Articolul 6 PDF

CLINICAL MICROBIOLOGY REVIEWS, Apr. 2008, p. 380–401 Vol. 21, No.
2
0893-8512/08/$08.00⫹0 doi:10.1128/CMR.00050-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
New Aspects of Neotropical Polycystic (Echinococcus vogeli) and

Unicystic (Echinococcus oligarthrus) Echinococcosis
Antonio D’Alessandro1* and Robert L. Rausch2
Department of Tropical Medicine, School of Public Health and Tropical Medicine SL-29, Tulane University, 1440 Canal Street,
Suite 2210, New Orleans, Louisiana 70112-2824,1 and Department of Comparative Medicine, School of Medicine,
University of Washington, Box 357190, Seattle, Washington 98195-71902
INTRODUCTION .......................................................................................................................................................380
Taxonomy of Echinococcus spp...........................................................................................................................................381
Neotropical Species of Echinococcus in the Final Host .....................................................................................381
Characteristics of the Strobilar Stages of E. vogeli and E. oligarthrus............................................................382
The Metacestode of E. vogeli in the Natural Intermediate Host and in Humans .........................................382
Histogenesis and Pathogenesis of the Metacestode of E. vogeli in Polycystic Echinococcosis.....................384
The Metacestode of E. oligarthrus in the Natural Intermediate Host .............................................................384
Histogenesis and Pathogenesis of the Metacestode of E. oligarthrus in Unicystic Echinococcosis .............385
MEDICAL ASPECTS OF NEOTROPICAL ECHINOCOCCOSES ....................................................................385
Clinical Characteristics of Polycystic and Unicystic Echinococcoses..............................................................386
Clinical Characteristics of Polycystic Echinococcosis (E. vogeli) (Types I to V) ...........................................386
Type I....................................................................................................................................................................386
Type II ..................................................................................................................................................................388
Type III.................................................................................................................................................................389
Type IV .................................................................................................................................................................390
Type V...................................................................................................................................................................390
Clinical Characteristics of Unicystic Echinococcosis (E. oligarthrus) (Types VI and VII)...........................391
Type VI .................................................................................................................................................................391
Type VII................................................................................................................................................................391
Consequences of Medical Treatment ...................................................................................................................391
DIAGNOSIS OF POLYCYSTIC ECHINOCOCCOSIS (E. VOGELI).................................................................392
Patients’ Histories...................................................................................................................................................393
Sex and Age Distribution.......................................................................................................................................393
Laboratory Findings ...............................................................................................................................................393
Physical Examination of the Abdomen ................................................................................................................393
Radiological Imaging..............................................................................................................................................393
Serological Tests .....................................................................................................................................................394
Parasitological Diagnosis.......................................................................................................................................395
EPIDEMIOLOGY .......................................................................................................................................................395
Geographical Distribution of Neotropical Echinococcoses ...............................................................................395
Natural Hosts of E. vogeli and E. oligarthrus ......................................................................................................396
CONCLUSIONS .........................................................................................................................................................399
ACKNOWLEDGMENTS ...........................................................................................................................................400
REFERENCES ............................................................................................................................................................400
INTRODUCTION tic echinococcosis, the main subject of the present discussion,

may be recognized as the most pathogenic species of Echino-
The most pathogenic of cestodes in the human host are
coccus.
those of the family Taeniidae Ludwig 1886 (suborder Taeniata
The genus Echinococcus contains four species readily distin-
Skriabin et Schulz 1937), when the organism at the asexually
guished on the basis of morphological characters in both the
reproducing stage, the metacestode, develops in the liver
strobilar and metacestode stages. They also differ markedly in
and/or lungs and elsewhere. In addition to the metacestode
biological characteristics. The strobilar stage of each occurs in
(cysticercus) of Taenia solium L. 1758, the metacestodes of the
the small intestine of a carnivore; the metacestodes develop
four species of the genus Echinococcus Rudolphi 1801 are the
in organs of an herbivorous intermediate host that is the typical
most important cause of severe to fatal disease in humans.
Investigations in the Neotropics during recent decades have prey of the respective final hosts. Each of the four species can
shown that Echinococcus vogeli, the causative agent of polycys- be distinguished morphologically and biologically produce a
distinctive form of echinococcosis in humans with the degree
of pathogenicity depending on the process involved in asexual
* Corresponding author. Present address: Arenales 2303, 3er piso,
reproduction in the metacestode. The species of Echinococcus
Buenos Aires 1124, Argentina. Phone: (54 11) 4824 1446. E-mail: are E. granulosus (Batsch 1786), which causes cystic echino-
[email protected]. coccosis; E. oligarthrus (Diesing 1863), which causes unicystic
380
VOL. 21, 2008 NEW ASPECTS OF NEOTROPICAL ECHINOCOCCOSIS 381
FIG. 1. Life cycle of Echinococcus vogeli in neotropical forests and the course of domiciliary transmission to humans.
echinococcosis; E. multilocularis Leuckart 1863, which causes mals of at least eight families (56). A major obstacle to a better
alveolar echinococcosis; and E. vogeli Rausch et Bernstein understanding of the taxonomic status of genotypes of cestodes
1972, which causes polycystic echinococcosis. in the genus Echinococcus has been the lack of investigations
involving experimental infections of ungulates and rodents that
Taxonomy of Echinococcus spp. serve as intermediate hosts. Thus far, no genotype has been
shown to be reproductively isolated, and the status of the
Two species, E. granulosus and E. multilocularis, occur in various nominal taxa therefore remains uncertain.
natural hosts in the northern hemisphere. The former now has
a cosmopolitan distribution in livestock-raising countries, hav-
Neotropical Species of Echinococcus in the Final Host
ing been introduced with animals from Europe beginning in
the early 16th century (55). The taxonomy of cestodes of the The two neotropical species and their respective hosts ap-
genus Echinococcus has been complicated by typological de- pear also to represent assemblages of ancient origin, as indi-
scriptions (1) of numerous taxa, the majority now recognized cated by the typical occurrence of their metacestodes in hys-
as E. granulosus. tricognath rodents. Those rodents were the dominant small
Several genotypes, ostensibly having metacestodes adapted terrestrial herbivores in South America by the Miocene epoch,
to the various species of domestic ungulates, have been distin- from ca. 22 million to 5 million years BP (25). The family
guished by molecular-genetic methods (84), but otherwise they Taeniidae is represented in South America by a few species of
are morphologically and biologically like E. granulosus. Such the genus Taenia, in addition to the indigenous E. vogeli and E.
genotypes appear to have arisen after the domestication of oligarthrus. During the Pliocene epoch, formation of the Pan-
ungulates, beginning about 8,000 years before the present (BP) amanian isthmus enabled numerous faunal exchanges between
(35). Echinococcus granulosus and its natural hosts (wolf [Canis North America and South America; various species of Taenia,
lupus L.] and deer [family Cervidae]) appear to represent an but none of Echinococcus, dispersed into South America with
ancient assemblage in the holarctic zones of tundra and taiga. their hosts by way of the isthmus of Panama. The cougar, Puma
By contrast, E. multilocularis shows little genetic variation (68), concolor (L.), for example, of North American origin and now
but it also, like E. granulosus, exhibits morphological variation having an extensive geographic range in South America (90),
in the strobila, and host-induced variation in the metacestode harbors at least one nearctic species of Taenia and has become
occurs (62). The recently described E. shiquicus Xiao et al. a common final host of the neotropical E. oligarthrus. It is
2005 resembles E. multilocularis morphologically; the metaces- evident that E. oligarthrus is capable of development in any
tode was found in pikas (family Ochotonidae) and differs mor- species of felid in the neotropical region and probably in the
phologically from that developing in the typical intermediate Nearctic as well.
hosts of E. multilocularis, rodents of the family Arvicolidae. Of the four species of Echinococcus considered in this re-
Such rodents are sympatric with pikas, from which the meta- view, only E. oligarthrus has wild cats (Felidae) as a final host
cestode of E. shiquicus was studied. Of the four species of (60). The strobilar stages of the three others occur in carni-
Echinococcus recognized here, the metacestode of E. mul- vores of the family Canidae, each in a characteristic species of
tilocularis exhibits the least degree of host specificity, having final host under natural conditions, but the domestic dog, Ca-
been recorded in natural infections in small, herbivorous mam- nis lupus forma familiaris, can readily replace their natural final
382 D’ALESSANDRO AND RAUSCH CLIN. MICROBIOL. REV.
FIG. 4. Strobilar stage of Echinococcus oligarthrus (length, 2 mm)

FIG. 2. The bush dog, final host of Echinococcus vogeli. (Reprinted from a naturally infected jaguarundi from Colombia.
with permission of the Los Angeles Zoo.)
tive final and intermediate hosts is typical also for E. granulosus

hosts. The domestic dog is the most significant source of in- and E. multilocularis (57, 61).
fection of humans by the etiologic agents of cystic, alveolar,
and polycystic forms of echinococcosis. Characteristics of the Strobilar Stages of E. vogeli and
The natural cycle of E. vogeli was first reported by Cabrera E. oligarthrus
et al. (8), who noted that the bush dog, Speothos venaticus
(Lund), the natural final host of that cestode, hunted its pre- The strobilae of the two neotropical species of Echinococcus
ferred prey, the paca, Cuniculus paca (L.), in packs, pursuing it are easily identifiable morphologically. That of E. oligarthrus is
on land and in water (Fig. 1, 2, and 3). Although bush dogs and evidently the smallest of the four species of the genus, with a
pacas are of similar sizes, single bush dogs may sometimes be length of ca. 2 to 3 mm and three proglottids. The rostellar hooks
capable of overcoming the rodents, as shown by Deutsch (21). are similar to those of E. vogeli in length but differ in shape (58,
A fox-like canid, Cerdocyon thous (L.), which occurs widely in 65). The form of the rostellar hooks is diagnostic. In experimen-
South America, was infected experimentally by D’Alessandro tally infected house cats, eggs appeared in the feces 86 to 87 days
(unpublished data). That canid, an omnivore that feeds also on postinfection (78). By contrast, E. vogeli has the longest strobila of
small mammals (67), does not hunt in packs and therefore any member of the genus Echinococcus, reaching a length of at
appears to be unable to capture mammals as large as a paca. In least 12 mm in experimentally infected dogs. In fully developed
Argentina, fox-like canids of the genus Dusicyon are often specimens, six proglottids are present (Fig. 4 and Fig. 5). The
infected by E. granulosus (5, 74). Those animals feed mainly on gravid proglottid is long and cylindrical, making up more than half
smaller mammals but evidently become infected by that ces- of the strobilar length. Eggs begin to appear in the uterus at about
tode from scavenging on carcasses of sheep (67). 90 days postinfection in domestic dogs.
At the present, the bush dog is the only known natural final
host of E. vogeli. Few bush dogs have been examined for the The Metacestode of E. vogeli in the Natural Intermediate
presence of intestinal helminths, but the high prevalence of the Host and in Humans
metacestode of E. vogeli in pacas is indicative of a much higher
rate in the final hosts. Such a differential between the respec- The paca, Cuniculus paca, is the natural intermediate host of
E. vogeli. The metacestode occurred almost always in the liver
and consisted of few to numerous spherical to subspherical
FIG. 3. The paca, intermediate host of Echinococcus vogeli. (Cour- FIG. 5. Strobilar stage of Echinococcus vogeli (length, 12 mm) from
tesy of Ignacio Borero, University del Valle, Cali, Colombia.) an experimentally infected domestic dog.
FIG. 6. Metacestode of Echinococcus vogeli in the liver of a paca

kept as a pet in a household in Carimagua, Colombia.
vesicles, isolated or frequently contiguous. In two animals, FIG. 8. Vesicles of Echinococcus vogeli in the mesentery near the
metacestodes occurred additionally in the hepatic ligament caecum in a naturally infected paca, Carimagua, Colombia.
and in the mesentery near the cecum. The greatest numbers
were in the left and median lobes, the largest of the four lobes
making up the liver of the paca. They were situated at all levels Brood capsules each contained 10 to 480 (average, 81) proto-
within the hepatic parenchyma but mostly were near the sur- scoleces (64). When fully developed, protoscoleces were 158 to
face, partially covered by Glisson’s capsule (64), there protrud- 203 ␮m in length by 108 to 145 ␮m in diameter (average, 175
ing slightly above the hepatic surface (Fig. 6). The metaces- by 133 ␮m).
todes were white and somewhat translucent, contrasting As seen in thick sections of liver, transected metacestodes of
markedly with the dark color of the liver. Within the paren- E. vogeli, when occurring singly, showed no indication of ex-
chyma, they were surrounded by connective tissue 70 to 250 ogenous proliferation. When two or more were contiguous,
␮m in thickness, the outer surface of which formed a boundary their separate boundaries usually could be discerned, and each
distinct from the unaffected hepatic tissue. When partially ex- appeared to have arisen from a single egg. The findings indi-
posed under Glisson’s capsule, the covering layer over the cated that proliferation in the liver does not occur in the
metacestode was only 20 to 30 ␮m in thickness. natural intermediate host. However, in one paca, vesicles in-
When transected in situ, the metacestodes were seen to be volving mesentery and cecum formed a mass that could have
enclosed within a laminated membrane variable in thickness arisen by means of proliferation (Fig. 8).
and often exhibiting folding. Intrusions of laminated mem- A difference in the developmental process and its conse-
brane usually produce a few trabeculae, forming chambers quences between the natural intermediate hosts and humans is
lined by germinal tissue from which the brood capsules arose not unique to E. vogeli, but that relationship is like that per-
(Fig. 7). Brood capsules were large and relatively few, more or taining to the metacestode of E. multilocularis. When voles
less spherical to pyriform, with the smaller end of each at- ingest a few eggs of E. multilocularis, development of the meta-
tached to the germinal tissue. They range from 424 ␮m to l.56 cestode takes place only in the liver and infective protoscoleces
mm in length by 389 ␮m to 1.45 mm in maximal diameter. are produced within 2 to 3 months; when infections are severe,
more hepatic lobes are affected, and exogenous proliferation
of germinal tissue may result in formation of masses of meta-
cestode in the peritoneal cavity but other organs usually are
not invaded.
The pattern of development of E. multilocularis is also dif-
ferent in the human host. Therein, development takes place in
the liver, where the membranes of the metacestode continue to
proliferate for the life of the host but protoscoleces are rarely
produced. Also in the human host, the membranes of the
metacestode proliferate only around the periphery of the le-
sion; the internal bulk of the lesion is replaced by connective
tissue in which areas of necrosis usually develop. Marked hep-
atomegaly is characteristic, and diffuse calcification is typical in
cases with advanced disease. The metacestode of E. multilocu-
laris may extend into contiguous organs (e.g., kidney); metas-
FIG. 7. Transected metacestode of Echinococcus vogeli, showing
tasis to distant sites (e.g., lung or brain) sometimes may occur.
brood capsules and other tissues, in the liver of a naturally infected The metacestodes of E. granulosus and, evidently, of E. oli-
paca, El Porvenir, Colombia. garthrus are alike in that their developments in the natural
FIG. 9. Proliferating vesicles of Echinococcus vogeli from the peri-

