Echinococcosis - unilocular in Morocco

[Graph 1]
Morocco. Echinococcosis, cases

1978 2005 2006 2007 2008 2009

1,488 1,495 1,390 1,300 1,500 1,600
2010 2011 2012 2013 2014  
1,576 1,466 1,550 947 1,033  

Notes:
1. 200 cases were reported in Casablanca in 1964. 1

 2000 - 1.1% of Berber people in the Mid-Atlas mountain region were infested. 2

 1992 - The annual incidence of surgical echinococcosis was 10 to 15 per 100,000 in

Khenifra prefecture, and 20 to 25 per 100,000 in Ifrane prefecture.
Prevalence surveys
Study
Years Region % Notes
Group

1987* Rabat dogs 22.8 22.8% of stray dogs in Rabat 3

58.82% of dogs in the northwest

Multiple
2007* dogs 55.42-58.82 (Loukkos), and 55.42% in the
locations
southwest (Tiznit) 4

5.3% of sheep, 44.6% of cattle and

1988* Ouarzazate animals 5.3-50.8
50.8% of stray dogs in Ouarzazate 5

22.98% of cattle, 10.58% of sheep,

2001 -
Nationwide animals 10.58-22.98 12.03% of camels, 17.80% of equines
2004
and 1.88% of goats 6

2016 -
Gharbeya sheep 7.63 7.63% of sheep at slaughter 7
2017

23% of sheep, 43% of cattle and

1951 ruminants 23-100
100% of camels 8

0.7% of goats and 80% of

1986* ruminants 0.7-80
dromedaries 9
* indicates publication year (not necessarily year of survey)
Notes:

1. 200 cases were reported in Casablanca in 1964. 1

 2000 - 1.1% of Berber people in the Mid-Atlas mountain region were infested. 2

 1992 - The annual incidence of surgical echinococcosis was 10 to 15 per 100,000 in

Khenifra prefecture, and 20 to 25 per 100,000 in Ifrane prefecture.
Prevalence surveys
Study
Years Region % Notes
Group

1987 *
Rabat dogs 22.8 22.8% of stray dogs in Rabat 3

58.82% of dogs in the northwest

Multiple
2007* dogs 55.42-58.82 (Loukkos), and 55.42% in the
locations
southwest (Tiznit) 4

5.3% of sheep, 44.6% of cattle and

1988* Ouarzazate animals 5.3-50.8
50.8% of stray dogs in Ouarzazate 5

22.98% of cattle, 10.58% of sheep,

2001 -
Nationwide animals 10.58-22.98 12.03% of camels, 17.80% of equines
2004
and 1.88% of goats 6

2016 -
Gharbeya sheep 7.63 7.63% of sheep at slaughter 7
2017

23% of sheep, 43% of cattle and

1951 ruminants 23-100
100% of camels 8

0.7% of goats and 80% of

1986* ruminants 0.7-80
dromedaries 9
* indicates publication year (not necessarily year of survey)

References for Echinococcosis - unilocular in Morocco

1 Hydatidosis: a global problem of increasing importance.  

Bull World Health Organ 1977 ;55(4):499-507.

Author(s):
Smyth JD

Abstract:
This review of recent literature reporting the occurrence of hydatid disease due to Echinococcus
granulosus and E. multilocularis throughout the world emphasizes the global nature of the
problem and the threat of its spread into those countries currently free from it. Attention is
drawn to the urgent need for measures to prevent the importation of infected livestock and this
would require the development of techniques for pre-mortem diagnosis and differentiation of
hydatidosis and cysticercosis of animals. There must also be increased awareness of the possible
occurrence of biological strains of the parasite which may be of greater or lower infectivity for
man. In the absence of information on infectivity, studies concerning the prevalence of the
disease may be meaningless.

[Click here to see the PubMed abstract]

2 Cystic echinococcosis in the Berber of the Mid Atlas mountains,

Morocco: new insights into the natural history of the disease in humans.  

