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Die alveoläre Echinokokkose ist eine der tödlichsten Zoonosen der Nordhalbkugel, die oft erst zu einem späten Zeitpunkt erkannt wird, wenn ein kurativ therapeutischer Ansatz nicht mehr möglich ist. Deshalb sind viele Patienten auf eine lebenslange medikamentöse Therapie angewiesen. Diese erfolgt mit den Benzimidazolderivaten Albendazol und Mebendazol, welche seit den 80er Jahren unangefochten auf dem Markt sind. Studien zur Wirksamkeit dieser Medikamente weisen aufgrund der geringen Häufigkeit dieser Erkrankung meist nur kleine Studienpopulationen auf. Deshalb soll in dieser retrospektiven Studie die Wirksamkeit der Benzimidazole an einem großen Studienkollektiv von 78 Patienten untersucht und deren Effekt auf unterschiedliche Parameter evaluiert werden. So wurde die Veränderung der Läsionsgröße, der SUV (Standardized Uptake Value)-Werte, der serologischen und immunologischen Parameter und der klinischen Symptome während des Therapieverlaufs untersucht, und im Vergleich zur Effizienz der Benzimidazole die auftretenden Nebenwirkungen beleuchtet. Diese Studie wurde an 78 Patienten, welche von 01.01.2000 bis zum 30.11.2015 in der Spezialambulanz für Echinokokkose der Universität Ulm vorstellig waren, durchgeführt. Diese wurden von Diagnosestellung an in diesem nationalen Zentrum therapiert und betreut und erhielten alle eine ausschließlich medikamentöse Therapie über mindestens 12 Monate. Die während des Therapieverlaufs gesammelten Daten wurden in einer Datenbank zusammengefasst und für diese Studie retrospektiv ausgewertet. Die analysierten Daten umfassen Angaben zu Person, klinische Symptome, Daten über die Langzeit-Medikation, Parasitic Mass in Liver (P) – Involving neighbouring organs (N) – Metastasis (M) - Klassifikation, Laborparameter, Bildgebung und Nebenwirkungen. Zusätzlich wurde eine Subgruppenanalyse zum Vergleich einer kontinuierlichen und einer diskontinuierlichen Therapie, mit Pausen länger als 60 Tagen durchgeführt. In dieser Studie wurden die Daten von 33 männlichen und 45 weiblichen Patienten ausgewertet mit einem mittleren Alter von 61,73 (± 16,38) Jahren. 5 Patienten wurden mit Mebendazol und 73 Patienten mit Albendazol behandelt. Bei 12 Patienten kam es während der Therapie zu einem Wechsel des Benzimidazols. Eine Dosisreduktion war bei 24 Patienten nötig eine Dosissteigerung bei 5 Patienten. Die Größe der parasitären Läsion zeigte eine signifikante Abnahme unter der Therapie, wobei die kontinuierliche Therapie einen eindeutigeren Effekt hatte als eine diskontinuierliche Therapie. Der SUV-Wert sank ebenfalls im Therapieverlauf. Auch hier zeigte sich der Vorteil einer konsequenten 61 Therapie. Die serologischen und immunologischen Werten erreichten durch eine Benzimidazoltherapie eine Normalisierung und bei den klinischen Symptomen konnte eine signifikante Besserung erreicht werden. Die häufigste und bedeutendste Nebenwirkung waren in diesem Studienkollektiv hepatotoxische Nebenwirkungen, die jedoch unterschiedliche Ausprägungen und Schweregrade aufwiesen. Durch diese Studie konnte die Wirksamkeit der Benzimidazole bei der alveoläreren Echinokokkose an einem großen Studienkollektiv anhand unterschiedlicher Parameter gezeigt werden. Benzimidazole haben einen deutlichen Effekt auf die Reduktion der Läsionsgröße sowie die Hemmung der parasitären Aktivität im 18F-Fluordeoxyglukose- Positronenemissionstomographie/Computertomographie- Untersuchung, die Normalisierung der Blutwerte und die klinische Symptomatik. Somit konnte der Nutzen dieser Medikamente hervorgehoben werden. Es wurden jedoch auch Schwächen der medikamentösen Therapie anhand der Nebenwirkungen herausgestellt, welche die Notwendigkeit der Entwicklung neuer Medikamente betont.

Pulmonary cystic echinococcosis is a very rare disease in Germany. It is caused by the larvae of the dog tapeworm (echinococcus granulosus). The liver is the most affected organ, followed by the lungs. Surgery remains the main therapeutic approach for pulmonary CE. Whenever possible, parenchyma-preserving lung surgery should be preferred over anatomic lung resections. To ensure best therapeutic results, surgery needs to be performed under precise consideration of important infectiological aspects and patients should be treated in specialised centres based on interdisciplinary consensus. In addition to surgical aspects, this review summarises special infectiological features of this disease, which are crucial to the surgical approach.

Neurocysticercosis is a leading cause of acquired epilepsy worldwide and endemic in underdeveloped and developing regions. As a result of increased migration and traveling, cases of neurocysticercosis reach Europe more frequently. Neurological symptoms are multifarious and often nonspecific, so that neurocysticercosis poses a diagnostic challenge. We report a case of a patient in whom the diagnosis of neurocysticercosis was achieved quickly via the patient's history, neuroimaging and serology.

