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

Huma Khan,Majid Fasihi Harandi,Haroon Ahmed,Adriano Casulli,Muhammad Arif Nadeem Saqib,Muhammad Sohail Afzal

doi:10.3390/pathogens11020194

Abstract

Human cystic echinococcosis (CE) is a worldwide-distributed parasitic zoonotic disease, which represents a threat for both human and animals. The current study aimed at estimating the prevalence of human CE in Khyber Pakhtunkhwa (KPK) province of Pakistan. Clinical records from four major hospitals in this region were reviewed for CE human cases during the period of 2006–2021. Out of 251 (0.00071%) CE patients identified during the considered period, 142 (56.6%) were females, and 109 (43.4%) were males. The highest number of CE cases was recorded in the 21–30 (27.9%) age group, followed by 31–40 (23.1%) and 41–50 (16.3%). Most of the CE patients in KPK province were members of the Afghani ethnic group (17.1%); secondarily, they were Pakistani (6.4%), while for 76.5% ethnicity data were not available. The liver (41%) and the lungs (4.8%) were the most infected organs identified among CE patients in KPK province. The present study identified CE as a significant public health problem in KPK province, and the current findings demonstrated a constant endemicity of CE during the last 15 years. Further filed studies on the active search of CE carriers by means of ultrasound population-based surveys are needed to fill knowledge gaps on clinical and molecular epidemiology of human CE in Pakistan.

Highlights

Cystic (CE) and alveolar (AE) echinococcosis are zoonotic parasitic diseases caused by the larval stages of tapeworms Echinococcus granulosus sensu lato (s.l.) and Echinococcus multilocularis, respectively
The highest number of histopathologically confirmed cystic echinococcosis (CE) cases were reported in Rehman Medical College (RMI) (60.95%; n = 153) followed by Peshawar Medical College (PMC) (32.66%; n = 82), while lower number of cases were in Khyber Teaching Hospital (KTH) (3.98%; n = 10) and Institute of Kidney Disease (IKD) (2.40%; n = 6)
The current retrospective study revealed that CE is prevalent in Khyber Pakhtunkhwa (KPK) province of Pakistan, indicating CE as a significant public health problem in the study area

Summary

Introduction

Cystic (CE) and alveolar (AE) echinococcosis are zoonotic parasitic diseases caused by the larval stages of tapeworms Echinococcus granulosus sensu lato (s.l.) and Echinococcus multilocularis, respectively. These zoonotic diseases are included in the World Health Organization (WHO) portfolio, which is prioritizing their control [1]. The life cycle of E. granulosus s.l. involves two mammal animal hosts Canids such as dogs act as definitive hosts, harbouring the adult worm stage in the intestine. Ungulates such as livestock act as intermediate hosts, harbouring the asexual metacestode stage in the abdominal cavity and can be infected through fecal oral route with eggs shed with dog feces [6]. The chance of cyst rupture is high, and spillage of cyst content (infective protoscoleces) may cause secondary infection [8]

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