An Update on the Epidemiological Features of Imported Schistosomiasis and Cystic Echinococcosis in Kuwait, 2010-2018.

OBJECTIVE: Kuwait is considered a non-endemic country for most parasitic infections. However, ∼70% of 4.7 million residents in Kuwait are expatriates from Asian and African countries, which are endemic for parasitic infections. Results of microbiological investigations for schistosomiasis and cystic echinococcosis (CE) performed in a reference national laboratory were retrospectively collected and analyzed to provide an insight on the epidemiology of these 2 neglected tropical diseases in Kuwait. SUBJECTS AND METHODS: Schistosoma infection in fecal and urine specimens from suspected patients was detected by microscopy. Schistosoma and CE infections were also detected by indirect hemagglutination assays (IHAs) using blood specimens. Patients' epidemiological data were extracted from the laboratory records. RESULTS: The overall prevalence rates of schistosomiasis and CE were 19.0 and 5.8%, respectively. Almost all schistosomiasis cases were seen among Egyptians, especially among males, and a significantly higher prevalence (p < 0.05) was seen for CE cases among the Syrian residents. A decreasing annual trend was observed for both the parasitic infections over time in Kuwait. CONCLUSIONS: This study confirmed that schistosomiasis is not autochthonous in Kuwait, as all cases were detected among expatriates from Schistosoma-endemic countries. Our data also showed that CE remains endemic among humans and livestock in Kuwait as is also seen in other Middle Eastern countries.

A Community-Based Study to Estimate the Seroprevalence of Trichinellosis and Echinococcosis in the Roma and Non-Roma Population of Slovakia.

Trichinellosis and cystic and alveolar echinococcosis are serious parasitic diseases transmissible between animals and humans. Moreover, alveolar echinococcosis is considered one of the most dangerous of human helminthoses. Roma communities are particularly numerous in Central and Eastern Europe. They are often concentrated in economically undeveloped regions and live in segregated localities with unsatisfactory housing and sanitary conditions. The study aimed to find out the seroprevalence of Trichinella and Echinococcus infections in the Roma population of segregated settlements and to compare it with the seropositivity of the non-Roma population of eastern Slovakia. Out of 823 samples, three sera showed seropositivity to Trichinella in the ELISA (Enzyme-linked immunosorbent assay) test. Subsequent Western blot reaction (WB) confirmed seropositivity in two Roma women. ELISA seropositivity to E. multilocularis was recorded in six persons (0.73%), and five (0.61%) respondents were seropositive to E. granulosus, but WB confirmed the presence of antibodies to Echinococcus spp. in one Roma participant. Positive persons suffered from unspecific clinical symptoms; Trichinella-positive persons reported headache, cough, fatigue, and muscle pain. The Echinococcus-positive participant suffered from headache and back pain. The study showed that the worse living conditions of the Roma community did not significantly influence the occurrence of Trichinella and Echinococcus infections in this minority.

Hidatidosis poliquística autóctona en dos pacientes Yanomami en el Alto Orinoco, Amazonas, Venezuela / Polycystic hydatid disease in two patients indigenous Yanomami in the Upper Orinoco, Amazonas, Venezuela

La infección por Echinococcus sp. es hipoendémica en Venezuela. Sólo cuatro casos de hidatidosis autóctona por E. vogeli han sido reportados, tres de ellos en la región de la Guayana venezolana. En Febrero del año 2009 se realizó el diagnóstico clínico-sero-epidemiológico de hidatidosis poliquística en una paciente femenina de la etnia Yanomami, procedente de Parima B, Alto Orinoco, en la Amazonía venezolana. Se resolvió con tratamiento médico y quirúrgico por laparoscopia y se evidenció en el quiste la presencia de ganchos rostelares compatibles con E. vogeli. En Abril del 2009 en una segunda paciente Yanomami de igual procedencia, se le diagnosticó hidatidosis por E. vogeli siendo operada exitosamente por cirugía laparoscópica asistida por robot. Dos casos humanos en una misma población y la presencia de factores de riesgo como la tenencia de perros domésticos y la comunicación por informantes indígenas del hallazgo de quistes en hígados de animales de cacería (Cuniculus paca o lapa y Dasyprocta sp. o picure), hacen pensar en transmisión activa en la cuenca del Alto Orinoco y en zonas selváticas de la Guayana venezolana. El presente, es el primer registro de casos de hidatidosis poliquística en indígenas de la etnia Yanomami.