Cutaneous larva migrans (CLM, creeping eruption) is a skin disease commonly seen in travelers returning from the tropics. The lesions are caused by intradermal migration of animal hookworm larvae which cannot mature in humans. While the typical serpiginous skin lesions are easily diagnosed and treated with albendazole or ivermectin, unusual presentations can be misdiagnosed and cause prolonged morbidity. We present 3 cases of CLM, which were difficult to diagnose and/or treat.Case 1 is a 34-year old Caucasian male who presented with itchy papular lesions on the soles of both feet and was initially treated for plantar psoriasis.Case 2 is a 54-year old Caucasian male who suffered from extensive follicular larva migrans on the buttocks for several months and was only cured after repeated courses of albendazole and ivermectin.Case 3 is a 29-year old Caucasian male with pruritic inflammatory papules on the trunk. Despite extensive diagnostic procedures including skin biopsies and tissue cultures the correct diagnosis was only made later during the course of the illness. After treatment for CLM with albendazole (800 mg/d for 3 days) and after resolution of perifocal edema and inflammation the typical serpiginous tracks became more obvious. They responded rapidly to anthelminthic treatment.These cases highlight the importance of careful history taking and work-up in individuals presenting with atypical skin lesions. In case of exposure to CLM empiric anthelminthic treatment might be considered.

Efficacies of selected drugs against in vitro cultivated Echinococcus multilocularis metacestodes: Alveolar echinococcus is a highly lethal parasitic disease in humans. It is caused by the larval stage (Metacestode) of tapeworm Echinococcus multilocularis (E. multilocularis). Two chemotherapeutics are licensed for the treatment, Albendazole (Eskazole R) and Mebendazole (Vermox forte R). Undesired side-effects and non-response to the therapy can be reason to terminate the treatment. Alternative drugs and lower dose of Albendazole or Mebendazole are necessary. E. multilocularis vesicles, which were grown intraperitoneally into mice, were transferred into culture flasks together with human liver cell line hep-G2. We evaluated macroscopically and microscopically the effect of following Anthelmintics at various concentrations: Albendazole, praziquantel and ivermectin. Neither ivermectin nor praziquantel damaged E. multilocularis vesicles. Low concentration of Albendazole (0.1 myg/ml) caused 50 % damage after 12 - 13 days. While combination of praziquantel together with Albendazole caused 50 % damage of E. multilocularis vesicles after 2 - 3 days, ivermectin together with low concentration of Albendazole created 50 % damage after 4 - 5 days. We combined in another test series the protease inbibitor Ritonavir, a cytochrom-p450-inhibitor, with Albendazole. Remarkably, 50 % damage of E. multilocularis vesicles was after 3 - 4 days achieved. Maybe a baby-dose Ritonavir modified the metabolism of Albendazole. These combinations could be a possible alternative to standard therapy. Our results encourage the implementation of pre-clinical trials in vivo to secure these effects.

High perinatal mortality, low milk yields and occasional ewe deaths were investigated in a Dorper sheep flock in Southern Germany. Parasitic gastroenteritis due to Trichostrongylus spp. associated with severe weight loss despite regular anthelmintic treatments of the flock was identified as the underlying cause. A faecal egg count reduction (FECR) test revealed zero reduction after treatment with ivermectin or albendazole, respectively, and a FECR of 57.9% following treatment with levamisole. These results indicate a lack of, or considerably reduced efficacy of substances from all three classical groups of anthelmintics and demonstrate that triple anthelmintic resistance is also present in Germany. The introduction of resistant worm populations with imported livestock, excessive use of anthelmintic drugs and under-dosing of goats have possibly led to the problem in the flock described. Veterinary advice on anthelmintic treatments and responsible parasite control programmes are therefore crucial in small ruminant flocks.

Strongyloidosis is highly endemic in humid tropical regions of the world and therefore should be considered in symptomatic travellers or immigrants. Clinical characteristics, diagnostic procedures and therapeutic options are discussed on the basis of a case report on a three years old adoptee from Ethiopia. In immunocompetent hosts the infection causes transient pruritic urticarial serpiginous lesions mostly located on the buttocks or lower extremities and unspecific gastrointestinal symptoms. In immunocompromised patients the infection can generalize and lead to hyperinfection, a syndrome lethal in up to 85% of patients. Diagnostic work up should include a white blood cell count and differential as well as serology. In case of eosinophilia and positive serology, detection of larvae with a concentration technique in minimum three stool samples should be performed. Ivermectin and Albendazole can be used for treatment. Response to treatment should be assessed by serology and eosinophil count three to six months after therapy.

The case of a 58-year-old female patient with well-differentiated breast cancer (T1 stadium) without axillar lymphadenopathy and with multiple suspect liver lesions is described. Liver metastases of the breast cancer could be excluded histologically, however, serologic testing for echinococcosis was negative. After contrast-enhanced sonography and because of the complex B-mode appearance of the liver lesions, cystic echinococcosis was suspected. This could be verified histologically after hemihepatectomy.

