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Antibodies to 2 crude antigens of Echinococcus multilocularis (Emc and Emf) in 2,540 study participants*
Source publication
The inhabitants of a rural community in southwestern Germany were examined for alveolar echinococcosis (AE). The study was prompted by the recent increase of the prevalence of the parasite in foxes and the increase of fox populations: in the study area, 75% of the foxes carried Echinococcus multilocularis. The human population was screened using he...
Contexts in source publication
Context 1
... samples from 20 participants could not be obtained or processed for technical reasons, leaving 2,540 participants who were screened by both ultrasound and serology. Of these, 50 participants reacted seropositive in at least 1 of the 2 screening ELISAs with Emc and Emf antigens, with 33 showing reactivity for Emf, 12 for Emc, and only 5 for both antigens ( Table 1). Ten of the screening seropositive indi- viduals also reacted in at least 1 of the tests with Em2, Em10, or EmII/3-10 antigens (Tables 1 and 2). ...
Context 2
... these, 50 participants reacted seropositive in at least 1 of the 2 screening ELISAs with Emc and Emf antigens, with 33 showing reactivity for Emf, 12 for Emc, and only 5 for both antigens ( Table 1). Ten of the screening seropositive indi- viduals also reacted in at least 1 of the tests with Em2, Em10, or EmII/3-10 antigens (Tables 1 and 2). ...
Context 3
... 5 of 50 screening sero- reactors tested positive with both antigens. While 7 (41%) of 17 Emc-reactors also tested positive with at least 1 spe- cific antigen, this rate was much lower with Emf (4 of 38, 11%) (Tables 1 and 2). Seroreactivity against E. multilocu- laris antigens (especially the specific Em2, EmII/3-10, and Em10) without a detectable presence of AE of is most often explained as a sign for contact with E. multilocularis (uptake of eggs or development of early, possibly aborting stages), and not as the result of cross-reactivity. ...
Similar publications
In 2003-2010 5483 persons suspected of echinococcosis were examined for Echinococcus granulosus and Echinococcus multilocularis infections using serological tests in the Department of Medical Parasitology National Institute of Public Health - National Institute of Hygiene. The screening test ELISA (Bordier Affinity Products S. A.), confirmation tes...
Citations
... The small-scale distribution showed high numbers of cases, especially for the Ravensburg district, with a total of nine cases in Leutkirch im Allgäu and five cases in Ehingen (Donau). Studies on foxes have shown very high infection rates since 1988, especially in the above-mentioned regions [12]. ...
Background
We describe the spatial distribution of Echinococcus multilocularis in its main definitive host, the red fox, and the distribution of human cases of alveolar echinococcosis (AE) within a highly endemic focus in southern Germany (13.7–19.9/100,000 in 1992–2018). Human cases were unequally distributed within the endemicity focus. The purpose of the study was to test whether this is reflected in the small-scale distribution of E. multilocularis in foxes.
Methods
Three areas with contrasting numbers of human cases were selected within the counties of Ravensburg and Alb-Donau, Baden-Württemberg, Germany. From 2018 to 2020, a total of 240 fox carcasses were obtained from traditional hunters in these areas. Carcasses were necropsied and examined for the presence of intestinal helminths. The statistical analysis was performed with SAS version 9.4, and the geo-mapping with QGIS version 3.16.0 Hannover.
Results
The prevalence of E. multilocularis in foxes was 44/106 (41.5%) in area I (commune Leutkirch and environs), 30/59 (50.8%) in area II (commune Isny and environs), and 31/75 (41.3%) in area III (commune Ehingen and environs). From 1992 to 2018, a total of nine human cases of alveolar echinococcosis were recorded in area I, five cases were recorded in study area III, and no cases were recorded in area II. No statistically significant differences between the areas were observed (P > 0.05) for intestinal infections with E. multilocularis, and no apparent spatial correlation with the small-scale distribution of human cases was found. Concerning other zoonotic helminths, Toxocara spp. were equally common, with prevalence of 38.7%, 47.4% and 48.0%, respectively, while the frequency of Alaria alata varied among the study areas (0.0–9.4%), probably reflecting the specific habitat requirements for the establishment of its complex life cycle.
