Abstract

As the title of the article by Sapkas et al indicates, spinal hydatid disease is rare and very few physicians will encounter this condition in North America. However, two strains of Echinococcus granulosus are endemic in animals in North America. The cervid strain is prevalent in the holarctic zones of the tundra and boreal forests of Alaska and Canada, while the sheep strain occurs sporadically in parts of Utah, Arizona, New Mexico, California and other western states.¹ Hydatid disease is not a reportable disease in the United States, so the extent of its prevalence is not known. Historically, the majority of patients diagnosed with the sheep strain of E. granulosus in the USA have been immigrants, who acquired the infection in their counties of origin. Until 1970, the majority of patients were of Italian and Greek origin, whereas in recent decades, patients from the Middle Eastern and South American countries have been the majority.^2,3 Indigenous infections occur sporadically in the north and in other parts of the USA, mainly in populations at relatively high risk, such as sheep farmers in endemic areas. It would be of interest to know whether the patient in the case reported was an immigrant, whether the infection was acquired in the US and whether there were any risk factors.