Occurrence of potential wild hosts of Echinococcus vogeli in the forests of southwestern Brazilian Amazonia / Ocorrência de potenciais hospedeiros silvestres de Echinococcus vogeli nas florestas do sudoeste da Amazônia brasileira

Abstract The helminth Echinococcus vogeliRausch & Bernstein, 1972 is a causative agent of Neotropical Echinococcosis, a chronic zoonotic disease which is endemic to the Neotropical region. This parasite is transmitted from bush dogs (Speothos venaticus) to their prey, which include lowland pacas (Cuniculus paca) and agoutis (Dasyprocta spp.). In Brazil, most human cases of Neotropical Echinococcosis have been recorded in the Amazonian states of Acre and Pará, although few data are available on the occurrence of the potential definitive or intermediate hosts of E. vogeli in the Amazon region. In the present study, we surveyed the forests surrounding 46 human communities located within and around of outside six sustainable-use protected areas in the southwestern Amazon basin of Brazil. The forests were surveyed using camera traps to determine the local presence of potential wild hosts of E. vogeli, and the exploitation of these hosts for game meat was evaluated through interviews with 136 subsistence hunters resident in the local communities. We recorded pacas, agoutis, and bush dogs, as well as domestic dogs (Canis familiaris), all potential reservoirs of Neotropical Echinococcosis, using the same habitats. We also confirmed the frequent consumption of paca and agouti meat by subsistence hunters and their families in the study communities. Our data contribute to the understanding of the occurrence of E. vogeli in Brazilian ecosystems.

Resumo O helminto Echinococcus vogeliRausch & Bernstein, 1972 é o agente causador da Equinococose Neotropical, uma doença zoonótica crônica e endêmica da região Neotropical. Este parasito é transmitido entre o cachorro-vinagre (Speothos venaticus) e suas presas, como pacas (Cuniculus paca) e cutias (Dasyprocta spp.). No Brasil, a maioria dos casos humanos de Equinococose Neotropical é registrada nos estados do Acre e Pará, embora existam poucos dados disponíveis sobre a ocorrência de potenciais hospedeiros definitivos e intermediários de E. vogeli na Amazônia. No presente estudo, foram investigadas áreas de floresta ao redor de 46 comunidades humanas localizadas no interior e entorno de seis unidades de conservação de uso sustentável no sudoeste da bacia amazônica brasileira e, por meio de armadilhas fotográficas, foram avaliadas as presenças de potenciais hospedeiros silvestres de E. vogeli. Adicionalmente, foram avaliados o padrão de consumo da carne dos hospedeiros silvestres por meio de entrevistas com 136 moradores dessas comunidades. Foram registradas pacas, cutias e cachorros-vinagre, bem como cães domésticos (Canis familiaris) utilizando os mesmos habitats, todos potenciais reservatórios da Equinococose Neotropical. Além disto, confirmamos a alto consumo de paca e cutia nas comunidades. Os dados do presente trabalho contribuem para pesquisas em andamento sobre a presença dos potenciais reservatórios de E. vogeli em ambientes brasileiros.

Equinococosis: actualización en terminologías utilizadas desde la biología a la terapéutica / Echinococcosis: update on terminologies used from biology to therapeutics

RESUMEN: El diagnóstico y tratamiento de las equinococosis requiere de la participación de especialistas multidisciplinarios,por lo que, estandarizar la terminología utilizada es fundamental. Para armonizar la terminología sobre bases científicas y lingüísticas sólidas, la Asociación Mundial de Equinococosis generó un proceso de consenso formal. Los principales logros de este proceso fueron: realizar una actualización de la nomenclatura actual de Echinococcus spp.; generar un acuerdo sobre nombres de enfermedades causadas por Echinococcus spp.: equinococosis quística (EQ), equinococosis alveolar (EA) y equinococosis neotropical (NE), y la exclusión de los demás nombres; ejecutar un acuerdo sobre el uso restringido del adjetivo "hidatido" para referirse al quiste y al líquido debido a E. granulosus sensu lato; y un acuerdo sobre una descripción estandarizada de las intervenciones quirúrgicas para EQ, de acuerdo con el marco de "Acceso, Apertura, Resección e Integridad del quiste" (AARI). Además, se enumeraron 95 términos "aprobados" y 60 "rechazados". Las recomendaciones proporcionadas serán aplicables a publicaciones científicas y comunicación con profesionales. El objetivo de este manuscrito fue generar un documento de estudio referente al uso de terminología actualizada en echinococcosis desde la biología a la terapéutica.

