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Epidemiological and Clinical Characteristics of Alveolar Echinococcosis: An Emerging Infectious Disease in Alberta, Canada

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  • 1 University of Alberta, Edmonton, Canada;
  • 2 University of British Columbia, Vancouver, Canada;
  • 3 University of Bern, Bern, Switzerland;
  • 4 University of Pisa, Pisa, Italy;
  • 5 University of Calgary, Calgary, Canada

ABSTRACT

Human alveolar echinococcosis (AE) is a zoonotic cestode infection which is usually fatal in the absence of treatment. Treatment involves major surgery or indefinite antiparasitic therapy. The incidence is rising in Europe and Asia, with an increased risk observed in immunocompromised individuals. Previously, AE acquisition in North America was extremely rare, except for one remote Alaskan Island. Recent studies have demonstrated a new European-like strain of Echinococcus multilocularis (Em) in wildlife and in human AE in western Canada. We report the experience of all AE patients diagnosed in Alberta. Each was diagnosed by histopathology, serology, and PCR-confirmed by a reference laboratory. Seventeen cases of human AE, aged 19–78 years, nine females, were diagnosed between 2013 and 2020: all definitely or probably acquired in Alberta. Six lived in urban areas, and 14 had kept dogs. In eight, the lesions were found incidentally on abdominal imaging performed for other indications. Six were immunocompromised to varying degrees. Six were first diagnosed at surgery. All have been recommended benzimidazole therapy. One died of surgical complications. Clinicians should be aware of this diagnostic possibility in patients presenting with focal nonmalignant hepatic mass lesions. Greater urbanization of coyotes, the predominant definitive host of Em in Alberta, and growing numbers of immune suppressed individuals in the human population may lead to increasing recognition of AE in North America.

Author Notes

Address correspondence to Stan Houston, University of Alberta, 1-124 Clinical Sciences Bldg., 11350 83 Ave., Edmonton T6G 2G3, Canada. E-mail: shouston@ualberta.ca

Disclosure: The University of Alberta (REB Pro00097735) approved the study.

Authors’ addresses: Stan Houston, Department of Medicine/Public Health, University of Alberta, Edmonton, Canada, E-mail: shouston@ualberta.ca. Sara Belga, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada, and Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada, E-mail: sara.belga@ubc.ca. Klaus Buttenschoen and Jutta Preiksaitis, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada, E-mails: klaus.buttenschoen@ualberta.ca and jutta@ualberta.ca. Ryan Cooper, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada, E-mail: rdcooper@ualberta.ca. Safwat Girgis, Department of Anatomical Pathology, University of Alberta, Edmonton, Canada, E-mail: sgirgis@ualberta.ca. Bruno Gottstein, Institute of Parasitology, University of Bern, Bern, Switzerland, E-mail: bruno.gottstein@ifik.unibe.ch. Gavin Low and Philippe Sarlieve, Department of Radiology and Diagnostic Imaging, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Canada, E-mails: low1@ualberta.ca and sarlieve@ualberta.ca. Alessandro Massolo, Department of Biology, University of Pisa, Pisa, Italy, E-mail: alessandro.massolo@unipi.it. Clayton MacDonald, University of Alberta Faculty of Medicine and Dentistry, Alberta, Edmonton, Canada, E-mail: clayton.macdonald2@vch.ca. Norbert Müller, Department of Parasitology, Vetsuisse Faculty Bern, Bern, Switzerland, E-mail: norbert.mueller@vetsuisse.unibe.ch. Stephen Vaughan, Department of Infectious Diseases, Universiity of Calgary, Calgary, Canada, E-mail: stephen.vaughan@albertahealthservices.ca. Kinga Kowalewska-Grochowska, Provincial Laboratory of Public Health, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Canada, E-mail: kinga.kowalewska-grochowska@albertaprecisionlabs.ca.

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