toneal cavity of an experimentally inoculated Mongolian gerbil. (Re-
printed from reference 59 with permission of the publisher.)
FIG. 10. Polycystic echinococcosis in the human liver (fatal case,

from a resident of Panama). (Courtesy of Octavio Sousa, Centro de
Investigación y Diagnóstico de Enfermedades Parasitarias, Facultad
intermediate hosts and their developments in humans do not de Medicina, República de Panamá.)
differ. In their respective intermediate hosts, the metacestodes
of both species enlarge concentrically, and many protoscoleces
are produced.
that advanced disease in humans may develop within a period
of about a decade (12).
Histogenesis and Pathogenesis of the Metacestode of
E. vogeli in Polycystic Echinococcosis The Metacestode of E. oligarthrus in the Natural
Intermediate Host
After ingestion of eggs of E. vogeli, the oncospheres released
in the intestine are transported to the liver, where the onco- As reported by D’Alessandro et al. (18), natural infections by
sphere forms a primary lacuna and development of the meta- the metacestode are known to occur in the following mammals in
cestode begins. In hosts other than the natural intermediate Central America and South America: opossums [Didelphis mar-
host, an initial vesicle, from which successive generations of supialis (L.)]; agoutis {Dasyprocta punctata Gray, D. fuliginosa
vesicles arise, is produced (Fig. 9). That process accounts for Wagler, D. aguti [⫽ D. leporina (L.)], and Dasyprocta sp. indet.};
the invasion of host tissues (59). In the human host, prolifer- spiny rats {Proechimys semispinosus (Tomes), P. guyannensis [⫽ P.
ation of vesicles leads initially to extensive involvement of the decumanus (Thomas)], and Proechimys sp. indet.}; and pacas.
liver (Fig. 10). After an undefined interval, the proliferating The metacestode described as E. cruzi Brumpt et Joyeux 1924 (7),
vesicles penetrate Glisson’s capsule and invasion of organs in from agoutis in Brazil, has been shown to be that of E. oligarthrus
the peritoneal and pleural cavities takes place (12). (63). The metacestode has been reported to occur in rabbits
Earlier stages of the disease in humans have not been de- (Sylvilagus floridanus (Allen)) in Venezuela (41). S. floridanus has
fined, because patients usually do not seek medical attention expanded its range into South America relatively recently, via the
until the infection has become symptomatic, by which time the Panamanian isthmus.
disease is far advanced. An outbreak of polycystic echinococ- Using eggs of E. oligarthrus from a cougar in Panama, Sousa
cosis in large primates at the Los Angeles Zoo was a source of and Thatcher (78) experimentally infected laboratory-reared
useful information, since, according to our observations with rodents, namely, spiny rat Proechimys semispinosus (Tomes),
experimentally infected nonhuman primates and from descrip- climbing rat Tylomys panamensis (Gray), and brown agouti D.
tions in the literature, infections produced in such animals by punctata. Then, using eggs from an experimentally infected
E. granulosus, E. multilocularis, and E. vogeli do not appear to house cat, they infected cotton rats (Sigmodon hispidus Say et
differ discernibly from those in the human host. At the zoo, Ord) and Mongolian gerbils. Probably small felids are not
primates of several species were confined as young juveniles in capable of preying on agoutis, so small rodents of various
an enclosure adjacent to one in which a bush dog (captured in species must serve also as natural intermediate hosts of E.
Colombia) was kept (36). Within 10 years, seven orangutans oligarthrus in South America.
died from polycystic echinococcosis or were noted to have In natural intermediate hosts, as well as in rodents infected
severe infections if other causes of death supervened. In addi- experimentally, the metacestodes of E. oligarthrus are sub-
tion, nine other large primates of various species died from spherical to irregular in form. Each is enclosed by a thin lam-
advanced echinococcosis, and two surviving gorillas showed inated membrane lined by germinal tissue containing abundant
signs of severe disease. Two gorillas having “very pendulous calcareous corpuscles (few in the metacestodes of E. vogeli).
abdomens” were diagnosed by means of ultrasonic examina- Unicystic metacestodes in subcutaneous muscles in agoutis
tion, and exploratory surgery revealed massive infections (36). measured 0.5 to 3 cm in diameter (78). In all infected rodents,
Both were euthanized, and necropsy revealed severe involve- the metacestodes developed normally, producing brood cap-
ment of the liver and disseminated disease affecting organs of sules and protoscoleces. According to Sousa and Thatcher
the peritoneal and pleural cavities (36). Those findings suggest (78), internal septae were often present, but as we also have
observed, proliferation did not occur. In contrast to that of E. hemisphere, and it is widely present in Eurasia and in north-
vogeli, in which brood capsules are few and scattered (Fig. 7), ern North America. An atypical form of the metacestode of
the germinal tissue in the metacestode of E. oligarthrus usually E. granulosus in the liver of ungulates, characterized by
is covered by brood capsules that, according to our observa- small vesicles without protoscoleces in a dense matrix of
tions of sections, often form contiguous layers that may fill connective tissue, often has been confused with the meta-
most of the lumen. The protoscoleces are somewhat larger cestode of E. multilocularis, but its identity has been clearly
than those of E. vogeli, having a diameter of 218 to 230 ␮m in established (47, 89, 93). Vogel proposed that the atypical
spiny rats (78). The rostellar hooks of the unicystic metaces- forms of E. granulosus in the liver of ungulates be designated
tode are consistently shorter than those of E. vogeli, and in that “multicystic” (89).
stage, the two species are distinguished as well by strongly Similar multicystic metacestodes have rarely been reported
defined differences in the shape of the hooks (65). Rodriguez in humans but have been the basis of considerable confusion in
et al. (70) have given a detailed description of the metacestode South America, where their occurrence has been taken to lend
of E. oligarthrus from the spiny rat Proechimys guairae. support to the “unicist” concept that one species of Echino-
coccus (E. granulosus) causes both of the aforementioned
forms of echinococcosis, compared with the “dualist” view
Histogenesis and Pathogenesis of the Metacestode of
(now recognized as valid) that two species of Echinococcus are
E. oligarthrus in Unicystic Echinococcosis
involved (33, 88, 94). In addition to the possible occurrence of
Like those of E. granulosus, the oncospheres of E. oligarthrus the multicystic form of E. granulosus in humans in South
may pass through the liver and be transported by the systemic America, such cases, considered in retrospect, might have been
circulation to various loci in natural, as well as atypical, inter- caused by E. vogeli or, less likely, by E. oligarthrus. Some alve-
mediate hosts. At the present, in humans, only three cases of olar lesions have been described in Argentina and reported to
unicystic echinococcosis have been recognized; thus, the po- have occurred in humans in Chile and Uruguay. Because the
tential range of loci in the human body is not known. In anomalous multicystic metacestode of E. granulosus does not
humans, the metacestode of E. oligarthrus has been described produce protoscoleces, rostellar hooks necessary for identifi-
as a more or less spherical structure that enlarges concentri- cation have not been available. As a consequence, we do not
cally, and pathogenesis appears to result from pressure effects know if the neotropical species of Echinococcus occur in those
caused by its expansion. Two of the three known cases involved countries (19, 22, 85, 86, 87, 88).
retro-ocular location of single vesicles, with production of sig- In Costa Rica, a human case of echinococcosis in the liver
nificant exophthalmos (4, 39). In the third case, the autopsy of was studied and tentatively diagnosed as being due to E. oli-
a patient who died of tetanus at 70 years of age revealed two garthrus, probably because that species had been found in a
metacestodes, each about 1.5 cm in diameter, in the left wall of Costa Rican cougar (6). The patient was an immigrant who had
the ventricle (16). In those patients, development of the meta- spent 27 of his 53 years in Spain. Later on, the study of the
cestode was evidently normal, and the rostellar hooks of pro- hooks demonstrated that he was infected by E. granulosus, but
toscoleces provided the means of identification of the organism the metacestode morphologically somewhat resembled a mul-
as E. oligarthrus. ticystic echinococcus. One of us (A.D.) studied the hooks of
the protoscoleces and was in agreement with R. Arroyo and R.
Brenes, who kindly sent samples of the specimens and had
MEDICAL ASPECTS OF NEOTROPICAL
recognized that the infection was due to E. granulosus (R.
ECHINOCOCCOSES
Arroyo, personal communication [7 April 1993]).
Polycystic and unicystic echinococcoses are helminthic in- D’Alessandro et al. (17) reported cases of polycystic echi-
fections that occur exclusively in rural areas of the Neotro- nococcosis in persons from four countries (Colombia, Ecua-
pics (60). As indicated earlier in this article, E. granulosus, dor, Panama, and Venezuela), and these cases involved tumor-
the cause of cystic echinococcosis, occurs widely in the like masses in the liver. The patients had resections or biopsies
southern cone of South America, particularly in sheep and of the lesions. The presurgical diagnoses were cancer of the
other ungulates in areas in which livestock is raised in Uru- gall bladder with metastases, tumor, abscess or hepatic cirrho-
guay, Argentina, Chile, the Andean regions of Peru and sis, gastric tumor, and chondrosarcoma of a rib. The clinical
Bolivia, and the state of Rio Grande do Sul in Brazil. On the and surgical diagnoses were found by pathologists to be erro-
other hand, autochthonous human cases of cystic echino- neous. Those and later reports on other autochthonous cases
coccosis are rare in other South American countries, al- described alveolar, multicystic, or multilocular echinococcosis,
though dogs and domestic ungulates may sometimes be in- due to E. granulosus or E. multilocularis and, only more re-
fected. The reason for this situation is not clear, but perhaps cently, due to E. oligarthrus. However, experimental infection
epidemiological conditions do not favor the infection in of cats and dogs, the only way to obtain the cestodes at the
humans, or less likely, the genotype of the cestode in those strobilar stage at the time, was not attempted. D’Alessandro et
regions does not readily infect humans. In those areas, al. (14, 17, 18) and Rausch et al. (65) were able to establish the
metacestodes of E. granulosus usually are found to occur in infections in such mammals, using metacestodes from humans
immigrants from other countries, especially from Europe. and other animals from Colombia. Findings from experimental
Human cases of infection by the two neotropical species of animals established that the metacestodes developing in hu-
Echinococcus are seen mostly where E. granulosus is not mans were polycystic and were that of E. vogeli and thus rep-
endemic. E. multilocularis, the etiologic agent of alveolar resented a new parasitic infection for humans. In addition, they
echinococcosis, is limited in occurrence to the northern established the criteria for not only the differential diagnosis of
TABLE 1. Frequency of clinical characteristics of polycystic and unicystic neotropical echinococcoses according to species
Clinical type No. of cases

