Liver cystic echinococcosis: A retrospective study on the demographics and clinical profile of patients managed at a single tertiary institution in central Eastern Cape Province, South Africa
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i5.2195Keywords:
Liver cystic echinococcosisAbstract
Background. Cystic echinococcosis (CE) is a zoonotic disease with an Africa-wide prevalence of 1.7%. CE is caused by the tapeworm Echinococcus granulosus sensu lato, with the liver being the most commonly affected organ. In South Africa (SA), there is a paucity of data on liver CE demographics and management.
Objectives. To describe the demographics and clinical profile of patients with liver CE in a single tertiary hospital in Eastern Cape Province, SA.
Methods. A 4-year (2019 - 2022) retrospective clinical record review study was conducted on patients presenting with liver CE to the Department of Surgery at Frere Hospital. The demographics, clinical characteristics and management of patients with liver CE are reported.
Results. A total of 56 patients diagnosed with and managed for liver CE were included in the study. The mean age of the patients was 37.5 years. Abdominal pain (n=39; 69.6%) was the most common presenting symptom, and a palpable abdominal mass (n=36; 64.3%) was the predominant presenting sign. Most patients had disease confined to the liver (n=35; 62.5%). The right lobe of the liver was most commonly affected (n=38; 67.9%), and most patients had a single liver cyst on imaging (n=32; 57.1%). The majority of the patients (n=36; 64.3%) were managed with surgical partial cystectomy, with a perioperative bile leak being the most common complication.
Conclusion. In our setting, liver CE contributes to a significant local burden of the disease. The disease often has a nonspecific clinical presentation, necessitating imaging for the diagnosis. We observed good short-term outcomes in patients managed with combined partial cystectomy and medical therapy, although there is a risk of perioperative bile leak.
References
Kern P, Menezes da Silva A, Akhan O, et al. The echinococcoses: Diagnosis, clinical management and burden of disease. Adv Parasitol 2017;96:259-369. https://doi.org/10.1016/bs.apar.2016.09.006
BhutaniN,KajalP.Hepaticechinococcosis:Areview.AnnMedSurg(Lond)2018;36:99-105.https:// doi.org/10.1016/j.amsu.2018.10.032
Tsoulfas G, Hoballah JJ, Velmahos GC, Ho Y-K. The Surgical Management of Parasitic Diseases. Cham, Switzerland: Springer, 2020.
Tamarozzi F, Akhan O, Cretu CM, et al. Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey: A cross-sectional, ultrasound-based, population study from the HERACLES project. Lancet Infect Dis 2018;18(7):769-778. https://doi.org/10.1016/S1473- 3099(18)30221-4
KhurooMS.Percutaneousdrainageinhepatichydatidosis–thePAIRtechnique:Concept,technique, and results. J Clin Exp Hepatol 2021;11(5):592-602. https://doi.org/10.1016/j.jceh.2021.05.005
Govindasamy A, Bhattarai PR, John J. Liver cystic echinococcosis: A parasitic review. Ther Adv Infect Dis 2023;10:20499361231171478. https://doi.org/10.1177/20499361231171478
Mönnink GLE, Stijnis C, van Delden OM, Spijker R, Grobusch MP. Percutaneous versus surgical interventions for hepatic cystic echinococcosis: A systematic review and meta-analysis. Cardiovasc Intervent Radiol 2021;44(11):1689-1696. https://doi.org/10.1007/s00270-021-02911-4
Dehkordi AB, Sanei B, Yousefi M, et al. Albendazole and treatment of hydatid cyst: Review of literature. Infect Disord Drug Targets 2019;19(2):101-104. https://doi.org/10.2174/1871526518666 180629134511
Fadel SA, Asmar K, Faraj W, Khalife M, Haddad M, El-Merhi F. Clinical review of liver hydatid disease and its unusual presentations in developing countries. Abdom Radiol (NY) 2019;44(4):1331- 1339. https://doi.org/10.1007/s00261-018-1794-7
Casulli A. New global targets for NTDs in the WHO roadmap 2021-2030. PLoS Negl Trop Dis 2021;15(5):e0009373. https://doi.org/10.1371/journal.pntd.0009373
John J. Cystic echinococcosis: The parasitic tale of a sinister cystic disease. S Afr Med J 2024;114(5):eXXXX. https://doi.org/10.7196/SAMJ.2024.v114i5.XXXX (this issue).
