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Journal Article•DOI•

Sero-epidemiological survey for alveolar echinococcosis (by Em2-ELISA) of blood donors in an endemic area of Switzerland

Bruno Gottstein1, Christian Lengeler, Pierre Bachmann2, Peter Hagemann, Pierre Kocher, Michel Brossard, Felix Witassek1, Johannes Eckert1 •
University of Zurich1, Swiss Red Cross2
01 Nov 1987-Transactions of The Royal Society of Tropical Medicine and Hygiene (Oxford University Press)-Vol. 81, Iss: 6, pp 960-964
TL;DR: Sera from 17,166 blood donors living in 10 cantons of northern Switzerland in an area endemic for Echinococcus multilocularis were investigated by serological survey for alveolar echinococcosis, finding 2 asymptomatic clinical cases of AE within this population of blood donors.
Abstract: Sera from 17 166 blood donors living in 10 cantons of northern Switzerland in an area endemic for Echinococcus multilocularis were investigated by serological survey for alveolar echinococcosis (AE). A highly species-specific antigen (Em2) and a commonly used E. granulosus hydatid fluid antigen (EgHF) were compared for their suitability in seroepidemiology. EgHF showed a degree of nonspecificity which did not allow direct detection of AE cases. Antibody reaction with Em2 resulted in the detection of 2 asymptomatic clinical cases of AE (seroprevalence 0·01%) within this population of blood donors. A further 4 persons were positive in Em2-ELISA. These 4 persons had negative imaging studies and will be followed serologically and clinically.

Summary (1 min read)

Jump to: [BRUNO GOTTSTEIN~, CHRISTIAN LENGELER', PIERRE BACHMANN~, PETER HAGEMANN~, PIERRE KOCHER~, MICHEL BROSSARD’, FELIX WITASSEK' AND JOHANNES ECKERT’] – [962 SEROEPIDEMIOLOGY OF ALVEOLAR ECHINOCOCCOSIS] and [964 SEROEPIDEMIOLOGY OF ALVEOLAR ECHINOCOCCOSIS]

BRUNO GOTTSTEIN~, CHRISTIAN LENGELER', PIERRE BACHMANN~, PETER HAGEMANN~, PIERRE KOCHER~, MICHEL BROSSARD’, FELIX WITASSEK' AND JOHANNES ECKERT’

  • A highly species-specific antigen (Em2) and a commonly used E. granulosus hydatid fluid antigen (EgHF) were compared for their suitability in seroepidemiology.
  • Further sera were obtained from 5166 healthy blood donors originating from 2 other cantons (Jura including Jura bernois, Neuchatel) of the endemic area (Fig. 1).
  • 4 persons had negative imaging studies and will be followed closely with periodic serology and US/CT studies.

962 SEROEPIDEMIOLOGY OF ALVEOLAR ECHINOCOCCOSIS

  • @ Villages screened by mobile Bquipes for blood donation performances.
  • The use of Em2 for immunodiagnosis of AE has been assessed in a pilot study in Alaska (GOTTSTEIN et uE., 1985; SCHANTZ & GOTTSTEIN, 1986), which showed that lesions were detectable by Em2 which were not indicated by EgHF.
  • One patient (G.A.), although asymptomatic, unfortunately had already reached an advanced stage of the disease and was considered to be inoperable.
  • Such positive antibody responses in asymptomatic persons without liver lesions may be due to early or abortive E. multilocularis infections, or possibly to challenge with eggs which did not develop into metacestodes.
  • The total number of inhabitants of the age allowing.

964 SEROEPIDEMIOLOGY OF ALVEOLAR ECHINOCOCCOSIS

  • Blood donation in the whole area of the present survey was estimated to be about 1 million.
  • Serological screening with Em2-ELISA will detect all persons infected with E. muZtiZocuZaris, especially early asymptomatic AE cases, which, if not detected by serology in a preclinical stage, may develop into symptomatic clinical cases of AE.
  • An international study on the serological differential diagnosis of human and alveolar echinococcosis.

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Citations
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Journal Article•DOI•
Biological, Epidemiological, and Clinical Aspects of Echinococcosis, a Zoonosis of Increasing Concern

[...]

