Medscape is available in 5 Language Editions – Choose your Edition here.


Echinococcosis Treatment & Management

  • Author: Dominique A Vuitton, MD, PhD; Chief Editor: Burke A Cunha, MD  more...
Updated: Apr 06, 2015

Medical Care

Alveolar echinococcosis is rare and can be severe. All cases merit prolonged follow-up. Refer patients to reference centers to confirm their diagnosis and to obtain advice on therapeutic strategy.

Antiparasitic chemotherapy

The basic medical treatment is chemotherapy with benzimidazoles (eg, mebendazole, albendazole) at high doses.

According to the 1996 WHO Informal Working Group on Echinococcosis and recently updated consensus recommendations,[12] long-term chemotherapy, for several years (and possibly for life), is mandatory in inoperable patients. The decision to withdraw treatment is particularly difficult without objective and irrefutable proof of definitive cure. An attempt at withdrawing benzimidazole treatment may rely on negative FDG-PET scanning findings, including delayed images and negative EM2+ or Em18 serology results. Follow-up with careful PET scanning and serology should be performed first 3 months after treatment interruption and then yearly for 10 years.

Complementary and continuous chemotherapy with, preferably, albendazole is mandatory for at least 2 years following surgery. Careful follow-up examinations in these patients must continue for at least 10 years. In all cases of palliative operations, either surgical or ultrasonographically guided, chemotherapy is mandatory and follows the same therapeutic schedule as for patients who have not undergone surgery.

Intravenous amphotericin B (preferably as lipid emulsion) may be used as a rescue chemotherapy in patients resistant or intolerant to benzimidazoles. Pilot trials with interferon-gamma and nitazoxanide were unsuccessful. Interferon-alpha has yet to be tested in a pilot trial.

Other medication

Additional medical treatment includes antibiotics and antifungal agents for bacterial and fungal superinfection of the lesions, cholangitis and/or septicemia (mostly gram-negative bacteria, antibiotic-resistant Streptococcus faecalis, Pseudomonas aeruginosa, and Candida species after surgical interventions), and chronic cholestasis (including vitamin K and D supplementation).

Use propranolol to prevent digestive bleeding related to portal hypertension.

Ursodeoxycholic acid may be used in patients with chronic cholestasis and/or biliary stenting; its use has not been evaluated by specific studies.


Surgical Care

Except in cases of limited lesions located in the left liver lobe, attempt surgical procedures only if the team is trained and equipped for major liver surgery.

Radical surgery

If operation is feasible and if resection of the entire parasitic lesion from other affected organs is possible, surgery is the first treatment choice.

Recurrence has been observed after liver resections judged radical by the surgeon based on macroscopic evidence.

Palliative surgery

When radical surgery is impossible, one option is nonradical liver resection to reduce the parasitic mass and to increase the chances of effective chemotherapy. These palliative resections, as well as other types of palliative surgery performed to treat complications of disease (especially biliary obstruction), may generate specific complications (eg, recurrent biliary obstruction with cholangitis, septicemia, intrahepatic gallstones leading to secondary biliary cirrhosis). The current recommendation is to avoid palliative surgical procedures because of the relative efficacy of medical treatment, the use of interventional radiology and/or endoscopy, and a possible further indication of liver transplantation in patients with severe disease.

Liver transplantation

Consider liver transplantation in very advanced cases. Since 1986, more than 50 liver transplantations have been performed in patients with alveolar echinococcosis. The overall associated survival rate is lower than that of other indications for liver transplantation but is acceptable. Survival periods of more than 20 years have been observed in patients with alveolar echinococcosis who have undergone liver transplantation, even in those with residual or recurrent lesions.

Recurrences and metastases are common after transplantation (even those judged radical) in immunosuppressed patients. Benzimidazole treatment is mandatory as soon as possible after transplantation in all patients; such therapy can stop the progression of residual or recurrent lesions.

To avoid prolonged therapeutic immune suppression and make major hepatectomy possible, ”bench-hepatectomy” followed by autotransplantation has been performed by Chinese surgeons since 2011 with reasonable success.[13]

Interventional radiology or endoscopy

Consider ultrasonographically guided percutaneous procedures (eg, internal/external biliary drainage, abscess drainage, stenting) to alleviate intrahepatic complications.

Consider perendoscopic stenting of the bile duct in patients with biliary obstruction. Retrospective evaluation of the technique in 19 European centers shows that it is efficient and safe and makes recalibration of the bile duct stricture possible by using multiple stenting.[9]

Consider using endoscopic sclerosis of esophageal varices to prevent hemorrhages due to portal hypertension.



Before any therapeutic decision, especially if major hepatectomy or liver transplantation is considered, carefully assess for distant metastasis (ie, brain, lung, bone localizations). Include appropriate morphologic examinations and consultations. Discuss the case with liver and infectious disease specialists, radiologists, and all involved surgeons.

Neurosurgery and thoracic surgery may be indicated if brain or lung metastasis is complicated and/or accessible to surgery. These decisions and procedures require appropriate consultations.



Patients require no special diet, except those with chronic cholestasis.



Activity modification is not indicated, but chronic inflammation and cytokine production usually result in fatigue, which typically limits activity and may greatly impair quality of life.

Contributor Information and Disclosures

Dominique A Vuitton, MD, PhD Coordinator of International Affairs, WHO Collaborating Center for Prevention and Treatment of Echinococcosis, Professor Emeritus in Clinical Immunology, University of Franche-Comté, Besançon, France

Dominique A Vuitton, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

John M Leedom, MD Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Phi Beta Kappa

Disclosure: Nothing to disclose.


Thanks to all colleagues who are actively working within the framework of the WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, and more generally within the framework of the WHO-Informal Working Group on Echinococcosis.

