Human alveolar echinococcosis in Poland: 1990-2011

Abstract

Background: Alveolar echinococcosis (AE) caused by Echinococcus multilocularis infections is a dangerous old disease in the Northern Hemisphere. The aim of the paper was to collect and analyze data on human AE in Poland in the last two decades.

Methodology/principal findings: The sources of data were both the cases officially registered and detected by an active field and laboratory surveillance. The cases were verified by clinical, epidemiological, and laboratory criteria. Altogether 121 human cases of AE were detected. Among these 83 (68,6%) cases were classified as confirmed, 16 as probable and 22 as possible. During the two decades a continuous increase in detection rate was noticed. The cases were 6-82 years old at the time of diagnosis (mean - 47.7 years). Sex ratio M/F was 0.86/1.0. The AE was fatal in 23 (19%) patients (mean age at death - 54.1 years). Family agglomeration of AE was found in 4 foci, involving 9 patients. Seventy six of the cases were diagnosed in an advanced stage of disease. In all cases the liver was the primary location of AE. In 30 (24.8%) patients a spread to other organs was observed. Ninety four of the patients were treated with albendazole. In 73 (60%) patients a surgical operation was performed, including 15 liver transplantations.

Conclusions/significance: The studies confirmed that AE is an emerging disease in Poland, which is the fourth country in Europe with over 120 cases detected. The results also indicate the need of a wider national programme for implementation of screening in the highest AE risk areas (north-eastern Poland) with an effort to increase the public awareness of the possibility of contracting E. multilocularis, and above all, training of the primary care physicians in the recognition of the risk of AE to allow for an early detection of this dangerous disease.

Figure 1. Human AE cases in Poland diagnosed in 5-year interval.

Figure 2. Age of 117 patients in the year of AE diagnosis and death of 21 persons.

Figure 3. Geographical distribution of human AE cases in Poland.

A – Number of AE cases in each province. Localizations of three patients could not be determined. A – Pomorskie Province; B – Varmia-Masuria Province; C- Podlaskie Province. B – Distribution of 65 AE cases in the Varmia - Masuria Province. Global area amounts to 24 173 km², and population 1 426 155 (2008). a – Elbląski district; b – Lidzbarski district; c – Kętrzyński district; d – Węgorzewski district; e – Iławski district.