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Polańska-Płachta M, Czerwińska M, Ostrowska M, Stefaniak J, Polański JA. Alveolar Echinococcosis: Is Non-Radical Liver Resection a Game Changer in the Current Treatment Approach to Patients with Advanced Alveolar Echinococcosis Disease? Single Center Experience of Poland. Acta Parasitol 2025; 70:100. [PMID: 40299105 DOI: 10.1007/s11686-025-01040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Accepted: 04/15/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Alveolar echinococcosis is parasitic disease caused by Echinococcus multilocularis and spread endemically in the northern hemisphere. Although alveolar echinococcosis is considered a rare disease, with approximately 18,000 new cases diagnosed annually, it continues to present significant diagnostic and therapeutic challenges. Alveolar echinococcosis affects the liver through slow, asymptomatic infiltration over many years. At the time of diagnosis, approximately 70% of cases are not eligible for radical lesion resection. The aim of the study was to evaluate whether non-radical surgery increases patients' survival rates. METHODS We conducted a prospective analysis on patients diagnosed with alveolar echinococcosis in years 1995-2017 who underwent liver resection. Age, gender, mass of lesion, extensive nature of the operation (radical vs. conservative) and surgical procedures were collected. Mortality was analyzed. RESULTS Mean resected lesions' weight was statistically higher in non-radically resected group 1396,00 g (SD ± 845,39) compared with radically resected group 549,43 g (SD ± 364,27), p = 0,004. The type of surgical treatment did not significantly affect patient survival. CONCLUSION The complete lesion resection (in combination with albendazole) is only a curative therapy, if feasible. In advance stages when radical resection is not feasible, the reductive or debulking surgery should be done for symptoms' alleviation and quality of life improvement.
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Affiliation(s)
- Małgorzata Polańska-Płachta
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Magdalena Czerwińska
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Ostrowska
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Stefaniak
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland
| | - Jerzy A Polański
- Second Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
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Katsuno T, Sugiura Y, Morishita M, Osaki S, Suzuki M, Takasaki J, Iikura M, Izumi S, Hojo M, Sugiyama H. Spinal Echinococcosis in a Japanese Woman Living in Tokyo: Diagnostic Challenges in Non-endemic Areas and Public Health Implications. Intern Med 2025; 64:971-977. [PMID: 39135255 PMCID: PMC11986315 DOI: 10.2169/internalmedicine.3713-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/23/2024] [Indexed: 03/18/2025] Open
Abstract
Echinococcosis, caused by Echinococcus spp., often affects the lungs and liver, and spinal involvement is rare. Echinococcus multilocularis is prevalent in Japan, particularly in Hokkaido. We herein report a rare case of spinal echinococcosis in a 31-year-old woman who was diagnosed in Tokyo. Spinal echinococcosis is uncommon and often leads to misdiagnoses. The patient likely contracted the disease via contaminated fresh produce transported from an endemic region. This study emphasizes the diagnostic challenges of spinal echinococcosis in non-endemic regions and highlights the public health concerns related to the spread of infections in non-endemic areas.
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Affiliation(s)
- Takashi Katsuno
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuriko Sugiura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Momoko Morishita
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shuhei Osaki
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Jin Takasaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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Simon G, Grenouillet F, Richou C, Delabrousse E, Blagoskonov O, Minello A, Thiefin G, Frentiu E, Wallon M, Bresson-Hadni S, Calame P. Correlation between imaging features and rEm18 antibodies in alveolar echinococcosis: results from a multicenter study in France. Parasite 2025; 32:8. [PMID: 39918234 PMCID: PMC11804184 DOI: 10.1051/parasite/2024076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 12/18/2024] [Indexed: 02/11/2025] Open
Abstract
BACKGROUND To correlate imaging features of alveolar echinococcosis (AE) with the antibodies to recombinant Em18 (rEm18AB) at diagnosis and evaluate initial imaging features associated with serologic response, this retrospective study used data from the prospective multicenter EchinoVISTA study (NCT02876146). Imaging and serology were performed at diagnosis and during follow-up. Univariate and multivariate analyses were used to evaluate imaging features associated with the rEm18AB index. Follow-up analyses evaluated the imaging features associated with serologic response (defined as a 50% reduction in the baseline value within 2 years) in non-operated patients treated with albendazole alone. RESULTS From June 2012 to July 2016, 45 patients were included, with 8/45 (18%) having an rEm18AB index < 1. Maximum lesion size (76 mm [IQR = 57-93] vs. 36 mm [IQR = 26-51], p = 0.006), microcyst percentage (70% [IQR = 3-8] vs. 20% [IQR = 0.5-3.5], p = 0.004), and maximum standardized uptake value (SUV) on fluorodeoxyglucose positron emission tomography (5.1 [IQR = 4.4-6.2] vs. 2.6 [IQR = 2.4-3.9], p = 0.001) were associated with an rEm18AB index > 1. In patients treated with albendazole, serologic responders at 2 years had smaller lesions (5.3 [IQR = 3.8-72] vs. 3.5 [IQR = 2.7-3.7], p = 0.010) with less pedicle involvement, and lower initial rEm18AB index (2.98 ± 1.63 vs. 7.81 ± 3.95, p = 0.011). CONCLUSION Maximum lesion size, percentage of microcysts within the lesion, and maximum lesion SUV are significant imaging features of AE correlated with the rEm18AB index. Serologic response at 2 years occurs primarily in patients with small lesions and a low rEm18AB index.
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Affiliation(s)
- Gabriel Simon
- Department of Radiology, University Hospital of Besançon 25030 Besançon France
- Research Unit “Synergie”, University of Franche-Comté 25030 Besançon France
| | - Frédéric Grenouillet
- UMR CNRS “Chrono-environnement”, University of Franche-Comté 25030 Besançon France
- Laboratory of fungi and parasite serology, University Hospital of Besançon 25030 Besançon France
| | - Carine Richou
- National Reference Center for Echinococcoses, Department of Parasitology-Mycology, University Hospital of Besançon 25030 Besançon France
- Department of Hepatology, University Hospital of Besançon 25030 Besançon France
| | - Eric Delabrousse
- Department of Radiology, University Hospital of Besançon 25030 Besançon France
- Research Unit “Synergie”, University of Franche-Comté 25030 Besançon France
- National Reference Center for Echinococcoses, Department of Parasitology-Mycology, University Hospital of Besançon 25030 Besançon France
| | - Oleg Blagoskonov
- National Reference Center for Echinococcoses, Department of Parasitology-Mycology, University Hospital of Besançon 25030 Besançon France
- Department of Nuclear Medicine, University Hospital of Besançon 25030 Besançon France
| | - Anne Minello
- Department of Hepatology, University Hospital of Dijon 21000 Dijon France
| | - Gerard Thiefin
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Reims 51100 Reims France
| | - Emilia Frentiu
- Department of Infectious Diseases, University Hospital of Caen 14000 Caen France
| | - Martine Wallon
- Department of Parasitology and Medical Mycology, University Hospital of Lyon 69002 Lyon France
| | - Solange Bresson-Hadni
- National Reference Center for Echinococcoses, Department of Parasitology-Mycology, University Hospital of Besançon 25030 Besançon France
| | - Paul Calame
- Department of Radiology, University Hospital of Besançon 25030 Besançon France
- Research Unit “Synergie”, University of Franche-Comté 25030 Besançon France
- National Reference Center for Echinococcoses, Department of Parasitology-Mycology, University Hospital of Besançon 25030 Besançon France
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Ollagnon M, Bresson-Hadni S, Spahr L, Rubbia-Brandt L, Toso C, Chappuis F. Alveolar echinococcosis in the canton of Geneva between 2010 and 2021: a descriptive analysis. Swiss Med Wkly 2025; 155:3863. [PMID: 39977361 DOI: 10.57187/s.3863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Alveolar echinococcosis is a rare but potentially severe parasitic disease caused by the larval stage of Echinococcus multilocularis, endemic in many countries in the northern hemisphere, including Switzerland. While the liver is most commonly affected, other organs can also be involved either by contiguity or haematogenous spread. To date, there is no epidemiological or clinical data on alveolar echinococcosis in the canton of Geneva. OBJECTIVES To describe the demographic, epidemiological, clinical and therapeutic characteristics of alveolar echinococcosis in the canton of Geneva between 2010 and 2021. METHODS An investigation was conducted among physicians from Geneva University Hospitals (HUG) and the private sector likely to encounter patients diagnosed with alveolar echinococcosis between 2010 and 2021. All patients being treated in the canton of Geneva were included. After obtaining their consent, an epidemiological questionnaire was completed by patients, and a clinical questionnaire by their referring physicians. Demographic, epidemiological and clinical data were entered into REDCap, then extracted and analysed. RESULTS Of a total of 27 patients diagnosed with alveolar echinococcosis, 25 were included in the study; one patient did not provide his consent and one patient could not be contacted. The annual incidence of alveolar echinococcosis in the canton of Geneva was calculated at 0.24 cases per 100,000 inhabitants based on the subset (n = 14) domiciled in Geneva. The vast majority of patients (n = 24; 96%) were followed at HUG. The median age of patients was 55 years (range: 17-79) with a slight predominance of women (56%). Reported risk factors for alveolar echinococcosis included owning a vegetable garden (70.8%), often unfenced, practicing composting (69.6%), and owning a dog (58.3%) or a cat (58.3%). Four patients (16%) had an immunosuppressive condition. Only 52% of patients were symptomatic at the time of diagnosis. The liver was affected in most cases (n = 24; 96%), but one patient had a primary splenic location. Surgical resection for curative purposes was performed in 13 patients (52%). All patients received parasitostatic treatment with albendazole, discontinued in 5 patients (20%) due to drug-induced hepatitis. Three patients died (12%), of which two directly related to alveolar echinococcosis. CONCLUSION Alveolar echinococcosis, a rare but severe disease, is endemic in the canton of Geneva. The establishment of mandatory reporting of this disease in Switzerland would allow monitoring of its epidemiological evolution. Primary and secondary prevention measures, currently non-existent, could potentially lower the incidence and severity of the disease.
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Affiliation(s)
- Manon Ollagnon
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Solange Bresson-Hadni
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Division of Gastroenterology and Hepatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurent Spahr
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Gastroenterology and Hepatology, University Hospitals of Geneva, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - François Chappuis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Kakamad FH, Anwar KA, Ahmed HK, Habibullah IJ, Kaka Ali HH, Nasralla HA, Abdullah HO, Tahir SH, Kareem HO, Hasan AH, Gharib DT, Asaad HR, Mohammed AA, Abdalla BA, Esmaeil DA, Rashid RJ, Hamahussein KF. Risk factors associated with human echinococcosis: a systematic review and meta-analysis. Front Vet Sci 2024; 11:1480579. [PMID: 39654835 PMCID: PMC11625768 DOI: 10.3389/fvets.2024.1480579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 11/11/2024] [Indexed: 12/12/2024] Open
Abstract
Introduction Echinococcosis is a widespread zoonotic disease caused by tapeworms of the Echinococcus genus, manifesting in mature or larval forms. Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are the primary types affecting humans, linked, respectively, to Echinococcus granulosus and Echinococcus multilocularis. This study is a systematic review and meta-analysis of the risk factors associated with CE and AE in humans. Methods Relevant English publications were found through a thorough search of eligible databases. The inclusion criteria focused on cross-sectional and case-control studies investigating risk factors for human echinococcosis. Collected data included author, country, study design, demographics, sample size, literacy, occupation, drinking water source, dog ownership, and hand hygiene. Results A total of 1,594 studies were found in the initial search, with only 36 papers (involving 1,207,436 cases) meeting the inclusion criteria. Most of the study population (99.35%) showed no echinococcosis infection, while 0.65% were infected. Of the infected cases, 77.92% had CE, while 22.08% had AE. Among 629,996 (52.18%) females, 4,830 (0.76%) were infected, compared to 2,968 (0.52%) infections among 565,872 (46.86%) males (p < 0.001). Rural areas, low education levels, agricultural/livestock workers, dog owners, water sources, and poor hand hygiene were all significantly associated with the infection (p < 0.05). Conclusion Echinococcosis remains a global health concern, particularly among rural residents, those with lower education, agricultural workers, and dog owners. Targeted public health measures, including improved hygiene practices and access to clean water, are essential to reducing its impact.