A 33 year old man is evaluated for a pruriginous plantar eruption on the right foot. Three weeks ago he walked across a river barefoot in the south of Vietnam. In the clinical examination of the foot a red, serpiginuous dermatitis was seen. Patient history and clinical picture were typical for a larva migrans. After starting a treatment with albendazol the patient felt well and the lesions disappeared.

Ocular toxocariasis represents an organ manifestation of the systemic infection with the Nematode larva Toxocara canis. The infection can provoke very different changes in the eye. Especially posterior uveitis, vitreous body infiltrates, epiretinal membranes and suberetinal granulomas can occur. The diagnosis of these changes can be difficult due to the variety of the symptoms and on the other side by the absence of characteristic specific changes. Moreover unclear findings can occur when only serological examinations are performed. In unclear cases the antibody-detection by means of ELISA from the vitreous body fluid can be useful. The examination of vitreous body material can prove toxocara infection when no systemic signs of infection are present and no antibodies are detectable in the serum. Besides the systemic anti-helminthic therapy with Albendazol the pars plana vitrectomy is a substantial therapeutic option in ocular toxocariasis when vitreo-retinal complications are present. A well timed adequate therapy can stabilize the visual acuity in many cases.

In a 27-year-old female German patient severe headache and wandering paresthesias appeared one week after returning from a holiday in the Dominican Republic. After 3 weeks of ongoing symptoms she was admitted to our hospital with the suspicion of an inflammatory or infectious disease of the central nervous system. Upon admission slight stiffness of the neck, fever (38.2 C) and paresthesias of the right elbow and the right thigh were noticed.Cerebrospinal fluid (CSF) revealed an eosinophilic pleocytosis. In the acute phase of the disease, antibodies against nematodes were found in CSF, without corresponding antibody-reactivity in serum. In the course levels of nematode antibodies in CSF increased and antibody-reactivity in serum was observed. Thorough investigation for other infectious or inflammatory causes of eosinophilic meningitis revealed no abnormalities.Symptoms, onset within the typical incubation period and the eosinophilic meningitis lead to the diagnosis of a suspected Angiostrongyliasis. Successful treatment was achieved with a combination of oral albendazole and corticosteroids given for 4 weeks.Infection with larvae of Angiostrongylus cantonensis is one of the main causes of eosinophilic meningitis worldwide. Human infection can occur after ingestion of intermediate hosts or contaminated vegetables. Angiostrongyliasis has been endemic to Southeast Asia and the Pacific Basin and only recently cases from the Caribbean have been described. Headache, paresthesias and the finding of an eosinophilic meningitis in patients returning from tropical or subtropical regions should lead to the suspicion and eventually the treatment of an Angiostrongyliasis.

A 33 year old woman from Lebanon presented with recurrent hemoptysis, subfebrile temperature, dyspnoe in stress, fatigue, weight loss, and pruritus. Serological tests and results from chest X-ray and computer tomography revealed cystic echinococcosis with pulmonary involvement. After refusal of surgical therapy a medical treatment with albendazole was implemented. Two months after the start of the therapy only a small fibrotic residuum in the lung was seen. A spontaneous healing success seems unlikely because of the duration of the pulmonary cyst and the progressive symptoms before treatment.