Conclusions
Echinococcus multilocularis is highly prevalent in foxes in all the studied areas. The varying number of human AE cases within these areas should therefore be caused by factors other than the intensity of parasite transmission in foxes.
Graphical Abstract
... This is in accordance with the trend observed in definitive hosts (red foxes) in Luxembourg, based on data reported to the European Food Safety Authority ( . The prevalence estimates from muskrats in Luxembourg are comparable to those found in Belgium a decade earlier [14,35] but lower than those observed in southwestern Germany, where 28.9% of 702 muskrats were infected with E. multilocularis metacestodes in the period 1995-1997 (from 14.8% to 39.0% in different rivers and water bodies); more recent data from this area are not available [36]. Contrary to these highly endemic areas, muskrats were infected at a much lower prevalence (from 0.0% to 8.1%) in western France, the Netherlands, northern/eastern Germany, and Lithuania [10][11][12][13][37][38][39]. ...
Muskrats (Ondatra zibethicus) are competent intermediate hosts for Echinococcus multilocularis, are frequently infected with this zoonotic cestode, and have even been proposed as a target species to monitor endemicity levels of this parasite. However, their contribution to maintaining the parasitic lifecycle is still unclear. To obtain data on infection frequency and reproductive potential, 280 muskrats from the Grand Duchy of Luxembourg were examined for cestode larvae in the years 2013–2017. Based on morphological and molecular identification, Echinococcus multilocularis was found at a prevalence of 14.6%. Other metacestodes were Hydatigera kamiyai, with a prevalence of 45.7%, Taenia martis with 8.9%, Taenia polyacantha with 5.0%, and Versteria mustelae, which was found in 0.7% of all muskrats. More than 80% of E. multilocularis-infected muskrats contained fertile metacestodes with a mean number of >300,000 (and up to 1,609,816) protoscoleces, which is by far the highest reproductive potential known from any intermediate host species in Europe. Temporal analysis of E. multilocularis prevalence within the study period (and in comparison with earlier data) strongly indicates a robust increase in the studied area. Host age seemed to be an important risk factor for infection, as well as co-infections with Hydatigera kamiyai. A preference for the right medial lobe of the liver as the location of E. multilocularis metacestode was observed. Intraspecific genetic variation among 89 discrete E. multilocularis metacestodes was non-existent based on 300–1590 bp sections of cox1. This is a stark contrast to H. kamiyai, of which nine haplotypes were found on a short 318 bp section of cox1, resulting in genetic diversity in the small country of Luxembourg at a similar level than previously reported from large stretches of Europe and northern Asia.
... USG is the preferred investigation for the screening of hepatic alveolar hydatid. [12][13][14] On ultrasound, alveolar hydatid manifests as a large space-occupying lesion with alternating areas of mixed echogenicity with irregular margins [3,7] with scattered foci of calcification. It also may show multiple hyperechoic nodules giving a "hailstorm" appearance. ...
... Alveolar echinococcosis (AE) is a potentially lethal parasitosis that extends throughout the northern hemisphere [1][2][3][4]. The adult tapeworms reside within the intestinal mucosa of carnivores-mainly foxes-as definite hosts, and produce eggs, which are excreted with the faeces and subsequently ingested by rodents as intermediate hosts. ...
Background: Alveolar echinococcosis (AE) is a potentially lethal parasitosis with a broad spectrum of disease dynamics in affected patients. To guide clinical management, we assessed initial prognostic factors for both progressive and controlled AE based on initial staging. Methods: A retrospective cohort study was conducted, examining 279 patients assigned to different clinical groups: cured, stable with and without the need for benzimidazole treatment, and progressive disease. Univariate analysis compared demographic and clinical variables. Significant variables were subsequently entered into two separate logistic regression models for progressive and controlled disease. Results: Based on the multivariate analysis, a large AE lesion (OR = 1.02 per millimetre in size; 95%CI 1.004–1.029), PNM staging (OR = 2.86; 95%CI 1.384–5.911) and especially the involvement of neighbouring organs (OR = 3.70; 95%CI 1.173–11.653) remained significant risk factors for progressive disease. A negative Em2+ IgG (OR = 0.25; 95%CI 0.072–0.835) and a small AE lesion (OR = 0.97; 95%CI 0.949–0.996) were significant protective factors. Conclusions: Patients with large lesions and advanced stages should be monitored closely and most likely require long-term treatment with benzimidazoles if curative resection is not feasible. Patients with small lesions and negative Em2+ IgG seem able to control the disease to a certain extent and a less strict treatment regimen might suffice.
