Hydatidosis–echinococcosis in Greece

doi:10.1016/S0001-706X(02)00273-5

Acta Tropica

Volume 85, Issue 2, February 2003, Pages 197-201

https://doi.org/10.1016/S0001-706X(02)00273-5 Get rights and content

Abstract

Hydatidosis/echinococcosis (Echinococcus granulosus infection) is considered to be a serious problem for both public health and the livestock economy in Greece. The present paper reviews and summarizes all data available on this disease since 1970. The disease was widely prevalent long before the 1970s. At that time the annual surgical incidence rate was 12.9 per 100 000 inhabitants. As a result of the seriousness of the disease, the Greek Department of Veterinary Services initiated an anti-echinococcosis campaign in 1984. When the program started, the prevalence of infection in farm animals was 82% in cattle, 80% in sheep, 24% in goats and 5% in pigs. Data obtained in a survey in Northern Greece in 1994, recorded the prevalence of CE as 100% in sheep, 56.6% in cattle, 15.4% in goats and 9.3% in pigs; sheep had not only more cysts but significantly higher rates of fertile cysts (e.g. contained viable protoscolices) than intermediate host species examined. Serologic surveys (specific IgG) in humans carried out between 1988 and 1999 had shown seroprevalence up to 29%. Surveillance in livestock species, since 1998, carried out as part of an European Union (E.U.) project, have documented the prevalences of CE in sheep (31.3%), in goats (10.3%), in pigs (0.6%) and in cattle (0%). The official campaign against this zoonosis in Greece is ongoing. It is concluded that since hydatidosis/echinococcosis is still present, surveillance and intervention measures should be continued to track the course of the infection and to eliminate risk to humans.

Introduction

Hydatidosis–echinococcosis (Echinococcus granulosus infection) is a very old and still existent problem in Greece. The disease was first described, in ancient times, by Hippocrates as ‘cysts full of water’ in a liver of a man, and by Aristotle in both human lungs and liver. To date, and in spite of the significant progress achieved in the field of research and control, human and animals cystic echinococcosis caused by E. granulosus remains a considerable problem for public health and the livestock economy in Greece. In continental situations control of E. granulosus is a very difficult and costly task that requires sustained efforts over many decades. To date, echinococcosis transmission has been successfully reduced or interrupted in some limited areas only, most notably on islands such as Iceland, Cyprus, New Zealand and Tasmania (Eckert, 2001).

The present paper reviews all data available on this disease in Greece since 1970.

Section snippets

Historical studies

The disease was widespread in Greece long before the 1970s. In the modern era, the first recognized human infection was reported in 1839. By 1900, the number of human cases was officially recorded as 51 (Tsaglas, 1985). Reviewing such historical data it was virtually impossible to assemble representative and accurate national epidemiological data, especially before the 1970s. This in general, and not only in Greece, is a very laborious task mostly because of the difficulties in collecting and

Human hydatidosis

According to the National Statistical Service of Greece and the Greek Ministry of Health the incidence of human cystic echinococcosis, for the years 1967–1981 was estimated to be 12.9 per 100 000 inhabitants. The incidence over this period steadily declined and more precisely the exact rates for the years 1967–1971, 1972–1976 and 1977–1981 were 14.8, 12.9, and 10.9 per 100 000 inhabitants, respectively. It should be mentioned that reports of human surgical cases rarely indicate if the patient

Hydatidosis in livestock species

The reported prevalence of hydatidosis among various species of farm animals varied significantly from year to year, area-to-area and with animals’ age. The official prevalence in Greece from 1973 to 1977 was: 53% for cattle raised outdoors, 17.9% for cattle raised indoors, 61% for sheep, 7.2% for goats and 1.9% for pigs (Vassalos et al., 1984, Tsaglas, 1985).

More precisely, cysts were detected in 16 and 80% of sheep less than and more than 2 years old, respectively (Vassalos, 1978, Donos, 1979

Echinococcosis in definitive hosts

Regarding prevalence of E. granulosus infection in dogs in Greece it has to be stressed that dog registration was not compulsory in Greece and consequently there are no data regarding canine population size. National estimates of the total numbers of dogs have varied between 500 000 and 1 500 000 (Himonas).