Johannes Eckert1, Peter Deplazes1•
University of Zurich1
01 Jan 2004-Clinical Microbiology Reviews
TL;DR: Various aspects of human echinococcosis are discussed in this review, including data on the infectivity of genetic variants of E. granulosus to humans, the increasing invasion of cities in Europe and Japan by red foxes, the main definitive hosts ofE.
Abstract: Echinococcosis in humans is a zoonotic infection caused by larval stages (metacestodes) of cestode species of the genus Echinococcus. Cystic echinococcosis (CE) is caused by Echinococcus granulosus, alveolar echinococcosis (AE) is caused by E. multilocularis, and polycystic forms are caused by either E. vogeli or E. oligarthrus. In untreated cases, AE has a high mortality rate. Although control is essentially feasible, CE remains a considerable health problem in many regions of the northern and southern hemispheres. AE is restricted to the northern hemisphere regions of North America and Eurasia. Recent studies have shown that E. multilocularis, the causative agent of AE, is more widely distributed than previously thought. There are also some hints of an increasing significance of polycystic forms of the disease, which are restricted to Central and South America. Various aspects of human echinococcosis are discussed in this review, including data on the infectivity of genetic variants of E. granulosus to humans, the increasing invasion of cities in Europe and Japan by red foxes, the main definitive hosts of E. multilocularis, and the first demonstration of urban cycles of the parasite. Examples of emergence or reemergence of CE are presented, and the question of potential spreading of E. multilocularis is critically assessed. Furthermore, information is presented on new and improved tools for diagnosing the infection in final hosts (dogs, foxes, and cats) by coproantigen or DNA detection and the application of molecular techniques to epidemiological studies. In the clinical field, the available methods for diagnosing human CE and AE are described and the treatment options are summarized. The development of new chemotherapeutic options for all forms of human echinococcosis remains an urgent requirement. A new option for the control of E. granulosus in the intermediate host population (mainly sheep and cattle) is vaccination. Attempts are made to reduce the prevalence of E. multilocualaris in fox populations by regular baiting with an anthelmintic (praziquantel). Recent data have shown that this control option may be used in restricted areas, for example in cities, with the aim of reducing the infection risk for humans.

1,591 citations

Cites background from "Sero-epidemiological survey for alv..."

  • ...Older data from Austria, Germany, France, and Switzerland have indicated that persons working in agriculture were at increased risk of infection (57, 110)....

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  • ...Biological, Epidemiological, and Clinical Aspects of Echinococcosis, a Zoonosis of Increasing Concern Johannes Eckert* and Peter Deplazes Institute of Parasitology, University of Zurich, CH-8057 Zurich, Switzerland INTRODUCTION .......................................................................................................................................................108 E. GRANULOSUS AND CYSTIC ECHINOCOCCOSIS........................................................................................108 The Parasite and Its Life Cycle ............................................................................................................................108 Cystic Echinococcosis in Humans ........................................................................................................................109 Course of infection..............................................................................................................................................109 Diagnosis..............................................................................................................................................................111 Treatment.............................................................................................................................................................112 (i) Surgery........................................................................................................................................................112 (ii) Puncture-aspiration-injection-reaspiration ..........................................................................................112 (iii) Percutaneous thermal ablation.............................................................................................................113 (iv) Chemotherapy ..........................................................................................................................................113 E. granulosus Infection in Animals .......................................................................................................................114 Defintive hosts .....................................................................................................................................................114 Intermediate hosts ..............................................................................................................................................114 Epidemiology ...........................................................................................................................................................114 Life cycle patterns...............................................................................................................................................114 Transmission dynamics......................................................................................................................................115 Infection risk for humans..................................................................................................................................115 Global distribution of E. granulosus and CE in humans ..............................................................................116 Factors associated with persistence, emergence, or reemergence................................................................117 Examples of emergence or reemergence ..........................................................................................................117 Control Options and Prevention ..........................................................................................................................117 E. MULTILOCULARIS AND ALVEOLAR ECHINOCOCCOSIS ........................................................................118 The Parasite and Its Life Cycle ............................................................................................................................118 Alveolar Echinococcosis in Humans ....................................................................................................................118 Course of infection..............................................................................................................................................118 Diagnosis..............................................................................................................................................................119 Treatment.............................................................................................................................................................120 (i) Surgery........................................................................................................................................................120 (ii) Chemotherapy...........................................................................................................................................120 E. multilocularis Infection in Animals ..................................................................................................................121 Defintive hosts .....................................................................................................................................................121 Intermediate and aberrant hosts......................................................................................................................121 Epidemiology ...........................................................................................................................................................121 Parasite-host assemblages .................................................................................................................................121 (i) Arctic region...............................................................................................................................................122 (ii) Sub-Arctic regions....................................................................................................................................122 Influences of landscape characters and rodent populations ........................................................................123 (i) Factors related to larger regions ............................................................................................................123 (ii) Factors related to macro- and microfoci ..............................................................................................123 Eggs in the environment ....................................................................................................................................123 Infection risk for humans..................................................................................................................................124 Global distribution in humans .........................................................................................................................124 Emergence and spread of E. multilocularis?....................................................................................................124 (i) Risk areas and spreading.........................................................................................................................124 (ii) AE in humans as a risk indicator .........................................................................................................125 (iii) Increasing fox populations and parasite prevalences........................................................................125 (iv) Invasion of urban areas by foxes ..........................................................................................................126 (v) Potential modes of spreading..................................................................................................................126 Control Options and Prevention ..........................................................................................................................126 Control in definitive hosts .................................................................................................................................126 * Corresponding author....

