Echinococcosis with particular reference to Southeast Asia.

Echinococcosis is a zoonosis caused by adult or larval cestodes belonging to the genus Echinococcus (family Taeniidae). The two major species of medical and public health importance are E. granulosus and E. multilocularis, which, respectively, cause cystic echinococcosis (CE) and alveolar echinococcosis (AE). Both CE and AE are serious and severe diseases, the latter especially so, with high fatality rates and poor prognosis if managed incorrectly. A number of recent reports indicate that CE and AE are of increasing public health concern and that both can be regarded as emerging or re-emerging diseases. This review discusses aspects of the biology, life-cycle characteristics, aetiology, and the global and Southeast Asian regional distribution and transmission of the Echinococcus organisms, and covers the epidemiology, clinical features, treatment and diagnosis of the diseases they cause. The current countermeasures available for the control and prevention of AE and CE, including the development of animal vaccines for the latter, are also reviewed. E. granulosus still has a wide geographical distribution although effective control against CE has been achieved in some regions. E. multilocularis is more problematic as the primary transmission cycle is almost always sylvatic so that efficient and cost-effective control of AE remains a formidable challenge. Chemotherapy has facilitated less invasive surgical management of CE and AE. Nevertheless, as will be emphasised, there is a clear need for new advances in the prevention and control of both these neglected diseases.