SummaryA comprehensive study of human echinococcosis (caused by Echinococcus granulosus or E. multilocularis), including assessment of hospital records, community surveys and patient follow-up, was conducted in Ningxia Hui Autonomous Region (NHAR), China. In contrast to hospital records that showed 96% of echinococcosis cases were caused by cystic echinococcosis (CE), 56% of cases detected in active community surveys were caused by alveolar echinococcosis (AE). The AE and CE cases co-existed frequently in the same village, even occurring in the same patient. A serious public health problem caused by echinococcosis was evident in southern NHAR, typified by: a long diagnostic history for both AE and CE (7.5 years) compared with a shorter treatment history (4.7 years); a significant mortality rate (39%) caused by AE in one surveyed village, where patients had no previous access to treatment; family aggregation of CE and AE cases; a high proportion of both AE (62.5%) and CE (58%) in females; a high rate of recurrent surgery (30%) for CE demonstrated by surgical records; and frequent symptomatic recurrences (51%) because of discontinuous or sporadic access to chemotherapy for AE. The disease burden for both human AE and CE is thus very severe among these rural communities in NHAR, and this study provides the first attempt to determine the costs of morbidity and surgical intervention of human CE and AE cases both at the hospital and community level in this setting. This information may be useful for assessing the cost effectiveness of designing effective public health programs to control echinococcosis in this and other endemic areas in China and elsewhere.

BackgroundHuman alveolar echinococcosis (AE) is caused by the accidental ingestion of the eggs of the fox tapeworm Echinococcus multilocularis. AE occurs frequently in rural western China due to the poor levels of hygiene, the close contact of people with dogs, and the lack of appropriate facilities for the correct and rapid diagnosis of the disease.FindingsWe describe a case of a patient with hepatic AE, and AE metastases of the brain. She was mistakenly diagnosed with suspected undifferentiated metastatic cancer of the liver and brain, and with a pulmonary bacterial infection, but was subsequently correctly diagnosed during a follow-up field survey for echinococcosis. The diagnosis of brain AE was confirmed by pathological examination of tissue biopsies removed during neurosurgery. We also briefly describe other symptomatic and asymptomatic AE cases, identified by chance, likely due to the inadequate facilities available in rural communities in China for AE diagnosis and management, since the rapid and accurate diagnosis of metastatic AE requires a high level of expertise in the appropriate diagnostic procedures.ConclusionsThis report highlights the necessity for an upgrade in the diagnosis, treatment, prevention and control of AE in rural China.

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Echinococcosis is caused by infection with larva (metacestode) of the tapeworms of the genus Echinococcus. Within genus Echinococcus, two species are known as public health concern worldwide: Echinococcus guanulosus causing cystic echinococcosis (CE) and Echinococcus multilocularis causing alveolar echinococcosis (AE). The co-evaluation due to the interaction between parasites and their hosts has been well known to be able to allow tolerating to maintain parasitism as long as possible. With many research advanced findings, scientists have been much interested in using either those molecules from parasites producing due to invading and surviving or those cytokines from hosts responding due to defenses to carry out immunotherapeutic practice that is not only against parasitic infection but also for cancer or other immunological related disorders. Taken advance of knowledge on Echinococcus genome research outcomes, recent attentions regarding the discoveries of targeting antiparasitic drug and/or vaccine were extensively discussed in this review.