Towards a taxonomic revision of the genus Echinococcus

Echinococcus remains a significant public health problem worldwide and, in several regions, the aetiological agents of cystic hydatid disease/echinococcosis are extending their range. The taxonomy of Echinococcus has been a controversial issue for decades, but the outcome of recent molecular epidemiological studies has served to reinforce proposals made ten years ago to revise the taxonomy of Echinococcus. A formal nomenclature is essential for effective communication, and provides the stability that underpins epidemiological investigations. It will also serve to recognize the contribution of early taxonomists.

A Review of the Genus Echinococcus Rudolphi, 1801

1. The genus Echinococcus Rudolphi, 1801, is reviewed. The recorded measurements of all species are shown in tables, and their taxonomic status is discussed. 2. Three species of Echinococcus can be distinguished by morphological criteria and are considered valid: E. granulosus, E. multilocularis and E. oligarthrus. The status of E. felidis and E. patagonicus is uncertain, but both may be conspecific with E. granulosus. Six species are considered synonyms of E. granulosus: E. cameroni, E. intermedius, E. longimanubrius, E. lycaontis, E. minimus and E. ortleppi.

Taxonomic Characters in the Genus Echinococcus (Cestoda: Taenlidae)

Not more than four species of cestodes of the genus Echinococcus Rudolphi, 1801, are recognized as valid. The larval stage of at least three of them is able to develop in man, causing respective types of hydatid disease. Accurate characterization of these cestodes, including both larval and adult stages, is essential for identification, upon which depends development of methods for preventing infection of man and domestic animals. Because morphological characteristics of the larval cestodes may be modified according to the species of host in which they develop, identification should be based upon taxonomic characters of specimens from the respective natural hosts, which can be identified by means of ecological investigations in endemic areas in combination with controlled infection of experimental animals. The morphological and biological characteristics of the known species are discussed, and the two species most important to public health and economically--E. granulosus (Batsch, 1786) and E. multilocularis Leuckart, 1863--are distinguished. French résumé: Trois espèces de cestodes du genre Echinococcus Rudolphi, 1801 ont été identifiées: E. granulosus (Batsch, 1786); E. multilocularis Leuckart, 1863; et E. oligarthrus (Diesing, 1863). On n'a pas encore déterminé avec certitude s'il fallait leur adjoindre E. patagonicus Szidat, 1960. Ce dernier mis à part, tous ces ténias sont connus pour provoquer chez l'homme des formes spécifiques d'échinococcose hydatique; l'infestation par les larves de E. granulosus est également fréquente chez les ongulés domestiques et la répartition de ce cestode est presque cosmopolite. E. multilocularis est très largement répandu dans l'hémisphère nord, tandis que E. oligarthrus ne se trouve que dans le centre et le sud de I'Amérique. Pour définir des critères morphologiques qui permettent de distinguer avec précision les différentes espèces d'Echinococcus, il convient de prendre les spécimens sur leurs hôtes naturels, sinon l'évolution du stade strobilaire se trouve habituellement retardée et le stade larvaire présente une gamme étendue de variations morphologiques. Pour identifier les hôtes naturels, il faut étudier l'écologie dans les zones d'éndemicité, ainsi que les manifestations de l'infection contrôlée chez des animaux d'expérience. Le stade strobilaire des ténias peut présenter plusieurs caractères spécifiques importants qui concernent notamment la taille, le nombre et la répartition des testicules, la position du pore génital dans les segments gravides, la forme de l'utérus gravide et, dans certains cas, la taille et la forme des crochets du rostre. La structure de la larve normalement développée est caractéristique de chacune des trois espèces relativement bien connues. Les caractéristiques biologiques jouent également un rôle important dans la différenciation de ces cestodes. Au stade larvaire, le laps de temps nécessaire au développement des scolex infectants est directement fonction de la durée de vie de l'hôte intermédiaire. La larve de E. multilocularis présente des scolex infectants dès le deuxième ou le troisième mois, alors qu'ils n'apparaissent qu'au bout d'un ou deux ans chez la larve de E. granulosus. Un tableau donne la liste comparative des caractéristiques taxonomiques qui permettent de faire la distinction entre ces deux espèces.

The Taxonomic Value and Variability of Certain Structures in the Cestode Genus Echinococcus (Rudolphi, 1801) and a Review of Recognized Species

Although cestodes of the genus Echinococcus have been much studied in the past, there is need for an evaluation of these morphological characters used as the basis for species differentiation. The generous cooperation of other investigators in providing necessary foreign material and the results of nearly five years of field work in Alaska make possible such a study. It is the purpose of the paper to evaluate morphological characters used at the species level to differentiate these cestodes, and to review the status of species currently considered valid.

