Further Inpatient Care

Patients with echinococcosis who have homogeneously calcified cysts do not usually require surgery and may follow the “watch and wait” treatment approach.

Deterrence/Prevention

General preventive measures include the following:

Thoroughly wash all fruits and vegetables before eating.
Wash hands after handling pets or other canines and before handling food. Teach children early on about the importance of washing their hands to prevent infection.
Use fences to keep animals away from gardens.
Use gloves when handling foxes, coyotes, or other wild canines.
Thoroughly cook meat, especially intestines intended for human consumption.

Prevention programs involve deworming of dogs, improved food inspection, improved slaughterhouse hygiene, and public education campaigns; vaccination of young sheep is currently being evaluated as a possible intervention.^[1]

Cystic echinococcosis (CE) is controlled by preventing transmission of the parasite. Prevention measures include limiting the areas where dogs are allowed and preventing animals from consuming meat infected with cysts. These measures can be accomplished in the following ways:

Prevent dogs from feeding on the carcasses of infected sheep.
Control stray dog populations.
Restrict home slaughter of sheep and other livestock.
No human consumption of food or water possibly contaminated by canine feces.
Wash hands with soap and warm water after handling dogs.

Surveillance for CE in animals is difficult because this infection is asymptomatic in livestock and dogs. CE is a preventable disease as it involves domestic animal species as definitive and intermediate hosts. Methods to prevent transmission and alleviate the burden of human disease are periodic deworming of dogs, improved hygiene in the slaughtering of livestock and the proper destruction of infected entrails and internal organs. Vaccination of sheep with an E. granulosus recombinant antigen (EG95) offers encouraging prospects for prevention and control. Small-scale EG95 vaccine trials in sheep have indicated high efficacy and safety with vaccinated lambs that are not becoming infected with E. granulosus.

A program that combines vaccination of lambs, deworming of dogs and culling of older sheep could eventually eliminate CE disease in humans.

Alveolar echinococcosis (AE) can be prevented by avoiding human contact with wild animals, such as foxes, coyotes, wild dogs and their feces, and by limiting interaction between dogs and rodents. Preventative measures are cited below:

Do not allow dogs to feed on rodents and other wild animals.
Avoid contact with wild animals such as foxes, coyotes and stray dogs.
Do not encourage wild animals to approach residential housing or for wild animals to be kept as family pets.
Wash hands with soap and warm water after handling dogs or cats, and before handling food.^[2]

AE prevention and control is more complex than for CE as the E. multilocularis lifecycle involves wild animal species as both definitive and intermediate hosts. Regular deworming of domestic carnivores that have access to wild rodents can help reduce the risk of human infection. Culling of foxes and wild free-roaming dogs is possible but inefficient. The deworming of wild and stray definitive hosts with anthelminthic baits resulted in significant reductions in AE cases in Europe and Japan; however, sustainability and cost–benefit effectiveness of this approach are controversial.^[1]

Complications

Complications include a secondary bacterial or fungal infection^[19]at the time of surgical intervention^[20]or other complications of cyst rupture.^[21]

Patient Education

See the list below:

Public education about proper sanitation methods, especially sanitary sheep butchering, can dramatically reduce disease transmission.
Avoid feeding entrails to canines.

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