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.

Methods & Materials: 214 dogs, a donkey and a horse were sampled, in June 2018, from three locations in the Kabylia region: Bouira, Tizi-Ouzou and Sétif. Sera were analyzed using rapid immunomigration test (Witness ® Leishmania, Zoetis, France) followed by immunofluorescence test (IFAT) with 1/50 as positivity threshold. Blood samples were analyzed by a real-time PCR pan-Leishmania designed system, targeting 28S rRNA gene followed by qPCR targeting L. infantum kDNA. All dogs were examined and classed into one of the clinical scores (CS), from CS0 to CS4, per the frequency of their clinical signs. Results: The total prevalence is of 34.5% (74/214) when at least one of the tests is positive. IFAT was more sensible and the prevalence collected scored a 31.8% (68/214), followed by Witness ® Leishmania (29.9%, 64/214) and PCR (4.7%, 10/214). All positive samples on Leishmania spp. PCR 28S rRNA were positives for kDNA L. infantum specific PCR. The donkey and the horse were, also, positives by the two PCR systems. The equids lived near Leishmania infected dogs. Each infected dog where diagnosed in different stages of the disease: 74.3% (55/74) had at least one clinical sign and 25.7% (19/74) were asymptomatics; 43.2% (32/74) had CS1, 21.6% (16/74) had CS2, 5.4% (4/74) had CS3 and 4% had CS4.Conclusion: Kabylia remains an active focus for CanL with a high prevalence; this epidemiological situation requires the implementation of a national program against this protozoosis. This study highlights, for the first time, L. infantum in equids from Algeria which suggests the possible involvement of these animals in the epidemiological chain of L. infantum in high-transmission areas. This preliminary study deserves further investigation due to the lack of equids.Purpose: To present a case of acute anteroseptal ST-elevation myocardial infarction in the West Nile virus (WNV) meningoencephalitis.

To our knowledge, this is the first confirmed autochthonous case of human alveolar echinococcosis in Hungary. To what extent diagnostic difficulties may contribute to underestimate this zoonosis in Eastern Europe is unknown. Differential diagnosis with alveolar echinococcosis should be considered for patients with multiple, tumor-like cystic lesions of the liver, in countries where this parasite is emerging.

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