Kliniken & Institute … Institute Zentrum für… Section Clinical… Research Echinococcosis

Publication List


Cystic Echinococcosis

Stojkovic, M., Adt, H.-M., Rosenberger, K., Boubaker, G., Hernandez-Gonzalez, A., Junghanss, T., Zwahlen, M. and Siles-Lucas, M. (2017), Follow-up of surgically treated patients with cystic echinococcosis: can novel recombinant antigens compete with imaging? Analysis of a patient cohort. Trop Med Int Health, 22: 614–621. doi:10.1111/tmi.12859


Stojkovic M, Rosenberger KD, Steudle F, Junghanss T (2016) Watch and Wait Management of Inactive Cystic Echinococcosis – Does the Path to Inactivity Matter – Analysis of a Prospective Patient Cohort. PLoS Negl Trop Dis 10(12): e0005243. https://doi.org/10.1371/journal.pntd.0005243


Stojkovic M, Junghanss T, Veeser M, Weber TF, Sauer P (2016) Endoscopic Treatment of Biliary Stenosis in Patients with Alveolar Echinococcosis – Report of 7 Consecutive Patients with Serial ERC Approach. PLoS Negl Trop Dis 10(2): e0004278. https://doi.org/10.1371/journal.pntd.0004278


J. Mueller, M. Stojkovic, A. K. Berger, K. D. Rosenberger, C. L. Schlett, H.-U. Kauczor, T. Junghanss, T. F. Weber (2016) How to not miss alveolar echinococcosis in hepatic lesions suspicious for cholangiocellular carcinoma. Abdom Radiol (2016) 41: 221. doi:10.1007/s00261-015-0561-2


K. Martakis, T. Junghanss, F. Körber, T. Simon, M. Stojkovic (2015) Zystische Echinokokkose mit hepatischer und thorakaler Manifestation bei einer adoleszenten Patientin. Klin Padiatr 2015; 227(01): 38-40. DOI: 10.1055/s-0034-1394415


Marija Stojkovic, Thomas Junghanss, Chapter 26 - Cystic and alveolar echinococcosis, In: Hector H. Garcia, Herbert B. Tanowitz and Oscar H. Del Brutto, Editor(s), Handbook of Clinical Neurology, Elsevier, 2013, Volume 114, Pages 327-334, ISSN 0072-9752, ISBN 9780444534903.


Junghanss T, Bialek R, Kern P, Stojković M, Tappe D, Kapital 30 – Echinokokkose. In: Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI) Infektionen bei Kindern und Jugendlichen, 6. vollständig überarbeitete Auflage, 2013, Seite 232 – 236, Georg Thieme Verlag, ISBN 978-3-13-144716-6


Stojković M, Gottstein B, Junghanss T, Section 10, Chapter 56:  Echinococcosis. In: Manson's Tropical Diseases, 23rd Edition, Saunders (W.B.) Co Ltd (Verlag), 978-0-7020-5101-2 (ISBN)


Alveolar Echinococcosis

Bruno Gottstein, Marija Stojkovic, Dominique A. Vuitton, Laurence Millon, Audrone Marcinkute, Peter Deplazes (2015) Threat of alveolar echinococcosis to public health – a challenge for Europe. Trends Parasitol 31(9): 407-412.


Stojkovic M, Mickan C, Weber T, Junghanss T. Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series. BMJ Open Gastroenterology. 2015;2(1):e000036. doi:10.1136/bmjgast-2015-000036.


Clinical Management of Patients with Cystic Echinococcosis ("Heidelberg Patient Cohort")


Funding: Bonus programme

Time frame: since 1998

Scientists (Section Clinical Tropical Medicine): M. Stojkovic, A. Kapaun, T. Junghanss

Cooperating partners:

● Dept. of Diagnostic and Interventional Radiology, Heidelberg University Hospital (T. Weber)

● Dept. of Surgery, Heidelberg University Hospital (A. Mehrabi)

● Dept. of Parasitology, Heidelberg University Hospital (T. Jaenisch, H. Gehrig-Feistl, H. Jung)

● Thoraxklinik, Heidelberg University Hospital (H. Hoffmann)



Clinical management of patients with cystic echinococcosis has been established at our hospital through interdisciplinary cooperation with the Department of Surgery, the Department of Diagnostic and Interventional Radiology (with weekly radiological conferences), the Department of Parasitology and the Thoraxklinik.


Today we are a national clinical reference centre for patients with cystic echinococcosis; in international terms, we are a well-established partner in the field of clinical echinococcosis research.




Phase II planning of clinical trial on stage-specific treatment of cystic echinococcosis (EchinoTrial)

NIH R 34 Clinical Trial Planning Grant


Funding:             U.S. National Institutes of Health

Time frame:       09/2010 – 08/2011
Scientists (Section Clinical Tropical Medicine):   T. Junghanss, M. Stojkovic

Cooperating partners:

  -  S. Luntz, KKS, Germany

  -  E. Brunetti, Universitá degli studi di Pavia, Italy

  -  H. Garcia, Universidad Peruana Cayetano Heredia, Peru

  -  S. Santivanez, INPPACE, Peru

  -  R. Gilman, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, US

  -  M. Zwahlen, University of Bern, Switzerland




The specific aims of the R34 planning grant are to develop the protocol, SOPs and related trial documents for a Phase 2 clinical trial of stage-specific treatment of cystic echinococcosis (EchinoTrial) and to select the trial sites in Peru. The main study is a pragmatic randomised controlled trial to determine the efficacy, safety and relapse rate of the four currently available treatment modalities of uncomplicated hepatic CE cysts stratified by cyst stage as defined by the WHO ultrasound classification 2002 [Phase 2 stage-specific clinical trial (main study)]. Given the extraordinary clinical complexity of CE, treatment standardization requires the exclusion of patients with complicated cysts in need of individualized therapy. Patients with complicated CE cysts (e.g. cysto-biliary fistulas, cyst rupture, secondary bacterial infection) will be investigated in a prospective observational non-comparative study arm (substudy). The trial site in Peru offers access to a highly endemic population for CE. The expected outcome of this trial will create a solid evidence base for the allocation of available treatment modalities on cyst stage level, will help to avoid unnecessary treatment of inactive cysts and will define the long term prognosis after treatment (relapse rate).