Epidemiology and strain characteristics of Echinococcus granulosus in the Benghazi area of eastern Libya

The incidence of surgically confirmed cystic echinococcosis in eastern Libya was estimated to be at least 4.2 cases/100,000, with significantly more female cases than male. The prevalences of infection with Echinococcus granulosus among 1087 sheep, 881 goats, 428 camels and 614 cattle from the same region, determined postmortem in abattoirs, were 20%, 3.4%, 13.6% and 11%, respectively. Infection in the livestock was age-dependent and, generally, the female animals were more often infected than the male. The measurements of rostellar hooks on protoscoleces collected from sheep and cattle were similar but significantly different from the corresponding measurements of parasites of human or camel origin. However, when a portion of the cytochrome c-oxidase subunit I (coxl) gene from each of 30 protoscolex samples from Libya (12 from cattle, three from humans, five from camels and 10 from sheep) was sequenced, the sequences were all found to be identical to that published for the common sheep strain of E. granulosus.

Short report: Molecular genetic characterization of an unusually severe case of hydatid disease in Alaska caused by the cervid strain of Echinococcus granulosusi

Distinct Echinococcus granulosus life cycle patterns have been described in North America: domestic and sylvatic. Gene sequences of the sylvatic E. granulosus indicate that it represents a separate variant. Case-based data have suggested that the course of sylvatic disease is less severe than that of domestic disease. which led to the recommendation to treat cystic echinococcosis patients in the Arctic by careful medical management rather than by aggressive surgery. We recently reported the first two documented E. granalosus human cases in Alaska with accompanying severe sequelae. Here we describe the results of molecular genetic analysis of the cyst material of one of the subjects that supported identification of the parasite as the sylvatic (cervid) strain and not the domestic (common sheep strain), which was initially thought to be implicated in these unusually severe Alaskan cases.

Complete mitochondrial genomes confirm the distinctiveness of the horse-dog and sheep-dog strains of Echinococcus granulosus

Unlike other members of the genus, Echinococcus granulosus is known to exhibit considerable levels of variation in biology, physiology and molecular genetics. Indeed, some of the taxa regarded as 'genotypes' within E. granulosus might be sufficiently distinct as to merit specific status. Here, complete mitochondrial genomes are presented of 2 genotypes of E. granulosus (G1-sheep-dog strain: G4-horse-dog strain) and of another taeniid cestode, Taenia crassiceps. These genomes are characterized and compared with those of Echinococcus multilocularis and Hymenolepis diminuta. Genomes of all the species are very similar in structure, length and base-composition. Pairwise comparisons of concatenated protein-coding genes indicate that the G1 and G4 genotypes of E. granulosus are almost as distant from each other as each is from a distinct species, E. multilocularis. Sequences for the variable genes atp6 and nad3 were obtained from additional genotypes of E. granulosus, from E. vogeli and E. oligarthrus. Again, pairwise comparisons showed the distinctiveness of the G1 and G4 genotypes. Phylogenetic analyses of concatenated atp6, nad1 (partial) and cox1 (partial) genes from E. multilocularis, E. vogeli, E. oligarthrus, 5 genotypes of E. granulosus, and using T. crassiceps as an outgroup, yielded the same results. We conclude that the sheep-dog and horse-dog strains of E. granulosus should be regarded as distinct at the specific level.

Selection, Recombination and History in a Parasitic Flatworm (Echinococcus) Inferred from Nucleotide Sequences

Three species of flatworms from the genus Echinococcus (E. granulosus, E. multilocularis and E. vogeli) and four strains of E. granulosus (cattle, horse, pig and sheep strains) were analysed by the PCR-SSCP method followed by sequencing, using as targets two non-coding and two coding (one nuclear and one mitochondrial) genomic regions. The sequencing data was used to evaluate hypothesis about the parasite breeding system and the causes of genetic diversification. The calculated recombination parameters suggested that cross-fertilisation was rare in the history of the group. However, the relative rates of substitution in the coding sequences showed that positive selection (instead of purifying selection) drove the evolution of an elastase and neutrophil chemotaxis inhibitor gene (AgB/1). The phylogenetic analyses revealed several ambiguities, indicating that the taxonomic status of the E. granulosus horse strain should be revised

A multiplex PCR for the simultaneous detection and genotyping of the Echinococcus granulosus complex.