Titelblatt, Abkürzungsverzeichnis, Inhalt, Danksagung, Selbständigkeitserklärung 1\. Einleitung 2\. Literaturteil 3\. Material und Methoden 4\. Ergebnisse 4.2 Ergebnisse der elektronenmikroskopischen Untersuchungen 4.2.2 Ergebnisse der transmissionselektronenmikroskopischen (TEM) Untersuchungen 5\. Diskussion 6\. Zusammenfassung 7\. Summary 8\. Anhang 9\. Literaturverzeichnis, Ultrastrukturelle Untersuchungen an Fasciola hepatica nach der Therapie mit Albendazolsulfoxid bei Rattus norvegicus und bei Schafen Im Rahmen dieser Arbeit wurde untersucht, ob und in welcher Konzentration Albendazolsulfoxid zur Therapie gegen F. hepatica geeignet war. Zudem wurde ermittelt, ob der Einsatz eines Enhancers zur Verbesserung der Wirkung und Verwendung von geringeren Wirkstoffmengen führte. Die durchgeführten Untersuchungen erfolgten sowohl an experimentell infizierten Ratten als auch an natürlich infizierten Schafen. Das Medikament wurde auf unterschiedlichen Applikationswegen verabreicht. Die Wirksamkeit des Wirkstoffes wurde anhand von Kotuntersuchungen überprüft. Im Anschluss wurde eine Sektion der Ratten durchgeführt. Des Weiteren wurde die Wirkung von Albendazolsulfoxid auf die Morphologie des Parasiten untersucht. Das Wurmgewebe wurde sowohl transmissionselektronenmikroskopisch als auch per Rasterelektronenmikroskopie analysiert. Im tierexperimentellen Teil dieser Arbeit ergab sich, dass Albendazolsulfoxid oral, subkutan und intraperitoneal bei Ratten in einer Dosierung von 30 mg pro Kg Körpergewicht kurativ wirkte. Durch die kombinierte Behandlung mit dem Enhancer konnte die Wirkstoffmenge bei den oben genannten Applikationsformen auf 20 mg pro Kg Körpergewicht reduziert werden. Für die pour- on Behandlung der infizierten Ratten ergab sich bei der alleinigen Applikation von Albendazolsulfoxid eine Dosis von 130 mg pro Kg Körpergewicht. Wurde der Wirkstoff in Kombination mit dem Enhancer verabreicht, lag die Dosierung von Albendazolsulfoxid bei 90 mg pro Kg Körpergewicht. Bei den durchgeführten Untersuchungen ergab sich, dass der Enhancer allein keine fasziolicide Wirkung hatte. Er bewirkte eine Reduktion des benötigten Wirkstoffes und reduzierte die Eiaussscheidung um einen Tag. Die an den Schafen durchgeführten Untersuchungen ergaben ebenfalls, dass die orale Wirkstoffmenge bei einer mit Enhancer kombinierten Behandlung bei 20 mg Albendazolsufoxid pro Kg Körpergewicht lag. Die ermittelte Dosierung für die pour- on behandelten Schafen lag bei 200 mg Albendazolsulfoxid pro Kg Körpergewicht in Kombination mit dem Enhancer . Für die elektronenmikroskopischen Untersuchungen wurden Ratten mit 20 mg und mit 40 mg Albendazolsulfoxid pro Kg Körpergewicht behandelt. Es erfolgte eine Behandlung mit Albendazolsulfoxid allein und eine Kombinationsbehandlung des Wirkstoffs zusammen mit dem Enhancer. Die Untersuchung der Würmer erfolgte nach 24 und nach 48 Stunden. Es zeigte sich sowohl bei der Rasterelektronenmikroskopie als auch bei der Transmissionselektronenmikroskopie, dass die Schäden am Gewebe mit der höheren Dosierung und bei der längerer Wirkzeit zunahmen. Durch den Zusatz des Enhancers waren die Schäden an F. hepatica im Vergleich zur alleinigen Behandlung mit Albendazolsulfoxid in allen untersuchten Präparaten deutlicher und stärker ausgeprägt. Bei den REM- Untersuchungen erwies sich, dass es durch die Behandlung der Parasiten offenbar zu einer deutlichen Schädigung der Wurmoberfläche kam. Bei allen behandelten Würmern wurde eine Schwellung des Teguments beobachtet, wodurch die darauf befindlichen Häkchen eingesunken erschienen. Auch traten auf dem Tegument Ansammlungen von Bläschen und zytoplasmatischen Trümmern hervor. In hoher Dosierung und durch die zusätzliche Applikation des Enhancers entstanden Furchen im Tegument und es kam zum Häkchenverlust an der Wurmoberfläche. Anhand der TEM- Aufnahmen wurde untersucht, welche Schäden auf zellulärer Ebene im Tegument, Darm und Ovar durch die Behandlung entstanden. In allen untersuchten Geweben wurden Schäden in Form von starker Vakuolenbildung festgestellt. Die stärkste Schädigung zeigte sich im Bereich der Basallamina in Form von verschmelzenden Vakuolen. Durch den Zusatz des Enhancers, wurden die Schäden stärker und es entstanden Spalträume. Zudem kam es zu morphologischen Veränderungen an den Mitochondrien in Form von Schwellungen bzw. Platzen. Teilweise löste sich die Basallamina vom umliegenden Gewebe ab und es entstanden große Hohlräume, so dass das Wurmgewebe zum Teil völlig lysiert wurde., Ultrastructural investigations in Fasciola hepatica after the therapy with albendazole sulphoxide with Rattus norvegicus and with sheep In the course of this study several tests were out into whether, and in what concentrations, albendazole sulphoxide is suitable for use in therapy against F. hepatica. It was also determined whether the use of an enhancer results in an improvement of efficacy and allows the reduction of the active substance. The study also investigated the effects of albendazole sulphoxide on the morphology of the parasite. Parasite tissue was analysed using both transmission electron and scanning electron microscopy in order to determine whether morphological changes occurred under exposure to the active substance. In the animal experimental part of the study, it was found that albendazole sulphoxide has a fasciolide effect whether administered orally, subcutaneously or intraperitoneally to rats in a dosage of 30 mg per kg bodyweight. In combination with the enhancer, the quantity of active substance in the aforementioned forms of administration can be reduced to 20 mg per kg bodyweight. For pour- on treatment of the infected rats, a dose of 130 mg per kg bodyweight was found to be necessary if albendazole sulphoxide was applied by itself. In combination with enhancer the albendazole sulphoxide dose for pour- on treatment could be reduced to 90 mg per kg bodyweight. The studies showed that the enhancer itself had no fasziolide effect. It allowed a reduction of the quantity of the active substance required and stoped the secretion of eggs faster. The effective quantity of the active compound in the oral application in sheep was found to be 20 mg albendazole sulphoxide per kg bodyweight. The pour- on dosage determined as being necessary in sheep was 20mg to be 200 mg albendazole sulphoxide per kg bodyweight in combination with the enhancer. For the electron microscope examinations, rats were treated with 20 mg and 40 mg albendazole sulphoxide per Kg bodyweight. Treatment was given both in the form of albendazole sulphoxide alone and in combination with the enhancer. The worms were examined after 24 and 48 hours. Both scanning and transmission electron microscopy showed that the higher the dose, the more substantial the damage caused to the worm. It was also found that the damage to the parasite increased the longer it was exposed to the active substance. With use of the enhancer, the damage to F. hepatica was greater and more marked than under treatment with albendazole sulphoxide alone. Examination under the scanning electron microscope revealed that the treatment evidently causes marked damage to the surface of the worm. In all the worms exposed to treatment, swelling of the tegument could be seen, causing the hooks located on top to appear sunken in. Additionally, an accumulation of small blisters and cytoplasmatic debris was observed on the tegument. Under higher dosages and with additional application of the enhancer, furrows occurred in the tegument, with loss of hooks from the worm`s surface. The examinations revealed no differences in reaction between the ventral and the dorsal tegument. However, the damage to the rear end of the worm was more marked than to the front end. With the aid of the TEM images, it was possible to examine the damage caused by albendazole sulphoxide alone and in combination with the enhancer to the tegument, intestine and ovary. In all the tissue examined, treatment with the active substance was found to cause damage in the form of extensive vacuole formation. The most severe damage in all the tissue examined was observed in the area of the basal lamina in the form of merging vacuoles. Use of the enhancer intensified the damage, with additionally fissuring. Mitochondrial changes in morphology such as swelling and bursting occured. In some cases, the basal lamina broke away from the surrounding tissue, creating large cavities in the worm tissue in some cases being completely lysed.

