ECHINOCOCCUS GRANULOSUS AND ITS

SCENARIO IN NEPAL

R.Bashyal1 and K. Kaphle2

1
B.V. Sc. & A.H. 9th Semester, Paklihawa Campus, Institute of
Agriculture and Animal Sciences, Tribhuvan University,
S.N.P-1, Bhairahawa, Rupandehi, Nepal

2
Department of Theriogenology, Paklihawa Campus, Institute
of Agriculture and Animal Sciences, Tribhuvan University,
S.N.P.-1, Bhairahawa, Rupandehi, Nepal

1
Abstract

Parasitic zoonotic diseases are prevalent throughout Nepal at varying rates. Reports of zoonotic
parasites has been recorded in both the humans and animals. Echinococcus granulosus is one of the
important zoonosis affecting human health and livestock production. It is a common gasterointestinal
parasite, that harbours canines as a definitive host and herbivores such as goat,sheep,buffalo and
swine as intermediate host.The human is a dead end host. Adult E. granulosus is found in the small
intestine of dogs and hyadatid cyst(metacestode) is manifested in herbivores and humans. Presence of
large number of E.granulosus cause enteritis , diarrhea and other digestive disturbances in dog. For
intermediate host,pathogenesis of hyadatid cyst depends upon the organ of their presence and also
upon their number and size. Echinococccus granulosus was first investigated in Nepal in 1973.Since
then, different researches about it in animals and humans have been conducted time to time.The aim of
this paper is to review reported information on status, associated risks and preventive measures of E.
granulosus in Nepal. A systematic review of available papers published in different magazines, journals,
conference souvenirs through hard copy and online search from Google Scholar, Research Gate was
done. The obtained information was thoroughly reviewed for biology, lifecycle , distribution and
transmission of E. granulosus ,and epidemiology, clinical features, treatment and effect of improved
diagnosis was re-analyzed and summarized. Despite some progress in the control of Echinococcus, this
zoonosis continues to be a major health hazard in different countries including Nepal and in several
others , it constitutes emerging and re-emerging disease.
 
Keywords: Echinococcus, review, status , Nepal

2
 What is
• It’s biology?
Echinococcus?

Echinococcus
granulosus

Zoonotic Control
Status?
significance? strategy?
3
 General Description
• Cestode that causes cystic echinococcosis/ hydatidosis in
diferent animals and humans.
• CE is listed in OIE Terrestrial Animal Health Code.
• Listed by the World Health Organization as a neglected
zoonotic disease.
• Major public health issue in both developed and developing
countries (Parija & Giri, 2012).
• According to WHO, more than 1 million people are
affected with echinococcosis at any one time.
• Annual costs associated with cystic echinococcosis are
estimated to be US$ 3 billion for treating cases and losses to
the livestock industry. 4
 Historical Background
• Hydatid cyst was first described by Hippocrates
in 4th century AD. (Connolly & Smith, 2019)
• Francesco Redi in 1684 AD recognized cyst of
Echinococcus granulosus in sheep as parasite.
(Connoll & Smith, 2019)
• Later in 1766, Pierre Simon Pallas correctly
suggested these were the larva of tapeworm.
• Full understanding of the clinical features came
about in late 1800’s.
5
Distribution

6
Semantic Scholar
 Morphology
• Segmented helminths(cestodes)
• Placed under Taenidae family
• Length:2 mm-7 mm
• Breadth:0.6 mm
• Entire body consists of a single scolex and 3-4
segments

7
Morphology

8
 Hosts
• Definitive Host: Canines(dog,jackal,fox),
felines
• Intermediate host:sheep , goat, cattle,
buffaloes, pig, camel and man
• Most susceptible intermediate host:sheep
• Human is accidental host(dead end host).

9
Life Cycle

10
Life Cycle

The Global Water Pathogen Project (GWPP) 11

 PATHOPHYSIOLOGY

• Hydatid cyst in Intermediate Host

• Digestive disorders in Definitive host

12
Allergy(Anaphylactic Swiss TPH
Peritoneal cyst
Shock)

Rupture Hepatomegaly

Hydatid cyst in liver

Liver infection

Lung cyst Bone cyst Brain Cyst Any organ

Breathlessness Fracture Compression Tumor

13
 Symptoms in Dogs
• Generally doesn’t present with specific symptoms.
• Some signs suggestive to Echinococcus infection are:
 Itching around the anus
 Licking of the perianal and anal areas
 Butt scooting
 Weight loss when appetite is normal
 Increased appetite without the expected weight gain
 Less than desirable coat and skin conditions
 Swollen and painful abdominal area
 Diarrhea ,Lethargy ,Irritability