The infection prevalence in dogs differs significantly from area-to-area and according to dogs’ environment and ‘occupation’. The data recorded are: shepherd dogs 50.4%, sentinel dogs 26.9%,

Anti-echinococcosis control campaign

As result of the high prevalence of infection in animals and man, the economic losses caused by this disease in Greece have been calculated to approximate 3 671 357 000 Greek drachmas (10 774 342 €) (Tsaglas, 1985). Since 1978 (law nr. 829/78) there is a national control program elaborated in 1984 (degree-law 400/84). When the program started, the prevalence of infection in farm animals was recorded as 82% in cattle, 80% in sheep, 24% in goats and 5% in pigs.

The main principles of this program

EC middle east/Mediterranean CE project

Since 1998 and, within the framework of an European Union project, studies regarding the epidemiology of the disease have been carried out in Thessaloniki, Northern Greece. The results obtained to date have documented prevalence of 31.3% in sheep (0.7% to <1 year old, 2.2% to 1–2 years old, 70.7% to >2 years old), 10.3% in goats (0% to <1 year old, 13.6% to >2 years old), 0% in cattle 0.6% in pigs. From the infected sheep 8% of the cyst were fertile, none from the infected goats and the cysts

References (33)

M. Antoniou et al.
The seroprevalence of ten zoonoses in two villages of Crete, Greece
Eur. J. Epidemiol.
(1995)
K. Athanasiadi et al.
Surgical treatment of echinococcosis by a transthoracic approach: a review of 85 cases
Eur. J. Cardiothorac. Surg.
(1998)
A. Donos
Echinococcosis in Greece
Geotexnika
(1979)
A.R. Ecca et al.
Cystic echinococcosis in the Mediterranean basin
Eckert, J., 2001. Echinococcosis: an emerging and re-emerging zoonoses. WHO Mediterranean Zoonoses Control Centre...
Eleftheriades, I., Manousos, A., 1981. The incidence of echinococcal disease in recruits. Hellenic Armed Forces Medical...
N. Eskitzis et al.
Portal vein hypertension syndrome as the first manifestation of liver hydatid cysts
Hellen. Iatr.
(1984)
M.A. Gemmell et al.
Control of echinococcosis/hydatidosis: present status of worldwide progress
Bull. World Health Organ.
(1986)
A. Gouskos et al.
Primary echinococciasis of the female genitalia (two cases report)
Hellen. Iatr.
(1974)
Gouzoumas, M., Tzinieris, D., 1984. Echinococcosis (problems in Greece), Diploma Thesis. Agia Sofia Hospital,...

Himonas, C., 1968. Parasites of dog in Greece and their importance to public health. Dissertation. Yearbook of...

Himonas, C., unpublished. Parasitic Diseases of...

C. Himonas et al.

The fertility of hydatid cysts in food animal in Greece

Helminth. Zoonoses

(1987)

C. Himonas et al.

Hydatidosis of food animals in Greece: prevalence of cysts containing viable protoscoleces

J. Helminthol.

(1994)

M. Kaoutzanis et al.

Hydatid disease affecting the vertebrae

Acta Neurochir.

(1989)

F. Kardaras et al.

Fifteen years surveillance of echinococcal heart disease from a referral hospital in Greece

Eur. Heart J.

(1996)

Cited by (65)

