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Cystic echinococcosis 

Cystic echinococcosis
Cystic echinococcosis

Paul R. Torgerson,

, C. N. L. Macpherson

, and D. A. Vuitton

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date: 27 October 2021

Cystic echinococcosis (CE)\cystic hydatid disease is one of the most widespread and important global helminth zoonoses. The parasite Echinococcus granulosus is maintained in a wide spectrum of intermediate hosts, including sheep, goats, camels, cattle, pigs and equines. A number of wild intermediate hosts occur, including cervids in the northern part of the North American continent and Eurasia, marsupials in Australia and wild herbivores in East and southern Africa. The application of a range of molecular techniques to the characterization of the parasite has confirmed the existence of mostly host-adapted strains and genotypes of the parasite and several new species have been proposed. The ubiquitous domestic dog serves as the most important definitive host for the transmission of the parasite throughout its wide geographical range.

A wide range of diagnostic techniques, including necropsy, arecoline purgation, coproantigen ELISA and DNA based tests are available for detecting E. granulosus infection in the definitive host. In intermediate animal hosts, diagnosis at post mortem still remains the most reliable option. In humans, imaging techniques including ultrasound, nuclear magnetic resonance (NMR) or computer aided tomography (CAT-scan provide not only a method of diagnosis but also reveal important clinical information on the location, condition, number and size of the hydatid cysts in man. Of these ultrasound is the most widely used diagnostic technique and is the only imaging technique for screening of populations in rural areas, where the disease is most common. A classification system has been developed which can be used to assess the likely development of a cyst and hence guide the clinician in treatment options for the patient. Treatment relies on surgery and/or percutaneous interventions, especially ‘Puncture, Aspiration, Injection, Re-aspiration’ (PAIR) and/or antiparasitic treatment with albendazole (and alternatively mebendazole).

CE is largely a preventable disease. Successful elimination programmes have focused on frequent periodic treatments of dogs with anthelmintics and the control of slaughter of domestic livestock. In many regions elimination or even control remains a problem as the parasite is endemic over vast areas of low income countries where there may be limited resources for control. In some areas, such as former communist administered countries, the parasite is resurgent. New tools are becoming available to control the parasite, including a highly effective vaccine in sheep which prevents the infection in sheep and breaks the transmission cycle. In addition cost effective methods are being developed which may be appropriate in low income countries where financial resources are not available for intensive control programmes that have been successful in high income countries.

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