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Background Rio Negro Province is endemic for cystic echinococcosis (CE). A CE control program includes early diagnosis in humans. During 1980-1996, screening was done with serology and surgery was the unique choice of treatment. Since 1997, ultrasound (US) has been the method of choice for screening, and new choices of treatment for asymptomatic carriers are discussed in the CE guidelines. Methods Between 1997 and 2016, 42 734 abdominal USs were performed, 192 new asymptomatic cases were diagnosed and underwent a protocol according to the size, location and type of cyst. Treatment options included active surveillance (US monitoring, 83 [43.3%]), antiparasitic (albendazole, 92 [47.9%]) and surgery (17 [8.8%], including percutaneous treatment). Results After 7.7 y of follow-up, of the cases under active surveillance, 28 (33.7%) had to change treatment: 5 (6%) to surgery and 22 (26.5%) to albendazole. Of the patients treated with albendazole, 3 (3.2%) were operated on and 13 (14%) were treated with a second cycle of albendazole. Conclusion As a result of the present study, resolution of CE in a non-surgical way with albendazole is confirmed to be effective in asymptomatic carriers with CE1 or CE3a cysts. An update eliminates the strategy of active surveillance in type CE1 cysts

Cystic echinococcosis (CE), a parasitic zoonosis with substantial human health and economic consequences, is highly endemic in Rio Negro Province, Argentina. The objective of this study was to estimate the direct and indirect human and livestock-associated monetary losses attributable to CE, in Rio Negro Province, for the year 2010. Human costs were estimated using data obtained from hospital chart reviews, patient interviews, and government reports. Livestock-associated losses were estimated using data from government reports and scientific publications. Spreadsheet models were developed utilizing Latin Hypercube sampling to account for uncertainty in the input parameters. In 2010, the estimated total cost of CE, in Rio Negro Province, ranged from US$4,234,000 (95% credible interval [CI]: US$2,709,000-US$6,226,000) to US$5,897,000 (95% CI: US$3,452,000-US$9,105,000), with livestock-associated losses representing between 80% and 94% of the total losses, depending on whether non-healthcare-seeking human cases were included and if livestock slaughter values were adjusted to account for underreporting. These estimates suggest that CE is responsible for considerable human and livestock-associated monetary losses in Rio Negro Province. Stakeholders and policymakers can use these data to better allocate public health and agricultural resources for this region.

Hydatidosis (cystic echinococcosis) is endemic in Rio Negro Province, Argentina. In 1980 started a control program against the disease. In 1984 Frider et al performed the first ultrasound screening in the world at Pilcaniyeu city, later extended to other localities of Rio Negro province. The initial prevalence in asymptomatic people was 7.1% in Pilcaniyeu and 10.1% in Comallo, being all new cases and with surgical indication.The aim of this investigation was to determine the current prevalence and analyze the evolution of the disease across 25 years of the control program.In 2009 and 2010 ultrasound screening studies were conducted in both locations in all age groups.In 512 ultrasound studies at Pilcaniyeu, the prevalence was 1.5% in children (6 to 14years old) and 4.2% in adults (total 2.5%). In 770 ultrasound studies at Comallo, the prevalence was 1.1 %in children and 6.6% in adults (total 3.0%). The overall reduction in the prevalence reached 67.2%. Regarding the age distribution, rates of 1.6%-1.9% were observed in Pilcaniyeu and of 1.0-1.9% in Comallo between 0 and 30 years old, increasing significantly above 10% after 60 years old in Pilcaniyeu and after 40 years old in Comallo.The implementation of the program actions reduced the prevalence of the disease but there are still new cases, and that indicates that some bias persists in the control of the epidemiology of the disease and levels of transmission to humans as a consequence of this failures. So the search of asymptomatic cases is still important and also their management based on the follow-up by ultrasound (watch and wait) or in the treatment with albendazol.

