Cystic echinococcosis in South Africa: the worst yet to come?

A considerable number of cases of cystic echinococcosis (CE) are reported from South Africa, but the exact epidemiology remains unknown. In addition, southern Africa is one of the global regions worst afflicted by an excessively high HIV- and TB co-endemicity. As deductable from anecdotal observation, the immune modulation caused by all three diseases seems to affect the clinical courses of all of them. Due to the ongoing high HIV and TB infection rates and the long latency period of CE, South Africa may experience increasing numbers of CE with potentially unusual and severe clinical courses due to concomitant immune suppression. The extent of the problem and the additional complexity of appropriate patient care remain to be recognized.