. multilocularis, N-linked glycopeptides and alpha-D-mannosyl and/or glucosyl residues were also associated with the laminated layer of E. vogeli. The laminated layer from both species was isolated from in vitro cultivated metacestodes, and the purified fractions were comparatively analyzed. The protein:carbohydrate ratio (1:1) was similar in both parasites; however, the protein banding pattern obtained by silver staining following sodium dodecyl sulfate polyacrylamide gel electrophoresis suggested intrinsic differences in protein composition. A polyclonal antiserum raised against the E. multilocularis laminated layer and a monoclonal antibody, G11, directed against the major E. multilocularis laminated layer antigen Em2 did not cross-react with E. vogeli, indicating distinct compositional and antigenic differences between these 2 parasites.

Hydatidosis: dynamics of transmission

Hydatidosis is a widespread zoonosis infecting a large number of animals and humans. Echinococcus granulosus has the smallest taenia adult of the cestodes but with the largest larva. Its morphologic and biologic features were identified with DNA analysis. Different strains were separated according to the intermediate hosts: sheep, cattle, pigs, horses, camels. Definitive host are canids, mostly dogs, where the worm grows to adulthood in several months. The eggs are scattered in the pasture by wind and water and are ingested by various hosts. The larvae migrate through the intestinal wall and penetrate the organs, mostly liver and lungs. The eggs survive several days outside, depending on the temperature, but numerous eggs die in nature because they cannot resist desiccation and extreme temperatures. Dissemination is accomplished by dogs. In Turkana (Kenya) the incidence of hydatidosis is high because of the close relationship between the population and dogs and the habit of leaving their dead bodies in the grasslands. In rural areas, the custom of slaughtering sheep at home, among the dogs, is an important dissemination factor. The circumstances of transmission vary according to the country. In Europe the natural life cycle of E. granulosus granulosus involves dogs as the definitive host and sheep as the intermediate host. In northern Europe E. granulosus borealis infects the canids and deer. E. granulosus canadensis infects wolves and reindeer, but there are no human cases. In the endemic Mediterranean area, sheep and dromedaries are the intermediate hosts. In South America, the life cycle of E. granulosus develops among several definitive and intermediate hosts. Hence the dynamics of transmission vary according to the countries with different hosts.

Modulation of the cellular immune response by a carbohydrate rich fraction from Echinococcus granulosus protoscoleces in infected or immunized Balb/c mice

Infection of Balb/c mice with Echinococcus granulosus protoscoleces constitutes the model for secondary hydatid infection. The immune response of Balb/c mice infected with E. granulosus is characterized by secretion of antibodies specific for carbohydrate epitopes and production of type-2 cytokines. A role for glycoconjugates in the induction of type-2 responses has been suggested in other host--parasite systems. Although glycoconjugates are immunogenic in E. granulosus infection, the role of these molecules in the establishment of the type-2 response has never been analysed. In this study, a carbohydrate rich fraction (E4+) from E. granulosus protoscoleces was obtained using the monoclonal antibody E492/G1 specific for the moiety Galalpha(1,4)Gal which is widely represented in protoscoleces and other E. granulosus antigenic preparations. The results showed that E4+ was immunogenic in Balb/c mice evoking an antibody response mainly directed against carbohydrate epitopes. In addition, splenocytes from E4+-immunized mice showed suppressed proliferative responses to Con A and E4+ induced IL-10 secretion by E4+-primed and naive splenocytes. The fraction E4+ also was immunogenic in infected mice during early infection. In this case also, splenocytes from infected mice as well as peritoneal cells from infected or naive mice, when stimulated in vitro with E4+, secreted IL-10. Collectively, these results suggest that E4+ may be involved in immunosuppression phenomena and, by stimulating IL-10 secretion, may contribute to the induction and sustaining of the type-2 cytokine response established in early experimental infection.

In vitro effect of praziquantel and albendazole combination therapy on the larval stage of Echinococcus granulosus

Protoscolices of Echinococcus granulosus were incubated in vitro with praziquantel (PZ), albendazole (ABZ), or a combination of both (PZ + ABZ). PZ and ABZ displayed slower protoscolicidal activity when applied separately than when used in combination. Despite the low PZ + ABZ concentrations used, protoscolex viability dropped rapidly (within 15 days). At this time, cysts did not develop following their inoculation into mice. The ultrastructural changes induced in the protoscolices by PZ + ABZ were (a) the loss of sucker concavity, (b tegumental contraction of the soma region, (c) the formation of digitiform tegumental extensions, (d) destruction of the tegument, and (e) the degeneration of parenchyma cells as reflected by the presence of numerous lamellar bodies. The PZ + ABZ treatment was effective only against small cysts, which had collapsed at 10 days postinoculation (p.i.). This treatment caused the following alterations: (a) loss of cyst turgidity at 6 days p.i.; (b) separation of the laminated and germinal layers; (c) loss of microtriches; (d) the appearance of numerous lipid droplets in the inner region of the germinal layer, (e) vacuolation of the cyton cytoplasm; and (f) the formation of abundant autophagosomes, which finally led to loss of the integrity of the germinal layer.