Infection by Echinococcus sp. is hypoendemic in Venezuela. Only four cases of autochthonous E. vogeli hydatidosis have been reported, including three in the Venezuelan region of Guayana. In February 2009, based on epidemiological data, signs and symptoms and serological tests, a female patient of the Yanomami ethnic group, was diagnosed with a polycystic hydatid disease in Parima B, Alto Orinoco, in the Venezuelan Amazon. Rostellar hooks compatible with E. vogeli were found in the cyst. It was resolved with medical and surgical treatment by laparoscopy. A second Yanomami patient from the same location was diagnosed with E. vogeli hydatidosis in April 2009, being successfully operated with robot-assisted laparoscopy. Two human cases in the same population and the presence of risk factors such as domestic dog ownership and findings of cysts in livers of hunted animals (such as Cuniculus and Dasyprocta sp.) reported by indigenous informants, suggest active transmission in the Upper Orinoco basin and forested areas of the Venezuelan Guayana. These are the first reported cases of polycystic hydatid disease of the Yanomami ethnic group.

The seroprevalences of cystic echinococcosis, and the associated risk factors, in rural-agricultural, bedouin and semi-bedouin communities in Jordan.

An ELISA was used to determine the seroprevalence of cystic echinococcosis (CE), caused by Echinococcus granulosus, in representatives of the rural-agricultural, semi-bedouin and bedouin communities of Jordan. The knowledge, attitudes and practices (KAP) pertaining to the transmission of CE in such communities were also investigated. In the ELISA, serum samples from 2388 subjects were tested for IgG antibodies reacting with antigens in crude sheep hydatid fluid (CSHF). The rural-agricultural subjects were significantly more likely to be seropositive (11.4%) than the semi-bedouin (5.0%) or bedouin (3.7%), but male and female subjects were equally likely to be seropositive. Among the rural-agricultural and semi-bedouin subjects, those aged 11-20 years were most likely to be seropositive. Among the bedouin subjects, however, seroprevalence was highest for those aged 31-40 years. When the distribution of 59 seropositive subjects detected within 36 rural-agricultural households was investigated, 12 (33.3%) of the households were each found to have at least two seropositive members. Immunoblotting indicated that 27.1% of the seropositive rural-agricultural subjects showed immunoreactivity to at least one of the CSHF antigen-B components (of 8-12, 16 and 24 kDa). The living conditions, practices and lifestyles of the rural-agricultural, semi-bedouin and bedouin communities favour the spread of CE in Jordan and warrant an effective programme for the control of the disease.

Prevalence of cystic echinococcosis among Muslim and Jewish populations in southern Israel.

Following a review of records at the Soroka University Medical Center (SUMC) showing a recent increase in the annual incidence of hydatidosis among the Bedouin population of southern Israel, a seroepidemiological survey was conducted. A total of 1439 blood samples were collected from Bedouins and Jews living in the Negev area in southern Israel. An enzyme-linked immunosorbent assay (ELISA) for immunoglobulin G, indirect haemagglutination (IHA) and immunoelectrophoresis (IEP) were used to detect anti-Echinococcus granulosus antibodies. The seroprevalence in the Bedouin group was 0.68% (7/1026), including two children under the age of 10. Among Jews, a seroprevalence of 0.5% was recorded in patients over 60 years of age only. A high rate of infection was shown in goats and sheep slaughtered in abattoirs in Bedouin localities. The results indicate that echinococcosis is a common disease in the Muslim communities of southern Israel.

Cystic echinococcosis in semi-nomadic pastoral communities in north-west China.

