CESTODES: Echinococcus
Section snippets
BASIC LIFE CYCLE
The life cycles of E. granulosus and E. multilocularis are illustrated in Figures 1 and 2. In both species, the adult tapeworm inhabits the small intestine of a definite host, primarily dogs or other canids for E. granulosus (Fig. 1) and foxes or other canids, rarely cats, for E. multilocularis (Fig. 2). The adult worms of E. granulosus are 2 to 7 mm long and typically composed of a scolex with three (three to six) segments, whereas E. multilocularis worms are only up to 4 mm long with five
Geographic Distribution and Epidemiology
E. granulosus is a cosmopolitan parasite, and endemic regions exist in each continent (Fig. 3). This is in contrast to E. multilocularis, which occurs only in the Northern Hemisphere. Considerable public health problems caused by E. granulosus occur in many endemic areas, including countries of South and Central America, western and southern/southeastern Europe, Middle East and North Africa, some Subsaharan countries, Russia and adjacent countries, and China. Annual incidence rates of diagnosed
ALVEOLAR ECHINOCOCCOSIS (CAUSED BY ECHINOCOCCUS MULTILOCULARIS)
In 1855, the German pathologist Virchow recognized that the tumorlike lesions of the liver, previously designated as colloid carcinoma of the liver, were caused by an Echinococcus species.116 For the next 100 years, it was debated whether this form of echinococcosis was due to E. granulosus or to another species. The controversy was finally settled based on the classic studies of Rausch and Schiller90 in Alaska and of Vogel117 in Germany demonstrating that E. granulosus and E. multilocularis
GENERAL CONCLUSIONS
Considerable progress has been achieved in diagnosis and monitoring of clinical cases of cystic and alveolar echinococcosis. Surgery remains the primary choice of treatment for all forms of echinococcosis in humans. In cystic echinococcosis, the new nonsurgical interventional method with percutaneous puncture under sonographic control and instillation of parasiticidal agents in combination with chemotherapy (PAIR) is a promising therapeutic alternative in selected patients primarily with
ACKNOWLEDGMENTS
The Swiss studies were kindly supported by: Swiss National Science Foundation 3.965-082, 3.058-085; Janssen Pharmaceutica, Beerse/Belgium; Smith Kline Beecham, Welwyn Garden City/UK; Theodor and Ida Herzog-Egli-Stiftung; and an anonymous sponsor through Union Bank of Switzerland.
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Address reprint requests to Rudolf W. Ammann, MD, Gastroenterology Unit, Department of Medicine, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland