Echinococcus granulosus in humans associated with disease incidence in domestic animals in Kermanshah, west of Iran

Epidemiological characteristics of human cystic echinococcosis in Khuzestan province (Iran), 2011-2021: a retrospective analytical study

Hydatid cyst (HC) disease is endemic in many Mediterranean countries. The most polluted areas of Iran include the Alborz and Zagros Mountain ranges, where animal husbandry is common. This study investigated the epidemiological dimensions of HC in patients admitted to hospitals in Khuzestan province from 2011 to 2021. Of all 183 patients identified, 113 (61.7%) were female with the mean age of 37.7 ± 17, men with the mean age of 36.7 ± 19. Also, we found that housewives made up 49.2% of our HC patients. 65% of the patients in this study lived in urban areas, and 42% had a history of contact with dogs. The liver was reported to be the most HC-affected organ. The most clinical symptoms were abdominal pain and hepatomegaly. 59% of the patients had only one cyst. This study found that surgery and radiology were the most common treatment and diagnostic methods. There were significant relationships between: gender and occupation (p < 0.001); location with dog contact, duration of dog contact (p < 0.001); ways of washing raw vegetables (p < 0.01), and type of treatment (p < 0.05); occupation and dog contact (p < 0.001); with the involvement of the liver being greater in patients who used only water to wash vegetables (p < 0.01). The key to successful disease management is early diagnosis. How to intervene and treat HC necessitates the identification of the stages of the cyst, which is dependent on imaging techniques. The prevalence of human hydatidosis has been overlooked as the most important disease that health policymakers should consider. Furthermore, training programs are required to better understand the disease's symptoms and identify sources of infection.

Status of human cystic echinococcosis based on hospital records in Mazandaran Province: A first registry-based evidence

Background

Human cystic echinococcosis, as an emerging neglected parasitic disease, is caused by tapeworms of the genus Echinococcus spp. Because of the medical and economic importance, this study aims to review the epidemiology and clinical features of hydatidosis in patients admitted to medical and surgical wards in three referral teaching hospitals over 15 years in Mazandaran Province, northern Iran.

Methods

Data were collected from hospital records that were accessible via the hospital information system (HIS) between 2005 and 2019 (15 years).The demographic information (age, sex, living area, and occupation), dog contact, number of the cysts, types of organs involved, and history of disease recurrence were assessed.

Results

One hundred twenty-one patients with human cystic echinococcosis (CE) were involved in the study, from whom 58 patients (47.93%) were male and 63 (52.07%) were female. The majority of patients were rural residents (64.46%) and also housewife (28.10%). Based on the results, only about 16.53% of the patients had history of close contacts with dogs. The liver was the organ involved in the most cases of CE. There were statistically significant differences between residence, occupation, history of close contacts with dogs, type of organs involved, number of cysts and history of disease recurrence (P < 0.05).

Conclusions

Our data provides valuable registry-based information about CE in an endemic region. The data highlights that most patients lived in rural areas and were housewives. Additionally, they had a low rate of disease recurrence but a high rate of close contact with dogs. Moreover, further monitoring on registry-based program and strengthening the HIS in the provincial hospitals in the studied area are required.

Molecular genotyping of Echinococcus granulosus sensu stricto from human Echinococcal cysts in Hatay, Türkiye

Cystic echinococcosis (CE) is one of the zoonotic infections in human, an important global health problem. It was aimed to determine the molecular characterization and phylogenetic analysis of isolates obtained from patients diagnosed with CE in Hatay province, according to the cox1 gene region. A total of 31 patients, 14 males and 17 females, with a mean age of 35.19 (±14.28) years were included in the study. 35 cyst materials obtained from patients were studied. DNA isolation was performed from the samples with protoscoleces determined in the cyst fluid. One-way DNA sequencing was performed with the Sanger Sequencing Protocol through the obtained PCR products. In the study, 35 hydatid cysts of human origin were examined and protoscoleces was detected in 11 (31.43%) of them. Twenty of the patients had liver involvement, seven had lung involvement, and four had both liver and lung involvement. All the samples with protoscoleces detected were observed of PCR product with a size of approximately 446 bp. When the sequence results of the isolates were evaluated within themselves, it was seen that there were three different sequences with 99% similarity to each other. As a result, of the phylogenetic analysis, it was determined that the isolates were identified in the Echinococcus granulosus sensu stricto (E. granulosus s. s.) (G1-G3) complex. This study is thought to contribute to the epidemiology, parasite control, effective diagnosis and treatment techniques, eradication, vaccine and drug development studies of E. granulosus s. s in Türkiye.

Human Cystic Echinococcosis in Lebanon: A Retrospective Study and Molecular Epidemiology

Purpose

Human cystic echinococcosis (CE) is a zoonotic parasitic disease that constitutes a public health challenge and a socio-economic burden in endemic areas worldwide. No specific surveillance system of CE infections in humans exists in Lebanon. The incidence and trends over time have not been documented. The current study aimed to assess the demographic and epidemiologic features of human CE surgical cases over a 14-year period in the five main regions of Lebanon.

Methods

From 2005 to 2018, a total of 894 surgically confirmed cases of hydatidosis were recorded from five anatomy and pathology laboratories.

Results

The mean annual surgical incidence was 1.23/100,000 inhabitants. Over the span of these years, the incidence increased from 0.53 to 1.94 cases/100,000 inhabitants in 2005 and 2018, respectively. CE is present in Lebanon with an uneven distribution from one region to the other with higher prevalence in Bekaa (29.0%), a rural area where sheep raising is widespread. Human CE cases were more common in females (60.1%) than in males (39.9%) and a high burden of infection was reported for the age group of 30–39 years. Besides, 66.7% of the cases expressed only liver complications whereas, 20.5% showed predilection towards lungs. The 7.8% of cases presented cysts in other organs, and 1.3% showed multiple localizations. Additionally, predominant involvement of Echinococcus granulosus sensu stricto was recorded in human infections. Comparison of Echinococcus granulosus s.s. populations from different Mediterranean countries also revealed high gene flow among this region and sharing of alleles.

Conclusion

The current study is a step forward to fill the gap of knowledge for the hydatidosis in Lebanon where the lack of epidemiological data and control measures have resulted in higher incidence of human CE.

Graphic Abstract

Echinococcosis of the spine

Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine.More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord.As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely.Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization.This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients' outcomes.The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas. Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130.

Parasitic causes of meat and organs in cattle at four slaughterhouses in Sistan-Baluchestan Province, Southeastern Iran between 2008 and 2016

This 8‐year (from 2008 to 2016) retrospective study calculated the percentage of carcass and organ (lung and liver) condemnations and estimated the direct financial costs at four slaughterhouses in Sistan‐Baluchestan Province, Southeastern Iran. Each carcass and organ (lung and liver) was thoroughly examined through inspection, palpation and incision following the standard protocol. Identification of the parasites was performed macroscopically. The total direct economic loss due to meat's condemnation was estimated by adding weights of each organ or carcass part and multiplying individual organ totals by their 2016 market unit price. A total of 857,039 cattle were slaughtered during this period, 64,497 livers (7.5%), 31,401 lungs (3.6%) and the carcasses of 1,171 cattle (0.1%) were condemned due to lesions caused by parasites. The main parasitic lesions in the condemned livers were attributed to Echinococcus granulosus (4.2%), Fasciola spp. (3.1%) and Dicrocoelium dendriticum (0.1%). All the condemned lungs were due to E. granulosus (3.6%). Taenia saginata cysticerci were detected in 0.1% of inspected animals. Liver condemnation due to cystic echinococcosis was the highest in fall (4.7%, p < 0.001); while lung condemnation was the highest during spring (3.98%, p < 0.001). Liver condemnation due to Fasciola spp. was the lowest in winter (2.99%, p < 0.001). Carcass condemnation as a result of cysticercosis was the highest in summer (p < 0.001). Considering the 2016 market prices, condemnations due to the studied parasites caused direct costs estimated U.S. $ 3,191,879. To the best of our knowledge, this is the first report estimating the monetary losses due to parasitic infections in the slaughterhouses of this province. Due to the high financial impact of the studied parasites, a control programme should be implemented to decrease this impact.

Practice of Surgical Treatment for Patients with Combined Echinococcosis of Chest and Abdominal Organs

BACKGROUND

Epidemiological significance of echinococcosis is determined by the severe clinical progression leading to disability, incapacitation and death, a wide range of hosts, and formation of synanthropic and mixed lesions. The aim of the work was to analyze cases of combined echinococcosis of the chest and abdominal organs and the results of its surgical treatment in clinics of Almaty (Kazakhstan) from 1997 to 2019.

MATERIALS AND METHODS

In 413 patients, 534 lesions of echinococcosis were revealed: single and multiple cysts. Concurrent echinococcectomy of 2-3 organs was performed in 261 patients; meanwhile phased echinococcectomy was performed in several organs in 152 patients.

RESULTS

Performed surgical interventions in more than 70% of cases had a favorable outcome.

CONCLUSION

The choice of rational surgical tactics for combined echinococcosis should be based on an individual approach, taking into account the general condition of the patient, risk analysis and the likelihood of complications.

Environmental, climatic and host population risk factors of human cystic echinococcosis in southwest of Iran

BACKGROUND

Cystic echinococcosis (CE), a worldwide zoonotic disease, is affected by various biological and environmental factors. We investigated dog/livestock populations, climatic and environmental factors influencing the distribution of human CE cases in Fars province, southwest Iran.

