Echinococcus Infection Research Articles

A phase 2a clinical study on the safety and efficacy of individualized dosed mebendazole in patients with advanced gastrointestinal cancer

Mebendazole is used extensively for treatment of local gut helminthic and invasive echinococcus infections. Anticancer effects of mebendazole have been shown in experimental cancer models and in case studies in patients with advanced cancer. Given these observations, the aims of this study were to investigate safety and efficacy of individualized dosed mebendazole in the cancer indication. Patients with treatment refractory gastrointestinal cancer were treated with individualized dose adjusted mebendazole up to 4 g/day to target a serum concentration of 300 ng/ml. Efficacy and safety were assessed by CT-scans, clinical surveillance and blood sampling. Eleven patients were included in the study and 10 started the treatment phase. Two patients stopped treatment prior to and the remaining eight after tumour evaluation by CT-scan at 8 weeks, all due to progressive disease. Four patients also fulfilled criteria suggested for hyperprogression. Only five patients reached the target serum-mebendazole concentration. No severe adverse effects were observed. Individualized dose adjusted mebendazole is safe and well tolerated in patients with advanced cancer but all patients experienced rapid progressive disease. New approaches such as prodrug development and combination with other anticancer drugs seem needed for further exploration of mebendazole as an anticancer drug.

Meta-analysis of the prevalence of Echinococcus in dogs in China from 2010 to 2019.

BackgroundEchinococcosis (canine Echinococcus disease) is a neglected tropical disease that causes serious public harm. Dogs, as a terminal host of Echinococcus spp., are a key part of the Echinococcus epidemic. Echinococcosis spreads easily in humans and animals in some areas of China and it is therefore necessary to fully understand the prevalence of Echinococcus spp. in dogs.Methodology/Principal findingsPubMed, ScienceDirect, Chongqing VIP, China National Knowledge Infrastructure (CNKI), and WanFang databases were searched for relevant articles published in the past 10 years. A final total of 108 studies were included. The overall prevalence of Echinococcus spp. in dogs in China was 7.3%, with the highest point estimate found in sampling year 2015 (8.2%) and publication year 2015 (16.5%). Northwestern China (7.9%) had the highest infection rate in China. Qinghai Province (13.5%) showed the highest prevalence among the 11 provinces we included. We also found that geographical and climatic factors are related to the incidence of canine echinococcosis. We further investigated the source of heterogeneity by analysis of subgroups (sampling district, detection method, dog type, season, parasite species, medication, and study quality level).Conclusions/SignificanceOur research indicated that Echinococcus spp. were still prevalent in some areas in China. More localized prevention and control policies should be formulated, including improving drinking water hygiene and strengthening hygiene promotion. We recommend the rational use of anti-Echinococcus drugs. In addition, treatment of livestock offal and feces and improving the welfare of stray dogs may play an important role in reducing canine Echinococcus infections.

Evaluation of fecal immunoassays for canine Echinococcus infection in China.

Human echinococcosis is present worldwide but it is in China that disease prevalence is the highest. In western China, especially in the Tibetan Plateau, the burden of echinococcosis is the most important. Dogs are a major definitive host of Echinococcus and monitoring the presence of Echinococcus worms in dogs is therefore essential to efficiently control the disease. Detection kits based on three different technologies including sandwich ELISA, (indirect) ELISA, and gold immunodiffusion, are currently marketed and used in China. The objective of this work was to assess the efficacy of these kits, in particular with respect to sensitivity and specificity. Four fecal antigen detection kits for canine infection reflecting the three technologies were obtained from companies and tested in parallel on 220 fecal samples. The results indicate that the performance is lower than expected, in particular in terms of sensitivity. The best results were obtained with the sandwich ELISA technology. The gold immunofiltration yielded the poorest results. In all cases, further development is needed to improve the performance of these kits which are key components for the control of echinococcosis.

