Alveolar echinococcosis is now endemic in southern Belgium

Introduction: Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis (AE). However it was recently demonstrated by necropsy series that up to 51% of the red foxes (Vulpes vulpes) may be infected by E. multilocaris in some parts of Southern Belgium. The first local Belgian human AE cases were described in the early 2000's. Aim: The aim of this study was to report the experience of a tertiary university hospital of Southern Belgium with AE management.
Methods: The authors retrospectively collected data from the parasitology laboratory (serologies), the hospital pharmacy in charge of supplying albendazole, and by searching through patient’s files with medico-economic information service of a tertiary university hospital. The medical files were retrospectively reviewed.
Results: Twenty-one cases (66% male) of local AE have been recorded from 1999 to 2016. All patients were Belgian citizens with more than 30 years of life in Southern Belgium (Liege province: 10 cases (47.4%), Luxembourg province: 8 cases (36.8%), Namur Province: 3 cases (15.8 %)). Mean age of diagnosis was 66 years (ranges: (35-85y). Eighteen patients had hepatic involvement: 14 underwent surgical resection and 5 had unresectable liver lesions and underwent albendazole palliative therapy until death. During the same period, the faculty of veterinary medicine observed an increased rate of lethal hepatic AE in dogs, another indication of high AE incidence.
Conclusions: AE appears to be spreading in Belgium and has actually an uneven geographical distribution with endemicity in areas of Southern and Eastern Belgium. However, it is probable that local AE cases will be diagnosed in the whole country, considering that there is no reason that infected foxes remain in Southern Belgium and also the fact that some people from Northern Belgium might spend long period in Southern Belgium, with or without their dogs. The liver is the most frequently involved organ and the only cure can be achieved by complete R0 resection of all AE lesions. In reaction to this experience, the authors created a multidisciplinary group for AE diagnosis and management, including hepatologists, infectiologists, microbiologists, pathologists, radiologists, nuclear medicine specialists, surgeons and veterinarians. The authorities should be aware of this medical issue and should facilitate the access to Albendazole for AE patients. A complete national survey should be encouraged, and BASL might have an important role in this study.