Ann Trop Med Parasitol 2004 Jul ;98(5):481-90.

Author(s):
El Hasnaoui M

Abstract:
Precise knowledge of the natural history of cystic echinococcosis (CE) in humans remains
somewhat arcane. The aim of the present study was to determine whether aspects of the natural
history of established human infection with Echinococcus granulosus could be investigated by
using a cross-sectional approach, in a community where CE was endemic. A mass ultrasound-
screening survey, coupled with a questionnaire to record all previous surgical histories related to
CE, was carried out amongst the primarily transhumant Berber people of the Mid Atlas
mountains in Morocco. During two periods of intensive screening, of 10 days in May 2000 and 11
days in May 2001, 11,612 people, representing > 98% of the local population, were checked.
One hundred and twenty six (1.1%) of the subjects--75 (59.5%) of the 6864 females
investigated and 51 (40.5%) of the 4748 males--were found ultrasound-positive for CE. Overall,
14.1% of the CE cases detected were children aged 1-15 years (who made up 44% of the study
population). Most (77.4%) of the ultrasound-positive subjects investigated were also found
seropositive for CE. The frequency of a past history of surgery for CE increased with subject age
(P = 0.024), 125 (1.1%) of the subjects being recorded as having had such surgery. The
frequency of surgery for pulmonary CE was relatively constant in all age-groups, indicating that
infection can occur at any time. The frequency of abdominal CE increased with age (R2 =
0.8102). Assuming that the incidence of infection remains fairly constant over time and that the
longer a person spends in this endemic area the more likely it is that he or she will develop CE,
then a progression from active through transitional to inactive CE should occur. The cysts
observed by ultrasound in the present study were categorized, as type 1, 2, 3, 4 or 5, according
to the new, standardized, ultrasound classification of CE developed by the World Health
Organization (WHO). There was a clear exponential decline in the frequency of the various cyst
types, from type 1 (the most frequent) to type 5 (the rarest). This decline validates the
assumptions made, about the natural history of established CE, by those who developed the
WHO's classification. The classification should therefore be invaluable to surgeons and clinicians,
when they have to consider treatment options for patients with the various types of CE, and to
policy makers trying to establish the economic costs of treating CE in endemic settings.

[Click here to see the PubMed abstract]

3 Parasites of stray dogs in the Rabat region, Morocco.  

Ann Trop Med Parasitol 1987 Feb ;81(1):53-5.

Author(s):
Elmamoune M

Abstract:
Eighteen parasites were identified from 57 stray dogs from the urban and rural areas of Rabat.
The prevalence of the species of parasites was: Ctenocephalides (C. canis, C. felis) 94.7%,
Rhipicephalus sanguineus 68.5%, Linguatula serrata, Babesia canis, Isospora canis each 3.5%,
Toxocara canis 7%, Dirofilaria immitis, Taenia hydatigena, T. pisiformis each 12.3%,
Dipetalonema dracunculoides 10.5%, Ancylostoma caninum 17.5% Echinococcus granulosus
22.8%, Toxascaris leonina 33.3%, Dipylidium caninum 40.4%, Spirocerca lupi 54.5%, Unicinaria
stenocephala 79%. Multiple infections (two to nine parasites) were seen in 56 dogs. T. canis was
present only in dogs younger than one year of age. D. immitis, D. dracunculoides, T. hydatigena
and T. pisiformis occurred only in animals older than one year. A. caninum, U. stenocephala, S.
lupi, D. immitis were more common in males than females. E. granulosus was never detected in
urban dogs.

[Click here to see the PubMed abstract]

4 Modelling the transmission of Echinococcus granulosus in dogs in the

northwest and in the southwest of Morocco.  

Vet Parasitol 2007 Apr 30;145(3-4):297-303.