Identification of candidate biomarkers of liver hydatid disease via microarray profiling, bioinformatics analysis, and machine learning

ObjectivesLiver echinococcosis is a severe zoonotic disease caused by Echinococcus (tapeworm) infection, which is epidemic in the Qinghai region of China. Here, we aimed to explore biomarkers and establish a predictive model for the diagnosis of liver echinococcosis.MethodsMicroarray profiling followed by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis was performed in liver tissue from patients with liver hydatid disease and from healthy controls from the Qinghai region of China. A protein–protein interaction (PPI) network and random forest model were established to identify potential biomarkers and predict the occurrence of liver echinococcosis, respectively.ResultsMicroarray profiling identified 1152 differentially expressed genes (DEGs), including 936 upregulated genes and 216 downregulated genes. Several previously unreported biological processes and signaling pathways were identified. The FCGR2B and CTLA4 proteins were identified by the PPI networks and random forest model. The random forest model based on FCGR2B and CTLA4 reliably predicted the occurrence of liver hydatid disease, with an area under the receiver operator characteristic curve of 0.921.ConclusionOur findings give new insight into gene expression in patients with liver echinococcosis from the Qinghai region of China, improving our understanding of hepatic hydatid disease.

Spatial distribution of canine echinococcosis in Inner Mongolia Autonomous Region from 2012 to 2018

To investigate the distribution and changing trend of canine echinococcosis in Inner Mongolia Autonomous Region, so as to provide the scientific evidence for prevention and control of canine echinococcosis in high-risk areas of Inner Mongolia Autonomous Region. All data pertaining to Echinococcus infections in canine feces and sampling survey of human echinococcosis were collected from the echinococcosis-endemic foci of Inner Mongolia Autonomous Region from 2012 to 2018, and the prevalence of Echinococcus infections was investigated in dogs and humans. In addition, the spatial distribution characteristics and clusters of canine echinococcoses were identified. A total of 164 139 canine fecal samples were detected in the echinococcosis-endemic foci of Inner Mongolia Autonomous Region from 2012 to 2018, and there were 2 136 fecal samples positive for Echinococcus coproantigens. The positive rates of Echinococcus coproantigens were 0.54% to 1.73% in dogs from 2012 to 2018, with a tendency towards a decline seen in the prevalence of Echinococcus infections in dogs (χ2 = 108.83, P < 0.01), and there was a significant difference in the positive rate of Echinococcus coproantigens in dogs among years (χ2 = 155.27, P < 0.01). Three-dimensional trend analysis showed that canine echinococcosis was mainly concentrated in east of central Inner Mongolia Autonomous Region, and a high prevalence was detected in New Barag Right Banner and Sonid Right Banner. The global spatial distribution of canine echinococcosis appeared a random pattern in Inner Mongolia Autonomous Region from 2012 to 2018 (Moran's I > 0, P > 0.05), and there were "high-high" and "high-low" clusters of canine echinococcosis in local areas. The prevalence of human echinococcosis was 0.08%, and there was a significant difference in the prevalence among regions (χ2 = 147.61, P < 0.01), with a high prevalence seen in West Ujimqin Banner, Jarud Banner and New Barag Right Banner. In addition, the prevalence of human echinococcosis correlated positively with the Echinococcus coproantigen-positive rate in dogs (r = 0.52, P < 0.01). The prevalence of Echinococcus infections shows an overall tendency towards a decline in dogs in Inner Mongolia Autonomous Region from 2012 to 2018, with a high prevalence found in New Barag Right Banner and Sonid Right Banner. Human echinococcosis is concentrated in clusters of canine echinococcosis, where health education and targeted control interventions requires to be intensified.

Bilateral Lung and Liver Hydatid Cyst with Massive Hydropneumothorax: A Rare Case Report in Kuwait

Bilateral lung and synchronous hydatid cyst is a unique presentation in a patient. It is endemic in some parts of the world, but it is rare in Kuwait. Hydatid cyst results from Echinococcus infection, and it affects between one and nine people in 10,000 countries where it is endemic. Management of hydropneumothorax because of hydatid cyst can proceed in two or one stage, depending on the extent and presentation of the disease. We are presenting the course and management of a 19-year-old male presented with a unique Echinococcus infection.

