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Khuroo MS, Khuroo NS, Rather AA. A Case Series and Literature Review of Alveolar Echinococcosis in Kashmir, India: An Emerging Endemic Zone for Echinococcus multilocularis. Life (Basel) 2024; 14:794. [PMID: 39063549 PMCID: PMC11277966 DOI: 10.3390/life14070794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
A prospective study on 110 patients with echinococcosis at Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, India, from March 2019 to April 2024 identified 12 cases (4 males, 8 females; mean age of 46.58 ± 11.97 years) of Alveolar echinococcosis (AE). Two patients were detected through ultrasound examinations carried out for unrelated causes; one presented with features of liver abscess, and nine had pain in the right upper quadrant for a mean period of 2.2 ± 1.79 years. All had the liver as the primary organ involved, with 15 tumor masses of a mean maximum diameter of 9.22 ± 3.21 cm and volume of 426 ± 374.61 cm3. Tumors placed centrally had invaded vessels and the biliary tract in eight patients, and those placed peripherally had invaded the liver capsule and adjacent organs in nine patients. Histologic examination of liver biopsies or resected organs revealed necrotic lesions, calcifications, and granulomatous inflammation with slender, thin-walled vesicles of bizarre configuration that stained strongly eosinophilic with periodic acid Schiff. Two patients had segmental liver resections; one was treated with liver aspiration, while the other nine with advanced disease received chemotherapy with albendazole along with praziquantel. Patients showed clinical improvement on a median follow-up of 12 months (range 1 to 60 months); however, MRI T2-weighted images and 18F-FDG-PET-CECT scans in two patients showed active disease on follow-up at one and five years, respectively. A systematic review detected 146 cases of AE in India from 1980 to April 2024. Twenty cases were from foreign countries, mostly from Central Asian republics, and 118 (93.65%) of the remaining 126 Indian patients were permanent residents of Kashmir Valley. The disease affected a population of 79,197 residing in 22 villages from 5 border districts of the valley. These villages were either high in or adjacent to the Himalayan mountain range. Disease prevalence in the affected population was 146.47/105 (males 131.53/105 and females 163.18/105) and the incidence was 12.41/105/year (males 11.16/105/year and females 13.81/105/year). Possible causes of the emergence of AE are discussed, and future directions for research to face this challenge arebeen identified.
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Affiliation(s)
- Mohammad Sultan Khuroo
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Kashmir, Srinagar 190010, India;
| | - Naira Sultan Khuroo
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Kashmir, Srinagar 190010, India;
| | - Ajaz Ahmad Rather
- Department of Surgery and Registrar Academics, Sher-I-Kashmir Institute of Medical Sciences Medical College and Hospital, Bemina, Kashmir, Srinagar 190010, India;
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Abdykerimov KK, Kronenberg PA, Isaev M, Paternoster G, Deplazes P, Torgerson PR. Environmental distribution of Echinococcus- and Taenia spp.-contaminated dog feces in Kyrgyzstan. Parasitology 2024; 151:84-92. [PMID: 38018240 PMCID: PMC10941041 DOI: 10.1017/s003118202300118x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
Recently, there have been epidemics of human cystic echinococcosis (CE) and alveolar echinococcosis (AE) in Kyrgyzstan. This study investigated 2 districts for the presence of Echinococcus granulosus s.l. and Echinococcus multilocularis eggs; species identity was confirmed by polymerase chain reaction in dog feces and the level of environmental contamination with parasite eggs in 2017–2018 was also investigated. In the Alay district 5 villages with a high reported annual incidence of AE of 162 cases per 100 000 and 5 villages in the Kochkor district which had a much lower incidence of 21 cases per 100 000 were investigated. However, the proportion of dog feces containing E. granulosus s.l. eggs was ~4.2 and ~3.5% in Alay and Kochkor respectively. For E. multilocularis, the corresponding proportions were 2.8 and 3.2%. Environmental contamination of Echinococcus spp. eggs was estimated using the McMaster technique for fecal egg counts, weight and density of canine feces. The level of environmental contamination with E. multilocularis eggs was similar at 4.4 and 5.0 eggs per m2 in Alay and Kochkor respectively. The corresponding values for E. granulosus s.l. were 8.3 and 7.5 eggs per m2. There was no association between village or district level incidence of human AE or CE and the proportion of dog feces containing eggs of Echinococcus spp. or the level of environmental contamination. Increased contamination of taeniid eggs occured in the autumn, after the return of farmers with dogs from summer mountain pastures.
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Affiliation(s)
- Kubanychbek K. Abdykerimov
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Kyrgyz Research Institute of Veterinary named after A. Duisheev, Ministry of Education and Science of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Philipp A. Kronenberg
- Vetsuisse and Medical Faculty, Institute of Parasitology, University of Zurich, Zurich, Switzerland
- Microbiology and Molecular Biology, Institute of Chemistry and Biotechnology, Zurich University of Applied Sciences (ZHAW), Wädenswil, Switzerland
| | - Myktybek Isaev
- Kyrgyz Research Institute of Veterinary named after A. Duisheev, Ministry of Education and Science of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Giulia Paternoster
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Federal Food Safety and Veterinary Office FSVO, Bern, Switzerland
| | - Peter Deplazes
- Vetsuisse and Medical Faculty, Institute of Parasitology, University of Zurich, Zurich, Switzerland
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Paul R. Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Jiang H, Wang X, Guo L, Tan X, Gui X, Liao Z, Li Z, Chen X, Wu X. Effect of sunitinib against Echinococcus multilocularis through inhibition of VEGFA-induced angiogenesis. Parasit Vectors 2023; 16:407. [PMID: 37936208 PMCID: PMC10631006 DOI: 10.1186/s13071-023-05999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Alveolar echinococcosis (AE) is a lethal zoonosis caused by the fox tapeworm Echinococcus multilocularis. The disease is difficult to treat, and an effective therapeutic drug is urgently needed. Echinococcus multilocularis-associated angiogenesis is required by the parasite for growth and metastasis; however, whether antiangiogenic therapy is effective for treating AE is unclear. METHODS The in vivo efficacy of sunitinib malate (SU11248) was evaluated in mice by secondary infection with E. multilocularis. Enzyme-linked immunosorbent assays (ELISAs) were used to evaluate treatment effects on serum IL-4 and vascular endothelial growth factor A (VEGFA) levels after SU11248 treatment. Gross morphological observations and immunohistochemical staining were used to evaluate the impact of SU11248 on angiogenesis and the expression of pro-angiogenic factors VEGFA and VEGF receptor 2 (VEGFR2) in the metacestode tissues. Furthermore, the anthelmintic effects of SU11248 were tested on E. multilocularis metacestodes in vitro. The effect of SU11248 on the expression of VEGFA, VEGFR2, and phosphorylated VEGFR2 (p-VEGFR2) in liver cells infected with protoscoleces in vitro was detected by western blotting, reverse transcription quantitative polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). The influence of SU11248 on endothelial progenitor cell (EPC) proliferation and migration was determined using CCK8 and transwell assays. RESULTS In vivo, SU11248 treatment markedly reduced neovascular lesion formation and substantially inhibited E. multilocularis metacestode growth in mice. Further, it exhibited high anti-hydatid activity as efficiently as albendazole (ABZ), and the treatment resulted in reduced protoscolex development. In addition, VEGFA, VEGFR2, and p-VEGFR2 expression was significantly decreased in the metacestode tissues after SU11248 treatment. However, no effect of SU11248 on serum IL-4 levels was observed. In vitro, SU11248 exhibited some anthelmintic effects and damaged the cellular structure in the germinal layer of metacestodes at concentrations below those generally considered acceptable for treatment (0.12-0.5 μM). Western blotting, RT-qPCR, and ELISA showed that in co-cultured systems, only p-VEGFR2 levels tended to decrease with increasing SU11248 concentrations. Furthermore, SU11248 was less toxic to Reuber rat hepatoma (RH) cells and metacestodes than to EPCs, and 0.1 μM SU11248 completely inhibited EPC migration to the supernatants of liver cell and protoscolex co-cultures. CONCLUSIONS SU11248 is a potential candidate drug for the treatment of AE, which predominantly inhibits parasite-induced angiogenesis. Host-targeted anti-angiogenesis treatment strategies constitute a new avenue for the treatment of AE.