... Cases of AE are seen in the northern hemisphere with the main endemic regions being in central Europe and western China. Baden-Württemberg and Bavaria are the main endemic regions in Germany with a tendency to spread to other parts of the territory [3][4][5][6][7][8]. In the period 1992-2016, the prevalence of AE in Germany was 0.64/100 000 inhabitants, with a prevalence of 2.18/100 000 inhabitants in Baden-Württemberg and 1.48/ 100 000 in Bavaria [3][4][5][6][7][8]. ...
... Baden-Württemberg and Bavaria are the main endemic regions in Germany with a tendency to spread to other parts of the territory [3][4][5][6][7][8]. In the period 1992-2016, the prevalence of AE in Germany was 0.64/100 000 inhabitants, with a prevalence of 2.18/100 000 inhabitants in Baden-Württemberg and 1.48/ 100 000 in Bavaria [3][4][5][6][7][8]. The greatest number of cases of the disease worldwide have been reported in China. ...
Background Alveolar echinococcosis (AE) is one of the most dangerous human parasitoses. The main site of disease manifestation is the liver (about 98 %). The Echinococcus Multilocularis Ulm Classification for Computed Tomography (EMUC-CT), presented in 2016, was the first compilation of CT morphological criteria of hepatic AE. Studies based on EMUC-CT made it possible to draw conclusions about the development of the lesions in the course of disease beyond purely diagnostic typing. Among the most important findings of these precursor studies was that EMUC-CT type IV presented as an initial lesion, whereas EMUC-CT type III lesions were mostly associated with an advanced disease constellation. An intermodal view of image morphological criteria provides further multi-layered indications for lesion evolution.
Method With the “Alveolar Echinococcosis Ulm Classification” (AEUC), a revision of the previous EMUC-CT was carried out with stage-oriented reorganization of the primary morphologies. Furthermore, an intermodal classification scheme for the evolution of hepatic AE lesions based on AEUC, MRI Kodama classification, and aspects of ultrasound could be outlined.
Results The first stage-oriented CT classification of hepatic AE “AEUC” is based with respect to its lesion characterization on the separate consideration of two classification pillars, the five “primary morphologies”, AEUC I–V (AEUC II–IV with subcriteria) and the five “patterns of calcification”. In addition, an intermodal classification scheme presents five stages of lesion evolution: “initial stage”, “progressive stage”, “advanced stage”, “transitional stage” and “regressive stage”.
Conclusion The imaging modalities differ with respect to their visualization of lesion criteria. This underlines the need for unimodal classification systems. Staging of an AE lesion can be done more accurately by evaluating different modalities.
Key Points:
Citation Format
... In Bavaria, southern Germany, a study among 58 patients with AE identified farmers as the occupational group with highest risk of acquiring the disease, and the distribution of prevalence in man was closely correlated with the infection rates in foxes (Nothdurft et al., 1995). Other studies have also found farmers to be at risk, due to handling contaminated soil or inhaling dust containing eggs (Romig et al., 1999). It is also reasonable to believe that veterinarians working with dogs and cats in regions were EM is endemic may have an occupational risk of being exposed to the parasite. ...
