Authors: J. Draganovič 1,2; J. Zajak 1; K. Vinklerová 1,3; P. Gebouský 2,4; F. Čečka 1,2 Authors‘ workplace: Chirurgická klinika Fakultní nemocnice Hradec Králové Přednosta: prof. MUDr. Jiří Páral Ph. D., MBA 1; Lékařská fakulta Univerzity Karlovy v Hradci Králové Děkan: prof. MUDr. Jiří Manďák, Ph. D. 2; Univerzita obrany Brno Vojenská lékařská fakulta Hradec Králové Katedra vojenské chirurgie Vedoucí: plk. gšt. doc. MUDr. Petr Lochman, Ph. D. 3; Klinika infekčních nemocí Fakultní nemocnice Hradec Králové Přednosta: doc. MUDr. Petr Prášil, Ph. D. 4 Published in: Prakt. Lék. 2025; 106(5-6): 215-220 Category: Of different specialties
Introduction: Hepatic echinococcosis is a parasitic disease caused by cestodes of the genus Echinococcus, most commonly E. granulosus and E. multilocularis. Although rare in Central Europe, its incidence has been increasing across Europe.
Epidemiology and pathogenesis: Transmission occurs via the fecal-oral route from animal hosts, with humans acting as accidental intermediate hosts. Cystic echinococcosis usually exhibits benign growth with local mass effect, whereas alveolar echinococcosis demonstrates infiltrative, destructive behavior with metastatic potential.
Clinical presentation: The liver is the most frequently affected organ. Clinical manifestations are often nonspecific and depend on lesion size, location, and complications such as biliary communication, cholestasis, or secondary infection. Diagnosis: Ultrasonography is the cornerstone of diagnosis, using the WHO classification for cystic echinococcosis. Computed tomography and magnetic resonance imaging are essential for assessing disease extent and surgical planning. Diagnosis is supported by serological testing using a two-step approach.
Management: Treatment of cystic echinococcosis includes benzimidazole therapy, percutaneous minimally invasive procedures, surgery, and a watch-and-wait strategy. Alveolar echinococcosis requires radical surgical resection combined with long-term adjuvant benzimidazole therapy
Conclusion: Hepatic echinococcosis requires a multidisciplinary approach and early diagnosis. General practitioners play a crucial role in secondary prevention and timely referral.
echinococcosis – Echinococcus granulosus – Echinococcus multilocularis – alveolar echinococcosis – liver – cystic echinococcosis
1. Bouwknegt M, Devleesschauwer B, Graham H, et al. Prioritisation of food-borne parasites in Europe, 2016. Euro Surveill. 2018; 23(9): 17–00161.
2. The European Union One Health 2024 Zoonoses Report. EFSA J. 2025; 23(12): e9759.
3. Davidson RK, Lavikainen A, Konyaev S, et al. Echinococcus across the north: current knowledge, future challenges. Food Waterborne Parasitol. 2016; 4 : 39–53.
4. Liccioli S, Giraudoux P, Deplazes P, Massolo A. Wilderness in the ‘city’ revisited: different urbes shape transmission of Echinococcus multilocularis by altering predator and prey communities. Trends Parasitol. 2015; 31(7): 297–305.
5. CDC-DPDx. Echinococcosis [online] 2019. Dostupné z: https:// www.cdc.gov/dpdx/echinococcosis/index.html [cit. 2026-01 - 06].
6. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev. 2004; 17(1): 107–135.
7. Laurimäe T, Kinkar L, Moks E, et al. Molecular phylogeny based on six nuclear genes suggests that Echinococcus granulosus sensu lato genotypes G6/G7 and G8/G10 can be regarded as two distinct species. Parasitology 2018; 145(14): 1929–1937.
8. Tamarozzi F, Deplazes P, Casulli A. Reinventing the wheel of Echinococcus granulosus sensu lato transmission to humans. Trends Parasitol. 2020; 36(5): 427–434.
9. Torgerson PR, Heath DD. Transmission dynamics and control options for Echinococcus granulosus. Parasitology 2003; 127(Suppl): S143–158.
10. Fabián O, Soukup J, Kratochvíl J, Kodet R. Jaká je vaše diagnóza? Odpověď: Cystická hydatidóza jater. Čes.-slov. Patol. 2014; 50(1): 38–39.
11. Thompson RCA. Biology and systematics of Echinococcus. Adv Parasitol. 2017; 95 : 65–109.
12. WHO/OIE Manual on echinococcosis in humans and animals A public health problem of global concern [online]. Dostupné z: https://www.who.int/publications/i/item/929044522X [cit. 18. březen 2025].