La vigilancia de la equinococcosis quística para detectar infestación por Echinococcus granulosus en la Provincia de Río Negro en el período 1980-2002 fue efectuada en el hombre mediante encuestas serológicas y ultrasonográficas en población joven, y en el perro por el test de arecolina. Dadas las limitaciones de esta técnica, se planteó suplantarla por el complejo copro ELISA Western Blot en heces caninas recolectadas del suelo. El objetivo del presente trabajo fue comparar las ventajas y limitaciones de las dos técnicas para medir la prevalencia de la infección en el perro, y evaluar la prevalencia actual de la infección en el hombre y en el perro. El área de trabajo comprendió 7 Departamentos endémicos con Programas de desparasitación canina sistemática (Area Programa) y 4 Departamentos no endémicos como Area Testigo. El test de arecolina se aplicó en los perros, con concurrencia voluntaria de sus propietarios (muestreo no aleatorizado). Las muestras para detección de coproantígenos fueron obtenidas de establecimientos ganaderos seleccionados en forma aleatorizada. En el hombre se determinó la prevalencia mediante tamizajes ultrasonográficos en escolares de 6 a 14 años y la incidencia por medio del sistema oficial de notificación de casos sintomáticos. Se dosificaron con arecolina 416 perros resultando 19 (5.2%) positivos en el Area Programa y ninguno positivo en el Area Testigo. Para la detección de coproantígenos se obtuvieron 748 muestras de materia fecal de 271 establecimientos ganaderos, resultando 37 muestras y 32 establecimientos (13.6%) positivos en el Area Programa y 4 muestras y 4 establecimientos (11.4%, IC: 0.3-32.3) positivos en el Área Testigo. En el Area Programa se efectuaron 7421 ecografías abdominales a escolares, detectándose 40 (0.5%) casos con imágenes compatibles con hidatidosis, mientras en el área testigo se efectuaron 1732 ecografías con 9 (0.5%) casos positivos. El test de arecolina aportó información de la prevalencia individual mientras que la detección de coproantigenos permitió mejorar la calidad de la información identificándose establecimientos donde concentrar acciones de control. El estudio permitió identificar nuevas áreas de transmisión.The surveillance of infection for Echinococcus granulosus in the Province of Rio Negro during 1980-2002 included serological and ultrasonographic screening in humans and arecoline test in dogs. In lieu of the limitations of the arecoline test the proposal was to supplant that test for the copro Elisa-copro/Western Blot complex applied to feces collected from the environment. The objective was to compare the pros and cons of the two tests and to evaluate the human and the canine infection prevalence. The working area encompassed 7 Departments with systematic canine parasiticide activities (Program Area) and 4 Departments, not endemic, as Control Area. The arecoline test was applied to the dogs in assembled groups with the voluntary participation of their owners (not randomized sampling). Samples for the detection of coproantigens were obtained from sheep farms selected at random and analyzed by the complex copro-Elisa /Western Blot. Prevalence in man was determined by screening the school population (6 to 14 years old) by ultrasound, and by means of the compulsory notification of cases from the official system. Dogs (416) were tested with arecoline, 365 of which belonged to the Program Area. Of these 19 (5.2%) resulted positive, while none of 51 dogs from the Control Area were positive. Samples (748) of feces were tested to detect coproantigens, obtaining 37 positive samples within the Program Area and 4 within the Control Area. Farms (271) from the livestock estate unit were evaluated, out of which 236 belonged to the Program Area, gave 32 (13.6%) positive results, while 4 (11.4%) of 35 from the Control Area resulted positive. Sonography tests (7421) were done in the Program Area detecting 40 (0.5%) carriers, while in the Control Area, over 1732 tests, 9 (0.5%) resulted positive. The arecoline test provides information about the dog prevalence while the detection of coproantigens in feces collected from the environment allowed to enhance the quality of the information, and the identification of environments where specific control activities focusing on risk must be concentrated. Also the study allowed to recognize new transmission areas.