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Affiliation(s)
- Huijiao Jiang
- National Health Commission of the People's Republic of China Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China
| | - Xiaoyi Wang
- National Health Commission of the People's Republic of China Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China
| | - Lijiao Guo
- National Health Commission of the People's Republic of China Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China
| | - Xiaowu Tan
- National Health Commission of the People's Republic of China Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China
| | - Xianwei Gui
- National Health Commission of the People's Republic of China Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China
| | - Zhenyu Liao
- Department of Immunology, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China
- Department of Experimental Medicine, Jintang First People's Hospital West China Hospital Sichuan University Jintang Hospital, Chengdu, 610400, Sichuan, China
| | - Zhiwei Li
- National Health Commission of the People's Republic of China Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China
| | - Xueling Chen
- Department of Immunology, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China.
| | - Xiangwei Wu
- National Health Commission of the People's Republic of China Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, Xinjiang, China.
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Alvi MA, Ali RMA, Khan S, Saqib M, Qamar W, Li L, Fu BQ, Yan HB, Jia WZ. Past and Present of Diagnosis of Echinococcosis: A Review (1999-2021). Acta Trop 2023; 243:106925. [PMID: 37080264 DOI: 10.1016/j.actatropica.2023.106925] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
The larval forms of taeniid cestodes belonging to the genus Echinococcus are the source of the zoonotic infection known as echinococcosis. Alveolar and cystic echinococcosis are caused by Echinococcus multilocularis and Echinococcus granulosus (s. s) respectively. It is endemic in several regions of the world. In this systematic review, we describe diagnosis, and the species (human, canids, livestock, and small rodents) affected by cystic (CE) and alveolar echinococcosis (AE). From 1999 to 2021, we searched the online directory through PubMed, SCOPUS, Web of Science, and google scholar. Among the 37,700 records found in the online databases, 187 publications met our eligibility requirements. The majority of investigations employed a range of diagnostic methods, such as ELISA, imaging, copro-PCR, necropsy or arecoline hydrobromide purgation, morphological cestode confirmation, and fecal sieving/flotation to detect and confirm Echinococcus infection. ELISA was the most commonly used method followed by PCR, and imaging. The research team retrieved data describing the incidence or assessment of the diagnostic test for E. multilocularis in humans (N = 99), canids (N = 63), small ruminants (N = 13), large ruminants (N= 3), camel (N= 2), pigs (N=2) and small mammals (N= 5). This study was conducted to explore the diagnostic tools applied to detect echinococcosis in humans as well as animals in prevalent countries, and to report the characteristic of new diagnostic tests for disease surveillance. This systematic review revealed that ELISA (alone or in combination) was the most common method used for disease diagnosis and diagnostic efficacy and prevalence rate increased when recombinant antigens were used. It is highly recommended to use combination protcols such as serological with molecular and imaging technique to diagnose disease. Our study identified scarcity of data of reporting echinococcosis in humans/ animals in low-income or developing countries particularly central Asian countries. Study reports in small rodents indicate their role in disease dissemination but real situation in these host is not refected due to limited number of studies. Even though echinococcosis affects both public health and the domestic animal sector, therefore, it is important to devise new and strengthe implementation of the existing monitoring, judging, and control measures in this estimate.
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Affiliation(s)
- Mughees Aizaz Alvi
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Rana Muhammad Athar Ali
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Sadiq Khan
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Saqib
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Warda Qamar
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Li Li
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Bao-Quan Fu
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Hong-Bin Yan
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China.
| | - Wan-Zhong Jia
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.
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Kronenberg PA, Deibel A, Gottstein B, Grimm F, Müllhaupt B, Meyer zu Schwabedissen C, Aitbaev S, Omorov RA, Abdykerimov KK, Minbaeva G, Usubalieva J, Siles-Lucas M, Pepe P, Rinaldi L, Spiliotis M, Wang J, Müller N, Torgerson PR, Deplazes P. Serological Assays for Alveolar and Cystic Echinococcosis—A Comparative Multi-Test Study in Switzerland and Kyrgyzstan. Pathogens 2022; 11:pathogens11050518. [PMID: 35631039 PMCID: PMC9146094 DOI: 10.3390/pathogens11050518] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 12/04/2022] Open
Abstract
Both alveolar (AE) and cystic echinococcosis (CE) are lacking pathognomonic clinical signs; consequently imaging technologies and serology remain the main pillars for diagnosis. The present study included 100 confirmed treatment-naïve AE and 64 CE patients that were diagnosed in Switzerland or Kyrgyzstan. Overall, 10 native Echinococcus spp. antigens, 3 recombinant antigens, and 4 commercial assays were comparatively evaluated. All native E. multilocularis antigens were produced in duplicates with a European and a Kyrgyz isolate and showed identical test values for the diagnosis of AE and CE. Native antigens and three commercial tests showed high diagnostic sensitivities (Se: 86–96%) and specificities (Sp: 96–99%) for the diagnosis of AE and CE in Swiss patients. In Kyrgyz patients, values of sensitivities and specificities were 10–20% lower as compared to the Swiss patients’ findings. For the sero-diagnosis of AE in Kyrgyzstan, a test-combination of an E. multilocularis protoscolex antigen and the recombinant antigen Em95 appears to be the most suitable test strategy (Se: 98%, Sp: 87%). For the diagnosis of CE in both countries, test performances were hampered by major cross-reactions with AE patients and other parasitic diseases as well as by limited diagnostic sensitivities (93% in Switzerland and 76% in Kyrgyzstan, respectively).