13. Bhutani N, Kajal P. Hepatic echinococcosis: A review. Ann Med Surg. 2018; 36 : 99–105.
14. Touma D, Sersté T, Ntounda R, et al. The liver involvement of the hydatid disease: a systematic review designed for the hepato-gastroenterologist. Acta Gastro-Enterol Belg. 2013; 76(2): 210–218.
15. Reddy AD, Thota A. Cysto-biliary communication (CBC) in hepatic hydatidosis: predictors, management and outcome. Int Surg J. 2019; 6(1): 61–65.
16. Akhan O, Koroglu M. Hydatid disease of the spleen. Semin Ultrasound CT MR 2007; 28(1): 28–34.
17. Kern P, Wen H, Sato N, et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int. 2006; 55(Suppl): S283–287.
18. Ammann RW, Eckert J. Cestodes. Echinococcus. Gastroenterol Clin North Am. 1996; 25(3): 655–689.
19. Piarroux M, Piarroux R, Giorgi R, et al. Clinical features and evolution of alveolar echinococcosis in France from 1982 to 2007: results of a survey in 387 patients. J Hepatol. 2011; 55(5): 1025–1033.
20. Bresson-Hadni S, Vuitton DA, Bartholomot B, Heyd B, Godart D, Meyer JP, et al. A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France. Eur J Gastroenterol Hepatol. 2000; 12(3): 327–336.
21. Kern P, Menezes da Silva A, Akhan O, Müllhaupt B, Vizcaychipi KA, Budke C, et al. Chapter Four – The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease. In: Thompson RCA, Deplazes P, Lymbery AJ. (eds.) Advances in Parasitology [Internet]. Academic Press 2017; 259–369 (and Echinococcosis, Part B; ročník 96). Dostupné z: https://www.sciencedirect.com/science/article/pii/S0065308X1630089623 [cit. 19. březen 2025].
22. WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. PubMed [Internet]. Dostupné z: https://pubmed.ncbi.nlm.nih.gov/12606104/ [cit. 19. březen 2025].
23. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology 1981; 139(2): 459 – 463.
24. Stojkovic M, Rosenberger K, Kauczor HU, et al. Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound? PLoS Negl Trop Dis. 2012; 6(10): e1880.
25. Keong B, Wilkie B, Sutherland T, Fox A. Hepatic cystic echinococcosis in Australia: an update on diagnosis and management. ANZ J Surg. 2018; 88(1–2): 26–31.
26. Siles-Lucas MM, Gottstein BB. Molecular tools for the diagnosis of cystic and alveolar echinococcosis. Trop Med Int Health 2001; 6(6): 463–475.
27. Siles-Lucas M, Casulli A, Conraths FJ, Müller N. Laboratory diagnosis of echinococcus spp. in human patients and infected animals. Adv Parasitol. 2017; 96 : 159–257.
28. Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO - -IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010; 114(1): 1–16.
29. Bedón López NM, Quispe Sánchez EA. Radical surgery for liver hydatidosis. Rev Esp Enferm Dig. 2021; 113(5): 391.
30. Akhan O. Percutaneous treatment of liver hydatid cysts: to PAIR or not to PAIR. Curr Opin Infect Dis. 2023; 36(5): 308–317.
31. Velasco-Tirado V, Alonso-Sardón M, Lopez-Bernus A, et al. Medical treatment of cystic echinococcosis: systematic review and meta-analysis. BMC Infect Dis. 2018; 18(1): 306.
32. Lissandrin R, Tamarozzi F, Piccoli L, et al. Factors influencing the serological response in hepatic echinococcus granulosus infection. Am J Trop Med Hyg. 2016; 94(1): 166–171.
33. Vuitton D, McManus D, Rogan M, et al. International consensus on terminology to be used in the field of echinococcoses. Parasite 2020; 27 : 41.
34. Alzoubi M, Daradkeh S, Daradka K, et al. The recurrence rate after primary resection of cystic echinococcosis: A meta-analysis and systematic literature review. Asian J Surg. 2025; 48(1): 78–88.
35. Mihmanli M, Idiz UO, Kaya C, et al. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol. 2016; 8(28): 1169–1181.
36. Kadry Z, Renner EC, Bachmann LM, et al. Evaluation of treatment and long-term follow-up in patients with hepatic alveolar echinococcosis. Br J Surg. 2005; 92(9): 1110–1116.
Don‘t have an account? Create new account
Enter the email address that you registered with. We will send you instructions on how to set a new password.
