Clinical and serological study of human alveolar echinococcosis in Slovakia in relation to the outcome of chemotherapy

Abstract

SummaryAlveolar echinococcosis (AE), caused by proliferating metacestodes of the parasitic fox tapeworm Echinococcus multilocularis, is a life-threatening disease in humans. In this study we report four human cases of AE in Slovak Republic with regard to various clinical manifestations and susceptibility to chemotherapy with albendazole or mebendazole. Patients were monitored serologically by ELISA test and Western Blots within 2 -5 years after initiation of chemotherapy/surgery. Using computerized tomography (CT) we compared morphological changes of the parasitic lesions in the liver during the course of treatment. The parasitic lesions in the CT were manifested as nodular hyperplasia with hyper or hypodense zones and calcified foci within the lesion. In other cases the lesion was visualised as a hypodense poorly-delineated septated focus without calcifications. In the last case, the diagnosis of AE was confirmed only at surgery. Calcified foci found inside the main parasitic lesions were the only abnormality that was detected in two cases and were absent in other two cases. The levels of specific anti-parasitic antibodies followed the pathomorphological changes in the livers. Total IgG levels to Em2+ and EmP antigen declined gradually during the follow-up (1 -5 years) and disappeared only in the patient receiving radical surgery (cured). In comparison with total IgG, concentration of the IgG4 antibody subclass seemed to correlate more adequately with the outcome of therapy as their levels decreased in improved/stabilised patients, but were elevated in "aggravated" patients. We showed that, in patients with AE in Slovakia, radical surgery of parasitic foci proved to be the most successful treatment and, in inoperable cases, albendazole and mebendazole were differently effective. Moreover, IgG4 levels rather than total IgG to protoscoleces antigens proved to be more sensitive serological marker of the progress of therapy.

Endoparasites of red fox (Vulpes vulpes) in the Slovak Republic with the emphasis on zoonotic species Echinococcus multilocularis and Trichinella spp.

“…Our recent analyses also showed a significant correlation between prevalence of this tapeworm and population density of small mammals (Miterpáková et al, 2006). However, also the first 10 autochthonous cases of human alveolar echinococcosis were diagnosed in patients lived in endemic regions with the highest prevalence of the parasite in foxes (Kinčeková et al, 2006;. Trichinellosis among foxes was widespread across Slovakia and the prevalence in red foxes increased from 4.9 % in 2000 up to 13.0 % in 2005/06.…”

From cestodes to nematodes: 15 years of scientific collaboration between the Parasitological Institute SAS and the Section of Parasitology of the Sapienza University of Rome

“…However, cysts in these hosts are mostly sterile and these hosts do not significantly contribute to the transmission of cystic echinococcosis in the region. Seropositivity in humans in the period of 1991 -2005 ranged from 0.17 to 1.1 per 100 000, with the highest prevalence recorded in 1997 (Kinčeková et al, 2001(Kinčeková et al, , 2006. In countries neighbouring the Slovak Republic, E. granulosus has been reported in Poland, Ukraine and Austria, while there are no previous reports of its presence in the Czech Republic (Romig et al, 2006).…”

A rare case of alveolar echinococcosis in a 14-year-old child

“…Alveolar echinococcosis is a rather uncommon parasitic disease in the Slovak Republic. The first human cases of AE were recorded in Slovak Republic in 2000 and within the following period we have diagnosed 9 new cases of all age categories (Kinčeková et al, 2006). Of these 9 patients were elderly or in middle age, and only one case was 14 year old child.…”