eMedicine Specialties > Infectious Diseases > Parasitic Infections

Echinococcosis: Treatment & Medication

Author: 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
Contributor Information and Disclosures

Updated: Jan 5, 2010

Treatment

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,1 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.
    • Administer chemotherapy for at least 2 years after radical liver transplantation and for life in patients who demonstrate evidence of parasitic remnants in the liver area and/or of distant metastases outside the liver.
  • 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.

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). Long-term follow-up of patients shows that palliative or debulking surgery should be avoided.
    • 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.
  • Interventional radiology or endoscopy
    • Consider ultrasonographically guided percutaneous procedures (eg, internal/external biliary drainage, abscess drainage, stenting) to alleviate intrahepatic complications.
    • Consider endosonography-guided permanent stenting of the bile duct in patients with biliary obstruction.
    • Consider using endoscopic sclerosis of esophageal varices to prevent hemorrhages due to portal hypertension.

Consultations

  • 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.

Diet

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

Activity

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.

Medication

The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to eradicate infection.

Benzimidazole anthelmintic drugs

Benzimidazoles have efficacy on E granulosus and E multilocularis larval stages. Mebendazole (MBZ) and albendazole (ABZ) are the only benzimidazoles effective in experimental models, but their efficacy is related to the clinical condition. These drugs bind to the free beta-tubulin of the parasite, thereby inhibiting both polymerization of tubulin and microtubule-dependent uptake of glucose. In E multilocularis infection, MBZ and ABZ are not parasiticidal, but they do reduce protoscolex viability in vitro and in vivo and inhibit the growth and development of germinal cells in vivo. Because of better bioavailability, better observance, and commercial availability and authorization worldwide, ABZ is usually the preferred drug. Although praziquantel is more effective against protoscoleces than benzimidazole, it is not indicated alone in the treatment of alveolar echinococcosis because it is totally ineffective against larval growth.


Mebendazole (Vermox)

Systemic bioavailability is low because MBZ is poorly absorbed and is subject to significant first-pass metabolism. Administering with a fatty meal enhances the extent and rate of absorption; resultant plasma concentration is 8 times higher than in fasting state. The decarboxylated inactive metabolite is excreted in urine and bile. Considerable between-patient variability in MBZ plasma concentrations. Measure MBZ radioimmunoassay and HPLC with ultraviolet or electrochemical detection. Individualize dosage by measuring plasma levels 4 h after administering the drug. Target MBZ concentration 4 h after morning dose averages 250 nmol/L (74 ng/mL).

Adult

40-50 mg/kg/d PO divided tid; not to exceed 6 g/d
Administer preprandially/postprandially with a fatty meal

Pediatric

Not established; weight-based dosing has been suggested for children >6 y

Carbamazepine and phenytoin may decrease effects; cimetidine may increase levels

Documented hypersensitivity; pregnancy (may be used during second or third trimester in urgent cases after careful risk analysis)

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Women of childbearing potential must use contraception during treatment (test for pregnancy prior to treatment); may reduce insulin requirement (monitor serum glucose concentrations in patients with diabetes mellitus); decrease dose in cholestasis and/or hepatocellular dysfunction.
Mild asymptomatic elevation of levels of serum aminotransferases is common, but they often return to reference ranges after a few weeks; more marked asymptomatic elevation of levels of serum aminotransferases may be related to hepatotoxicity; aminotransferase levels return to normal after therapy withdrawal; measure serum aminotransferase levels before starting therapy and regularly thereafter (ie, q2wk for 3 mo, then q3mo); upon level increases above 5 times the upper limit of normal, the following steps are recommended: (1) Check for other causes of the increase (other medication, viral hepatitis, alveolar echinococcosis–related biliary obstruction or liver abscess), (2) monitor drug levels, (3) decrease MBZ dosage if MBZ plasma levels are higher than the recommended range of concentrations, (4) shift to the alternative BMZ (ABZ) if the elevation persists, and (5) consult a reference center if the level persistently exceeds 5 times the upper limit of normal
Leukopenia is an absolute indication for terminating therapy because severe granulocytopenia is possible; monitor leukocyte count q2wk for 3 mo, then regularly thereafter.
Continue therapy only if increase in either aminotransferases or leukopenia is moderate and stable; in some cases, replacement of MBZ by ABZ is well tolerated and should be tried in case of side effect.