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  • ...For example, prevalences up to 21 and 39% have been recorded in two studies of water voles (Arvicola terrestris) in high-endemicity foci in Switzerland (89, 188) and prevalances of 12 to 14% have been recorded in Microtus arvalis in a focus in France (79)....

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  • ...In Zurich, Switzerland, high contamination with fox feces was found in the recreational area, and it was observed that foxes deposit their feces directly on ground systems of A. terrestris (38)....

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  • ...By the end of the 1980s, areas of endemic infection with E. multilocularis were known to exist in only four countries (Austria, France, Germany, and Switzerland), but by the end of 2001 the parasite was known to occur in red foxes in at least nine further central European countries (Belgium, Czech Republic, Denmark, Italy, Liechtenstein, Luxembourg, Poland, Slovak Republic, and The Netherlands) (references 51, 58, and 173 and references therein)....

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Book Chapter•DOI•
Detection, screening and community epidemiology of taeniid cestode zoonoses: cystic echinococcosis, alveolar echinococcosis and neurocysticercosis.

[...]

Philip S. Craig1, M.T. Rogan1, J C Allan1•
University of Salford1
01 Jan 1996-Advances in Parasitology
TL;DR: The chapter addresses the problem of neurocysticercosis and epilepsy in developing countries particularly Latin America and its public health consequences in the USA and elsewhere.
Abstract: Publisher Summary This chapter focuses on the public health importance of taeniid cestode zoonoses especially cystic echinococcosis, alveolar echinococcosis and T. solium cysticercosis. The chapter addresses the problem of neurocysticercosis and epilepsy in developing countries particularly Latin America and its public health consequences in the USA and elsewhere. E. multilocularis , which is the cause of one of the most pathogenic of all human parasitic infections, appears to be spreading in parts of western Europe, USA, and Japan. The remarkable development in the past 20 years or so of high resolution imaging technologies, such as computerized tomography (CT) scan and ultrasound have enabled precision detection of taeniid larval cystic infection in humans. Coupled with improvements in immunodiagnostic test sensitivity and antigen specificity, diagnosis of cestode zoonoses is now more accurate than ever before. Although further developments in immunodiagnosis are required, laboratory tests have provided improved capability for screening populations in both epidemiological and community studies. Parallel and recent development of genus specific coproantigen tests for human taeniasis and canine echinococcosis have also provided major new tools for epidemiological and surveillance programs.

213 citations

Journal Article•DOI•
Epidemiology of alveolar echinococcosis with particular reference to China and Europe.

[...]

