Echinococcus multilocularis: an emerging pathogen in Hungary and Central Eastern Europe?

Spatial distribution of Dermacentor reticulatus and Ixodes ricinus in Hungary: evidence for change?

A survey was conducted to investigate the spatial distribution of Ixodes ricinus and Dermacentor reticulatus in Hungary and to compare these data with the results of a previous large-scale survey. In the survey conducted in the 1950s, D. reticulatus adults were detected in two isolated areas of two counties, and the presence of these ticks in the collection was explained by accidental introduction. In the present survey, D. reticulatus became the second most common species occurring in all 16 counties involved in the monitoring and showed high prevalence. The change in the spatial distribution of this tick species, the increase of incidence of Babesia canis infection in Hungary, and the increasing number of canine babesiosis case reports from other Central and Central Eastern European countries since the 1970s suggest an expansion of the geographic range of D. reticulatus and intensification of the transmission rate of B. canis and probably other D. reticulatus-borne diseases (e.g. tularemia and tick-borne lymphadenopathy) in the region. The spatial distribution of I. ricinus was roughly in line with the results of the earlier survey. I. ricinus was the most common tick species being present in all 16 counties with the highest prevalence. Nevertheless, the comparison of the data of the previous and current survey cannot be used for fine-scale analysis; thus, it cannot be dismissed that the spatial distribution of I. ricinus also changed during the past decades. The spatial distribution patterns of tick-borne encephalitis in Hungary and other Central Eastern European countries may indicate such a change.

Anaplasma phagocytophilum: an emerging tick-borne pathogen in Hungary and Central Eastern Europe

Anaplasma phagocytophilum (formerly Ehrlichia phagocytophila, Ehrlichia equi and Anaplasma phagocytophila) is the causative agent of granulocytic ehrlichiosis (anaplasmosis) in humans, horses, sheep, cattle, dogs and cats. In the present study, 452 European sheep ticks (Ixodes ricinus) collected from 100 red foxes (Vulpes vulpes) in Hungary were tested for the pathogen, as 112 pools each containing five or fewer ticks from one fox. Six of the pools, representing ticks from six different foxes, were found infected in the PCR-based test employed. This is the first time that A. phagocytophilum has been reported in Hungary. A summary of the information available from Central Eastern Europe on the prevalence of A. phagocytophilum in ticks, its seroprevalence in humans, and the number of human cases of granulocytic ehrlichiosis known in the region is presented.

Wilderness in the city: the urbanization of Echinococcus multilocularis

A distinct increase in fox populations, particularly in urban areas, has been observed in Europe. This is of particular concern in endemic regions of the small fox tapeworm Echinococcus multilocularis, the aetiological agent of human alveolar echinococcosis. Novel tools have facilitated the investigation of the ecology of urban foxes and have demonstrated the urban wildlife cycle of E. multilocularis. Such studies are essential for estimating the risk of transmission to humans and to determine the basics for the development of control strategies.

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.

Echinococcosis

Echinococcosis is a near-cosmopolitan zoonosis caused by adult or larval stages of cestodes belonging to the genus Echinococcus (family Taeniidae). The two major species of medical and public health importance are Echinococcus granulosus and Echinococcus multilocularis, which cause cystic echinococcosis and alveolar echinococcosis, respectively. Both are serious and severe diseases, the latter especially so, with high fatality rates and poor prognosis if managed incorrectly. Several reports have shown that both diseases are of increasing public health concern and that both can be regarded as emerging or re-emerging diseases. In this review we discuss aspects of the biology, life cycle, aetiology, distribution, and transmission of the Echinococcus organisms, and the epidemiology, clinical features, treatment, and diagnosis of the diseases they cause. We also discuss the countermeasures available for the control and prevention of these diseases. E granulosus still has a wide geographical distribution, although effective control against cystic echinococcosis has been achieved in some regions. E multilocularis and alveolar echinococcosis are more problematic, since the primary transmission cycle is almost always sylvatic so that efficient and cost-effective methods for control are unavailable.

Extraintestinal nematode infections of red foxes (Vulpes vulpes) in Hungary

A survey was carried out to investigate the prevalence and worm burden of extraintestinal nematodes in 100 red foxes (Vulpes vulpes) of Hungary. The overall prevalence of nematode infections of the respiratory tract was 76%. Eucoleus aerophilus (Capillaria aerophila) was the predominant species (66%), followed by Crenosoma vulpis (24%), Eucoleus (Capillaria) böhmi (8%) and Angiostrongylus vasorum (5%). Pearsonema (Capillaria) plica was found in 52% of the urinary bladders. In 3% of the foxes, Trichinella britovi was present in muscle samples. The high prevalence of lungworms and P. plica and the fox colonisation in urban areas may enhance the prevalence of these nematode infections in domestic dogs and cats, and the flow of T. britovi from the sylvatic cycle to the domestic cycle, enhancing the risk of infections in humans.

Ectoparasite infestations of red foxes (Vulpes vulpes) in Hungary

A survey was carried out to investigate the ectoparasite infestations of 100 red foxes (Vulpes vulpes) in Hungary. The overall prevalence of flea and tick infestation was high (62 and 86% with the dominance of the anthropophil Pulex irritans and Ixodes ricinus), but the number of parasites was low to moderate. Felicola vulpis was not found in the present study, and the prevalence of Otodectes cynotis was only 2%. Based on prevalence (21%), mange lesion scores, and the negative correlation between lesion scores and condition of foxes, Sarcoptes infestation should be considered as the most important parasitosis of foxes in Hungary. Besides the ecological significance of these parasites, the high overall prevalence of mange and anthropophil flea and tick infestations of foxes and the appearance of these animals in the synanthropic environment as a result of the increasing population size, may result in the increasing incidence of flea, tick and accidental mite infestation of man and domestic animals, and may enhance the transmission rate of some vector-borne diseases.