A Retrospective Cohort Study on Human Cystic Echinococcosis in Khyber Pakhtunkhwa Province (Pakistan) Based on 16 Years of Hospital Discharge Records

Cystic echinococcosis in Pakistan: Identification and genotyping of Echinococcus Granulosus Sensu Stricto in human cyst isolates

Few studies have analysed the current status of cystic echinococcosis (CE) in Pakistan. The study aimed to molecularly characterise Echinococcus infections in humans in Khyber Pakhtunkhwa (KP), Pakistan. A total of 251 formalin-fixed, paraffin-embedded (FFPE) CE cysts, with the clinical data of patients, were collected from four major hospitals in Peshawar, KP, during 2007-2021. The genomic DNAs (gDNA) containing 106 samples were successfully extracted. A multiplex PCR and a real-time PCR assay were performed to detect Echinococcus species. All 106 samples were confirmed as E. granulosus sensu lato and identified as E. granulosus sensu stricto (s.s.). Further analysis by using SNP genotyping showed that the G1 (79.3 %) genotype was the most prevalent compared to G3 (20.7 %). The study pointed out that E. granulosus s.s. G1 genotype is the primary cause of cystic echinococcosis (CE) in Peshawar, highlighting sheep as a major transmission source. The findings underscore the persistent zoonotic risk due to human-livestock interactions over 14 years. The limited access to healthcare facilities for early diagnosis and treatment, poor awareness about the disease among the population, and traditional livestock management practices may be possibly considered as the major factors causing the persistence of human disease in this area. To reduce the disease's impact on human health and economic losses in livestock, further epidemiological studies are essential to support effective control programs against this zoonotic disease in Pakistan.

ELISA based seroprevalence and risk factors for three zoonotic parasites (Toxoplasma gondii, Echinococcus granulosus and Trichinella spiralis) in humans in Khyber Pakhtunkhwa, Pakistan

Zoonotic parasitic infections can affect both animal and human health, while also having food safety and economic implications. These pathogens can also pose occupational risks for certain groups, including veterinary professionals, animal handlers, and butchers. This study was conducted in the district of Swabi located in the Khyber Pakhtunkhwa Province of northwestern Pakistan. Serum samples from 187 males 15 years of age and older representing four different exposure groups were tested for the presence of specific antibodies to Toxoplasma gondii, Echinococcus granulosus, and Trichinella spiralis antigen using an enzyme-linked immunosorbent assay (ELISA). The exposure groups were no current animal ownership, livestock ownership, dogs and/or cats in the household, and the occupation groups butchers, and veterinarians or para-veterinarians. Seropositivity for each parasite was evaluated by subgroup. Fisher's exact test was used to evaluate possible associations between seropositivity, and potential categorical variables obtained through administration of a questionnaire. Anti-Toxoplasma antibodies were detected in 55 (29.4 %) of the 187 samples. In addition, 26.8 % (47/175) of individuals with available samples had antibodies to E. granulosus, and a single (0.5 %; 1/187) individual had antibodies to T. spiralis. One individual was seropositive for all three parasites and 9 individuals were seropositive for two parasites. The only significant factor was that Echinococcus seropositivity was associated with age group (p = 0.023) among butchers. The knowledge obtained through this study will be informative for the implementation of prevention and control strategies against these parasites at a local scale.

Epidemiological and genotypic assessment of cystic echinococcosis in ruminant populations of Northern Punjab, Pakistan: a neglected zoonotic disease