Clinical presentation
of echinococcosis E. vogeli E. cf. vogeli a
E. oligarthrus E. granulosus Total (%)c
Polycystic
I Cysts in the liver and abdominal cavity 19 11 0 1 30 (37)
II Cysts in the liver and abdominal cavity plus hepatic insufficiency 9 12 0 0 21 (26)
III Cysts in the liver and lung/chest 4 7 0 0 11 (14)
IV Cysts only in the mesentery of the intestine or of the stomach 9 4 0 0 13 (16)
V Calcified cysts in the liver and lungb 1 2 0 0 3 (4)
Unicystic
VI Cysts only in the orbit 0 0 2 0 2 (2)
VII Cysts only in the heart 0 0 1 0 1 (1)
Total 42 36 3 1 81 (100)
a
E. cf. vogeli causes infections with polycystic lesions but with no hooks found.
b
The total number of these patients with liver cysts was 66/81 (81%), and the number with lung cysts was 11/81 (14%).
c
Excludes the E. granulosus case.
infection with the two neotropical species, E. vogeli and E. to consider that some of those persons from areas in which the
oligarthrus, but also criteria separating the causative agents infection is endemic may have had asymptomatic infections by
from the other two recognized species, E. granulosus and E. E. vogeli. Therefore, the number of infected persons in the
multilocularis. neotropical countries may be 232 and, in Brazil alone, 160 (52;
Fortunately, in recent years, investigators have become in- U. Meneghelli, personal communication [2006]). Forty Brazil-
creasingly aware of and interested in the two zoonoses caused ian cases of polycystic echinococcosis occurring in the states of
by the neotropical cestodes and have improved their capabil- Para and Amapa, in the western Amazonian region, were sum-
ities for recognition and diagnosis of such infections. Due to its marized by Soares et al. (76). Included in that group were 14
frequency, polycystic echinococcosis is no longer a medical cases reported by Orlando Fonseca and Aurelio Costa in 1995
curiosity, and it should be considered in the differential diag- (12).
nosis of polycystic masses in humans. On the other hand, As of March 2007, the clinical information from 81 patients
human infections with the unicystic metacestode of E. oliga- is available among the 172 known cases (Table 1). By far, the
rthrus have been rarely diagnosed. liver was the organ most frequently affected. Indeed, in 81% of
the cases, metacestodes were found in the liver alone or with
vesicles situated in the abdomen, in the liver and the lungs/
Clinical Characteristics of Polycystic and
pleural cavities, or only as calcified vesicles in the liver. Organs
Unicystic Echinococcoses
involved in the abdomen included the diaphragm, spleen, pan-
The clinical characteristics of polycystic echinococcosis in creas, omentum, mesenteries, rectal-vesical sac, ovaries,
patients depend on the location of the metacestode as well as uterus, abdominal wall, psoas muscle, and vertebra. In the
the extent of invasion of tissues, particularly the liver (Table 1). chest, the lungs were infiltrated in 11 (14%) cases; also in-
D’Alessandro et al. (17) published observations on all re- volved were ribs, intercostals and subscapular muscle, pleura,
ported or known cases of polycystic echinococcosis. In addi- pericardium, auricle, vena cava, and other large mediastinal
tion, D’Alessandro invited senior parasitologists of Central vessels. The remaining 13 polycystic lesions were located only
American and South American countries to report, during in the mesentery. Of unicystic lesions, due to metacestodes of
various meetings of the Federación Latinoamericana de Para- E. oligarthrus, one was located in the heart and two were in the
sitologos, the status of echinococcosis in their countries, in orbit. Those single-site infections were reported as being not
particular concerning polycystic echinococcosis in humans and concomitant or secondary to any other lesions located else-
other animals. Their contributions have been reported (12). where in the body.
The present report includes all data, published and unpub-
lished, obtained from reliable sources since that time. Clinical Characteristics of Polycystic Echinococcosis
The total number of known cases of neotropical echinococ- (E. vogeli) (Types I to V)
cosis, as of March 2007, is 172. Included in that number are 18
new cases observed by Ulysses Meneghelli (personal commu- Examination of the patients’ case histories offered the op-
nication [October 2006]). In addition, two serological surveys portunity to group them in types so that frequency of clinical
in Brazil demonstrated that 41 of 1,064 and 19 of 40 persons features, severity of the illness, complications, types of treat-
(total, 60 of 1,104 [5%]) showed antibodies for Echinococcus in ments used, and mortality could be better assessed.
the counterelectrophoresis test. Whether all those 60 persons Type I. The most common type of presentation, type I,
had asymptomatic echinococcosis is not known, because one included lesions in the liver (Fig. 11) and in the abdomen, seen
single test may overlook or involve a cross-reaction with other in 30 of 81 (37%) cases (Table 1). The patients presented with
conditions or parasitic infections. Nonetheless, it seems logical palpable, hard, and rounded masses, painful or not painful,
FIG. 11. Portion of the wall of a polycystic lesion, showing germinal

and laminated membranes (rightmost arrows) and accumulated dead FIG. 12. Section of biopsy specimen from a human liver (from the
eosinophils (larger arrow) between the metacestode and the fibrotic 58-year-old female case from reference 12), containing part of a poly-
pericyst (hematoxylin-eosin stain). cystic lesion, showing a granulomatous reaction with palisaded histio-
cytes (periodic acid-Schiff stain).
usually within or connected with the liver (the hepatic masses

and size of abdomen progressively enlarging), abdominal pain, cities of Buenaventura and Cali, Colombia, had a 15-year his-
gastrointestinal problems, marked weight loss, and fever. The tory of an abdominal mass as of presentation in 1981. Within
illness was first treated with analgesics or other symptomatic one year, she lost 8 to 10 kg in body weight and the mass had
drugs. For seven of the patients in this group, a diagnostic become larger, compressing the thorax, and was movable by
laparotomy/biopsy (Table 2) was the only invasive procedure hand. The enlarged abdomen gave the impression of advanced
carried out; these patients usually were considered to have pregnancy. The mass was hard and painless; laboratory results
intractable disease (carcinoma) and left alone. With recogni- were normal. Imaging showed round calcifications. Laparos-
tion of the nature of this tropical illness, surgical intervention copy revealed polycystic masses in the abdominal cavity, liver,
was begun. Surgery was well tolerated, and none of 17 cases omentum, and abdominal wall. Simple X rays, computerized
died during the surgery or as a direct consequence. For at least tomography (CT) scan, and ultrasonic examination were per-
4 of those 17 cases, a partial hepatectomy was carried out; for formed (Fig. 12, 13, 14, 15, and 16). We recommended pallia-
others, the entire metacestode was resected or a partial cys- tive surgery because the abdominal cysts were interfering with
tectomy was performed. The entire metacestode could not breathing and eating. The surgeon excised only the vesicles
always be removed. At times, some spilling of its fluid content from the sites mentioned. The liver, stomach, and spleen
into the abdominal cavity occurred, with the risk of secondary formed a unified mass that was not disturbed. With the re-
proliferation causing recurrent disease. Polycystic echinococ- moval of 2 kg of cysts, the patient had a short, uneventful
cosis in most cases takes a chronic course, sometimes over recovery after surgery, with relief of intra-abdominal pressure.
many years. However, surgery that failed to resect the entire A year later, she again became symptomatic and for 28 days
metacestode was usually beneficial to the patient, who might was treated with albendazole, which was well tolerated. She
then live for a long time with minimal disturbances. improved clinically for several months and did not return for a
A typical case of type I disease is as follows (12): a 58-year- follow-up. Subsequently, it was learned that the patient be-
old female who was born in a rural area and relocated to the came cachectic and developed ascites and collateral abdominal
TABLE 2. Management and treatment of 78 cases of polycystic echinococcosis and 3 cases of unicystic echinococcosis with sufficient information
No. of patients with indicated treatment or outcome No. of patients
Clinical disease who died after
Surgery
typea Lapa/biopsyb
Albendazole Died of Autopsy Calcified Total (% of all study
Survived Died alone PEc finding cysts patients) completion
I 7 17 0 5 1 30 (37) 1
II 0 8 4 4 4 1 21 (26) 5
III 0 3 1 3 3 1 11 (14) 3
IV 3 7 0 1 1 1 13 (16)
V 3 3 (4)
VI 2 (2)
VII 1 (1)
Total 10d 35 5 13 9 3 3 81 (100) 9

a
Note that types VI and VII represent unicystic echinococcosis.
b
Lapa, laparotomy.
c
PE, polycystic echinococcosis.
d
One Costa Rican case was excluded from the total because rostellar hooks were not found.
FIG. 13. Macroscopic appearance of polycystic vesicles removed

from the omentum of a patient (58-year-old female case from refer- FIG. 15. Ultrasonic image of a liver, showing polycystic lesions
ence 12) by palliative surgery. (Reprinted from reference 12 with (from the 58-year-old female case from reference 12). The anechoic
permission from Elsevier.) vesicles were round and of different sizes, with regular walls. (Re-
printed from reference 12 with permission of the publisher.)
circulation compatible with portal hypertension; she died at tomy, after which albendazole was administered for a period of
home in 1999. Serological tests (enzyme-linked immunosor- 6 months. At 11 months following surgery, examination by
bent assay [ELISA] and immunoblot [IB]) were always positive means of CT revealed no evidence of recurrence. Cures were
for echinococcosis. also reported by Chigot et al. (10), who followed a similar
Ghiotti Siqueira et al. (29) evidently cured a patient from course of treatment, including CT scanning, and the patient
whom all metacestodes in the liver, omentum, and peritoneum remained well for at least 3 years. In another series, 1 patient
were removed by means of partial hepatectomy and omentec- died, but 16 improved after surgery (76).
Chemotherapy sometimes has been used in the treatment of
polycystic echinococcosis. In one series of patients, five were
treated with albendazole alone, with apparently favorable re-
sults (76). The courses of treatment were reportedly for dif-
ferent lengths of time and with different degrees of success. It
was not known if the patients followed the regimen of treat-
ment, and usually they did not continue to take the drug or
only attended a clinic and returned home. In most cases it was
not possible to determine the ultimate fate of those individuals.
Type II. The second type of clinical presentation, type II, is
similar to type I but includes signs that the vesicles are located
close to and compressing the portal blood supply and/or the
biliary system of the liver. That compression evoked jaundice,
FIG. 16. CT scan, demonstrating vesicles of Echinococcus vogeli in

FIG. 14. Abdominal posteroanterior X ray, showing three small, the abdomen (from the 58-year-old female case from reference 12).
round calcifications (arrows) in a polycystic lesion involving the liver The vesicles are hypodense and round to oval. The intestine has been
and omentum (from the 58-year-old female case from reference 12). displaced against the posterior wall. (Reprinted from reference 12 with
(Reprinted from reference 12 with permission from Elsevier.) permission from Elsevier.)
FIG. 18. Posteroanterior X ray of the thorax, indicating right pul-

monary lobe and left and right pericardial tumors (arrows). From the
first X-ray study of case no. 1 (from the 22-year-old male case from
reference 12), subsequently proved to be polycystic echinococcosis.
(Reprinted from reference 17 with permission of the publisher.)
moved to an urban dwelling. An X ray revealed several masses