In the light of the recent findings of the tapeworm Echinococcus multilocularis (EM) in four red foxes from three different locations in Sweden, the Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen; VKM), Panel of Biological Hazards (Faggruppe hygiene og smittestoffer) took the initiative to undertake a risk assessment regarding the probability of this parasite being introduced to mainland Norway and thus becoming a threat to public health in the country. EM is a small tapeworm that resides in the intestine of carnivores (e.g. foxes, dogs) that function as final hosts for the adult tapeworm. The infection here gives few or no symptoms. Adult tapeworms produce eggs that are released in the faeces of the carnivores and may be ingested by mammals, usually rodents or lagomorphs1, which act as intermediate hosts. In the intermediate hosts, the larval form of the tapeworm produces cysts, predominantly in the liver, where they proliferate and may invade the surrounding tissues. If the infected intermediate host is eaten by a susceptible final host, the adult tapeworm develops in the intestine and the lifecycle is completed. EM is of public health significance as humans may act as accidental intermediate hosts if they ingest eggs, either through contaminated foods or water, or from contact with infected final hosts (dogs, foxes) or their faeces. In untreated patients the disease is often fatal (10 year survival rate of 29 %), and in treated patients the 10 year survival rate is 80 %. The anthelmintic treatment is long-term (for several years, possibly life-long) and expensive. Liver transplantation may be required. Conclusions: Based on the fact that EM is endemic in many European countries, that the incidence in endemic countries is increasing, and that the areas of endemicity are expanding it seems likely that EM will be imported into Norway at some point, perhaps within the next 10 years. Given the high numbers of pets crossing the border between Sweden and Norway and the paucity of checks regarding compliance with treatment legislation, this seems to be a likely route of entry of EM to Norway, should this occur. Introduction of checks may reduce this likelihood. Under the current monitoring conditions, VKM find it less likely that EM will be detected upon the first introduction to Norway. EM will probably only be detected once the prevalence in foxes is greater than 1%. The red fox population size is estimated to be between 70 000 to 120 000 animals. This means between 700 to 1200 red foxes would need to be infected before EM infection is likely to be detected under the current monitoring program. If EM is identified early enough after introduction, then it might be possible to avoid the establishment of EM in Norway and/or to limit the region of endemicity. This is dependent on optimal detection techniques and sufficient monitoring. VKM considers that it is unlikely that EM will be imported to Norway via contaminated produce (berries, fruits and mushrooms). Norway’s strong ‘outdoor’ culture, in which hunting, camping, berry-picking and other outdoor activities play a significant role, may place the Norwegian population at greater likelihood of contracting EM than populations in other European countries. However, it should be noted that even in countries with endemic EM, human echinococcosis is, apparently, relatively rare.
... Diagnosis of AE is multimodal, based on clinical presentation along with epidemiological data, typical imaging signs, and serological tests [11]. One finding on its own might be misleading, as, for example, most seropositive people identified by epidemiological screening in Germany and France never developed active disease [60][61][62]. Serologic and histologic ormolecular confirmation is central [11,63]. A two-step approach is recommended, using a high sensitivity screening test followed by a more specific confirmatory test, resulting in both high sensitivity and specificity of nearly 100% [63]. ...
Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, the incidence is increasing, especially in Europe. Correct diagnosis is often delayed because clinicians are unfamiliar with respective entities. Therefore, this review aims at providing a clinical picture of hepatic parasites for clinicians, in order to bring these neglected parasitic liver diseases into the spotlight of hepatologic stakeholders in Europe.
... USG is the preferred investigation for the screening of hepatic alveolar hydatid. [12][13][14] On ultrasound, alveolar hydatid manifests as a large space-occupying lesion with alternating areas of mixed echogenicity with irregular margins [3,7] with scattered foci of calcification. It also may show multiple hyperechoic nodules giving a "hailstorm" appearance. ...
Objective
The objective of this study was to calculate the prevalence of hepatic alveolar hydatid disease in hospital-based population in North India, a nonendemic region for alveolar hydatid disease.
Materials and Methods
This study was conducted at a tertiary care center in North India between April 2017 and March 2019. Patients with suspected hepatic alveolar hydatid on ultrasonography were evaluated with further imaging studies based on classical radiological findings and then confirmed by histopathology.
Results
Twenty-five cases of hepatic alveolar hydatid were diagnosed primarily based on the classical imaging/radiological findings with histopathology confirmation, with a 2-year period prevalence of 0.207 cases/1000 population. Majority of the cases were in the age group of 41–60 years, with a mean age of 53.04 years. Fifty-two percent of the cases were female. Majority of them were from hilly areas and working with livestock animals. Abdominal pain was the most common presenting symptom.
Conclusion
Hepatic alveolar hydatid is considered as a rare disease in India; however, the increased number of cases been diagnosed in our study could be either due to increased diagnostic modalities or due to actual increase in the number of cases. Therefore, hepatic alveolar hydatid should be considered in the differentials of suspicious liver mass in nonendemic regions.
