Intended for healthcare professionals

Clinical Review

Diagnosis, treatment, and management of echinococcosis

BMJ 2012; 344 doi: (Published 11 June 2012) Cite this as: BMJ 2012;344:e3866
  1. Donald P McManus, National Health and Medical Research Council (Australia) senior principal research fellow; laboratory head1,
  2. Darren J Gray, Australian Research Council fellow (DECRA); visiting scientist12,
  3. Wenbao Zhang, senior research officer1,
  4. Yurong Yang, Griffith University research fellow; professor; visiting scientist134
  1. 1Queensland Institute of Medical Research, Herston, Brisbane, Queensland, Australia
  2. 2School of Population Health, University of Queensland, Brisbane, Australia
  3. 3Griffith Health Institute, Griffith University, Brisbane, Australia
  4. 4Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, People’s Republic of China
  1. Correspondence to: D P McManus don.mcmanus{at}

Summary points

  • Echinococcosis is a parasitic zoonosis caused by Echinococcus cestode worms

  • The two major species of medical importance are Echinococcus granulosus and E multilocularis, which cause cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively

  • CE and especially AE are life threatening chronic diseases with a high fatality rate and poor prognosis if careful clinical management is not carried out

  • Human CE is cosmopolitan and the more common presentation, accounting for most of the estimated two to three million global echinococcosis cases. AE has an extensive geographical range in the northern hemisphere

  • Diagnosis is based on clinical findings, imaging (radiology, ultrasonography, computed axial tomography, magnetic resonance imaging), and serology

  • Treatment options for CE are: surgery, percutaneous sterilisation, drugs, and observation (watch and wait). Surgery is the basis of treatment for early AE, but patients not suitable for surgery and those who have had surgical resection of parasite lesions must be treated with benzimidazoles (albendazole, mebendazole) for several years

Echinococcosis (hydatid disease) is caused by the larvae of dog and fox tapeworms (cestodes) of the genus Echinococcus (family Taeniidae).1 2 3 This zoonosis is characterised by long term growth of metacestode (hydatid) cysts in humans and mammalian intermediate hosts. The two major species that infect humans are E granulosus and E multilocularis, which cause cystic echinococcosis (CE) and alveolar echinococcosis (AE). A few reported cases of polycystic echinococcosis in Central and South America are caused by E vogeli and E oligarthrus.2 w1 w2 The clinical potential of two other Echinococcus species (E shiquicus and E felidis) is unknown.1 2

Sources and selection criteria

We obtained information from personal reference archives, personal experience, and extensive literature searches of the PubMed and Cochrane databases. We sourced English language papers that were fully published mainly between 2000 and March 2012 using appropriate index terms. …

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