in the chest and also displacement of the ureters. Tentative
diagnoses included lymphoma, retroperitoneal sarcoma, sem-
FIG. 17. Polycystic lesion of the pericardium, the frontal section inoma, and pulmonary carcinoma. At laparotomy, small poly-
(from the 22-year-old male case from reference 12). (Reprinted from
reference 17 with permission of the publisher.)
cystic masses removed from each hepatic lobe led to a diag-
nosis of polycystic echinococcosis. During two thoracotomies,
left and right, cysts were found in the pericardium, superior
vena cava and right auricle, inferior pulmonary lobe, central
hepatosplenomegaly, collateral circulation, and hematemesis right pulmonary lobe, pleura, and diaphragm. Surgery was
due to the rupture of esophageal varices. Laboratory tests uneventful, and all vesicles were removed (Fig. 17, 18, and 19).
revealed abnormalities due to the hepatic injuries not found in Six years later, in 1981, lesions had returned, but the patient
type I patients. Twenty-one of the 78 (26%) cases showed that was asymptomatic. In 1986, due to a protrusion in the right
complication. Four died during surgery or because of postsur- flank, albendazole treatment was prescribed; it was well toler-
gical complications (33, 79; unpublished data). Four additional ated and evidently effective, because the mass disappeared and
patients died of the disease, and another was found at autopsy the patient gained weight. CT scanning showed vesicles in the
to have a pulmonary abscess. Four improved after chemother- abdomen and in the retroperitoneal region. The patient con-
apy with albendazole alone. After the management of that tinued working and had a normal life, but we unfortunately
group ended, it was reported that five eventually died of seri- have no photos or images from that period. His serology was
ous complications of polycystic echinococcosis, i.e., hepatic always positive (ELISA and IB). The patient tolerated the
failure due to biliary cirrhosis and hematemesis, etc. (12, 22, infection quite well and accepted treatment with albendazole
26, 34, 38, 50, 77).
Type III. In the clinical presentation of type III, lesions were
present in both liver and pleural cavity of 11 (14%) patients.
They complained of pain in the chest and epigastrium, cough,
hemoptysis and signs of bacterial infection of the lungs, and
jaundice and other signs of hepatic insufficiency and cardio-
megaly, as well as congestive heart failure and acute pulmonary
edema, which were indicators that the heart was badly dam-
aged by the invading metacestode of E. vogeli. Three patients
died of later complications (76). The attempt to clear bile ducts
of parasites was unsuccessful, but surgery was followed by
treatment with albendazole after which the general condition
of the patients improved, although jaundice persisted (patient
number 5) (44). In this case, as well as in others, improvement
was observed after chemotherapy for up to 30 months, but the
patients did not return for follow-up, and their fates remain
uncertain.
A typical case of type III was that of a 22-year-old male born FIG. 19. CT scan, made 5 years after surgery (from the 22-year-old
male case from reference 12), showing hypodense, round polycystic
in a tropical rural area of Colombia, who presented in 1975 vesicles, mainly posterior in the right hepatic lobe and right lung.
with a 4-year history of purulent expectoration with fever and Triangular calcifications are evident in the liver. (Reprinted from ref-
chills (12). He had been treated with antibiotics before he erence 12 with permission from Elsevier.)
only after he became icteric or had some other disorder. He series (49), had three small cysts in the intestinal mesenteries
was killed in a street accident. The autopsy was conducted by that were removed surgically at the Disconessen Hospital in
a medical examiner. It was not possible to obtain information Paramaribo in 1985. The diagnosis was echinococcosis. She
about the lesions caused by E. vogeli. voluntarily attended the clinic, had been well after surgery, and
A relevant case history of one patient who died in a surgical had taken mebendazole (3 g/day) for three months. At the time
accident also is presented here. This is a remarkable case of her attendance at the clinic she was well, her serology (by
history of a patient whose disease presentation was classified as ELISA and IB) was negative, and an ultrasonic examination
type III; one of us (A.D.) had the opportunity to meet this also was negative. She had been well for 14 years, and it was
patient. At the end of 1983, while in Bogota, A.D. was invited concluded that she had been cured (48, 49). This case also was
to discuss with a group of colleagues the case of a Colombian exceptional because she could be located and traced. The fates
woman of about 35 years of age with polycystic echinococcosis. of many of the humans suffering from polycystic echinococco-
The diagnosis had been made by means of a liver biopsy and a sis considered in this review are unknown, because many re-
detailed study of thoracic images, in particular of the large
turned to their homes from the modern hospitals where they
vessels and the heart. The discussion was to determine whether
had undergone treatment.
surgery might be indicated or beneficial to the patient. A.D.’s
Another case history of a type IV patient is given here (12).
opinion was that surgery would be too risky, particularly to a
A 78-year-old man evaluated in Colombia complained of a
patient who at the time was asymptomatic. After the meeting,
painful mass in the left hemiabdomen. He was diagnosed as
A.D. was able to talk with the patient, who flatly refused to
undergo surgery, because she had been well since the hepatic possibly having an echinococcal cyst of the spleen (based on a
biopsy and was asymptomatic. Twelve years later, in 1996, it calcification observed in the roentgenogram) or a leiomyoma
was learned that she was working at a local hospital and was of the small intestine. At surgery, the mass was found to be
still asymptomatic. The case was presented again at a medical attached to the posterior wall of the abdomen, surrounded by
meeting, and a new set of thoracic images revealed ever-en- a loop of the small intestine. The mass, along with 90 cm of the
larging lesions in the heart and in the large vessels in the intestine, was resected, but portions of cysts remained attached
mediastinum. It was strongly recommended that the patient to the base of the mesenteries; also, fluid from the mass was
should have surgery and that a description of the unique case spilled into the abdominal cavity. The etiologic agent was iden-
should be published. A year later, it was learned that the tified as E. vogeli. The patient was well for seven months and
patient had developed congestive heart failure and had gone to then died of a myocardial infarction.
a different hospital, where an auricular resection had been Type V. Calcified cysts of the liver and mesentery are cate-
successfully performed. The operation was well tolerated and gorized as type V. Three cases of dead and calcified cysts, two
the patient had become asymptomatic. She was convinced, resembling infections by E. vogeli and the third caused by E.
however, that a complete cure would depend on the excision of vogeli, have been reported. Meneghelli et al. (45) reported two
the hepatic lesion. In 1998, during surgery to remove the he- Brazilian cases of hepatic calcification that resembled lesions
patic lesion, the patient died of a surgical accident. A complete in other patients having polycystic echinococcosis. R. L.
report of the case would no doubt be informative. Rausch thought that the clinical, epidemiological, and radio-
Type IV. In the type IV patients, lesions were limited to the logical data provided were compatible with the suggested di-
mesentery of the small or large intestine (and in one case, in agnosis. One of the two patients had presented with abdominal
that of the stomach) of 13 (16%) of the 78 patients. The liver distention that had been attributed to calculus cholecystitis,
and other organs were reported to be free of metacestodes. but at surgery, the gall bladder was normal. The thoracic X
The lesions and pain were centrally located in the abdomen, ray revealed small, calcified nodules in the lungs and a large
and at surgery, the vesicles in the mesenteries could be excised, conglomeration of cysts particularly at the margin of the
sometimes along with portions of the intestine surrounding the liver. The second patient was asymptomatic but had similar
cystic mass. Surgery was well tolerated by seven patients, but
hepatic calcifications. He had lived in rural areas, was fa-
for three, only a biopsy specimen could be obtained because
miliar with pacas, and always had kept dogs. His case was
the metacestode involved large vessels, making surgery too risky.
considered to be similar to that of the first type V patient
In some of the cases involving operations, portions of the poly-
described.
cystic mass remained attached to the posterior wall of the abdo-
The third case was reported by Moraes et al. (46). A calcified
men, too close to vessels to attempt removal. All were treated
with albendazole. One was considered cured after surgery and a mass situated in the mesentery was discovered by X ray of the
second after two years of albendazole treatment alone (44). lumbar region for evaluation of possible prolapse of an inter-
Nine cases of polycystic echinococcosis recently were re- vertebral disk. The cystic structure was calcified, but some
ported in Suriname. In four of the nine patients, the metaces- rostellar hooks were found in the mass after its surgical re-
todes involved the intestinal mesentery (4, 48, 49). In 1999, the moval, permitting identification of E. vogeli.
late Beltus Oostburg (University of Suriname in Paramaribo) Those three cases, involving dead metacestodes of E. vogeli,
organized a field trip to visit each of the areas of residence of illustrate that some patients, when infected, exhibit an unusual
the patients mentioned above to determine the outcome of tissue response. Total calcification of the metacestodes and their
their illness. Fortunately, one of the patients had attended the presence only in the mesenteries, may be indicative of a defensive
clinic organized for the purpose. Her case history is presented host response to infection by E. vogeli. Such a relationship be-
here. tween the cestode and the host has been explored already in
A 25-year-old Amerindian woman, case 2 of the Suriname human infections caused by E. multilocularis (30, 32).
FIG. 20. Palpebral ptosis and chemosis in a child with a retro-

ocular unicyst of Echinococcus oligarthrus. (Reprinted from reference
4 with permission of the publisher.)
Clinical Characteristics of Unicystic Echinococcosis

FIG. 21. CT scan of the young patient shown in Fig. 20, indicating
(E. oligarthrus) (Types VI and VII) the liquid-filled, retro-ocular unicyst (four dots). (Reprinted from ref-
erence 4 with permission of the publisher.)
The unicystic lesions of E. oligarthrus in humans have been
so far reported in only two loci: in the orbit of the eye and in
the myocardium. We designate them type VI and type VII,
respectively, using the same terminology as that used for cases and died soon after admission. The autopsy revealed an en-
of E. vogeli. larged pericardium with 50 ml of clear, yellowish liquid in the
Type VI. Unicysts in the orbit (two cases due to E. oliga- pericardial space. The heart was increased in volume and
rthrus) are categorized as type VI. One case involved a 61-year- weight. In the ventricular wall, two masses, each 1.5 cm in
old Venezuelan woman who had lived in a rural semiarid area diameter, were seen. When sectioned, those were found to be
of hot climate, bushes, and thorny plants. Villagers and their unicysts that could be easily separated from the myocardium.
animals drank water from small, artificial ponds. Raising goats The vesicles’ content was gelatinous and clear and contained
was the main economic activity in the area. The patient pre- brood capsules of E. oligarthrus. The patient also had chagasic
sented with proptosis of the left eye, ptosis of the eyelid, and myocarditis, but no other Echinococcus vesicles were found at
headache. The CT scan revealed a single orbital, retro-ocular necropsy. As previously observed in long-standing cysts of the
vesicle of 2 cm in diameter. The immunoelectrophoresis Arc 5 two neotropical species, these unicysts showed signs of degen-
test for echinococcosis was positive. The vesicle was evacuated eration next to areas in which the metacestode appeared nor-
and then removed. The rostellar hooks of the protoscoleces mal in condition.
obtained were of E. oligarthrus. Whether the eyesight of that
patient was preserved was not stated (39). The second case of Consequences of Medical Treatment
E. oligarthrus infection in the orbit was seen in a 6-year-old
child from Suriname. The exophthalmos was irreducible, the Table 2 indicates that type I lesions were the most frequent
chemosis was extensive, and only light reception vison func- (37%) as well as the most frequently operated with no acci-
tioned (Fig. 20 and 21). Ultrasound (US) and CT showed a dents occurring (57%). A single earlier patient died after man-
large, liquid-filled vesicle 27 by 32 mm, surrounded by a 3-mm- agement was completed, case 4 (12). Type II lesions occurred
thick fibrotic capsule at the apex of the orbit. The indirect two-thirds as frequently as those of type I, but mortality was
hemagglutination assay (IHA) for echinococcosis was negative. rather high (four surgical accidents, four deaths from polycys-
Surgery was carried out in Paris, France, using a fronto-tem- tic echinococcosis, and five postmanagement deaths). Type III
poral incision. After the fibrous capsule was opened, 10 ml of and IV lesions occurred in 11 (14%) and 13 (16%) of the
clear liquid was aspirated from the vesicle and hypertonic patients. Ten were treated surgically, and only one died (of a
saline solution was injected and later replaced by isotonic fluid. surgical accident). Soares et al. (76) reported necropsy findings
Hooks of E. oligarthrus were recognized. Due to the risk to the from three individuals with type III disease who died of severe
eye that might accompany the complete removal of the cyst, cardiac, pulmonary, and hepatic failure.
the surgeon opted to prescribe postsurgical chemotherapy with Thirteen patients (16%) were treated only with albendazole.
albendazole. The severe proptosis and chemosis were cor- Results are given in Table 3, which summarizes the outcomes
rected, but a slight blepharoptosis remained, as well as blind- of treatment of 78 patients having polycystic echinococcosis
ness of the left eye. One year later, back in Suriname, the and for whom sufficient information was available. Thirty-five
patient was in good health (4). cases (45%) involved surgical attempts to remove large, inva-
Type VII. Unicysts in the heart due to E. oligarthrus are sive polycystic lesions or attempts to clear biliary obstructions.
categorized as type VII. Discussed herein is a previously pub- The patients tolerated surgery well and had no complications;
lished case (16) of echinococcosis in the heart of a Brazilian only five (6%) died (due to surgical accidents) (17 [case 13], 33,
person who died of tetanus. The 70-year-old male agricultural 76, 80, and the present report).
worker from Minas Gerais was taken to the hospital with D’Alessandro (12) included by error, among persons who
tetanus. He presented in poor health and marked malnutrition had died from surgical complications of polycystic echinococ-
TABLE 3. Outcome of 78 human cases of polycystic echinococcosis tion in the number and size of cysts may be evident. Abdominal
No. (%) pain or respiratory signs may disappear in days or weeks. The
Outcome or parameter
of cases use of mebendazole has been limited, because it is less soluble
Uncomplicated surgery ...................................................................................35 (45) (26, 54, 66).
Death due to surgical accident ...................................................................... 5 (6) To summarize Table 2 and Table 3, 23 (29%) of 78 patients
Death due to polycystic echinococcosis during the
study and after the study ended ............................................................18 (23) died. Mortality by type of polycystic echinococcosis was as
Total mortality .................................................................................................23 (29) follows: one patient, four patients, three patients, and one
Treatment with albendazole alone................................................................13 (16)
Success (Meneghelli et al., 1992 关44兴) ...................................................... 6a patient had types I, II, III, and IV, respectively. Nine patients
No action on cysts (Almeida et al., 1997 关2兴).......................................... 1/1 died after the study was completed; five of them were had type
Improved symptoms (Pastora et al., 2003 关52兴) ...................................... 2/2
Improvement/US negative at 1 yr (Pieres et al. 关53兴) ............................ 1/1 II, the category with highest mortality, probably due to hepatic
Improvement (Soares et al., 2004 关76兴).................................................... 5/5b failure and its complications. The only patients most probably
cured were treated surgically in combination with chemother-
Total cured ....................................................................................................... 5 (6)
Total nondead cases........................................................................................59 (76) apy (albendazole). Apparently, however, albendazole alone
a
was parasitostatic against the metacestode of E. vogeli. As a
Two cases achieved partial success (one later died, one was albendazole
resistant), and four achieved full success (patients did not complete follow-up). consequence of past experience, we learned that patients are
b
Patients did not complete follow-up. best handled by surgical intervention followed by a few weeks
of therapy with albendazole. When the invasion by the meta-
cestode involves essential organs or especially vulnerable parts
cosis, those who had died from E. vogeli infections; the confu- of organs, the judgment of the surgeon must determine
sion has been recognized and corrected. whether to leave portions of the metacestode and continue
Of the 13 patients treated only with albendazole, results for therapy with albendazole or, in the future, perhaps to admin-
the first six were reported as partially or wholly successful. ister other drugs that reduce the invasiveness or are para-
Meneghelli et al. (44) had followed them for 10 to 30 months, sitocidal for the metacestode. Liver transplant has also been
the elapsed time now being about 15 years. To obtain addi- considered as a possibility (44).
tional information, we contacted Ulysses Meneghelli (personal We consider that the metacestode of E. oligarthrus is uni-
correspondence [27 October 2006]). Unfortunately, he had lost cystic, single or multiple (when multiple, each cyst is separate
contact with all but two patients. One had died of hemorrhage and independent), and that it does not proliferate in the hu-
due to the rupture of esophageal varices, and the second had man host but that its structure in humans is evidently identical
active polycystic echinococcosis that did not respond to che- with that in the natural intermediate host (see above). Micro-
motherapy with albendazole. scopic and macroscopic findings from the three known cases of
The observations from the other investigations listed in Ta- unicystic echinococcosis were unlike those from cases of infec-
ble 3 indicated results of albendazole treatment similar to tion by E. vogeli. Anatomically, the unicystic metacestode ex-
those of Meneghelli et al.: diminished size of the metacestodes hibits a quite different arrangement of brood capsules, and of
and clinical improvement in the patient. It seems therefore course, the size and form of rostellar hooks of protoscoleces
that the drug is not parasitocidal but rather parasitostatic. are diagnostic. Only a few metacestodes of E. oligarthrus, from
Nonetheless, it may be used to ameliorate the overall condition a cardiac infection in one individual, have been studied. One
of patients, both pre- and postsurgery. The experience gained cannot certainly predict that lesions of long standing may not
during the last 10 years indicates that surgery is a very impor- exhibit some greater degree of invasiveness, or other E. vogeli-
tant part of treatment for patients who can tolerate the pro- like characteristics in the human host, but interspecific simi-
cedure (depending on age, general health, and willingness to larities of such magnitude would not be expected to occur
undergo the operation, etc.). In the group of patients evaluated among species of Echinococcus.
in this review, surgery was carried out in almost half of the 78 E. vogeli (and evidently E. oligarthrus) is less organ-specific
cases surveyed; only five patients died of surgical accident (as than is the metacestode of E. multilocularis, which usually
mentioned above). The only five patients that seem to have remains localized in the liver. E. multilocularis undergoes in-
been cured were treated surgically with the additional chemo- trahepatic proliferation, typically not producing protoscoleces
therapy with albendazole. CT scan and US, performed after in the human host; extension into the peritoneal cavity does
treatment was terminated, were negative (10, 29, 42, 44, not occur, but contiguous organs (kidney) may be invaded, and
49, 53). occasionally metastasis to lung or brain may occur. E. vogeli
Albendazole has been administered at a dosage of 10 mg/kg appears to be the most pathogenic of the four species of the
of body weight/day, divided into two or three doses daily. The genus Echinococcus.
usual schedule has been three months of treatment with a
2-week interval between months, but higher dosages have been DIAGNOSIS OF POLYCYSTIC ECHINOCOCCOSIS
used, as well as longer treatment with no interruptions. Side (E. VOGELI)
effects discerned have included increased aminotransferase,
leucopenia, proteinuria, alopecia, gastrointestinal symptoms, Before this illness was recognized as being due to a parasitic
and allergic reactions. Such side effects were transitory and infection, the intra-abdominal masses were erroneously con-
disappeared if the drug was discontinued and treatment could sidered to represent a variety of disorders, including hepatic
then be restarted with no ill effects. Early during treatment, tumor, abscess, cirrhosis or cholecystitis, gall bladder cancer,
appetite improved, temperature was reduced, and general mesenteric tumor, and costal chondrosarcoma (17). With mod-
well-being improved. After three weeks of treatment, reduc- ern diagnostic methods, the recognition of polycystic echino-
coccosis has been greatly facilitated. Moreover, with an in- reported in about 21% of cases, ranging from 9 to 28%, but it
creasing number of published reports concerning this disease, is not considered to have specific diagnostic value.
medical personnel in tropical areas, as in Colombia and more
recently in Brazil, have been keenly interested in undertaking Physical Examination of the Abdomen
epidemiological surveys (51, 69).
In most instances, the patients affected with polycystic echi-
nococcosis consult for abdominal pain and have recognized the
Patients’ Histories presence of a mass in the abdomen close to the liver. Hepa-
Geographical origin of the patients is very important. They tomegaly was usually present because that organ was certainly
typically are born, or have lived for prolonged periods, in rural involved in 80% of cases of polycystic echinococcosis. When
tropical areas of continental South America, particularly in the metacestode is located in the mesentery, it usually can be
regions with past or present abundance of wildlife. Familiarity palpated as a mass separate from the liver.
with pacas, hunting pacas, knowledge of possible presence of
“water vesicles” in their livers, and whether domestic dogs Radiological Imaging
were fed viscera of pacas are demographic data that are very
useful to the clinician in reaching a correct diagnosis. Pro- With the help of the newer radiological techniques, US and
longed contact with domestic dogs is equally important. (It was CT, the tridimensional form of the metacestode becomes vis-
mentioned earlier that neotropical echinococcosis occurs out- ible, making possible the detection of its polycystic character,
side the geographical area of transmission of E. granulosus to which was not demonstrable by palpation and simple X ray
humans.) only. As a consequence, the differential diagnoses became less
complicated and diagnosis required consideration of fewer ill-
nesses. (Definitive diagnosis, however, is accomplished by
Sex and Age Distribution study of the metacestode itself, obtained by means of biopsy,
surgery, or autopsy.) A simple X ray may show the parasitic
The number of cases that has been published and those mass and any calcifications in the parasite suggestive of echi-
findings from reliable sources make a total of 172. Those for nococcosis. Calcifications are annular, 2 to 3 cm in diameter,
which information is sufficient number 81. Of those cases, 45% with a radiodense halo and a clear center. They are located
were males and 55% were females. The median age was 43 within the polycystic lesions in the liver or elsewhere in the
years. That figure is the same as that obtained in our previous abdomen if there are extensions into other organs (Fig. 14 and
review of cases 10 years ago. Ages of patients ranged from 6 to 18). Initially, we used simple tomography that could show the
77 years. The youngest age group, 6 to 22 years, made up 16% lobulated character of lesions.
of the total. The youngest patient from whom data were re- US of the polycystic lesions shows multiple rounded, uniloc-
corded was 6 years old; a 12-year-old child died of portal ular, anechoid formations with regular walls. That picture by
hypertension 1.7 years after the onset of symptoms (26). Of the itself does not provide the diagnosis of echinococcosis but is
81 patients for whom adequate information is available, 6, 12, useful in assessing serological findings. For those reasons, US
16, 19, 17, 4, and 5 patients were in the first, second, third, has become important in field studies of human populations at
fourth, fifth, sixth, and seventh decades of life, respectively. the time of confirming serological tests. In surveys of popula-
Most of the patients infected with E. vogeli were born and tions, US is considered to be more accurate than serology (27,
had lived all their lives in rural tropical areas of Central Amer- 75). Portable equipment is available at affordable prices, and
ica and South America where wildlife was abundant, and it was therefore, US is also being used in developing countries in-
impossible to determine the duration of their infection. If the stead of the much more expensive apparatus for CT.
infected individual had moved permanently to a city dwelling, CT scans show multiple, hypodense, cystic structure, round
it was possible to determine the approximate age of the Echi- or ovoid, of various sizes, often coalescent in liver, spleen,
nococcus infection, which, for three of our patients, were 12, pancreas, omentum, pelvis, and lung, etc. Calcifications of vari-
25, or 60 years. Symptoms had appeared at 2, 10, and 36 years able appearance, usually solid and small but at times large and
of age, respectively, after the patients left the rural area. The bizarre, can be detected and help to make an accurate diag-
median age at diagnosis of alveolar echinococcosis (E. nosis. Meneghelli et al. (44, 45) published excellent US and CT
multilocularis) was 53 years (91). photos of Brazilian patients with polycystic echinococcosis.
Also included in their publications are images showing changes
Laboratory Findings in size and number of cysts following albendazole treatment
(Fig. 22). CT scanning is expensive but is the best procedure, so
General observations, including our own, indicate that lab- far, for differential diagnosis of polycystic lesions (cystic echi-
oratory findings, outside of the obvious significance of mor- nococcosis, polycystic liver and kidney disease, primary or met-
phological features of the cestodes, are not useful in the diag- astatic malignancies, and hepatic amebic abscess [15], pancre-
nosis of neotropical echinococcoses. However, it is important atic epithelioma, ovarian cyst and, in the lungs, dermatoid cysts
to assess possible injury to the liver when infiltration of the with inclusions, neurinoma, aortic aneurism, primary bronchial
biliary system may be diagnosed. Increases of alkaline phos- carcinoma, metastatic sarcoma, seminoma, and lesions in ovary
phatase, bilirubin, liver transaminases, and gamma globulin and uterus, etc.) and for assessment of albendazole treatment.
and diminished albumen and hemoglobin are common findings We are not aware of reports on the use of magnetic resonance
in cases of polycystic echinococcosis (45). Eosinophilia was imaging in diagnosing polycystic echinococcosis.
A patient with senescent, calcified, or dead cysts is generally