The submission of the trial protocol and application for a "Clinical trial implementation grant" was due in January 2012.


Analysis of Benzimidazole Efficacy based on Individual Patient Data - a Multicentre Study (EchinoMEDREV)

Funding: Bonus programme

Time frame: 2004–2009

Scientists (Section Clinical Tropical Medicine): M. Stojkovic, T. Junghanss

Cooperating partners:

● M Zwahlen, Department of Social and Preventive Medicine, University Bern, Bern, Switzerland

● CM Cretu, "C. Davila" University of Medicine and Pharmacy, Colentina Teaching Hospital, Bucharest, Romania

● D Dogru, Hacettepe Medical University Hospital, Pediatric Pulmonary Medicine, Ankara, Turkey

● J El-On, Department of Microbiology and Immunology, Ben Gurion University of the Negev, Beer Shiva, Israel

● A Göcmen, Department of Pediatrics, Hacettepe Children’s Hospital, Ankara, Turkey

● W. Hao, Xinjang Medical University, Xinjang Hydatid Clinical Research Institute, Urumqi, Xinjiang, P. R. China

● F He, Urumqi, Xinjiang Medical College, Urumqi, Xinjiang, P. R. China

● RJ Horton, Life Sciences Network, Hitchin, UK

● Maragakis, University General Hospital “Αttikon”, Department of Surgery, Haidari, Greece

● P Nicolaidou-Karpathiou, University General Hospital “Αttikon”, Department of Pediatrics, Haidari, Greece

● Y Shao, Urumqi, Xinjiang Medical College, Urumqi, Xinjiang, P. R. China

● A Teggi, Department of Infectious and Tropical Diseases, University of Rome “La Sapienza”, Rome, Italy

● R Virdone, Azienda Ospedaliera “V.CERVELLO”, Department of Gastroenterology, Palermo, Italy

● K Vutova, Department of Infectious Diseases, Parasitology and Tropical Medicine, University of Medicine, University Hospital “St. I. Rilski”, Sofia, Bulgaria



Drug therapy with benzimidazoles is one of four options available for the treatment of cystic echinococcosis, which has been investigated in a great number of clinical studies. However, individual studies are not large enough to provide reliable estimates regarding the effect of treatment. Heterogeneity of the inclusion criteria and the study endpoints does not allow for meta-analysis. Moreover, most of the studies published to date do not allow for the stratification of the treatment results according to cyst staging determined by ultrasound. However, this is a classification that seems indispensable today regarding the choice of treatment modality and the monitoring of treatment success.

Individual patient data is reanalysed to (1) gather evidence regarding the efficacy of benzimidazole treatment based on the data available and (2) plan a multicentre clinical study to compare the four treatment modalities currently available stratified by cyst stage, with benzimidazoles being the only drug therapy.


From country level to a pan-European perspective: a coordinated approach to controlling cystic echinococcosis (EchinoNET)

Funding:  European Union (INCO-MED)

Time frame: 2004-2008

Scientist (Section Clinical Tropical Medicine): T. Junghanss, J. Kaur, M. Stojkovic, A. Kapaun

Cooperating partners:

● Department of Epidemiology and Public Health, University of Bielefeld, Germany (O. Razum)

● Division of Infectious and Tropical Diseases – IRCCS S. Matteo – University of Pavia, Italy (E. Brunetti)

● Servico de Cirurgia Geral e Digestiva , Hospital de Pulido Valente, Universidade Nova de Lisboa, Portugal (A.Menezes da Silva)

● Area de Zoonosis, Consejeria de Salud y Servicios Sociales, Gobierno de la Rioja, Spain (S. Jimenez)

● Department of Parasitology, Hassan II Institute of Agronomy and Veterinary Medicine, Rabat, Morocco (M. Kachani)

● Hepato-Gastro-Enterology Unit, Ibn Sina University Hospital, Rabat, Morocco (M. Benazouz)

● Research and Training Center on Vectors of Diseases, Ain Shams University, Kairo, Egypt (R. Ramzy)

● Department of Veterinary Sciences, Laboratory of Parasitology, Université Mentouri, Constantine, Algeria (M.C. Benchikh-Elfegoun)

● Department of Biological Sciences, Yarmouk University, Irbid, Jordan (S.K. Abel-Hafez)

● National School of Veterinary Medicine Sidi Thabet, Tunesia (S. Lahmar)

● Unit of Interventional Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey (O. Akan)


The project aims to develop a standardised methodology for transnational data collection and data presentation in the fields of surveillance, prevention and clinical management of cystic echinococcosis (CE); to collect and assess data on prevention measures in the endemic partner countries as well as collect and assess data on the four treatment modalities surgery, PAIR, drug treatment and ‘watch & wait’ from endemic (Mediterranean partner countries) and non-endemic (EU) countries; to make recommendations on surveillance, prevention, treatment and quality management.

Data collection regarding the diagnosis, treatment and control of cystic echinococcosis in the EchinoNET partner countries as well as data analysis have been completed. EchinoNET is currently expanding its network to include CE-endemic countries in Latin America with the aim to compare the four treatment modalities currently available in a multicentre clinical study stratified by cyst stage. This would be the first clinical study on this neglected disease to be large enough and carried out to the required standards.