Author(s):
El Berrahmani M
Abstract:
Echinococcus granulosus (E. granulosus) infection was studied in 151 dogs in two regions of
Morocco: 68 dogs in the northwest (Loukkos) and 83 dogs in the southwest (Tiznit). The mean
prevalence rates of echinococcosis in dogs were 58.82% (46.23-70.63%) in Loukkos and
55.42% (44.10-66.34%) in Tiznit and the mean abundances of E. granulosus per dog were 75
(59-93) and 547 (504-595), respectively. The mean abundance of E. granulosus in dogs was
fitted to a negative binomial distribution by the maximum likelihood techniques to define
parameters. E. granulosus was aggregated in dogs in the two regions. The prevalence of
infection and the abundance of E. granulosus in dogs were fitted to mathematical models in
order to determine if the parasite population is partly regulated by definitive host immunity. The
best fit was obtained with the models assuming the presence of immunity. The mean time of
exposure to infection was similar in the two regions and ranged from 8 months to about 2 years.
The infection pressures (number of E. granulosus) obtained per dog each year were 65 (8-294)
in Loukkos and 476 (316-886) in Tiznit. The proportion of dogs susceptible to infection was still
high along the life of the dogs in Loukkos, while it was not different from zero in old dogs of
Tiznit.

[Click here to see the PubMed abstract]

5 Epidemiology of hydatidosis/echinococcosis in Ouarzazate, the pre-

Saharian region of Morocco.  

Ann Trop Med Parasitol 1988 Oct ;82(5):461-70.

Author(s):
Moumen A

Abstract:
In the Ouarzazate province of Southern Morocco, 1085 cattle and 358 sheep were examined for
hydatid cysts. The prevalence was 44.6% (range 8.3-83.4%) in cattle and 5.3% (range 1.3-
28.6%) in sheep. The prevalence increased with the age of the animals. The lung was the
predominant site of infection, followed by the liver. In cattle, 14.2% of hydatid cysts were fertile
and 16.4% had degenerative changes. The mean loss per head of cattle slaughtered was about 1
kg of liver and 900 g of lungs in the urban abattoirs. In monetary terms at the current price of
1980, this meant a loss of U.S. +4.5 at urban and +1.6 at rural abattoirs. The mean prevalence
of infection in 61 stray dogs was 50.8%, with a mean worm burden of 413. The urban dogs had
a lower infection rate (42.9%) than the rural dogs (61.5%). There were 130 dogs per 1000
inhabitants. The human population was ignorant of the life-cycle of Echinococcus granulosus and
was not aware of risk of infection through dogs. Dogs become infected at abattoirs, at home
slaughter and in the field by consuming dead carcasses. The maintenance and transmission of E.
granulosus in animals and man is related to social, religious and cultural factors.

[Click here to see the PubMed abstract]

6 Epidemiological study of the cystic echinococcosis in Morocco.  

Vet Parasitol 2006 Apr 15;137(1-2):83-93.

Author(s):
Dakkak A

Abstract:
The objectives of this epidemiological study on cystic echinococcosis (CE) in Morocco (2001-
2004) were to update the prevalence of CE in different animal species living in the most
important areas of the country and to collect protoscoleces and germinal layers for genetic
research purposes. The post mortem inspection concerned 2948 sheep, 2337 goats, 618 cattle,
482 camels and 455 equines (325 horses, 60 mules and 70 donkeys) in five different regions:
the Rif (Mediterranean coast and high mountains of the Rif), the Loukkos (Atlantic northwest
plain), the center (Rabat and Casablanca regions), the Middle Atlas mountains and the south
(arid and semi desert areas). The global CE infection prevalence rates obtained were 22.98% in
cattle, 10.58% in sheep, 12.03% in camels, 17.80% in equines and 1.88% in goats. The
infection rates were especially high in the Middle Atlas in cattle (48.72%) and in the Loukkos in
cattle and sheep (37.61 and 31.65%, respectively). The majority of infected cattle (49.6%) and
sheep (52.1%) had hydatid cysts in both liver and lungs. Except for cattle, the liver was more
infected than lungs in all the other animal species. Animals more than 5 years old were the most
infected in all species. The mean CE infection rates of these animals were about 56% in cattle,
40% in sheep, 20% in camels, 17.80% in equines and 7% in goats. These rates were much
higher in the Loukkos (85% of cattle and 59% of sheep) and in the Middle Atlas (68% of cattle
and 45% of sheep) than in the other regions. Results showed that Echinococcus granulosus is in
an endemic steady state with no evidence of protective immunity in the intermediate hosts. The
mean numbers of infections per year are 0.099 for cattle, 0.063 for sheep, 0.03 for camels and
0.010 for goats.

