the imaging technique of choice for alveolar echinococcosis and is usually complemented by ct scans since ct scans are able to detect the largest number of lesions and calcifications that are characteristic of alveolar echinococcosis. mris are also used in combination with ultrasonography though ct scans are preferred. like cystic echinococcosis, imaging is the major method used for the diagnosis of alveolar echinococcosis while the same types of serologic tests (except now specific for e. multilocularis antigens) are used to verify the imaging results. it is also important to note that serologic tests are more valuable for the diagnosis of alveolar echinococcosis than for cystic echinococcosis since they tend to be more reliable for alveolar echinococcosis since more antigens specific for e. multilocularis are available. in addition to imaging and serology, identification of e. multilocularis infection via pcr or a histological examination of a tissue biopsy from the person is another way to diagnose alveolar echinococcosis. polycystic similar to the diagnosis of alveolar echinococcosis and cystic echinococcosis, the diagnosis of polycystic echinococcosis uses imaging techniques, in particular ultrasonography and ct scans, to detect polycystic structures within the person's body. however, imaging is not the preferred method of diagnosis since the method that is currently considered the standard is the isolation of protoscoleces during surgery or after the person's death and the identification of definitive features of e. oligarthrus and e. vogeli in these isolated protoscoleces. this is the main way that pe is diagnosed, but some current studies show that pcr may identify e. oligarthrus and e. vogeli in people's tissues. the only drawback of using pcr to diagnose polycystic echinococcosis is that there aren't many genetic sequences that can be used for pcr that are specific only e. oligarthrus or e. vogeli. prevention boiling sheep livers containing hydatid cysts for 30 minutes kills the cestode larvae – a simple method for prevention in remote areas cystic echinococcosis there are several different strategies that are currently being used to prevent and control cystic echinococcosis (ce). most of these various methods try to prevent and control ce by targeting the major risk factors for the disease and the way it is transmitted. for instance, health education programs focused on cystic echinococcosis and its agents, and improved water sanitation attempt to target poor education and poor drinking water sources, which are both risk factors for contracting echinococcosis. furthermore, since humans often come into contact with echinococcus eggs via touching contaminated soil, animal feces and animal hair, another prevention strategy is improved hygiene. in addition to targeting risk factors and transmission, control and prevention strategies of cystic echinococcosis also aim at intervening at certain points of the parasite's life cycle, in particular, the infection of hosts (especially dogs) that reside with or near humans. for example, many countries endemic to echinococcosis have researched programs geared at de-worming dogs and vaccinating dogs and other livestock, such as sheep, that also act as hosts for e. granulosus. proper disposal of carcasses and offal after home slaughter is difficult in poor and remote communities and therefore dogs readily have access to offal from livestock, thus completing the parasite cycle of echinococcus granulosus and putting communities at risk of cystic echinococcosis. boiling livers and lungs that contain hydatid cysts for 30 minutes has been proposed as a simple, efficient and energy- and time-saving way to kill the infectious larvae. alveolar echinococcosis a number of strategies are geared towards prevention and control of alveolar echinococcosis—most of which are similar to those for cystic echinococcosis. for instance, health education programs, improved water sanitation, improved hygiene and de-worming of hosts (particularly red foxes) are all effective to prevent and control the spread of alveolar echinococcosis. unlike cystic echinococcosis, however, where there is a vaccine against e. granulosus, there is currently no canidae or livestock vaccine against e. multilocularis. polycystic echinococcosis while a number of control and prevention strategies deal with cystic and alveolar echinococcosis, there are few methods to control and prevent polycystic echinococcosis. this is probably due to the fact that polycystic echinococcosis is restricted to central and south america, and that the way that humans become accidental hosts of e. oligarthrus and e. vogeli is still not completely understood. human vaccines currently there are no human vaccines against any form of echinococcosis. however, there are studies being conducted that are looking at possible vaccine candidates for an effective human vaccine against echinococcosis. treatment cystic international consensus on nomenclature framework for cystic echinococcosis surgery a number of therapy options are presently available. treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (< 5 cm). only 30% of cysts disappear with medical treatment alone. albendazole is preferred twice a day for 1–5 months. an alternative to albendazole is mebendazole for at least 3 to 6 months. surgery is indicated for bigger liver cysts (> 10 cm), cysts at risk of rupture and/or complicated cysts. a laparoscopic approach provides excellent cure rates with minimal morbidity and mortality. the radical technique (total cystopericystectomy) is preferable because of its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. pair (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. pair is a minimally invasive procedure that involves three steps: puncture and needle aspiration of the cyst, injection of a scolicidal solution for 20–30 min, and cyst-re-aspiration and final irrigation. people who undergo pair typically take