National reference laboratory (NRL) for Echinococcus
Echinococcosis is a parasitic zoonosis caused by the larvae of small tapeworms of the genus Echinococcus. There are two main forms of this parasite, depending on the species involved: alveolar echinococcosis (EA) and cystic echinococcosis (EK), caused by Echinococcus multilocularis and Echinococcus granulosus sensu lato.
The Laboratory for Microbiology at the Liège University Hospital has been appointed since 2021 as a National Reference Laboratory for cystic and alveolar echinococcosis. Its main role is to diagnose echinococcosis (by serology and/or PCR) and to confirm diagnoses made by laboratories outside the CHU de Liège. The NRL is also responsible for epidemiological surveillance, compiling an annual list of cases diagnosed in Belgium and forwarding the figures to the ECDC at European level.
Furthermore, the NR also provides biological expertise, scientific advice, support for health professionals, warning and prevention of echinococcosis. These activities help to improve the diagnosis and management of echinococcosis. The NRL also works closely with the EchinoLiège multidisciplinary medical group, which has developed expertise in the management of cases of EA and EK. This group is made up of infectious diseases specialists, hepatologists, microbiologists, surgeons, radiologists, nuclear medicine specialists, anatomopathologists, and veterinary surgeons.
For more information on echinococcosis and the methods used at the NRL, please consult the official page of the National Reference Laboratory (webpage under development).
Over the last two decades, an increase in the incidence of echinococcosis has been observed in Belgium, particularly in the alveolar form. Alveolar echinococcosis is transmitted autochthonously in Belgium, mainly in Wallonia, where 38.6% of red foxes (the main definitive hosts) are infected (data from Professor A. Linden, ULiège Veterinary Faculty), compared with 2.1% in Flanders, according to Jansen et al.. Conversely, cystic echinococcosis is not indigenous in Belgium, and the patients counted each year have become infected in endemic areas, either because they have lived there for many years, or because their family lives there and they visit regularly. The endemic countries most frequently involved in the Belgian census are Morocco, Turkey, the Balkans (mainly Bulgaria, Albania and Romania) and, more recently, Ukraine.
Although the emergence of echinococcosis has been observed (see NRL Activity Report 2021), it is probably still underestimated in Belgium, mainly due to a lack of knowledge on the part of doctors, but also due to under-reporting to the NRL despite the call to all Belgian laboratories. This is why it is necessary to report confirmed or probable cases to the NRL, so as to monitor the most representative trends in Belgium and inform the health authorities about the emergence of these zoonotic diseases, in order to improve monitoring and prevention.
 Jansen, F., Claes, M., Bakkers, E., Aryal, A., Madimba, K. C., Gabriël, S., … & Dorny, P. (2020). Echinococcus multilocularis in red foxes in North Belgium: Prevalence and trends in distribution. Veterinary Parasitology: Regional Studies and Reports, 22, 100470.
At the bottom of this page, you can find the corresponding NRL reports.
You can consult the accompanying epidemiological surveillance also reports at: Healthtopic Echinococcosis