[Click here to see the PubMed abstract]

7 Epidemiological study of in sheep in the Gharb plain (North-West of

Morocco).  

J Parasit Dis 2018 Dec ;42(4):505-510.

Author(s):
Belghyti D

Abstract:
Hydatidosis is considered endemic in Morocco and caused serious health problems in ruminants.
The aim of this research is to present an epidemiological study on echinococcosis in sheep. The
study was carried out between April 2016 and May 2017. A total number of 1600 sheeps was
examined via autopsy for in various slaughterhouses in the Gharb plain of Morocco. The Results
of the study showed that the prevalence of cystic echinococcosis was 7.63%. The infection was
not significant among sheep which age is < 1 year (2.67%), while it increases among those
which age is from 1 to 3 years old (8.63%). It also grows significantly among sheep which age is
over 3 years old (11.71%). Parasitized at 62%, the liver is the most affected organ followed by
the lungs (38%). Protoscoleces are only found in liquid cysts and contribute to their fertility
which is estimated at 66.66% in the liver and 57.74% in the lungs. In addition, the prevalence
of calcified cysts is 12.24% in the liver and 21.11% in the lungs. Examination of the fertile cysts
revealed a high level of Protoscoleces viability, whether it's in the liver (65.93%) or in the lungs
(59.30%). This study also shows how the evolution of echinococcosis is closely linked to sex and
age.

[Click here to see the PubMed abstract]

8 Hydatidosis: a global problem of increasing importance.  

Bull World Health Organ 1977 ;55(4):499-507.

Author(s):
Smyth JD

Abstract:
This review of recent literature reporting the occurrence of hydatid disease due to Echinococcus
granulosus and E. multilocularis throughout the world emphasizes the global nature of the
problem and the threat of its spread into those countries currently free from it. Attention is
drawn to the urgent need for measures to prevent the importation of infected livestock and this
would require the development of techniques for pre-mortem diagnosis and differentiation of
hydatidosis and cysticercosis of animals. There must also be increased awareness of the possible
occurrence of biological strains of the parasite which may be of greater or lower infectivity for
man. In the absence of information on infectivity, studies concerning the prevalence of the
disease may be meaningless.

[Click here to see the PubMed abstract]

9 Hydatidosis in sheep, goats and dromedaries in Morocco.  

Ann Trop Med Parasitol 1986 Oct ;80(5):525-9.

Author(s):
Ouchtou M

Abstract:
Two thousand two hundred and forty-six sheep, 510 goats and 35 dromedaries were examined
for hydatid cysts. The mean prevalence was 0.7% (range 0.4-38.5%) in sheep, 1.4% (range
0.2-7.7%) in goats and 80% in dromedaries. The increase in prevalence with age of the animals
was statistically significant in sheep only. In all species examined infection of the lungs was more
common and important than that of the livers. The fertility rate of hydatids was 50% in sheep
and 67.8% in dromedaries; and degenerative changes were shown by 65.8% of hydatids from
dromedaries as compared to 16.3% in sheep. Dromedaries seem to play an important role in the
epidemiology of hydatidosis in Morocco.

[Click here to see the PubMed abstract]

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