14
 Diagnosis in Humans
• Direct X-rays
• Ultrasonography
• Computed tomography scan
• Magnetic resonance imaging

15
USG: Hydatid cyst in liver X-ray: Hydatid cyst in lungs
(Rediopedia) (Rediopedia)

16
 Diagnosis in Dogs
• Faecal egg Examination
• Coproantigen Enzyme-linked immunosorbent
assay (CELISA)
• Identification by PCR

17
 Treatment in Humans
• Surgical removal of hydatid cyst
• PAIR procedure(PercutaneousAspiration-Injection-
Reaspiration)
• Anti-infective drug treatment
 The efficacy of albendazole is superior to that of
mebendazole (Raymond,2005)
 Albendazole:10-15mg/kg BID
 Mebendazole: 40-50 mg/kg TID
 Praziquantel: 50 mg/kg (once a week or twice a week)

18
 Treatment in Dogs

• Praziquantel is approved at 5mg/kg orally or

subcutaneously for elimination of intestinal
stages of adult  Echinococcus  spp. in dogs.
(McManus et al, 2012)
• To limit opportunities for re-infection,
treatment of Echinococcus spp. in dogs and
cats must be combined with management.

19
 Scenario in Nepal
• First investigated in 1973 when echinococcal
cyst was found in buffalo, goat, sheep and pigs
in slaughter house in Kathmandu Valley.
• Between 2000 and 2012, Echinococcosis is the
third most parasitic zoonosis imposing annual
burden after neurocystocercosis and congenital
toxoplasmosis.(Dorny,2015)

20
S.N. Animal Sample Positive cases Positive cases
species Size in Number in Percentage

1 Buffalo 3065 153 5%

2 Goat 1783 55 3%

3 Sheep 150 12 8%

4 Pig 143 10 7%

Echinococcosis in Kathmandu, Nepal (Joshi; 1995).

21
S.N Site Sample size Positive Positive Record Method
Cases in cases in
number percentage

1. Kathmandu 244 3 1.22% Boronet, 1994 Coproantigen

1 Kathmandu 291 30 10 % Joshi, 1995 Faecal egg

2 Kathmandu 348 64 18% Joshi, 1996 Faecal egg

3 Kathmandu 366 47 12.8% Manandhar, Faecal egg

2006
4 Kathmandu 210 15 7% Satyal, 2013 Faecal eggs

5 Kathmandu 66 0 0 Shrestha, 2015 Faecal egg

6 Rupandehi 400 37 9.36% Yadav, 2017 Faecal egg

Table: Canine Faecal examination 22
 Hydatid Cyst cases in Human in Nepal
S.N Duration Total Location Hydatid Male Female Liver Lungs
(Record) cases of case
surgery

1. 1979- 27118 kathmandu 76 30 46 57 19

1983
(Joshi,
1996)
2. 1985- 30792 Kathmandu 47 26 21 25 22
1990
(Joshi,
2003)

3. 2006- - Manipal Teaching 33 9 24 24 4

2014 Hospital,pokhara
(Hazra et
al, 2015) 23
 Risk Factors in Nepal
• High population of street dogs and allowing street
and pet dogs to roam free.
• Lack of regular deworming in dogs.
• Feeding dogs with viscera.
• Slaughtering at home.
• Lack of sanitation, personal hygiene.
• Lack of government supervision in meat inspection.
• Roadside grazing of animals.

24
 Control and Prevention

• Population control and management of stray dogs.

• Prevention of predation and scavenging activity of dogs and
cats.
• Regular deworming of dogs and cats
• Treatment with praziquantel before transportion of dogs and
cats.
• Slaughter management and proper disposal of condemn meat
and offals.
• Vaccination in sheeps with  an E. granulosus recombinant
antigen (EG95)

25
 Conclusion
• Echinococcosis is an emerging and re-emerging
zoonotic disease affecting both humans and
animals.
• Hydatidosis has lead to many human deaths in
Nepal.
• Infection remains persistant for life in
intermediate host due to slow growing pattern
of cysts and retards overall growth of animals
and their production affecting farmers’
economics. 26
 Conclusion cont..
• Research done in E. granulosus in Nepal is
very less and is centered to kathmandu valley.
• Adequate and widespread research and
plannings along with their implementation are
prerequisite for its control.