METHODS

We mapped the addresses of 266 hospitalised CE patients (2004-2014) and studied the effects of different temperature models, mean annual rainfall and humidity, number of frosty days, slope, latitude, land covers, close proximity to nomads travel routes, livestock and dog densities on the occurrence of CE using geographical information systems approach. Data were analyzed by logistic regression.

RESULTS

In the multivariate model predicting CE, living in an urban setting and densities of cattle and dogs were the most important CE predictors, sequentially. Dry (rained) farm, density of camel and sheep, close proximity to nomads travel routes, humidity, and slope also were considered as the determinants of CE distribution, when analyzed independently. Slope had a negative correlation with CE while temperature, frost days and latitude were not associated with CE.

CONCLUSIONS

In our study, an urban setting was the most important risk factor and likely due to a combination of the high density of key life cycle hosts, dogs and livestock, a large human susceptible population and the high number of abattoirs. Farmland and humidity were highly suggestive risk factors and these conditions support the increased survival of Echinococcus granulosus eggs in the soil. These findings support the development of strategies for control of disease. More research is needed test optimal interventions.

Epidemiology, burden, and geographical distribution of cystic echinococcosis in Central Iran

Background and Aim: Human cystic echinococcosis (CE) is an important, neglected zoonotic disease with worldwide distribution which has been reported in different regions of Iran, including the central areas (e.g. Qom Province). The disease is caused by the Echinococcus granulosus parasite living in the intestine of dogs and other canids as definitive hosts. This study aimed to investigate the epidemiology, burden, and geographical distribution of CE in Qom Province, Central Iran. Materials and Methods: In this descriptive-analytic study, the data of patients with diagnosed CE during 2011-2018 were collected from all urban and rural areas of Qom Province. The data of the epidemiological status of CE cases were extracted from the CE surveillance system in the Centers for Disease Control and Prevention in the Qom University of Medical Sciences which is owned and run by Iran's Ministry of Health and Medical Education. In addition, the economic burden of the disease was evaluated by Azarakhsh and Roozamad financial software; the geographical distribution of CE was obtained by ArcGIS 10.3 software (IBM Corp., Chicago, USA). Results: The results reveal that the incidence rate of CE was 6.81/100,000 people over the 8-year period of the study. More than half of the cases were females (57.95%), housewives (57.47%), and residents (89.77%). The majority of the cases were Iranian (88.77%) and the rest were from the two neighboring countries: Afghanistan and Pakistan. The economic burden of the human CE in the 8 years was estimated to be 3,761,352,526 rials (75,227 $). In terms of spatial distribution, the highest incidence rate of CE was observed in Salafchegan District in the southwest of Qom Province. Conclusion: The economic burden of human CE infection provided by governmental health-care systems or as out-of-pocket expenses is relatively high, and housewives, especially those living in Salafchegan District, are more likely to be affected. More studies are recommended on different epidemiological aspects and the definitive hosts of the parasite; besides, people at risk need to be warned and educated so that the incidence rate of the disease is reduced.

Epidemiology of echinococcosis in Iran: a systematic review and meta-analysis

BACKGROUND

Echinococcosis is a zoonotic disease caused by the larval stages of taeniid cestodes of the genus Echinococcus. The two major types of infection in humans are cystic echinococcosis (CE) or hydatidosis and alveolar echinococcosis (AE). It is endemic in some parts of the world, such as the Middle East, with Iran being a part of it. This systematic review and meta-analysis were conducted to determine the prevalence of CE and AE echinococcosis and their epidemiological and clinical aspects in Iran.

METHODS

Electronic databases, including MEDLINE (via PubMed), SCOPUS, Web of Science, SID and Mag Iran (two Persian scientific search engines) were searched from 1 January 1990 to 8 August 2017. The prevalence of CE and AE echinococcosis was estimated using the random effects meta-analysis. Heterogeneity was evaluated by subgroup analysis. Data were analyzed by STATA version 12.

RESULTS

Of the 2051 records identified in the mentioned electronic databases, Seventy-eight articles met our eligibility criteria, with a total of 214124individuals. The meta-analysis was performed on only 37 out of 78 included studies. The pooled prevalence of CE and AE in Iran was 5% [95% confidence interval )CI(: 3-6%] and 2% [95% CI: 0-5%], respectively. Subgroup meta-analysis revealed that the prevalence of CE was significantly higher in North [9%, 95% CI: 4-18%] and West of Iran [6%, 95% CI: 3-11%], patients younger than 40 years of age [7%, 95% CI: 4-12%], villagers and nomads [6%, 95% CI: 2-12%], and studies that used the combination of serological, clinical, and imaging diagnostic methods [7%, 95% CI: 5-9%]. There were no significant differences between the prevalence of CE among low and high-quality studies. Housewives were the most affected group by hydatidosis (n=24/77, 31%), followed by illiterate people (n=11/77, 14%) and farmers (n= 9/77, 12%). Liver [55%, 95% CI: 46-65%] and lung [28%, 95% CI, 22-35%] were the most common sites of cyst formation.