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Affiliation(s)
- Philipp A. Kronenberg
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8075 Zurich, Switzerland;
- Graduate School for Cellular and Biomedical Sciences, University of Bern, 3012 Bern, Switzerland
- Correspondence: (P.A.K.); (P.D.); Tel.: +41-(0)44-635-87-01 (P.A.K.)
| | - Ansgar Deibel
- Clinics of Hepatology and Gastroenterology, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.); (B.M.); (C.M.z.S.)
| | - Bruno Gottstein
- Laboratory of Parasitology, Institute for Infectious Diseases, Medical Faculty, University of Bern, 3001 Bern, Switzerland; (B.G.); (M.S.); (J.W.)
| | - Felix Grimm
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8075 Zurich, Switzerland;
| | - Beat Müllhaupt
- Clinics of Hepatology and Gastroenterology, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.); (B.M.); (C.M.z.S.)
| | - Cordula Meyer zu Schwabedissen
- Clinics of Hepatology and Gastroenterology, University Hospital Zurich, 8091 Zurich, Switzerland; (A.D.); (B.M.); (C.M.z.S.)
| | - Sezdbek Aitbaev
- City Clinical Hospital #1, Surgical Department, Faculty of Surgery of the Kyrgyz State Medical Academy, Bishkek 720054, Kyrgyzstan; (S.A.); (R.A.O.)
| | - Rakhatbek A. Omorov
- City Clinical Hospital #1, Surgical Department, Faculty of Surgery of the Kyrgyz State Medical Academy, Bishkek 720054, Kyrgyzstan; (S.A.); (R.A.O.)
| | - Kubanychbek K. Abdykerimov
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (K.K.A.); (P.R.T.)
- Life Science Zürich Graduate School, University of Zürich, 8057 Zurich, Switzerland
| | - Gulnara Minbaeva
- Government Sanito-Epidemiology Unit, Kyrgyz Ministry of Health, Bishkek 720033, Kyrgyzstan; (G.M.); (J.U.)
| | - Jumagul Usubalieva
- Government Sanito-Epidemiology Unit, Kyrgyz Ministry of Health, Bishkek 720033, Kyrgyzstan; (G.M.); (J.U.)
| | - Mar Siles-Lucas
- Instituto de Recursos Naturales y Agrobiologia (IRNASA-CSIC), 37008 Salamanca, Spain;
| | - Paola Pepe
- Unit of Parasitology and Parasitic Diseases, Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80138 Naples, Italy; (P.P.); (L.R.)
| | - Laura Rinaldi
- Unit of Parasitology and Parasitic Diseases, Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80138 Naples, Italy; (P.P.); (L.R.)
| | - Markus Spiliotis
- Laboratory of Parasitology, Institute for Infectious Diseases, Medical Faculty, University of Bern, 3001 Bern, Switzerland; (B.G.); (M.S.); (J.W.)
| | - Junhua Wang
- Laboratory of Parasitology, Institute for Infectious Diseases, Medical Faculty, University of Bern, 3001 Bern, Switzerland; (B.G.); (M.S.); (J.W.)
| | - Norbert Müller
- Institute of Parasitology, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland;
| | - Paul R. Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (K.K.A.); (P.R.T.)
| | - Peter Deplazes
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8075 Zurich, Switzerland;
- Correspondence: (P.A.K.); (P.D.); Tel.: +41-(0)44-635-87-01 (P.A.K.)
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Deibel A, Meyer zu Schwabedissen C, Husmann L, Grimm F, Deplazes P, Reiner CS, Müllhaupt B. Characteristics and Clinical Course of Alveolar Echinococcosis in Patients with Immunosuppression-Associated Conditions: A Retrospective Cohort Study. Pathogens 2022; 11:pathogens11040441. [PMID: 35456117 PMCID: PMC9032794 DOI: 10.3390/pathogens11040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: Since the change in the millennium, an increase in cases of alveolar echinococcosis (AE) has been observed in endemic European countries. Previous studies indicate that a significant proportion of the new AE cases have an immunosuppression-associated condition (IAC). The aim of the current study was to determine how IACs impact the number of new AE diagnoses per year and the characteristics of AE at diagnosis and its clinical course at our center. Methods: Retrospective analysis of 189 patients with AE diagnosed between 2000 and 2021 and participating in the Zurich Echinococcosis Cohort Study (ZECS) included clinical characteristics of AE at diagnosis and report of an IAC, as well as the clinical course during follow-up. Results: Of 189 patients participating in this study, 38 had an IAC reported at, or shortly after, AE diagnosis. Over time, there was a steeper increase in the number of newly diagnosed AE patients without an IAC than the number of patients with IAC. Patients with an IAC were older at diagnosis, more frequently had an incidental finding of AE, smaller mean lesion size, and negative Em18 serology. All but two showed favorable outcomes on the last follow-up. Conclusion: IACs have little impact on the increase in new AE cases, as well as on the extent of the disease at diagnosis and clinical course.
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Affiliation(s)
- Ansgar Deibel
- Department of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland; (C.M.z.S.); (B.M.)
- Correspondence: ; Tel.: +41-432539700
| | | | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Felix Grimm
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8057 Zurich, Switzerland; (F.G.); (P.D.)
| | - Peter Deplazes
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zurich, 8057 Zurich, Switzerland; (F.G.); (P.D.)
| | - Cäcilia S. Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland; (C.M.z.S.); (B.M.)
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Maca against Echinococcosis?-A Reverse Approach from Patient to In Vitro Testing. Pathogens 2021; 10:pathogens10101335. [PMID: 34684284 PMCID: PMC8537204 DOI: 10.3390/pathogens10101335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-based treatment of alveolar echinococcosis (AE) with benzimidazoles is in most cases non-curative, thus has to be taken lifelong. Here, we report on a 56-year-old male AE patient who received standard benzimidazole treatment and biliary plastic stents, and additionally self-medicated himself with the Peruvian plant extract Maca (Lepidium meyenii). After 42 months, viable parasite tissue had disappeared. Based on this striking observation, the anti-echinococcal activity of Maca was investigated in vitro and in mice experimentally infected with Echinococcus multilocularis metacestodes. Albendazole (ABZ)-treated mice and mice treated with an ABZ+Maca combination exhibited a significantly reduced parasite burden compared to untreated or Maca-treated mice. As shown by a newly established UHPLC-MS/MS-based measurement of ABZ-metabolites, the presence of Maca during the treatment did not alter ABZ plasma levels. In vitro assays corroborated these findings, as exposure to Maca had no notable effect on E. multilocularis metacestodes, and in cultures of germinal layer cells, possibly unspecific, cytotoxic effects of Maca were observed. However, in the combined treatments, Maca inhibited the activity of ABZ in vitro. While Maca had no direct anti-parasitic activity, it induced in vitro proliferation of murine spleen cells, suggesting that immunomodulatory properties could have contributed to the curative effect seen in the patient.