[Asymptomatic carriers of hydatidosis: epidemiology, diagnosis, and treatment]

Until a short time ago, hydatidosis was considered a pathology that could only be resolved surgically. However, in recent years progress has been made with the epidemiology, diagnosis, and treatment of the disease, and new information on the natural history of hydatidosis has helped define new criteria for its treatment. It is now known that as many as 67% of the carriers of liver cysts who are asymptomatic remain so throughout their lives. This situation produces special results in immunologic testing. Enzyme-linked immunosorbent assay (ELISA) has a sensitivity of 63% and a specificity of 97% with asymptomatic carriers, while the double diffusion arc 5 test (DD5) achieves a sensitivity of only 31% with the same population. On the other hand, imaging studies based on ultrasonography have become the method of choice to detect asymptomatic carriers. Ultrasonography studies are 49% to 73% more sensitive than serological tests, and they can even be used as a part of epidemiological surveillance systems and to monitor control programs. Treatment schemes have also been modernized. Treating asymptomatic carriers chemotherapeutically with albendazole produces favorable results in as many as 69% of cases, while such minimally invasive surgical treatments as puncture-aspiration-injection-reaspiration (PAIR) reduce average cyst volume by as much as 66%. These factors have made it possible for hospital services in the province of Río Negro, Argentina, to establish a treatment scheme for asymptomatic carriers. It is based on the monitoring of small cysts (type Ia on the modified Gharbi scale); initial treatment with albendazole, followed by PAIR if there is no response, in larger or more complex cysts (types Ib, II, and III); and follow-up of inviable or dead cysts (types IV and V).

Efficacy of Droncit Spot-on (praziquantel) 4% w/v against immature and mature Echinococcus multilocularis in cats

The causative agent of alveolar hydatidosis in humans, the fox tapeworm Echinococcus multilocularis, is extending its geographical range in Europe and has been found in domestic cats in some areas. A dermally applied cestocidal treatment for domestic cats has been developed and the efficacy of this treatment is reported. Thirty purpose-bred cats were experimentally infected each with 10000 protoscoleces of Echinococcus multilocularis. Ten days later one group of ten cats was treated with Droncit(R) Spot-on (Praziquantel) 4% w/v dermally in one place on the dorsal aspect of the neck at a dose of 8 mg/kg. Eleven days later (21 days p.i.) a second group of ten cats was also treated with Droncit(R) Spot-on the same way. One group of ten cats was left untreated as controls. Twenty three days after infection the cats were examined for the presence of E. multilocularis tapeworms. No E. multilocularis were recovered from any of the cats in either of the treated groups. Echinococcus multilocularis were recovered from eight of the ten cats left untreated as controls. The worm burdens in the untreated cats were 0, 0, 5, 15, 75, 110, 220, 815, 2635, and 3045 worms per cat. The worms ranged in development from the three to four segment stage. Many of the E. multilocularis with four segments contained unshelled eggs in the terminal segment. This study indicates that Droncit(R) Spot-on (Praziquantel) 4% w/v applied dermally at 8 mg/kg is highly effective in removing E. multilocularis from the small intestine of cats infected with immature and mature (prepatent) infections of E. multilocularis. In the cats with the mature infections all tapeworms were absent from the small intestine within 2 days of treatment.

Development and sexual maturation of Echinococcus vogeli in an alternative definitive host, Mongolian gerbil (Meriones unguiculatus)

An alternative definitive host model for Echinococcus vogeli was developed using Mongolian gerbils. The animals treated with prednisolone tert-butylacetate were orally inoculated with protoscoleces of E. vogeli and the development of worms in the small intestine was observed until 50 days post infection (DPI). The parasites were recovered most frequently from the anterior part of the small intestine. The band formation (the sign of proglottisation) of the worm was observed at 7 DPI, the second proglottid and tests formation at 14 DPI, spermatozoa in seminal receptacle and cleavage of ova in uterus at 21 DPI, the hook formation of oncospheres at 28 DPI and the embryophore formation at 34 DPI. Eggs in the feces were first detected at 35 DPI. The coproantigen detection method developed for E. multilocularis could detect the E. vogeli coproantigen early in the infection, at 7 DPI during the prepatent period. Therefore, this technique could be used for the diagnosis of E. vogeli, replacing ordinary fecal egg examination.

How Echinococcus granulosus deals with complement

Here, Ana Mar a Ferreira and colleagues discuss the interplay between the larval stages of Echinococcus granulosus and an important effector arm of immunity: the host complement system. During early infection, the parasite activates complement, and hence complement-dependent inflammatory responses. However, on differentiation into the hydatid cyst, the parasite exposes to the host a structure - the cyst wall - that does not activate complement strongly. Mechanisms inhibiting complement activation on the cyst wall have been elucidated, contributing to the understanding of how this large, persistent, tissue-dwelling pathogen controls the inflammatory response.

Canine echinococcosis: an alternative for surveillance epidemiology

The essential activities for programmes of cystic echinococcosis control are the census of all dogs from the program and identification of parasitised animals. Currently, in South America evaluations and epidemiological surveillance are based on the administration of arecoline hydrobromide. This method has the disadvantage of increasing environmental pollution and risk for operators and owners of treated dogs. A genus-specific ELISA capture method has been employed for recently issued faeces and the confirmation of positive examination was performed by dog autopsies. Our work presents an alternative method based on collection of dry field-dispersed faeces, followed by serological diagnosis by Copro-ELISA and confirmation by Copro-Western blot. If Copro-ELISA were used to define positive samples of dry faeces, the Copro-Western blot assay would provide 70% sensitivity and 100% specificity. Global efficiency of the system using dry faeces would reach 76%, allowing epidemiological surveillance to be oriented to analysis of surface units instead of dog as measurement unit.