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Affiliation(s)
- Fahmi H. Kakamad
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Kscien Organization for Scientific Research (Middle East Office), Sulaymaniyah, Iraq
| | - Khanda A. Anwar
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Harem K. Ahmed
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Imad J. Habibullah
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Hemn H. Kaka Ali
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Gastroenterology and Hepatology Teaching Hospital, Sulaymaniyah, Iraq
| | - Hawkar A. Nasralla
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Hiwa O. Abdullah
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Kscien Organization for Scientific Research (Middle East Office), Sulaymaniyah, Iraq
| | - Soran H. Tahir
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Honar O. Kareem
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Ali H. Hasan
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Dana T. Gharib
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Gastroenterology and Hepatology Teaching Hospital, Sulaymaniyah, Iraq
| | - Hoshmand R. Asaad
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Gastroenterology and Hepatology Teaching Hospital, Sulaymaniyah, Iraq
| | - Ayoob A. Mohammed
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Berun A. Abdalla
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Kscien Organization for Scientific Research (Middle East Office), Sulaymaniyah, Iraq
| | - Deari A. Esmaeil
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq
| | - Rezheen J. Rashid
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Department of Radiology, Hiwa Cancer Hospital, Sulaymaniyah, Iraq
| | - Karokh F. Hamahussein
- Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
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Lallemand S, Oyhenart J, Valot B, Borne R, Bohard L, Umhang G, Karamon J, Konyaev S, Rönnberg C, Gottstein B, Weil-Verhoeven D, Richou C, Bresson-Hadni S, Millon L, Bellanger AP, Knapp J. Challenging the phylogenetic relationships among Echinococcus multilocularis isolates from main endemic areas. Int J Parasitol 2024; 54:569-582. [PMID: 38815855 DOI: 10.1016/j.ijpara.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/05/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
Alveolar echinococcosis (AE) is a rare but severe disease that affects more than 18,000 people worldwide per year. The complete sequencing of the mitochondrial genome of Echinococcus multilocularis has made it possible to study the genetic diversity of the parasite and its spatial and temporal evolution. We amplified the whole mitochondrial genome by PCR, using one uniplex and two multiplex reactions to cover the 13,738 bp of the mitogenome, and then sequenced the amplicons with Illumina technology. In total, 113 samples from Europe, Asia, the Arctic and North America were analyzed. Three major haplogroups were found: HG1, which clustered samples from Alaska (including Saint-Lawrence Island), Yakutia (Russia) and Svalbard; HG2, with samples from Asia, North America and Europe; and HG3, subdivided into three micro-haplogroups. HG3a included samples from North America and Europe, whereas HG3b and HG3c only include samples from Europe. In France, HG3a included samples from patients more recently diagnosed in a region outside the historical endemic area. A fourth putative haplogroup, HG4, was represented by only one isolate from Olkhon Island (Russia). The increased discriminatory power of the complete sequencing of the E. multilocularis mitogenome has made it possible to highlight four distinct geographical clusters, one being divided into three micro-haplogroups in France.
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Affiliation(s)
- Séverine Lallemand
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France
| | - Jorge Oyhenart
- Instituto de Ciencias de la Tierra y Ambientales de La Pampa, Consejo Nacional de Investigaciones Científicas y Técnicas - Facultad de Ciencias Naturales Universidad Nacional de La Pampa, La Pampa, Argentina
| | - Benoit Valot
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France
| | - Romain Borne
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France
| | - Louis Bohard
- Department of Infectiology, University Hospital of Besançon, 25030 Besançon, France
| | - Gérald Umhang
- INTERFAS Unit, National Reference Laboratory for Echinococcus spp., Rabies and Wildlife Laboratory, ANSES, Malzéville, France
| | - Jacek Karamon
- Department of Parasitology and Invasive Diseases, National Veterinary Research Institute, Puławy, Poland
| | - Sergey Konyaev
- Institute of Systematics and Ecology of Animals, SB RAS, Novosibirsk, Russia
| | - Caroline Rönnberg
- Public Health Agency of Sweden, Department of Microbiology, Unit for Parasitology, Solna, Sweden
| | - Bruno Gottstein
- Institute of Infectious Diseases, Faculty of Medicine, University of Bern, CH-3012 Bern, Switzerland
| | - Delphine Weil-Verhoeven
- Department of Hepatology and Intensive Cares, University Hospital of Besançon, 25030 Besançon, France
| | - Carine Richou
- Department of Hepatology and Intensive Cares, University Hospital of Besançon, 25030 Besançon, France
| | - Solange Bresson-Hadni
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Laurence Millon
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Anne-Pauline Bellanger
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Jenny Knapp
- UMR CNRS 6249 Chrono-Environnement, University of Franche-Comté, 16 Route de Gray, 25030 Besançon cedex, France; Department of Parasitology-Mycology, Reference National Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France.
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Malik Da Silva A, Afonso E, Raoul F, Giraudoux P, Mergey M, Umhang G, Courquet S, Rieffel D, Millon L, Knapp J. Assessing the role of individual foxes in environmental contamination with Echinococcus multilocularis through faecal samples. Int J Parasitol 2024; 54:321-332. [PMID: 38460722 DOI: 10.1016/j.ijpara.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/26/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
Key parasite transmission parameters are difficult to obtain from elusive wild animals. For Echinococcus multilocularis, the causative agent of alveolar echinococcosis (AE), the red fox is responsible for most of the environmental contamination in Europe. The identification of individual spreaders of E. multilocularis environmental contamination is crucial to improving our understanding of the ecology of parasite transmission in areas of high endemicity and optimising the effectiveness of prevention and control measures in the field. Genetic faecal sampling appears to be a feasible method to gain information about the faecal deposition of individual animals. We conducted a 4 year faecal sampling study in a village that is highly endemic for E. multilocularis, to assess the feasibility of individual identification and sexing of foxes to describe individual infection patterns. Individual fox identification from faecal samples was performed by obtaining reliable genotypes from 14 microsatellites and one sex locus, coupled with the detection of E. multilocularis DNA, first using captive foxes and then by environmental sampling. From a collection of 386 fox stools collected between 2017 and 2020, tested for the presence of E. multilocularis DNA, 180 were selected and 124 samples were successfully genotyped (68.9%). In total, 45 unique individual foxes were identified and 26 associated with at least one sample which tested positive for E. multilocularis (Em(+)). Estimation of the population size showed the fox population to be between 29 and 34 individuals for a given year and 67 individuals over 4 years. One-third of infected individuals (9/26 Em(+) foxes) deposited 2/3 of the faeces which tested positive for E. multilocularis (36/60 Em(+) stools). Genetic investigation showed a significantly higher average number of multiple stools for females than males, suggesting that the two sexes potentially defecated unequally in the studied area. Three partially overlapping clusters of fox faeces were found, with one cluster concentrating 2/3 of the total E. multilocularis-positive faeces. Based on these findings, we estimated that 12.5 million E. multilocularis eggs were produced during the study period, emphasizing the high contamination level of the environment and the risk of exposure faced by the parasite hosts.
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Affiliation(s)
- Abdou Malik Da Silva
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Eve Afonso
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Francis Raoul
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Patrick Giraudoux
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Marina Mergey
- University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France
| | - Gérald Umhang
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp. Wildlife Surveillance and Eco-epidemiology Unit, Agricultural and Veterinary Technopole, 54220 Malzéville, France
| | - Sandra Courquet
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, University Hospital of Besançon, 25030 Besançon, France
| | - Dominique Rieffel
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Laurence Millon
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, University Hospital of Besançon, 25030 Besançon, France
| | - Jenny Knapp
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, University Hospital of Besançon, 25030 Besançon, France.
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Sallo FB, Misutkova Z, Munting A, Bessat C, Guex-Crosier Y. An Unusual Cause of Serous Retinal Detachment. Klin Monbl Augenheilkd 2024; 241:485-488. [PMID: 38653280 DOI: 10.1055/a-2268-9454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
| | | | - Aline Munting
- Infectious Diseases Service, University Hospital of Lausanne, Switzerland
| | - Cecile Bessat
- Infectious Diseases Service, University Hospital of Lausanne, Switzerland
| | - Yan Guex-Crosier
- Department of Ophthalmology, University Eye Hospital, FAA, Lausanne, Switzerland
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Antolová D, Šnábel V, Jarošová J, Cavallero S, D’Amelio S, Syrota Y, Rosoľanka R, Avdičová M, Miterpáková M. Human alveolar echinococcosis in Slovakia: Epidemiology and genetic diversity of Echinococcus multilocularis, 2000-2023. PLoS Negl Trop Dis 2024; 18:e0011876. [PMID: 38198452 PMCID: PMC10805277 DOI: 10.1371/journal.pntd.0011876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/23/2024] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Human alveolar echinococcosis (AE) is a serious parasitic disease caused by larval stages of Echinococcus multilocularis. Between January 2000 and October 2023, 137 AE cases were confirmed in Slovakia. The average annual incidence increased from 0.031 per 100,000 inhabitants between 2000 and 2011, to an average of 0.187 since 2012, i.e. about six times. Among patients, 45.3% were men and 54.7% were women; the mean age at the time of diagnosis was 52.8 years. Most cases were diagnosed in the age groups 51-60 years and 61-70 years (33 cases each), and eight patients fell into the age category ≤ 20 years. To better recognize the gene diversity in clinical samples, metacestodes from 21 patients collected between 2013 and 2021 were subjected to DNA sequencing of four mitochondrial genes. Using concatenated sequences of cob (603 bp), nad2 (882 bp) and cox1 (789 bp) gene fragments, 14 isolates (66.7%) were assigned to the European E5 profile of E. multilocularis, two isolates (9.5%) to the E5a subtype, four isolates (19%) to the E4 profile, and one isolate (4.8%) to haplogroup E1/E2. The E5-type profiles and E4 profiles were distributed throughout the country, whereas the E1/E2 profile was found in the patient from western Slovakia. According to the data obtained and GenBank sequences, the E5-type dispersal is so far limited to central-eastern Europe and the variant seems to be indigenous to that region. The admixture with the haplotypes E4 and E1/E2 could have taken place from a historical endemic focus during the fox expansion in the last decades. By employing the nad1 fragment, a typical European haplotype was observed in all 21 resolved Slovak samples. The acceleration in the AE incidence in the last decade suggests the emergence of the disease and the need for further research on human and animal isolates.
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Affiliation(s)
- Daniela Antolová
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
| | - Viliam Šnábel
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
| | - Júlia Jarošová
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
| | - Serena Cavallero
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Stefano D’Amelio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Yaroslav Syrota
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
- I. I. Schmalhausen Institute of Zoology of National Academy of Sciences of Ukraine, Ukraine, Kyiv, Ukraine
| | - Róbert Rosoľanka
- Clinic of Infectology and Travel Medicine, Jessenius Faculty of Medicine and University Hospital in Martin, Comenius University Bratislava, Martin, Slovakia
| | - Mária Avdičová
- Regional Authority of Public Health Banská Bystrica, Banská Bystrica, Slovakia
| | - Martina Miterpáková
- Institute of Parasitology of the Slovak Academy of Sciences, Košice, Slovakia
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Bohard L, Lallemand S, Borne R, Courquet S, Bresson-Hadni S, Richou C, Millon L, Bellanger AP, Knapp J. Complete mitochondrial exploration of Echinococcus multilocularis from French alveolar echinococcosis patients. Int J Parasitol 2023:S0020-7519(23)00076-0. [PMID: 37148987 DOI: 10.1016/j.ijpara.2023.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Alveolar echinococcosis (AE) is a parasitosis that is expanding worldwide, including in Europe. The development of genotypic markers is essential to follow its spatiotemporal evolution. Sequencing of the commonly used mitochondrial genes cob, cox1, and nad2 shows low discriminatory power, and analysis of the microsatellite marker EmsB does not allow nucleotide sequence analysis. We aimed to develop a new method for the genotyping of Echinococcus multilocularis based on whole mitochondrial genome (mitogenome) sequencing, to determine the genetic diversity among 30 human visceral samples from French patients, and compare this method with those currently in use. Sequencing of the whole mitochondrial genome was carried out after amplification by PCR, using one uniplex and two multiplex reactions to cover the 13,738 bp of the mitogenome, combined with Illumina technology. Thirty complete mitogenome sequences were obtained from AE lesions. One showed strong identity with Asian genotypes (99.98% identity) in a patient who had travelled to China. The other 29 mitogenomes could be differentiated into 13 haplotypes, showing higher haplotype and nucleotide diversity than when using the cob, cox1, and nad2 gene sequences alone. The mitochondrial genotyping data and EmsB profiles did not overlap, probably because one method uses the mitochondrial genome and the other the nuclear genome. The pairwise fixation index (Fst) value between individuals living inside and those living outside the endemic area was high (Fst = 0.222, P = 0.002). This is consistent with the hypothesis of an expansion from historical endemic areas to peripheral regions.
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Affiliation(s)
- Louis Bohard
- Department of Infectious Disease, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Séverine Lallemand
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Romain Borne
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France
| | - Sandra Courquet
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Solange Bresson-Hadni
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Carine Richou
- Department of Hepatology, University Hospital of Besançon, 3 boulevard A. Fleming, Besançon France
| | - Laurence Millon
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Anne-Pauline Bellanger
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France
| | - Jenny Knapp
- UMR CNRS 6249 Chrono-environnement Laboratory, University of Franche-Comté, 16 Route de Gray, 25030 Besançon, France; Department of Parasitology-Mycology, Reference National Center for Echinococcosis, University Hospital of Besançon, 3 boulevard A. Fleming, 25030 Besançon, France.
