Cohen H, Paolillo E, Bonifacino R, Botta B, Parada L, Cabrera P, Snowden K, Gasser R, Tessier R, Dibarboure L, Wen H, Allan J C, Soto de Alfaro H, Rogan M T, Craig P S
Fundación San Antonio de Padua, Sarandi del Yi, Durazno, Uruguay.
Am J Trop Med Hyg. 1998 Oct;59(4):620-7. doi: 10.4269/ajtmh.1998.59.620.
A prevalence and transmission study of human cystic echinococcosis (CE), due to infection with the dog tapeworm Echinococcus granulosus, was undertaken in the village of La Paloma in central Uruguay. The human population was registered and screened for CE by abdominal ultrasound scan as well as a number of serologic tests. Dogs were screened for E. granulosus infection by arecoline purgation as well as specific coproantigen testing. The total prevalence of human CE (new cases and those with a previous history) was 5.6% (64 of 1,149); 3.6% (40) of the cases were new ultrasound detected asymptomatic cases (mean age = 45 years). Age prevalence increased from 1.1% in the 4-6-year-old group to > 11% in the > 60-year-old group; the 20-29-year-old group had a significantly higher CE rate of 7.4%, compared with younger and older age groups, and there was no difference between sexes. A CE rate of 3.9% (20 of 514) was also recorded by ultrasound for new cases in the population residing outside the village. Most of the hydatid cysts were located in the liver presenting as either univesicular cysts or a solid mass, and of those 71% and 63%, respectively, with such cyst presentations were seropositive against E. granulosus cyst fluid antigens. Two of eight individuals who were filter paper blood spot seropositive, but ultrasound scan negative, were subsequently diagnosed respectively with pulmonary hydatidosis after radiography, and hepatic hydatidosis after computed tomography scan. Of 36 households with a CE patient, 32 were single cases while four households each harbored two CE cases. This did not represent a clustered distribution within families (23 of 117). Almost 20% of the dogs from La Paloma were found infected with E. granulosus after purge examination, with a mean worm number of 67 (range = 1-1,020). An additional eight dogs that were purge negative were Echinococcus coproantigen positive. The study showed that human CE is highly endemic in Uruguay, with one of the highest local prevalence rates in the world. Transmission appears to occur readily within well-developed towns, as well as on rural sheep ranches. Mass screening by ultrasound scanning with confirmatory serologic testing is an effective approach to case detection at the community level.
在乌拉圭中部的拉帕洛马村开展了一项关于人体囊型棘球蚴病（CE）的患病率及传播情况的研究，该病由感染犬绦虫细粒棘球绦虫引起。对该村人口进行登记，并通过腹部超声扫描以及多项血清学检测对CE进行筛查。通过槟榔碱泻下法以及特定粪便抗原检测对犬类进行细粒棘球绦虫感染筛查。人体CE的总患病率（新病例及既往有病史者）为5.6%（1149人中64例）；3.6%（40例）为新超声检测出的无症状病例（平均年龄 = 45岁）。年龄患病率从4 - 6岁组的1.1%增至60岁以上组的超过11%；20 - 29岁组的CE患病率显著更高，为7.4%，与较年轻和较年长年龄组相比，且男女之间无差异。居住在村外人群中的新病例通过超声检测的CE患病率为3.9%（514人中20例）。大多数包虫囊肿位于肝脏，表现为单房囊肿或实性肿块，其中分别有71%和63%的此类囊肿表现者对细粒棘球绦虫囊肿液抗原血清学呈阳性。8名滤纸血斑血清学呈阳性但超声扫描阴性的个体中，有2人随后分别经X线摄影诊断为肺包虫病，经计算机断层扫描诊断为肝包虫病。在有CE患者的36户家庭中，32户为单病例，4户家庭各有2例CE病例。这并不代表在家庭内部呈聚集性分布（117户中有23户）。经泻下检查后，发现拉帕洛马村近20%的犬感染了细粒棘球绦虫，平均虫数为67条（范围 = 1 - 1020条）。另外8只泻下检测为阴性的犬粪便棘球绦虫抗原呈阳性。该研究表明，人体CE在乌拉圭高度流行，是世界上局部患病率最高的地区之一。传播似乎在发达城镇以及农村牧羊场中都很容易发生。通过超声扫描进行大规模筛查并辅以确证性血清学检测是在社区层面进行病例检测 的有效方法。