Wahlers K, Menezes CN, Wong M, et al. Human cystic echinococcosis in South Africa. Acta Trop 2011;120(3):179-184. https://doi.org/10.1016/j.actatropica.2011.08.006
MogoyeBK,MenezesCN,WongML,etal.FirstinsightsintospeciesandgenotypesofEchinococcus in South Africa. Vet Parasitol 2013;196(3-4):427-432. https://doi.org/10.1016/j.vetpar.2013.03.033
Statistics South Africa. Census 2022: Eastern Cape. https://census.statssa.gov.za/#/province/2/2 (accessed 2 January 2024).
Baruah A, Sarma K, Barman B, Phukan P, Nath C, Boruah P, et al. Clinical and laboratory presentation of hydatid disease: A study from northeast India. Cureus 2020;12(9):e10260. https:// doi.org/10.7759/cureus.10260
Karshima SN, Ahmed MI, Adamu NB, Magaji AA, Zakariah M, Mohammed K. Africa-wide meta- analysis on the prevalence and distribution of human cystic echinococcosis and canine Echinococcus granulosus infections. Parasit Vectors 2022;15(1):357. https://doi.org/10.1186/s13071-022-05474-6
Parkoohi PI, Jahani M, Hosseinzadeh F, et al. Epidemiology and clinical features of hydatid cyst in northern Iran from 2005 to 2015. Iran J Parasitol 2018;13(2):310-316. http://www.embase.com/ search/results?subaction=viewrecord&from=export&id=L622794133 (accessed 4 January 2024).
Shahriarirad R, Erfani A, Eskandarisani M, Rastegarian M, Taghizadeh H, Sarkari B. Human cystic echinococcosis in southwest Iran: A 15-year retrospective epidemiological study of hospitalized cases. Trop Med Health 2020;48:49. https://doi.org/10.1186/s41182-020-00238-3
BotezatuC,MastalierB,PatrascuT.Hepatichydatidcyst–diagnoseandtreatmentalgorithm.JMed Life 2018;11(3):203-209. https://doi.org/10.25122/jml-2018-0045
Dorjsuren T, Ganzorig S, Dagvasumberel M, et al. Prevalence and risk factors associated with human cystic echinococcosis in rural areas, Mongolia. PLoS ONE 2020;15(7):e0235399. https://doi. org/10.1371/journal.pone.0235399
Acosta-Jamett G, Hernández FA, Castro N, et al. Prevalence rate and risk factors of human cystic echinococcosis: A cross-sectional, community-based, abdominal ultrasound study in rural and urban north-central Chile. PLoS Negl Trop Dis 2022;16(3):e0010280. https://doi.org/10.1371/ journal.pntd.0010280
Erfani A, Shahriarirad R, Eskandarisani M, Rastegarian M, Sarkari B. Management of liver hydatid cysts: A retrospective analysis of 293 surgical cases from southern Iran. J Trop Med 2023;2023:9998739. https://doi.org/10.1155/2023/9998739
KhumaloP,ThakhathiDR.ChallengesfacedbytheAmatholeDistrictMunicipalityinimplementing LED policy. Adm Publica 2012;20(4):47-63.
McCann M. Annexure 5: District Profile Eastern Cape O.R. Tambo District Municipality (DC15). European Consultants Organisation, 2005. https://www.ecsecc.org/documentrepository/ informationcentre/030407135344.pdf (accessed 20 January 2024).
Department of Cooperative Governance and Traditional Affairs. District Development Model: Amathole District, Eastern Cape. 2020. https://www.cogta.gov.za/index.php/docs/amathole- district/ (accessed 20 January 2024).