Uncommon Locations of Hydatid Disease

Echinococcosis is an infection caused in humans by larval stage of Echinococcus, especially Echinococcus granulosus and is endemic in the Middle East and Central Asia. Humans who act as intermediate host get infected incidentally by ingestion of eggs from the fecal matter. The eggs hatch inside the intestine, penetrate the walls enter portal circulation and lymphatic system eventually reaching the liver and lungs commonly. They can lodge in almost any part of body including brain, heart, and bones. There are two types of Echinococcus infections, Echinococcus granulosis and Echinococcus multilocularis. In this article, we are going to report atypical locations of hydatid disease with reference to review of literature.

317. Case Series of Echinococcus Infections at Mayo Clinic Florida

BackgroundEchinococcus multilocularis is a destructive zoonotic cestode with low human incidence. Hydatid disease classically presents with hepatic or lung involvement with infrequent extrahepatic bone destruction. Diagnosis is challenging due to its latency and mimicry.Fig.1: Case 1 - X-ray imaging of the pelvis shows osseous destruction of the iliac crest secondary to known osteomyelitis status post left ilium debridement. Fig.2: Case 1 - Magnetic resonance imaging demonstrates extensive osteomyelitis throughout left ilium. Stable scattered focal fluid collections seen throughout the left lower quadrant. MethodsCASE 1: A 57 year-old Albanian male with diabetes, latent TB, and left iliac lytic lesion presented with 4 weeks of left flank pain and was treated with 6 weeks of IV Ceftriaxone and Flagyl. 2 years later he returned with flank pain and purulent lumbar drainage. Hip x-ray suggested chronic osteomyelitis, with left psoas fluid collections on CT. Bartonella, Q fever, Brucella, HIV, AFB and fungal serologies were negative. Hemipelvis debridement revealed structures concerning for hydatid disease. Echinococcus IgG was equivocal. Histopathology was consistent with Echinococcus multilocularis species, and albendazole was started. On follow-up, he presented with left hip tenderness and toe extensor weakness. Labs showed mild leukocytosis. CT revealed progressive destruction of the left iliac with sacroiliac extension concerning for abscess.CASE 2: A 36 year-old female presented with lung and liver cysts, progressive dyspnea, and non-productive cough. She lived in Africa, Asia, and Europe and consumed local street food and unpasteurized milk. Hobbies included spelunking and swimming in freshwater lakes. She had exposure to stray animals, but denied bites or scratches. Over 4 years dyspnea progressed to orthopnea. MR abdomen revealed a 10x6x12cm liver cyst and chest CT showed 2 fluid-attenuating lesions in the LLL and RLL, measuring 4.9 x 6.0 cm and 6.8 x 4.3 cm respectively. Echinococcus, Bartonella, Q fever, Brucella, HIV, AFB and fungal serologies were negative. Schistosomiasis serology was equivocal.Fig. 3: Case 2 - MRI abdomen demonstrating 10x6x12cm liver cyst Fig. 4: Case 2 - Chest CT showed 2 dominant fluid attenuating lesions within the LLL and RLL. The larger lesion in RLL measures 6.8 x 4.3 cm. The left lower lobe lesion measures 4.9 x 6.0 cm. ResultsPatient 1 underwent type I hemipelvectomy. Patient 2 underwent pulmonary segmentectomy and liver lobectomy. Both were continued on albendazole.Fig. 5: Case 1 - Photo taken during debridement of left ileac and hip. Note presence of white cysts discovered intraoperatively. Fig. 6: Case 1 - Histopathologic slides (H&E stain) demonstrating hooks and scolices consistent with Echinococcus multilocularis. A. Hooklet (100x magnification). B. Hydatid cyst with black-staining structures suggestive of degenerating hooklets. C. Zoomed detail of cyst wall. D. Degenerating hydatid cyst and hooklets. ConclusionEquivocal IgG serology does not exclude infection. History and clinical presentation are key to diagnosis, but histopathology remains the gold standard. Hydatid bone infection progresses insidiously and frequently recurs, depending upon excision and debridement. Finally, echinococcosis demands aggressive long-term therapy and surveillance.Disclosures Claudia R. Libertin, MD, Pfizer, Inc. (Grant/Research Support, Research Grant or Support)

A case for adoption of continuous albendazole treatment regimen for human echinococcal infections.