Albendazole (Albenza)

Poorly and variably absorbed and subject to significant first-pass metabolism, resulting in a sulfoxide metabolite (ASOX) that may be the active form of the drug. Administering with fatty meal enhances extent and rate of absorption; resultant plasma concentrations are 4-5 times higher than in a fasting state. Considerable interindividual/intraindividual variation in ASOX plasma concentration/time curves. Continuous therapy has better efficacy without marked increase in adverse effects and is currently recommended in all cases of alveolar echinococcosis.

Adult

400 mg PO bid, preprandially/postprandially with a fatty meal; effective serum ASOX levels are estimated to be 650-3000 nmol/L (average of 1000-3000 nmol/L)

Pediatric

Not established; weight-based dosing has been suggested for children >6 y (10-15 mg/kg/d PO)

Carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity

Documented hypersensitivity; pregnancy (may be used during second or third trimester in urgent cases after careful risk analysis)

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Women of childbearing potential must use contraception during treatment (test for pregnancy prior to treatment); may reduce insulin requirement (monitor serum glucose concentrations in patients with diabetes mellitus); lower dose in cholestasis and/or hepatocellular dysfunction, since cholestasis leads to delayed absorption and impaired elimination, resulting in increased ASOX area-under-curve; may cause GI distress; may cause weight increase after long-term administration
Mild asymptomatic elevation of levels of serum aminotransferases is common, but they often return to reference ranges after a few weeks; more marked asymptomatic elevation of levels of serum aminotransferases may be related to hepatotoxicity; aminotransferase levels return to normal after therapy withdrawal; measure serum aminotransferase levels before starting therapy and regularly thereafter (ie, q2wk for 3 mo, then q3mo); upon level increases above 5 times the upper limit of normal, the following steps are recommended: (1) Check for other causes of the increase (other medication, viral hepatitis, alveolar echinococcosis–related biliary obstruction or liver abscess), (2) monitor drug levels, (3) decrease MBZ dosage if MBZ plasma levels are higher than the recommended range of concentrations, (4) shift to the alternative BMZ (ABZ) if the elevation persists, and (5) consult a reference center if the level persistently exceeds 5 times the upper limit of normal
Leukopenia is an absolute indication for terminating therapy because severe granulocytopenia is possible; monitor leukocyte count q2wk for 3 mo, then regularly thereafter.
Continue therapy only if increase in either aminotransferases or leukopenia is moderate and stable; in some cases, replacement of MBZ by ABZ is well tolerated and should be tried in case of side effect.

Other Antifungal/antiparasitic drugs

Although these drugs have not been formally authorized for use in this indication, evidence of their efficacy against E multilocularis in vitro and data from pilot trials in humans may support their use in rare cases in which inefficacy or contraindication of benzimidazoles is demonstrated. Only 2 such drugs may be proposed: amphotericin B and nitazoxanide. Among them, data are available only for amphotericin B; a pilot trial of nitazoxanide in Europe was unsuccessful.


Amphotericin B (Amphocin, Fungizone)

Produced with a strain of Streptomyces nodosus, amphotericin B is a broad-spectrum antifungal drug but also has diverse antiprotozoal activity against Leishmania and Trypanosoma species. Its destructive mechanism against E multilocularis, shown in vitro, could be explained by formation of complexes with membrane phospholipids, which are major components of E multilocularis larval membrane; furthermore, amphotericin B affects membrane-bound enzymes and binds to sterols, thereby forming transmembrane channels. Importantly, amphotericin B is parasitostatic against only E multilocularis. In addition, IV administration and various side effects limit its use to salvage treatment in otherwise untreatable alveolar echinococcosis.

Adult

Loading dose of 0.5 mg/kg/d IV for first 2 wk, then 0.5 mg/kg IV 3 times/wk; adjustment of dosage according to creatinine levels (increase to 2 times/wk if creatinine levels rise to more than twice the upper limit)

Pediatric

Not established

Cyclosporin increases nephrotoxicity; antineoplastic agents increase nephrotoxicity, bronchospasm, and hypotension; corticosteroids, digitalis, and thiazides increase hypokalemia

Documented hypersensitivity; renal failure

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Monitor renal and liver function, serum electrolyte levels (especially potassium), CBC counts (leukopenia, thrombopenia), and hemoglobin concentration; fever and chills may occur during or after IV infusion (reduce IV infusion rate) and give paracetamol (side effects may be prevented with use of lipid-associated formulation of drug, which also limits nephrotoxicity); sodium loading and maintaining a high urine output of more than 4,000 mL/d may reduce the risk of tubular necrosis

