Human and canine echinococcosis infection in informal, unlicensed abattoirs in Lima, Peru

Abstract

Echinococcus granulosus infections are a major public health problem in livestock-raising regions around the world. The life cycle of this tapeworm is sustained between dogs (definitive host, canine echinococcosis), and herbivores (intermediary host, cystic hydatid disease). Humans may also develop cystic hydatid disease. Echinococcosis is endemic in rural areas of Peru; nevertheless, its presence or the extension of the problem in urban areas is basically unknown. Migration into Lima, an 8-million habitant's metropolis, creates peripheral areas where animals brought from endemic areas are slaughtered without veterinary supervision. We identified eight informal, unlicensed abattoirs in a peripheral district of Lima and performed a cross-sectional study in to assess the prevalence of canine echinococcosis, evaluated by coproELISA followed by PCR evaluation and arecoline purge. Eight of 22 dogs (36%) were positive to coproELISA, and four (18%) were confirmed to be infected with E. granulosus tapeworms either by PCR or direct observation (purge). Later evaluation of the human population living in these abattoirs using abdominal ultrasound, chest X-rays and serology, found 3 out of 32 (9.3%) subjects with echinococcal cysts in the liver (two viable, one calcified), one of whom had also lung involvement and a strongly positive antibody response. Autochthonous transmission of E. granulosus is present in Lima. Informal, unlicensed abattoirs may be sources of infection to neighbouring people in this urban environment.

Figure 1. Sequence of evaluations performed in dogs (n = 26).

Figure 2. Map of Peru, indicating the geographical localization of Lima and studied abattoirs.

Figure 3. Human cystic hydatid disease.

Top row: Abdominal US images of patients with liver hydatid cysts, stages CE1 (A and C) or CE4 (B). Bottom row: Chest X-Rays (D and E) demonstrating a cystic lesion in the cardiophrenic angle, note the presence of air-liquid levels (arrow). (F) EITB result of a patient with liver and lung disease (strip 2), compared to a positive control (strip 3) and a negative control (strip1).