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Gottstein B, Deplazes P. Alveolar echinococcosis: what triggers emergence in North America, Central Europe and Asia? Curr Opin Infect Dis 2021; 34:440-446. [PMID: 34524197 DOI: 10.1097/qco.0000000000000765] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Infection with the larval (metacestode) stage of Echinococcus multilocularis causes alveolar echinococcosis (AE), a serious hepatic disorder. The parasite has increased its infection extensity in wildlife and domestic dogs, mainly due to urbanization and spatial extension of wildlife hosts in Europe, Asia as well as North America, resulting in emerging infection risk for humans. RECENT FINDINGS In hyperendemic areas such as Kyrgyzstan and China, ecological and socioeconomic changes have been associated with the unpredictable increase of AE cases. In North America, the appearance of the European-like genotype is of concern. In Europe, the annual increase of human case numbers reached a plateau even in hyperendemic situations. Therefore, we conclude that most of the exposed individuals are resistant to parasite invasion and/or to disease development. Thus, AE develops in a few healthy individuals, but preferentially in immunosuppressed patients. SUMMARY In the future, improved diagnostic strategies will allow more precise estimations of transmission routes including the role of food, water and direct dog contact, which should yield improved public health recommendations. Finally, understanding protective innate and acquired immune mechanisms as well as parasite-driven immune-evasion processes will be essential to develop curative therapies in nonoperable patients and, futuristically, appropriate vaccines.
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Affiliation(s)
- Bruno Gottstein
- Institute of Infectious Diseases, Faculty of Medicine, University of Bern, Bern
| | - Peter Deplazes
- Institute of Parasitology, Vetsuisse Faculty and Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Association between environmental and climatic risk factors and the spatial distribution of cystic and alveolar echinococcosis in Kyrgyzstan. PLoS Negl Trop Dis 2021; 15:e0009498. [PMID: 34161356 PMCID: PMC8259979 DOI: 10.1371/journal.pntd.0009498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 07/06/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Cystic and alveolar echinococcosis (CE and AE) are neglected tropical diseases caused by Echinococcus granulosus sensu lato and E. multilocularis, and are emerging zoonoses in Kyrgyzstan. In this country, the spatial distribution of CE and AE surgical incidence in 2014-2016 showed marked heterogeneity across communities, suggesting the presence of ecological determinants underlying CE and AE distributions. Methodology/Principal findings For this reason, in this study we assessed potential associations between community-level confirmed primary CE (no.=2359) or AE (no.=546) cases in 2014-2016 in Kyrgyzstan and environmental and climatic variables derived from satellite-remote sensing datasets using conditional autoregressive models. We also mapped CE and AE relative risk. The number of AE cases was negatively associated with 10-year lag mean annual temperature. Although this time lag should not be considered as an exact measurement but with associated uncertainty, it is consistent with the estimated 10–15-year latency following AE infection. No associations were detected for CE. We also identified several communities at risk for CE or AE where no disease cases were reported in the study period. Conclusions/Significance Our findings support the hypothesis that CE is linked to an anthropogenic cycle and is less affected by environmental risk factors compared to AE, which is believed to result from spillover from a wild life cycle. As CE was not affected by factors we investigated, hence control should not have a geographical focus. In contrast, AE risk areas identified in this study without reported AE cases should be targeted for active disease surveillance in humans. This active surveillance would confirm or exclude AE transmission which might not be reported with the present passive surveillance system. These areas should also be targeted for ecological investigations in the animal hosts. Cystic and alveolar echinococcosis (CE and AE) are parasitic zoonoses that cause a substantial disease burden in Kyrgyzstan. The etiologic agents of these diseases are parasites in the genus Echinococcus. These parasites have complex life cycles which include mammalian definitive and intermediate hosts and a free-living egg stage in the environment. Consequently, environmental and climatic factors can affect the prevalence and geographical distribution of these diseases because such factors influence the parasites’ eggs survival and longevity, and can affect suitable habitats for the intermediate and definitive hosts. In this geographic correlation study, we assessed environmental and climatic determinants of the spatial distributions of CE and AE in Kyrgyzstan. We found that 10-year lag annual temperature plays an important role in AE distribution, whilst none of the variables assessed was found to significantly affect that of CE. Moreover, communities at risk where these diseases are potentially under- or misdiagnosed were identified. Our findings provide vital information for targeted, area-specific interventions in Kyrgyzstan, and add to the body of knowledge on the ecology of these neglected parasitic diseases that are emerging and reemerging in several regions in North America, Europe and Asia.
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Lundström-Stadelmann B, Rufener R, Hemphill A. Drug repurposing applied: Activity of the anti-malarial mefloquine against Echinococcus multilocularis. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2020; 13:121-129. [PMID: 32636148 PMCID: PMC7389337 DOI: 10.1016/j.ijpddr.2020.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
The current chemotherapeutical treatment against alveolar echinococcosis relies exclusively on benzimidazoles, which are not parasiticidal and can induce severe toxicity. There are no alternative treatment options. To identify novel drugs with activity against Echinococcus multilocularis metacestodes, researchers have studied potentially interesting drug targets (e.g. the parasite's energy metabolism), and/or adopted drug repurposing approaches by undertaking whole organism screenings. We here focus on drug screening approaches, which utilize an in vitro screening cascade that includes assessment of the drug-induced physical damage of metacestodes, the impact on metacestode viability and the viability of isolated parasite stem cells, structure-activity relationship (SAR) analysis of compound derivatives, and the mode of action. Finally, once in vitro data are indicative for a therapeutic window, the efficacy of selected compounds is assessed in experimentally infected mice. Using this screening cascade, we found that the anti-malarial mefloquine was active against E. multilocularis metacestodes in vitro and in vivo. To shed more light into the mode of action of mefloquine, SAR analysis on mefloquine analogues was performed. E. multilocularis ferritin was identified as a mefloquine-binding protein, but its precise role as a drug target remains to be elucidated. In mice that were infected either intraperitoneally with metacestodes or orally with eggs, oral treatment with mefloquine led to a significant reduction of parasite growth compared to the standard treatment with albendazole. However, mefloquine was not acting parasiticidally. Assessment of mefloquine plasma concentrations in treated mice showed that levels were reached which are close to serum concentrations that are achieved in humans during long-term malaria prophylaxis. Mefloquine might be applied in human AE patients as a salvage treatment. Future studies should focus on other repurposed anti-infective compounds (MMV665807, niclosamide, atovaquone), which showed stronger in vitro activity against E. multilocularis than mefloquine.