Ngcobo K, Madansein R, Ndlovu M, Masekela R. Surgical management of pulmonary hydatid cysts in children in KwaZulu-Natal Province, South Africa. Afr J Thorac Crit Care Med 2020;26(3):81-86. https://doi.org/10.7196/AJTCCM.2020.v26i3.108
Illuri HR, Souza CD, Dias EAI, Das PP. Hydatid disease: A 2 years retrospective study in a tertiary care center in South India. Int Surg J 2018;5(2):602. https://doi.org/10.18203/2349-2902.isj20180361 28. Petrone L, Cuzzi G, Colace L, et al. Cystic echinococcosis in a single tertiary care center in Rome,
Italy. Biomed Res Int. 2013;2013:978146. https://doi.org/10.1155/2013/978146
Rashid MM, Rabbi H, Ahmed AT, et al. Outcome of surgically treated 79 patients of hepatic hydatidosis: A single center tertiary care hospital experience in Bangladesh. J Surg Sci
;22(2):118-124. https://doi.org/10.3329/jss.v22i2.44076
WenH,VuittonL,TuxunT,etal.Echinococcosis:Advancesinthe21stcentury.ClinMicrobiolRev
;32(2):e00075-18. https://doi.org/10.1128/CMR.00075-18
Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch S, Tamarozzi F. Cystic echinococcosis of
the liver: A primer for hepatologists. World J Hepatol 2014;6(5):293-305. https://doi.org/10.4254/
wjh.v6.i5.293
Escolà-Vergé L, Salvador F, Sánchez-Montalvá A, et al. Retrospective study of cystic echinococcosis in a recent cohort of a referral center for liver surgery. J Gastrointest Surg 2019;23(6):1148-1156. https://doi.org/10.1007/s11605-018-3971-y
Butt A, Khan JA. Cystic echinococcosis: A 10-year experience from a middle-income country. Trop Doct 2020;50(2):117-121. https://doi.org/10.1177/0049475519891338
Keong B, Wilkie B, Sutherland T, Fox A. Hepatic cystic echinococcosis in Australia: An update on diagnosis and management. ANZ J Surg 2018;88(1-2):26-31. https://doi.org/10.1111/ans.14117
Stojković M, Weber TF, Junghanss T. Clinical management of cystic echinococcosis: State of
the art and perspectives. Curr Opin Infect Dis 2018;31(5):383-392. https://doi.org/10.1097/
QCO.0000000000000485
Mihmanli M, Tanal M, Bozkurt E, Guven O. The surgical management of hydatid cyst of the liver: What is new? In: Derbel F, Braiki M, eds. Overview on Echinococcosis. IntechOpen, 2020. https:// doi.org/10.5772/intechopen.90726
Tamarozzi F, Silva R, Fittipaldo VA, Buonfrate D, Gottstein B, Siles-Lucas M. Serology for the diagnosis of human hepatic cystic echinococcosis and its relation with cyst staging: A systematic review of the literature with meta-analysis. PLoS Negl Trop Dis 2021;15(4):e0009370. https://doi. org/10.1371/journal.pntd.0009370
SymeonidisN,PavlidisT,BaltatzisM,etal.Complicatedliverechinococcosis:30yearsofexperience from an endemic area. Scand J Surg 2013;102(3):171-177. https://doi.org/10.1177/1457496913491877 39. Ahmadi NA, Hamidi M. A retrospective analysis of human cystic echinococcosis in Hamedan province, an endemic region of Iran. Ann Trop Med Parasitol 2008;102(7):603-609. https://doi.
org/10.1179/136485908X337517
Aydin Y, Ulas AB, Ince I, et al. Large case series analysis of cystic echinococcosis. Indian J Surg 2021;83(Suppl 4):897-906. https://doi.org/10.1007/s12262-021-03061-0
Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114(1):1-16. https://doi.org/10.1016/j. actatropica.2009.11.001
Kosmidis C, Efthimiadis C, Anthimidis G, et al. Management of peritoneal hydatid cysts: A forty- year experience. Heliyon 2018;4(12):e00994. https://doi.org/10.1016/j.heliyon.2018.e00994
Vagholkar K, Pawanarkar A, Chougle Q, Vagholkar S. Surgery for intra-abdominal hydatid disease: A single centre experience. Int J Res Med Sci 2016;4(10):4241-4245. https://doi.org/10.18203/2320- 6012.ijrms20163106
Öztürk G, Uzun MA, Özkan ÖF, et al. Turkish HPB Surgery Association consensus report on hepatic cystic echinococcosis (HCE). Turk J Surg 2022;38(2):101-120. https://doi.org/10.47717/ turkjsurg.2022.5757
Deo KB, Kumar R, Tiwari G, Kumar H, Verma GR, Singh H. Surgical management of hepatic hydatid cysts – conservative versus radical surgery. HPB (Oxford) 2020;22(10):1457-1462. https:// doi.org/10.1016/j.hpb.2020.03.003
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