Cystic (CE) and alveolar (AE) echinococcosis are chronic, neglected parasitic diseases burdened by high morbidity and, for AE, by high mortality, if left untreated. CE and AE have a widespread distribution, including Europe. Albendazole (ABZ), a broad-spectrum benzimidazole drug widely used to treat parasitic infections, is the drug of choice for the management of CE and AE, and is parasitostatic on echinococcal metacestodes. In Europe, ABZ is licensed for interrupted “cyclic” treatment, for a maximum of 3 cycles. However, better efficacy with no increased side effects has been shown when the drug is administered continuously and for longer periods. Current international recommendations, on the basis of clinical, pharmacological, and biological studies, recommend continuous administration of ABZ for months to years for the treatment of CE and AE, and this schedule has been widely in use for the past 20 years. However, in Europe this internationally recommended schedule, with the exception of France, is technically “off-label”, and, as such, requires an informed consent by the patient and, in some countries, even precludes the reimbursement of the drug cost. Adding to the very high cost of the drug, frequent “out-of-stock” situation, and packaging format impractical for long therapies, these conditions put patients with CE and AE regularly at risk of treatment discontinuation and disease progression. European regulations envisage variations to marketing authorization, but postauthorization studies should be carried out by the holder of the license of the drug, in the form of randomized controlled trials. While such studies do not seem feasible and would probably not be ethically justified for CE and AE, European regulations envisage other possibilities in particular situations, which apply to CE and AE, but there is limited interest to invest in this perspective. We urge a coordination between stakeholders to find effective and feasible ways to take action to revise the benzimidazole dosage regimens for CE and AE and to ensure a fair, regular, and easy access to the appropriate treatment to those suffering from these serious diseases.

Cattle co-infection of Echinococcus granulosus and Fasciola hepatica results in a different systemic cytokine profile than single parasite infection

E. granulosus is a cestode that causes Cystic Echinococcosis (CE), a zoonotic disease with worldwide presence. The immune response generated by the host against the metacestode induces a permissive Th2 response, as opposed to pro-inflammatory Th1 response. In this view, mixed Th2 and regulatory responses allow parasite survival. Overall, larval Echinococcus infections induce strong regulatory responses. Fasciola hepatica, another common helminth parasite, represents a major infection in cattle. Co-infection with different parasite species in the same host, polyparasitism, is a common occurrence involving E. granulosus and F. hepatica in cattle. ‘While it is known that infection with F. hepatica also triggers a polarized Th2/Treg immune response, little is reported regarding effects on the systemic immune response of this example of polyparasitism. F. hepatica also triggers immune responses polarized to the Th2/ Treg spectrum. Serum samples from 107 animals were analyzed, and were divided according to their infection status and Echinococcal cysts fertility. Cytokines were measured utilizing a Milliplex Magnetic Bead Panel to detect IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12 and IL-18. Cattle infected only with F. hepatica had the highest concentration of every cytokine analyzed, with both 4.24 and 3.34-fold increases in IL-10 and IL-4, respectively, compared to control animals, followed by E. granulosus and F. hepatica co-infected animals with two-fold increase in IL-10 and IL-4, compared to control animals, suggesting that E. granulosus co-infection dampens the cattle Th2/Treg immune response against F. hepatica. When considering Echinococcal cyst fertility and systemic cytokine concentrations, fertile cysts had higher IFN-γ, IL-6 and IL-18 concentrations, while infertile cysts had higher IL-10 concentrations. These results show that E. granulosus co-infection lowers Th1 and Th2 cytokine serological concentration when compared to F. hepatica infection alone. E. granulosus infections show no difference in IFN-γ, IL-1, IL-2, IL-6 and IL-18 levels compared with control animals, highlighting the immune evasion mechanisms of this cestode.