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Affiliation(s)
- Britta Lundström-Stadelmann
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Längggassstrasse 122, 3012, Bern, Switzerland.
| | - Reto Rufener
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Längggassstrasse 122, 3012, Bern, Switzerland
| | - Andrew Hemphill
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Längggassstrasse 122, 3012, Bern, Switzerland
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11
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Paternoster G, Boo G, Wang C, Minbaeva G, Usubalieva J, Raimkulov KM, Zhoroev A, Abdykerimov KK, Kronenberg PA, Müllhaupt B, Furrer R, Deplazes P, Torgerson PR. Epidemic cystic and alveolar echinococcosis in Kyrgyzstan: an analysis of national surveillance data. LANCET GLOBAL HEALTH 2020; 8:e603-e611. [PMID: 32199126 DOI: 10.1016/s2214-109x(20)30038-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/07/2020] [Accepted: 01/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Human cystic and alveolar echinococcosis are among the priority neglected zoonotic diseases for which WHO advocates control. The incidence of both cystic echinococcosis and alveolar echinococcosis has increased substantially in the past 30 years in Kyrgyzstan. Given the scarcity of adequate data on the local geographical variation of these focal diseases, we aimed to investigate within-country incidence and geographical variation of cystic echinococcosis and alveolar echinococcosis at a high spatial resolution in Kyrgyzstan. METHODS We mapped all confirmed surgical cases of cystic echinococcosis and alveolar echinococcosis reported through the national echinococcosis surveillance system in Kyrgyzstan between Jan 1, 2014, and Dec 31, 2016, from nine regional databases. We then estimated crude surgical incidence, standardised incidence, and standardised incidence ratios (SIRs) of primary cases (ie, excluding relapses) based on age and sex at country, region, district, and local community levels. Finally, we tested the SIRs for global and local spatial autocorrelation to identify disease hotspots at the local community level. All incidence estimates were calculated per 100 000 population and averaged across the 3-year study period to obtain annual estimates. FINDINGS The surveillance system reported 2359 primary surgical cases of cystic echinococcosis and 546 primary surgical cases of alveolar echinococcosis. Country-level crude surgical incidence was 13·1 per 100 000 population per year for cystic echinococcosis and 3·02 per 100 000 population per year for alveolar echinococcosis. At the local community level, we found annual crude surgical incidences up to 176 per 100 000 population in Sary-Kamysh (Jalal-Abad region) for cystic echinococcosis and 246 per 100 000 population in Uch-Dobo (Alay district, Osh region) for alveolar echinococcosis. Significant hotspots of cystic echinococcosis were found in four regions: Osh (five local communities in Uzgen district and four in Alay district), Naryn (three local communities in Jumgal district and one in Naryn district), Talas (three local communities in Talas district), and Chuy (one local community in Jayyl district). Significant alveolar echinococcosis hotspots were detected in the Osh region (11 communities in Alay district, including the local community of Sary Mogol, and one in Chong-Alay district) and in the Naryn region (five communities in Jumgal district and three in At-Bashy district), in the southwest and centre of the country. INTERPRETATION Our analyses reveal remarkable within-country variation in the surgical incidence of cystic echinococcosis and alveolar echinococcosis in Kyrgyzstan. These high-resolution maps identify precise locations where interventions and epidemiological research should be targeted to reduce the burden of human cystic echinococcosis and alveolar echinococcosis. FUNDING Swiss National Science Foundation.
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Affiliation(s)
- Giulia Paternoster
- Section of Epidemiology, University of Zurich, Zurich, Switzerland; Life Science Zurich Graduate School, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Gianluca Boo
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Craig Wang
- Vetsuisse Faculty, Department of Mathematics, University of Zurich, Zurich, Switzerland; Life Science Zurich Graduate School, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Gulnara Minbaeva
- Government Sanito-Epidemiology Unit, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Jumagul Usubalieva
- Government Sanito-Epidemiology Unit, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Kursanbek Mamasalievich Raimkulov
- Center for Disease Prevention and Sanitary Epidemiological Surveillance of Osh region, Ministry of Health of the Kyrgyz Republic, Osh, Kyrgyzstan
| | - Abdykadyr Zhoroev
- Government Sanito-Epidemiology Unit, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Kubanychbek Kudaibergenovich Abdykerimov
- Section of Epidemiology, University of Zurich, Zurich, Switzerland; Institute of Parasitology, University of Zurich, Zurich, Switzerland; Kyrgyz Research Institute of Veterinary Science named after A Duisheev, Ministry of Education and Science of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Philipp Andreas Kronenberg
- Institute of Parasitology, University of Zurich, Zurich, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Beat Müllhaupt
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reinhard Furrer
- Vetsuisse Faculty, Department of Mathematics, University of Zurich, Zurich, Switzerland; Department of Computational Science, University of Zurich, Zurich, Switzerland
| | - Peter Deplazes
- Institute of Parasitology, University of Zurich, Zurich, Switzerland
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12
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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: 39] [Impact Index Per Article: 9.8] [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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Alvarez Rojas CA, Kronenberg PA, Aitbaev S, Omorov RA, Abdykerimov KK, Paternoster G, Müllhaupt B, Torgerson P, Deplazes P. Genetic diversity of Echinococcus multilocularis and Echinococcus granulosus sensu lato in Kyrgyzstan: The A2 haplotype of E. multilocularis is the predominant variant infecting humans. PLoS Negl Trop Dis 2020; 14:e0008242. [PMID: 32401754 PMCID: PMC7219741 DOI: 10.1371/journal.pntd.0008242] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022] Open
Abstract
Alveolar and cystic echinococcosis (AE, CE) caused by E. multilocularis and E. granulosus s.l., respectively, are considered emerging zoonotic diseases in Kyrgyzstan with some of the world highest regional incidences. Little is known regarding the molecular variability of both species in Kyrgyzstan. In this study we provide molecular data from a total of 72 parasite isolates derived from humans (52 AE and 20 CE patients) and 43 samples from dogs (23 infected with E. multilocularis and 20 with E. granulosus s.l.).Genetic variability in E. multilocularis was studied using the concatenated complete sequences of the cob, nad2 and cox1 mitochondrial genes adding a total of 3,558bp per isolate. The cob/nad2/cox1 A2 haplotype was identified in 63.4% of the human and in 65.2% of the dog samples. This haplotype was originally described in samples from Kazakhstan and St. Lawrence Island (Alaska, USA). We also describe here 16 non-previously defined variants of E. multilocularis (called A11-A26). All haplotypes cluster together within the Asian group in the haplotype network. Based on Fst values, low level of genetic differentiation was found between the populations of E. multilocularis isolated from different regions within the