title: Autochthonous human alveolar echinococcosis in a Hungarian patient.
abstract: BACKGROUND
  Alveolar echinococcosis is a zoonotic parasitic disease causing a severe clinical condition and is known as the most deadly of all helminth infections. Moreover, this disease is also an increasing concern in Northern and Eastern Europe due to its spread in the wildlife animal host.
  
  
  METHODS
  An asymptomatic 70-year-old woman from south-western Hungary was diagnosed with multiple liver lesions. Imaging techniques (ultrasound, computed tomography and magnetic resonance imaging), serology (ELISA, indirect hemagglutination and Western blot), and conventional staining methods (hematoxylin-eosin and periodic acid-Schiff) were used for the detection of the disease. A histopathological re-evaluation of formalin-fixed paraffin block by immunohistochemical staining with the monoclonal antibody Em2G11 definitively confirmed the diagnosis of alveolar echinococcosis.
  
  
  CONCLUSIONS
  To our knowledge, this is the first confirmed autochthonous case of human alveolar echinococcosis in Hungary. To what extent diagnostic difficulties may contribute to underestimate this zoonosis in Eastern Europe is unknown. Differential diagnosis with alveolar echinococcosis should be considered for patients with multiple, tumor-like cystic lesions of the liver, in countries where this parasite is emerging.
authors.affiliation: Joint Hospital of St. Stephen and St. Ladislau, Budapest, Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Dezsényi
authors.affiliation: National Institute of Oncology, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Strausz
authors.affiliation: National Institute of Oncology, Budapest, Hungary.
authors.forename: Zita
authors.initials: Z
authors.lastname: Makrai
authors.affiliation: Joint Hospital of St. Stephen and St. Ladislau, Budapest, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Csomor
authors.affiliation: National Center for Epidemiology, Budapest, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Danka
authors.affiliation: Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kern
authors.affiliation: Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanitá, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rezza
authors.affiliation: Institute of Pathology, Ulm University, Ulm, Germany.
authors.forename: Thomas F E
authors.initials: TF
authors.lastname: Barth
authors.affiliation: Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanitá, Rome, Italy. adriano.casulli@iss.it.|European Reference Laboratory for Parasites, Rome, Italy. adriano.casulli@iss.it.|World Health Organization Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (in Humans and Animals), Rome, Italy. adriano.casulli@iss.it.
authors.forename: Adriano
authors.initials: A
authors.lastname: Casulli
mesh_terms: D000368:Aged; D000818:Animals; D004443:Echinococcosis; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000635:transmission; D048210:Echinococcus multilocularis; D005260:Female; D006801:Humans; D006814:Hungary; D008099:Liver / Q000469:parasitology / Q000473:pathology
keywords: Alveolar echinococcosis; Case report; Differential diagnosis; Echinococcus multilocularis; Histopathological re-evaluation; Public health threat