A 53-year-old West African man presented two years after a travel to Guinea because of severe headache, neck stiffnes, fever and pruritus. The patient had been in orthopedical treatment for the last five months.Stool microscopy revealed a high number of Strongyloides stercoralis larvae. Hematology, biochemistry and all other parasitology results were normal. HIV-1/2 testing was negative and CD4+-lymphocyte count was normal. Concomitant infection by Human T Cell lymphotropic virus type 1 (HTLV-1) was confirmed by serology and PCR. The phylogenetic analysis confirmed African origin of the virus.The infection responded to a five-day course of albendazol at 400 mg/d but during the following five years repeat recrudescences were observed inspite of high-dosage and prolonged antiparasitic treatments. Eventually, eradication of the infection was achieved by a four day course of ivermectin 0.2 mg/kg/d.Although both strongyloidiasis and HTLV-1 infections occur most frequently in tropical areas, these may also be observed in temperate regions. Suppression of the immune system by HTLV-1 differs from that by HIV. CD4+-lymphocytes were rarely decreased. Prolonged treatment with ivermectin in a dosage exceeding the current recommendations may be required in HTLV-1 infected patients and was well tolerated. The unusual presentation of the infection with muscular symptoms contributed to the delay of the diagnosis. HTLV-1 positive patients must be monitored for years. They and their partners must be instructed how to prevent transmission of the virus.

With increasing migration tropical diseases such as Loa loa infections are becoming more frequent in Europe. While the ocular diagnosis is usually straight forward, systemic work-up and treatment requires an interdisciplinary approach. We review the diagnostic and therapeutic work-up of ocular Loa loa infections based on a series of 4 cases that presented between 1998 and 2004.The first symptoms in all cases were ocular irritations occurring 2 months to 8 years after a trip to West Africa. One case presented with a swollen upper eyelid without a visible worm. In three patients microfilariae were detected in the blood.In two cases visible subconjunctival worms could be removed under the slit lamp. Three cases required systemic treatment as inpatients while one case could be observed without systemic treatment. All 4 cases had a favourable outcome with complete eradication of the disease.Surgical removal of adult Loa loa worms from the subconjunctival space only improves the ocular symptoms. An interdisciplinary approach (ophthalmology, infectious disease and parasitology) for a systemic work-up and treatment is usually required.

Toxocara canis and T. cati are not only ubiquitously distributed parasites of dogs, foxes and cats, but may also infest humans, causing a great variety of symptoms and sometimes also severe diseases: the visceral larva migrans syndrome, the ocular larva migrans syndrome, covert toxocarosis, common toxocarosis, neurological toxocarosis, and some other clinical pictures (asthma bronchiale, epilepsy, rheumatoid arthritis) are considered to be induced by Toxocara species. Both Toxocara species are also widely distributed in Austrian dog, fox and cat populations; seroepidemiological studies carried out in Austria revealed seroprevalence rates of 3.7% among the normal human population and up to 44% among persons particularly exposed to those parasites (i.e. veterinarians, farmers). Although many Toxocara infestations do not cause severe clinical manifestations, a few dozens of toxocarosis patients have been registered every year during the last years; in reality, however, we have to assume that several hundreds of patients suffer from toxocarosis. This paper tries to give a synoptic overview of the nosology of this (still) largely almost unknown helminthozoonosis, moreover it summarizes the most important epidemiologic parameters, and presents the diagnostic and therapeutic possibilities available today.