Primary cardiac hydatid cyst presenting with massive pericardial effusion: a case report

BackgroundCardiac hydatidosis is a rare manifestation of Echinococcus infection. It represents 0.5 to 2% of hydatic disease (Mustafa et al., Can J Cardiol 22:2, 2006). The most common localization is the myocardium of the left ventricle but can also touch the right ventricle, atrium, pericardium, interventricular septum, and pulmonary artery. Clinical presentation is varied ranging from clinical latency or minor symptoms to cardiogenic shock and sudden death. The present case describes a primary pericardial hydatid cyst, a very exceptional localization of cardiac hydatidosis, which can lead to a delayed diagnosis or to an erroneous treatment that can expose the life of the patient to complications and death if it is not considered. Diagnosis can be established by cardiac imaging and hydatid serology. Therapy management should combine both surgery and medical treatment by albendazole or mebendazole.Case presentationWe report a 70-year-old woman from Sale, who was admitted for dyspnea New York Heart Association (NYHA) class IV evolving in a febrile context with signs of right heart failure related to a rupture of a primary pericardial hydatid cyst with pre-tamponade. The diagnosis was confirmed by echocardiography, computed tomography scan (CT scan), and hydatic serology, and the patient was operated and put on albendazole for 3 months with favorable clinical course.ConclusionsThe aims of this article are to consider the diagnosis of cardiac hydatid cysts in the presence of pericardial effusion, especially if there is a prior history of hydatid disease, a contact with animals, or when it occurs in an endemic country, and to be able to make a differential diagnosis with cardiac imaging in order to avoid its complications and to guide the management.

Unsolved Mystery of Synchronous Metastatic Adenocarcinoma and Echinococcus Cystic Infection, a Major Break Through in Clinical Oncology: A Case Report

Echinococcus cystic infection is a zoonotic infection caused by the larval stage of cestode species belonging to the genus Echinococcus. Through the modulation of the immune system by this parasite, there is an established link of this infection with the metastasis and progression of a tumor. We present a case of a patient with synchronous findings of metastatic adenocarcinoma with unknown primary along with the previous history of echinococcal infection, which highlights the need for prompt management of such infections with a regular follow up of such patients.

Evaluation of Prognostic Factors Associated with Postoperative Complications Following Pulmonary Hydatid Cyst Surgery.

Background:Hydatid cysts are one of the serious complications following echinococcus infection. The liver and the lungs are the most affected organs, respectively. The severity of the disease is associated with the increase in the number and the size of the cysts, cysts rupture, and systemic effects. The aim of this study is to evaluate prognostic factors that are associated with the increased incidence of postoperative complications following pulmonary hydatid cyst surgery.Methods:Patients referred to Madani hospital from 2014-2018, presenting pulmonary hydatid cysts were included in this study. All the patients were evaluated based on the following parameters: age, gender, location and size of the cysts, rupture status of the cysts (intact or perforated), type of surgical intervention (capitonnage or segmentectomy) and Erythrocyte Sedimentation Rate (ESR). The factors were then compared with postoperative complications. Statistical analysis of the data obtained was conducted using R-softwareResults:Of 76 patients enrolled in our study, 52.63% were males and 47.36% were female. Air leak complication was reported in 13.15% of the patients and 3.94% of the patients were presented with pleural effusion. Postoperative complications were significantly associated with the perforated (ruptured) cysts p= 0.001, segmentectomy p= 0.013, giant hydatid cysts p= 0.007 and ESR p= 0.014. However, the side of the lung was not significantly related to postoperative complications.Conclusion:Our study reports that perforated cysts, increased size, segmentectomy and abnormal ESR are likely to increase postoperative complications following pulmonary hydatid cysts surgery. Prospective studies with perioperative parameters and greater sample size can help to deduce better inferences.

