Echinococcosis - information and specialists

What is echinococcosis?

Echinococcosis is an infection caused by infestation with a fox tapeworm or a small dog tapeworm.

There are two types of the disease:

• The fox tapeworm (Echinococcus multilocularis) causes so-called alveolar echinococcosis
• the small dog tapeworm (Echinococcus granulosus) causes cystic echinococcosis

The fox tapeworm is mainly found in southern parts of Europe and Germany, while the dog tapeworm is found worldwide.

Every year, 80 people in Germany contract the dog tapeworm and 54 the fox tapeworm. Most of these people are between the ages of 50 and 60. Children only very rarely fall ill.

The symptoms of echinococcosis

Echinococcosis does not necessarily have to be accompanied by symptoms. It can remain undetected for years. During this time, cysts can grow in the organs, which at a certain stage can impair well-being.

The cysts make themselves felt as a vague feeling of pressure, pressing on nerves and blood vessels.

Additional symptoms that can occur:

• Infections
• nausea
• weight loss
• Allergy symptoms

Causes & risk factors: How echinococcosis develops

People in southern Germany or vacationers in Italy, Spain or other southern countries have a higher risk of fox tapeworm disease.

Take care not to come into contact with fox excrement, for example on forest floors.

Avoid eating wild berries, fallen fruit or mushrooms from the forest. Raw meat can also be a source of infection.

Dog owners can have their animals dewormed regularly. Alternatively, an examination of the dog's excrement is possible to rule out an infestation. As a rule, dog owners are only more affected if they live in unfavorable hygienic conditions. Worm infestation is also facilitated by the feeding of raw meat, especially sheep offal.

Occupational contact with sheep can also be a risk factor.

Examination & diagnosis of echinococcosis

If you think you have the disease, you should consult an infectious disease specialist. Specialized medical centers and clinics are also responsible for diagnosis.

In an initial consultation, the doctor will clarify

• Whether you have ever had worms or other parasites
• Whether there were any other abnormalities
• Whether there is pain or pressure in the right upper abdomen and
• Whether you suffer from an unexplained cough

Previous illnesses and medication are also important.

The doctor will use imaging techniques to diagnose echinococcosis with certainty.

These are used:

• Ultrasound device
• Magnetic resonance imaging (MRT)
• Computer tomography (CT)

The doctor can first see calcified cysts in the ultrasound. The calcification and smooth borders of a cyst are typical signs of cystic echinococcosis. The cyst must remain intact so that there is no release of worm eggs.

To confirm the diagnosis, the doctor uses a blood test. A worm infestation often causes an increase in white blood cells (eosinophils). This increase indicates that the body is busy defending itself.

A specialist laboratory examines the blood sample for echinococcosis. It can detect specific antibodies.

A negative result does not mean that there is no echinococcosis. However, a positive result proves the disease and must be reported. The doctor must forward the findings to the Robert Koch Institute.

What treatments are available and which doctors are responsible?

There are several options for treating cystic echinococcosis:

• In some cases, the doctor will first wait and see. This is the case if the cysts do not cause any problems. Otherwise, the doctor will treat the infection with medication containing albendazole.
• Control examinations should check the success of the therapy. If liver cysts occur, doctors can remove them surgically.
• Another option is to inject high-proof alcohol (95%) into the cyst. This method can only be considered if there are no fistulas.
• The doctor treats alveolar echinococcosis in inoperable cases with benzimidazoles. The duration of therapy can be lifelong. If surgery is possible, concomitant drug therapy with benzimidazoles is carried out for at least two years.

The right address for suspected echinococcosis is human medicine specialists specializing in infectiology. Veterinarians who specialize in parasitology are also responsible.

Course and prognosis of echinococcosis

The tricky thing about the infection is that it can take up to 15 years for symptoms to appear. In both forms of echinococcosis, the worm larvae do not remain in the intestine, but migrate to other organs.

Alveolar echinococcosis (Echinococcus multilocularis) is an infection with the fox tapeworm. It is very rare, but can be fatal. The worm eggs first colonize the intestinal wall and then the liver. The larvae form a sponge-like tumor there, which slowly destroys the tissue. The lungs, brain and peritoneum can also be affected. It can take at least five years before pain occurs in the upper abdomen. Surgical removal is then no longer possible. The mortality rate of fox tapeworm echinococcosis is between 50 and 70 percent.

In around 70 percent of cases, the liveris affected by echinococcosis @ Dr_Microbe /AdobeStock

The trigger for cystic echinococcosis (Echinococcus granulosus) is the dog tapeworm. This form occurs more frequently, but is less dangerous. These tapeworm eggs also penetrate the intestinal wall, colonize the liver, possibly the lungs and, rarely , other organs.

However, no tumors form, but clearly defined cysts. These are usually discovered during an imaging examination. They can also cause pain in the upper abdomen. Cystic echinococcosis has a benign course and stops on its own.

Cysticechinococcosis is often accompanied by singular (liver) cysts @ Dr_Microbe /AdobeStock