A 63-year-old man, who had travelled extensively in Asia and had lived in South Africa, presented with increasing dysphagia. Physical examination showed no abnormalities.Upper gastrointestinal endoscopy showed a concentric oesophageal stenosis, 5 cm long, consisting of thickening of the wall without any sign of malignancy or mucocutaneous lesions. The histological examination of this lesion demonstrated infiltrations of eosinophilic cells. Serology was positive for Gnathostoma spinigerum.After treatment with albendazole 400 mg per day for 3 weeks the clinical, histological and serological symptoms resolved completely.In case of any eosinophilia or local infiltrations of eosinophilic cells, parasitic disease have to be considered.

Imaging studies, ultrasonography, play a central role for the diagnosis and follow-up of cystic echinococcosis (hydatid disease) due to the non-specific clinical symptoms and still inadequate sensitivity and specificity of currently available serological tests. Due to the increasing number of people immigrating to central Europe from countries with a high incidence of cystic echinococcosis, cystic echinococcosis has become an important differential diagnosis of cystic lesions. The imaging modality to localize and stage the disease depends on the organs affected. Ultrasonography is the most important imaging technique to screen for abdominal lesions (more than 75 % of the cases). Therefore, an expert committee of the WHO Working Group on echinococcosis has recently suggested a standardized ultrasonographic classification of hepatic cystic echinococcosis. This classification proofs to be very useful for staging echinococcal cysts with respect to parasite activity. Ultrasonography is not only an excellent tool for the primary diagnosis and therapeutic decision but also for follow-up of patients treated for cystic echinococcosis. Indications for computed tomography or magnetic resonance tomography are restricted to extra abdominal disease, patients not suited for ultrasonography because of obesity or meteorism, complicated cysts and planning of surgery or interventional therapy. Apart from surgery three other treatment options are well established: (1) chemotherapy with albendazole or mebendazole, (2) percutaneous drainage and sterilization (PAIR) and (3) observation of inactive echinococcal stages ("watch and wait" approach).

We describe reference to a family from Bosnia that the diagnosis of Trichinellosis can be difficult despite notice of travel-history and eosinophilia but lack of further epidemiological datas and due to the rarity of this zoonosis. Clinical pattern of trichinellosis are fever, headache, myalgia, periorbital oedema, less frequently diarrhea and abdominal pain. Dreaded complications are myocarditis and encephalitis. High eosinophilia and increased creatine phosphocinase activity are the most frequently observed laboratory features. The detection of specific circulating antibodies or the parasitological examination of a muscle biopsy will confirm the diagnosis. The medical treatment includes albendazol and steroid.

A 39-year-old patient with advanced HIV infection was admitted to our hospital with a 6-month history of diarrhoea, abdominal pain and pansinusitis.Ultrasound and endoscopic retrograde cholangiography revealed cholangitis of the larger bile ducts. Stool examinations and coloscopy were unremarkable. No pathogenic organisms were identified by routine investigations. Finally, microsporidia of the genus encephalitozoon were diagnosed by electron microscopy in biopsies from the bile duct and the nasal mucous membrane and in stool samples by polymerase chain reaction (PCR).Albendazole treatment was successful. The cholestatic liver tests and the ultrasound findings normalized. Control tests of stool, bile and nasal secretions by light microscopy, electron microscopy, and PCR were negative.Microsporidia, along with human cytomegalovirus, cryptosporida and mycobacteria other than tuberculosis are increasingly recognized as causing opportunistic infections in immunodeficient patients, especially in AIDS-related cholangitis. Some species can cause systemic infection. Therefore microsporidia infection should be considered in the differential diagnosis of all patients with immunodeficiency.

A 46-year-old Swiss woman presents with intermittent abdominal pain and persistent eosinophilia that is suggestive of helminthic etiology. Though her stay in Africa goes back35 years, an imported disease is a possibility. However, contact with a puppy suggests a locally acquired organism. Antibodies to filariae and Toxocara are demonstrated in the serum. Following treatment with albendazole 400 mg daily for 14 days the patient makes a full recovery, and the final diagnosis is active Toxocara canis infection.

A 46-year-old woman was admitted with a first generalised tonic-clonic seizure. Past medical history was unremarkable. She reported no travels abroad within the past five years.Brain MRI demonstrated disseminated cerebral and cerebellar focal lesions. Cerebrospinal fluid analysis showed a mild eosinophilic pleocytosis. Extensive imaging investigations and serological tests revealed no hints for a systemic parasitic disease. A stereotactic brain biopsy detected no pathogenic agent. 10 months following the initial admission, brain MRI showed multiple cystic lesions with ring-like enhancement following Gd-DTPA administration. At that time serological tests were positive for an infection with Echinococcus granulosus.The diagnosis was based on positive sequential serological tests and the typical MRI findings in conjunction with an eosinophilic cerebrospinal fluid pleocytosis.An antihelmintic therapy with Albendazole was initiated. Following two-months of oral Albendazole administration, brain MRI revealed a clear reduction in size and number of the hydatid lesions. The patient was free of complaints and the clinical examination was unremarkable.Isolated intracerebral manifestation of cystic echinococcosis is very rare. Compared to the typical presentation with a solitary cerebral hydatid cyst, the dissemination of hydatid cysts is quite uncommon in cystic echinococcosis. Diagnosis should be based on the typical MRI findings and serological tests. The present case demonstrates that the later may be negative over a long period within the clinical course of the disease offering a real challenge to the clinician.