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11
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Differentiation of hepatic alveolar echinococcosis with a hemangioma-like pattern compared to typical liver hemangioma using contrast-enhanced ultrasound: a pilot study. Infection 2023; 51:159-168. [PMID: 35776381 PMCID: PMC9879800 DOI: 10.1007/s15010-022-01866-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Echinococcus multilocularis infects humans as a false intermediate host, primarily with intrahepatic manifestation. Incorrect diagnostic interpretation of these liver tumors, especially the hemangioma-like pattern, can lead to progressive disease. The aim of the study was to investigate the differentiation of typical hemangioma and a hemangioma-like pattern of E. multilocularis using contrast-enhanced ultrasound (CEUS). METHODS This prospective clinical pilot study comprised patients with hemangioma (n = 14) and patients with alveolar echinococcosis (AE) and hemangioma-like pattern (n = 7). Inclusion criteria were the detection of a liver lesion according to a hemangioma-like pattern on E. multilocularis Ulm classification-ultrasound (EMUC-US) and "confirmed" or "probable" AE according to WHO case definition. The comparison group had hepatic hemangioma with typical B-scan sonographic morphology. All participants underwent conventional and contrast-enhanced ultrasonography. RESULTS The patient group comprised five men (71.4%) and two women (28.6%) with a mean average age of 64.1 ± 11.2 years. The patient group with hemangioma comprised nine female subjects (64.3%) and five male subjects (35.7%) with a mean average age of 56.1 ± 12.0 years. Early arterial bulbous ring enhancement (p < 0.0001) and iris diaphragm phenomenon could only be visualized in the patients with hemangioma (p < 0.0001). Furthermore, the patients with hemangioma exhibited hyperenhancement in the late phase (p = 0.0003). In contrast, the patients exhibited typical early arterial rim enhancement (p < 0.0001) and, in the portal venous and late phase, complete or incomplete non-enhancement (black hole sign; p = 0.0004). CONSLUSION The behavior of hemangioma-like AE lesions and typical liver hemangiomas is significantly different on CEUS. AE should be considered as a possible differential diagnosis, especially in high-endemic areas.
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Wang LY, Qin M, Gavotte L, Wu WP, Cheng X, Lei JX, Yan J, Frutos R. Societal drivers of human echinococcosis in China. Parasit Vectors 2022; 15:385. [PMID: 36271415 PMCID: PMC9587573 DOI: 10.1186/s13071-022-05480-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echinococcosis is a parasitic zoonotic disease that threatens human health and economic development. In China, 370 counties are endemic for echinococcosis. Qinghai-Tibet Plateau has the most patients and people at risk. Therefore, analyzing the societal factors related to susceptibility to the disease is critical for efficient prevention and control of echinococcosis. METHODS The demographic characteristics and lifestyle of echinococcosis cases were clustered using K-means cluster analysis to determine the main factors of risk of echinococcosis. RESULTS Middle-aged and young people as well as those with a low education level and herdsmen are at risk of contracting echinococcosis. Nomadism, domestic and feral dogs in the surrounding environment, and drinking heavily polluted natural surface water are the main behavioral risk factors. The cystic echinococcosis (CE) and alveolar echinococcosis (AE) cluster analysis focused on female, middle-aged, and young people, winter settlement and summer nomadism, and domestic and feral dogs in the surrounding environment. There were significant differences in lifestyle between Qinghai-Tibet Plateau cases and non-Qinghai-Tibet-Plateau cases. CONCLUSION According to the distribution of cases and CE and AE, this study identified the factors of risk of echinococcosis in the Qinghai-Tibet Plateau and non-Qinghai-Tibet Plateau. Adapted control techniques appropriate for the various epidemic areas should be established to serve as a reference for echinococcosis prevention.
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Affiliation(s)
- Li-Ying Wang
- Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic DiseasesWHO Collaborating Centre for Tropical DiseasesNational Centre for International Research On Tropical Diseases, Shanghai, People's Republic of China.,NHC Key Laboratory of Echinococcosis Prevention and Control, Tibet Center for Disease Control and Prevention, Lhasa, China.,Espace-Dev, UMR 228, Université de Montpellier, Montpellier, France.,Cirad, UMR 17, Intertryp, Campus international de Baillarguet, Montpellier, France
| | - Min Qin
- Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic DiseasesWHO Collaborating Centre for Tropical DiseasesNational Centre for International Research On Tropical Diseases, Shanghai, People's Republic of China
| | - Laurent Gavotte
- Espace-Dev, UMR 228, Université de Montpellier, Montpellier, France
| | - Wei-Ping Wu
- Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic DiseasesWHO Collaborating Centre for Tropical DiseasesNational Centre for International Research On Tropical Diseases, Shanghai, People's Republic of China
| | - Xixi Cheng
- Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic DiseasesWHO Collaborating Centre for Tropical DiseasesNational Centre for International Research On Tropical Diseases, Shanghai, People's Republic of China
| | - Jia-Xi Lei
- Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic DiseasesWHO Collaborating Centre for Tropical DiseasesNational Centre for International Research On Tropical Diseases, Shanghai, People's Republic of China
| | - Jun Yan
- Chinese Centre for Disease Control and Prevention, Beijing, China.
| | - Roger Frutos
- Cirad, UMR 17, Intertryp, Campus international de Baillarguet, Montpellier, France.
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Schmidberger J, Uhlenbruck J, Schlingeloff P, Maksimov P, Conraths FJ, Mayer B, Kratzer W. Dog Ownership and Risk for Alveolar Echinococcosis, Germany. Emerg Infect Dis 2022; 28:1597-1605. [PMID: 35850154 PMCID: PMC9328925 DOI: 10.3201/eid2808.212514] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human alveolar echinococcosis is caused by the parasite Echinococcus multilocularis, and dog ownership has been identified as a risk factor. We sought to specify the factors of dog ownership underlying this risk by conducting a case–control study among dog owners in Germany. The analysis revealed an increased odds ratio of ≈7-fold for dog owners whose dogs roam unattended in fields, 13-fold for dog owners who feed their dogs organic waste daily, 4-fold for dog owners who take their dog to a veterinarian only in case of illness, and 10-fold for dog owners who have never been informed by a veterinarian about the risk for infection. The results highlight the risk for infection associated with various factors of dog ownership and the value of veterinarians informing owners about prevention.
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Manukyan A, Avetisyan L, Sahakyan G, Jimenez AP, Paronyan L, Gevorgyan K, Vanyan A. A review of human alveolar echinococcosis in the Republic of Armenia from 2008 to 2020. Parasite Epidemiol Control 2022; 17:e00246. [PMID: 35284664 PMCID: PMC8904619 DOI: 10.1016/j.parepi.2022.e00246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Since the 90s' Echinococcus multilocularis infection has expanded the geographical area and central-eastern European countries had seen first alveolar echinococcosis (AE) human cases. AE is considered to be a very rare disease in Europe with average incidences of 0.03–0.2/100,000 inhabitants/year. Because of a suitable orography, this study aims to confirm whether there are human AE cases in Armenia, identify areas at risk, and also estimate AE annual incidence. Methods Retrospective AE case finding was carried out at main multi-profile medical centers equipped with the modern diagnostic means. The medical records of all patients with liver surgery admitted between January 2008 and June 2020 were reviewed. A specific form was developed in EpiInfo v.7.2. Annual national incidence was estimated using population denominators provided by the National Institute of Statistics. Results Overall, 11 AE cases have been identified. All patients were diagnosed at advanced stages, with subsequent poor prognosis and costly treatment. Confirmation was based on tissue biopsy and medical imaging results. Age ranged from 12 to 58 years with a median of 33 yrs. Patients were from rural communities, mostly in the Gegharkunik region (6 cases, 55%). Annual average incidence of AE was 0.033/100,000 varying between 0.032 in 2008 and 0.1 in 2017. Conclusions There are human AE cases happening in Armenia since more a decade ago. In the absence of an AE surveillance system, the burden of AE disease is difficult to estimate. Development of national AE guidelines with a case definition should help enforcing registry of all cases, early diagnosis and also clinical and public awareness. A total of 11 confirmed alveolar echinococcosis (AE) cases were identified. First confirmation of human sporadic AE cases in several regions of Armenia. AE is an emerging, and so far silent, threat in Armenia
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Tamarozzi F, Manciulli T, Brunetti E, Vuitton DA. Echinococcosis. HELMINTH INFECTIONS AND THEIR IMPACT ON GLOBAL PUBLIC HEALTH 2022:257-312. [DOI: 10.1007/978-3-031-00303-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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16
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Da Silva AM, Bastien M, Umhang G, Boué F, Bastid V, Boucher JM, Caillot C, de Garam CP, Renault C, Faisse M, Courquet S, Scalabrino V, Millon L, Knapp J, Poulle ML. Soil contamination by Echinococcus multilocularis in rural and urban vegetable gardens in relation to fox, cat and dog faecal deposits. Parasite 2021; 28:74. [PMID: 34723788 PMCID: PMC8559720 DOI: 10.1051/parasite/2021073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/17/2021] [Indexed: 11/23/2022] Open
Abstract
Echinococcus multilocularis eggs are deposited on the ground with the faeces of the carnivore definitive hosts. A reliable assessment of the spatial distribution of E. multilocularis eggs in environments used by humans is crucial for the prevention of alveolar echinococcosis (AE). This study was conducted in 192 rural and 71 urban vegetable gardens in AE endemic areas of north-eastern France. Its objective was to explore the relationship between the spatial distribution of E. multilocularis estimated from the collection and molecular analysis of two types of samples: faeces and soil. A total of 1024 carnivore faeces and 463 soil samples were collected and analysed by real-time PCR. No fox droppings and no positive soil samples were collected from the urban gardens. Positive soil samples, positive carnivore faeces, or both, were found in 42%, 24% and 6% of the sampled rural gardens, respectively. No significant association was found between the detection of E. multilocularis in soil samples collected from 50 gardens during a single sampling session and the extent and frequency of deposits of fox and cat faeces collected during repeated sampling sessions conducted in the previous months. In 19/50 gardens, E. multilocularis was detected in the soil while no positive faeces had been collected in the previous 12 months. Conversely, in 8/50 gardens, no soil samples were positive although positive faeces had been collected in the previous months. Collecting and analysing faeces provide information on soil contamination at a given time, while analysing soil samples provides an overview of long-term contamination.
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Affiliation(s)
- Abdou Malik Da Silva
- Chrono-Environnement, UMR UBFC/CNRS 6249 Aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France - Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Matthieu Bastien
- Entente for the Control of Zoonoses, Malzéville, 54220 Nancy, France - Epidémio-Surveillance et Circulation des Parasites dans les Environnements (ESCAPE), EA 7510, CAP SANTE, Université de Reims Champagne Ardenne, 51095 Reims Cedex, France
| | - Gérald Umhang
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Franck Boué
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Vanessa Bastid
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Jean-Marc Boucher
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Christophe Caillot
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Carine Peytavin de Garam
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Camille Renault
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Marine Faisse
- Entente for the Control of Zoonoses, Malzéville, 54220 Nancy, France - ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Sandra Courquet
- Chrono-Environnement, UMR UBFC/CNRS 6249 Aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France - Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Vincent Scalabrino
- Chrono-Environnement, UMR UBFC/CNRS 6249 Aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France
| | - Laurence Millon
- Chrono-Environnement, UMR UBFC/CNRS 6249 Aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France - Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Jenny Knapp
- Chrono-Environnement, UMR UBFC/CNRS 6249 Aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France - Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Marie-Lazarine Poulle
- Epidémio-Surveillance et Circulation des Parasites dans les Environnements (ESCAPE), EA 7510, CAP SANTE, Université de Reims Champagne Ardenne, 51095 Reims Cedex, France - CERFE, Université de Reims Champagne-Ardenne, 08240 Boult-aux-Bois, France
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Niamsi-Emalio Y, Nana-Djeunga HC, Chesnais CB, Pion SDS, Tchatchueng-Mbougua JB, Boussinesq M, Basáñez MG, Kamgno J. Unusual Localization of Blood-Borne Loa loa Microfilariae in the Skin Depends on Microfilarial Density in the Blood: Implications for Onchocerciasis Diagnosis in Coendemic Areas. Clin Infect Dis 2021; 72:S158-S164. [PMID: 33909066 PMCID: PMC8201578 DOI: 10.1093/cid/ciab255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The diagnostic gold standard for onchocerciasis relies on identification and enumeration of (skin-dwelling) Onchocerca volvulus microfilariae (mf) using the skin snip technique (SST). In a recent study, blood-borne Loa loa mf were found by SST in individuals heavily infected with L. loa, and microscopically misidentified as O. volvulus due to their superficially similar morphology. This study investigates the relationship between L. loa microfilarial density (Loa MFD) and the probability of testing SST positive. Methods A total of 1053 participants from the (onchocerciasis and loiasis coendemic) East Region in Cameroon were tested for (1) Loa MFD in blood samples, (2) O. volvulus presence by SST, and (3) Immunoglobulin (Ig) G4 antibody positivity to Ov16 by rapid diagnostic test (RDT). A Classification and Regression Tree (CART) model was used to perform a supervised classification of SST status and identify a Loa MFD threshold above which it is highly likely to find L. loa mf in skin snips. Results Of 1011 Ov16-negative individuals, 28 (2.8%) tested SST positive and 150 (14.8%) were L. loa positive. The range of Loa MFD was 0–85 200 mf/mL. The CART model subdivided the sample into 2 Loa MFD classes with a discrimination threshold of 4080 (95% CI, 2180–12 240) mf/mL. The probability of being SST positive exceeded 27% when Loa MFD was >4080 mf/mL. Conclusions The probability of finding L. loa mf by SST increases significantly with Loa MFD. Skin-snip polymerase chain reaction would be useful when monitoring onchocerciasis prevalence by SST in onchocerciasis–loiasis coendemic areas.
