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Cystic and Alveolar Echinococcosis: Fraternal Twins Both in Search of Optimal Treatment

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Zoonoses: Infections Affecting Humans and Animals

Abstract

The burden of the two different diseases, “cystic echinococcosis” (CE), due to several species of Echinococcus among the E. granulosus sensu lato cluster, and “alveolar echinococcosis,” due to E. multilocularis, has long been underestimated. Other species, E. oligarthra and E. vogeli, may also cause disease in humans, similar to CE and AE, respectively. CE is usually maintained by a synanthropic domestic cycle (dog/domestic ungulates); a cycle in wild animals (fox/small mammals) allows E. multilocularis to subsist in nature, and environmental factors play a critical role. The larval stage of Echinococcus spp., the “metacestode,” is characterized by a germinal layer surrounded by a laminated layer and an adventitial layer. The germinal layer forms isolated cysts (CE) or aggregated microcysts (AE), which are filled with a water-like liquid (“hydatid fluid”). The diagnosis of both diseases in humans relies on imaging: ultrasound examination (also useful for mass screening), computed tomography, and magnetic resonance imaging, which provides pathognomonic images; incidental diagnosis is frequent. WHO-US-based classification of CE cysts (CE-1 to CE-5) and staging system for AE (PNM classification) are used to choose among a variety of therapeutic options available, including surgery to remove the lesions and nonsurgical image-guided interventions to sterilize CE cysts or treat complications in CE and AE. Benzimidazoles – with a strict monitoring to ensure optimal efficacy and avoid adverse events – are still the only antiparasitic agents available. For CE as well as AE, there is a need to find new antiparasitic compounds and evaluate therapeutic strategies.

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Correspondence to Dominique A. Vuitton .

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Vuitton, D.A., Millon, L., Manciulli, T., Brunetti, E. (2022). Cystic and Alveolar Echinococcosis: Fraternal Twins Both in Search of Optimal Treatment. In: Sing, A. (eds) Zoonoses: Infections Affecting Humans and Animals. Springer, Cham. https://doi.org/10.1007/978-3-030-85877-3_29-1

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  • DOI: https://doi.org/10.1007/978-3-030-85877-3_29-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-85877-3

  • Online ISBN: 978-3-030-85877-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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