SUMMARY: The diagnosis and treatment of echinococcosis requires the participation of different multidisciplinary specialists Therefore, standardizing the terminology used is essential. To harmonize terminology on a sound scientific and linguistic basis, the World Echinococcosis Association generated a formal consensus process. The main achievements of this process were to update the current nomenclature of Echinococcus spp .; to generate an agreement on names of diseases caused by Echinococcus spp .: cystic echinococcosis (CE), alveolar echinococcosis (EA) and neotropical echinococcosis (NE), and the exclusion of other names; execute an agreement on the restricted use of the adjective "hydatid" to refer to the cyst and the fluid due to E. granulosus sensu lato; and an agreement on a standardized description of surgical interventions for CE, according to the framework of "Cyst Access, Opening, Resection and Integrity" (AARI). In addition, 95 "approved" and 60 "rejected" terms were listed. The recommendations provided will be applicable to scientific publications and communication with professionals. The aim of this manuscript was to generate a study document referring to echinococcosis from biology to therapy.

Polycystic echinococcosis in the state of Acre, Brazil: contribution to patient diagnosis, treatment and prognosis

The lack of knowledge regarding polycystic hydatid disease results in delayed or even incorrect diagnosis. The lack of systematic information regarding treatment also makes it difficult to assess the results and prognosis in patients with peritoneal and hepatic lesions caused by Echinococcus vogeli. Here we describe the clinical features of patients, propose a radiological classification protocol and describe a therapeutic option for the treatment of hydatid disease that previously had only been used for cases of cystic echinococcosis (Echinococcus granulosus). A prospective cohort study was initiated in 1999 and by 2009 the study included 60 patients. These patients were classified according to the PNM classification (parasite lesion, neighbouring organ invasion and metastases) and placed in one of three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10 mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts via puncture, aspiration, injection and re-aspiration (PAIR). The results were stratified according to therapeutic outcome: "cure", "clinical improvement", "no improvement", "death" or "no information". The PNM classification was useful in indicating the appropriate therapy in cases of polycystic hydatid disease. In conclusion, surgical therapy produced the best clinical results of all the therapies studied based on "cure" and "clinical improvement" outcomes. The use of PAIR for treatment requires additional study.

Equinococosis hepática poliquística autóctona por Echinococcus vogeli en el amazonas venezolano: Descripción de un caso / Autochthonous polycystic hepatic Echinococcosis due to Echinococcus vogeli at the Venezuelan amazon: Case report

Resumen Echinococcus vogeli y Echinococcus oligarthrus, especies autóctonas de América, producen equinococosis poliquística. El objetivo del trabajo es presentar un caso de equinococosis hepática poliquística por Echinococcus vogeli en una indígena de la etnia Yekuana del área amazónica venezolana. Presentó dolor abdominal punzante, hepatomegalia y eosinofilia marcada. Los estudios por imágenes mostraron lesiones poliquísticas en hígado. La serología para equinococosis resultó positiva. Se inicia tratamiento con albendazol previo a la cirugía, sin mejoría clínica. Se extrajo una gran masa quística del hígado por cirugía. Se determinó el promedio de longitud de los ganchos cefálicos de los protoescólices y las proporciones correspondían a E. vogeli. La paciente evolucionó satisfactoriamente y continuó el tratamiento con albendazol por 6 meses. La zona amazónica de Venezuela es abundante en animales silvestres, como roedores infectados con E. vogeli, Cuniculus paca o lapa y Dasyprocta aguti o picure venezolano. La paca es la principal presa tanto para Speothus venaticus como para los humanos que cazan las lapas por el excelente sabor de su carne. Los cazadores alimentan a los perros domésticos con las vísceras de la paca infectada, traspasando la infección a los humanos a través de los huevos excretados por las heces. Se sugiere pensar en equinococosis poliquística en individuos nativos con dolor abdominal, imágenes poliquísticas, calcificaciones en el hígado y eosinofilia, procedentes de la zona selvática del amazonas venezolano.

Abstract Echinococcus vogeli and Echinococcus oligarthrus, new world autochthonous species are responsible for polycystic echinoco-ccosis. The purpose of this work is the presentation of a polycystic hepatic echinococcosis case due to Echinococcus vogeli in an indigenous inhabitant of the Venezuelan amazon area. The patient presented a penetrating abdominal pain, hepatomegalia and marked eosinophilia. Liver imaging (echosonogram and computerized axial tomography) as well an echinococcosis positive serology (ELISA and Western-blot) contributed to the pre-surgical diagnosis. Treatment with albendazol was initiated previous to surgery. The cephalic hooks of the protoscolexes were studied and it was determined that their mean length, morphology and proportions corresponded to E. vogeli. The patient evolved satisfactorily and continued albendazol treatment during six months. In the Venezuelan amazon area there are still numerous wilds animals which are intermediate and final hosts of this cestode. Cuniculus paca or lapa, Dasyprocta aguti or Venezuelan aguti, Speothus veneticus, wild dogs and wild cats, are natural host of both species. We suggest considering the possibility of polycystic echinococcosis in native individuals with polycystic imagining and liver calcifications (and eosinophilia) who come from Venezuelan tropical forests. Nevertheless, it should be remembered that domestic dogs and cats are responsible of human infections.