Hasta hace poco tiempo, la hidatidosis se consideraba un estado patológico de resolución exclusivamente quirúrgica. Sin embargo, en los últimos años se ha avanzado en los campos de la epidemiología, el diagnóstico y el tratamiento de la enfermedad y la nueva información aportada sobre la historia natural de la hidatidosis ha permitido definir nuevos criterios de atención. Ahora se sabe que hasta 67% de los portadores no sintomáticos de quistes hepáticos mantienen esa condición durante toda la vida. Esta situación genera resultados especiales en el inmunodiagnóstico. Así, la inmunoadsorción enzimática (ELISA) rinde una sensibilidad de 63% y una especificidad de 97% en portadores asintomáticos, mientras que la doble difusión cinco (DD5) tiene una sensibilidad de solo 31% en esos portadores. Por otra parte, los estudios por imágenes basados en la ecografía se han transformado en el método de elección para detectar a los portadores no sintomáticos. Son de 49 a 73% más sensibles que la serología e incluso pueden utilizarse como parte del sistema de vigilancia epidemiológica y del monitoreo de programas de control. También se han modernizado los esquemas de intervención. El tratamiento quimioterápico de portadores asintomáticos con albendazol produce hasta 69% de respuestas favorables, mientras que los tratamientos quirúrgicos mínimamente invasores como la punción-aspiración- inyección-reaspiración (PAIR) producen una reducción del volumen medio del quiste de hasta 66%. Estos factores han permitido instaurar un protocolo de tratamiento para portadores asintomáticos en los servicios hospitalarios de la Provincia de Río Negro, Argentina. Este se basa en el seguimiento de los quistes pequeños (tipo Ia de la escala de Gharbi modificada), tratamiento inicial con albendazol y con PAIR si no hay respuesta, en los quistes de mayor tamaño o complejidad (tipos Ib, II y III), y seguimiento de los quistes no vitales o muertos (tipos IV y V).Until a short time ago, hydatidosis was considered a pathology that could only be resolved surgically. However, in recent years progress has been made with the epidemiology, diagnosis, and treatment of the disease, and new information on the natural history of hydatidosis has helped define new criteria for its treatment. It is now known that as many as 67% of the carriers of liver cysts who are asymptomatic remain so throughout their lives. This situation produces special results in immunologic testing. Enzyme-linked immunosorbent assay (ELISA) has a sensitivity of 63% and a specificity of 97% with asymptomatic carriers, while the double diffusion arc 5 test (DD5) achieves a sensitivity of only 31% with the same population. On the other hand, imaging studies based on ultrasonography have become the method of choice to detect asymptomatic carriers. Ultrasonography studies are 49% to 73% more sensitive than serological tests, and they can even be used as a part of epidemiological surveillance systems and to monitor control programs. Treatment schemes have also been modernized. Treating asymptomatic carriers chemotherapeutically with albendazole produces favorable results in as many as 69% of cases, while such minimally invasive surgical treatments as puncture-aspiration-injection-reaspiration (PAIR) reduce average cyst volume by as much as 66%. These factors have made it possible for hospital services in the province of Río Negro, Argentina, to establish a treatment scheme for asymptomatic carriers. It is based on the monitoring of small cysts (type Ia on the modified Gharbi scale); initial treatment with albendazole, followed by PAIR if there is no response, in larger or more complex cysts (types Ib, II, and III); and follow-up of inviable or dead cysts (types IV and V).

Until a short time ago, hydatidosis was considered a pathology that could only be resolved surgically. However, in recent years progress has been made with the epidemiology, diagnosis, and treatment of the disease, and new information on the natural history of hydatidosis has helped define new criteria for its treatment. It is now known that as many as 67% of the carriers of liver cysts who are asymptomatic remain so throughout their lives. This situation produces special results in immunologic testing. Enzyme-linked immunosorbent assay (ELISA) has a sensitivity of 63% and a specificity of 97% with asymptomatic carriers, while the double diffusion arc 5 test (DD5) achieves a sensitivity of only 31% with the same population. On the other hand, imaging studies based on ultrasonography have become the method of choice to detect asymptomatic carriers. Ultrasonography studies are 49% to 73% more sensitive than serological tests, and they can even be used as a part of epidemiological surveillance systems and to monitor control programs. Treatment schemes have also been modernized. Treating asymptomatic carriers chemotherapeutically with albendazole produces favorable results in as many as 69% of cases, while such minimally invasive surgical treatments as puncture-aspiration-injection-reaspiration (PAIR) reduce average cyst volume by as much as 66%. These factors have made it possible for hospital services in the province of Rio Negro, Argentina, to establish a treatment scheme for asymptomatic carriers. It is based on the monitoring of small cysts (type Ia on the modified Gharbi scale); initial treatment with albendazole, followed by PAIR if there is no response, in larger or more complex cysts (types Ib, II, and III); and follow-up of inviable or dead cysts (types IV and V).

Although cystic echinococcosis (CE) is an important public health problem in Rio Negro Province, current epidemiological data for CE, in this region of Argentina, are not available. Therefore, a community-based study, which incorporated diagnostic imaging and a questionnaire, was conducted in Ingeniero Jacobacci, a small town in southern Rio Negro Province. This study sought to assess the prevalence of human CE, in the study population, and to evaluate epidemiologic factors associated with CE transmission within the study area. Of the 560 individuals who volunteered to participate in the study, 189 (34%) were children and 371 (66%) were adults. All study participants were screened for CE using abdominal ultrasound scanning, with CE-positive or suspect individuals also receiving thoracic radiographs. The overall prevalence of CE was 7.1% (40/560), with 1.6% (3/189) of children, and 10% (37/371) of adults diagnosed as CE-positive. Although 92.5% (37/40) of the CE-positive individuals had only hepatic lesions, two participants had both hepatic and pulmonary lesions, and one participant had a single renal lesion. Approximately 92% (340/371) of the adult study participants completed the questionnaire, which was used to identify factors associated with an increased risk for human infection. Age, level of education, dog ownership, and contact with sheep were found to be significantly associated with CE status. This study demonstrated that CE continues to be highly endemic in this region of Rio Negro Province, Argentina. In addition, community-based ultrasound screening surveys are a noninvasive, effective approach to case detection at the community level.

