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Les échinococcoses sont des parasitoses liées au développement, chez les mammifères herbivores et omnivores, donc aussi chez l’homme, des larves de ténias du genre Echinococcus. L’échinococcose est une hémizoonose: le cycle des parasites s’arrête chez l’homme puisque l’homme n’est pas une proie pour les carnivores qui sont seuls les hôtes définitifs des parasites.

Il existe deux formes d'échinoccocose, due aux larves de deux espèces différentes de ténias. Nous traiterons ici de l'échinococcose alvéolaire (ténia échinococcus multilocularis) car l'échinococcose cystique (ténia Echinococcus granulosus) est quasi absente de France.

Cycle de l’échinococcose alvéolaire

Le parasite adulte vit dans l’intestin d’un carnivore (renard, chien, chat...), hôte définitif qui se contamine en consommant des petits rongeurs parasités. Le carnivore guérit spontanément, mais peut se réinfecter.

Il évacue les œufs infestants dans ses matières fécales. Des insectes coprophiles peuvent contribuer à disséminer les œufs.
Les rongeurs (campagnols surtout), hôtes intermédiaires, se contaminent en ingérant les œufs avec leur nourriture végétale. Une forme larvaire se développe alors dans le foie ce qui entraîne, à terme, la mort du rongeur.

On parle de cycle puisque des rongeurs infectés sont mangés par un carnivore, qui par ses fèces disséminera des œufs :


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L’homme et l’échinococcose alvéolaire

L’homme peut se contaminer en mangeant des végétaux souillés (situés donc au sol ou près du sol). Il peut aussi être contaminé par contact direct avec un chat ou un chien infecté.
En effet, ces deux espèces domestiques peuvent être des hôtes définitifs lorsqu’ils sont prédateurs de rongeurs sauvages infestés. «Le risque majeur pour l’homme survient lorsque des chats ou des chiens se nourrissent de rongeurs sauvages ; les œufs d’E. multilocularis dans les matières fécales du chat sont alors la principale source d’infestation de l’homme » (Zoonoses et maladies transmissibles commune à l’homme et aux animaux, Office International des Epizooties, Paris 2000). « Une activité comme la chasse semble également exposer au risque de façon plus importante », selon A. Gérard (Traité de parasitologie médicale, éditions Pradel) : sans doute à cause du contact des chasseurs avec des mammifères tués (renards et autres) et leurs chiens, pouvant abriter des œufs dans leur pelage.

L’échinococcose humaine est caractérisée par l’apparition de kystes alvéolé ou multiloculaires localisés principalement dans le fois (98% des cas). La maladie évolue lentement, les signes cliniques apparaissent de cinq à quinze ans après le contact, en ressemblant parfois à l’invasion par une tumeur maligne.

L’échinococcose humaine peut être grave, surtout dans sa forme multiloculaire, mais elle n’est pas toujours fatale, et l’on sait que certains sujets contaminés ne développent pas la maladie. Pendant longtemps, le traitement a été uniquement chirurgical (exérèse du ou des kystes hépatiques) ; il existe actuellement des traitements médicamenteux.