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Echinococcosis – Causes, Symptoms and Treatment

Echinococcosis is a parasitic disease caused by larval tapeworms of the genus Echinococcus, which can form cysts or infiltrates in internal organs.

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Things worth knowing about "Echinococcosis"

Echinococcosis is a parasitic disease caused by larval tapeworms of the genus Echinococcus, which can form cysts or infiltrates in internal organs.

What is Echinococcosis?

Echinococcosis is a parasitic infection caused by the larval stage of tapeworms belonging to the genus Echinococcus. Humans are considered accidental hosts, as they do not play a role in the natural life cycle of the parasite. Two main forms are clinically significant: cystic echinococcosis (caused by Echinococcus granulosus) and alveolar echinococcosis (caused by Echinococcus multilocularis).

Causes and Transmission

Humans become infected by accidentally ingesting tapeworm eggs, typically through:

Close contact with infected dogs, foxes, or wolves (definitive hosts)
Consuming raw or unwashed fruits, vegetables, or wild plants contaminated with feces from infected animals
Contact with contaminated soil or water

Cystic echinococcosis occurs worldwide, particularly in rural areas of South America, Africa, the Middle East, and Central Asia. Alveolar echinococcosis is mainly found in the northern hemisphere, including Central Europe, Russia, China, and North America.

Symptoms

The disease is often asymptomatic for years or even decades, as larvae grow slowly. When symptoms do appear, they depend on the organ involved:

Cystic Echinococcosis

Pressure or pain in the upper right abdomen (liver involvement)
Cough, chest pain, or shortness of breath (lung involvement)
Allergic reactions up to anaphylactic shock in the event of cyst rupture

Alveolar Echinococcosis

Liver pain, jaundice, and weight loss
Tumor-like, invasive growth of larvae within liver tissue
In advanced stages: liver failure and spread to other organs

Diagnosis

Diagnosis of echinococcosis is based on a combination of methods:

Imaging: Ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) to visualize cysts or infiltrates
Serological tests: Detection of specific antibodies in the blood (e.g., ELISA, immunoblot)
Medical history: Travel to endemic regions and animal contact

Biopsy of the cyst is generally avoided due to the risk of rupture and anaphylactic reactions.

Treatment

Treatment depends on the form of echinococcosis, the location of the lesion, and the extent of the disease.

Medical Therapy

Albendazole, an anthelmintic (antiparasitic) drug, is the first-line medication. It inhibits larval growth and is often used long-term, frequently in combination with other treatment approaches.

PAIR Technique (Cystic Echinococcosis)

The PAIR method (Puncture, Aspiration, Injection, Re-Aspiration) is a minimally invasive procedure in which the cyst is punctured, its contents aspirated, and a scolicidal agent injected to kill the parasite.

Surgical Treatment

In complicated cases or for alveolar echinococcosis, surgical removal of the affected tissue is the preferred approach. In advanced alveolar echinococcosis, liver transplantation may be necessary.

Prevention

Regular deworming of dogs and cats
Thorough washing of hands, fruits, vegetables, and wild plants
Avoiding consumption of raw offal (e.g., during hunting)
Avoiding direct contact with wildlife such as foxes without protective measures

References

World Health Organization (WHO) - Echinococcosis Fact Sheet, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/echinococcosis
Robert Koch Institut (RKI) - Echinococcosis Profile, 2022. Available at: https://www.rki.de
Brunetti E, Kern P, Vuitton DA - Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Tropica, 2010; 114(1): 1-16.

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