Cystic Echinococcosis in Northern New Hampshire, USA

Echinococcus granulosus is a zoonotic cestode that lives within the gut of its definitive host, canids (e.g., canine, coyotes, foxes, wolves). Embryonated eggs launched in canid feces are instantly infectious when consumed by an intermediate host, normally an ungulate (e.g., moose, deer, sheep) or generally a human (aberrant intermediate host). An ingested egg hatches within the small gut, changing into an oncosphere that travels to organs such because the lung, liver, spleen, bone, or mind the place it kinds a thick-walled cyst. Canids turn out to be contaminated once they ingest flesh and viscera of an contaminated intermediate host (1). We report 2 human circumstances of E. granulosus tapeworm an infection in northern New Hampshire, USA, throughout 2022.

In April 2022, an in any other case wholesome middle-aged man (affected person 1) from rural northern New Hampshire sought care from his primary-care doctor for a routine bodily examination. On chest auscultation, the doctor heard localized wheezes, prompting chest radiograph and subsequent computed tomography scan; the pictures confirmed a noncalcified 4-cm mass within the decrease lobe of the appropriate lung. After preliminary endobronchial biopsy of the mass was nondiagnostic, the affected person underwent thoracoscopic lung wedge resection. A grey cystic lesion ruptured through the process, releasing clear fluid. The ruptured cyst was excised, and histologic examination confirmed the presence of a laminated outer cyst wall and quite a few daughter cysts, every containing a number of protoscolices with inner hooklets and calcareous corpuscles (Determine), options diagnostic of E. granulosus tapeworm an infection. The affected person was prescribed a therapy course of albendazole and deliberate shut follow-up, given the excessive threat for recurrence.

In December 2022, affected person 2, an in any other case wholesome middle-aged lady, sought medical consideration for anaphylaxis that was decided to be brought on by a ruptured cyst. Radiography confirmed 2 lung lesions and 1 small (<5 cm) liver lesion. Outcomes of serum Echinococcus antibody testing was optimistic. A course of albendazole was prescribed (400 mg 2×/d) and, 4 weeks into remedy, the affected person had the primary bigger pulmonary lesion efficiently excised with plans for resection of the second excision.

Each sufferers reported comparable epidemiologic threat components of dressing regionally hunted moose and publicity to canine in northern New Hampshire. Neither affected person reported related journey historical past outdoors of New Hampshire. Affected person 1 reported observing that the proportion of moose carcasses with intensive cystic lung lesions has elevated lately. The stool of his 4-year-old home canine examined damaging for E. granulosus by way of a industrial veterinary laboratory. We postulate that each sufferers acquired E. granulosus an infection both by consuming produce contaminated with contaminated canid feces or by way of consumption of eggs shed of their canine’ stool. The sufferers gave verbal permission to publish this report.

In the USA, regionally acquired human E. granulosus infections stay uncommon. Nevertheless, circumstances in Arctic and sub-Arctic areas of Canada and Alaska are properly described, primarily amongst Native American populations (2–4). Within the contiguous United States, a number of human circumstances are reported yearly in Arizona, New Mexico, California, and Utah (4). E. granulosus infections have been described in wildlife of northern New England (5,6); in 2012, surveillance of the hunter-harvested moose inhabitants (Alces alces) in Maine documented the presence of the G8 genotype E. granulosus (Canadensis) in 21/54 (39%) of lung units examined. Home canine and japanese coyotes (Canis latrans) have been recommended as definitive hosts, given the absence of wolves within the space. Different areas within the contiguous United States the place sylvatic cycles of transmission have been confirmed embody Idaho, Minnesota, California, and Montana; secure cycles have been described primarily within the Arctic and sub-Arctic areas of Canada and Alaska (2). Details about E. granulosus infections in native wild canids in northern New England is missing.

New Hampshire Division of Well being and Human Companies has notified healthcare suppliers caring for sufferers concerned in moose searching about preventive measures. Such measures embody sporting waterproof gloves when dressing moose carcasses, stopping home canine and wild canids from consuming uncooked viscera, disposing of all viscera in accordance with suggestions from New Hampshire Fish and Sport Division, totally cooking all recreation meat that’s fed to canine, and administering to canine a deworming agent efficient in opposition to tapeworms a minimum of twice per 12 months.

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