Cystic echinococcosis (CE) is a chronic, complex and neglected disease caused by the larval stage of Echinococcus granulosus. The effects of this neglect have a stronger impact in remote rural areas whose inhabitants have no chances of being diagnosed and treated properly without leaving their jobs and travelling long distances, sometimes taking days to reach the closest referral center. Background In 1980 our group set up a control program in endemic regions with CE in rural sections of Rio Negro, Argentina. Since 1997, we have used abdominopelvic ultrasound (US) as a screening method of CE in school children and determined an algorithm of treatment. Objectives To describe the training system of general practitioners in early diagnosis and treatment of CE and to evaluate the impact of the implementation of the field program. Materials and Methods In 2000, to overcome the shortage of radiologists in the area, we set up a short training course on Focused Assessment with Sonography for Echinococcosis (FASE) for general practitioners with no previous experience with US. After the course, the trainees were able to carry out autonomous ultrasound surveys under the supervision of the course faculty. From 2000 to 2008, trainees carried out 22,793 ultrasound scans in children from 6 to 14 years of age, and diagnosed 87 (0.4%) new cases of CE. Forty-nine (56.4%) were treated with albendazole, 29 (33.3%) were monitored expectantly and 9 (10.3%) were treated with surgery. Discussion The introduction of a FASE course for general practitioners allowed for the screening of CE in a large population of individuals in remote endemic areas with persistent levels of transmission, thus overcoming the barrier of the great distance from tertiary care facilities. The ability of local practitioners to screen for CE using US saved the local residents costly travel time and missed work and proved to be an efficacious and least expensive intervention tool for both the community and health care system., Author Summary Cystic echinococcosis (CE) is an important and widespread disease that affects sheep, cattle, and humans living in areas where sheep and cattle are raised. CE is highly endemic in rural sections of Rio Negro, Argentina, where our group is based. However, it requires continuous monitoring of both populations with human disease best assessed by means of ultrasound (US) screening. This is challenging in remote rural areas due to the shortage of imaging specialists. To overcome this hurdle, we set up a two-day training program of Focused Assessment with Sonography for Echinococcosis (FASE) on CE for family medicine practitioners with no previous experience in US. After the course, they were equipped with portable US scanners and dispatched to remote rural areas in Rio Negro where they screened patients, located and staged the cysts and decided on the treatment with the help of surgeons and radiologists in local tertiary care centers. The need to travel to referral hospitals for traditional surgical interventions was therefore limited to a few cases. US was instead brought to rural areas thereby extending affordable healthcare to people who would otherwise not have access to it.

Cystic echinococcosis is an endemic disease in the Province of Rio Negro, Argentina. Ultrasound surveys carried out in 1984 found prevalence rates of 5.6% in children between 6 and 14 years of age. Objective To describe and to evaluate the results of the strategy applied in school children by hospital services of the Province of Rio Negro with regard to diagnosis, treatment and monitoring of cystic echinococcosis and to evaluate simultaneously the results of the control program against cystic echinococcosis. Materials and methods In 1997 ultrasound was chosen to carry out population surveys and the medical treatment criteria for the detected cases were standardized. The population under study involved 5745 students in the first survey and 22,793 in subsequent studies. The detected cases were classified according to Gharbi's scheme. A treatment algorithm was defined based only on monitoring (“watch and wait”), albendazole, surgery (open or laparoscopic) or mini-invasive procedures, according to type, location and size of the cyst. Information was also obtained on cases notified to the Health System between 1980 and 2008. Results In the first survey, 70 carriers (1.2%) were detected; of these, 25 started albendazole treatment (35.7%) and only 3 (4.3%) underwent surgery. Ten years after treatment, 60.1% of 42 cases, presented Types IV and V cysts and 14.5% presented total involution of their cysts. In subsequent studies, 87 (0.4%) cases were detected, 49 of which started albendazole treatment (56.3%) and 9 underwent surgery (10.3%). The incidence rate of cystic echinococcosis cases decreased from 38 × 100,000 in 1980 to 3.7 × 100,000 in 2008. Discussion A strong decrease in cystic echinococcosis was obtained although persistent levels of transmission were maintained. The cases produced under these conditions are diagnosed by means of ultrasound surveys and are treated using a plan based on albendazole and monitoring by the Health System during a period of 10 years.