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Affiliation(s)
- Yannick Niamsi-Emalio
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Cédric B Chesnais
- Institut de Recherche pour le Développement (IRD), UMI233/INSERM U1175, Université de Montpellier , Montpellier, France
| | - Sébastien D S Pion
- Institut de Recherche pour le Développement (IRD), UMI233/INSERM U1175, Université de Montpellier , Montpellier, France
| | - Jules B Tchatchueng-Mbougua
- Service d'Epidémiologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI233/INSERM U1175, Université de Montpellier , Montpellier, France
| | - María-Gloria Basáñez
- MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Dep artment of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Peters L, Burkert S, Grüner B. Parasites of the liver - epidemiology, diagnosis and clinical management in the European context. J Hepatol 2021; 75:202-218. [PMID: 33636243 DOI: 10.1016/j.jhep.2021.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, their incidence is increasing, especially in Europe. The correct diagnosis of a hepatic parasite is often delayed because clinicians are unfamiliar with respective entities. Therefore, in this review, we aim to provide clinicians with a comprehensive clinical picture of hepatic parasites and to bring these neglected parasitic liver diseases to the wider attention of hepatology stakeholders in Europe and around the world.
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Affiliation(s)
- Lynn Peters
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Sanne Burkert
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Beate Grüner
- University Hospital of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Waindok P, Raue K, Grilo ML, Siebert U, Strube C. Predators in northern Germany are reservoirs for parasites of One Health concern. Parasitol Res 2021; 120:4229-4239. [PMID: 33547507 PMCID: PMC8599236 DOI: 10.1007/s00436-021-07073-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/27/2021] [Indexed: 12/20/2022]
Abstract
Urbanisation and invasion of wildlife into urban areas as well as human leisure activities create diverse wildlife-domestic animal-human interfaces, increasing the risk of (zoonotic) parasite spillover from sylvatic to domestic and synanthropic cycles. This study investigated the endo- and ectoparasite fauna, emphasising on parasites of One Health Concern, of the most common predators in northern Germany between November 2013 and January 2016. Eighty red foxes (Vulpes vulpes), 18 stone martens (Martes foina) and nine raccoon dogs (Nyctereutes procyonoides) were available for the study. Overall, 79 (73.8%) of the examined predators (n=107) harboured at least one endoparasite. The most frequently detected endoparasites in red foxes were Toxocara canis (43.8% positive individuals), Capillaria spp. (36.3%), Alaria alata (25.0%), Echinococcus multilocularis (26.3%) and Uncinaria stenocephala (25.0%). Furthermore, Toxascaris leonina, Trichuris vulpis, Taenia ssp., Mesocestoides spp. and coccidian oocysts were observed. The endoparasite species richness in raccoon dogs was comparable to red foxes, while in stone martens, only Capillaria spp. were found. Muscle digestion for detection of Trichinella spp. and antigen testing for Giardia spp. did not show positive results. Ectoparasite analyses revealed infestations with ticks species of the genus Ixodes as well as Dermacentor reticulatus. Scabies mites were not present in digested skin samples, while Demodex spp. mites were observed by faecal flotation in one red fox. Furthermore, fleas (Archaeopsylla erinacei and Chaetopsylla globiceps) were observed in the fur of red foxes, while lice were not present in any predator species. However, infestation frequency with ectoparasites was with 19.2% generally low in available predator skins (n=99). Overall, the present study showed that predators in northern Germany serve as reservoirs for parasites of One Health concern, with four of the five most frequent endoparasites being zoonotic, highlighting the need of parasite surveillance in wildlife predators in order to implement measures avoiding spillovers to domestic animals and humans.
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Affiliation(s)
- Patrick Waindok
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hanover, Germany
| | - Katharina Raue
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hanover, Germany
| | - Miguel L Grilo
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Hanover, Germany.,CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
| | - Ursula Siebert
- Institute for Terrestrial and Aquatic Wildlife Research, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Christina Strube
- Institute for Parasitology, Centre for Infection Medicine, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hanover, Germany.
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20
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Kotwa JD, Greer T, Jardine CM, Weese JS, Isaksson M, Pearl DL, Berke O, Mercer N, Peregrine AS. Evaluation of the prevalence of Echinococcus multilocularis in dogs that visit off-leash dog parks in southern Ontario, Canada. Zoonoses Public Health 2020; 68:533-537. [PMID: 33336543 DOI: 10.1111/zph.12792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
Prior to 2012, Echinococcus multilocularis was not known to occur in any host in Ontario, Canada. However, since that year, five cases of alveolar echinococcosis have been diagnosed in dogs that resided at the western end of Lake Ontario. In addition, E. multilocularis has been shown to be a common infection in wild canids (i.e. coyotes and foxes) across southern Ontario with a high-risk infection cluster in the area surrounding the western shores of Lake Ontario and northern shores of Lake Erie. In regions endemic for E. multilocularis, dog ownership is considered a risk factor for human alveolar echinococcosis. A study was therefore carried out to determine the prevalence of E. multilocularis intestinal infections in dogs within the high-risk infection cluster. From May to November 2018, faecal samples were collected from 477 dogs aged ≥6 months that visited 12 off-leash dog parks in the Halton, Hamilton and Niagara public health units. Faecal samples were analysed via a magnetic capture probe DNA extraction and real-time PCR method for E. multilocularis DNA. Overall, 0% (97.5% CI: 0%-0.80%) of samples tested positive. This result informs preventive recommendations for E. multilocularis infections in dogs in this region.
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Affiliation(s)
- Jonathon D Kotwa
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Tyler Greer
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Claire M Jardine
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.,Canadian Wildlife Health Cooperative, Guelph, ON, Canada
| | - J Scott Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | | | - David L Pearl
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Olaf Berke
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Nicola Mercer
- Wellington-Dufferin-Guelph Public Health, Guelph, ON, Canada
| | - Andrew S Peregrine
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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21
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Fischer I, Graeter T, Kratzer W, Stark K, Schlingeloff P, Schmidberger J. Distribution of alveolar echinococcosis according to environmental and geographical factors in Germany, 1992-2018. Acta Trop 2020; 212:105654. [PMID: 32783956 DOI: 10.1016/j.actatropica.2020.105654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
Abstract
Alveolar echinococcosis (AE) is a rare zoonotic disease caused by the larval stage of Echinococcus multilocularis. Despite its low world-wide prevalence, this disease shows differences in the regional distribution of cases. In the present cohort study, we analyse the distribution of AE according to environmental and geographical factors in Germany. We identified the place of residence of 591 cases of AE from the national database for AE, and georeferenced these localities in the Universal Transverse Mercator coordinate system. Data on elevation, air temperature, precipitation height and land cover were mapped out and correlated with the distribution of cases of disease during the period 1992-2018. Moran's I statistic was used for spatial autocorrelation. Differences in frequency distribution between elevation, air temperature, precipitation height and landscape feature classes were analysed with the Kruskal-Wallis test. With the multiple linear regression analysis, we determined the influences and interactions of geographical and climatic factors on the number of AE cases. The results showed a heterogeneous distribution of AE cases with a higher concentration in southern Germany than in the rest of Germany (I = 0.225517, Z = 35.8182 and p < 0.001). There was a statistically significant difference in frequency distribution between precipitation height, air temperature, elevation and landscape feature classes and AE cases in Germany (p < 0.0001). In regions with higher elevations (505-672 m), moderate average air temperatures (6.0-7.9°C) and higher precipitation rates (701-1000 mm) most AE cases were recorded. It seems, that regions with higher precipitation rates, higher elevations and moderate average air temperatures have a higher infection burden and infection conditions. It is therefore extremely important to generate greater awareness of the disease in these regions, with the aim of recognising potential cases of AE as early as possible and introducing the appropriate therapeutic measures.
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Affiliation(s)
- Iris Fischer
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany
| | - Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, 89081 Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, 13353 Berlin, Germany
| | | | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, 89081 Ulm, Germany.
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Assessment of the exposure to Echinococcus multilocularis associated with carnivore faeces using real-time quantitative PCR and flotation technique assays. Int J Parasitol 2020; 50:1195-1204. [PMID: 32896570 DOI: 10.1016/j.ijpara.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 01/07/2023]
Abstract
The eggs of Echinococcus multilocularis, the infectious stage, are spread into the environment through wild and domestic carnivore faeces. The spatial location of the faeces containing infective E. multilocularis eggs is a key parameter for studying areas of exposure and understanding the transmission processes to the intermediate hosts and humans. Echinococcus multilocularis faecal prevalence is often assessed by detecting E. multilocularis DNA, not necessarily eggs. This work aimed to determine the percentage of faeces containing E. multilocularis eggs in a rural town and its surroundings and whether this level of precision is relevant in assessing exposure to E. multilocularis. For this purpose, we developed a combined molecular and microscopic approach to investigate the E. multilocularis exposure of potential hosts in the environment from field-collected carnivore faeces. Carnivore defecation patterns were then spatialized to study the spatial distribution of E. multilocularis. Faeces were screened for E. multilocularis DNA using a specific real-time quantitative PCR (qPCR). Echinococcus multilocularis eggs were morphologically identified from E. multilocularis-specific qPCR-positive faeces after sucrose flotation and individually confirmed through specific PCR and sequencing. The spatial distribution of E. multilocularis was studied using Kulldorff statistics. Echinococcus multilocularis eggs were identified mostly in fox faeces positive for E. multilocularis DNA by qPCR (n = 27/70) and only from 1 of 15 copro-samples from dogs and 1 of 5 from cats. The faecal prevalence of E. multilocularis DNA and eggs was overdispersed, with the same geographical patterns. These data suggest that E. multilocularis DNA and/or egg detection in carnivore faeces, mainly that of foxes, is appropriate in ecological studies of E. multilocularis transmission.
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23
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Graeter T, Bao HH, Shi R, Liu WY, Li WX, Jiang Y, Schmidberger J, Brumpt E, Delabrousse E, Kratzer W, the XUUB Consortium. Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis. World J Gastroenterol 2020; 26:4302-4315. [PMID: 32848335 PMCID: PMC7422544 DOI: 10.3748/wjg.v26.i29.4302] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The main endemic areas of alveolar echinococcosis (AE) are in Central Europe and Western China. Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE. AIM To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim. METHODS Consecutively, five experienced examiners evaluated contrast-enhanced abdominal computed tomography (CT) scans for 200 patients with hepatic AE of each of four locations (n = 50) in Germany, France and China. Therefore, we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center, performed because of hepatic AE from September 21, 2007 to March 21, 2018. AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT (EMUC-CT). Distant extrahepatic manifestations were documented either by whole body positron emission tomography-CT or with the addition of thoracic CT and cranial magnetic resonance imaging. Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion. Statistical analysis was performed using SAS Version 9.4 (SAS Institute Inc., Cary, NC, United States). RESULTS Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (P = 0.0091). A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size (P = 0.0075). Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe (P < 0.0001), and vascular/biliary involvement depended on lesion size. Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations: Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88% of type IV liver lesions to 100% among type III lesions. Type IV differed significantly in these associations from types I, II, and III (P < 0.0001). With respect to extrahepatic disease, the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease. In contrast, distant extrahepatic manifestations in types I-III were found to varying degrees, with a maximum of 22% for type III. CONCLUSION Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations. There are intercontinental differences regarding the characteristics of AE manifestation.