Skeletal manifestation of alveolar (E. multilocularis) or cystic (E. granulosus) echinococcosis is seldom, with an incidence of less than 2% of all cases. By reporting on a rare case of bony manifestation of E. granulosus, we intend to emphasize current standards in surgical and drug management of the disease. Typical radiographic and blood-chemistry findings are highlighted on a 62-year-old Arabiqu female suffering from a cystic echinococcosis with skeletal manifestation in the left ileum and lower lumbar spine.Radiographically typical are fine zones of osteolysis which, at a later stage, show confluence. Due to the rigid structure of cortical bone, cysts tend to grow slowly, and seldom exceed 2 cm in diameter. Only after having broken through the cortical bone, may a massive increase in size be observed. By means of serological tests, it is postoperatively possible to evaluate how successful radical surgery with removal of larvae was. Furthermore, serological tests can be used as a screening method, offering a diagnostic tool that can also utilized in detecting a recurrence.The surgical aim in the treatment of osseous echinococcosis should be in accordance to curative tumor surgery. Even after radical removal of the parasites, the WHO suggests an adjuvant chemotherapy with mebendazole or albendazole for at least two years after surgery. In cases where only a palliative treatment is possible, the antihelminthic drug administration can be continuous.

Lymphatic filariasis currently affects some 120 million people in 73 tropical countries. Almost one-half of all those affected have manifest signs and symptoms of disease, of which elephantiasis is the most serious. A large majority of the remainder have subclinical lymphopathy and nephropathy. New scientific discoveries give rise to the hope that the global elimination of this disease--which is associated with physical disfigurement, sexual dysfunction and social decline--might be possible. Today, we have available simple diagnostic tools and highly effective, safe and cost-effective medications. New insights into the pathogenesis now make it possible to alleviate individual suffering and prevent further progression of the disease.

Obstructive jaundice caused by a parasitosis is very rare. It can be a complication of a cystic echinococcosis. We present the case of a 33-year-old man who suffered from cystic echinococcosis with an affection of the liver for several years. As a complication an echinococcal cyst had ruptured into the biliary tract and had led to an occlusion of the ductus hepatocholedochus. By means of ERCP the membrane of the echinococcal liver cyst was extracted in toto. Cholangioscopy followed and showed a free biliary tract without remaining cyst fragments. After these interventions the blood parameters normalized and the patient recovered. An additive chemotherapy with albendazole was started.

An overview is presented of the various therapy options in cystic and alveolar echinococcosis based on the recent literature and upon personal experience with chemotherapy over the last 20 years. In regions with an optimal surgical infrastructure and relatively small patient cohorts, long-term chemotherapy is practically limited to patients with inoperable echinococcosis, i. e.10 % cystic and around 70 % alveolar echinococcosis.

Hydatid disease, still frequent in endemic areas, is usually localized in the liver. Despite the benign nature of the disease it is one of the problematic fields of surgery due to the high complication rate and long hospital stay. Based on our experience we recommend evacuation of the cyst and omentoplasty as the surgical method of choice, as it is associated with a relatively low incidence of complications and can be performed easily.

Cysticercosis is one of the two infections caused by Taenia solium. It is endemic in areas with poor hygienic standards. In western countries the patients history of previous living or travelling in endemic areas is important. Neurocysticercosis is a manifestation with single or multiple ocular, orbital or cerebral lesions.Two patients presented with severe headache and pain in the ocular region. Both patients were diagnosed to have a cystic lesion in an extraocular muscle.Both patients had a manifestation of cysticercosis. Additionally patient no. 1 had a myositis of this muscle, patient no. 2 had a posterior scleritis.Without evidence of an eosinophilia and stool ova and cysts and without a positive ELISA-test for cysticercosis the pathognomonic appearance of the thickened muscle, the cyst and the scolex inside should lead to the diagnosis cysticercosis.

Alveolar echinococcosis (A. E.), caused by Echinococcus multilocularis, behaves biologically like a malignant tumour of the liver which is best treated by radical surgery. However, radical surgery can be performed only in about 20-30% of A. E. cases. The efficacy of chemotherapy with benzimidazole derivatives for inoperable cases is debated. The results of a prospective Swiss chemotherapy trial, which started in 1976, are reviewed. In the last 20 years a total of 110 patients has been included in our protocol and 74 of these patients had inoperable or palliatively operated A. E. (average observation time 12.8 years). The efficacy of long-term chemotherapy was documented by increase of 10-year survival compared to historical (untreated) A. E. cases (80 vs 6%) and by reduction or stabilisation of the liver lesions in 83% of cases during long-term chemotherapy. Several relevant problems remain to be clarified, e.g. optimal duration of chemotherapy, the controversy as to whether chemotherapy is parasitostatic or parasitocidal, the establishment of reliable routine methods for short-term assessment of therapeutic efficacy, and comparative studies between mebendazole and albendazole. Furthermore, additional studies are necessary in collaboration with basic science, for example on the impact of the increasing fox population, with invasion of large agglomerations, on infection risk in the Swiss population, and the importance of individual immune competence for susceptibility or resistance to A. E.

Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this prospective study we present and evaluate the outcome of the long-term treatment with both drugs.Forty-four patients were treated with either mebendazole or albendazole and they were followed up for an average of 42 months. Success of treatment was defined as non-progression for more than 1 year.The overall success-rate was approximately 80% (35/44). An initial regimen was recurrence-free in 64% of cases under mebendazole and in 73% of cases under albendazole. Half of the cases with recurrent disease could be stabilized after changing the therapeutic regimen. Seven patients received a continuous regimen with albendazole. They were observed over an average of 19 months without signs of progression nor significant side effects.This open-labelled prospective study demonstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. In Germany, serum levels for mebendazole can easily be obtained at numerous institutes, while serum levels for albendazole are rarely available. On the other hand, albendazole reduces costs by over 40%. A simplified mode of intake and a reduced number of side effects argue in favor of the preferred use of albendazole. Albendazole in alveolar echinococcosis is only licensed for intermittent application. Nonetheless, continuous treatment may be considered in inoperable cases or progressive disease.

We report on a five year old boy who was admitted to hospital because of obstructive airway disease; initially, findings were interpreted to indicate bronchial asthma. In addition, the patient presented with a behavioural abnormality of aggressiveness and hyperactivity. Laboratory examinations showed an elevated IgE level and eosinophilia, chest x-ray revealed infiltrations in both lungs. After excluding a spectrum of chronic lung disorders by relevant investigations, serological testing for parasitosis revealed massively elevated toxocara IgG antibodies. The diagnosis of a "covert form" of toxocarosis was established and an antihelminthic therapy with albendazole was initiated. Chronic respiratory symptoms in childhood can also indicate the presence of a parasitic infestation.

Based on the portal infection root, the hydatid disease of the spleen represents a rarity. Because of a lack of prospective studies, spleen-preserving procedures and splenectomies were published as surgical therapy in case reports. In this report, the case of a 72-year-old woman with symptomatic hydatid disease of the spleen will be reported. Surgical and pharmaceutical strategy to minimize the risk of an OPSI syndrome as well as the value of adjuvant therapy with Albendazole will be discussed.

The patient, now 50 years old, an immigrant miner from the former Yugoslavia who was known to have AIDS, was in 1992 found to have non-Hodgkin lymphoma of the oesophagus and given five cycles of multiple chemotherapy (CHOP) with complete remission. Subsequently he complained of retrosternal pain, dysphagia, dry cough and upper abdominal discomfort. On admission he had slight fever of 39.1 degrees C, but physical examination was unremarkable.Blood count revealed an eosinophilia of 41%. IgE concentration was raised to 432IU/ml. The CD4+ T-cell count was reduced to 10/microliter, that of CD8+ to 89/microliter.Blood culture, fecal and sputum samples and bronchoalveolar lavage demonstrated Mycobacterium avium intracellulare.Treatment of the disseminated atypical mycobacterial infection was started with clarithromycin, rifabutin, ciprofloxacin and ethambutol. There was no improvement of the upper abdominal discomfort, but the fever subsided. Oesophagogastroscopy excluded recurrence of the lymphoma. Biopsy and examination of the duodenal juice revealed worms and larvae of Strongyloides stercoralis. Stool samples contained no mycobacteria, but strongyloides larvae were demonstrated. Albendazole was given (2 x 400 mg daily for 6 days, followed by a maintenance dose of 1 x 400 mg daily). Repeat endoscopy and stool sample after a month no longer showed any parasites.Even in Western Europe, persons coming from endemic areas who, as this patient, have various risk factors that may facilitate the occurrence of strongyloidiasis. With early diagnosis and treatment albendazole is an efficacious drug.

A 56-year-old turkish patient, previously in good health, was admitted because of pain suggesting myocardial infarction. Physical examination of the heart, lungs and abdomen was unremarkable.The concentrations of myocardium-specific enzymes were not elevated and the ECG showed no signs of ischaemia. Echocardiography and magnetic resonance imaging ruled out acute aortic dissection, but demonstrated a round cystic space-occupying mass over the anterior wall of the heart. Hydatid cyst was suspected from the imaging results and the patient's origin from area endemic for Echinococcus. The diagnosis was confirmed by a titre of 1:6,400 (normal: 1:100) for Echinococcus antibodies.Albendazole administration was initiated. Planned elective surgical removal of the hysatid cyst had to be performed urgently because of acute pericardial tamponade. Cyst rupture was suspected but an actually undamaged cyst was subtotally removed under cardiopulmonary bypass. The postoperative course was uneventful and albendazole treatment was continued.Because of the high incidence of fatal complications urgent surgical removal under cardiopulmonary bypass is the treatment of choice for hydatid cyst involving the heart. Perioperative albendazole administration is also essential.