country. However, high degree of differentiation was found when all the concatenated sequences from Kyrgyzstan are considered as a single population and compared with the population of the parasite from the neighbouring country China. In the case of E. granulosus s.l. the analysis was based in 1,609bp of the cox1 gene. One isolate from a dog was identified as E. equinus, while all the other sequences were identified belonging to E. granulosus s.s. In total, 24 cox1 haplotypes of E. granulosus s.s. were identified including the already described variants: Eg01 (in 6 samples), Eg33 (in 4 samples), EgCl04 (in 2 samples), Eg03 (in 1 sample) and Eg32 (in 1 sample). From the twenty-five other isolates of E. granulosus s.s. a total of 19 non-previously described cox1 haplotypes were identified and named as EgKyr1 to EgKyr19. The most common haplotype infecting human is the EgKyr1 which was found in 5 isolates.The cob/nad2/cox1 A2 haplotype of E. multilocularis is responsible for the majority of human infections in Kyrgyzstan and is also found in the majority of dogs included in this study. Further similar studies in different parts of Asia could elucidate if it is also the most common variant infecting humans in other countries. It remains unknown if this particular haplotype presents differences in virulence which could have contributed to the emergency of alveolar echinococcosis in Kyrgyzstan. In the case of E. granulosus s.s. it seems that there is no dominant haplotype infecting humans in Kyrgzstan. Further characterization of biological or antigenic features of dominant mitochondrial haplotypes could help to elucidate if they present differences which could be relevant in the diagnostic, pathogenicity or in the host/parasite interaction when infecting humans. Analysis of the genetic variability in Echinococcus species from different endemic countries have contributed to the knowledge in the taxonomy and phylogeography of these parasites. The most important species of this genus, Echinococcus granulosus sensu lato and Echinococcus multilocularis, co-exist in Kyrgyzstan causing serious public health issues. E. granulosus s.l. causes cystic echinococcosis and E. multilocularis is the causative agent of alveolar echinococcosis. The most relevant finding of our study is the identification of the cob/nad2/cox1 A2 haplotype of E. multilocularis as the most commonly found in humans and dogs. However, it remains unknown if this variant of E. multilocularis, based on genetic differences in mitochondrial genes, presents differences in virulence which could have contributed to the emergence of alveolar echinococcosis in Kyrgyzstan. The results also show a number of non-previously described genetic variants of E. multilocularis and E. granulosus s.s.
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Affiliation(s)
- Cristian A. Alvarez Rojas
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zürich, Zürich, Switzerland
- * E-mail:
| | - Philipp A. Kronenberg
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Sezdbek Aitbaev
- City Clinical Hospital #1, Surgical Department, Faculty of Surgery of the Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Rakhatbek A. Omorov
- City Clinical Hospital #1, Surgical Department, Faculty of Surgery of the Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | | | - Giulia Paternoster
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Beat Müllhaupt
- Clinics of Hepatology and Gastroenterology, University Hospital of Zürich, Zürich, Switzerland
| | - Paul Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Peter Deplazes
- Institute of Parasitology, Vetsuisse and Medical Faculty, University of Zürich, Zürich, Switzerland
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14
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Pathology of Echinococcosis: A Morphologic and Immunohistochemical Study on 138 Specimens With Focus on the Differential Diagnosis Between Cystic and Alveolar Echinococcosis. Am J Surg Pathol 2020; 44:43-54. [PMID: 31567204 DOI: 10.1097/pas.0000000000001374] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infection of humans by the larval stage of the tapeworms Echinococcus granulosus sensu lato or Echinococcus multilocularis causes the life-threatening zoonoses cystic echinococcosis (CE) and alveolar echinococcosis (AE). Although cystic liver lesions are a hallmark of both diseases, course, prognosis, and patients' management decisively differ between the two. The wide and overlapping spectrum of morphologies and the limited availability of ancillary tools are challenges for pathologists to reliably diagnose and subtype echinococcosis. Here, we systematically and quantitatively recorded the pathologic spectrum in a clinically and molecularly defined echinococcosis cohort (138 specimens from 112 patients). Immunohistochemistry using a novel monoclonal antibody (mAbEmG3) was implemented, including its combined application with the mAbEm2G11. Six morphologic criteria sufficiently discriminated between CE and AE: size of smallest (CE/AE: >2/≤2 mm) and largest cyst (CE/AE: >25/≤25 mm), thickness of laminated layer (CE/AE: >0.15/≤0.15 mm) and pericystic fibrosis (CE/AE: >0.6/≤0.6 mm), striation of laminated layer (CE/AE: moderate-strong/weak), and number of cysts (CE/AE: ≤9/>9). Combined immunohistochemistry with mAbEm2G11 (E. multilocularis specific) and mAbEmG3 (reactive in AE and CE) was equally specific as and occasionally more sensitive than polymerase chain reaction. On the basis of these findings, we developed a diagnostic algorithm for the differential diagnosis of echinococcosis. In summary, we have not only identified the means to diagnose echinococcosis with greater certainty, but also defined morphologic criteria, which robustly discriminate between CE and AE. We expect our findings to improve echinococcosis diagnostics, especially of challenging cases, beneficially impacting the management of echinococcosis patients.
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15
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Assessment of Electronic Sensing Techniques for the Rapid Identification of Alveolar Echinococcosis through Exhaled Breath Analysis. SENSORS 2020; 20:s20092666. [PMID: 32392783 PMCID: PMC7249121 DOI: 10.3390/s20092666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
Here we present a proof-of-concept study showing the potential of a chemical gas sensors system to identify the patients with alveolar echinococcosis disease through exhaled breath analysis. The sensors system employed comprised an array of three commercial gas sensors and a custom gas sensor based on WO3 nanowires doped with gold nanoparticles, optimized for the measurement of common breath volatile organic compounds. The measurement setup was designed for the concomitant measurement of both sensors DC resistance and AC fluctuations during breath samples exposure. Discriminant Function Analysis classification models were built with features extracted from sensors responses, and the discrimination of alveolar echinococcosis was estimated through bootstrap validation. The commercial sensor that detects gases such as alkane derivatives and ethanol, associated with lipid peroxidation and intestinal gut flora, provided the best classification (63.4% success rate, 66.3% sensitivity and 54.6% specificity) when sensors’ responses were individually analyzed, while the model built with the AC features extracted from the responses of the cross-reactive sensors array yielded 90.2% classification success rate, 93.6% sensitivity and 79.4% specificity. This result paves the way for the development of a noninvasive, easy to use, fast and inexpensive diagnostic test for alveolar echinococcosis diagnosis at an early stage, when curative treatment can be applied to the patients.