Dominique-Angèle Vuitton1, H. Zhou1, Solange Bresson-Hadni1, Qian Wang1, Martine Piarroux1, Francis Raoul1, Patrick Giraudoux1 •
University of Franche-Comté1
01 Oct 2003-Parasitology
TL;DR: Improved diagnostic technology, as well as a real increase in the infection rate and an extension to new areas, can explain that more than 500 cases of alveolar echinococcosis have been reported for these 2 decades while less than 900 cases were published for the previous 7 decades.
Abstract: Human alveolar echinococcosis (AE), caused by the metacestode of the fox tapeworm Echinococcus multilocularis, is the most pathogenic zoonosis in temperate and arctic regions of the northern hemisphere. Prospective collection of human cases in some areas and mass screenings using ultrasound imaging and confirmation with serological techniques have markedly improved our knowledge of the epidemiology of the disease in humans during the past two decades. Transmission occurs when eggs of the tapeworm, excreted by the final hosts (usually foxes but also dogs, wolves and cats), are ingested accidentally by humans or during normal feeding by a variety of rodents and small lagomorphs. However, the species of host animals differ according to regional changes in mammalian fauna. This review mostly focuses on epidemiology of alveolar echinococcosis in those parts of the world where new and more accurate epidemiological data are now available, i.e. China and Europe, as well as on new epidemiological trends that can be suspected from recent case reports and/or from recent changes in animal epidemiology of E. multilocularis infection. The People's Republic of China (PRC) is a newly recognized focus on AE in Asia. Human AE cases were firstly recognized in Xinjiang Uygur Autonomous Region and Qinghai Provinces at the end of 1950s and infected animals were first reported from Ningxia in central China and northeast of Inner Mongolia in the 1980s. E. multilocularis (and human cases of AE) appears to occur in three areas: (1) Northeastern China (northeast focus): including Inner Mongolia Autonomous region and Heliongjiang Province (2) Central China (central focus): including Gansu Province, Ningxia Hui Autonomous Region, Sichuan Province, Qinghai Province and Tibet Autonomous Region and (3) Northwestern China: including Xinjiang Uygur Autonomous Region, bordered with Mongolia, Russia, Kazakhstan and Kyrgyzstan. The highest prevalence of the disease, up to 15 per cent of the population in some villages, is reached in China. In Europe, data from the European Echinococcosis Registry (EurEchinoReg: 1982-2000) show 53 autochthonous cases of AE in Austria, 3 in Belgium, 235 in France, 126 in Germany, 1 in Greece, and 112 in Switzerland, and 15 'imported' cases, especially from central Asia; 14 cases were collected in Poland, a country not previously considered endemic for AE. Improved diagnostic technology, as well as a real increase in the infection rate and an extension to new areas, can explain that more than 500 cases have been reported for these 2 decades while less than 900 cases were published for the previous 7 decades. New epidemiological trends are related to an unprecedented increase in the fox population in Europe, to the unexpected development of urban foxes in Japan and in Europe, and to changes in the environmental situation in many countries worldwide due to climatic or anthropic factors which might influence the host-predator relationship in the animal reservoir and/or the behavioural characteristics of the populations in the endemic areas.

199 citations

Cites background from "Sero-epidemiological survey for alv..."

  • ...Sero-epidemiological survey for alveolar echinococcosis (by Em2-ELISA) of blood donors in an endemic area of Switzerland....

    [...]

  • ...Between 1980 and 2000, autochthonous human cases of AE have been documented and published from several European countries, namely Austria, France, Germany, Switzerland and the European part of Turkey (see Bresson-Hadni et al. 1988, 1997, 2000; Stössel, 1989; Vuitton et al. 1990; Schantz et al. 1995; Ammann&Eckert, 1995; Eckert, 1997; Eckert & Deplazes, 1999; Eckert et al. 2001)....

    [...]

  • ...Mass screenings performed at the middle of the 1980s in the endemic areas of Franche-Comté (east of France at the border with Switzerland), which disclosed several cases within 5 years and more generally raised the awareness of the disease in this region, might explain the observed increase in the number of cases in France....

    [...]

  • ...A concomitant increase in fox populations has been observed in several countries of Europe since the beginning of the 1990s: regionally in Spain, Bulgaria, Sweden, France, Germany, Switzerland, Belgium and Czech Republic (Artois, 1997; Chautan, Pontier & Artois, 2000), a combination of rabies vaccination and modification in human-fox interactions (fox control, habitat changes) may account for higher survival and fertility (Chautan et al. 2000)....

    [...]