albendazole or mebendazole from 7 days before the procedure until 28 days after the procedure. it is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. there have been a number of studies that suggest that pair with medical therapy is more effective than surgery in terms of disease recurrence, and morbidity and mortality. there is currently research and studies looking at new treatment involving percutaneous thermal ablation (pta) of the germinal layer in the cyst by means of a radiofrequency ablation device. this form of treatment is still relatively new and requires much more testing before being widely used. alveolar for alveolar echinococcosis, surgical removal of cysts combined with chemotherapy (using albendazole and/or mebendazole) for up to two years after surgery is the only sure way to completely cure the disease. however, in inoperable cases, chemotherapy by itself can also be used. in treatment using just chemotherapy, one could use either mebendazole in three doses or albendazole in two doses. since chemotherapy on its own is not guaranteed to completely rid of the disease, people are often kept on the drugs for extended periods of times (i.e. more than 6 months, years). in addition to surgery and chemotherapy, liver transplants are being looked into as a form of treatment for alveolar echinococcosis although it is seen as incredibly risky since it often leads to echinococcosis re-infection in the person afterwards. polycystic since polycystic echinococcosis is constrained to such a particular area of the world and is not well described or found in many people, treatment of polycystic echinococcosis is less defined than that of cystic and alveolar echinococcosis. while surgical removal of cysts was the treatment of choice for the previous two types of echinococcosis, chemotherapy is the recommended treatment approach for polycystic echinococcosis. while albendazole is the preferred drug, mebendazole can also be used if the treatment is to be for an extended period of time. only if chemotherapy fails or if the lesions are very small is surgery advised. epidemiology location of people, controls, and areas in france where persons are at risk for alveolar echinococcosis. see legend below the image. regions very few countries are considered to be completely free of e. granulosus. areas of the world where there is a high rate of infection often coincide with rural, grazing areas where dogs are able to ingest organs from infected animals. e. multilocularis mainly occurs in the northern hemisphere, including central europe and the northern parts of europe, asia, and north america. however, its distribution was not always like this. for instance, until the end of the 1980s, e. multilocularis endemic areas in europe were known to exist only in france, switzerland, germany, and austria. but during the 1990s and early 2000s, there was a shift in the distribution of e. multilocularis as the infection rate of foxes escalated in certain parts of france and germany. as a result, several new endemic areas were found in switzerland, germany, and austria and surrounding countries such as the netherlands, belgium, luxembourg, poland, the czech republic, the slovak republic, and italy. there is also evidence showing that the baltic countries are endemic areas. while alveolar echinococcosis is not extremely common, it is believed that in the coming years it will be an emerging or re-emerging disease in certain countries as a result of e. multilocularis’ ability to spread. unlike the previous two species of echinococcus, e. vogeli and e. oligarthrus are limited to central and south america. furthermore, infections by e. vogeli and e. oligarthrus (polycystic echinococcosis) are considered to be the rarest form of echinococcosis. deaths as of 2010 it caused about 1200 deaths, down from 2000 in 1990. history laminated layer of a cyst found in a corpse in a grave from the late roman period in france, interpreted as a probable hydatidosis cyst echinococcosis is a disease that has been recognized by humans for centuries. there has been mention of it in the talmud. it was also recognized by ancient scholars such as hippocrates, aretaeus, galen and rhazes. the recommended treatments were based on herbs like thymus vulgaris and raw garlic. although echinococcosis has been well known for the past two thousand years, it was not until the past couple of hundred years that real progress was made in determining and describing its parasitic origin. the first step towards figuring out the cause of echinococcosis occurred during the 17th century when francesco redi illustrated that the hydatid cysts of echinococcosis were of "animal" origin. then, in 1766, pierre simon pallas predicted that these hydatid cysts found in infected humans were actually larval stages of tapeworms. a few decades afterwards, in 1782, goeze accurately described the cysts and the tapeworm heads, while in 1786 e. granulosus was accurately described by batsch. half a century later, during the 1850s, karl von siebold showed through a series of experiments that echinococcus cysts do cause adult tapeworms in dogs. shortly after this, in 1863, e. multilocularis was identified by rudolf leuckart. then, during the early to mid 1900s, the more distinct features of e. granulosus and e. multilocularis, their life cycles and how they cause disease were more fully described as more and more people began researching and performing experiments and studies. while e. granulosus and e. multilocularis were both linked to human echinococcosis before or shortly after the 20th century, it was not until the mid-1900s that e. oligarthrus and e. vogeli were identified as and shown as being causes of human echinococcosis. two calcified objects recovered from a 3rd- to 4th-century grave of an adolescent in amiens (northern france) were interpreted as probable hydatid cysts. a study of remains from two 8,000-year-old cemeteries in siberia showed presence of echinococcosis.