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16
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Zheng C, Xue C, Han S, Li Z, Wang H, Wang L, Wang Y, Wang Q, Feng Y, Hou Y, Ma X, Ma J, Han X, Quzhen G, Jiang X, Guo W, Wu X, Yang Y, Cao L, Li F, Chen W, Yan X, Yu S, Fu M, Yu Q, Xiao N, Cao J, Yan J, Wu W, Zhou XN. National Alveolar Echinococcosis Distribution - China, 2012-2016. China CDC Wkly 2020; 2:1-7. [PMID: 34594609 PMCID: PMC8422174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/31/2019] [Indexed: 11/07/2022] Open
Abstract
What is already known about this topic? Both alveolar echinococcosis (AE) and cystic echinococcosis are endemic in China, among which alveolar echinococcosis has a very high mortality rate. What is added by this report? The survey results showed the prevalence and scope of AE in China and identified high-risk groups including children, monks, herdsmen and illiterate people. At the same time, all the cases found in the survey (more than 90% of the patients did not go to the hospital for diagnosis and treatment before survey) were promptly diagnosed and treated. What are the implications for public health practice? This study provides information for the development of a plan for AE prevention and control and for the implementation of interventions targeted to high-risk populations.
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Affiliation(s)
- Canjun Zheng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chuizhao Xue
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Shuai Han
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Zhongjie Li
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hu Wang
- Health Commission of Qinghai Province, Xining, Qinghai, China
| | - Liying Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Ying Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Qian Wang
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yu Feng
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Yanyan Hou
- Xingjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, Xinjiang, China
| | - Xiao Ma
- Qinhai Institute for Endemic Disease Prevention and Control, Xining, Qinghai, China
| | - Junying Ma
- Qinhai Institute for Endemic Disease Prevention and Control, Xining, Qinghai, China
| | - Xiumin Han
- Qinghai Provincial People’s Hospital, Xining, Qinghai, China
| | - Gongsang Quzhen
- Tibet Center for Diseases Control and Prevention, Lhasa, Tibet, China
| | - Xiaofeng Jiang
- Inner Mongolia Autonomous Region Center for Diseases Control and Prevention, Hohhot, Inner Mongolia, China
| | - Weidong Guo
- Inner Mongolia Autonomous Region Center for Diseases Control and Prevention, Hohhot, Inner Mongolia, China
| | - Xianglin Wu
- Ningxia Center for Disease Control and Prevention, Yinchuan, Ningxia, China
| | - Yaming Yang
- Yunnan Institute of Parasitic Diseases, Puer, Yunnan, China
| | - Lei Cao
- Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, Shaanxi, China
| | - Fanka Li
- Xinjiang Production and Construction Corps Center for Disease Control and Prevention, Urumqi, Xinjiang, China
| | - Weiqi Chen
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Xinliu Yan
- Yunnan Institute of Parasitic Diseases, Puer, Yunnan, China
| | - Shicheng Yu
- Office of epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Meihua Fu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Qing Yu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Jiangping Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
| | - Jun Yan
- National Health Commission of the People’s Republic of China, Beijing, China
| | - Weiping Wu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China,Weiping Wu,
| | - Xiao-nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China,Xiao-nong Zhou,
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17
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Ritler D, Rufener R, Li JV, Kämpfer U, Müller J, Bühr C, Schürch S, Lundström-Stadelmann B. In vitro metabolomic footprint of the Echinococcus multilocularis metacestode. Sci Rep 2019; 9:19438. [PMID: 31857639 PMCID: PMC6923418 DOI: 10.1038/s41598-019-56073-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022] Open
Abstract
Alveolar echinococcosis (AE) is a zoonotic disease that is deadly if left untreated. AE is caused by the larval metacestode stage of the cestode Echinococcus multilocularis. Better knowledge on the host-parasite interface could yield novel targets for improvement of the treatment against AE. We analyzed culture media incubated with in vitro grown E. multilocularis metacestodes by 1H nuclear magnetic resonance spectroscopy to identify the unknown metabolic footprint of the parasite. Moreover, we quantitatively analyzed all amino acids, acetate, glucose, lactate, and succinate in time-course experiments using liquid chromatography and enzymatic assays. The E. multilocularis metacestodes consumed glucose and, surprisingly, threonine and produced succinate, acetate, and alanine as major fermentation products. The metabolic composition of vesicle fluid (VF) from in vitro grown E. multilocularis metacestodes was different from parasite-incubated culture medium with respect to the abundance, but not the spectrum, of metabolites, and some metabolites, in particular amino acids, accumulated in the VF. Overall, this study presents the first characterization of the in vitro metabolic footprint of E. multilocularis metacestodes and VF composition, and it provides the basis for analyses of potentially targetable pathways for future drug development.
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Affiliation(s)
- Dominic Ritler
- Institute of Parasitology, Department of Infectious Disease and Pathobiology, Vetsuisse Bern, University of Bern, Bern, Switzerland
| | - Reto Rufener
- Institute of Parasitology, Department of Infectious Disease and Pathobiology, Vetsuisse Bern, University of Bern, Bern, Switzerland
| | - Jia V Li
- Division of Systems and Digestive Medicine, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Urs Kämpfer
- Department of Chemistry and Biochemistry, University of Bern, Bern, Switzerland
| | - Joachim Müller
- Institute of Parasitology, Department of Infectious Disease and Pathobiology, Vetsuisse Bern, University of Bern, Bern, Switzerland
| | - Claudia Bühr
- Department of Chemistry and Biochemistry, University of Bern, Bern, Switzerland
| | - Stefan Schürch
- Department of Chemistry and Biochemistry, University of Bern, Bern, Switzerland
| | - Britta Lundström-Stadelmann
- Institute of Parasitology, Department of Infectious Disease and Pathobiology, Vetsuisse Bern, University of Bern, Bern, Switzerland.
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18
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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: 61] [Impact Index Per Article: 12.2] [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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19
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Frey CF, Jenkins E, Lundström-Stadelmann B. Editorial overview: From farms and forests to forks? A review of diagnosis and management of globally important zoonotic Echinococcus spp. cestodes. Food Waterborne Parasitol 2019; 16:e00061. [PMID: 32095631 PMCID: PMC7034014 DOI: 10.1016/j.fawpar.2019.e00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022] Open
Abstract
This FAWPAR Special Issue is dedicated to zoonotic Echinococcus species. It is a compilation of invited papers that spans important aspects from molecular markers of emergence, diagnostics in both definitive and intermediate hosts, treatment of human alveolar echinococcosis, to control strategies in definitive hosts.
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Affiliation(s)
- Caroline F. Frey
- Centre for Food-borne and Animal Parasitology, Canadian Food Inspection Agency, Saskatoon, Canada
| | - Emily Jenkins
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Britta Lundström-Stadelmann
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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20
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Trevisan C, Torgerson PR, Robertson LJ. Foodborne Parasites in Europe: Present Status and Future Trends. Trends Parasitol 2019; 35:695-703. [PMID: 31358427 DOI: 10.1016/j.pt.2019.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023]
Abstract
Although foodborne parasites (FBPs) are becoming recognized as important foodborne pathogens, they remain neglected compared with bacterial and viral foodborne pathogens. As drivers for infection with FBPs are variable, it is often unclear for funding bodies where research should be prioritized. Through a COST Action (Euro-FBP; FA1408), we harnessed Europe-wide expertise to address these questions, using an Expert Knowledge Elicitation approach. Eating habits, lack of food-chain control, lack of awareness from relevant agencies, globalization, and water quality were identified as major drivers for FBP infection. Prioritized research needs to be largely focused on methodological gaps, but also on surveillance concerns, impact-assessment issues, and the role of microbiota. Despite the European focus, these responses should be relevant to those concerned with FBPs globally.