found to be seronegative. At the present, the best available
serological diagnosis is obtained by using a combination of
tests. ELISA or IHA is used to screen all specimens; a positive
reaction is confirmed by an immunoblot assay or any gel dif-
fusion assay that demonstrates the presence of the echinococ-
cal Arc 5. Although those confirmatory assays give false-posi-
tive reactions with sera from 5 to 25% of persons with
neurocysticercosis, the clinical and epidemiological presenta-
tion of neurocysticercosis patients should rarely be confused
with that of echinococcosis. Following successful radical sur-
gery, antibody levels decline and sometimes disappear; anti-
bodies rise again if secondary hydatid cysts develop. Tests for
Arc 5 or immunoglobulin E antibodies appear to reflect an
antibody decline during the first 24 months postsurgery,
whereas the IHA and other tests remain positive for at least 4
years. Chemotherapy has not been followed by consistent de-
clines in antibody levels. Consequently, the usefulness of se-
rology to monitor the course of disease is limited; imaging
techniques provide a more accurate assessment of the patient’s
condition.
The antigen used for serodiagnosis of infection with E.
granulosus and E. multilocularis, as well as that with E. vogeli
and in one case that with E. oligarthrus, has been the fluid from
metacestodes of E. granulosus. In addition, purified antigens of
all echinococcal species but E. oligarthrus have been developed
and used. From crude tissues, Gottstein et al. (31) derived the
E. vogeli Ev2 antigen that differentiates between E. vogeli and
E. granulosus but not between E. vogeli and E. multilocularis.
The latter two species, however, are not sympatric; therefore,
epidemiological data are important for distinguishing them.
Unfortunately, the test using the Ev2 antigen could not be
FIG. 22. CT scan of a patient with polycystic echinococcosis (from
Brazil), treated with albendazole alone. (Top) Pretreatment, rounded,
evaluated in a blind serological survey carried out in a large
hypoechoid formations in the peritoneum and hepatic parenchyma. indigenous human population in a South American country.
(Bottom) Reduction in number and size of vesicles 70 days after the As originally agreed upon, the results of the serological tests
beginning of treatment. (Courtesy of Ulysses G. Meneghelli, Depar- were mailed to our colleagues, but the parasitological infor-
tamento de Clinica Médica, Facultad de Medicina de Ribeirâo Preto, mation concerning the humans tested was never received by us.
Brazil.)
Antigen of E. oligarthrus is not available, nor is serum from
patients with that infection.
Only the case (orbital) reported by Lopera et al. (39) was
Serological Tests positive for Arc 5 by immunoelectrophoresis, indicating cross-
reactivity between antigens of E. oligarthrus and E. granulosus,
Wilson et al. (92) published a report concerned with molec-
the latter having been used in the test. It was stated 10 years
ular and immunological diagnosis of parasitic infections, based
ago that separation of metacestodes of the two neotropical
on their experience at the Centers for Disease Control and
species was not possible serologically, and that situation has
Prevention. The authors discussed serological diagnosis as it
not changed (12).
applies to cystic and alveolar echinococcoses, but the methods
As stated by Wilson et al. (92), use of two serological tests,
also apply to diagnosis of neotropical echinococcoses:
one very sensitive (ELISA) and another very specific (IB), is
False-positive reactions may occur in persons with convenient. Among the 81 patients with neotropical echino-
other helminthic infections, cancer and chronic im- coccosis that we evaluated, 40 were studied serologically; for 12
mune disorders. Negative test results do not rule out of them, the two tests gave identical results. For a particular
echinococcosis because some cyst-carriers do not patient undergoing surgery in France, the IHA and the Arc 5
have detectable antibodies. Whether the patient has tests were positive, as were the ELISA and IB tests.
detectable antibodies is dependent on the physical Among other patients tested, the results were as follows.
location, structural integrity, and vitality of the larval IHA was positive for 14 of 19 persons. Of the five negative
cysts. Cysts in the liver are more likely to elicit an cases, from one, a metacestode of E. vogeli had been removed
antibody response than those in the lung, and, re- 1.5 years earlier, while two had active E. vogeli infections and
gardless of location, tests for antibody are least sen- two were negative, having completely calcified hepatic cysts
sitive for patients with hyaline cysts (p. 561–562 in (42). Counter electrophoresis was positive in 6 of 7 cases,
reference 92). immunoelectophoresis Arc 5 was positive in 7 of 9, ELISA was
FIG. 23. Large rostellar hooks from protoscoleces of Echinococcus vogeli, E. oligarthrus, and E. granulosus (left to right, all at the same
magnification).
positive in 4 of 5 (the case with a negative result was also We have listed in Table 4 a total of 172 cases in 12 Central
negative by IB test), and 18 of the 19 patients with positive American and South American countries, from Nicaragua and
results described above also had positive IB tests. A single Costa Rica in the north to Argentina in the south (86, 87, 88),
serological test for the diagnosis of echinococcosis, either pos- as well as Uruguay (19, 22) and Chile (85). Fifty-four cases
itive or negative, may be misleading: a negative test should not were due to E. vogeli, 114 cases were due to Echinococcus cf.
be taken to exclude infection, and the opposite may be true. vogeli, and 3 cases were due to E. oligarthrus. E. vogeli and E.
oligarthrus occur only in the Neotropics, with the exception of
Parasitological Diagnosis one recorded instance of E. oligarthrus in Mexico. Two human
cases of submaxillary echinococcosis in India were erroneously
Metacestodes of the three species of Echinococcus occurring reported to have been caused by E. oligarthrus but instead were
in Central America and South America are distinguishable on caused by E. granulosus (13, 37, 71). The number of reported
the basis of form and size of rostellar hooks from protoscoleces cases of E. vogeli infection has increased within the last 10
(Fig. 23). If rostellar hooks are not observed, definitive iden- years, going from 72 persons in 11 countries to 172 in 12
tification usually is not possible. countries. Peru is the newest country of record. The country
with most cases was formerly Colombia but now is Brazil, with
EPIDEMIOLOGY 58% of all reported cases. Polycystic echinococcosis has re-
ceived much attention and emphasis from the medical profes-
Geographical Distribution of Neotropical Echinococcoses sion in Brazil, which accounts for the relatively large number of
The number and distribution of cases of polycystic and uni- reported cases in that country. We consider that the total
cystic echinococcosis are presented in Tables 1 and 4. Table 1
indicates that of the 81 patients we evaluated, three were
determined to be infected by E. oligarthrus and 42 were in- TABLE 4. Number of cases of echinococcosis in the Neotropics by
fected by E. vogeli, and for 36 patients, rostellar hooks were not country and species of Echinococcusa
found and identification of the cestode could not be made. In No. of cases with indicated infection
those 36, the diagnosis was stated to be polycystic echinococ- Country
E. vogeli E. cf. vogeli E. oligarthrus E. granulosus Total
cosis. Our judgment now, after more than 20 years of evalua-
tions of lesions produced in polycystic echinococcosis, is that Nicaragua 1 1
the etiological agent was E. vogeli. The structures of the meta- Costa Rica 1 1 2
Panama 2 2
cestodes, the pathogenic processes, and the epidemiological Colombia 15 14 29
information provided by the patients (metacestodes with and Ecuador 6 5 11
without hooks, the patients’ knowledge of pacas and their Venezuela 2 1 1 4
infections, the awareness of feeding liver of pacas, with any Peru 1 1
Brazil 21 77 1 99
cysts present, to domestic dogs, and the presence of domestic Suriname 7 1 1 9
dogs around previous or current dwellings of patients) were Uruguay 2 2
similar whether or not the species of cestode could be identi- Argentinab 11 11
fied. In addition, the lesions observed in the patients with E. Chile 1 1
vogeli infections in which rostellar hooks were present were
Total 54 114 3 1 172
similar to those in which hooks could not be found. In our
a
judgment, when rostellar hooks are not found in polycystic As of March 2007. (Adapted and updated from reference 12 with permission
from Elsevier.) E. cf. vogeli, E. vogeli causing infections with polycystic lesions but
lesions, it is diagnostically acceptable to designate the etiologic with no hooks found.
agent Echinococcus cf. vogeli. b
Synanthropic infections by E. granulosus not included.
number of cases in Central America and South America indi-

cates but a small proportion of actual infections; the number of
diagnosed cases may represent only the tip of the iceberg.
Natural Hosts of E. vogeli and E. oligarthrus

