Echinococcus

Echinococcus granulosus Paidi
Echinococcus
Identification
The genus Echinococcus contains two species of special importance to

veterinary medicine, E. granulosus and E. multilocularis, which are very
small (2 to 8 mm long) adult tapeworms having only four or five
segments, of which only the terminal segment is gravid (Figure 4-43).
In E. granulosus, 45 to 65 testes are generally distributed, and the genital
pore is located at or posterior to the middle of the segment. In E.
multilocularis, 17 to 26 testes are found posterior to the genital pore,
which is located anterior to the middle of the segment. Caution: Human
hydatid infection may be acquired by ingesting the eggs
of Echinococcus species; wear gloves and wash carefully when handling
the feces of potentially infected carnivores.
FIGURE 4-43 Echinococcus granulosus (Taeniidae), entire worm.
E. granulosus is endemic in North and South America, England, Africa,

the Middle East, Australia, and New Zealand. E. multilocularis is endemic
in north-central Europe, Alaska, Canada, and the central United States
as far south as Illinois and Nebraska (Ballard and Vande Vusse, 1983).
Life history
E. granulosus is a parasite as adults of the dog, coyote, wolf, and dingo.

Its larva is a unilocular hydatid cyst in sheep, swine, cattle, humans,
moose, caribou, kangaroos, and others. Species vary in their suitability as
intermediate hosts. Hydatid cysts found in sheep are usually fertile,
whereas those in cattle tend to be sterile. Subspecies of E.
granulosus differ in their preferences for intermediate hosts. For
example, E. granulosus granulosus hydatids belong to the subspecies
adapted to sheep and humans, whereas E. granulosus equinus is the
subspecies found in horses, asses, and mules. The hydatid membrane
may bud off daughter cysts either internally or externally. The whole
structure occupies progressively more space as it grows, but hydatid cysts
do not infiltrate, in contrast to alveolar hydatids. Pathogenic effects of
hydatid cysts include pressure atrophy of surrounding organs and allergic
reactions to hydatid fluid leaks. Rupture of a fertile hydatid cyst may
scatter bits of germinative membrane, scolices, and brood capsules
throughout the pleural or peritoneal cavity and result in multiple
hydatidosis. Pulmonary hydatid cysts may rupture into a bronchus, the
contents may be coughed up, and the lesion may be healed. Hydatid cysts
that remain intact eventually die and degenerate, but the course is
protracted.
E. multilocularis is a parasite of canids, mainly foxes and wolves in arctic
regions. The larval stage, the alveolar hydatid cyst, develops in the
liver of voles and lemmings (see Figures 8-57 and 8-58Figure 8-57Figure
8-58). The alveolar hydatid is characterized by exogenous budding that
continuously proliferates and infiltrates surrounding tissue. As with
unilocular hydatid cysts, the alveolar hydatid contains many small
scolices, each of which is termed a protoscolex (plural, protoscolices).
People become infected when they ingest the egg of E. multilocularis.
Unilocular hydatid disease
The unilocular hydatid cyst is the second-stage larva of E. granulosus and

is infective to dogs and other canids that serve as definitive hosts (Figure
4-44). Starting as an oncosphere less than 30 μm in diameter, the larva
grows very slowly and infrequently exceeds more than a few centimeters
in diameter in slaughtered sheep and cattle. Because humans live longer,
a fertile hydatid infecting man may grow very large and interfere with the
function of neighboring organs by pressing against them. The hydatid
membrane is surrounded by, but usually not attached to, an inflammatory

connective tissue capsule (see Figure 8-64). The space between the host
and the parasite generally contains a small volume of clear, colorless, or
light-yellow liquid. Brood capsules, each containing many scolices,
develop from the germinal epithelium lining the laminated hydatid
membrane (Figure 4-45). Some of these rupture, releasing scolices to
form a sediment of so-called “hydatid sand” in the hydatid fluid (Figure 4-
46). Endogenous daughter cysts may be found free in the fluid-filled cyst
cavity or attached to the germinal epithelium. Exogenous daughter cysts
are relatively unusual; they may be found in the pericystic space between
the hydatid membrane and the host connective tissue capsule. “Sterile”
hydatids, so-called because they lack protoscolices, often form in cattle
and swine, making the diagnosis sometimes difficult and presumptive.
FIGURE 4-44 A hydatid cyst (Echinococcus granulosus) in the liver of a horse. This
horse displayed no clinical signs of hepatic involvement despite the presence of 20
to 30 cysts like the one illustrated.
FIGURE 4-45 Echinococcus granulosus hydatid cyst with three brood capsules,
each containing three or more protoscolices.
FIGURE 4-46 Protoscolices of Echinococcus granulosus from a hydatid cyst. The