27
 Acknowledgement
I would like to acknowlodge
• Subash Chhetri
• Binita Poudel
• And all my friends

28
 References
• Joshi DD. Surveillance of Echinococcosis/Hydatidosis in Humans and Animals of
Kathmandu, Nepal. Published by Nepal Medical Research Committee and submitted to
WHO, 1984.
• Joshi DD. Epidemiological survey of human Echinococcosis/Hydatidosis in Kathmandu.
Proceedings of the Twelfth all Nepal Medical Conference. 1985a: 1.27-1.35.
• Final Report of the Epidemiological Study of Echinococcosis/Hydatidosis in Humans
and Animals of Kathmandu, Nepal. Prepared by National Zoonoses and Food Hygiene
Research Centre and submitted to IORC, Ottawa, Canada, 1992.
• First Annual Progress Report. Urban Echinococcosis in Health Transition (Nepal).
Prepared by National Zoonoses and Food Hygiene Research Centre and submitted to
IORC, Ottawa, Canada, 1993.
• Joshi DD. Echinococcosis/Hydatidosis infection in animals of Kathmandu. Bul Vet Sci A
H Nepal 1985b; 13: 5-9.
• Yadav KK, Shrestha B. Prevalence of Zoonotic Gastrointestional Helminth Parasites in
Pet and Stray Dogs of Rupandehi District, Nepal. Microbiol Infect Dis. 2017; 1(2): 1-7.

29
• Joshi DD, Waltner-Toews 0, Gurung CK, Chanda PB, Schantz PM, Bhatta DR.
Echinococcosis in Kathmandu, Nepal. (unpublished document). 1995.
• Raymond A. Smego, Peter Sebanego,Treatment options for hepatic cystic
echinococcosis, International Journal of Infectious Diseases, Volume 9, Issue 2,
2005,Pages 69-76, ISSN 1201-9712,
• McManus DP, Gray DJ, Zhang W, and Yang Y. Diagnosis, treatment, and management
of echinococcosis.  BMJ Jun 2012,11; 344:e3866
• De NV, Le Van D. The first report of two cases of cystic echinococcosis in the lung
by Echinococcus ortleppi infection, in Vietnam, Dovepress, Volume 8, 2017, Pages45-
51
• Devleesschauwer B, Ale A, Torgerson P, Praet N, Maertens de Noordhout C, Pandey
BD, et al. The Burden of Parasitic Zoonoses in Nepal: A Systematic Review. PLoS Negl
Trop Dis,2014, 8(1): e2634. https://doi.org/10.1371/journal.pntd.0002634 11.Yadav
KK, Shrestha B. Prevalence of Zoonotic Gastrointestional Helminth Parasites in Pet
and Stray Dogs of Rupandehi District, Nepal. Microbiol Infect Dis. 2017; 1(2): 1-7.

30
• Satyal, R., Manandhar, S., Dhakal, S., Mahato, B., Chaulagain, S., Ghimire, L., & Pandeya, Y.
Prevalence of gastrointestinal zoonotic helminths in dogs of Kathmandu,
Nepal. International Journal of Infection and Microbiology. 2013; 2(3), 91-94.
https://doi.org/10.3126/ijim.v2i3.8211
• D. Baronet, D. Waltner-Toews, P. S. Craig & D. D. Joshi Echinococcus granulosus infections in
the dogs of Kathmandu, Nepal, Annals of Tropical Medicine & Parasitology, 1994,88:5, 485-
492, DOI: 10.1080/00034983.1994.11812895
• Manandhar S, Hörchner F, Morakote N, Kyule MN, Baumann MP. Occurrence of hydatidosis
in slaughter buffaloes (Bos bubalis) and helminths in stray dogs in Kathmandu Valley, Nepal.
Berl Munch Tierarztl Wochenschr. 2006 Jul-Aug;119(7-8):308-11. PubMed PMID: 17009714.
• Hazra, N. K., Batajoo, H., Ghimire, S., & Sathian, B. Open conservative surgical
management of cystic echinococcosis in a tertiary care hospital, Nepal. Journal of Clinical
and Diagnostic Research, 2017,9(7), 16–18. https://
doi.org/10.7860/JCDR/2015/12599.6151
• Bhatia B.B., F. professor and H. E.-E. S., Pathak K.M.L., D. D. G. (Animal S., & Juyal P.D.,
P. and E.-H. D. of V. P. (2004). No Title (Third Revi). New Delhi: Kalyani Publishers.
• Devleesschauwer, Brecht & Ale, Anita & Torgerson, Paul & Praet, Nicolas & Maertens de
Noordhout, Charline & Pandey, Basu & Bahadur Pun, Sher & Lake, Rob & Vercruysse,
Jozef & Datt Joshi, Durga & Havelaar, Arie & Duchateau, Luc & Dorny, Pierre &
Speybroeck, Niko. (2014). The Burden of Parasitic Zoonoses in Nepal: A Systematic
Review. PLoS neglected tropical diseases. 8. e2634. 10.1371/journal.pntd.0002634.
31
32