  • ...In fact, taking the population size in the two counties into account, the prevalence rate may be estimated to be 200 per 100000 inhabitants in comparison to 65 per 100 000 in St Lawrence (Alaska), 10 per 100 000 in Franche-Comté (eastern France) or in northern Switzerland (Schantz et al. 1995; Bresson-Hadni et al. 1997; Eckert, 1997)....

    [...]

Journal Article•DOI•
An epidemiological and ecological study of human alveolar echinococcosis transmission in south Gansu, China

[...]

Philip S. Craig1, Patrick Giraudoux, Dazhong Shi, Brigitte Bartholomot, G. Barnish2, Pierre Delattre3, Jean-Pierre Quéré3, S Harraga, Genshu Bao, Yunhai Wang4, F. Lu, Akira Ito5, Dominique-Angèle Vuitton •
University of Salford1, Liverpool School of Tropical Medicine2, University of Montpellier3, Xinjiang Medical University4, Asahikawa Medical College5
02 Nov 2000-Acta Tropica
TL;DR: Long-term transmission of Echinococcus multilocularis and risk of zoonotic infection of south Gansu farmers may be related ultimately to a process of deforestation driven by agriculture and subsequent development of a peri-domestic cycle involving dogs.

187 citations

Journal Article•DOI•
A large focus of alveolar echinococcosis in central China.

[...]

Philip S. Craig1, Liu Deshan, Calum N. L. Macpherson2, Shi Dazhong2, D. Reynolds3, Guy Barnish3, Bruno Gottstein4, Wang Zhirong •
University of Salford1, University of the West Indies2, Liverpool School of Tropical Medicine3, University of Zurich4
03 Oct 1992-The Lancet
TL;DR: The high prevalence of human AE in this region of central China is most probably due to semi-domestic transmission of E multilocularis between wild rodents and dogs, together with the poverty and poor hygiene in these rural communities.

162 citations

References
More filters
Journal Article•DOI•
Serological screening for Echinococcus multilocularis infections with ELISA.

[...]

Bruno Gottstein, P.M. Schantz1, Joseph F. Wilson2•
Centers for Disease Control and Prevention1, Alaska Native Medical Center2
11 May 1985-The Lancet

40 citations

Journal Article•
An international study on the serological differential diagnosis of human cystic and alveolar echinococcosis.

[...]

Bruno Gottstein, Peter M. Schantz, Todor Todorov, Adrien G. Saimot, Patrick Jacquier 
01 Jan 1986-Bulletin of The World Health Organization
TL;DR: An enzyme-linked immunosorbent assay for the serological differentiation of cystic (Echinococcus granulosus) and alveolar (E. multilocularis) echinococcosis in man has been evaluated and found to be suitable for immunodiagnostic purposes as well as for seroepidemiological studies.
Abstract: An enzyme-linked immunosorbent assay (ELISA) for the serological differentiation of cystic (Echinococcus granulosus) and alveolar (E. multilocularis) echinococcosis in man has been evaluated. A discrimination rate of 95.1% was found for 82 sera from patients of geographically disparate endemic areas. This rate was essentially the same as that found for 57 Swiss patients, indicating that inter- and intraspecific strain differences do not influence the test results. The assay method is suitable for immunodiagnostic purposes as well as for seroepidemiological studies.

33 citations

"Sero-epidemiological survey for alv..." refers background in this paper

  • ...For EgHF-ELISA, the sensitivity was 91% (GOTTSTEIN et al., 1986b), and the specificity with regard to an adult healthy Swiss population was 93.6% (ST~~RCHLER et al., 1986)....

    [...]

  • ...(GOTTSTEIN et al., 1983; 1986a; GoreSTEIN, 1985)....

    [...]

Journal Article•DOI•
Problems of epidemiology and prophylaxis of alveococcosis (multilocular echinococcosis): A general review—with particular reference to the U.S.S.R.

[...]

N.P. Lukashenko
01 Sep 1971-International Journal for Parasitology
TL;DR: Prophylactic measures differ markedly from those for (unilocular) echinococcosis, and must be directed towards eliminating the possibility of infecting definitive hosts and towards increased hygiene education.

29 citations

"Sero-epidemiological survey for alv..." refers background in this paper

  • ...The spontaneous death of larval E. multilocularis, which is known to occur in animals with high natural resistance against this parasite, like cattle and sheep (LUKASHENKO, 1971), was also postulated for humans but has never yet been demonstrated....