Immunomodulating agents

Immune modulation of parasitic growth in alveolar echinococcosis has been demonstrated, with a markedly unbalanced Th1/Th2 profile. Efficacy of interferon gamma, which has been tested in the mouse model of alveolar echinococcosis and in a few patients, has not been demonstrated. Recombinant interleukin 12 (IL-12) is fairly efficient in E multilocularis –infected mice but may not be used in humans. Recombinant interferon alpha-2a was able to shrink alveolar echinococcosis lesions size in a patient with a combination hepatitis C and E multilocularis infection and was proven to protect infected mice against the development of alveolar echinococcosis lesions. No clinical trials are available yet.


Interferon alpha-2a (Roferon-A)

Protein produced by recombinant DNA technology. Efficacy in alveolar echinococcosis seems to be due to stimulation of Th1 cytokine production and reversal of the Th1/Th2 unbalance observed in patients with chronic infection by E multilocularis; stimulation of macrophage activation, phagocytosis, and killing has also been shown in experimental studies. Clinical experience with the drug comes from a single observation.
No information is available on interferon alpha-2a/albendazole combined efficacy or side effects.
Given the status of the clinical experience, interferon alpha-2a should be given only for salvage treatment for otherwise untreatable alveolar echinococcosis or as part of a controlled trial.

Adult

3 million U SC 3 times/wk

Pediatric

Not established

Theophylline may increase toxicity by reducing clearance; cimetidine may increase carcinogenic risk of interferon alpha; zidovudine and vinblastine increase toxicity; possible interactions with benzimidazoles are unknown

Documented hypersensitivity to product, mice proteins, egg, and neomycin; avoid use in patients with autoimmune hepatitis

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Leucopenia (and bone marrow suppression in general); increase in suicidal attempts or aggression, increase in autoantibodies, and hypothyroidism are main side effects of interferon alpha; monitoring of CBC count and TSH level is mandatory; psychiatric evaluation before therapy is initiated is recommended

More on Echinococcosis

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Differential Diagnoses & Workup: Echinococcosis
Treatment & Medication: Echinococcosis
Follow-up: Echinococcosis
Multimedia: Echinococcosis
References
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References

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

  2. 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. Nov 1 1988;66(21):1060-73. [Medline].

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

  4. 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. Nov 1990;43(5):506-15. [Medline].

  5. 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].

  6. 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. Sep 2006;6(5):390-400. [Medline].

  7. 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. Sep 2007;59(1):93-5. [Medline].

  8. 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. Jan 2002;66(1):23-9. [Medline].

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

  10. 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].

  11. 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. May 1996;34(5 Pt 2):873-7. [Medline].

  12. 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. Oct 1999;30(4):857-64. [Medline].

  13. 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. Dec 1994;51(6):837-46. [Medline].

  14. 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. Nov 1990;82(2):378-83. [Medline].

  15. 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. Jul 1992;16(1):279-80. [Medline].

  16. 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. Jan 21 1989;18(2):83. [Medline].

  17. 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. Mar 2000;12(3):327-36. [Medline].

  18. 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. Oct 1989;78(1):61-6. [Medline].

  19. 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. Jul 2005;73(1):2-10. [Medline].

  20. 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. Jul 2004;71(1):56-64. [Medline].

  21. 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. Jul 2004;71(1):56-64. [Medline].

  22. 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. Jul-Aug 1990;14(4):608-14. [Medline].

  23. 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. Nov 1984;65(11):773-80. [Medline].

  24. 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. Aug-Sep 1985;66(8-9):507-13. [Medline].

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

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

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

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

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

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

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

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

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

  34. 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). Nov-Dec 1986;27(6):671-4. [Medline].

  35. 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. Oct 23 2009;[Medline].

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

  37. 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].

  38. 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. Sep 2000;121(3):484-90. [Medline].

  39. 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. Sep 2000;121(3):491-8. [Medline].

  40. 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. Dec 1997;8(4):401-8. [Medline].

  41. 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. May 2003;124(5):1441-50. [Medline].

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

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

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

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

  46. 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. Sep 2001;35(3):367-75. [Medline].

  47. 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. Jul 1999;29(1):205-6. [Medline].

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

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

  50. 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. Oct 2009;47(10):3191-6. [Medline].

  51. 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. Jan 1995;52(1):41-4. [Medline].