Echinococcus granulosus is characterized by high intra-specific variability (genotypes G1-G10) and according to the new molecular phylogeny of the genus Echinococcus, the E. granulosus complex has been divided into E. granulosus sensu stricto (G1-G3), E. equinus (G4), E. ortleppi (G5), and E. canadensis (G6-G10). The molecular characterization of E. granulosus isolates is fundamental to understand the spatio-temporal epidemiology of this complex in many endemic areas with the simultaneous occurrence of different Echinococcus species and genotypes. To simplify the genotyping of the E. granulosus complex we developed a single-tube multiplex PCR (mPCR) allowing three levels of discrimination: (i) Echinococcus genus, (ii) E. granulosus complex in common, and (iii) the specific genotype within the E. granulosus complex. The methodology was established with known DNA samples of the different strains/genotypes, confirmed on 42 already genotyped samples (Spain: 22 and Bulgaria: 20) and then successfully applied on 153 unknown samples (Tunisia: 114, Algeria: 26 and Argentina: 13). The sensitivity threshold of the mPCR was found to be 5 ng Echinoccoccus DNA in a mixture of up to 1 µg of foreign DNA and the specificity was 100% when template DNA from closely related members of the genus Taenia was used. Additionally to DNA samples, the mPCR can be carried out directly on boiled hydatid fluid or on alkaline-lysed frozen or fixed protoscoleces, thus avoiding classical DNA extractions. However, when using Echinococcus eggs obtained from fecal samples of infected dogs, the sensitivity of the mPCR was low (<40%). Thus, except for copro analysis, the mPCR described here has a high potential for a worldwide application in large-scale molecular epidemiological studies on the Echinococcus genus.

Echinococcus P29 antigen: molecular characterization and implication on post-surgery follow-up of CE patients infected with different species of the Echinococcus granulosus complex.

The protein P29 is a potential serological marker for post-treatment monitoring of cystic echinococcosis (CE) especially in young patients. We now have demonstrated that P29 is encoded in the Echinococcus genus by a single gene consisting of 7 exons spanning 1.2 kb of DNA. Variability of the p29 gene at inter- and intra-species level was assessed with 50 cDNA and 280 genomic DNA clones isolated from different E. granulosus s.l. isolates (E. granulosus sensu stricto (G1), E. equinus (G4), E. ortleppi (G5), E. canadensis (G6), E. canadensis (G7) and E. canadensis (G10)) as well as four E. multilocularis isolates. Scarce interspecies polymorphism at the p29 locus was observed and affected predominantly E. granulosus s.s. (G1), where we identified two alleles (A1 and A2) coding for identical P29 proteins and yielding in three genotypes (A1/A1, A2/A2 and A1/A2). Genotypic frequencies expected under Hardy-Weinberg equilibrium revealed a high rate of heterozygosity (47%) that strongly supports the hypothesis that E. granulosus s.s. (G1) is predominantly outbreeding. Comparative sequence analyses of the complete p29 gene showed that phylogenetic relationships within the genus Echinococcus were in agreement with those of previous nuclear gene studies. At the protein level, the deduced P29 amino acid (AA) sequences exhibited a high level of conservation, ranging from 97.9% AA sequence identity among the whole E. granulosus s.l. group to 99.58% identity among E. multilocularis isolates. We showed that P29 proteins of these two species differ by three AA substitutions without implication for antigenicity. In Western-blot analyses, serum antibodies from a human CE patient infected with E. canadensis (G6) strongly reacted with recombinant P29 from E. granulosus s.s. (G1) (recEg(G1)P29). In the same line, human anti-Eg(G1)P29 antibodies bound to recEcnd(G6)P29. Thus, minor AA sequence variations appear not to impair the prognostic serological use of P29.

Taxonomy, phylogeny and molecular epidemiology of Echinococcus multilocularis: From fundamental knowledge to health ecology.