Echinococcus granulosus is a zoonotic dog parasite, which causes cystic echinococcosis in humans and animals, adversely affecting health and food production. The resultant socio-economic impacts in lower-middle-income countries and the paucity of epidemiology data prompted the World Health Organization to classify cystic echinococcosis as a neglected tropical disease. Between November 2019 and December 2020, the prevalence of cystic echinococcosis was assessed from 3600 post-slaughter livestock (1142 sheep, 1258 goats and 1200 buffalo) from three districts, Narowal, Sheikhupura and Sialkot, in Northern Punjab, Pakistan. The collected hydatid cysts were subjected to microscopy and PCR followed by Sanger sequencing and phylogenetic analysis. A questionnaire targeted 3600 animal owners to assess disease risk factors. Of the 28 cyst samples sequenced for mtDNA COI, the species was confirmed as Echinococcus granulosus and phylogenetic analysis revealed the presence of both G1 and G3 lineages. Overall, we noted a regional difference in prevalence, where infections were significantly higher in Sheikhupura (9.8%) than Sialkot (6.1%) or Narowal (5.9%) districts. Prevalence was higher in buffalo (9.3%) than sheep (7%) or goats (5.5%), significantly higher (9.3%) in older (> 4 years) compared to younger (< 4 years) animals (5.7%) and higher in females (9.1%) compared to males (3.8%). In sheep and buffalo, more cysts were found in the liver (77.7% and 68.7%, respectively), whereas the lungs were more commonly infected in goats (67.1%). Epidemiological data revealed that combining dog deworming with effective disposal of viscera is needed for a significant reduction in infection prevalence. Similarly, animal deworming was only associated with significantly reduced infections when the animals were not kept near an abattoir, where dogs would normally be present and feeding on discarded viscera. This study adds to growing evidence that simple public health measures and awareness are needed to reduce the prevalence of cystic echinococcosis infection.

Cystic Echinococcosis in Hospitalized Children from Western Romania: A 25-Year Retrospective Study

Cystic echinococcosis (CE) is a cosmopolitan parasitic disease caused by Echinococcus granulosus. We aimed to assess the epidemiological aspects of the disease in hospitalized children from Western Romania, a well-known endemic area for CE. We retrospectively investigated the medical records of children hospitalized between 1998 and 2022. A total of 144 patients were included, and 58.3% were from rural areas. The number of cases increased with age, from 9% in the age group 3-5 years to 59.7% in the age group 11-17 years. The liver was more frequently affected (65.3%), and a significant association between gender and the affected organ was noted; liver cysts were more frequently diagnosed in girls, while lung cysts were recorded mostly in boys. Complications were more frequently reported in patients with pulmonary CE compared to hepatic CE (p = 0.04). Boys had more complications (16/23, 69.6%) compared to girls (7/23, 30.4%) (p = 0.03). A third of the children were hospitalized for more than 14 days, and multiple hospitalizations were recorded in 31.3% of the patients. This paper provides new insights into the epidemiologic features of cystic echinococcosis in children from Western Romania. Our findings indicate that exposure to the parasite starts in childhood, and the rate of hospitalization increases with age. Public health strategies should be implemented and permanently improved in order to lower the prevalence of CE in children.

Cystic Echinococcosis in Hospitalized Adult Patients from Western Romania: 2007-2022

Cystic echinococcosis (CE) is a neglected parasitic disease caused by the tapeworm Echinococcus granulosus. The aim of this study was to assess the epidemiological features of human cystic echinococcosis in patients from Western Romania. We retrospectively investigated the medical records of patients hospitalized with CE between 1 January 2007 and 1 September 2022. A total of 366 patients (range 18-90 years) were recorded. The number of hospitalized individuals was higher in patients aged 50-59 years (83/366, 22.7%), in females (194/366, 53%), and in residents of rural areas (225/366, 61.5%). The liver was the most common localization of the cysts (302/366, 82.5%). Ninety-eight patients (26.8%) presented complications, including biliary fistula, allergies, and infection of the cyst. Patients with complications had a longer mean hospital stay (15.7 ± 8.3 days) compared to patients without complications (11.5 ± 7.3 days) (p < 0.001). The results of this study revealed that patients diagnosed with CE required hospitalization and extended medical care, indicating that this zoonotic disease remains a significant public health problem in Western Romania. Public health authorities should enhance CE surveillance by implementing control programs and mandatory notification of new cases.

Basic Operative Tactics for Pulmonary Echinococcosis in the Era of Endostaplers and Energy Devices

Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species Echinococcus. The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed.