Case studies emphasising the difficulties in the diagnosis and management of alveolar echinococcosis in rural China

We describe a case of a patient with hepatic AE, and AE metastases of the brain. She was mistakenly diagnosed with suspected undifferentiated metastatic cancer of the liver and brain, and with a pulmonary bacterial infection, but was subsequently correctly diagnosed during a follow-up field survey for echinococcosis. The diagnosis of brain AE was confirmed by pathological examination of tissue biopsies removed during neurosurgery. We also briefly describe other symptomatic and asymptomatic AE cases, identified by chance, likely due to the inadequate facilities available in rural communities in China for AE diagnosis and management, since the rapid and accurate diagnosis of metastatic AE requires a high level of expertise in the appropriate diagnostic procedures.This report highlights the necessity for an upgrade in the diagnosis, treatment, prevention and control of AE in rural China.Alveolar echinococcosis (AE) is caused by the larval stage of the fox tapeworm Echinococcus multilocularis. E. multilocularis has a sylvatic lifecycle with canids (foxes and coyotes) as the definitive hosts, and arvicolid rodents (voles), which harbour the larval metacestode stage, as intermediate hosts. Foci of human AE also occur where foxes or domestic dogs feed on infected rodents [1] and where there is accidental ingestion of E. multilocularis eggs from canine faecal matter.Generally, human infection with E. multilocularis results in an asymptomatic chronic disease lasting 10-15 years. AE is characterised by primary lesions in the liver which produce a tumour-like multi-vesicular, infiltrating structure. Early diagnosis of AE by characteristic symptoms, imaging techniques, serology, histopathological examination or molecular analysis of biopsied material can improve the management and treatment of AE patients. Recently developed and improved serological tests for AE have been shown to be reliable [2] but, in most rural communities of China, these tests are not generally available.