  1. Wang J, Lin R, Zhang W, Li L, Gottstein B, Blagosklonov O, et al. Transcriptional profiles of cytokine/chemokine factors of immune cell-homing to the parasitic lesions: a comprehensive one-year course study in the liver of E. multilocularis-infected mice. PLoS One. 2014. 9(3):e91638. [Medline]. [Full Text].

  2. Wang J, Zhang C, Wei X, Blagosklonov O, Lv G, Lu X, et al. TGF-ß and TGF-ß/Smad signaling in the interactions between Echinococcus multilocularis and its hosts. PLoS One. 2013. 8(2):e55379. [Medline]. [Full Text].

  3. Massolo A, Liccioli S, Budke C, Klein C. Echinococcus multilocularis in North America: the great unknown. Parasite. 2014. 21:73. [Medline]. [Full Text].

  4. Piarroux M, Piarroux R, Giorgi R, et al. Clinical features and evolution of alveolar echinococcosis in France from 1982 to 2007: Results of a survey in 387 patients. J Hepatol. 2011 Nov. 55(5):1025-33. [Medline].

  5. Piarroux M, Piarroux R, Knapp J, Bardonnet K, Dumortier J, Watelet J, et al. Populations at risk for alveolar echinococcosis, France. Emerg Infect Dis. 2013 May. 19(5):721-8. [Medline]. [Full Text].

  6. Chauchet A, Grenouillet F, Knapp J, Richou C, Delabrousse E, Dentan C, et al. Increased incidence and characteristics of alveolar echinococcosis in patients with immunosuppression-associated conditions. Clin Infect Dis. 2014 Oct 15. 59(8):1095-104. [Medline].

  7. Liu W, Delabrousse É, Blagosklonov O, Wang J, Zeng H, Jiang Y, et al. Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones. Parasite. 2014. 21:74. [Medline]. [Full Text].

  8. Kodama Y, Fujita N, Shimizu T, Endo H, Nambu T, Sato N, et al. Alveolar echinococcosis: MR findings in the liver. Radiology. 2003 Jul. 228(1):172-7. [Medline].

  9. Tamarozzi F, Vuitton L, Brunetti E, Vuitton DA, Koch S. Non-surgical and non-chemical attempts to treat echinococcosis: do they work?. Parasite. 2014. 21:75. [Medline]. [Full Text].

  10. Caoduro C, Porot C, Vuitton DA, Bresson-Hadni S, Grenouillet F, Richou C, et al. The role of delayed 18F-FDG PET imaging in the follow-up of patients with alveolar echinococcosis. J Nucl Med. 2013 Mar. 54(3):358-63. [Medline].

  11. Azizi A, Blagosklonov O, Lounis A, Berthet L, Vuitton DA, Bresson-Hadni S, et al. Alveolar echinococcosis: correlation between hepatic MRI findings and FDG-PET/CT metabolic activity. Abdom Imaging. 2015 Jan. 40(1):56-63. [Medline].

  12. Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2009 Nov 18. [Medline].

  13. Mantion GA, Vuitton DA. Auto-versus allo-transplantation of the liver for end-stage alveolar echinococcosis?. Chin Med J (Engl). 2011 Sep. 124(18):2803-5. [Medline].

  14. Ammann R, Tschudi K, von Ziegler M, Meister F, Cotting J, Eckert J, et al. [The long-term course of 60 patients with alveolar echinococcosis in continuous therapy with mebendazole (1976-85)]. Klin Wochenschr. 1988 Nov 1. 66(21):1060-73. [Medline].

  15. Ammann RW, Eckert J. Cestodes. Echinococcus. Gastroenterol Clin North Am. 1996 Sep. 25(3):655-89. [Medline].

  16. Ammann RW, Hirsbrunner R, Cotting J, Steiger U, Jacquier P, Eckert J. Recurrence rate after discontinuation of long-term mebendazole therapy in alveolar echinococcosis (preliminary results). Am J Trop Med Hyg. 1990 Nov. 43(5):506-15. [Medline].

  17. Auer H, Aspock H. Incidence, prevalence and geographic distribution of human alveolar echinococcosis in Austria from 1854 to 1990. Parasitol Res. 1991. 77(5):430-6. [Medline].

  18. Bart JM, Knapp J, Gottstein B, El-Garch F, Giraudoux P, Glowatzki ML, et al. EmsB, a tandem repeated multi-loci microsatellite, new tool to investigate the genetic diversity of Echinococcus multilocularis. Infect Genet Evol. 2006 Sep. 6(5):390-400. [Medline].

  19. Bart JM, Piarroux M, Sako Y, Grenouillet F, Bresson-Hadni S, Piarroux R. Comparison of several commercial serologic kits and Em18 serology for detection of human alveolar echinococcosis. Diagn Microbiol Infect Dis. 2007 Sep. 59(1):93-5. [Medline].

  20. Bartholomot G, Vuitton DA, Harraga S, Shi DZ, Giraudoux P, Barnish G, et al. Combined ultrasound and serologic screening for hepatic alveolar echinococcosis in central China. Am J Trop Med Hyg. 2002 Jan. 66(1):23-9. [Medline].

  21. Bresson-Hadni S, Beurton I, Bartholomot B, Vuitton DA, Kern P, Mantion G, et al. Alveolar echinococcosis. Hepatology. 1998 May. 27(5):1453-6. [Medline].

  22. Bresson-Hadni S, Delabrousse E, Blagosklonov O, Bartholomot B, Koch S, Miguet JP, et al. Imaging aspects and non-surgical interventional treatment in human alveolar echinococcosis. Parasitol Int. 2006. 55 Suppl:S267-72. [Medline].

  23. Bresson-Hadni S, Humbert P, Paintaud G, Auer H, Lenys D, Laurent R. Skin localization of alveolar echinococcosis of the liver. J Am Acad Dermatol. 1996 May. 34(5 Pt 2):873-7. [Medline].

  24. Bresson-Hadni S, Koch S, Beurton I, Vuitton DA, Bartholomot B, Hrusovsky S, et al. Primary disease recurrence after liver transplantation for alveolar echinococcosis: long-term evaluation in 15 patients. Hepatology. 1999 Oct. 30(4):857-64. [Medline].

  25. Bresson-Hadni S, Laplante JJ, Lenys D, Rohmer P, Gottstein B, Jacquier P, et al. Seroepidemiologic screening of Echinococcus multilocularis infection in a European area endemic for alveolar echinococcosis. Am J Trop Med Hyg. 1994 Dec. 51(6):837-46. [Medline].

  26. Bresson-Hadni S, Liance M, Meyer JP, Houin R, Bresson JL, Vuitton DA. Cellular immunity in experimental Echinococcus multilocularis infection. II. Sequential and comparative phenotypic study of the periparasitic mononuclear cells in resistant and sensitive mice. Clin Exp Immunol. 1990 Nov. 82(2):378-83. [Medline].

  27. Bresson-Hadni S, Miguet JP, Lenys D, Vuitton DA, Viennet G, Becker MC, et al. Recurrence of alveolar echinococcosis in the liver graft after liver transplantation. Hepatology. 1992 Jul. 16(1):279-80. [Medline].

  28. Bresson-Hadni S, Vuitton D, Didier D, Etievent JP, Mantion G, Miguet JP, et al. [Pulmonary metastasis of alveolar echinococcosis. Frequency and mechanisms of occurrence]. Presse Med. 1989 Jan 21. 18(2):83. [Medline].

  29. Bresson-Hadni S, Vuitton DA, Bartholomot B, Heyd B, Godart D, Meyer JP, et al. A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France. Eur J Gastroenterol Hepatol. 2000 Mar. 12(3):327-36. [Medline].

  30. Bresson-Hadni S, Vuitton DA, Lenys D, Liance M, Racadot E, Miguet JP. Cellular immune response in Echinococcus multilocularis infection in humans. I. Lymphocyte reactivity to Echinococcus antigens in patients with alveolar echinococcosis. Clin Exp Immunol. 1989 Oct. 78(1):61-6. [Medline].

  31. Budke CM, Jiamin Q, Qian W, Torgerson PR. Economic effects of echinococcosis in a disease-endemic region of the Tibetan Plateau. Am J Trop Med Hyg. 2005 Jul. 73(1):2-10. [Medline].

  32. Budke CM, Jiamin Q, Zinsstag J, Qian W, Torgerson PR. Use of disability adjusted life years in the estimation of the disease burden of echinococcosis for a high endemic region of the Tibetan plateau. Am J Trop Med Hyg. 2004 Jul. 71(1):56-64. [Medline].

  33. Budke CM, Jiamin Q, Zinsstag J, Qian W, Torgerson PR. Use of disability adjusted life years in the estimation of the disease burden of echinococcosis for a high endemic region of the Tibetan plateau. Am J Trop Med Hyg. 2004 Jul. 71(1):56-64. [Medline].

  34. Claudon M, Bessieres M, Regent D, Rodde A, Bazin C, Gerard A, et al. Alveolar echinococcosis of the liver: MR findings. J Comput Assist Tomogr. 1990 Jul-Aug. 14(4):608-14. [Medline].

  35. Claudon M, Chaulieu C, Delgoffe C, Desplechain C, Thomas D, Regent D. [Role of echography in the diagnosis and monitoring of hepatic alveolar echinococcosis]. J Radiol. 1984 Nov. 65(11):773-80. [Medline].

  36. Claudon M, Regent D, Delgoffe C, Bernard C, Gerard A, Treheux A. [Role of computed tomography in the diagnosis and surveillance of hepatic alveolar echinococcosis]. J Radiol. 1985 Aug-Sep. 66(8-9):507-13. [Medline].

  37. Craig PS. Echinococcus granulosus: immunodiagnosis and vaccination, a perspective. Parassitologia. 1997 Dec. 39(4):345-7. [Medline].

  38. Craig PS, Deshan L, MacPherson CN, Dazhong S, Reynolds D, Barnish G, et al. A large focus of alveolar echinococcosis in central China. Lancet. 1992 Oct 3. 340(8823):826-31. [Medline].

  39. Craig PS, Li T, Qiu J, Zhen R, Wang Q, Giraudoux P, et al. Echinococcosis and Tibetan communities. Emerg Infect Dis. 2008 Oct. 14(10):1674-5. [Medline]. [Full Text].

  40. Craig PS, Rogan MT, Campos-Ponce M. Echinococcosis: disease, detection and transmission. Parasitology. 2003. 127 Suppl:S5-20. [Medline].

  41. Deplazes P, Eckert J. Diagnosis of the Echinococcus multilocularis infection in final hosts. Appl Parasitol. 1996 Dec. 37(4):245-52. [Medline].

  42. Didier D, Weiler S, Rohmer P, Lassegue A, Deschamps JP, Vuitton D, et al. Hepatic alveolar echinococcosis: correlative US and CT study. Radiology. 1985 Jan. 154(1):179-86. [Medline].

  43. Eckert J. Epidemiology of Echinococcus multilocularis and E. granulosus in central Europe. Parassitologia. 1997 Dec. 39(4):337-44. [Medline].

  44. Eckert J, Jacquier P, Baumann D, Raeber PA. [Human echinococcosis in Switzerland, 1984-1992]. Schweiz Med Wochenschr. 1995 Oct 21. 125(42):1989-98. [Medline].

  45. Eiermann TH, Bettens F, Tiberghien P, Schmitz K, Beurton I, Bresson-Hadni S, et al. HLA and alveolar echinococcosis. Tissue Antigens. 1998 Aug. 52(2):124-9. [Medline].

