References
Update on Echinococcus multilocularis with particular emphasis on its impact on humans
Abstract
The range of
Infection of humans has a lag time of between 5 and 15 years before clinical signs are seen, thus it will be some time before the scale of zoonotic infections is known from the areas where the infection has now spread to. Diagnosis in humans relies on serology, polymerase chain reaction (PCR), and magnetic resonance imaging (MRI) or computed tomography (CT) scans to detect characteristic cystic lesions normally in the liver. Cure is most likely to be achieved if resection of the entire lesion is possible. Long-term benzimidazole treatment is normally administered to ensure control.
In addition to regular cestocidal treatment of dogs and cats, cleanliness measures including hand washing before eating and wearing gloves when gardening can help with preventing human infection.
The focus in the UK on the parasite E. multilocularis has largely been associated with maintaining the requirement for pre-entry treatment of dogs, which of course was successfully maintained with the rule changes introduced in January 2012. While that was a milestone it was by no means the end of the story. The range of the parasite continues to increase dramatically in Europe, there is some increase in understanding of the risk factors associated with human infection and it is acknowledged that this infection has a zoonotic impact even in developed, wealthy European countries. Current EU focus appears to be on ensuring that those countries currently fortunate enough not to have the infection present in their country have a sufficiently rigorous scientific process to prove that the country remains free of infection: there appears to be no initiatives to control the infection in countries where it is endemic. Owners with dogs and cats travelling to the areas where this infection is now endemic should be aware of the risk and take suitable measures to prevent zoonotic infection and to control infection in their pets. This review does not go systematically through all aspects of the infection and these details can be found on, for example, the www.esccapuk.org.uk website.
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