... Increasing AE incidence in the Central European AE belt is believed to be founded in the steeply rising parasite biomass due to a sharply increasing fox population and parasite prevalence since introduction of oral vaccination campaigns against rabies in foxes in the early 80ies [13]. In southern Germany fast-growing fox population showed increasing parasite prevalence to up to 75% and 80% in 1995 and 2002/2003 in the most affected areas resulting in tenfold higher biomass estimates in the period 1995-2000 compared to estimates before 1990 [1,2,14,15] (Fig. 2). ...
Ecology and epidemiology of Echinococcus multilocularis and human alveolar echinococcosis (AE) are changing in Central Europe. Our data from a regional referral center for AE in southwest Germany suggest rising regional incidence for AE (annual incidence per 100,000 population 2004–2011: 0.12; 2012–2019: 0.20) and emerging urban AE (of 7 cases of AE in Freiburg city dwellers none was diagnosed before 2012) calling for an intensification of E. multilocularis and AE surveillance and of AE prevention measures.
... The main ‚historical' endemic areas in Europe include Northern Switzerland, Western Austria, Eastern France and Southern Germany (Baumann et al., 2019;Deplazes et al., 2017;Kern et al., 2003;Romig, 2003). Estimates put the prevalence of human AE in these regions between 2 and 40 cases per 100,000 inhabitants (Eckert et al., 2001;Romig et al., 1999). For the past decades, in Europe an increasing spread of E. multilocularis from the old known endemic areas to nonendemic areas has been observed (Baumann et al., 2019;Deplazes et al., 2017;Eckert et al., 2000;Romig, 2003). ...
... The geographical distribution of the definitive and intermediate hosts of E. multilocularis in Germany extends far beyond the high-risk areas detected (Eckert et al., 2001;Eckert and Deplazes, 2004). Several studies showed that regional differences in the prevalence of E. multilocularis in foxes does seem to have an effect on the distribution of human AE (Guislain et al., 2008;Romig et al., 1999;Tanner et al., 2006). A high prevalence of infected foxes -75% (95% CI: 61-86) -has been observed in German high-risk areas such as Römerstein on the Swabian Alb (Romig et al., 1999). ...
... Several studies showed that regional differences in the prevalence of E. multilocularis in foxes does seem to have an effect on the distribution of human AE (Guislain et al., 2008;Romig et al., 1999;Tanner et al., 2006). A high prevalence of infected foxes -75% (95% CI: 61-86) -has been observed in German high-risk areas such as Römerstein on the Swabian Alb (Romig et al., 1999). Furthermore, a large number of infected foxes have been found in areas with a higher prevalence of human AE in the Canton of Graubünden in the Swiss Alps (Tanner et al., 2006). ...
Alveolar echinococcosis (AE) is a rare zoonotic disease caused by the larval stage of Echinococcus multilocularis. Despite its low world-wide prevalence, this disease shows differences in the regional distribution of cases. In the present cohort study, we analyse the distribution of AE according to environmental and geographical factors in Germany. We identified the place of residence of 591 cases of AE from the national database for AE, and georeferenced these localities in the Universal Transverse Mercator coordinate system. Data on elevation, air temperature, precipitation height and land cover were mapped out and correlated with the distribution of cases of disease during the period 1992-2018. Moran's I statistic was used for spatial autocorrelation. Differences in frequency distribution between elevation, air temperature, precipitation height and landscape feature classes were analysed with the Kruskal-Wallis test. With the multiple linear regression analysis, we determined the influences and interactions of geographical and climatic factors on the number of AE cases. The results showed a heterogeneous distribution of AE cases with a higher concentration in southern Germany than in the rest of Germany (I = 0.225517, Z = 35.8182 and p < 0.001). There was a statistically significant difference in frequency distribution between precipitation height, air temperature, elevation and landscape feature classes and AE cases in Germany (p < 0.0001). In regions with higher elevations (505-672 m), moderate average air temperatures (6.0-7.9°C) and higher precipitation rates (701-1000 mm) most AE cases were recorded. It seems, that regions with higher precipitation rates, higher elevations and moderate average air temperatures have a higher infection burden and infection conditions. It is therefore extremely important to generate greater awareness of the disease in these regions, with the aim of recognising potential cases of AE as early as possible and introducing the appropriate therapeutic measures.