  46. Etievent JP, Vuitton D, Allemand H, Weill F, Gandjbakhch I, Miguet JP. Pulmonary embolism from a parasitic cardiac clot secondary to hepatic alveolar echinococcosis. J Cardiovasc Surg (Torino). 1986 Nov-Dec. 27(6):671-4. [Medline].

  47. Feng X, Wen H, Zhang Z, Chen X, Ma X, Zhang J, et al. Dot immunogold filtration assay (DIGFA) with multiple native antigens for rapid serodiagnosis of human cystic and alveolar echinococcosis. Acta Trop. 2009 Oct 23. [Medline].

  48. Frei P, Misselwitz B, Prakash MK, Schoepfer AM, Prinz Vavricka BM, Müllhaupt B, et al. Late biliary complications in human alveolar echinococcosis are associated with high mortality. World J Gastroenterol. 2014 May 21. 20(19):5881-8. [Medline]. [Full Text].

  49. Gigandet S, Agache A, Parizet C, Weill F. [Venous study of the limbs with duplex Doppler and color Doppler. An iconographic review]. J Radiol. 1991 Jun-Jul. 72(6-7):341-8. [Medline].

  50. Giraudoux P, Craig PS, Delattre P, Bao G, Bartholomot B, Harraga S, et al. Interactions between landscape changes and host communities can regulate Echinococcus multilocularis transmission. Parasitology. 2003. 127 Suppl:S121-31. [Medline].

  51. Godot V, Harraga S, Beurton I, Deschaseaux M, Sarciron E, Gottstein B, et al. Resistance/susceptibility to Echinococcus multilocularis infection and cytokine profile in humans. I. Comparison of patients with progressive and abortive lesions. Clin Exp Immunol. 2000 Sep. 121(3):484-90. [Medline].

  52. Godot V, Harraga S, Beurton I, Tiberghien P, Sarciron E, Gottstein B, et al. Resistance/susceptibility to Echinococcus multilocularis infection and cytokine profile in humans. II. Influence of the HLA B8, DR3, DQ2 haplotype. Clin Exp Immunol. 2000 Sep. 121(3):491-8. [Medline].

  53. Godot V, Harraga S, Deschaseaux M, Bresson-Hadni S, Gottstein B, Emilie D, et al. Increased basal production of interleukin-10 by peripheral blood mononuclear cells in human alveolar echinococcosis. Eur Cytokine Netw. 1997 Dec. 8(4):401-8. [Medline].

  54. Godot V, Harraga S, Podoprigora G, Liance M, Bardonnet K, Vuitton DA. IFN alpha-2a protects mice against a helminth infection of the liver and modulates immune responses. Gastroenterology. 2003 May. 124(5):1441-50. [Medline].

  55. Gottstein B. Echinococcus multilocularis infection: immunology and immunodiagnosis. Adv Parasitol. 1992. 31:321-80. [Medline].

  56. Gottstein B. Molecular and immunological diagnosis of echinococcosis. Clin Microbiol Rev. 1992 Jul. 5(3):248-61. [Medline].

  57. Gottstein B. Purification and characterization of a specific antigen from Echinococcus multilocularis. Parasite Immunol. 1985 May. 7(3):201-12. [Medline].

  58. Gottstein B, Schantz PM, Wilson JF. Serological screening for Echinococcus multilocularis infections with ELISA. Lancet. 1985 May 11. 1(8437):1097-8. [Medline].

  59. Grenard P, Bresson-Hadni S, El Alaoui S, Chevallier M, Vuitton DA, Ricard-Blum S. Transglutaminase-mediated cross-linking is involved in the stabilization of extracellular matrix in human liver fibrosis. J Hepatol. 2001 Sep. 35(3):367-75. [Medline].

  60. Harraga S, Godot V, Bresson-Hadni S, Pater C, Beurton I, Bartholomot B, et al. Clinical efficacy of and switch from T helper 2 to T helper 1 cytokine profile after interferon alpha2a monotherapy for human echinococcosis. Clin Infect Dis. 1999 Jul. 29(1):205-6. [Medline].

  61. Horton RJ. Albendazole in treatment of human cystic echinococcosis: 12 years of experience. Acta Trop. 1997 Apr 1. 64(1-2):79-93. [Medline].

  62. Horton RJ. Albendazole: a review of the pharmacology, pharmacokinetics, clinical efficacy and safety in hydatid disease. Uchino J, Sato N, eds. Alveolar Echinococcosis. Sapporo, Japan: Fuji Shoin; 1996. 261-97.

  63. Ishikawa Y, Sako Y, Itoh S, Ohtake T, Kohgo Y, Matsuno T. Serological monitoring of progression of alveolar echinococcosis with multiorgan involvement by use of recombinant Em18. J Clin Microbiol. 2009 Oct. 47(10):3191-6. [Medline]. [Full Text].

  64. Ito A, Schantz PM, Wilson JF. Em18, a new serodiagnostic marker for differentiation of active and inactive cases of alveolar hydatid disease. Am J Trop Med Hyg. 1995 Jan. 52(1):41-4. [Medline].

  65. Ito A, Xiao N, Liance M, Sato MO, Sako Y, Mamuti W, et al. Evaluation of an enzyme-linked immunosorbent assay (ELISA) with affinity-purified Em18 and an ELISA with recombinant Em18 for differential diagnosis of alveolar echinococcosis: results of a blind test. J Clin Microbiol. 2002 Nov. 40(11):4161-5. [Medline].

  66. Kadry Z, Renner EC, Bachmann LM, Attigah N, Renner EL, Ammann RW, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg. 2005 Sep. 92(9):1110-6. [Medline].

  67. Kapel CM, Torgerson PR, Thompson RC, Deplazes P. Reproductive potential of Echinococcus multilocularis in experimentally infected foxes, dogs, raccoon dogs and cats. Int J Parasitol. 2006 Jan. 36(1):79-86. [Medline].

  68. Kern P, Abboud P, Kern W, Stich A, Bresson-Hadni S, Guerin B, et al. Critical appraisal of nitazoxanide for the treatment of alveolar echinococcosis. Am J Trop Med Hyg. 2008. 79:119.

  69. Kern P, Bardonnet K, Renner E, Auer H, Pawlowski Z, Ammann RW, et al. European echinococcosis registry: human alveolar echinococcosis, Europe, 1982-2000. Emerg Infect Dis. 2003 Mar. 9(3):343-9. [Medline].

  70. Kern P, Frosch P, Helbig M, Wechsler JG, Usadel S, Beckh K, et al. Diagnosis of Echinococcus multilocularis infection by reverse-transcription polymerase chain reaction. Gastroenterology. 1995 Aug. 109(2):596-600. [Medline].

  71. Kern P, Wen H, Sato N, Vuitton DA, Gruener B, Shao Y. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int. 2006. 55 Suppl:S283-7. [Medline].

  72. Knapp J, Bart JM, Giraudoux P, Glowatzki ML, Breyer I, Raoul F, et al. Genetic Diversity of the Cestode Echinococcus multilocularis in Red Foxes at a Continental Scale in Europe. PLoS Negl Trop Dis. 2009 Jun 9. 3(6):e452. [Medline]. [Full Text].

  73. Koch S, Bresson-Hadni S, Miguet JP, Crumbach JP, Gillet M, Mantion GA, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation. 2003 Mar 27. 75(6):856-63. [Medline].

  74. Kratzer W, Reuter S, Hirschbuehl K, Ehrhardt AR, Mason RA, Haenle MM, et al. Comparison of contrast-enhanced power Doppler ultrasound (Levovist) and computed tomography in alveolar echinococcosis. Abdom Imaging. 2005 May-Jun. 30(3):286-90. [Medline].

  75. Kreidl P, Allerberger F, Judmaier G, Auer H, Aspock H, Hall AJ. Domestic pets as risk factors for alveolar hydatid disease in Austria. Am J Epidemiol. 1998 May 15. 147(10):978-81. [Medline].

  76. Liance M, Bresson-Hadni S, Meyer JP, Houin R, Vuitton DA. Cellular immunity in experimental Echinococcus multilocularis infection. I. Sequential and comparative study of specific in vivo delayed-type hypersensitivity against E. multilocularis antigens in resistant and sensitive mice. Clin Exp Immunol. 1990 Nov. 82(2):373-7. [Medline].

  77. Liance M, Bresson-Hadni S, Vuitton DA, Lenys D, Carbillet JP, Houin R. Effects of cyclosporin A on the course of murine alveolar echinococcosis and on specific cellular and humoral immune responses against Echinococcus multilocularis. Int J Parasitol. 1992 Feb. 22(1):23-8. [Medline].

  78. Liance M, Janin V, Bresson-Hadni S, Vuitton DA, Houin R, Piarroux R. Immunodiagnosis of Echinococcus infections: confirmatory testing and species differentiation by a new commercial Western Blot. J Clin Microbiol. 2000 Oct. 38(10):3718-21. [Medline].

  79. Liance M, Vuitton DA, Guerret-Stocker S, Carbillet JP, Grimaud JA, Houin R. Experimental alveolar echinococcosis. Suitability of a murine model of intrahepatic infection by Echinococcus multilocularis for immunological studies. Experientia. 1984 Dec 15. 40(12):1436-9. [Medline].

  80. Lidove O, Chauveheid MP, Papo T, Vuitton DA, Piarroux R, Hernigou A, et al. Echinococcus multilocularis massive pericardial infection: late and dramatic improvement under albendazole therapy. Am J Med. 2005 Feb. 118(2):195-7. [Medline].

  81. Lin RY, Wang JH, Lu XM, Zhou XT, Mantion G, Wen H, et al. Components of the mitogen-activated protein kinase cascade are activated in hepatic cells by Echinococcus multilocularis metacestode. World J Gastroenterol. 2009 May 7. 15(17):2116-24. [Medline]. [Full Text].

  82. Macpherson CN, Bartholomot B, Frider B. Application of ultrasound in diagnosis, treatment, epidemiology, public health and control of Echinococcus granulosus and E. multilocularis. Parasitology. 2003. 127 Suppl:S21-35. [Medline].

  83. Malczewski A, Rocki B, Ramisz A, Eckert J. Echinococcus multilocularis (Cestoda), the causative agent of alveolar echinococcosis in humans: first record in Poland. J Parasitol. 1995 Apr. 81(2):318-21. [Medline].

  84. Martinek K, Kolarova L, Cerveny J, Andreas M. Echinococcus multilocularis (Cestoda: Taeniidae) in the Czech Republic: the first detection of metacestodes in a naturally infected rodent. Folia Parasitol (Praha). 1998. 45(4):332-3. [Medline].

  85. Mathis A, Deplazes P, Eckert J. An improved test system for PCR-based specific detection of Echinococcus multilocularis eggs. J Helminthol. 1996 Sep. 70(3):219-22. [Medline].

  86. Nicod L, Bresson-Hadni S, Vuitton DA, Emery I, Gottstein B, Auer H, et al. Specific cellular and humoral immune responses induced by different antigen preparations of Echinococcus multilocularis metacestodes in patients with alveolar echinococcosis. Parasite. 1994 Sep. 1(3):261-70. [Medline].

  87. Petavy AF, Tenora F, Deblock S, Sergent V. Echinococcus multilocularis in domestic cats in France. A potential risk factor for alveolar hydatid disease contamination in humans. Vet Parasitol. 2000 Jan. 87(2-3):151-6. [Medline].