CONCLUSIONS

Given to the importance of echinococcosis on human health and domestic animals industry, it is necessary to implement monitoring and control measures in this regard.

Prevalence and risk factors associated with human cystic echinococcosis in Iran

Cystic echinococcosis (CE), as a zoonotic helminthic infection, imposes a large socioeconomic burden to societies throughout the world. This study aimed to analyze the demographic, clinical, diagnostic and therapeutic data of CE patients across all provinces in Iran. In this cross-sectional study, the mentioned data were routinely collected by provincial medical universities during the time from March 2016 to March 2017. The provincial population census was used to calculate the prevalence of CE per 1,000,000 populations for all provinces. T test and Chi squared test were used to compare variables between genders. Statistical analysis was done at 95% significant level using STATA 14 software. The overall prevalence of CE was 6.8 cases per 1,000,000 populations in Iran. The highest and lowest prevalence was reported for Northeast (15.2) and southeast (0.7) of Iran, respectively. There was a significant difference in the prevalence between male and female (5.8 vs. 7.9, p < 0.001). An increasing trend of the prevalence was found by age in both males and females. Abdominal pain was reported as the highest proportion of symptom (39.0%) and the liver was a commonly infected organ (62.7%). CT scan (39.0%) and MRI (1.9%) had the highest and lowest proportion among types of CE diagnosis, respectively. About 67% of the patients washed the vegetable by water without any disinfectant. Due to global efforts on the control and prevention of CE, it still remains endemic in many countries throughout the world. Incidence trend of CE in Iran showed being endemic for CE and more investigations are needed on all aspects of the disease.

Scolicidal Effects of Chitosan-Curcumin Nanoparticles on the Hydatid Cyst Protoscolices

PURPOSE

In the current era, cystic echinococcosis (CE), as larval stage of Echinococcus granulosus, is considered as a threat to human health. Scolicidal agents used in the surgery of cysts have different side effects. Therefore, the present study aimed to assess the effects of chitosan nanoparticles containing curcumin (Ch-Cu NPs) on the protoscolices of the hydatid cyst in vitro.

METHODS

Ch-Cu NPs were synthesized using a simple co-precipitation method and their structural and morphological properties were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), zeta analyzer, and Fourier transform infrared (FT-IR) spectroscopy. Then, the effects of different concentrations of Ch-Cu NPs (0.25, 0.05, 1, 2, and 4 mg/mL) on the fatality rate, and the length and width of protoscolices in different times (5, 10, 20, 30, and 60 min) were investigated. In addition, the SEM technique was used to evaluate the structure of the protoscolices after treatment.

RESULTS

Based on the results, the presence of curcumin on the chitosan nanoparticles was confirmed by FT-IR analysis. Further, XRD analysis approved the crystal structure of chitosan NPs. Furthermore, the highest fatality rate was 68% in 4 mg/mL concentration of Ch-Cu NPs. The length and width of protoscolices decreased based on the high concentrations of Ch-Cu NPs, compared to the control group.

CONCLUSION

Finally, Ch-Cu NPs expressed good scolicidal activities, which made them suitable to be considered as an anti-protoscolex agent.

Surgically managed human cystic echinococcosis in north-eastern Iran: a single center's experience from 2001 to 2008

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the tapeworm Echinococcus granulosus. Although CE has a large geographic distribution, data are lacking on the frequency of infection and epidemiology of CE in many endemic areas of the world, including the Middle East. Demographic and clinical information on surgically managed human CE cases were evaluated from a referral hospital in north-eastern Iran for the years 2001-2008. Of the 400 CE cases, 218 (54.5%) were male. The median age of patients was 35 years (range 2-83 years). The lungs (41.0%) and liver (37.7%) were the most commonly infected organs. However, 12.7% of patients had multiple organ involvement. The majority of cases (54.3%) were diagnosed using ultrasound, with only 12.0% diagnosed with the help of serology. Total white blood cell count was elevated in 26.8% (107/400) of patients, neutrophil count was elevated in 24.0% (96/400) of patients, and eosinophil count was elevated in 13.3% (53/400) of patients. Lymphocyte count was the only complete blood count (CBC) value that differed based on organ location (P = 0.001). Despite some successes in the control of CE, the number of surgical CE cases in north-eastern Iran remains high. Although not diagnostic alone, CBC values allow for clinicians to obtain a more complete clinical picture of CE before, during, and after treatment. While serology has its place, the use of diagnostic imaging continues to be the most commonly used tool for the diagnosis of CE cases.