Echinococcus cases reported in New Hampshire: First locally acquired cases

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The New Hampshire Department of Health and Human Services (DHHS) reported in a Health alert Last week, there were two human cases of Echinococcus (tapeworm) infection acquired in northern New Hampshire.

photo/CDC

On April 11, 2022, health officials were notified of a confirmed case of human Echinococcus pneumoniae (EG) causing cystic echinococcosis (CE). On 1 December 2022, a second case of CE was confirmed in an unrelated patient. Both patients were likely infected in northern New Hampshire and reported epidemiological risks from locally caught dressing and exposure to dogs, which could act as definitive hosts.

These are the first identified cases of locally acquired Echinococcus in the state of New Hampshire.

In the United States, interstitial cystitis is a rare parasitic infection that was historically recognized in the western and midwestern states. However, EG has recently appeared in the wild in the Northeast.

EG is a zoonotic parasite. Adult tapeworms live in the intestines of canines (such as dogs, coyotes, and foxes). Dog feces contain parasite eggs that are infective for humans and other intermediate animal hosts (for example, ungulates such as moose, deer, and sheep). In the intermediate host, the eggs hatch in the small intestine to form tumor spheres that penetrate the intestinal mucosa, enter the circulatory system, and then infect the organs, particularly the liver and lungs, where cysts form. Dogs can become infected when they swallow raw meat and the viscera of an infected intermediate host.

Humans become infected when they ingest eggs that are eliminated in dog feces, usually through eating raw products contaminated with dog feces or through direct contact with infected feces. Eating meat infected with Echinococcus cysts does not cause disease in humans.

Patients usually present when cysts are identified in a vital organ either incidentally or because the cysts cause symptoms such as mass effect. The incubation period is currently unknown, but it could be years. Complications (such as an allergic reaction) can occur if the cyst ruptures either spontaneously or during surgical manipulation. Cyst rupture can also cause secondary seeding of Dougther’s cysts in the affected person.



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