HERACLES · Human cystic Echinococcosis ReseArch in CentraL and Eastern Societies

Human cystic echinococcosis (CE), one of the most widespread helminthic zoonoses, is a chronic disease caused by infection with the larval stage of the tapeworm Echinococcus granulosus. This disease is highly endemic in some southern (Spain and Italy), eastern (Bulgaria and Romania) European countries and associated (Turkey) countries, where it still represents a major health and economic problem. In endemic areas the annual incidence of CE ranges from 1 to 200 per 100,000 inhabitants and 2-3 million cases are globally estimated. Case series and small clinical trials show a mortality rate of 2-4% for CE, but this increases markedly with substandard treatment and care. The diagnosis of human CE is mainly based on imaging techniques and serological confirmation. Clinical decision making is difficult and the natural history of the cyst is still poorly known. CE is chronic, complex and still neglected. For these reasons the main objectives of HERACLES are:• Identify by ultrasound screening the population affected by CE in endemic rural areas of CEE countries;• Create CEE national registries for surveillance of CE;• Establish a representative bio-bank of genetic Egc isolates and blood/serum/plasma samples;• Validate new molecular-based POC-LOC kits for immunological surveillance, diagnosis and follow-up;• Identify factor/s associated with CE response to therapy or lack thereof through investigation of host-parasite interplay (parasite virulence vs human immunity);• Increase drug bioavailability in an in vivo model, decreasing the length of antiparasitic (ABZ based) treatment of CE and synthesize a new enantiomeric drug based on ABZ.The project stakeholders, especially the rural populations in which CE is endemic, as well as SMEs, will be engaged as an integral part of the project. Special events to increase general awareness of CE and training activities for local health care providers will be organized.