Seroprevalence of human cystic echinococcosis in South Kashmir, India
2020, Parasite Epidemiology and Control
Cystic echinococcosis is a zoonotic disease that causes economic losses and public health problems throughout the globe. Present study was undertaken to estimate the seroprevalence of cystic echinococcosis in humans of South Kashmir and to determine the risk factors associated with this disease. The present study was carried out from April 2017 to March 2018, during which 458 blood samples (from 222 males and 236 females) were collected from selected subjects from 12 villages of four districts along with demographic characteristics. Samples were analyzed by an Enzyme-linked Immunosorbent Assay (ELISA) (commercially prepared kit) for detection of immunoglobulin IgG against cystic echinococcosis. Out of 458 samples, 20(4.36%) samples were found positive. Results implied that the seroprevalence of cystic echinococcosis in South Kashmir had significant relationship with age, gender and occupation (P < .05). Seroprevalence for cystic echinococcosis was significantly higher among males, children, and illiterate persons.
Global Distribution of Alveolar and Cystic Echinococcosis
2017, Advances in Parasitology
Citation Excerpt :
In Greece, CE was widely prevalent long before the 1970s (Sotiraki and Chaligiannis, 2010). The prevalence of infection in farm animals was as high as 82% in cattle, 80% in sheep, 24% in goats and 5% in pigs (Sotiraki et al., 2003). In definitive hosts, prevalences were as follow: sheepdogs 50.4%, sentinel dogs 26.9%, hunting dogs 19.2%, urban stray dogs 9.3% and companion (pet) dogs 0–1% (Sotiraki et al., 2003).
Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.
An ethnopharmacological and historical analysis of "dictamnus", a European traditional herbal medicine
2015, Journal of Ethnopharmacology
“Dictamnus” was a popular name for a group of medicinal herbaceous plant species of the Rutaceae and Lamiaceae, which since the 4th century have been used for gynaecological problems and other illnesses BCE and still appear in numerous ethnobotanical records.
This research has as four overarching aims:
Determining the historical evolution of medical preparations labelled “Dictamnus” and the different factors affecting this long-standing herbal tradition.
Deciphering and differentiating those medicinal uses of “Dictamnus” which strictly correspond to Dictamnus (Rutaceae), from those of Origanum dictamnus and other Lamiaceae species.
Quantitatively assessing the dependence from herbal books, and pharmaceutical tradition, of modern Dictamnus ethnobotanical records.
Determining whether differences between Western and Eastern Europe exist with regards to the Dictamnus albus uses in ethnopharmacology and ethnomedicine.
An exhaustive review of herbals, classical pharmacopoeias, ethnobotanical and ethnopharmacological literature was conducted. Systematic analysis of uses reported which were standardized according to International Classification of Diseases – 10 and multivariate analysis using factorial, hierarchical and neighbour joining methods was undertaken.
The popular concept “Dictamnus” includes Origanum dictamnus L., Ballota pseudodictamnus (L.) Benth. and B. acetabulosa (L.) Benth. (Lamiaceae), as well as Dictamnus albus L. and D. hispanicus Webb ex Willk. (Rutaceae), with 86 different types of uses. Between 1000 and 1700 CE numerous complex preparations with “Dictamnus” were used in the treatment of 35 different pathologies. On biogeographical grounds the widespread D. albus is a far more likely prototypical “Dictamnus” than the Cretan endemic Origanum dictamnus. However both form integral parts of the “Dictamnus” complex.
Evidence exists for a sufficiently long and coherent tradition for D. albus and D. hispanicus, use to treat 47 different categories of diseases.
This approach is a model for understanding the cultural history of plants and their role as resources for health care. “Dictamnus” shows how transmission of traditional knowledge about materia medica, over 26 centuries, represents remarkable levels of development and innovation. All this lead us to call attention to D. albus and D. hispanicus which are highly promising as potential herbal drug leads. The next steps of research should be to systematically analyse phytochemical, pharmacological and clinical evidence and to develop safety, pharmacology and toxicology profiles of the traditional preparations.
Echinococcus granulosus infection dynamics in livestock of Greece
2015, Acta Tropica
An epidemiological and molecular survey on the occurrence of Echinococcus hydatid cysts in livestock was conducted in Greece. In total 898 sheep, 483 goats, 38 buffaloes, 273 wild boars and 15 deer were examined and 30.2% (6.45% cyst fertility), 7.86% (3.2% cyst fertility), 42% (7.9% cyst fertility), 1.1% (0% cyst fertility), 0% of them were found infected, respectively. Infection rate in different geographical regions varied between 26.1 and 53.8% (cyst fertility 2.04 and 34.6%) in sheep, 7.33 and 13.3% (cyst fertility 0 and 3.2%) in goats. Genotyping, based on cox1 and nad1 analyses, demonstrated the predominance of E. granulosus s.s. (G1 genotype). The presence of one single genotype-complex within a relatively large spectrum of intermediate host species in Greece indicates the presence of a dominant transmission dog–sheep cycle involving additional host species which may act as disease reservoir for human infections.