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Affiliation(s)
- Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Paul R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Winterthurerstrasse 270, 8057 Zürich, Switzerland
| | - Lucy J Robertson
- Parasitology Laboratory, Department of Food Safety and Infection Biology, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, P.O. Box 369 Sentrum, 0102 Oslo, Norway.
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21
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Lundström-Stadelmann B, Rufener R, Ritler D, Zurbriggen R, Hemphill A. The importance of being parasiticidal… an update on drug development for the treatment of alveolar echinococcosis. Food Waterborne Parasitol 2019; 15:e00040. [PMID: 32095613 PMCID: PMC7034016 DOI: 10.1016/j.fawpar.2019.e00040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 02/06/2023] Open
Abstract
The lethal disease alveolar echinococcosis (AE) is caused by the metacestode stage of the fox tapeworm Echinococcus multilocularis. Current chemotherapeutical treatment of AE relies on albendazole and mebendazole, with the caveat that these compounds are not parasiticidal. Drugs have to be taken for a prolonged period of time, often life-long, which can cause adverse effects and reduces the patients' quality of life. In some individuals, benzimidazoles are inactive or cause toxicity, leading to treatment discontinuation. Alternatives to benzimidazoles are urgently needed. Over the recent years, in vivo and in vitro models for low-to-medium throughput drug discovery against AE have been set in place. In vitro drug tests include the phosphoglucose-isomerase (PGI) assay to measure physical damage induced to metacestodes, and viability assays to assess parasiticidal activity against metacestodes and stem cells. In vitro models are also employed for studies on mechanisms of action. In vivo models are thus far based on rodents, mainly mice, and benefits could be gained in future by comparative approaches in naturally infected dogs or captive monkeys. For the identification of novel drugs against AE, a rare disease with a low expected market return, drug-repurposing is the most promising strategy. A variety of chemically synthesized compounds as well as natural products have been analyzed with respect to in vitro and/or in vivo activities against AE. We here review and discuss the most active of these compounds including anti-infective compounds (benzimidazoles, nitazoxanide, amphotericin B, itraconazole, clarithromycin, DB1127, and buparvaquone), the anti-infective anti-malarials (artemisinin, ozonids, mefloquine, and MMV665807) and anti-cancer drugs (isoflavones, 2-methoxyestradiol, methotrexate, navelbine, vincristine, kinase inhibitors, metallo-organic ruthenium complexes, bortezomib, and taxanes). Taking into account the efficacy as well as the potential availability for patients, the most promising candidates are new formulations of benzimidazoles and mefloquine. Future drug-repurposing approaches should also target the energy metabolism of E. multilocularis, in particular the understudied malate dismutation pathway, as this offers an essential target in the parasite, which is not present in mammals. Benzimidazoles are used to treat AE, but new drugs are needed. New drugs against AE can be identified by drug repurposing. Drugs against other infectious diseases and cancer can be repurposed against AE. Most promising are new formulations of benzimidazoles and mefloquine. Future approaches should include targeting the energy metabolism of the parasite.
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Affiliation(s)
- Britta Lundström-Stadelmann
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Reto Rufener
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Dominic Ritler
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Raphael Zurbriggen
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Andrew Hemphill
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
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22
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Umhang G, Possenti A, Colamesta V, d'Aguanno S, La Torre G, Boué F, Casulli A. A systematic review and meta-analysis on anthelmintic control programs for Echinococcus multilocularis in wild and domestic carnivores. Food Waterborne Parasitol 2019; 15:e00042. [PMID: 32095614 PMCID: PMC7034083 DOI: 10.1016/j.fawpar.2019.e00042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 11/04/2022] Open
Abstract
Human alveolar echinococcosis (AE), caused by the tapeworm Echinococcus multilocularis, is one of the most dangerous zoonoses in the Northern hemisphere. In Europe, the parasite's life cycle is sylvatic, involving small rodents as intermediate hosts and red foxes as the major definitive hosts. Given the severity of this disease in humans and the high levels of environmental contamination with E. multilocularis in endemic areas, it seems crucial to implement control measures in order to prevent human AE. This systematic review identifies previous anthelmintic control programs targeting E. multilocularis in wild and domestic carnivores and evaluates the effectiveness of the different strategies implemented. A search through six databases identified 302 scientific papers for the period 1950–2015, of which only 17 were retained according to the inclusion criteria set. These 17 papers focused on control of E. multilocularis by baiting foxes in highly endemic areas of Europe or Japan, with the exception of one study focused on dogs in Alaska. The papers highlighted differences in baiting types, baiting frequency, choice of control areas and length of treatment period. Overall, these studies resulted in a sharp and statistically significant decrease in parasite prevalence, confirmed by the absence of overlap between confidence intervals for the pooled risk differences of control and treated areas. A monthly baiting frequency was proven to be highly effective at decreasing E. multilocularis prevalence in foxes, even in highly endemic areas and in a short period of time. Nevertheless, when foxes were not fully dewormed, the parasite showed a strong capacity to rapidly recover its initial prevalence. The fox baiting approach appears to be the most useful method for controlling the sylvatic life cycle of E. multilocularis, but it require a cost/benefit analysis before it is likely to be accepted by stakeholders. This systematic review evaluated the effectiveness of the control programmes of E. multilocularis. Differences in baiting types, baiting frequency, selection of control areas and treatment period were highlighted. A monthly baiting was proved to be efficient to decrease E. multilocularis prevalence in foxes.
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Affiliation(s)
- Gérald Umhang
- ANSES, Wildlife Surveillance and Eco-epidemiology unit, Technopôle Agricole et Vétérinaire, B.P. 40009, 54220 Malzéville, France
| | - Alessia Possenti
- European Union Reference Laboratory for Parasites (EURLP), Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Vittoria Colamesta
- Sapienza University of Rome, Department of Public Health and Infectious Diseases, Rome, Italy
| | - Silvia d'Aguanno
- Sapienza University of Rome, Department of Public Health and Infectious Diseases, Rome, Italy
| | - Giuseppe La Torre
- Sapienza University of Rome, Department of Public Health and Infectious Diseases, Rome, Italy
| | - Franck Boué
- ANSES, Wildlife Surveillance and Eco-epidemiology unit, Technopôle Agricole et Vétérinaire, B.P. 40009, 54220 Malzéville, France
| | - Adriano Casulli
- European Union Reference Laboratory for Parasites (EURLP), Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy.,World Health Organization Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (in humans and animals), Department of Infectious Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
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