    [...]

Journal Article•
[Echinococcosis in humans in Switzerland 1956-1969].

[...]

Drolshammer I, Wiesmann E, Eckert J
29 Sep 1973-Schweizerische Medizinische Wochenschrift

18 citations

"Sero-epidemiological survey for alv..." refers background in this paper

  • ...Between 1956 and 1969 an annual average of 8.7 new cases of AE was diagnosed, amounting to 122 cases (DROLSHAMMER et al., 1973)....

    [...]

  • ...In Switzerland the epidemiological situation is comnlicated bv the fact that E. multiloculuris and E. grunulosus occur sympatrically (ECKERT, 1970; DROLSHAMMER et al., 1973)....

    [...]

  • ...…donors were obtained between September 1984 and March 1985 from 9 cantons of northern Switzerland (Aargau, 1495; Appenzell, 109; Basel, 2370; Bern, 279; Schaffhausen, 1158; Solothurn, 197; St Gallen, 369; Thurgau, 4932; Zurich, 1091) which are endemic areas of AE (DROLSHAMMER et al., 1973) (Fig....

    [...]

  • ...This, however, is not very likely because primary lesions of AE are located in the liver in 98% to 100% of cases (DROLSHAMMER et al., 1973)....

    [...]

Journal Article•
Epidemiological aspects of toxocariasis in Switzerland

[...]

Stürchler D, Bruppacher R, Speiser F
16 Aug 1986-Schweizerische Medizinische Wochenschrift
TL;DR: In the regions of Basel, Jura and Zürich (Switzerland) 765 blood donors completed a questionnaire with respect to symptoms, animal contacts and occupation, and their sera were tested for antibodies to tissue helminths in ELISA.
Abstract: In the regions of Basel, Jura and Zurich (Switzerland) 765 blood donors completed a questionnaire with respect to symptoms, animal contacts and occupation, and their sera were tested for antibodies to tissue helminths in ELISA. 5.1%, 3.3% and 6.5% exhibited antibodies solely to the respective antigens of Toxocara canis, Fasciola hepatica, and Echinococcus granulosus. Combined seroreactions were mainly observed between F. hepatica and E. granulosus antigens. Reactivity to T. canis antigen was associated with animal contacts at work, as well as contacts with cattle and sheep but not dogs or cats. Toxocara antibodies were found in all age groups. Their prevalence varied markedly by region.

18 citations

Related Papers (5)
Spontaneous death of Echinococcus multilocularis: cases diagnosed serologically (by Em2 ELISA) and clinical significance.

[...]

01 May 1987-American Journal of Tropical Medicine and Hygiene
Robert L. Rausch, Joseph F. Wilson, Peter M. Schantz, Brian J. McMahon 
Serological differentiation between Echinococcus granulosus and E. multilocularis infections in man.

[...]

01 Jan 1983-Parasitology Research
Bruno Gottstein, Johannes Eckert, Hans Fey
Seroepidemiologic screening of Echinococcus multilocularis infection in a European area endemic for alveolar echinococcosis

[...]

01 Dec 1994-American Journal of Tropical Medicine and Hygiene
Solange Bresson-Hadni, Jean-Jacques Laplante, D. Lenys, Paul Rohmer, Bruno Gottstein, Patrick Jacquier, Philippe Mercet, Jean-Philippe Meyer, Jean-Philippe Miguet, Dominique-Angèle Vuitton 
Improved primary immunodiagnosis of alveolar echinococcosis in humans by an enzyme-linked immunosorbent assay using the Em2plus antigen.

[...]

01 Feb 1993-Journal of Clinical Microbiology
Bruno Gottstein, P Jacquier, S Bresson-Hadni, J Eckert 
Purification and characterization of a specific antigen from Echinococcus multilocularis.

[...]

01 May 1985-Parasite Immunology
Bruno Gottstein
Frequently Asked Questions (1)
Q1. What are the contributions in "Sero-epidemiological survey for alveolar echinococcosis (by em2-elisa) of blood donors in an endemic area of switzerland" ?

Gottstein et al. this paper compared a highly species-specific antigen ( Em2 ) and a commonly used E. granulosus hydatid fluid antigen ( EgHF ) for their suitability in seroepidemiology.