Echinococcosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Mahshid Mir, M.D. [2] Cafer Zorkun, M.D., Ph.D. [3]; Kalsang Dolma, M.B.B.S.[4]


Echinococcosis is classified based on the site of infection and the type of tapeworm causing the infection, into cystic echinococcosis and alveolar echinococcosis. It can also be classified based on the ultrasound findings and appearance. Based on WHO classification, cystic echinococcus can be classified to 5 stages: CE1, CE2, CE3a, CE3b, CE4, CE5.


Based on the site of infection, echinococcosis can be classified into:[1]

Based on an international classification, cystic echinococcosis can be classified based on the ultrasound features into 5 categories:[1]

This classification system can be helpful for application in clinical and field epidemiological setting.

World Health Organization classification of cystic echinococcosis based on cyst stage [2][3]

CE: cystic echinococcus.

WHO stage Description Stage Size
CE1 Unilocular unechoic cystic lesion with double line sign Active <5 cm
>5 cm
CE2 Multiseptated, "rosette-like" "honeycomb" cyst Active Any
CE3a Cyst with detached membranes (water-lily sign) Transitional <5 cm
>5 cm
CE3b Cyst with daughter cysts in solid matrix Transitional Any
CE4 Cyst with heterogenous hypoechoic/hyperechoic contents; no daughter cysts Inactive Any
CE5 Solid plus calcified wall Inactive Any


  1. 1.0 1.1 Working Group, WHO Informal (2003). "International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings". Acta Tropica. 85 (2): 253–261. doi:10.1016/S0001-706X(02)00223-1. ISSN 0001-706X.
  2. Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E (2008). "Clinical management of cystic echinococcosis: state of the art, problems, and perspectives". Am. J. Trop. Med. Hyg. 79 (3): 301–11. PMID 18784219.
  3. Brunetti E, Kern P, Vuitton DA (2010). "Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans". Acta Trop. 114 (1): 1–16. doi:10.1016/j.actatropica.2009.11.001. PMID 19931502.

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