The two species of Echinococcus indigenous to the Neotro-
pics, E. vogeli and E. oligarthrus, are sympatric over extensive
areas of the New World where their requisite hosts are present.
In order to study the epidemiology and transmission of those
two neotropical species of Echinococcus, we carried out a sur-
vey involving more than 4,000 wild mammals from different
regions of Colombia (18), collected by trapping or shooting. In
addition, also included in the survey were data from necropsy
records from studies carried out by members of the Tulane
University-del Valle University International Center for Med-
ical Research in Cali, from collections of the del Valle Uni-
versity-Rockefeller Foundation Virus Program, and from
other sources. The investigators, hunters, and others perform-
ing the necropsies were aware of the interest in detecting cystic
or tumor-like structures in organs, muscles, and subcutaneous
tissues.
Animals were collected (from 1962 to 1979) in the following
regions of Colombia: oriental plains, eastern piedmont, Pacific
coast, and the Andean Cordilleras. Echinococcus-infected an-
imals were found in the oriental plains and piedmont. Figure
24 shows the plains and the gallery forest along rivers and
streams of the Orinoco River basin. There, the tropical forest
has abundant wildlife, although during the daytime, the forest
appears to be deserted because most mammals are not active
then. The investigations in Colombia demonstrated a large FIG. 24. Aerial view of gallery forest in the oriental plains of
enzootic area of transmission in the oriental plains of that Colombia. (Reprinted from reference 17 with permission of the
publisher.)
country.
Of 4,198 mammals belonging to 8 orders, 67 genera, and 78
species, 156 were carnivores (potential final host). Strobilae of
Echinococcus spp. were sought in 121 carnivores and found in represented in Fig. 1. Eggs of that cestode expelled by bush
5 of them (1 of 15 domestic dogs, 1 cougar, 1 of 11 ocelots, and dogs in the natural environment would seem to be of little
2 of 9 jaguarundis). The dog, which belonged to a hunter, died, public health significance. However, pacas (intermediate host)
probably of an infection of Trypanosoma evansi, and had fully are much hunted by the local peoples for food; so far as we
developed strobilae of E. vogeli and a few underdeveloped have learned, viscera of such pacas are typically fed to domes-
specimens of E. oligarthrus in the intestine. Additional strobi- tic dogs, who then serve as the major source of infection in
lae of both species were obtained experimentally in appropri- humans (Fig. 1). Evidently, the domestic dog is also the only
ate hosts. Carnivores of families other than Felidae and Cani- significant source of infection of humans by E. granulosus and
dae included in our survey are not discussed here because none E. multilocularis.
was found to be infected. Bush dogs were present in the en- The human cases of neotropical echinococcosis (i.e., with no
zootic area of neotropical echinococcosis, but because they are hooks present in the metacestode and thus, the species is not
very wary, none could be obtained for examination. On a few determined) in Nicaragua and Costa Rica in Central America
occasions, they could be seen by us out on the plains during and from southern Argentina, Uruguay, and Chile are outside
daytime. In Suriname, three of four sport hunters never had the range of the bush dog. It is possible, therefore, that the
seen a single Speothus bush dog, despite the frequency of their metacestode involved could have been E. oligarthrus rather
hunting; the fourth hunter had seen a bush dog one time only. than E. vogeli. The supportive information for this suggestion
The local people do not hunt bush dogs, since the skins have no is, first, the presence of three species of wild cats infected with
market value. E. oligarthrus in those countries and, secondly, that E. oligar-
Natural infections by the strobila of E. vogeli have been thrus has been reported from other regions from humans
found only in bush dogs (Speothus venaticus) captured for (three only) in whom the metacestodes were unicystic and
zoological gardens; no others have been examined for hel- extrahepatic, rather than polycystic and hepatic, as those of E.
minths. The detailed work of Drüwa (24) and others has shown vogeli. If E. vogeli is demonstrated in countries where bush dogs
that the geographic range of the bush dog encompasses Pan- are absent, other canids, such as the coyote in Central America
ama southward, not including Chile, most of Argentina, and or other species in South America, may be responsible for
Uruguay (Fig. 25). The pattern of transmission of E. vogeli is transmission. Only under unusual circumstances may infection
FIG. 25. Map of Central America and South America, indicating the geographic range of the bush dog, as compiled from various sources.
be acquired by the ingestion of eggs of that cestode expelled pacas could not be determined. The paca (Fig. 3) is a large
with the feces of a bush dog. The accidental microepidemic in (weighing up to 13.5 kg) hystricognath rodent of nocturnal
numerous primates in a zoo, described above, is a tragic ex- habits. When alarmed, it takes readily to water, near which it
ample. In another example of accidental transmission, nutrias is usually found. It is hunted (not trapped) for food by local
became infected by E. vogeli in a second American zoo where people, who appreciate its meat. Pacas are herbivorous, and
South American carnivores were housed. Infections might also their diet consists mainly of fruits of arborescent plants, with
occur in humans in close contact with wild canids or felids kept some herbaceous vegetation seasonally (25). In the state of
as pets in people’s dwellings (11, 65, 81). Chiapas, in southern Mexico, Gallina (28) determined that
Among the 2,809 rodents surveyed in Colombia, metaces- pacas consumed the fruits of trees of 18 species, representing
todes of Echinococcus were found in only the pacas and the 18 families. Periods of fruit production by trees of the various
spiny rats (Proechimys spp.; 6 of 1,168) (18), but agoutis, species overlap, making such food resources generally avail-
Dasyprocta spp., are known to be a prominent host of the able. Because bush dogs hunt in packs on land (and in water if
metacestode of E. oligarthrus. The distribution of pacas and pacas enter watercourses to escape them), it is considered that
agoutis extends from southern Mexico to Ecuador and, east of their fecal deposits are extensively dispersed in habitat where
the Andes, south to Bolivia, Paraguay, northeastern Argentina, the rodents forage. Under such conditions, incidental ingestion
and Santa Catalina, Brazil. They also occur in the Lesser An- of eggs must account for the comparatively high prevalence of
tilles (Fig. 26). the metacestodes of E. vogeli in the intermediate host.
Of 325 pacas, 96 (29.5%) were infected. In 61, the species Age classes of pacas were estimated: adults were animals of
was E. vogeli; in 12, the species was Echinococcus cf. vogeli; and more than 7.5 kg, subadults were animals between 5.5 kg and
in 3 (0.9%), the species was E. oligarthrus. The identity of 7.5 kg, and juveniles were animals of less than 5.5 kg. The
metacestodes, all without rostellar hooks, in the remaining 20 frequency of infection in the adult class (28/95; 29.5%) was
FIG. 26. Map of Central America and South America, showing the geographic ranges of the paca and agoutis. (Reprinted from reference 12
with permission from Elsevier.)
found to be significantly greater than that of infection in the ing domestic swine; T. hydatigena possibly occurs in wild pigs
subadult class (8/50; 16%), and the subadult infection fre- (indigenous species) in South America.
quency was significantly greater than the juvenile class infec- In mammals of the four species from which metacestodes of
tion frequency (0/26). Echinococcus have been recorded in Argentina and Chile, only in
In a field study in Brazil, Pastore et al. (51) asked the local the case of the European hare was it well established that the
people if they had seen cysts in animals other than pacas. A cestode was E. granulosus (73). The taxonomic statuses of meta-
large proportion of them indicated that domestic pigs fre- cestodes recorded from rodents of the genera Microcavia, Oct-
quently showed large cysts in the abdomen. Those authors odon, and Myocastor are undetermined because at the time of
stated that there were no data indicating that pigs participate earlier publications, neotropical species of Echinococcus were not
in the cycle of E. vogeli. We had the opportunity to study one well distinguished (3, 20) and E. vogeli had not yet been described.
such cyst, and Gustavo Morales, who reviewed the histopathol- We know that the nutria (Myocastor sp.) is susceptible to exper-
ogy, reported that possibly it was a peritoneal reaction to a imental infection with E. vogeli (Fig. 27) (59).
foreign body. The wall was fibrous and had a pseudoepithelium The strobilar stage of E. oligarthrus has been reported from
with no parasitic elements. However, another cestode, Taenia 6 of the 10 species of felids occurring in South America and
hydatigena, occurs in dogs, and its metacestode may be found Central America. It was first collected from a cougar examined
in the abdomen of pigs and other ungulates in which the by J. Natterer in Brazil during the 1830s but incorrectly iden-
cysticercus is attached to, or in, abdominal organs. The identity tified as Taenia crassicollis Rudolphi 1810 (⫽ Taenia taeniae-
of that cestode can be determined from the rostellar hooks of formis Batsch 1786, a common cestode in the house cat) by
the cysticercus. Pigs also are susceptible to infection by E. Diesing (23). Lühe (40) restudied Diesing’s cestodes from fe-
granulosus, but the tropical forest is not an environment favor- lids and correctly recognized that morphologically, they corre-
Colombia was infected. However, hunters in Colombia pro-