one on the left is invaginated, whereas the one on the right is evaginated.
Alveolar hydatid disease
Alveolar hydatid cysts are the second larval stage of E. multilocularis (the
first being the hexacanth embryo within the egg) and contain
protoscolices that are infective to dogs, foxes, and cats, which serve as
definitive hosts (Figure 4-47). Alveolar hydatids may develop in voles,
lemmings, cattle, horses, swine, and humans. In humans the cysts are
typically “sterile” and become a proliferating germinal membrane that
continuously proliferates and infiltrates surrounding tissue like a
malignant neoplasm. Alveolar hydatid infection proves invariably fatal in a
few years. In North America the largest numbers of cases in human beings
have occurred in areas where the parasite has entered the peridomestic
cycle by infecting dogs and rodents in native American villages. This
occurred in St. Lawrence Island, Alaska, where a large number of villagers
were infected with this parasite. Cases continue to be reported from
Alaska; and there has been one case reported from the lower 48 United
States, in Minnesota. In central Europe, almost 600 cases have been
reported in recent years, with most being from eastern France to western
Switzerland. Often in people the entire cyst cannot be removed by
surgical resection because of its indiscrete boundaries, making it harder to
treat than the discrete cysts of unilocular hydatidosis. Patients are often
placed on long-term anthelmintic therapy with products such as
albendazole. Of 408 patients who were alive in 2000 whose cases were
reported to the central European hydatid registry, only 4.9% were
considered to have been cured of their infection.
FIGURE 4-47 Echinococcus multilocularis alveolar hydatid.
Control
Both E. granulosus and E. multilocularis tend to establish sylvatic cycles

when suitable predator-prey relationships exist in the wildlife population
of a region. Therefore E. granulosuscycles are maintained among wild
ruminants and wolves in the Canadian north woods and among wallabies
and dingoes in Australia. Natural nidi of E. multilocularis are maintained in
various rodents and foxes. The sylvatic cycle reaches humans through
their domesticated animals. Dogs that scavenge the entrails of wild game
infected with Echinococcus species become direct sources of hydatid
infection to humans and their domestic animals. Contamination of
pastures with the feces of infected wild carnivorans also results in hydatid
infection of domestic ruminants and swine. The establishment of a
pastoral cycle may then result from the feeding of uncooked offal from
these domestic animals to dogs and, in the case of E. multilocularis, to
cats (Figure 4-48).
FIGURE 4-48 Pastoral and sylvatic cycles of Echinococcus

granulosus and Echinococcus multilocularis.
The direct source of human infection is, in most instances, the domestic
dog or cat, and scrupulous hygiene is the first line of defense. Periodic
anthelmintic medication of dogs or cats, depending on the species of
tapeworm involved, carries the threat one step further away. In the case
of a well-established sylvatic cycle, this is about as far as it is practical to
go.Echinococcus infection may be reduced to insignificant incidence in
cases in which it is limited to a pastoral cycle and thus accessible to
manipulation by humans. Destruction of all straydogs, regimented
anthelmintic medication of the rest, and prohibition against feeding
uncooked offal to dogs and cats are mandatory.
A campaign against hydatid disease was begun in Iceland 1864. At the
outset, about one in six or seven people and virtually all ages of slaughter
sheep and cattle harbored hydatid cysts, and about one fourth of the dogs
were infected with the adult worm. By 1900 the human infection rate had
fallen dramatically and has basically reached the point of nonexistence.
The campaign, devised by Dr. Harald Krabbe of the Royal Veterinary and
Agricultural University of Copenhagen, consisted of alerting the public to
the need to observe strict hygiene in dealing with dogs, destroying all
cysts and infected offal, and administering mandatory anthelmintic
medication to all dogs (Palsson, 1976). Thus salutary results
in Echinococcus control can be achieved in a century or so, provided there
is no sylvatic cycle to complicate the issue. In Australia, for example, a
sylvatic cycle involving kangaroos and Canis dingo would have to be
considered in any eradication attempt. “Obviously the denial of sheep
offal to domestic dogs will not eliminate infection if dogs have access to
macropods in dingo-infested areas” (Herd and Coman, 1975). In the
United States, E. granulosus appears to be most prevalent in sheep-
raising areas of Utah (Loveless et al, 1978) and California. In California the
spread of echinococcosis appears to be related to a quaint transhuman
form of husbandry in which bands of sheep migrate from place to place
under the control of contract Basque shepherds from Spain and France.
These shepherds, for the most part, are ignorant of the epidemiology of
hydatid disease and feed their dogs mostly on dead sheep (Araujo et al,
1975).
There have been vaccines for sheep produced that have been successful
in preventing the development of hydatid cysts in sheep. These vaccines
are currently undergoing field trials in various parts of the world and may
go a long way in providing new means for the eradication of this parasite
in certain locals.

Echinococcus

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Echinococcus granulosus Paidi

The genus Echinococcus contains two species of special importance to

FIGURE 4-43 Echinococcus granulosus (Taeniidae), entire worm.

E. granulosus is endemic in North and South America, England, Africa,

E. granulosus is a parasite as adults of the dog, coyote, wolf, and dingo.

Unilocular hydatid disease

The unilocular hydatid cyst is the second-stage larva of E. granulosus and

membrane is surrounded by, but usually not attached to, an inflammatory

FIGURE 4-46 Protoscolices of Echinococcus granulosus from a hydatid cyst. The

Alveolar hydatid disease

FIGURE 4-47 Echinococcus multilocularis alveolar hydatid.

Both E. granulosus and E. multilocularis tend to establish sylvatic cycles

FIGURE 4-48 Pastoral and sylvatic cycles of Echinococcus

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