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E. multilocularis larva develops by external budding to form an infiltrative growing tumor. In most cases, the liver is the primary organ affected, whatever the parasite species. Surgical removal of the parasitic tissue is the most efficient therapy for the diseases, and the efficiency of antiparasitic drugs depends upon size of the larvas. Thus, early diagnosis and subsequent treatment may reduce mortality. As the symptoms vary according to the rate of parasite growth, the clinical diagnosis of echinococcosis is difficult. There is rarely any parasitologic evidence of infection. Ultrasound-guided fine-needle aspiration of the lesions sometimes fails to detect parasites in patients with alveolar echinococcosis. The distinction between cystic and alveolar echinococcoses is not always easy in those countries where both species occur together.