Canine echinococcosis: Global epidemiology and genotypic diversity
2013, Acta Tropica
Canine echinococcosis is a potential zoonotic infection caused by the adult form of several cestode species belonging to the genus Echinococcus, of which E. granulosus sensu lato and E. multilocularis are the most epidemiologically relevant. Dogs infected with E. granulosus and E. multilocularis are widely regarded as the main source of infection for human cystic and alveolar echinococcosis, diseases that cause substantial morbidity and socio-economic burden in several regions of the world. Following our previous review on the global situation of cystic echinococcosis in livestock species (Cardona and Carmena. Vet. Parasitol. 2013;192:10–32), we summarize here current knowledge on the global epidemiology, geographical distribution and molecular diversity of Echinococcus spp. infection in dogs. We address relevant topics including the implications of the increasing urbanization of wildlife species such as foxes, coyotes, and dingoes in the establishment of urban cycles of Echinococcus spp., or the rising concerns regarding the role of unsupervised translocation of infected dogs in spreading the infection to Echinococcus-free areas. The involvement of wildlife species as natural reservoirs of disease to domestic animals and humans and the epidemiological significance of the sympatric occurrence of different Echinococcus species in the same geographical region are also debated. Data presented are expected to be useful for policy makers, educational and health authorities responsible for designing and implementing effective measures for disease control and prevention.
A mass screening survey of cystic echinococcosis by ultrasonography, Western blotting, and ELISA among university students in Manisa, Turkey
2013, Acta Tropica
Cystic echinococcosis (CE) is one of the most important zoonotic diseases in a wide geographic area, including Turkey. In the present project, a total of 4275 students from Celal Bayar University, Manisa, Turkey, were screened by ultrasonography (US) and specific antibodies for CE were examined by Western blotting (WB) and ELISA in finger prick blood samples of 2034 of 4275 volunteered students. We aimed to report the apparent prevalence of CE based on different diagnostic procedures and to compare WB and ELISA with US in diagnosis of CE in a mass screening setting. Six new cases were diagnosed as CE by US during the survey. In addition to these cases, three students were also detected to have been previously operated and pathologically confirmed for hepatic CE. US revealed parenchymal changes in these cases in concordance with their operation history; so, the prevalence of CE by US was calculated as 0.21% (9/4275) (95%CI, 0.11–0.39%) among university students in Manisa. Bands were detected at 8, 28, 32, 38, 42, 47, 70 and 90 kDa by WB and the cases were considered to be positive for CE when at least three of the bands were seen together. Apparent prevalence of CE by ELISA and WB were found to be 2.11% (43/2034) (95%CI, 1.57–2.83%) and 0.25% (5/2034) (95%CI, 0.10–0.57%), respectively. Of the six US positive cases, WB was positive in only one case with two cysts in the liver. All of four cases with liver involvement were positive by ELISA. The high prevalence of CE among university students in Manisa indicated that CE is a major health problem in this area of Turkey. Our results supported that WB is rather difficult and not feasible as a mass screening test and may not be effective for confirmation especially in asymptomatic cases. As a result, we recommend US to be used initially in mass screening surveys for CE followed by confirmation by ELISA for suspected cases. Further examination primarily by chest X-ray followed by computed tomography and/or magnetic resonance imaging, if needed, should be recommended for US negative, ELISA and WB positive individuals who may have non-abdominal cysts.

View all citing articles on Scopus

View full text

Review articleHydatidosis–echinococcosis in Greece

Abstract

Introduction

Section snippets

Historical studies

Human hydatidosis

Hydatidosis in livestock species

Echinococcosis in definitive hosts

Anti-echinococcosis control campaign

EC middle east/Mediterranean CE project

The seroprevalence of ten zoonoses in two villages of Crete, Greece

Eur. J. Epidemiol.

Surgical treatment of echinococcosis by a transthoracic approach: a review of 85 cases

Eur. J. Cardiothorac. Surg.

Echinococcosis in Greece

Geotexnika

Cystic echinococcosis in the Mediterranean basin

Portal vein hypertension syndrome as the first manifestation of liver hydatid cysts

Hellen. Iatr.

Control of echinococcosis/hydatidosis: present status of worldwide progress

Bull. World Health Organ.

Primary echinococciasis of the female genitalia (two cases report)