The surveillance of infection for Echinococcus granulosus in the Province of Rio Negro during 1980-2002 included serological and ultrasonographic screening in humans and arecoline test in dogs. In lieu of the limitations of the arecoline test the proposal was to supplant that test for the copro ELISA-copro/Western Blot complex applied to feces collected from the environment. The objective was to compare the pros and cons of the two tests and to evaluate the human and the canine infection prevalence. The working area encompassed 7 Departments with systematic canine parasiticide activities (Program Area) and 4 Departments, not endemic, as Control Area. The arecoline test was applied to the dogs in assembled groups with the voluntary participation of their owners (not randomized sampling). Samples for the detection of coproantigens were obtained from sheep farms selected at random and analyzed by the complex copro-ELISA /Western Blot. Prevalence in man was determined by screening the school population (6 to 14 years old) by ultrasound, and by means of the compulsory notification of cases from the official system. Dogs (416) were tested with arecoline, 365 of which belonged to the Program Area. Of these 19 (5.2%) resulted positive, while none of 51 dogs from the Control Area were positive. Samples (748) of feces were tested to detect coproantigens, obtaining 37 positive samples within the Program Area and 4 within the Control Area. Farms (271) from the livestock estate unit were evaluated, out of which 236 belonged to the Program Area, gave 32 (13.6%) positive results, while 4 (11.4%) of 35 from the Control Area resulted positive. Sonography tests (7421) were done in the Program Area detecting 40 (0.5%) carriers, while in the Control Area, over 1732 tests, 9 (0.5%) resulted positive. The arecoline test provides information about the dog prevalence while the detection of coproantigens in feces collected from the environment allowed to enhance the quality of the information, and the identification of environments where specific control activities focusing on risk must be concentrated. Also the study allowed to recognize new transmission areas.

Hydatidosis or cystic echinococcosis (CE) caused by Echinococcus granulosus is endemic in the Province of Rio Negro, Argentina. The objective of this investigation was to evaluate the results of a program carried out in endemic areas of the Province of Rio Negro, Argentina, in the years 1997-2002. Abdominal ultrasonography was used, classifying the cases detected according to WHO guidelines. A treatment algorithm was defined which included observation, albendazol therapy, PAIR or surgery, according to cyst type and size. A total of 5745 schoolchildren were evaluated, detecting hydatid cyst carriers in 70 (1.2%). Of these; 40 (57.1%) were included in follow-up protocol, 25 (35.7%) in treatment protocol with albendazol, 2 (2.9%) with PAIR and 3 (4.3%) with conventional surgery. After a mean of 44 months, among 25 cases treated with albendazol, in 2 (8%) cysts underwent total involution, in 17 (68%) they presented positive changes, in one (4%) they remained unchanged and in 4 (16%) they progressed to type II, while 1 (4%) displayed negative evolutionary changes. Out of 39 cases under observation alone protocol, in 8 cases (21%) cysts underwent total involution, in 7 (18%) they presented positive changes, in 11 (28%) they remained unchanged, in 2 (5%) they progressed to Type II and in 11 (28%) they presented negative evolutionary changes and had to be included in the other protocol types. In this study, conventional surgery, was applied to 10% of detected cases. The combination of ultrasonographic screening and albendazol treatment showed promising results.

Percutaneous puncture-aspiration-injection-reaspiration (PAIR) of hydatid liver cysts, was performed in 38 patients 14-80 years old, with a total of 60 liver hydatid cysts. After aspiration under computed tomography guidance, hypertonic saline was injected into the cystic cavities of patients as a scolecidal agent. No major complications were associated with the procedures. In the follow-up period of 18 months, control CT scans of 35 cysts revealed a gradual decrease in cyst size with a mean volume reduction of 66%. Complications included two cases of urticaria, one case of anaphylaxis and one subcapsular hematoma. No mortality occurred. It is concluded that percutaneous aspiration and hypertonic saline injection for liver hydatid cysts appears to be an effective form of treatment and may eventually prove to be an alternative to surgical intervention.