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Affiliation(s)
- Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm 89081, Germany
| | - Hai-Hua Bao
- Qinghai University, Qinghai University First Affiliated Hospital, Xining 810001, Qinghai Province, China
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm 89081, Germany
| | - Wen-Ya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi 830054, Xinjiang Uyghur Autonomous Region, China
| | - Wei-Xia Li
- Qinghai University, Qinghai University First Affiliated Hospital, Xining 810001, Qinghai Province, China
| | - Yi Jiang
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi 830054, Xinjiang Uyghur Autonomous Region, China
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
| | - Eleonore Brumpt
- WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and Besançon University Hospital, Besançon 25030, France
| | - Eric Delabrousse
- WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and Besançon University Hospital, Besançon 25030, France
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany
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Torgerson PR, Robertson LJ, Enemark HL, Foehr J, van der Giessen JWB, Kapel CMO, Klun I, Trevisan C. Source attribution of human echinococcosis: A systematic review and meta-analysis. PLoS Negl Trop Dis 2020; 14:e0008382. [PMID: 32569309 PMCID: PMC7332091 DOI: 10.1371/journal.pntd.0008382] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/02/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A substantial proportion of echinococcosis transmission to humans via contamination of food has been assumed. However, the relative importance of food as a transmission vehicle has previously been estimated through expert opinion rather than empirical data. OBJECTIVE To find and evaluate empirical data that could be used to estimate the source attribution of echinococcosis, in particular the proportion that is transmitted through contaminated food. METHODS A systematic review was undertaken to identify reports on the risk factors for human cystic (CE) and alveolar (AE) echinococcosis. Data bases searched included PubMed, Scopus, Web of Knowledge, Cab Direct, Science Direct, Google Scholar, eLIBRARY.RU, CyberLeninka, CNKI and VIP. Search terms included Echinococc*, hydatid, epidemiology, logistic regression, risk factors, odds ratio, relative risk, risk factors. Reports, including grey literature where available, that had suitable data were selected and data were extracted. The main pathways of transmission were hypothesised to be contact with the definitive host, contaminated water, contaminated food and contaminated environment (other than food). For each study the attributable fraction for these potential sources of infection was calculated from the data presented. A meta-analysis was then undertaken to obtain pooled estimates for the relative contribution of these transmission pathways. RESULTS Data from 28 cross-sectional studies and 14 case-control studies were extracted. There was strong evidence for transmission by direct contact with dogs for both CE and AE. The estimated attributable fractions were 26.1% (CI 13.8%-39.6%) and 34.4% (CI 20.7% -48.2%) respectively. Transmission through contaminated water was estimated to be responsible for approximately 29.4% (CI 12.1%-51.7%) for CE and 24.8% (CI 10.6% to 42.6%) for AE. Contaminated food may be responsible for approximately 23.4% of CE cases (CI 2.1%-47.3%). Globally, there was insufficient evidence to conclude AE can be transmitted by food, although case control studies from low human incidence areas suggested that possibly 32.5% (CI 10.0%-53.2%) could be transmitted by food. There was also insufficient evidence that direct contact with foxes was a significant source of human disease. There were no suitable studies with a risk of environmental contact reported, but the residual attributable fraction thatwould likely include this pathway was approximately 21.1% for CE and 11.1% for AE. CONCLUSIONS The results support the hypothesis that dog contact and drinking contaminated water are major pathways of transmission of both CE and AE. For contaminated food, the results are less consistent, but suggest that it is an important transmission pathway and provide better evidence than expert elicitations as previously used.
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Affiliation(s)
- Paul R. Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Switzerland
| | - Lucy J. Robertson
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Adamstuen Campus, Norway
| | - Heidi L. Enemark
- Department of Animal Health and Food Safety, Norwegian Veterinary Institute, Oslo, Norway
| | - Junwei Foehr
- Vetsuisse Faculty, University of Zürich, Switzerland
| | - Joke W. B. van der Giessen
- Center for Zoonoses and Environmental Microbiology, National Institute of Public Health and the Environment, Netherlands
| | - Christian M. O. Kapel
- Department of Plant and Environmental Sciences, Faculty of Science, Section for Organismal Biology, Denmark
| | - Ivana Klun
- Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Chiara Trevisan
- Department of Biomedical Science, Institute of Tropical Medicine, Belgium
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Knapp J, Gottstein B, Bretagne S, Bart JM, Umhang G, Richou C, Bresson-Hadni S, Millon L. Genotyping Echinococcus multilocularis in Human Alveolar Echinococcosis Patients: An EmsB Microsatellite Analysis. Pathogens 2020; 9:pathogens9040282. [PMID: 32295095 PMCID: PMC7238142 DOI: 10.3390/pathogens9040282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
For clinical epidemiology specialists, connecting the genetic diversity of Echinococcusmultilocularis to sources of infection or particular sites has become somewhat of a holy grail. It is very difficult to trace the infection history of alveolar echinococcosis (AE) patients as there may be an incubation period of five to 15 years before reliable diagnosis. Moreover, the variability of parasitic manifestations in human patients raises the possibility of genetically different isolates of E. multilocularis having different levels of pathogenicity. Thus, the exposure of human patients to different strains or genotypes circulating in geographically different environments may lead to different disease outcomes. Molecular tools, such as the microsatellite marker EmsB, were required to investigate these aspects. This genetic marker was previously tested on a collection of 1211 European field samples predominantly of animal origin, referenced on a publicly available database. In this study, we investigated a panel of 66 metacestode samples (between 1981 and 2019) recovered surgically from 63 patients diagnosed with alveolar echinococcosis originating from four European countries (France, Switzerland, Germany, Belgium). In this study, we identified nine EmsB profiles, five of which were found in patients located in the same areas of France and Switzerland. One profile was detected on both sides of the French-Swiss border, whereas most patients from non-endemic regions clustered together in another profile. EmsB profiles appeared to remain stable over time because similar profiles were detected in patients who underwent surgery recently and patients who underwent surgery some time ago. This study sheds light on possible pathways of contamination in humans, including proximity contamination in some cases, and the dominant contamination profiles in Europe, particularly for extrahepatic lesions.
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Affiliation(s)
- Jenny Knapp
- UMR CNRS 6249 Laboratoire Chrono-environnement, Université Franche-Comté, 16 Route de Gray, 25030 Besançon, France; (S.B.-H.); (L.M.)
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
- Correspondence: ; Tel.: +33-370-632-106
| | - Bruno Gottstein
- Institute for Infectious Diseases, Faculty of Medicine, University of Berne, 3001 Berne, Switzerland;
| | - Stéphane Bretagne
- Parasitology-Mycology Laboratory, Lariboisière-Saint Louis-Fernand Widal Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 75475 Paris, France;
| | - Jean-Mathieu Bart
- UMR INTERTRYP, IRD/CIRAD, University of Montpellier, 34398 Montpellier, France;
| | - Gérald Umhang
- ANSES, Nancy Laboratory for Rabies and Wildlife, Wildlife Surveillance and Eco-Epidemiology Unit, Technopôle Agricole et Vétérinaire, B.P. 40009, 54220 Malzéville, France;
| | - Carine Richou
- Department of Hepatology, University Hospital of Besançon, 25000 Besançon, France;
| | - Solange Bresson-Hadni
- UMR CNRS 6249 Laboratoire Chrono-environnement, Université Franche-Comté, 16 Route de Gray, 25030 Besançon, France; (S.B.-H.); (L.M.)
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
| | - Laurence Millon
- UMR CNRS 6249 Laboratoire Chrono-environnement, Université Franche-Comté, 16 Route de Gray, 25030 Besançon, France; (S.B.-H.); (L.M.)
- Department of Parasitology-Mycology, National Reference Centre for Echinococcoses, University Hospital of Besançon, 25030 Besançon, France
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Baumann S, Shi R, Liu W, Bao H, Schmidberger J, Kratzer W, Li W. Worldwide literature on epidemiology of human alveolar echinococcosis: a systematic review of research published in the twenty-first century. Infection 2019; 47:703-727. [PMID: 31147846 PMCID: PMC8505309 DOI: 10.1007/s15010-019-01325-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Human alveolar echinococcosis (AE) is a potentially lethal zoonosis caused by the cestode Echinococcus multilocularis. The aim of this systematic review is to establish a comprehensive global AE literature overview taking into account the epidemiologically relevant AE research of the twenty-first century. METHODS We systematically searched the global literature published from 2001 through 2018 via MEDLINE, EMBASE, the Russian databases eLIBRARY.RU, CyberLeninka, the Chinese databases CNKI, VIP, Journals. RESEARCH ac.ir (Farsi language-based), Jordan E-Library (Arab language-based) and supplementary Google Scholar, in accordance with the PRISMA guidelines. QGIS software was used for the mapping of the affected countries. RESULTS We have listed 154 relevant publications in the final literature synopsis in consideration of our quality assessment. Including non-autochthonous cases, human AE was reported in 36 countries within the northern hemisphere from 2001 to 2018. The first publication of AE in Tajikistan, Pakistan, South Korea, Belgium, the Netherlands, Slovakia, Hungary, Lithuania, Latvia, Slovenia and Morocco occurred in this century; further first cases in Taiwan, Thailand, and Denmark were considered to be non-autochthonous by the authors. The highest total case numbers (n ≥ 100 in a single article) were reported in France, Germany, Switzerland, Poland, and Lithuania, including China and Kyrgyzstan with by far the highest prevalence figures. CONCLUSIONS Our paper emphasises the increasing spread of reported cases and the rise in its numbers in the literature of the twenty-first century, especially in western, northern and eastern Europe, as well as in central Asia. Epidemiological studies on human infections are lacking in many parts of the world.
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Affiliation(s)
- Sven Baumann
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wenya Liu
- Xinjiang Medical University, First Affiliated Hospital, WHO Collaborating Centre on Prevention and Care Management of Echinococcosis, Urumqi, 830000, Xinjiang Uyghur Autonomous Region, People's Republic of China
| | - Haihua Bao
- Qinghai University Affiliated Hospital, Qinghai University, Xining, 810001, Qinghai, People's Republic of China
| | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Weixia Li
- Qinghai University Affiliated Hospital, Qinghai University, Xining, 810001, Qinghai, People's Republic of China
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Kotwa JD, Isaksson M, Jardine CM, Campbell GD, Berke O, Pearl DL, Mercer NJ, Osterman-Lind E, Peregrine AS. Echinococcus multilocularis Infection, Southern Ontario, Canada. Emerg Infect Dis 2019; 25:265-272. [PMID: 30666935 PMCID: PMC6346450 DOI: 10.3201/eid2502.180299] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Alveolar echinococcosis, the disease caused by infection with the intermediate stage of the Echinococcus multilocularis tapeworm, is typically fatal in humans and dogs when left untreated. Since 2012, alveolar echinococcosis has been diagnosed in 5 dogs, 3 lemurs, and 1 chipmunk in southern Ontario, Canada, a region previously considered free of these tapeworms. Because of human and animal health concerns, we estimated prevalence of infection in wild canids across southern Ontario. During 2015–2017, we collected fecal samples from 460 wild canids (416 coyotes, 44 foxes) during postmortem examination and analyzed them by using a semiautomated magnetic capture probe DNA extraction and real-time PCR method for E. multilocularis DNA. Surprisingly, 23% (95% CI 20%–27%) of samples tested positive. By using a spatial scan test, we identified an infection cluster (relative risk 2.26; p = 0.002) in the western-central region of the province. The cluster encompasses areas of dense human population, suggesting zoonotic transmission.
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Schmidberger J, Weimer H, Schlingeloff P, Kratzer W, Grüner B. Health-related quality of life in patients with alveolar echinococcosis: a cross-sectional study. Infection 2019; 47:67-75. [PMID: 30225656 DOI: 10.1007/s15010-018-1219-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/11/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE The Alveolar echinococcosis (AE) is a rare zoonosis caused by the parasite Echinococcus multilocularis. To date, nothing is known about the health-related quality of life (HRQoL) in patients with AE. The aim of the study was to evaluate the HRQoL in patients with AE in comparison of the healthy population. METHODS We used the 36-Item Short Form Health Survey (SF-36) questionnaire to evaluate the HRQoL. The SF-36 scales have a range of 0-100 (0 represents the worst and 100 the most favourable state of health). SAS Version 9.2 was used for the statistical analysis of AE-cases (n = 30) and the healthy control group (n = 35). RESULTS The analysis showed that the HRQoL in people with AE is reduced in comparison with the control population. The study group consisted of 15 (50.0%) men and 15 (50.0%) women; the control group of 16 (45.7%) men and 19 (54.3%) women. The mean age was 55.73 ± 16.65 years, while that of the control group was 54.57 ± 15.34 years. The physical quality of life in patients with AE (45.21 ± 11.42) was not significantly less than that of the control group (50.54 ± 10.52); p = 0.0568. Nevertheless, AE-patients show lower SF-36 scores for the physical quality of life. For the mental quality of life, patients with AE had a significantly lower score (45.46 ± 10.57) than the control group (51.57 ± 9.04); p = 0.0154. CONCLUSIONS The HRQoL in people with AE is reduced in comparison with a control population. Assessment of the physical and mental quality of life in patients with AE may help to evaluate the patient outcome.
