Chapter

Alveolar echinococcosis (<i>Echinococcus multilocularis</i>)

J. Eckert, P. Deplazes and P. Kern

in Oxford Textbook of Zoonoses

Second edition

Published on behalf of Oxford University Press

ISBN: 9780198570028
Published online July 2011 | e-ISBN: 9780199697823 | DOI: http://dx.doi.org/10.1093/med/9780198570028.003.0061

Series: Oxford Textbooks

Alveolar echinococcosis (Echinococcus multilocularis)

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In this chapter three forms of echinococcosis in humans are described that are caused by a larval stage (metacestode) of Echinococcus multilocularis Leuckart, 1863, Echinococcus oligarthrus (Diesing, 1863) or Echinococcus vogeli Rausch and Bernstein, 1972. E. multilocularis is the causative agent of alveolar echinococcosis (AE). In the human host the metacestode of E. multilocularis behaves like a malignant tumour, characterized by infiltrative proliferation and the potential to induce serious disease. The liver is nearly exclusively the primary site of metacestode development, but metastases may by formed in adjacent and distant organs. Typically AE exhibits a chronic progressive clinical course, which finally leads to death in up to 90% of untreated patients within 10 years after diagnosis. An undefined proportion of cases are abortive with inactivation of the parasite. Evidence has accumulated in recent years that anti-parasitic therapy with benzimidazoles (albendazole or mebendazole) over many years or lifelong, if necessary combined with interventional procedures, can inhibit disease progression and improve or stabilse the patient’s clinical condition. Radical surgery in an early stage of the infection combined with anti-parasitic therapy for two years may lead to cure. The introduction of benzimidazole therapy of AE (1977), combined with improved diagnostic and surgical procedures, has resulted in significantly increased life-expectancies of adequately treated AE patients. In highly endemic areas ultrasound population screening (partially combinated with antibody detection) has been successfully used for early detection of AE cases. Countrywide annual AE incidence rates are mostly low at approximately < 0.1 to 2.0 per 100,000 inhabitants, but they can be much higher locally. Furthermore, there are indications of emerging case numbers in some areas of Europe and Asia. In spite of relatively low case numbers, AE is a significant disease due to its severity and high costs of treatment (median costs of approximately 145,800 per case).

Chapter.  28499 words.  Illustrated.

Subjects: Public Health and Epidemiology ; Infectious Diseases ; Epidemiology

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