  88. Pleydell DR, Yang YR, Danson FM, Raoul F, Craig PS, McManus DP. Landscape composition and spatial prediction of alveolar echinococcosis in southern ningxia, china. PLoS Negl Trop Dis. 2008. 2(9):e287. [Medline]. [Full Text].

  89. Rausch RL, Wilson JF, Schantz PM. A programme to reduce the risk of infection by Echinococcus multilocularis: the use of praziquantel to control the cestode in a village in the hyperendemic region of Alaska. Ann Trop Med Parasitol. 1990 Jun. 84(3):239-50. [Medline].

  90. Rausch RL, Wilson JF, Schantz PM, McMahon BJ. Spontaneous death of Echinococcus multilocularis: cases diagnosed serologically (by Em2 ELISA) and clinical significance. Am J Trop Med Hyg. 1987 May. 36(3):576-85. [Medline].

  91. Reuter S, Buck A, Grebe O, Nussle-Kugele K, Kern P, Manfras BJ. Salvage treatment with amphotericin B in progressive human alveolar echinococcosis. Antimicrob Agents Chemother. 2003 Nov. 47(11):3586-91. [Medline].

  92. Reuter S, Buck A, Manfras B, Kratzer W, Seitz HM, Darge K. Structured treatment interruption in patients with alveolar echinococcosis. Hepatology. 2004 Feb. 39(2):509-17. [Medline].

  93. Reuter S, Jensen B, Buttenschoen K, Kratzer W, Kern P. Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature. J Antimicrob Chemother. 2000 Sep. 46(3):451-6. [Medline].

  94. Reuter S, Merkle M, Brehm K, Kern P, Manfras B. Effect of amphotericin B on larval growth of Echinococcus multilocularis. Antimicrob Agents Chemother. 2003 Feb. 47(2):620-5. [Medline].

  95. Reuter S, Nussle K, Kolokythas O, Haug U, Rieber A, Kern P, et al. Alveolar liver echinococcosis: a comparative study of three imaging techniques. Infection. 2001 May-Jun. 29(3):119-25. [Medline].

  96. Reuter S, Schirrmeister H, Kratzer W, Dreweck C, Reske SN, Kern P. Pericystic metabolic activity in alveolar echinococcosis: assessment and follow-up by positron emission tomography. Clin Infect Dis. 1999 Nov. 29(5):1157-63. [Medline].

  97. Ricard-Blum S, Bresson-Hadni S, Guerret S, Grenard P, Volle PJ, Risteli L, et al. Mechanism of collagen network stabilization in human irreversible granulomatous liver fibrosis. Gastroenterology. 1996 Jul. 111(1):172-82. [Medline].

  98. Ricard-Blum S, Bresson-Hadni S, Vuitton DA, Ville G, Grimaud JA. Hydroxypyridinium collagen cross-links in human liver fibrosis: study of alveolar echinococcosis. Hepatology. 1992 Apr. 15(4):599-602. [Medline].

  99. Ricard-Blum S, Liance M, Houin R, Grimaud JA, Vuitton DA. Covalent cross-linking of liver collagen by pyridinoline increases in the course of experimental alveolar echinococcosis. Parasite. 1995 Jun. 2(2):113-8. [Medline].

  100. Sarciron EM, Bresson-Hadni S, Mercier M, Lawton P, Duranton C, Lenys D, et al. Antibodies against Echinococcus multilocularis alkaline phosphatase as markers for the specific diagnosis and the serological monitoring of alveolar echinococcosis. Parasite Immunol. 1997 Feb. 19(2):61-8. [Medline].

  101. Schantz PM. Tapeworms (cestodiasis). Gastroenterol Clin North Am. 1996 Sep. 25(3):637-53. [Medline].

  102. Schantz PM, Brandt FH, Dickinson CM, Allen CR, Roberts JM, Eberhard ML. Effects of albendazole on Echinococcus multilocularis infection in the Mongolian jird. J Infect Dis. 1990 Dec. 162(6):1403-7. [Medline].

  103. Schantz PM, Chai J, Craig PS. Epidemiology and control of hydatid disease. Thompson RCA, Lymbery AJ, eds. Echinococcus and Hydatid Disease. Wallingford, United Kingdom: Cab International; 1995. 233-331.

  104. Schelling U, Frank W, Will R, Romig T, Lucius R. Chemotherapy with praziquantel has the potential to reduce the prevalence of Echinococcus multilocularis in wild foxes (Vulpes vulpes). Ann Trop Med Parasitol. 1997 Mar. 91(2):179-86. [Medline].

  105. Schmitt M, Saucy F, Wyborn S, Gottstein B. [Infestation of water voles (Arvicola terrestris) with metacestodes of Echinococcus multilocularis in the canton Freiburg (Switzerland)]. Schweiz Arch Tierheilkd. 1997. 139(2):84-93. [Medline].

  106. Schweiger A, Ammann RW, Candinas D, Clavien PA, Eckert J, Gottstein B. Human alveolar echinococcosis after fox population increase, Switzerland. Emerg Infect Dis. 2007 Jun. 13(6):878-82. [Medline]. [Full Text].

  107. Stettler M, Fink R, Walker M, Gottstein B, Geary TG, Rossignol JF, et al. In vitro parasiticidal effect of Nitazoxanide against Echinococcus multilocularis metacestodes. Antimicrob Agents Chemother. 2003 Feb. 47(2):467-74. [Medline].

  108. Stettler M, Rossignol JF, Fink R, Walker M, Gottstein B, Merli M, et al. Secondary and primary murine alveolar echinococcosis: combined albendazole/nitazoxanide chemotherapy exhibits profound anti-parasitic activity. Int J Parasitol. 2004 Apr. 34(5):615-24. [Medline].