  52. 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. Nov 2002;40(11):4161-5. [Medline].

  53. 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. Sep 2005;92(9):1110-6. [Medline].

  54. 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. Jan 2006;36(1):79-86. [Medline].

  55. 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.

  56. 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. Mar 2003;9(3):343-9. [Medline].

  57. 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. Aug 1995;109(2):596-600. [Medline].

  58. 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].

  59. 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. Jun 9 2009;3(6):e452. [Medline].

  60. 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. Mar 27 2003;75(6):856-63. [Medline].

  61. 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. May-Jun 2005;30(3):286-90. [Medline].

  62. 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. May 15 1998;147(10):978-81. [Medline].

  63. 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. Nov 1990;82(2):373-7. [Medline].

  64. 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. Feb 1992;22(1):23-8. [Medline].

  65. 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. Oct 2000;38(10):3718-21. [Medline].

  66. 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. Dec 15 1984;40(12):1436-9. [Medline].

  67. 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. Feb 2005;118(2):195-7. [Medline].

  68. 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. May 7 2009;15(17):2116-24. [Medline].

  69. 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].

  70. 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. Apr 1995;81(2):318-21. [Medline].

  71. 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].

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

  73. 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. Sep 1994;1(3):261-70. [Medline].

  74. 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. Jan 2000;87(2-3):151-6. [Medline].

  75. 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].

  76. 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. Jun 1990;84(3):239-50. [Medline].

  77. 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. May 1987;36(3):576-85. [Medline].

  78. 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. Nov 2003;47(11):3586-91. [Medline].

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

  80. 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. Sep 2000;46(3):451-6. [Medline].

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

  82. 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. May-Jun 2001;29(3):119-25. [Medline].

  83. 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. Nov 1999;29(5):1157-63. [Medline].

  84. 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. Jul 1996;111(1):172-82. [Medline].

  85. 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. Apr 1992;15(4):599-602. [Medline].

  86. 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. Jun 1995;2(2):113-8. [Medline].

  87. 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. Feb 1997;19(2):61-8. [Medline].

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

  89. 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. Dec 1990;162(6):1403-7. [Medline].

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

  91. 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. Mar 1997;91(2):179-86. [Medline].

  92. 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].

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

  94. 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. Feb 2003;47(2):467-74. [Medline].

  95. 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. Apr 2004;34(5):615-24. [Medline].

  96. 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. May 1995;63(5):1688-97. [Medline].

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

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

  99. 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. Jul 2008;49(1):72-7. [Medline].

  100. 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. Oct 1999;61(4):559-65. [Medline].

  101. 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. Nov 1996;39(5):762-4. [Medline].

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

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

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

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

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

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

  108. 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. Oct 1989;78(1):67-74. [Medline].

  109. 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. Feb 1988;71(2):247-52. [Medline].

  110. 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].

  111. 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].

  112. 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. Jul 1984;6(4):329-40. [Medline].

  113. 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].

  114. 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].

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

  116. 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. May 2004;90(3):285-93. [Medline].

  117. 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. Jun 2006;12(6):1008-10. [Medline].

  118. 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. Nov-Dec 1995;89(6):692-7. [Medline].

  119. 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. Oct 1995;89(5):485-95. [Medline].

  120. 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. Aug 1996;113 (Pt 2):111-21. [Medline].

  121. [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].

  122. 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. Aug 2008;79(2):245-7. [Medline].

  123. 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. Mar 2006;74(3):487-94. [Medline].

  124. 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. Jun 2006;100(6):597-600. [Medline].

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

  126. 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. Dec 2005;99(12):937-41. [Medline].

  127. 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. May 1 2008;197(9):1341-9. [Medline].

  128. 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. Apr 2003;30(2):133-9. [Medline].

  129. 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. Apr 1998;92(3):335-7. [Medline].

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Further Reading

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Keywords

echinococcosis, alveolar hydatid disease, multilocular echinococcosis, Echinococcus multilocularis infection, E multilocularis infection, Echinococcus granulosus infection, E granulosus infection, alveolar echinococcosis, AE, echinococci, platyhelminths, cestode, parasites, intestinal worms, taenia, taeniasis, metacestode

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Contributor Information and Disclosures

Author

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.

Medical Editor

John M Leedom, MD, Professor of Medicine, Keck School of Medicine, University of Southern California; Chief, Division of Infectious Diseases, Department of Internal Medicine, Los Angeles County, University of Southern California Medical Center
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, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
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, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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