![]() ![]() Differently, ultrasound-based surveys describe more accurately the epidemiology of CE at population level. 13– 20 However, hospital-based studies do not capture asymptomatic cases, and HDR do not account for outpatients. 7– 12 Other studies have analyzed clinical cohorts in single centers. Studies based on hospital discharge records (HDR) have been performed in several countries. However, epidemiological data on CE are often lacking in both developing and high-income settings. 5 Mediterranean areas of Europe have always been considered endemic for CE, 6 and some studies have explored the clinical epidemiology of the disease using different methods. 4 Furthermore, in high-income countries, CE may be considered an “orphan” disease as it is perceived as “rare” and not representing a real public health problem. 3 The disease is included in the list of neglected tropical diseases for which the WHO advocates control. 2 Worldwide estimates suggest that 1.2 million individuals may be infected, with consistent economic losses for human treatment and animal production. 1 Cystic echinococcosis has a cosmopolitan distribution and is particularly prevalent where sheep raising is practiced. The parasite life cycle is maintained between canids, mainly dogs, which are definitive hosts harboring the adult stage of the parasite in the intestine, and livestock, mainly sheep, as intermediate hosts. Authors’ addresses: Tommaso Manciulli, Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, PhD School of Experimental Medicine, Pavia, Italy, E-mail: Riccardo Serraino, Enrico Maria Trecarichi, Maria Mazzitelli and Carlo Torti, Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, “Magna Graecia” University, Catanzaro, Italy, E-mails: and Gian Luca D’Alessandro, Roberta Narra, Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy, E-mails: Letizia Cattaneo, Unit of Infectious Diseases, University of Naples-Federico II, Napoli, Italy, E-mail: Mara Mariconti and Ambra Vola, Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy, E-mails: and Francesco Taccari, Institute of Clinical Infectious Disease, Catholic University of the Sacred Heart, Rome, Italy, E-mail: Giuseppe De Vito, Public Health Agency of the Catanzaro Province, Catanzaro, Italy, E-mail: Giovanni Matera and Nadia Marascio, Department of Health Sciences, Unit of Clinical Microbiology, “Magna Graecia” University, Catanzaro, Italy, E-mails: and Adriano Casulli, Department of Infectious Diseases, WHO Collaborating Centre for Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy, and Department of Infectious Diseases, European Reference Laboratory for Parasites, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy, E-mail: Enrico Brunetti, Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy and Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy, E-mail: Francesca Tamarozzi, Department of Infectious Diseases, WHO Collaborating Centre for Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy, E-mail: echinococcosis (CE) is a zoonotic infection caused by the larval stage of the cestode Echinococcus granulosus sensu lato.
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