Echinococcal hydatid cysts in a Pleistocene Camel

ABSTRACT Echinococcal infection in camels has been considered a disease of domestication. Observation of bone lesions in a fossil camel further challenges the concept of such derivation. A metapodial of fossil camel, Camelops was examined macroscopically and radiologically. For comparative purposes, the gross anatomy of recent bovine bone with similar lesions was studied. Several slightly elliptical cystic metaphyseal cortical lesions, 7 × 9 mm in size, and smooth borders were recognised in the examined fossil. The studied lesions are interpreted as hydatid cyst pockets. Differential diagnosis suggests a hydatism as the most probable aetiology, documenting the oldest case of echinococcosis.

Prevalence and risk factors associated with human cystic echinococcosis in rural areas, Mongolia.

Cystic echinococcosis is a chronic, complex and neglected zoonotic disease with considerable socio-economic impact on the affected population. Even though Mongolia is included in the list of high cystic echinococcosis risk countries, there has been very limited research and evidence on the prevalence or prevention of cystic echinococcosis. This field-based cross-sectional study to investigate the prevalence of cystic echinococcosis and its potential risk factors in Mongolia was conducted from April 2016 to March 2018. A total of 1,993 people were examined by ultrasound in five provinces of Mongolia. All cystic echinococcosis positive cases were classified according to the WHO-IWGE expert recommendations. The logistic regression model was used to detect the association between the presence of echinococcus infection and each potential risk factor. This was the first community survey based on ultrasound screening in Mongolia. We found 98 cystic echinococcosis cases (prevalence = 4.9%), including 85 abdominal ultrasound cystic echinococcosis positive cases and 13 abdominal ultrasound cystic echinococcosis negative cases (surgically treated cystic echinococcosis cases 11, and 2 confirmed cases of lung cystic echinococcosis by chestcomputed tomography in hospital of Ulaanbaatar). The prevalence of cystic echinococcosis varied greatly among different provinces, ranging from 2.0% to 13.1%. Children, elderly people and those with lower education had higher chances of getting cystic echinococcosis. Rather than dog ownership itself, daily practice for cleaning dog feces was associated with increased odds of cystic echinococcosis. The results of the present study show very high endemicity of cystic echinococcosis in Umnugovi province. Evaluation of potential risk factors associated with cystic echinococcosisshow high significance for following factors: demographics (age), social condition (education level) and hygiene practices (cleaning dog feces and use of gloves). Children under 18 and elderly people are considered as the most risk age groups in Mongolia.

Cysts and parasites in an abattoir in Northwest Ethiopia; an urgent call for action on "one health".

Zoonotic parasitic infections such as echinococcosis affect cattle, sheep and goats by lowering quality of meat and hides as well as decreasing milk production. The burden of such diseases among humans is usually underestimated as they are difficult to diagnose. We used abattoir data to estimate the prevalence of zoonotic parasitic infections in animals. Data from 2005-2018 was used from the registry of an abattoir in Northwest Ethiopia. Frequencies, proportions and trends over time were analyzed. Meat inspection was conducted by visualization, palpation and incision. A total of 58,787 animals were slaughtered in the abattoir during the study period. These included 51,956 (88 %) cattle, 5,890 (10%) sheep and 941 (2%) goats. The detected parasites included Echinococcus in 12,334/58,787 (21%) and Fasciola in 10,551/58,787 (18%) animals. Echinococcus infection was highest among goats (267/941, 28%), followed by cattle (11,591/51,956, 22%) and sheep (476/5,890, 8%). Fasciolosis was detected in 9,877/51,956 (19%) cattle and 178/941 (19%) goats. The number of animals slaughtered strongly decreased over time from 8,405 in 2006 to 1,605 in 2018. However, the proportion of parasitic infections remained high with some fluctuations over the study period. Echinococcosis and fasciolosis were very common with one out of five animals slaughtered infected. This is of public health concern and needs urgent multi-sectorial efforts from stakeholders at the national and regional level for control of these diseases. One health program approaches may warrant the control of transmission to humans.

