Source: Belsat TV [in Russian, machine trans., edited]
An outbreak [of suspected echinococcosis] among cadets in Ulyanovsk Suvorov Military School, was discovered in early February . At least, 49 cadets of the military Suvorov school, instead of 26 as reported earlier, are infected with _Echinococcus_.
The Ministry of Defense of Russia excludes that the infection could have been transmitted through the food and believes that it happened by touching contaminated dogs.
Echinococcosis was initially suspected in 5 cadets. Their X-rays showed suspected cysts in the lungs.
On [5 Feb 2019], a criminal case under part 1, article 236 of the criminal code suspected violations of the sanitary and epidemiological rules, which led to mass disease. On [6 Feb 2019], at the Suvorov School, representatives of the Ministry of Defense of the Russian Federation met with the parents of the students. They reported the investigation, rejecting the version of infection through food in the school's canteen. The head of the institution, Vladimir Shkirkov, and the chief parasitologist of the Ministry of Defense, Sergey Kozlov, informed the parents that the cadets could have become ill by stroking an infected dog, Novaya Gazeta newspaper reported. On [14 Feb 2019], the newspaper "Izvestia" published a new version: the students were infected during the use of nasvaya smokeless tobacco mixture made from chicken or camel dung.
The publication refers to an anonymous source close to the investigation, but it gives the opinion of researchers who believe this option unlikely. The newspaper claims to have found several more sick cadets, 2018 graduates. But on [2 Feb 2019] the media reported about disease among staff of the school cafeteria.
The response of the Ministry of Health to [Ulyanovsk Region State Duma Deputy] Alexei Kurinny, it was specified that the ministry had performed a full examination of more than 518 and 305 employees of Suvorov military school.
Date: Fri 1 Mar 2019
Source: OTR (Public Television of Russia) [in Russian, machine trans.,
As of [20 Feb 2019] it is known about 49 cases in the military Suvorov school.
Foci of infection also have been found in the liver, pancreas, brain, eyes, and spleen.
Date: Mon 4 Feb 2019
Source: Interfax-Russia [in Russian, machine trans., abridged,
Initially, echinococcosis was detected during routine examination in 5 cadets after X-ray of the lungs. None of them had health complaints. On [4 Feb 2019], Mass Media published information of already 25 cases among cadets.
[Infection of humans with _Echinococcus granulosis_ happens when eggs are ingested and hatch in the intestines, penetrate the intestinal wall, and migrate to different organs. The infection can happen through eggs from dog feces contaminating water, greens, and berries.
The notions that the subjects has consumed "nasvaya-tobacco mixture made from chicken or camel dung" does not explain infection with _Echinococcus_ and neither camels nor or chickens excrete _Echinococcus_ eggs in their feces. If the "tobacco" was made from dog feces it could be a source of infection.
The incubation period is usually years, and for instance a study from Kirgyzstan estimated an incubation period of 15 years (Usubalieva J et al. Human alveolar echinococcosis in Kyrgyzstan. Emerg Infect Dis. 2013; 19(7): 1095-7. doi: 10.3201/eid1907.121405).
The news report in item  above only mentions chest X-rays, but the article in item  mentions "suspected cysts in the lungs" and the article in item  mentions that foci of infection [cysts?] have been found in multiple other organs. In 95% of human cases the liver is involved because it receives the blood draining the intestines.
Given the long incubation period of _Echinococcus_, an outbreak involving at least 49 persons developing symptoms within a few months with a common source of infection is highly unlikely if not impossible.
What else can it be?
If the lesions were limited to the lungs TB is much more likely, but an outbreak of pulmonary TB would not be associated with multiple lesions in other organs. Foodborne infections could be caused by _Trichinella_, but _Trichinella_ does not result in cystic lesions; it is a multiorgan infection, it is foodborne, and several outbreaks have been reported from Russia.
ProMED will be happy to post more information including more information on the X-ray and CT results, and whether the patients had eosinophilia (sign of a helminth infection). - ProMED Mod.EP]
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