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Echinococcus multilocularis

Parasite Facts and Geography:
Human echinococcosis (hydatid disease) and cysticercosis, caused by the proliferation of larval tapeworms in vital organs (Garcia et al., 2007), are among the most severe parasitic diseases in humans and account for 2 of the 17 neglected tropical diseases prioritized by the World Health Organization (WHO, 2012).When diagnosed, the disease is often at an advanced stage at which surgery is no longer an option (Brunetti et al., 2010). E. multilocularis occurs in the northern hemisphere, including central and northern Europe, Central Asia, northern Russia, northern Japan, north-central United States, northwestern Alaska, and northwestern Canada. In North America, Echinococcus multilocularis is found primarily in the north-central region as well as Alaska and Canada. Rare human cases have been reported in Alaska, the province of Manitoba, and Minnesota. Only a single autochthonous case in the United States (Minnesota) has been confirmed.

Morphology:
The adult parasite of E. multilocularis is very similar to E. granulosus, but is slightly smaller, with a maximum length of approximately 4 mm, and consisting of 4–5 proglottids

Life Cycle:
Domestic dog is suspected to be the primary definitive host for the transmission of E. Multilocularis to humans in this locality Definitive hosts = Foxes and Canines Intermediate hosts = Rodents Larval growth remains indefinitely in the proliferative stage, resulting in invasion of the surrounding tissues

Reproduction:
Adults of E. multilocularis are monecious, they possess all parts of both male and female systems and reproduce by self-fertilization. They have both sexual and asexual life stages. The reproductive life cycle will typically require two hosts, and intermediate host and a definitive host. The adult worm releases its proglottids filled with eggs from the definitive host via the feces.

Pathology:
E. Multilocularis affects the liver as a slow growing, destructive tumor, often with abdominal pain and biliary obstruction being the only manifestations evident in early infection

Diagnosis:
There is an urgent need for reliable and simple techniques for the diagnosis of the infection in populations of final hosts (foxes, dogs, cats) and also in individual dogs and cats. The standard technique presently used is parasitological examination of the small intestine at necropsy. This reliable technique requires high expenditure and special safety precautions. An alternative approach is coproantigen detection.

Treatment:
Initially, if acute infection then albendazole can be used to treat this infection via worm because it will prevent new larvae from growing/multiplying. Although, it appears that surgery is the most effective way of removal of this particular parasite from the host. Unfortunately, surgery does not guarantee removal of the entire mass of parasites embedded in host cells or bloodstream- likewise, further follow-up medication may be needed for elongated suppression of parasite. Recurrence after surgery is ~2% to 40% and solely depends on the size and localization of the cyst. Another Form of treatment are known as: Percutaneous treatment. Entails two types: PAIR method in which the destruction of germinal membrane occurs via specific agents and the second none involves using a specialized tube to remove solid content of the cyst. This sub-method is also known as catheterization; this method is more commonly used for post-PAIR relapsing cyst.

Disease Control and Prevention:
Certain endemic areas, such as North Central Regions (Montana,Ohio, Alaska, Canada) should be cautious to avoid canines in the wild and rodents (dead or alive) such as stray cats or dogs, fox, or wolves that could potentially be affected nor should these animals be kept in a domestic environment such as a home or public area. Be cautious of eating fruits that are freshly picked, especially if already found on the ground. Be aware to not let domestic pets prey on wild canines or rodents that could potentially pass on the infection, making your pet a potential (definitive) host. Likewise, it is pertinent to practice proper hygiene such as washing hands, washing food before consuming, and properly cooking food even if it is a vegetable. Various measures are being taken by the CDC to control, prevent, and evidently attempt to eradicate this parasite. Such as: eliminating stray dogs, filtering water, cooking food properly, and most importantly spreading and advocating individuals for proper hygiene and preventative measures to reduce spreading the parasite from host to host.