In order to determine the prevalence of human cystic echinococcosis (CE) in semi-nomadic traditional pastoralist groups in north-west China, 2 large community studies were undertaken in Altai and Tacheng Prefectures in 1990/91 and 1995/96, respectively. The Kekergash community (Altai) comprised mainly ethnic Kazakhs, whereas the Narenhebuke community (Tacheng) comprised mainly Mongolians. Populations were screened for CE by abdominal ultrasound scan (US) and serological tests. The total prevalence of confirmed human CE was higher in Narenhebuke (2.7%, 49/1844) than in Kekergash (0.9%, 17/1861; P < 0.01). Within each community there was no significant difference of CE prevalence between the Kazakh and Mongolian groups, although Han Chinese exhibited twice the rate of CE (4.9%) in Narenhebuke compared to the dominant Mongolian population. For each community, human CE prevalence increased with age and there was a greater risk associated with the practice of home slaughter of livestock. Dogs were screened for Echinococcus granulosus infection and re-infection levels using a highly specific coproantigen test. The proportion of dogs with positive coproantigen tests was significantly higher in Narenhebuke (36.0%, 50/139) compared to Kekergash (17.8%, 16/90). In Narenhebuke the re-infection levels of dogs, as determined by coproantigen positivity, were higher in the winter quarters (49.4%, 39/79) compared to the summer quarters (18.3%, 11/60; P < 0.01). Furthermore, coproantigen re-test positivity was 25% at 3 months and 29.2% at 7 months. Highest dog coproantigen positivity was obtained over the winter period.

[Sudden death caused by an arterial hydatid embolism]. / Plötzlicher Tod durch arterielle Hydatidenembolie.

HISTORY: A 45-year-old woman from Turkey who had been living in Germany for 6 years, suddenly became short of breath, developed seizures and died within 2 minutes. There was no evidence of previous illness. INVESTIGATIONS: At autopsy a large hydatid and many other hydatids of varying sizes were found inside the left heart. Rupture of one of the hydatid cysts in the left atrium had caused embolism to the arterial system. The cyst walls showed typical laminar cuticular structure. The sediments of the cyst fluid contained scolices of Echinococcus granulosus, but no antibodies were demonstrated by indirect haemagglutination. DIAGNOSIS AND CONCLUSION: This is a rare case of Echinococcus granulosus infection, limited to the heart, which had followed an asymptomatic course until sudden death caused by arterial embolism of the hydatids. Such diagnosis should be considered in case of sudden death of persons from areas in which the disease is endemic.

Imported echinococcosis in southern California.

A retrospective chart review conducted at two teaching hospitals in Los Angeles County identified 28 patients with infection due to Echinococcus granulosus diagnosed by positive echinococcal serology and/or tissue biopsy between January 1981 and December 1990. Of these patients, 25 (89%) were foreign born and 19 (68%) were immigrants from the Middle East or central Asia. Only 12 of 22 immigrants questioned about epidemiologic risk factors described a history of rural residence or direct exposure to dogs in their native country. Single cysts of liver, lung, and soft tissue were present in six of 28 patients; multiple cysts in the 22 remaining patients were exclusively hepatic in 13 patients, exclusively pulmonary in two patients, and involved mixed sites including liver, lung, abdomen, central nervous system, and bone in seven patients. Natives of middle eastern countries currently constitute a major risk group for imported infection due to E. granulosus in the United States. Since their epidemiologic risk factors may be absent and clinical presentations varied, a high index of suspicion for echinococcosis is warranted in this population based solely on the presence of a cystic mass in liver, lung, or another organ site.

[Human echinococcosis in Switzerland, 1984-1992]. / Echinokokkose des Menschen in der Schweiz, 1984-1992.

In a retrospective study (1984-1992), new cases of human echinococcosis were registered in Switzerland based on information obtained from (a) questionnaires sent to 294 of the 300 acute hospitals in all parts of the country and to 17 institutes of pathology (268 answers form hospitals: 91%), and (b) from tracing back cases reported under the official notification system since 1 January 1988 by laboratories to the Federal Health Office or recorded at the Institute of Parasitology in Zurich. Cases were regarded as verified if the diagnosis was documented by unequivocal findings (by radiology, ultrasonography, pathomorphology etc. and often by additional detection of anti-Echinococcus antibodies). Patients with antibodies but without reports on further findings were classified as suspected cases. From 1984 to 1992 (9 years), 302 new cases of human echinococcosis were diagnosed in Switzerland and verified in this study, corresponding to an annual average of 34 new cases and a range between 26 and 43 cases. The total number of 302 cases included 228 (75%) of cystic echinococcosis (CE) (Echinococcus granulosus), 65 (22%) of alveolar echinococcosis (AE) (E. multilocularis), and 9 (3%) of non-specified echinococcosis (NSE) (Echinococcus sp.). Among 185 patients with CE and 60 patients with AE and known geographic origin, the ratio of Swiss nationals to foreigners was 25%:75% and 88%:12% respectively. Based on a total population (Swiss nationals and foreigners) of 6.62 million in 1988 and the case numbers of 1984-1992, the following average annual incidence rates per 100,000 inhabitants were calculated: 0.51 for all new cases, 0.38 for CE, 0.11 for AE and 0.01 for NSE. In the 37 years since 1956 there has been steady increase in new cases of CE due to the importation of such cases by foreigners, whereas the case numbers of AE have remained nearly constant with a range between 7 and 10 new cases per year. In our study 258 suspected seropositive patients were registered but not added to the total number of cases, due to the lack of further findings.

