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Spontaneous Death of Echinococcus multilocularis: Cases Diagnosed Serologically (by Em₂ Elisa) and Clinical Significance

R. L. Rausch^*, J. F. Wilson, P. M. Schantz AND B. J. McMahon

^* Division of Animal Medicine SB-42, School of Medicine, University of Washington, Seattle, Washington 98195,
and Departments of Surgery and Medicine, Alaska Native Medical Center, P.O. Box 7-741, Anchorage, Alaska 99510,
and Helminthic Diseases Branch, Division of Parasitic Diseases, Centers for Disease Control, Atlanta, Georgia 30333

Nine cases of asymptomatic alveolar hydatid disease (AHD) of the liver were diagnosed in 1985 among Eskimos from the endemic region of western Alaska. The patients were identified by screening with the enzyme-linked immunosorbent assay, using purified Echinococcus multilocularis antigen (Em₂ ELISA). Five patients, and one diagnosed earlier (1979), were found to have lesions in which the larval E. multilocularis had died spontaneously at an early stage of infection. Viability was assessed histologically; by the avidinbiotin immunohistochemical method; and in vivo through intraperitoneal inoculation of membranes of the larval cestode into red-backed voles, Clethrionomys rutilus. The results were in agreement with the clinical impression, based on findings by computerized tomography and ultrasound scanning, and on the macroscopic appearance of the lesions, that the cestode was dead. Spontaneous death of E. multilocularis in humans has not been previously reported. The findings show that the Em₂ ELISA may be positive in patients having lesions of AHD in which the etiologic agent is no longer viable.

Accepted for publication October 22, 1986.

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