Alveolar echinococcosis, caused by the tapeworm Echinococcus multilocularis, is one of the most severe parasitic diseases in humans and represents one of the 17 neglected diseases prioritised by the World Health Organisation (WHO) in 2012. Considering the major medical and veterinary importance of this parasite, the phylogeny of the genus Echinococcus is of considerable importance; yet, despite numerous efforts with both mitochondrial and nuclear data, it has remained unresolved. The genus is clearly complex, and this is one of the reasons for the incomplete understanding of its taxonomy. Although taxonomic studies have recognised E. multilocularis as a separate entity from the Echinococcus granulosus complex and other members of the genus, it would be premature to draw firm conclusions about the taxonomy of the genus before the phylogeny of the whole genus is fully resolved. The recent sequencing of E. multilocularis and E. granulosus genomes opens new possibilities for performing in-depth phylogenetic analyses. In addition, whole genome data provide the possibility of inferring phylogenies based on a large number of functional genes, i.e. genes that trace the evolutionary history of adaptation in E. multilocularis and other members of the genus. Moreover, genomic data open new avenues for studying the molecular epidemiology of E. multilocularis: genotyping studies with larger panels of genetic markers allow the genetic diversity and spatial dynamics of parasites to be evaluated with greater precision. There is an urgent need for international coordination of genotyping of E. multilocularis isolates from animals and human patients. This could be fundamental for a better understanding of the transmission of alveolar echinococcosis and for designing efficient healthcare strategies.

Clinical and serological outcomes with different surgical approaches for human hepatic hydatidosis

ABSTRACTINTRODUCTION:Hydatidosis is the result of infection with the larval stages of some species of the genus Echinococcus. Treatment approaches for hydatid cysts include the use of albendazole, surgery, and/or medico-surgical procedures. The choice of the therapeutic surgical approach depends on the cyst number and localization, surgeon expertise, and presence of complications. The present study aimed to compare the outcomes of the following therapeutic approaches for the treatment of hepatic hydatid cysts: pericystectomy; the puncture, aspiration, injection, and reaspiration (PAIR) technique; and the PAIR technique followed by deroofing, evacuation of cysts, and omentoplasty.METHODS:The 54 patients were divided into 3 groups: Group I (14 patients) who underwent pericystectomy, Group II (23 patients) who underwent the PAIR technique, and Group III (17 patients) who underwent the PAIR technique followed by deroofing and omentoplasty. The diagnosis of hydatid cysts was based on serological testing using enzyme-linked immunosorbent assay, abdominal ultrasound, and parasitological examination of the cyst contents. Morbidity, mortality, length of hospital stay, recurrence, and postoperative complications were evaluated.RESULTS:Postoperative bleeding, infection, and recurrence were reported in Groups I and II; Group III did not experience postoperative infection and had shorter hospital stays. Recurrence and postoperative complications did not occur in Group III.CONCLUSIONS:The partial surgical procedure with deroofing, evacuation of the cysts, and omentoplasty, as performed in the present study, is recommended as a safe and effective method for elimination of the entire parasite with minimal possibility for intra-peritoneal spillage.

Intracerebral alveolar echinococcosis.

There are two species of the genus Echinococcus, Echinococcus multilocularis (also called alveolar hydatid) and Echinococcus granulosus, characterized by distinct growth features in humans. The main endemic regions for human alveolar echinococcosis (AE) caused by E. multilocularis are Central Europe, Russia, Turkey, Japan, China, eastern France and North America. Human echinococcosis is usually caused by an intrahepatic growth of parasitic larvae. Cerebral occurrence of E. multilocularis disease is rare, accounting for only 1% of cases, and is generally considered to be fatal. This report presents two cases of intracerebral E. multilocularis disease which occurred in two infected patients with AE pulmonary metastases. The anatomical and clinical features are discussed. Our retrospective survey would indicate that surgical treatment should be envisaged whenever possible.

Hidatidose policística no Estado do Acre: contribuição para o diagnóstico, tratamento e prognóstico dos pacientes