  109. Sturm D, Menzel J, Gottstein B, Kern P. Interleukin-5 is the predominant cytokine produced by peripheral blood mononuclear cells in alveolar echinococcosis. Infect Immun. 1995 May. 63(5):1688-97. [Medline].

  110. Suzuki K, Uchino J, Sato N. Development and efficacy of mass screening of alveolar echinococcosis. Uchino J, Sato N, eds. Alveolar Echinococcosis. Sapporo, Japan: Fuji Shoin; 1996. 213-7.

  111. Thompson RCA. Biology and systematics of Echinococcus. Thompson RC, Lymbery AJ, eds. Echinococcus and Hydatid Disease. Wallingford, United Kingdom: Cab International; 1995. 1-50.

  112. Torgerson PR, Schweiger A, Deplazes P, Pohar M, Reichen J, Ammann RW, et al. Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years. J Hepatol. 2008 Jul. 49(1):72-7. [Medline].

  113. Viel JF, Giraudoux P, Abrial V, Bresson-Hadni S. Water vole (Arvicola terrestris scherman) density as risk factor for human alveolar echinococcosis. Am J Trop Med Hyg. 1999 Oct. 61(4):559-65. [Medline].

  114. Vogel J, Görich J, Kramme E, Merkle E, Sokiranski R, Kern P. Alveolar echinococcosis of the liver: percutaneous stent therapy in Budd-Chiari syndrome. Gut. 1996 Nov. 39(5):762-4. [Medline].

  115. Vogel M, Muller N, Gottstein B, Flury K, Eckert J, Seebeck T. Echinococcus multilocularis: characterization of a DNA probe. Acta Trop. 1990 Dec. 48(2):109-16. [Medline].

  116. Vuitton D. Alveolar echinococcosis of the liver: a parasitic disease in search of a treatment. Hepatology. 1990 Sep. 12(3 Pt 1):617-8. [Medline].

  117. Vuitton DA. Benzimidazoles for the treatment of cystic and alveolar echinococcosis: what is the consensus?. Expert Rev Anti Infect Ther. 2009 Mar. 7(2):145-9. [Medline].

  118. Vuitton DA. Echinococcosis and allergy. Clin Rev Allergy Immunol. 2004 Apr. 26(2):93-104. [Medline].

  119. Vuitton DA. New trends in the treatment of echinococcosis. Helminthologia. 1999. 36:167-70.

  120. Vuitton DA. The ambiguous role of immunity in echinococcosis: protection of the host or of the parasite?. Acta Trop. 2003 Feb. 85(2):119-32. [Medline].

  121. Vuitton DA, Bresson-Hadni S, Laroche L, Kaiserlian D, Guerret-Stocker S, Bresson JL, et al. Cellular immune response in Echinococcus multilocularis infection in humans. II. Natural killer cell activity and cell subpopulations in the blood and in the periparasitic granuloma of patients with alveolar echinococcosis. Clin Exp Immunol. 1989 Oct. 78(1):67-74. [Medline].

  122. Vuitton DA, Bresson-Hadni S, Lenys D, Flausse F, Liance M, Wattre P, et al. IgE-dependent humoral immune response in Echinococcus multilocularis infection: circulating and basophil-bound specific IgE against Echinococcus antigens in patients with alveolar echinococcosis. Clin Exp Immunol. 1988 Feb. 71(2):247-52. [Medline].

  123. Vuitton DA, Bresson-Hadni S, Liance M, Meyer JP, Giraudoux P, Lenys D. [Human alveolar echinococcosis. Epidemiologic hazard or immunologic incident?]. Gastroenterol Clin Biol. 1990. 14(2):124-30. [Medline].

  124. Vuitton DA, Guerret-Stocker S, Carbillet JP, Mantion G, Miguet JP, Grimaud JA. Collagen immunotyping of the hepatic fibrosis in human alveolar echinococcosis. Z Parasitenkd. 1986. 72(1):97-104. [Medline].

  125. Vuitton DA, Lasségue A, Miguet JP, Hervé P, Barale T, Seillés E. Humoral and cellular immunity in patients with hepatic alveolar echinococcosis. A 2 year follow-up with and without flubendazole treatment. Parasite Immunol. 1984 Jul. 6(4):329-40. [Medline].

  126. Vuitton DA, Zhang SL, Yang Y, Godot V, Beurton I, Mantion G, et al. Survival strategy of Echinococcus multilocularis in the human host. Parasitol Int. 2006. 55 Suppl:S51-5. [Medline].

  127. Vuitton DA, Zhou H, Bresson-Hadni S, Wang Q, Piarroux M, Raoul F, et al. Epidemiology of alveolar echinococcosis with particular reference to China and Europe. Parasitology. 2003. 127 Suppl:S87-107. [Medline].

  128. Walker M, Rossignol JF, Torgerson P, Hemphill A. In vitro effects of nitazoxanide on Echinococcus granulosus protoscoleces and metacestodes. J Antimicrob Chemother. 2004 Sep. 54(3):609-16. [Medline].

  129. Wang Q, Vuitton DA, Qiu J, Giraudoux P, Xiao Y, Schantz PM, et al. Fenced pasture: a possible risk factor for human alveolar echinococcosis in Tibetan pastoralist communities of Sichuan, China. Acta Trop. 2004 May. 90(3):285-93. [Medline].

  130. Wang Q, Vuitton DA, Xiao Y, Budke CM, Campos-Ponce M, Schantz PM, et al. Pasture types and Echinococcus multilocularis, Tibetan communities. Emerg Infect Dis. 2006 Jun. 12(6):1008-10. [Medline].