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Affiliation(s)
- Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Henriette Weimer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Patrycja Schlingeloff
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Beate Grüner
- Department of Internal Medicine III, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Malkamäki S, Näreaho A, Oksanen A, Sukura A. Berries as a potential transmission vehicle for taeniid eggs. Parasitol Int 2019; 70:58-63. [PMID: 30711641 DOI: 10.1016/j.parint.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
Potential role of wild forest berries as a transmission vehicle for taeniid eggs was examined using non-zoonotic Taenia laticollis eggs as a model. The berries studied were bilberries (Vaccinium myrtillus) (1 m2 plot, n = 10) and lingonberries (Vaccinium vitis-idaea) (1 m2 plot, n = 11). The plots in the managed forest were evenly sprayed with 30,000 or 60,000 T. laticollis eggs suspended in water, and berries were collected 24 h after spraying. The berries were rinsed with water, and the water was sieved through a 1-mm and a 63-μm sieve to remove coarse material and through a 20-μm sieve to collect possible eggs. A small proportion of the sieved material was examined by microscopy after treatment with fluorescent Calcofluor White stain, which binds to eggshell chitin. In the recovery tests in artificially spiked samples, the detection limit was 5 eggs in 100 g of commercial frozen bilberries and lingonberries. Taeniid eggs were detected in all of the 10 experimentally contaminated bilberry samples and in 10 of 11 lingonberry samples. The sieved debris was also analyzed for T. laticollis DNA using semi-quantitative PCR. All samples were positive in quantitative SYBR Green real-time PCR using a T. laticollis-specific primer pair amplifying a short fragment of mitochondrial NADH dehydrogenase subunit 1 gene. This indicates that forest berries contaminated in shrubs contained T. laticollis eggs, and that berries can serve as a vehicle for taeniid eggs and may pose a possible risk to humans.
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Affiliation(s)
- Sanna Malkamäki
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki (FINPAR), Finland.
| | - Anu Näreaho
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki (FINPAR), Finland
| | - Antti Oksanen
- Finnish Food Safety Authority Evira (FINPAR), Oulu, Finland
| | - Antti Sukura
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki (FINPAR), Finland
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Bastien M, Vaniscotte A, Combes B, Umhang G, Raton V, Germain E, Villena I, Aubert D, Boué F, Poulle ML. Identifying drivers of fox and cat faecal deposits in kitchen gardens in order to evaluate measures for reducing contamination of fresh fruit and vegetables. Food Waterborne Parasitol 2018; 14:e00034. [PMID: 32095604 PMCID: PMC7034018 DOI: 10.1016/j.fawpar.2018.e00034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022] Open
Abstract
Preventing foodborne pathogen contamination of raw fruit and vegetables in the field is critically important for public health. Specifically, it involves preventing faecal deposit by wildlife or domestic animals in fields of crops and kitchen gardens. The present study aims to identify the drivers of fox, dog and cat faecal deposits in kitchen gardens in order to mitigate the risk of contamination of raw produce with parasites shed in carnivore faeces. The focus was on Echinococcus multilocularis, ranked highest in the importance of foodborne parasites in Europe, but attention was also paid to other parasites of major concern - Toxoplasma gondii and Toxocara spp. During the winters of 2014 to 2016, faecal samples were collected from 192 kitchen gardens located in north-eastern France. From these samples, 77% contained scat of carnivores. Molecular analyses revealed that 59% of the 1016 faeces collected were from cats, 31% from foxes, and 10% from dogs. The ease of accessibility to kitchen gardens, the presence of food in the vicinity, and the composition of the surrounding vegetation were used to explain the distribution of fox and cat faeces. Generalized Linear Mixed Effects modelling showed that: i) fencing was not efficient in reducing cat faecal deposits, but drastically decreases those of foxes; ii) the abundance of Microtus sp. indicates a reason for the presence of both fox and cat faecal deposits, iii) the abundance of Arvicola terrestris, the proximity of fruit trees or farms and the predominance of forest and grassland around the village are all drivers of fox faecal deposits. These results point to the importance of fencing around kitchen gardens located in E. multilocularis endemic areas, particularly those surrounded by forest and grassland or close to fruit trees or farms. 192 kitchen gardens sampled 6 times over 2 winters, 1016 carnivore faeces collected. Fencing, food and vegetation cover tested as explanatory factors for faeces location. Numerous cat faeces, even in enclosed gardens. Microtus sp. drives their deposit. Garden accessibility, food and vegetation cover drive the faecal deposits of foxes. Fencing off kitchen gardens should be encouraged in E. multilocularis endemic areas.
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Affiliation(s)
- M. Bastien
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 7510 ESCAPE, 51092 Reims cedex, France
- University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France
- French Establishment for Fighting Zoonoses (ELIZ), Domaine de Pixérécourt, 54220 Malzéville, France
- Corresponding author at: University of Reims Champagne-Ardenne, SFR Cap Santé, EA 7510 ESCAPE, 51092 Reims cedex, France.
| | | | - B. Combes
- French Establishment for Fighting Zoonoses (ELIZ), Domaine de Pixérécourt, 54220 Malzéville, France
| | - G. Umhang
- ANSES, Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Eco-epidemiology and Surveillance Unit, 54220 Malzéville, France
| | - V. Raton
- French Establishment for Fighting Zoonoses (ELIZ), Domaine de Pixérécourt, 54220 Malzéville, France
| | - E. Germain
- CROC, Carnivore Research and Observation Center, 57590 Lucy, France
| | - I. Villena
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 7510 ESCAPE, 51092 Reims cedex, France
- University Hospital of Reims, Department of Parasitology-Mycology, National Reference Center for Toxoplasma, 51092 Reims cedex, France
| | - D. Aubert
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 7510 ESCAPE, 51092 Reims cedex, France
- University Hospital of Reims, Department of Parasitology-Mycology, National Reference Center for Toxoplasma, 51092 Reims cedex, France
| | - F. Boué
- ANSES, Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Eco-epidemiology and Surveillance Unit, 54220 Malzéville, France
| | - M.-L. Poulle
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 7510 ESCAPE, 51092 Reims cedex, France
- University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France
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Koutsoumanis K, Allende A, Alvarez-Ordóñez A, Bolton D, Bover-Cid S, Chemaly M, Davies R, De Cesare A, Herman L, Hilbert F, Lindqvist R, Nauta M, Peixe L, Ru G, Simmons M, Skandamis P, Suffredini E, Cacciò S, Chalmers R, Deplazes P, Devleesschauwer B, Innes E, Romig T, van der Giessen J, Hempen M, Van der Stede Y, Robertson L. Public health risks associated with food-borne parasites. EFSA J 2018; 16:e05495. [PMID: 32625781 PMCID: PMC7009631 DOI: 10.2903/j.efsa.2018.5495] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Parasites are important food‐borne pathogens. Their complex lifecycles, varied transmission routes, and prolonged periods between infection and symptoms mean that the public health burden and relative importance of different transmission routes are often difficult to assess. Furthermore, there are challenges in detection and diagnostics, and variations in reporting. A Europe‐focused ranking exercise, using multicriteria decision analysis, identified potentially food‐borne parasites of importance, and that are currently not routinely controlled in food. These are Cryptosporidium spp., Toxoplasma gondii and Echinococcus spp. Infection with these parasites in humans and animals, or their occurrence in food, is not notifiable in all Member States. This Opinion reviews current methods for detection, identification and tracing of these parasites in relevant foods, reviews literature on food‐borne pathways, examines information on their occurrence and persistence in foods, and investigates possible control measures along the food chain. The differences between these three parasites are substantial, but for all there is a paucity of well‐established, standardised, validated methods that can be applied across the range of relevant foods. Furthermore, the prolonged period between infection and clinical symptoms (from several days for Cryptosporidium to years for Echinococcus spp.) means that source attribution studies are very difficult. Nevertheless, our knowledge of the domestic animal lifecycle (involving dogs and livestock) for Echinoccocus granulosus means that this parasite is controllable. For Echinococcus multilocularis, for which the lifecycle involves wildlife (foxes and rodents), control would be expensive and complicated, but could be achieved in targeted areas with sufficient commitment and resources. Quantitative risk assessments have been described for Toxoplasma in meat. However, for T. gondii and Cryptosporidium as faecal contaminants, development of validated detection methods, including survival/infectivity assays and consensus molecular typing protocols, are required for the development of quantitative risk assessments and efficient control measures.
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Abstract
Many infectious diseases originating from, or carried by, wildlife affect wildlife conservation and biodiversity, livestock health, or human health. We provide an update on changes in the epidemiology of 25 selected infectious, wildlife-related diseases in Europe (from 2010-16) that had an impact, or may have a future impact, on the health of wildlife, livestock, and humans. These pathogens were selected based on their: 1) identification in recent Europe-wide projects as important surveillance targets, 2) inclusion in European Union legislation as pathogens requiring obligatory surveillance, 3) presence in recent literature on wildlife-related diseases in Europe since 2010, 4) inclusion in key pathogen lists released by the Office International des Epizooties, 5) identification in conference presentations and informal discussions on a group email list by a European network of wildlife disease scientists from the European Wildlife Disease Association, or 6) identification as pathogens with changes in their epidemiology during 2010-16. The wildlife pathogens or diseases included in this review are: avian influenza virus, seal influenza virus, lagoviruses, rabies virus, bat lyssaviruses, filoviruses, canine distemper virus, morbilliviruses in aquatic mammals, bluetongue virus, West Nile virus, hantaviruses, Schmallenberg virus, Crimean-Congo hemorrhagic fever virus, African swine fever virus, amphibian ranavirus, hepatitis E virus, bovine tuberculosis ( Mycobacterium bovis), tularemia ( Francisella tularensis), brucellosis ( Brucella spp.), salmonellosis ( Salmonella spp.), Coxiella burnetii, chytridiomycosis, Echinococcus multilocularis, Leishmania infantum, and chronic wasting disease. Further work is needed to identify all of the key drivers of disease change and emergence, as they appear to be influencing the incidence and spread of these pathogens in Europe. We present a summary of these recent changes during 2010-16 to discuss possible commonalities and drivers of disease change and to identify directions for future work on wildlife-related diseases in Europe. Many of the pathogens are entering Europe from other continents while others are expanding their ranges inside and beyond Europe. Surveillance for these wildlife-related diseases at a continental scale is therefore important for planet-wide assessment, awareness of, and preparedness for the risks they may pose to wildlife, domestic animal, and human health.
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Schmidberger J, Kratzer W, Stark K, Grüner B. Alveolar echinococcosis in Germany, 1992-2016. An update based on the newly established national AE database. Infection 2018; 46:197-206. [PMID: 29090421 DOI: 10.1007/s15010-017-1094-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Alveolar echinococcosis is a rare disease caused by the parasite Echinococcus multilocularis. The newly established national database should enable us to determine high-risk areas and evaluate the endemic levels. METHODS The national database was implemented using SQL Workbench. We used EpiInfo™ software to display the prevalence of disease. Moran's I geodata analysis according to cluster and high risk areas was performed with GeoDa™. SAS Version 9.2 was used for the statistical analysis of the cases (n = 523). RESULTS The analysis showed a concentration of cases in Baden-Württemberg and Bavaria. Moran's I showed a heterogeneous case distribution throughout Germany (I = 0.208815, Z = 32.6175, p < 0.001). In the period from 1992 to 2016, the prevalence was 0.64/100,000 inhabitants in the whole of Germany, 2.18/100,000 inhabitants in Baden-Württemberg and 1.48/100,000 inhabitants in Bavaria. The analysis also revealed a difference between men and women, with a prevalence of 0.58/100,000 and 0.69/100,000, respectively. The analysis of spatial autocorrelation and possible risk areas showed that the southeast regions of Baden-Württemberg (I = 0.188514, Z = 11.3197, p < 0.001) and the southwest part of Bavaria (I = 0.176953, Z = 13.5144, p < 0.001) constitute the high risk areas. CONCLUSIONS The prevalence of disease is noticeably high in the Swabian Jura, the Bavarian Alps and the Alpine foothills. Raising awareness and educating doctors in high risk areas may prevent new cases and assist in earlier diagnosis.