Renal Alveolar Echinococcosis Mimicking Renal Neoplasm with Brain Metastasis

Alveolar echinococcosis is a rare parasitic disease that is endemic to the northern hemisphere in many parts of the world. Humans are coincidental intermediate hosts infected after eating contaminated food, including fruits and vegetables or being in contact with foxes or dogs. Although most alveolar echinococcal infections are localized to the liver, the larvae may spread to other organs by regional extension or distant metastasis along hematogenous or lymphatic pathways. The liver and lungs are the most commonly affected organs. Alveolar echinococcosis involving the kidneys is very rare. Parasitic infection causes granulomatous response on the host immune system. These lesions may be misdiagnosed as malignant neoplasms. Imaging modalities such as MRI provide useful diagnostic information for the accurate diagnosis of alveolar echinococcosis. In this case, we aimed to present radiological imaging and pathological findings of alveolar echinococcosis mimicking renal cell carcinoma of the right kidney with brain metastasis in a 40-year-old male patient with right lumbar pain.

Prevalence and distribution of Echinococcus spp. in wild and domestic animals across Africa: A systematic review and meta-analysis.

Cystic echinococcosis (CE), a worldwide zoonosis, is highly prevalent in Africa particularly in northern and eastern Africa where data are more abundant than other regions. However, harmonization of available data through systematic review and meta-analysis may foster improved transboundary cooperation for the control of CE in Africa. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, research articles (from 2000 to 2019) were retrieved from ScienceDirect, PubMed, African Journals OnLine and Google Scholar databases. A total of 98 studies of 806,624 animals from 13 countries comprising 264,016 goats, 247,326 sheep, 251,106 cattle, 28,314 camels, 4,764 buffaloes, 2,920 equids, 1,966 pigs, 408 wild boars and 50 Norway rats were available for systematic review and meta-analysis of pooled prevalence including 5,048 dogs, 345 lions, 220 hyenas, 94 wolves and 47 jackals/foxes analysed for Echinococcus infection. In total, 46,869 animals were infected and pooled prevalence of CE in intermediate hosts was highest in camels (17.1%; 95% CI: 12.1-22.8) and lowest in pigs (0.3%; 95% CI: 0.1-0.6). Results also showed uneven species/genotype distribution across the continent such that Echinococcus granulosus sensu stricto (G1, G3) constituted 74.45% of the total isolates from East Africa, E. canadensis (G6/7) accounted for 60.3% and 97.4% in North and West Africa, respectively, while 81.3% of E. ortleppi (G5) were recorded for southern Africa. The comparatively higher prevalence estimates for eastern and northern Africa than other regions indicate where efforts on CE management should now be given greater attention in Africa. Additionally, this study also advocates for better cooperation between countries within the same sub-region and the establishment of joint CE control programmes.

An old drug as a promising new cure for the hard-to-treat echinococcosis

An old drug as a promising new cure for the hard-to-treat echinococcosis

Targeted Sequencing of Genomic Repeat Regions Detects Circulating Cell-free Echinococcus DNA

BackgroundEchinococcosis is a chronic zoonosis caused by tapeworms of the genus Echinococcus. Treatment of the disease is often expensive and complicated, sometimes requiring extensive surgery. Ultrasonographic imaging is currently the main technique for diagnosis, while immunological analysis provides additional information. Confirmation still needs pathological analysis. However, these diagnostic techniques generally detect infection in late stages of the disease. An accurate, early and non-invasive molecular diagnostic method is still unavailable.Methodology/Principal findingsWe sequenced the cell-free DNA (cfDNA) from plasma of echinococcosis patients and confirmed the presence of Echinococcus DNA. To improve detection sensitivity, we developed a method based on targeted next-generation sequencing of repeat regions. Simulation experiments demonstrate that the targeted sequencing is sensitive enough to detect as little as 0.1% of an Echinococcus genome in 1 mL of plasma. Results obtained using patient plasma shows that the Area Under the Curve (AUC) of the method is 0.862, with a detection sensitivity of 62.50% and specificity of 100%, corresponding to a Youden-index of 0.625.Conclusions/SignificanceThis study provides evidence that hydatid cysts release cfDNA fragments into patient plasma. Using the repeat region targeted sequencing method, highly specific detection of Echinococcus infection was achieved. This study paves a new avenue for potential non-invasive screening and diagnosis of echinococcosis.