  131. Wen H, Bresson-Hadni S, Vuitton DA, Lenys D, Yang BM, Ding ZX, et al. Analysis of immunoglobulin G subclass in the serum antibody responses of alveolar echinococcosis patients after surgical treatment and chemotherapy as an aid to assessing the outcome. Trans R Soc Trop Med Hyg. 1995 Nov-Dec. 89(6):692-7. [Medline].

  132. Wen H, Craig PS, Ito A, Vuitton DA, Bresson-Hadni S, Allan JC, et al. Immunoblot evaluation of IgG and IgG-subclass antibody responses for immunodiagnosis of human alveolar echinococcosis. Ann Trop Med Parasitol. 1995 Oct. 89(5):485-95. [Medline].

  133. Wen H, New RR, Muhmut M, Wang JH, Wang YH, Zhang JH, et al. Pharmacology and efficacy of liposome-entrapped albendazole in experimental secondary alveolar echinococcosis and effect of co-administration with cimetidine. Parasitology. 1996 Aug. 113 (Pt 2):111-21. [Medline].

  134. [Guideline] WHO Informal Working Group on Echinococcosis. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ. 1996. 74(3):231-42. [Medline]. [Full Text].

  135. Yamasaki H, Nakao M, Nakaya K, Schantz PM, Ito A. Genetic analysis of Echinococcus multilocularis originating from a patient with alveolar echinococcosis occurring in Minnesota in 1977. Am J Trop Med Hyg. 2008 Aug. 79(2):245-7. [Medline].

  136. Yang YR, Ellis M, Sun T, Li Z, Liu X, Vuitton DA. Unique family clustering of human echinococcosis cases in a chinese community. Am J Trop Med Hyg. 2006 Mar. 74(3):487-94. [Medline].

  137. Yang YR, Liu XZ, Vuitton DA, Bartholomot B, Wang YH, Ito A. Simultaneous alveolar and cystic echinococcosis of the liver. Trans R Soc Trop Med Hyg. 2006 Jun. 100(6):597-600. [Medline].

  138. Yang YR, Sun T, Li Z, Li X, Zhao R, Cheng L, et al. Echinococcosis, Ningxia, China. Emerg Infect Dis. 2005 Aug. 11(8):1314-6. [Medline].

  139. Yang YR, Vuitton DA, Jones MK, Craig PS, McManus DP. Brain metastasis of alveolar echinococcosis in a hyperendemic focus of Echinococcus multilocularis infection. Trans R Soc Trop Med Hyg. 2005 Dec. 99(12):937-41. [Medline].

  140. Zhang S, Hüe S, Sène D, Penfornis A, Bresson-Hadni S, Kantelip B, et al. Expression of major histocompatibility complex class I chain-related molecule A, NKG2D, and transforming growth factor-beta in the liver of humans with alveolar echinococcosis: new actors in the tolerance to parasites?. J Infect Dis. 2008 May 1. 197(9):1341-9. [Medline].

  141. Zhang S, Penfornis A, Harraga S, Chabod J, Beurton I, Bresson-Hadni S, et al. Polymorphisms of the TAP1 and TAP2 genes in human alveolar echinococcosis. Eur J Immunogenet. 2003 Apr. 30(2):133-9. [Medline].

  142. Zhou HX, Wen H, Wang YH, Delattre P, Quere JP, Vuitton DA, et al. Experimental susceptibility of Spermophilus erythrogenys to Echinococcus multilocularis. Ann Trop Med Parasitol. 1998 Apr. 92(3):335-7. [Medline].

Foxes are the definitive hosts of the cestode Echinococcus multilocularis. Courtesy of Dominique A. Vuitton, MD, PhD.
Macroscopic aspect of alveolar echinococcosis lesions in the liver. Courtesy of Bernadette Kantelip, MD.
Ultrasonographic, CT scan, and perioperative aspect of a typical lesion of alveolar echinococcosis with central necrosis. Courtesy of Jean-Philippe Miguet, MD.
Microtus larvalis (common vole) is one of the most common intermediate hosts of Echinococcus multilocularis in Europe. Courtesy of Patrick Giraudoux, PhD.
Sonogram of a typical form of alveolar echinococcosis of the liver, discovered at a screening in China. Courtesy of Dominique A. Vuitton, MD, PhD; Brigitte Bartholomot, MD; and Philip S. Craig, PhD.
Sonogram of an abortive form of alveolar echinococcosis of the liver, discovered at a screening in China. Courtesy of Dominique A. Vuitton, MD, PhD; Brigitte Bartholomot, MD; and Philip S. Craig, PhD.
Pathognomonic aspect of alveolar echinococcosis lesions invading the adrenal gland (resembling a honeycomb) that shows a necrotic area in the contiguous left liver lesion; MRI showing multiple parasitic cysts smaller than 1 cm in diameter appearing in high signal intensity on T2-weighted sequence. Courtesy of Brigitte Bartholomot, MD.
Brain metastasis of alveolar echinococcosis. Courtesy of Jean-Philippe Miguet, MD.
Skin metastasis of alveolar echinococcosis. Courtesy of Solange Bresson-Hadni, MD, PhD.
Histologic features of alveolar echinococcosis vesicles and periparasitic granuloma in humans, periodic acid-Schiff staining of the laminated layer. Courtesy of Bernadette Kantelip, MD.
Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan aspect of active alveolar echinococcosis. White-yellow colors show a very high FDG uptake due to the periparasitic granulomatous infiltration and/or active germinal layer of Echinococcus multilocularis, and green-gray colors show the absence of the FDG uptake by inactive parasitic lesions (mostly necrotic). Courtesy of Solange Bresson-Hadni, MD, PhD, and Oleg Blagosklonov, MD, PhD.
Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan aspect of inactive alveolar echinococcosis. No abnormal FDG uptake by the parasitic lesions after several years of albendazole treatment. Courtesy of Solange Bresson-Hadni, MD, PhD, and Oleg Blagosklonov, MD, PhD.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.