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Affiliation(s)
- Julian Schmidberger
- Central Ultrasound, Department of General Internal Medicine I, Medical Centre, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Wolfgang Kratzer
- Central Ultrasound, Department of General Internal Medicine I, Medical Centre, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Beate Grüner
- Comprehensive Infectious Diseases Centre, Department of General Internal Medicine III, Medical Centre, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Bastien M, Vaniscotte A, Combes B, Umhang G, Germain E, Gouley V, Pierlet A, Quintaine T, Forin-Wiart MA, Villena I, Aubert D, Boue F, Poulle ML. High density of fox and cat faeces in kitchen gardens and resulting rodent exposure to Echinococcus multilocularis and Toxoplasma gondii. Folia Parasitol (Praha) 2018. [DOI: 10.14411/fp.2018.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Baraquin A, Zait H, Grenouillet FE, Moreau E, Hamrioui B, Grenouillet F. Large-scale evaluation of a rapid diagnostic test for human cystic echinococcosis. Diagn Microbiol Infect Dis 2017; 89:20-25. [PMID: 28647066 DOI: 10.1016/j.diagmicrobio.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 12/27/2022]
Abstract
Cystic echinococcosis (CE) is a neglected zoonotic disease, diagnosed through clinical findings, imaging techniques, and serology, for which many serological tests are available. Here we report a rapid unit assay, the immunochromatographic VIRapid® HYDATIDOSIS test (Vircell, Granada, Spain), potentially suitable for laboratories in low-prevalence or poorly equipped areas. This test was evaluated with a large retrospective cohort (224 sera), including patients suffering from CE or from other parasitic or liver diseases. The test was also assessed in routine conditions with a prospective cohort (115 sera) in areas where both cystic and alveolar echinococcoses have been diagnosed. Its performance (in terms of sensitivity, specificity, and both positive and negative likelihood ratios) was similar to an ELISA based on a crude antigen. Our study shows that this test performs adequately in the diagnostic process, when used with caution, especially regarding cross-reactivity with other parasitic diseases.
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Affiliation(s)
- Alice Baraquin
- Chrono-environnement, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne/Franche-Comté, Besançon, France
| | - Houria Zait
- Parasitology & Mycology Department, Mustapha University Hospital, Algiers, Algeria
| | - Florence-Elisabeth Grenouillet
- Parasitology & Mycology Department, French National Reference Center for Alveolar Echinococcosis and WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France
| | - Elise Moreau
- Parasitology & Mycology Department, French National Reference Center for Alveolar Echinococcosis and WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France
| | - Boussad Hamrioui
- Parasitology & Mycology Department, Mustapha University Hospital, Algiers, Algeria
| | - Frédéric Grenouillet
- Chrono-environnement, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne/Franche-Comté, Besançon, France; Parasitology & Mycology Department, French National Reference Center for Alveolar Echinococcosis and WHO Collaborating Center for Prevention and Treatment of Human Echinococcosis, University Hospital, Besançon, France.
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Poulle ML, Bastien M, Richard Y, Josse-Dupuis É, Aubert D, Villena I, Knapp J. Detection of Echinococcus multilocularis and other foodborne parasites in fox, cat and dog faeces collected in kitchen gardens in a highly endemic area for alveolar echinococcosis. ACTA ACUST UNITED AC 2017; 24:29. [PMID: 28748783 PMCID: PMC5530766 DOI: 10.1051/parasite/2017031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
Echinococcus multilocularis, Toxoplasma gondii and Toxocara spp. are foodborne parasites whose eggs or oocysts are spread in the environment via canid or felid faeces. They can cause infections in humans following the raw consumption of contaminated fruit or vegetables. In this study, their occurrence was investigated by quantitative polymerase chain reaction (qPCR) in 254 carnivore faeces deposited in 94 kitchen gardens of northeastern France that were sampled between two and six times from October 2011 to April 2013. Less than 25% of the sampled kitchen gardens contained more than 75% of the collected faeces. Of the 219 faeces that could be attributed to an emitter, cat accounted for 58%, fox for 32% and dog for 10%. Echinococcus multilocularis was detected in 35%, 11% and 7% of fox, dog and cat faeces, respectively, and Toxocara spp. in 33%, 12% and 5.5% of cat, fox and dog faeces, respectively. Toxoplasma gondii was detected in 2/125 cat faeces and 2/21 dog faeces. The 34 faeces that tested positive for E. multilocularis were found in only 19 out of the 94 sampled kitchen gardens, and the 40 faeces that tested positive for Toxocara spp. were found in 28 of them. Consequently, some kitchen gardens appeared particularly at risk of human exposure to foodborne parasites, including E. multilocularis responsible for alveolar echinococcosis (AE), which is a serious zoonosis. In endemic areas, kitchen garden owners should be informed about the zoonotic risk linked to carnivore faeces deposits and encouraged to set up preventive measures.
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Affiliation(s)
- Marie-Lazarine Poulle
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 3800 PROTAL, 51092 Reims cedex, France - University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France
| | - Matthieu Bastien
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 3800 PROTAL, 51092 Reims cedex, France - University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France - French Institute for Fighting Zoonoses (ELIZ), Domaine de Pixéricourt, 54220 Malzéville, France
| | - Yolan Richard
- University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France
| | - Émilie Josse-Dupuis
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 3800 PROTAL, 51092 Reims cedex, France - University Hospital of Reims, Department of Parasitology-Mycology, 51092 Reims cedex, France
| | - Dominique Aubert
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 3800 PROTAL, 51092 Reims cedex, France - University Hospital of Reims, Department of Parasitology-Mycology, 51092 Reims cedex, France
| | - Isabelle Villena
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 3800 PROTAL, 51092 Reims cedex, France - University Hospital of Reims, Department of Parasitology-Mycology, 51092 Reims cedex, France
| | - Jenny Knapp
- University of Bourgogne Franche-Comté, Laboratory of Chrono-environment, UMR UFC/CNRS 6249 affi. INRA, 25030 Besançon, France - University Hospital of Besançon, Department of Parasitology-Mycology, 25030 Besançon, France
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Umhang G, Bastien M, Renault C, Faisse M, Caillot C, Boucher JM, Hormaz V, Poulle ML, Boué F. A flotation/sieving method to detect Echinococcus multilocularis and Toxocara spp. eggs in soil by real-time PCR. ACTA ACUST UNITED AC 2017; 24:28. [PMID: 28737135 PMCID: PMC5523443 DOI: 10.1051/parasite/2017029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022]
Abstract
Soil can be a source of human infection by many zoonotic helminth species including Echinococcus multilocularis and Toxocara spp. The prevention of alveolar echinococcosis could be greatly improved through the identification of at-risk areas. Yet very few data are available about the detection of E. multilocularis in soil, while more studies have been reported for Toxocara spp. Identification of soil contamination by E. multilocularis eggs requires the use of specific methods. This study describes the development of a method for the detection of E. multilocularis in soil samples with the concentration of eggs using a flotation/sieving method and detection by duplex real-time polymerase chain reaction (PCR). Toxocara spp. egg detection was also undertaken due to the widespread presence of this parasite in soil, despite it being considered less pathogenic. Method sensitivity of 100% was reached for the detection of 10 E. multilocularis eggs spiked in 10 g of soil. Concerning Toxocara spp., method sensitivity was lower but assumed to be due to the reduced effectiveness of the DNA extraction protocol. The parasitological status for E. multilocularis and Toxocara spp. of 63 carnivore fecal samples collected in highly endemic rural areas of France and of soil samples collected under and near these fecal samples was compared. The contamination of soil samples collected under positive fecal samples for E. multilocularis (n = 3) or Toxocara spp. (n = 19) confirmed the transfer of eggs from the definitive host to the environment.
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Affiliation(s)
- Gérald Umhang
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Matthieu Bastien
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 3800 PROTAL, 51092 Reims cedex, France - University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France - French Establishment for Fighting Zoonoses (ELIZ), Domaine de Pixerécourt, 54220 Malzéville, France
| | - Camille Renault
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Marine Faisse
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France - French Establishment for Fighting Zoonoses (ELIZ), Domaine de Pixerécourt, 54220 Malzéville, France
| | - Christophe Caillot
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Jean-Marc Boucher
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Vanessa Hormaz
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Marie-Lazarine Poulle
- University of Reims Champagne-Ardenne, SFR Cap Santé, EA 3800 PROTAL, 51092 Reims cedex, France - University of Reims Champagne-Ardenne, CERFE, 08240 Boult-aux-Bois, France
| | - Franck Boué
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
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Potential risk factors associated with human alveolar echinococcosis: Systematic review and meta-analysis. PLoS Negl Trop Dis 2017; 11:e0005801. [PMID: 28715408 PMCID: PMC5531747 DOI: 10.1371/journal.pntd.0005801] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/27/2017] [Accepted: 07/12/2017] [Indexed: 12/28/2022] Open
Abstract
Background Human alveolar echinococcosis (AE) is a severe zoonotic disease caused by the metacestode stage of Echinococcus multilocularis. AE is commonly associated with a long incubation period that may last for more than ten years. The objective of this systematic literature review was to identify and summarize the current knowledge on statistically relevant potential risk factors (PRFs) associated with AE in humans. Methodology/Principal findings Six bibliographic databases were searched, generating a total of 1,009 publications. Following the removal of duplicate records and the exclusion of papers that failed to meet the criteria of a previously agreed a priori protocol, 23 publications were retained; however, 6 of these did not contain data in a format that allowed their inclusion in the meta-analysis. The remaining 17 publications (6 case-control and 11 cross-sectional studies) were meta-analysed to investigate associations between AE and PRFs. Pooled odds ratios (OR) were used as a measure of effect and separately analysed for case-control and cross-sectional studies. In the case-control studies, the following PRFs for human AE showed higher odds of outcome: “dog ownership”, “cat ownership”, “have a kitchen garden”, “occupation: farmer”, “haymaking in meadows not adjacent to water”, “went to forests for vocational reasons”, “chewed grass” and “hunting / handling foxes”. In the cross-sectional studies, the following PRFs showed higher odds of outcome: “dog ownership”, “play with dogs”, “gender: female”, “age over 20 years”, “ethnic group: Tibetan”, “low income”, “source of drinking water other than well or tap”, “occupation: herding” and “low education”. Our meta-analysis confirmed that the chance of AE transmission through ingestion of food and water contaminated with E. multilocularis eggs exists, but showed also that food- and water-borne PRFs do not significantly increase the risk of infection. Conclusions/significance This systematic review analysed international peer-reviewed articles that have over the years contributed to our current understanding of the epidemiology of human AE. The identification of potential risk factors may help researchers and decision makers improve surveillance and/or preventive measures that aim at decreasing human infection with E. multilocularis. More primary studies are needed to confirm potential risk factors and their role in the epidemiology of human AE. Human alveolar echinococcosis is a severe zoonotic disease caused by the metacestode stage of the tapeworm Echinococcus multilocularis. The objective of this systematic literature review was to identify and summarize the current knowledge on potential risk factors associated with human alveolar echinococcosis. The categories of potential risk factors included dog-related factors such as dog ownership or play with dogs; vocational factors like being a farmer or handling foxes; human habits such as chewing grass; gender (being female) and socio-cultural factors like being Tibetan or having a low income or poor education, which may be relevant only in particular endemic areas. The identification of potential risk factors may help identify strategies that aim to decrease human infection with E. multilocularis.
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Qu B, Guo L, Sheng G, Yu F, Chen G, Wang Y, Shi Y, Zhan H, Yang Y, Du X. Management of Advanced Hepatic Alveolar Echinococcosis: Report of 42 Cases. Am J Trop Med Hyg 2017; 96:680-685. [PMID: 28070011 PMCID: PMC5361545 DOI: 10.4269/ajtmh.16-0557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/18/2016] [Indexed: 12/27/2022] Open
Abstract
Radical resection is the first choice for hepatic alveolar echinococcosis (HAE). However, many patients with advanced HAE have no chance to be treated with curative resection owing to the long clinical latency. This study aimed to evaluate the necessity of aggressive operations, like palliative resection and orthotopic liver transplantation (OLT), in the management of advanced HAE. A retrospective study analyzed 42 patients with advanced HAE treated with palliative resection (N = 15), palliative nonresective procedures (N = 13), OLT (N = 3), or albendazole therapy alone (N = 11). The patients' condition before treatments was comparable among all the four groups. The overall 1-year, 3-year, and 5-year survival rates of the 42 cases were 81.0%, 45.2%, and 23.8%, respectively. No event occurred to end the follow-up during the 5-year observation period except death. The survival time (median ± standard error) of the palliative resection group (3.6 ± 1.4 years) was longer than that of the palliative nonresective procedures group (1.5 ± 0.2) and the albendazole therapy-alone group (1.0 ± 0.4). The 5-year survival rates after palliative resection and liver transplantation were 40.0% and 66.7%, compared with only 7.7% and 9.1% after palliative nonresective procedures or albendazole therapy alone. Therefore, we concluded that aggressive treatment with a multimodality strategy could contribute to prolonged survival in patients with advanced HAE. Moreover, the prognosis of the patients who received albendazole therapy alone or palliative nonresective procedures is poor.