[Hydatid disease in Israel].

The prevalence pattern of hydatid disease (echinococcosis) in Israel has changed during the past 40 years. Until 1948 it was mainly common in the non-Jewish community; after 1948 its prevalence was high in Jews who immigrated to Israel from Arab countries; and since 1967 endemicity has gradually increased in some rural and semirural Arab and Druze communities. Of 224 surgically-confirmed cases of hydatid disease from these communities during 1960-1989, 52 were from Yirka, a Druze community with a population of 8200. In that town 8% of 63 dogs tested after an arecoline purge and 10% of 255 sheep at the local abattoir were found to be infected. Randomized serosurvey of 758 inhabitants indicated a 1.6% cumulative percentage of hydatid infections, leading to an extrapolated rate of 1583/100,000. Yirka thus is one of the most highly endemic areas for hydatid disease in the world.

The epidemiology of echinococcosis in Israel.

Shifts in population and employment patterns in Israel since 1948 have been accompanied by profound changes in the distribution of echinococcal disease. Formerly, it was most commonly imported with the mass immigration of Jews after 1948 from the Arab countries of North Africa and Asia Minor, and appeared to be relatively uncommon in Israel-born Jews and Arabs. In 1980 the disease was made notifiable, and this paper presents a review of the years 1981-1989. The prevalence pattern that prevailed after the end of mass immigration has reversed so that cases are now twice as common in Arabs as in Jews. Among the Arabs the disease appears most commonly in the north of the country, especially among the Druze, less commonly among Christians and least in Muslims. We suggest that this prevalence pattern is related largely to home slaughter of sheep, to differing attitudes to dogs, and possibly also to the hunting of wild pig. Targetted education and better enforcement of existing regulations can lead to a reduction in disease.

Resurgence of hydatid disease (echinococcosis) in communities in northern Israel.

Hydatid disease (echinococcosis), formerly endemic in the area of Israel, has occurred only sporadically in the past 40 years, mostly in immigrants. An unusual spatial and temporal cluster of surgically confirmed infections in northern Israel led to a review of echinococcosis hospital records. This revealed a resurgence of the disease in some rural and semirural Arab and Druze communities. Between 1960 and 1989, 224 cases of hydatid disease were surgically confirmed in residents of these communities. During this period, as the Arab-Druze population doubled, the mean annual surgical incidence of new cases per 100,000 rose 5-fold from 1.4 to 7.1. In Yirka, a Druze community of 7500 persons, from which no cases were known before 1970 and in which 52 cases were surgically confirmed thereafter, the mean annual surgical incidence for 1980-1989 rose to 53/100,000, to become one of the highly endemic areas of the world. The probable explanation of the outbreak is that, since 1967 with the opening of the border, importation of infected sheep has occurred from the hydatid-endemic West Bank region to individual homes in the communities in northern Israel. The sheep are raised to maturity in pens before home slaughtering; the offal, available to dogs, resulted in canine and then human infections.

Cystic echinococcosis in the Xinjiang/Uygur Autonomous Region, People's Republic of China. I. Demographic and epidemiologic data.

