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Journal ArticleDOI

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

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)

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 ArticleDOI
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 ChapterDOI
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 ArticleDOI
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....

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  • ...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)....

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  • ...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....

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  • ...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)....

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  • ...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)....

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Journal ArticleDOI
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 ArticleDOI
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
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Journal ArticleDOI
TL;DR: The computer tomographic appearances and differential diagnosis in 22 patients with echinococcosis are described; of these, twelve were of the cystic and ten of the alveolar type and the absence of CT evidence of partial necrosis and calcification of the pseudotumour makes it difficult to establish a specific diagnosis.
Abstract: The computer tomographic appearances and differential diagnosis in 22 patients with echinococcosis are described; of these, twelve were of the cystic and ten of the alveolar type. The computer tomographic appearances are characterised by the presence of daughter cysts (66%) within the sharply demarkated parasitic cyst of water density. In the absence of daughter cysts, a definite aetiological diagnosis cannot be made, although there is a tendency to calcification of the occasionally multiple echinococcus cysts. The computer tomographic appearances of advanced alveolar echinococcosis are characterised by partial collequative necrosis, with calcification around the necrotic areas (90%). The absence of CT evidence of partial necrosis and calcification of the pseudotumour makes it difficult to establish a specific diagnosis. The conclusive and non-invasive character of the procedure and its reproducability makes computer tomography the method of choice for the diagnosis and follow-up of echinococcosis.

11 citations


Additional excerpts

  • ...Both methods are very sensitive in diagnosing liver echinococcosis (HAERTEL et al., 1980; Orro et al., 1982)....

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Journal Article

11 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)....

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

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  • ...…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....

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  • ...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)....

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Journal Article
TL;DR: The latter includes a new technique for serological differential diagnosis of cystic and alveolar echinococcosis, the determination of parasite-specific immunoglobulin classes and circulating antigens in ELISA, and the introduction of arc-5 detection in routine serodiagnosis.
Abstract: The following new aspects of cystic and alveolar echinococcosis (= infections with the metacestode stages of Echinococcus granulosus and E. multilocularis respectively) are reported: identification of a Swiss E. granulosus isolate as "cattle strain" which differs from the "sheep strain"; new observations on proliferation and metastasis formation of larval E. multilocularis; information on chemotherapy of human echinococcosis; recent developments in immunoserology. The latter includes a new technique for serological differential diagnosis of cystic and alveolar echinococcosis, the determination of parasite-specific immunoglobulin classes (IgG, IgM, IgA and IgE) and circulating antigens in ELISA, and the introduction of arc-5 detection in routine serodiagnosis. A highly purified, species-specific antigen from E. multilocularis is now available for seroepidemiological studies.

9 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)....

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

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Journal ArticleDOI
TL;DR: Comparing the two methods in 29 patients with manifestations of hepatic involvement by echinococcosis it was demonstrated that ultrasound is only slightly inferior, in cases of small-size involvement, which fails to be diagnosed as focal disease of the liver parenchyma.
Abstract: Hepatic echinococcosis generally gives rise to typical signs by ultrasound and computed tomography, even though a relatively large number of conditions has to be considered in the differential diagnosis. Comparing the two methods in 29 patients with manifestations of hepatic involvement by echinococcosis it was demonstrated that ultrasound is only slightly inferior, in cases of small-size involvement, which fails to be diagnosed as focal disease of the liver parenchyma. But ultrasound is the primary method of investigation, especially when the differential diagnosis is still open, and it is preferred for serial studies during and after treatment. Computed tomography is the method of choice particularly when it is necessary pre-operatively to document involvement beyond the liver itself.

5 citations


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

  • ...US, however, is slightly inferior to CT when imaging lesions of small size in the liver (OTTO et al., 1982)....

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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.