vided a liver from an agouti infected with E. oligarthrus and
information about another with cysts in the heart, muscle, and
liver. The most frequent locations of the metacestode of that
species are in muscle and subcutaneous tissues, where the cysts
could be more easily overlooked. Pacas are an occasional in-
termediate host of E. oligarthrus, according to our data (18).
Metacestodes were found in 6 (0.5%) of 1,168 spiny rats.
In Argentina, beyond the geographic range of pacas, agoutis,
and spiny rats, other species of rodents must serve as the
intermediate host of E. oligarthrus where small felids become
infected (73). An opossum, Didelphis marsupialis, has been
reported as an intermediate host of E. oligarthrus (81). In our
survey, none of the 527 opossums examined was infected, and
FIG. 27. Metacestodes of Echinococcus vogeli in the liver of an
adult nutria (body weight, 5.1 kg), examined 50 days after receiving therefore, the opossum does not appear to be important in
gravid proglottids from a domestic dog. The dog 129 days previously transmission of the cestode to the final host.
had received metacestodes from a naturally infected paca captured at
Carimagua, Colombia.
CONCLUSIONS
In the natural transmission cycle of E. vogeli, the bush dog and
sponded to Echinococcus spp. E. oligarthrus has been reported the paca are known hosts. That cycle is not responsible for human
from the cougar at various South American and Central Amer- infections, but a synanthropic association is required. Dogs that
ican localities, following the earliest record in that host in have received viscera from pacas become infected by the cestodes,
Brazil (40), namely, Panama (78, 82), Costa Rica (6), and which produce eggs that are expelled in gravid segments and may
Colombia (18). It has been reported also from the ocelot be ingested by people in close contact with their dogs.
(Leopardus pardalis (L.)) in Colombia (18); jaguarundi (Puma Cestodes in dogs (and cats) could be eliminated as a risk to
yagouaroundi (Geoffroy Saint-Hillaire)) in Colombia and Pan- humans through treatment with an anthelminthic (praziquan-
ama and from the London Zoo, geographic origin uncertain tel) at the appropriate intervals. The cost of such treatment
(9); jaguar (Panthera onca (L.)) in Panama (83); and pampas probably would be prohibitive for most people in the Neotro-
cat (Leopardus colocolo (Molina)) in Argentina (designated pics. It is known, however, that arecoline hydrobromide is
Echinococcus pampeanus Szidat 1967) (79). A survey by being used in several areas of transmission.
Schantz and Colli added Geoffroy’s cat, Leopardus geoffroyi Polycystic echinococcosis and unicystic echinococcosis are
(d’Orbigny et Gervais), in southern Argentina (7 of 47 in- natural-focal diseases, the two species of Echinococcus and
fected) (73, 74). In felids examined in Colombia, numbers of their respective hosts having existed independently as compo-
the cestode ranged from hundreds to thousands in individual nents of neotropical biocoenoses for many millennia in South
animals. E. oligarthrus has been recorded also from a bobcat, America and Central America. Following the establishment of
Lynx rufus (Schreber), in North America, in northern Mexico, people in the Neotropics, the lack of a mechanism for exposure
about 100 km south of Brownsville, Texas (72). The bobcat, an to eggs of E. vogeli would appear to have precluded infection of
endangered species in Mexico, has an extensive geographic human inhabitants. When subsequent immigrants were accom-
range, occurring from the latitude of southern British Colum- panied by domestic dogs, an event that occurred probably less
bia south as far as Oaxaca, Mexico (90). The record from than 10,000 years BP (25), an interaction between humans and
North America suggests that if the cestode spreads northward, the cestode became at least potentially established. Hunting
house cats might become involved in the cycle. pacas for food was probably an early practice and was perhaps
Because only three cases of unicystic echinococcosis have accomplished with the involvement of dogs. In contrast to E.
been reported, nothing is known about the epidemiology of the vogeli, E. oligarthrus is of little public health significance be-
infection of humans. Perhaps it can be assumed that humans cause, so far as we can judge, no mechanism exists for the
may have very rare contact with eggs of E. oligarthrus, through intrusion of humans into its natural cycle. That situation pos-
some activity within the natural habitat of the wild felids. sibly could change if domestic cats become involved along with
According to our observations, the keeping of house cats by the natural final hosts.
residents of the regions where such disease is endemic would The infection of primates and nutrias by eggs of E. vogeli
be unusual. from bush dogs in North American zoos, or other carnivores
Agoutis, Dasyprocta spp., which are medium-sized terrestrial housed there, suggests that human visitors might also be at
rodents of essentially diurnal habits, are known to be a prom- risk. As well, canids and felids imported from areas where the
inent intermediate host of E. oligarthrus. Eleven species, widely disease is endemic and kept as pets might be sources of infec-
occurring in the Neotropics, have been described (Fig. 27). tion. Cases of polycystic echinococcosis no doubt often escape
Agoutis are also hunted for meat. In those rodents, occurrence diagnosis, and significant morbidity and mortality are the con-
of metacestodes of E. oligarthrus appears to be well estab- sequence. Enthusiastic interest in polycystic echinococcosis by
lished, and they are considered to be the usual intermediate the medical profession, as in Brazil (43), indicates significant
host of E. oligarthrus, as for example in Panama (78, 82) and progress toward needed action.
elsewhere (63), although none of the 130 agoutis examined in Programs to educate populations at risk might eventually be
beneficial, but means of establishing such programs seem gen- 21. Deutsch, L. A. 1983. An encounter between bush dog (Speothos venaticus)
and paca (Agouti paca). J. Mammal. 64:532–533.
erally to be unavailable. The risk of acquiring echinococcosis 22. Dévé, F., R. Piaggio-Blanco, and F. Garcia-Capurro. 1936. Échinococcose
(sensu lato) is seen to be greatly diminished if dogs are not hépatique maligne micropolykystique infiltrate. Forme intermédiara entre
kept (57), but the ancient association between people and their l’échinococcose hydatic et l’échinococcose alveolaire. Arch. Urug. Med. Cir.
Est. 8:3–28.
dogs is disrupted only under exceptional demands for changes 23. Diesing, C. M. 1850. Systema helminthum. Historiae naturalis classica, vol.
in lifestyle. XI. [Reprint, H. R. Engelmann (J. Cramer), Weinheim, Germany, 1960.]
Vindobonae, Braumüller, Germany.
24. Drüwa, P. 1982. Perro de grulleiro, der Südamerikanische Waldhund—ein
ACKNOWLEDGMENTS Rätsel für die Hundeforschung. Zeitsch. Kölner Zoo. 25:71–81.
25. Eisenberg, J. F. 1989. Mammals of the Neotropics. The Northern Neotro-
We express our thanks to Ulysses Meneghelli, who kindly provided pics, vol. 1. University of Chicago Press, Chicago, IL.
information on the outcome of patients he had treated earlier with 26. Ferreira, M. S., S. A. Nishioka, A. Rocha, and A. D’Alessandro. 1995. Echi-
albendazole from unpublished results of a human serological survey nococcus vogeli polycystic hydatid disease: report of two Brazilian casesout-
for echinococcosis in Brazil as well as permission to use some of the side the Amazon region. Trans. Roy. Soc. Trop. Med. Hyg. 89:286–287.
imaging from his patients. We also thank Mark Wiser, Maria Frontini, 27. Frider, B., J. Moguilensky, J. C. Salvitti, M. Odriozol, and E. Larrieu. 1999.
and Kris Swalm, Tulane University, School of Public Health and Trop- Epidemiological surveillance of human hydatidosis by means of ultrasonog-
raphy: Its contribution to the evaluation of control programs. Acta Trop.
ical Medicine, Department of Tropical Medicine, Epidemiology and 79:219–223.
Computing Services, respectively, for their help with the preparation of 28. Gallina, S. 1981. Contribución al conocimiento de los hábitos alimenticios
the manuscript due to their expertise with the computer. Special del tapezcuintle (Aguti paca Lin.) en Lancajá-Chansayab, Chiapas, p. 58–67.
thanks to Virginia Rausch, Burke Museum of Natural History, Uni- In P. R. Castillo (ed.), Estudios ecológicos en el trópico Mexicano, publica-
versity of Washington, for her interest and help in this work and for tion 6. Instituto de Ecologı́a A. C., Mexico, D.F., Mexico
preparing the drawing of the life cycle. We are grateful as well to Mark 29. Ghiotti Siqueira, N., F. Barbosa de Almeida, S. R. Silva Chalub, J. R.
Derby and David Wolbrecht, University of Washington, who kindly Machadao-Silva, and R. Rodrigues-Silva. 2007. Successful outcome of he-
provided technical assistance. patic polycystic echinococcosis managed with surgery and chemotherapy.
Trans. R. Soc. Trop. Med. Hyg. 101:624–626.
30. Gottstein, B. 1992. Molecular and immunological diagnosis of echinococco-
REFERENCES sis. Clin. Microbiol. Rev. 5:248–261.
1. Abuladze, K. I. 1964. Teniaty—lentochnye gel’minty zhivotnykh i cheloveka 31. Gottstein, B., A. D’Alessandro, and R. L. Rausch. 1995. Immunodiagnosis of
i vyzyvaemye imi zabolevaniia. Osnovy tsestodologii, vol. 4. Nauka, Moskva, polycystic hydatid disease/polycystic echinococcosis due to Echinococcus vo-
U.S.S.R. geli. Am. J. Trop. Med. Hyg. 53:558–563.
2. Almeida, S. C. X., R. L. Martins, A. P. Morales, C. A. Viegas, and M. Grilo. 32. Gottstein, B., B. Mesarina, I. Tannrer, R. D. Ammann, J. F. Wilson, J.
1997. Hidatidosis pulmonar policı́stica mimetizando lesaôs metastáticas: re- Eckert, and A. Lanier. 1991. Specific cellular and humoral immune responses
lato de caso. J. Pneumonol. 23:261–263. in patients with different long-term courses of alveolar echinococcosis infec-
3. Alvarez, V. 1961. Investigaciones sobre echinococcosis silvestre en Chile. tion with Echinococcus multilocularis. Am. J. Trop. Med. Hyg. 45:734–742.
Biologica 31:89–94. 33. Grases, P., and N. Salazar. 1970. Hidatidosis alveolar. G. E. N. 25:71–89.
4. Basset, D., C. Girou, I. P. Nozais, F. D’Hermies, C. Hoang, R. Gordon, and 34. Guderian, R., K. R. Kerrigan, M. E. Chico, A. Guevara, and G. Hidalgo.
A. D’Alessandro. 1998. Neotropical echinococcosis in Suriname: Echinococ- 1990. Hidatidosis humana en el Oriente Ecuatóriano: informe de los prim-
cus oligarthrus in the orbit and Echinococcus vogeli in the abdomen. Am. J. eros casos. Rev. Med. Vozandes 4:57–60.
Trop. Med. Hyg. 59:787–790. 35. Herre, W., and M. Röhrs. 1973. Haustiere—zoologisch gesehen. Gustav
5. Blood, B. D., and J. L. Lelijveld. 1969. Studies on sylvatic echinococcosis in Fischer Verlag, Stuttgart, Germany.
southern South America. Z. Tropenmed. Parasitol. 20:475–482. 36. Howard, E. B., and A. P. Gendron. 1980. Echinococcus vogeli infection in
6. Brenes Madrigal, R. R., G. Munoz Montoya, G. E. M. Ocampo, and G. R. higher primates at the Los Angeles Zoo, p. 379–382. In R. J. Montali and G.
Herrera. 1973. Presencia en Costa Rica de Echinococcus oligarthrus Diesing Migaki (ed.), The comparative pathology of zoo animals. Symposia of the
1863, colectado en el intestino delgado de Felis concolor costaricensis. Rev. National Zoological Park. Smithsonian Institution Press, Washington, DC.
Biol. Trop. 21:139–141. 37. Kini, U., S. Chariff, and V. Nirmala. 1997. Aspiration cytology of Echino-
7. Brumpt, E., and C. Joyeux. 1924. Description d’un nouvel Échinocoque: coccus oligarthrus. A case report. Acta Cytol. 41:544–548.
Echinococcus cruzi n. sp. Ann. Parasitol. Hum. Comp. 2:226–231. 38. Lazo, R., C. Moran, E. Plaza, and A. Mite. 1985. Hidatidosis humana por
8. Cabrera, A., J. Yepes, and C. C. Wiedner. 1960. Mamiferos sud americanos. Echinococcus vogeli en el Ecuador, p. 237–244. In Memorias del VII Con-
Historia natural, vol. 1, 2nd ed. Ediar S. A. Editores, Buenos Aires, Argentina. greso Latinoamericano de Parasitologı́a. Trabajos Graficos Juan Montalvo
9. Cameron, T. W. M. 1926. Observations on the genus Echinococcus Rudolphi Ciao Ldta., Guayaquil, Ecuador.
1801. J. Helminthol. 4:13–22. 39. Lopera, R. D., R. D. Melendez, I. Fernandez, J. Sirit, and M. P. Perera. 1989.
10. Chigot, J. J., F. Menegaux, R. Hammoud, J. P. Nozias, and C. Hoang. 1995. Orbital hydatid cyst of Echinococcus oligarthrus in a human in Venezuela. J.
A propos d’un cas d’hydatidose à Echinococcus vogeli ayant bénéficié d’un Parasitol. 75:467–470.
traitement chirurgical complet. Sem. Hosp. Paris 71:429–431. 40. Lühe, M. 1910. Cystotänien südamerikanischer Feliden. Zool. Jahrb. Suppl.
11. Cross, J., and R. M. Thomas. 1966. Hydatid disease in the nutria. J. Para- 12:687–710.
sitol. 52:1215–1216. 41. Meléndez, R. D., M. S. Yépez, and A. Coronado. 1984. Echinococcus oli-
12. D’Alessandro, A. 1997. Polycystic echinococcosis in tropical America: Echi- garthus cysts of rabbits in Venezuela. J. Parasitol. 70:1004–1005.
nococcus vogeli and E. oligarthrus. Acta Trop. 67:43–65. 42. Meneghelli, U. G. 1985. Multiple hepatic calcifications resulting from polycystic
13. D’Alessandro, A., and R. L. Rausch. 2004. Erroneous report of Echinococcus hydatid disease. Rev. Goiania Med. 31:53–60.
oligarthrus as a cause of echinococcosis in India. J. Parasitol. 90:202–203. 43. Meneghelli, U. G. 2002. Hidatidose policı́stica: a comprovação de sua ocorrência
14. D’Alessandro, A., H. Henao, and C. Cuello. 1978. Una caso colombiano e a possı́vel dimensão epidemiológica da doença no Brasil. A gastroenterologı́a
autóctono de hidatidosis poliquistica múltiple de hidago, paricardio, pul- no Brasil II. Lemos Editorial, Sao Paulo, Brazil.
mones, pleura y corazon. Acta Med. Valle 9:23–35. 44. Meneghelli, U. G., A. L. C. Martinelli, A. D. Bellucci, M. G. Villanova,
15. D’Alessandro, A., J. Lega, and M. A. Vera. 1966. Cystic calcifications of the M. A. S. Llorach Velludo, and J. E. Magro. 1992. Polycystic hydatid disease
liver in Colombia. Echinococcosis or calcified abscesses? Am. J. Trop. Med. (Echinococcus vogeli). Treatment with albendazole. Ann. Trop. Med. Para-
Hyg. 15:908–913. sitol. 86:151–156.
16. D’Alessandro, A., L. E. Ramirez, E. Chapadeiro, E. R. Lopes, and P. M. De 45. Meneghelli, U. G., A. L. C. Martinelli, M. A. S. Llorach Velludo, A. D.
Mesquita. 1995. Second recorded case of human infection by Echinococcus Bellucci, J. E. Magro, and M. L. P. Barbo. 1992. Polycystic hydatid disease
oligarthrus. Am. J. Trop. Med. Hyg. 52:29–33. (Echinococcus vogeli). Clinical, laboratory and morphological findings in
17. D’Alessandro, A., R. L. Rausch, C. Cuello, and N. Aristibal. 1979. Echino- nine Brazilian patients. J. Hepatol. 14:203–210.
coccus vogeli in man, with a review of polycystic hydatid disease in Colombia 46. Moraes, M. A. P., M. N. M. Sobreira, P. Medeiros Filho, A. Cavalca Tavares,
and neighboring countries. Am. J. Trop. Med. Hyg. 28:303–317. and M. I. Gomes. 2003. Polycystic hydatidosis: casual finding of calcified
18. D’Alessandro, A., R. L. Rausch, G. A. Morales, S. Collet, and D. Angel. 1981. hydatid cyst simulating mesenteric neoplasm. Rev. Soc. Bras. Med. Trop.
Echinococcus infections in Colombian animals. Am. J. Trop. Med. Hyg. 36:519–521.
30:1263–1276. 47. Ohbayashi, M., R. L. Rausch, and F. H. Fay. 1971. On the ecology and
19. Dardel, G. 1955. A propósito de la equinococosis alveolaris en el Uruguay. distribution of Echinococcus species (Cestoda: Taeniidae), and characteris-
Arch. Urug. Med. Cir. Esp. 46:25–32. tics of their development in the intermediate host. II. Comparative studies
20. De La Barrera, J. M. 1947. Echinococcus granulosus in Microcavia australis. on the development of E. multilocularis Leuckart, 1863, in the intermediate
Arch. Int. Hidat. 7:175–176. host. Jpn. J. Vet. Res. 19(Suppl. 3):1–53.
48. Oostburg, B. F. J., M. A. Vrede, and A. E. Bergen. 2000. The occurrence of hidatico producio por Echinococcus oligarthrus en el hospedero intermedi-
polycystic echinococcosis in Suriname. Ann. Trop. Med. Parasit. 94:247–252. ario Proechimys cf. guairae (rata espinosa) en Casanare, Colombia. Bio-
49. Oostburg, B. F. J., M. Eersel, M. A. Vrede, B. Gottstein, R. L. Rausch, and medica 20:238–247.
A. D’Alessandro. 2004. Preliminary field observation on neotropical echino- 71. Sahni, J. K., M. Jain, Y. Bajaj, V. Kumar, and A. Jain. 2000. Submandibular
coccosis in Suriname. Rev. Pat. Trop. (Goiania) 35:125–134. hydatid cyst caused by Echinococcus oligarthrus. J. Laringol. Otol. 114:473–476.
50. Passos, D. M. M., M. Pinho Alves, O. Creuv, G. Fritas, J. P. Matushita, and 72. Salinas-López, N., F. Jiménez-Guzmán, and A. Cruz-Reyes. 1996. Presence
E. Marchiori. 1982. Equinococcose alveolar hepatica (descrição de um caso). of Echinococcus oligarthrus (Diesing, 1863) Lÿhe, 1910 in Lynx rufus texensis
Radiol. Bras. 15:129–132. Allen, 1895. from San Fernando, Tamaulipas State, in north-east Mexico.
51. Pastore, R., L. H. Vitali, V. O. Macedo, and A. Prata. 2003. A serological Int. J. Parasitol. 26:793–796.
survey of the infection by Echinococcus sp. in the municipality of Sena 73. Schantz, P. M., and C. Colli. 1973. Echinococcus oligarthrus (Diesing, 1863)
Madureira, Acre. Rev. Soc. Bras. Med. Trop. 36:473–477. from Geoffroy’s cat (Felis geoffroyi D’Orbigny and Gervais) in temperate
52. Pastore, R., L. H. Vitali, J. Weirich, A. C. Tojal, V. O. Macedo, and A. Prata. South America. J. Parasitol. 59:1138–1140.
2003. Hidatidosis poliquistica: relato de dois casos procedentes de Sena 74. Schantz, P. M., A. Cruz-Reyes, C. Colli, and R. D. Lord. 1975. Sylvatic
Madureira, Acre, na Amazônia brasileira. Rev. Soc. Bras. Med. Trop. 36: echinococcosis in Argentina. I. On the morphology and biology of strobilar
97–101. Echinococcus granulosus (Batsch, 1786) from domestic and sylvatic animal
53. Pieres, J. A. A., G. B. Pereira, R. Pastore, and L. Lauria-Pires. 2001. Doença hosts. Tropenmed. Parasitol. 26:334–344.
hepática policı́stica. J. Bras. Patol. 37:90–98. 75. Shambesh, M. A., P. S. Craig, C. N. L. Macpherson, M. T. Rogan, A. B.
54. Pinilla, L. G., K. Zamora, and G. Gonzalez. 1982. Hidatidosis poliquı́stica. Gusbi, and F. E. Echtuish. 1999. An extensive ultrasound and serological
Tribuna Med. 11:47–50. study to investigate the prevalence of human cystic echinococcosis in North-
55. Rausch, R. L. 1967. On the ecology and distribution of Echinococcus spp. ern Libya. Am. J. Trop. Med. Hyg. 60:462–468.
(Cestoda: Taeniidae), and characteristics of their development in the inter- 76. Soares, M. V. C. P., C. A. Moreira-Silva, M. Moreira Alves, H. M. Nunes, I.
mediate host. Ann. Parasitol. Hum. Comp. 42:19–63. Abraçado do Amaral, L. J. M. Pereira Móia, S. R. S. Silva Conde, F. Barbosa
56. Rausch, R. L. 1986. Life cycle patterns and geographic distribution of Echi- Almeida, R. Rodrigues-Silva, and J. A. Barletta Crescente. 2004. Equinoco-
nococcus species, p. 44–80. In R. C. A. Thompson (ed.), The biology of cose policı́stica na Amazônia oriental brasileira: atualização da casuı́stica.
Echinococcus and hydatid disease. George Allen and Unwin, London, Rev. Soc. Bras. Med. Trop. 37(Suppl.):75–83.
United Kingdom. 77. Sousa, O. E., and J. Lombardo Ayala. 1965. Informe de un caso de hidatido-
57. Rausch, R. L. 2003. Cystic echinococcus in the Arctic and sub-Arctic. Par- sis en sujeto nativo panameño. Primer caso autoctono. Arch. Med. Panama
asitology 127(Suppl.):S73–S85. 14:79–86.
58. Rausch, R. L., and J. J. Bernstein. 1972. Echinococcus vogeli sp. n. (Cestoda: 78. Sousa, O. E., and V. E. Thatcher. 1969. Observations on the life-cycle of
Taeniidae) from the bush dog, Speothos venaticus (Lund). Z. Tropenmed. Echinococcus oligarthrus (Diesing, 1863) in the Republic of Panama. Ann.
Parasitol. 23:25–34. Trop. Med. Parasitol. 63:165–175.
59. Rausch, R. L., and A. D’Alessandro. 1999. Histogenesis in the metacestode 79. Szidat, L. 1967. Echinococcus pampeanus. Una nueva especie de la Argen-
of Echinococcus vogeli and mechanism of pathogenesis in polycystic hydatid tina, parásita de Felis colocolo pajeros Desmarest, 1916 (Cestoda). Neotrop.
disease. J. Parasitol. 85:410–418. 13:90–96.
60. Rausch, R. L., and A. D’Alessandro. 2002. The epidemiology of echinococ- 80. Szotlender, N., F. Acevedo, E. Cargonell, and E. Sogbe. 1969. Hidatidosis
cosis caused by Echinococcus oligarthrus and E. vogeli in the Neotropics, p. hepática. Presentación de un caso. Arch. Hosp. Vargas (Caracas) 25:71–89.
107–113. In P. Craig and Z. Pawlowski (ed.), Proceedings of the NATO 81. Thatcher, V. E. 1972. Neotropical echinococcosis in Colombia. Ann. Trop.
Workshop on Cestode Zoonoses: echinococcosis and cysticercosis—an Med. Parasitol. 66:99–105.
emergent and global problem. IOS Press, Amsterdam, The Netherlands. 82. Thatcher, V. E., and O. E. Sousa. 1966. Echinococcus oligarthrus Diesing,
61. Rausch, R. L., and F. H. Fay. 2002. Epidemiology of alveolar echinococcosis, 1863, in Panama and a comparison with a recent human hydatid. Ann. Trop.
with reference to St. Lawrence Island, Bering Sea, p. 309–325. In P. Craig Med. Parasitol. 60:405–416.
and Z. Pawlowski (ed.), Proceedings of the NATO Workshop on Cestode 83. Thatcher, V. E., and O. E. Sousa. 1967. Echinococcus oligarthrus (Diesing,
Zoonoses: echinococcosis and cysticercosis—an emergent and global prob- 1863) from a Panamanian jaguar (Felis onca L.). J. Parasitol. 53:1040.
lem. IOS Press, Amsterdam, The Netherlands. 84. Thompson, R. C. A., and D. P. McManus. 2003. Towards a taxonomic
62. Rausch, R. L., and S. R. Richards. 1971. Observations on parasite-host revision of the genus Echinococcus. Trends Parasitol. 18:452–457.
relationships of Echinococcus multilocularis Leuckart, 1863, in North Dakota. 85. Villaroel, L., J. Seitz, and O. Castillo. 1983. Hidatidosis pulmonar por Echi-
Can. J. Zool. 49:1317–1330. nococcus multilocularis. Rev. Chilena Cir. 36:436–437.
63. Rausch, R. L., A. D’Alessandro, and M. Ohbayashi. 1984. The taxonomic 86. Viñas, M. 1903. Quistes hidaticos multiloculares o alveolares. La Semana
status of Echinococcus cruzi Brumpt and Joyeux, 1924 (Cestoda: Taeniidae) Méd. (Argentina) 10:1234–1236.
from an agouti (Rodentia: Dasyproctidae) in Brazil. J. Parasitol. 70:295–302. 87. Viñas, M. 1904. Echinococcus alveolar. La Semana Méd. (Argentina) 11:
64. Rausch, R. L., A. D’Alessandro, and V. R. Rausch. 1981. Characteristics of 931–932.
the larval Echinococcus vogeli Rausch and Bernstein, 1972 in the natural 88. Viñas, M. 1905. Parasitologia del Echinococcus alveolar. An. Depart. Nac.
intermediate host, the paca, Cuniculus paca L. (Rodentia: Dasyproctidae). Hig. (Buenos Aires) 12:71–82.
Am. J. Trop. Med. Hyg. 30:1043–1052. 89. Vogel, H. 1957. Über den Echinococcus multilocularis Süddeutschlands. I.
65. Rausch, R. L., V. R. Rausch, and A. D’Alessandro. 1978. Discrimination of Das Bandwurmstadium von Stämmen menschlicher und tierischer Herkunft.
the larval stages of Echinococcus oligarthrus (Diesing, 1863) and E. vogeli Z. Tropenmed. Parasit. 8:404–456.
Rausch and Bernstein, 1972 (Cestoda: Taeniidae). Am. J. Trop. Med. Hyg. 90. Wilson, D. E., and D.-A. M. Reeder. 2005. Mammal species of the world.
27:1195–1202. Johns Hopkins University Press, Baltimore, MD.
66. Rausch, R. L., J. F. Wilson, B. J. McMahon, and M. A. O’Gorman. 1986. 91. Wilson, J. F., R. L. Rausch, and F. R. Wilson. 1995. Alveolar hydatid disease.
Consequences of continuous mebendazole therapy in alveolar hydatid dis- Review of the surgical experience in 42 cases of active disease among Alas-
ease—with a summary of a 10-year clinical trial. Ann. Trop. Med. Parasitol. kan eskimos. Ann. Surg. 221:315–323.
80:403–419. 92. Wilson, M., P. M. Schantz, and T. Nutman. 2006. Molecular and immuno-
67. Redford, K. H., and J. F. Eisenberg. 1992. Mammals of the Neotropics. The logical approaches to the diagnosis of parasitic infections, p. 557–568. In B.
Southern Cone, vol. 2. University of Chicago Press, Chicago, IL. Detrick, R. G. Hamilton, and J. D. Folds (ed.), Manual of molecular and
68. Rinder, H., R. L. Rausch, K. Takahashi, H. Kopp, A. Thomschke, and T. clinical laboratory immunology, 7th ed. American Society for Microbiology,
Löscher. 1997. Limited range of genetic variation in Echinococcus multilocu- Washington, DC.
laris. J. Parasitol. 83:1045–1050. 93. Xiao, N., J. Qui, M. Nakao, K. Makaya, H. Yamashaki, Y. Sako, P. M.
69. Rodrigues-Silva, R., J. R. V. Peixoto, R. M. F. Oliveira, R. Maghalaes Pinto, Mamuti, P. M. Schantz, P. Craig, and A. Ito. 2003. Identification of Echi-
and D. Corrêa-Gomez. 2002. An autochtonous case of Echinococcus vogeli nococcus species from a yak in the Qinghai-Tibet Plateau region of China.
Rausch & Bernstein, 1972. Polycystic echinococcosis in the State of Rôn- Am. J. Trop. Med. Hyg. 69:445–446.
donia, Brazil. Mem. Inst. Oswaldo Cruz 97:123–126. 94. Zérega, F. 1965. Hidatidosis alveolar. Rev. Ecuador Hig. Med. Trop. 22:115–
70. Rodriguez, G., M. Tamayo, and J. Boshell. 2000. Estructura del quiste 117.