Demographic and epidemiologic data on those factors potentially related to the prevalence and transmission of hydatid disease caused by Echinococcus granulosus were collected in 1987 from each household in 85 villages in the two communities of Yuanhucun and Ershilidian within Hutubi County in the Xinjiang/Uygur Autonomous Region, PRC, with additional questionnaire data collected from approximately 40 households randomly selected from each of 16 villages within those communities. Yuanhucun and Ershilidian represent a combined area of 522.7 square km, and have 4,853 households with 25,684 inhabitants. Of those households, 69.9% are of the Han ethnic group, 22.1% Hui, 5.3% Uygur, and 2.7% Kazak. The total number of animals censused included 4,169 dogs, 41,369 sheep, 3,673 goats, 2,639 cattle, 5,400 pigs, 1,472 horses, and 59 donkeys. Levels of infection of the causative organism of cystic hydatid disease in various hosts were: dogs harboring Echinococcus granulosus tapeworms - 63 (16.2%) positive of 390 examined in 16 villages; domestic animals with hydatid cysts - 1,593 (88.6%) sheep of 1,797 examined, 69 (56.1%) of 123 goats, and 47 (94.0%) of 50 cattle; and 15 surgeries in inhabitants from 85 villages during the last 16 months prior to completion of the survey (annual case rate of 43.8/100,000). Questionnaire data collected from inhabitants in 16 villages showed that about 82% of the families owned at least one dog and 78% owned sheep. Of those families with sheep, most (84%) killed sheep for meat at least periodically, 76% had seen hydatid cysts in liver or lungs of butchered animals, and 77% routinely gave raw offal to their dog.(ABSTRACT TRUNCATED AT 250 WORDS)

Echinococcosis in Austria.

In 1982, a research project on the prevalence of human echinococcosis in Austria was started. Within the period from 1982 to 1988, data on 188 patients with cystic (CE) and of 16 patients with alveolar (AE) echinococcosis were obtained. 15 out of 16 AE patients and 79 (= 42%) out of 188 CE patients were Austrian nationals, 1 AE patient was of Swiss nationality, and 94% of the 109 non-Austrian patients came from Mediterranean countries. Cases of (presumably autochthonous) cystic echinococcosis were found in Lower Austria, Vienna, Burgenland, Styria, Upper Austria, Carinthia, Salzburg and Vorarlberg, the eastern part of Austria being the main distribution area. Cases of (certainly autochthonous) alveolar echinococcosis were recorded in the Tyrol, in Carinthia and in Lower Austria. At the time of diagnosis, the average ages of Austrian patients with E. multilocularis (49 years) and with E. granulosus (55 years), respectively were significantly higher than those of foreign CE patients (34 years). The finding concerning the localisation of the infection (78% of E. granulosus cysts and 100% of E. multilocularis lesions were located in the liver) are consistent with previously published reports.

[The assessment of the epidemiologic situation of echinococcosis in the Nenets Autonomous Okrug based on data from a dynamic serologic examination of the population]. / Otsenka épidemiologicheskoi situatsii po ékhinokokkozam v Nenetskom avtonomnom okruge po dannym dinamicheskogo serologicheskogo obsledovaniia naseleniia.

Paper presents the RIHA and EIA data of an annual 3-year survey of populations of two reindeer breeders' settlements in the Nenets Autonomous Okrug of Arkhangelsk Province with the use of intact Echinococcus antigen (RIHA) and fractions of Echinococcus multilocularis antigens (EIA). In 1984-1986, seropositivity has been established by 2 immunoassays for 98 (21.6 +/- 1.9%) out of 454 apparently healthy subjects. The annual Echinococcus invasion rate in population varied within 2.8-3.7%, as estimated by RIHA, and 4.6-4.8%, according to EIA data. The highest invasion rate was observed among the those engaged in reindeer breeding, hunting, animal breeding as well as among the aboriginal populations the Nentsi and the Komi.

Hydatidiform mole in China: a preliminary survey of incidence on more than three million women.

A nationwide retrospective survey to determine the incidence of hydatidiform mole has been conducted in China since 1979 by inquiring into the history of past pregnancies. Up to the end of 1983, a total of 3 089 399 women with 10 929 354 pregnancies from 26 provinces, special municipalities and autonomous regions had been investigated. The overall incidence was one mole in 1238 pregnancies (0.81 per 1000 pregnancies). The incidence was higher in five provinces of south-east China than in other parts of the country and higher among the coastal people than inlanders. Ethnic comparisons were made between the major Han and three main minority groups. The incidence was higher among the Zhuang in Guangxi and the Mongolians in Inner Mongolia than among the Han living in the same areas. However, in Ningxia, the incidence among the Hui (Muslims) was almost the same as that of the Han. There was no significant difference in the incidence of hydatidiform mole between urban and rural residents.The traditional view that hydatidiform mole occurs much more frequently among women in China and other Asian countries has to be revised. The present study shows that the incidence in China is higher than that among Caucasian women in some European countries, but it is by no means as high as previously believed.