The first human case of multilocular Echinococcosis recognized in Serbia

Abstract

Introduction. Echinococcus multilocularis causes multilocular or alveolar echinococcosis, which differs from infection caused by Echinococcus granulosus in clinical presentation in humans. The most common definitive hosts for E. multilocularis are foxes and jackals, while domestic mammals like dogs and cats are rare. Humans are rare and accidental intermediate hosts. Cystic echinococcosis in humans is endemic in Serbia, while more severe alveolar echinococcosis has not yet been recorded. Case outline. We present a case of a 67-year-old female from a small village in the Sremska Mitrovica municipality. The onset of symptoms was several years ago, with liver pain which progressed over time. Differential diagnoses included benign liver tumors like haemangioma, cystic echinococcosis and abscess formed in the cystic echinococcal lesion. Left lateral hepatectomy was performed, and S II/III liver segments were removed. Pathological examination showed numerous small empty vesicle spaces with chitin membrane without protoscolices, surrounded by massive fibrosis and infiltrative growth into the liver parenchyma, all indicative marks of multilocular echinococcosis. Surgical margins were found positive for echinococcal vesicles showing that echinococcal tissue was not completely removed. Thus albendazole therapy was introduced. Epidemiological interview revealed that the patient lived in an endemic region of multilocular echinococcosis, in a house with two hunting dogs and backyard where contamination of soil with fox feces could occur. Conclusion. This is the first case of human multilocular echinococcosis recorded in Serbia, which should alert the medical community to improve prophylactic and diagnostic procedures and surgical techniques to better manage this zoonotic disease.