Emerging human alveolar echinococcosis in Hungary (2003–2018): a retrospective case series analysis from a multi-centre study

Abstract

Background Human alveolar echinococcosis (AE) caused by Echinococcus multilocularis is an underreported, often misdiagnosed and mistreated parasitic disease mainly due to its low incidence. The aim of this study was to describe the epidemiological and clinical characteristics of human AE patients in Hungary for the first time. Method Between 2003 and 2018, epidemiological and clinical data of suspected AE patients were collected retrospectively from health database management systems. Results This case series included a total of 16 AE patients. The mean age of patients was 53 years (range: 24–78 years). The sex ratio was 1:1. Four patients (25%) revealed no recurrence after radical surgery and adjuvant albendazole (ABZ) therapy. For five patients (31.3%) with unresectable lesions, a stabilization of lesions with ABZ treatment was achieved. In seven patients (43.8%), progression of AE was documented. The mean diagnostic delay was 33 months (range: 1–122 months). Three AE related deaths (fatality rate 18.8%) were recorded. Conclusions AE is an emerging infectious disease in Hungary with a high fatality rate since based on our results, almost every fifth AE patient died in the study period. Differential diagnosis and appropriate surgical and medical therapy for AE is an urging challenge for clinicians in Hungary, as well as in some other European countries where E. multilocularis is prevalent.

Alveolar echinococcosis in nutria (Myocastor coypus), invasive species in Slovenia

“…However, the raising number of foxes and nutrias might present a potential threat for AE in humans. In neighbouring Croatia, the first human case of AE was confirmed in 2017 ( Dušek et al, 2020 ) and the disease appears to be emerging in Hungary ( Dezsényi et al, 2021 ). Nevertheless, the results of our study and those of others ( Umhang et al, 2013 ) lead us to consider nutrias can be a relevant bioindicators of the presence of E. multilocularis in environment.…”

Plasma Circulating Cell-Free DNA Facilitated the Detection of an Alveolar Echinococcosis Patient Initially Misdiagnosed as Cystic Echinococcosis: A Case Report

“…Additionally, it is estimated that another 17,400 new alveolar echinococcosis (AE) cases occur annually, mostly in the Northern Hemisphere [ 2 ]. Increasing reports suggest that echinococcosis, especially AE, is becoming an emerging/re-emerging disease with growing reported cases globally [ 3 , 4 , 5 , 6 , 7 ]. As one of the 17 diseases targeted to be eliminated in the World Health Organization Neglected Tropical Diseases Roadmap, echinococcosis does not seem to be disappearing yet [ 8 ].…”

“…According to the Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans , the diagnosis of echinococcosis mainly relies on clinical findings, imaging technology such as ultrasounds (US), conventional radiography (for thoracic and bone involvement), computed tomography (CT), and magnetic resonance imaging (MRI), and serology [ 13 ]; and it has been reported that misdiagnosis may occur when atypical features are presented in imaging [ 13 , 14 , 15 , 16 ]. As CE is more cosmopolitan, more doctors have experience dealing with CE; however, AE is also emerging in areas where no AE case was reported before [ 3 , 4 , 5 , 6 , 7 , 17 ]. In the endemic areas of western China, especially in the Tibetan Plateau region, AE is sometimes more prevalent than CE [ 18 ].…”

Risk factors for post-endoscopic retrograde cholangiopancreatography cholangitis in patients with hepatic alveolar echinococcosis—an observational study

“…Hepatic alveolar echinococcosis (HAE) is considered to be one of the most deadly chronic parasitic diseases in the world, posing a serious threat to life and health [ 1–4 ]. In humans, AE larvae develop almost exclusively in the liver, leading to slowly progressive, life-threatening tumor-like growth [ 5 , 6 ].…”