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Affiliation(s)
- Bo Qu
- Department of General Surgery, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China
| | - Long Guo
- Department of Hepatobiliary Surgery, Liver Transplantation Center, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, People's Republic of China
| | - Guannan Sheng
- Department of General Surgery, Postgraduate Training Basement of Jinzhou Medical University, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China
| | - Fei Yu
- Department of General Surgery, Postgraduate Training Basement of Jinzhou Medical University, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China
| | - Guannan Chen
- Department of General Surgery, Postgraduate Training Basement of Jinzhou Medical University, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, People's Republic of China
| | - Yupeng Wang
- Department of Oncology, Tianjin Beichen Hospital, Tianjin, People's Republic of China
| | - Yuan Shi
- Department of Hepatobiliary Surgery, Organ Transplantation Center, Tianjin First Center Hospital, Tianjin, People's Republic of China
| | - Hanxiang Zhan
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Yi Yang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xiaoyan Du
- Department of Hematology, Peking University Third Hospital, Peking University, Beijing, People's Republic of China
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Deplazes P, Rinaldi L, Alvarez Rojas CA, Torgerson PR, Harandi MF, Romig T, Antolova D, Schurer JM, Lahmar S, Cringoli G, Magambo J, Thompson RCA, Jenkins EJ. Global Distribution of Alveolar and Cystic Echinococcosis. ADVANCES IN PARASITOLOGY 2017; 95:315-493. [PMID: 28131365 DOI: 10.1016/bs.apar.2016.11.001] [Citation(s) in RCA: 626] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.
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Affiliation(s)
- P Deplazes
- University of Zürich, Zurich, Switzerland
| | - L Rinaldi
- University of Naples Federico II, Napoli, Italy
| | | | | | - M F Harandi
- Research centre of Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran
| | - T Romig
- University of Hohenheim, Stuttgart, Germany
| | - D Antolova
- Institute of Parasitology SAS, Kosice, Slovak Republic
| | - J M Schurer
- University of Saskatchewan, Saskatoon, SK, Canada; University of Washington, Seattle, WA, United States
| | - S Lahmar
- National School of Veterinary Medicine, Sidi Thabet, Tunisia
| | - G Cringoli
- University of Naples Federico II, Napoli, Italy
| | - J Magambo
- Meru University of Science and Technology, Meru, Kenya
| | | | - E J Jenkins
- University of Saskatchewan, Saskatoon, SK, Canada
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Abstract
Human cystic echinococcosis (CE) has been eliminated or significantly reduced as a public health problem in several previously highly endemic regions. This has been achieved by the long-term application of prevention and control measures primarily targeted to deworming dogs, health education, meat inspection, and effective surveillance in livestock and human populations. Human CE, however, remains a serious neglected zoonotic disease in many resource-poor pastoral regions. The incidence of human alveolar echinococcosis (AE) has increased in continental Europe and is a major public health problem in parts of Eurasia. Better understanding of wildlife ecology for fox and small mammal hosts has enabled targeted anthelmintic baiting of fox populations and development of spatially explicit models to predict population dynamics for key intermediate host species and human AE risk in endemic landscapes. Challenges that remain for echinococcosis control include effective intervention in resource-poor communities, better availability of surveillance tools, optimal application of livestock vaccination, and management and ecology of dog and wildlife host populations.
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Echinococcosis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Knapp J, Combes B, Umhang G, Aknouche S, Millon L. Could the domestic cat play a significant role in the transmission of Echinococcus multilocularis? A study based on qPCR analysis of cat feces in a rural area in France. ACTA ACUST UNITED AC 2016; 23:42. [PMID: 27739398 PMCID: PMC5782850 DOI: 10.1051/parasite/2016052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/28/2016] [Indexed: 11/19/2022]
Abstract
Echinococcus multilocularis, a cestode parasite responsible for alveolar echinococcosis in humans, is often reported in Europe. It involves red foxes, domestic dogs, and domestic and wild cats as definitive hosts. The parasite infects small mammals and accidentally humans as intermediate hosts and develops in a similar way to a tumor, usually in the liver. Domestic animals are suspected of playing a role in parasite transmission, but this is rarely proven. Moreover, the role of domestic cats is thought to be small, because of experimental studies showing incomplete development of the parasite observed in their intestines. In the present study, we investigated copro-sampling performed in a rural and highly endemic area in Eastern France, on carnivore feces (n = 150). From these samples, the parasite was detected and identified by DNA analysis using quantitative PCR targeting part of a mitochondrial gene (Em-qPCR). Taeniid eggs were isolated from positive-Em-qPCR samples by flotation, and species identification was confirmed by sequencing on DNA extracts. From a total of 43 copro-samples from cats, four tested positive for E. multilocularis by the Em-qPCR. In two of these, we found parasite eggs that were identified as E. multilocularis. This finding was confirmed by sequencing, while one dog stool out of 61 collected was found to be positive, no egg was detectable. At the same time, 34% of fox stools tested positive for the parasite. The present study challenges the current idea that cats are only of minor significance in the E. multilocularis life cycle.
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Affiliation(s)
- Jenny Knapp
- Chrono-Environnement Laboratory, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France - Department of Parasitology-Mycology, University Hospital of Besançon, 25030 Besançon, France
| | - Benoît Combes
- Entente for the Control of Zoonoses, 54220 Malzéville, France
| | - Gérald Umhang
- ANSES Nancy Laboratory for Rabies and Wildlife, National Reference Laboratory for Echinococcus spp., Wildlife Surveillance and Eco-Epidemiology Unit, Technopole Agricole et Vétérinaire, 54220 Malzéville, France
| | - Soufiane Aknouche
- Chrono-Environnement Laboratory, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France
| | - Laurence Millon
- Chrono-Environnement Laboratory, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne Franche-Comté, 25030 Besançon, France - Department of Parasitology-Mycology, University Hospital of Besançon, 25030 Besançon, France
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Vuitton DA, Azizi A, Richou C, Vuitton L, Blagosklonov O, Delabrousse E, Mantion GA, Bresson-Hadni S. Current interventional strategy for the treatment of hepatic alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 14:1179-1194. [DOI: 10.1080/14787210.2016.1240030] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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van Cauteren D, Millon L, de Valk H, Grenouillet F. Retrospective study of human cystic echinococcosis over the past decade in France, using a nationwide hospital medical information database. Parasitol Res 2016; 115:4261-4265. [PMID: 27473835 DOI: 10.1007/s00436-016-5204-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
No specific surveillance system of cystic echinococcosis infections in humans exists in France. The incidence and trends over time have not been documented since the last decade of the twentieth century. We performed the current analysis to assess human cystic echinococcosis epidemiology over a 10-year period in France (including the island of Corsica but excluding the overseas territories) using a nationwide hospital medical information database. A total number of 2629 patients were identified in this database between 2005 and 2014. The average annual incidence rate was 0.42 hospitalized cases/100,000 inhabitants. It was highest in the Island of Corsica (1.76 cases/100,000) and in the region Provence-Alpes-Côte d'Azur (0.85 cases/100,000). This retrospective analysis of hospital records provides a population-based estimate of cystic echinococcosis incidence and trends over a 10-year period at a national level. It indicates a significant decrease of the incidence between 2005 and 2014 at the national level and in the area that reported the highest incidence. It stresses the fact that in France, cystic echinococcosis is not re-emerging and that the incidence remains low in comparison with similar studies in other Mediterranean countries.
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Affiliation(s)
| | - Laurence Millon
- French National Reference Centre for Alveolar Echinococcosis, University of Franche-Comté and University Hospital, Besançon, France
| | | | - Frederic Grenouillet
- French National Reference Centre for Alveolar Echinococcosis, University of Franche-Comté and University Hospital, Besançon, France
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Rijks J, Cito F, Cunningham A, Rantsios A, Giovannini A. Disease Risk Assessments Involving Companion Animals: an Overview for 15 Selected Pathogens Taking a European Perspective. J Comp Pathol 2016; 155:S75-97. [DOI: 10.1016/j.jcpa.2015.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/24/2015] [Accepted: 08/13/2015] [Indexed: 12/27/2022]
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Cadavid Restrepo AM, Yang YR, McManus DP, Gray DJ, Giraudoux P, Barnes TS, Williams GM, Soares Magalhães RJ, Hamm NAS, Clements ACA. The landscape epidemiology of echinococcoses. Infect Dis Poverty 2016; 5:13. [PMID: 26895758 PMCID: PMC4759770 DOI: 10.1186/s40249-016-0109-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/15/2016] [Indexed: 12/29/2022] Open
Abstract
Echinococcoses are parasitic diseases of major public health importance globally. Human infection results in chronic disease with poor prognosis and serious medical, social and economic consequences for vulnerable populations. According to recent estimates, the geographical distribution of Echinococcus spp. infections is expanding and becoming an emerging and re-emerging problem in several regions of the world. Echinococcosis endemicity is geographically heterogeneous and over time it may be affected by global environmental change. Therefore, landscape epidemiology offers a unique opportunity to quantify and predict the ecological risk of infection at multiple spatial and temporal scales. Here, we review the most relevant environmental sources of spatial variation in human echinococcosis risk, and describe the potential applications of landscape epidemiological studies to characterise the current patterns of parasite transmission across natural and human-altered landscapes. We advocate future work promoting the use of this approach as a support tool for decision-making that facilitates the design, implementation and monitoring of spatially targeted interventions to reduce the burden of human echinococcoses in disease-endemic areas.
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Affiliation(s)
- Angela M Cadavid Restrepo
- Research School of Population Health, The Australian National University, Canberra, New South Wales, Australia.
| | - Yu Rong Yang
- Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, P. R. China.
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Donald P McManus
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Darren J Gray
- Research School of Population Health, The Australian National University, Canberra, New South Wales, Australia.
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Patrick Giraudoux
- Chrono-environment lab, UMR6249, University of Bourgogne Franche-Comté/CNRS, Besançon, France.
- Institut Universitaire de France, Paris, France.
| | - Tamsin S Barnes
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, Australia.
- The University of Queensland, Queensland Alliance for Agriculture and Food Innovation, Gatton, Queensland, Australia.
| | - Gail M Williams
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Ricardo J Soares Magalhães
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, Australia.
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
| | - Nicholas A S Hamm
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands.
| | - Archie C A Clements
- Research School of Population Health, The Australian National University, Canberra, New South Wales, Australia.
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Lopez-Bernus A, Belhassen-García M, Alonso-Sardón M, Carpio-Perez A, Velasco-Tirado V, Romero-Alegria Á, Muro A, Cordero-Sánchez M, Pardo-Lledias J. Surveillance of Human Echinococcosis in Castilla-Leon (Spain) between 2000-2012. PLoS Negl Trop Dis 2015; 9:e0004154. [PMID: 26484764 PMCID: PMC4618931 DOI: 10.1371/journal.pntd.0004154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/19/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cystic echinococcosis (CE) is an important health problem in many areas of the world including the Mediterranean region. However, the real CE epidemiological situation is not well established. In fact, it is possible that CE is a re-emerging disease due to the weakness of current control programs. METHODOLOGY We performed a retrospective observational study of inpatients diagnosed with CE from January 2000 to December 2012 in the Western Spain Public Health-Care System. PRINCIPAL FINDINGS During the study period, 5510 cases of CE were diagnosed and 3161 (57.4%) of the cases were males. The age mean and standard deviation were 67.8 ± 16.98 years old, respectively, and 634 patients (11.5%) were younger than 45 years old. A total of 1568 patients (28.5%) had CE as the primary diagnosis, and it was most frequently described in patients <45 years old. Futhermore, a secondary diagnosis of CE was usually found in patients >70 year old associated with other causes of comorbidity. The period incidence rate was 17 cases per 105 person-years and was significantly higher when compared to the incidence declared through the Notifiable Disease System (1.88 cases per 105 person-years; p<0.001). CONCLUSIONS CE in western Spain is an underestimated parasitic disease. It has an active transmission, with an occurrence in pediatric cases, but has decreased in the recent years. The systematic search of Hospital Discharge Records of the National Health System Register (HDR) may be a more accurate method than other methods for the estimation of the incidence of CE in endemic areas.
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Affiliation(s)
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, CIETUS, IBSAL, Salamanca, Spain
| | - Montserrat Alonso-Sardón
- Área de Medicina Preventiva y Salud Publica, CIETUS, IBSAL, Universidad de Salamanca, Salamanca, Spain
| | | | | | | | - Antonio Muro
- Laboratorio de Inmunología Parasitaria y Molecular, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Miguel Cordero-Sánchez
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, CIETUS, IBSAL, Salamanca, Spain
| | - Javier Pardo-Lledias
- Servicio de Medicina Interna, CAUPA Hospital General de Palencia “Río Carrión,” Palencia, Spain
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Vuitton D, Demonmerot F, Knapp J, Richou C, Grenouillet F, Chauchet A, Vuitton L, Bresson-Hadni S, Millon L. Clinical epidemiology of human AE in Europe. Vet Parasitol 2015; 213:110-20. [DOI: 10.1016/j.vetpar.2015.07.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Threat of alveolar echinococcosis to public health – a challenge for Europe. Trends Parasitol 2015; 31:407-12. [DOI: 10.1016/j.pt.2015.06.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 02/02/2023]
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