Emerging Human Alveolar Echinococcosis in Hungary. Early Experiences in Clinical Management in a Single Center Study from 2005-2018

Purpose: Cystic echinococcosis is the most prevalent reportable helminthosis and also a neglected zoonotic disease in Hungary. Still nowadays the majority of cases are cystic echinococcosis (CE) caused by Echinococcus granulosus s.l. which is known to be endemic in central and Southeastern rural parts of Hungary. The appearance of Echinococcus multilocularis in wild definitive hosts, such as Red fox was first documented in Hungary in 2002. Untill now, based on national serological data, 15 possible human alveolar echinococcosis (AE) cases caused by this species have been detected. The first confirmed human AE and the first confirmed autochton human AE in Hungary was officially reported and published in 2008 and in 2016 respectively. The purpose of this study was to describe the clinical characteristics of AE cases in a single center which recently follows most of the Hungarian patients. Methods & Materials: We collected clinical data about AE patients under follow-up in our infectological center, encompassing the time period between 05.07.2005 and 01.07.2018. Data were retrieved from database management system (Medsol) of Dél-Pesti Centrum Kórház, Országos Hematológiai és Infektológiai Intézet, Budapest. For the evaluation of clinical features regarding diagnosis and treatment we applied the international guideline proposed by the WHO-IWGE expert consensus. Results: A total of seven patients under follow-up in our center received the diagnosis of probable (n = 3) and confirmed (n = 4) AE. In the four histopathologically confirmed cases additional supporting methods such as immunohistochemistry (n = 2) and polymerase chain reaction (n = 1) were applied. Curative liver resection could be done in two cases. In four unresectable cases progression was stopped by continuous parasitostatic albendazol therapy. In one unresectable case albendazol therapy had to be ceased because of drug-toxicity and allergic reactions. In this case pulmonary propagation is suspected. AE related liver insufficiency or death has not occured. Conclusion: Echinococcus multilocularis is an emerging parasite in Hungary. It causes alveolar echinococcosis which is a potentially lethal zoonosis. Because of its still low incidence differential diagnosis and therapy of AE is a new challenge in clinical practice in Hungary.