A equinococose é uma zoonose cujos agentes etiológicos são helmintos do gênero Echinococcus. Há cinco espécies de Echinococcus, duas delas, o E. oligarthrus (Diesing, 1863) e o E. vogeli (Rausch & Bernstein, 1972) ocorrem apenas em zonas neotropicais. A equinococose pelo E. vogeli provoca cistos hidáticos múltiplos, principalmente no fígado dos hospedeiros intermediários, dos quais um deles é o ser humano. O pouco conhecimento acerca da doença faz com que o diagnóstico seja retardado ou até mesmo equivocado. A falta de sistematização nas indicações de tratamento também dificulta a avaliação dos resultados e prognóstico dos pacientes com lesões hepáticas e peritoneais causadas pelo E. vogeli. Neste trabalho, descrevemos o quadro clínico dos pacientes; propomos protocolo de classificação radiológica, utilizado na classificação da equinococose alveolar (E. multilocularis, Classificação “PNM”, Kern et al., 2006), que foi adequado também para a equinococose policística (E. vogeli); e descrevemos uma opção terapêutica para o tratamento dessa hidatidose que anteriormente só havia sido utilizada para casos de equinococose cística (E. granulosus, PAIR -Puncture, Aspiration, Injection, Reaspiration, Brunnetti et al., 2001). Uma coorte prospectiva foi iniciada no ano de 1999 e até 2009 foram incluídos 60 pacientes. Foram descritos os principais sintomas e sinais: dor no andar superior do abdome (65%) e hepatomegalia (60%) e os pacientes foram classificados conforme a Classificação “PNM” e submetidos a três modalidades terapêuticas: (i) quimioterapia com albendazol na dose de 10mg/Kg/dia, (ii) tratamento cirúrgico com ressecção dos cistos ou (iii) punção percutânea – PAIR. Após exclusão de 2 casos, por preenchimento inadequado do protocolo de pesquisa, os grupos foram assim distribuídos: terapêutica com albendazol: n=28 (48,3%; 28/58), terapêutica cirúrgica: n=25 (52,1%; 25/58) e PAIR: n=5 (8,1%; 5/58). Os resultados foram estratificados conforme o resultado da terapêutica: “Cura”, representada pelo desaparecimento das lesões após tratamento clínico ou cirúrgico; “Melhora clínica”, entendidas como pacientes assintomáticos, sem perda ponderal e com as funções fisiológicas preservadas; “Sem Melhora”, incluiu os pacientes que permaneceram sintomáticos; “Óbito”; e “Sem informação”, o acompanhamento não permitiu a conclusão sobre o desfecho. Nos três grupos terapêuticos a taxa de letalidade de 15,5% (9/58), “sem melhora” 1,7% (1/58), “melhora clínica” em 40,0% (23/58) e “cura” em 32,8% (19/58). Com relação ao desfecho “óbito”, não houve diferença entre as terapêuticas com albendazol ou cirúrgica com 4 (14,2%) e 3 (12%) óbitos respectivamente; porém, no primeiro grupo, albendazol, o desfecho “cura” foi de 4,3% (1/23) e “melhora clínica” 74,0% (17/23), enquanto que no grupo “cirurgia” a “cura” representou 71,0% (17/24) e “melhora clínica” com 16,7(4/24). A terapêutica “PAIR” foi associado a taxa de letalidade de 40% (2/5), cura em 20% (1/5) e melhora clínica em 40% (2/5). A Classificação “PNM” foi útil para indicar tipo terapêutica nos casos de hidatidose policística. Em conclusão, na série estudada a terapêutica cirúrgica apresenta melhor resultado que a terapêutica clínica quanto aos desfechos “cura” e “melhora clínica”. A terapêutica por PAIR necessita de mais estudos.

Molecular discrimination of taeniid cestodes :

DNA approaches are now being used routinely for accurate identification of Echinococcus and Taenia species, subspecies and strains, and in molecular epidemiological surveys of echinococcosis/taeniasis in different geographical settings and host assemblages. The publication of the complete sequences of the mitochondrial (int) genomes of E. granulosus, E. multilocularis, T solium and Asian Taenia, and the availability of mtDNA sequences for a number of other taeniid genotypes, has provided additional genetic information that can be used for more in depth phylogenetic and taxonomic studies of these parasites. This very rich sequence information has provided a solid molecular basis, along with a range of different biological, epidemiological, biochemical and other molecular-genetic criteria, for revising the taxonomy of the genus Echinococcus and for estimating the evolutionary time of divergence of the various taxa. Furthermore, the accumulating genetic data has allowed the development of PCR-based tests for unambiguous identification of Echinococcus eggs in the faeces of definitive hosts and in the environment. Molecular phylogenies derived from mtDNA sequence comparisons of geographically distributed samples of T solium provide molecular evidence for two genotypes, one being restricted to Asia, with the other occurring in Africa and America. Whether the two genetic forms of T solium differ in important phenotypic characteristics remains to be determined. As well, minor DNA sequence differences have been reported between isolates of T saginata and Asian Taenia. There has been considerable discussion over a number of years regarding the taxonomic position of Asian Taenia and whether it should be regarded as a genotype, strain, subspecies or sister species of T saginata. The available molecular genetic data do not support independent species status for Asian Taenia and T saginata. What is in agreement is that both taxa are closely related to each other but distantly related to T solium. This is important in public health terms as it predicts that cysticercosis in humans attributable to Asian Taenia does not occur, because cysticercosis is unknown in T saginata. (C) 2005 Elsevier Ireland Ltd. All rights reserved.