Articolul 6 PDF

Uploaded by

Copyright:

Available Formats

Articolul 6 PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Articolul 6 PDF

Uploaded by

Copyright:

Available Formats

CLINICAL MICROBIOLOGY REVIEWS, Apr. 2008, p. 380–401 Vol. 21, No.

New Aspects of Neotropical Polycystic (Echinococcus vogeli) and

INTRODUCTION tic echinococcosis, the main subject of the present discussion,

FIG. 4. Strobilar stage of Echinococcus oligarthrus (length, 2 mm)

tive final and intermediate hosts is typical also for E. granulosus

FIG. 6. Metacestode of Echinococcus vogeli in the liver of a paca

FIG. 9. Proliferating vesicles of Echinococcus vogeli from the peri-

FIG. 10. Polycystic echinococcosis in the human liver (fatal case,

Clinical type No. of cases

FIG. 11. Portion of the wall of a polycystic lesion, showing germinal

usually within or connected with the liver (the hepatic masses

Total 10d 35 5 13 9 3 3 81 (100) 9

FIG. 13. Macroscopic appearance of polycystic vesicles removed

FIG. 16. CT scan, demonstrating vesicles of Echinococcus vogeli in

FIG. 18. Posteroanterior X ray of the thorax, indicating right pul-

moved to an urban dwelling. An X ray revealed several masses

FIG. 20. Palpebral ptosis and chemosis in a child with a retro-

Clinical Characteristics of Unicystic Echinococcosis

A patient with senescent, calcified, or dead cysts is generally

number of cases in Central America and South America indi-

Natural Hosts of E. vogeli and E. oligarthrus

Colombia was infected. However, hunters in Colombia pro-

You might also like