Abstract
PurposeHuman 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.MethodsFrom 2005 to 2018, a total of 894 surgically confirmed cases of hydatidosis were recorded from five anatomy and pathology laboratories.ResultsThe 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.ConclusionThe 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
Highlights
Cystic echinococcosis (CE), or hydatidosis, is one of the most severe parasitological diseases ranking as second most concerning food-borne disease globally [1, 2]
CE is caused by the tapeworms belonging to the Echinococcus granulosus sensu lato (E. granulosus s.l.) species complex comprised of ten separate genotypes (G1–10) and E. felidis, each with specific geographical distribution and host affinities [6,7,8]
Human infections have largely been attributed to E. granulosus sensu stricto (s.s.) (G1 genotype, sheep strain) due to its cosmopolitan distribution and maintenance through sheep–dog cycle [13]; genotype G3 is implicated in human CE [14]
Summary
Cystic echinococcosis (CE), or hydatidosis, is one of the most severe parasitological diseases ranking as second most concerning food-borne disease globally [1, 2]. Humans are the dead-end (aberrant hosts) in this life cycle acquiring infection through ingestion of infectious eggs while in contact with dogs [9]. The infection starts when oncospheres released from ingested eggs penetrate the intestinal wall, the larvae migrate through the portal venous system reaching the liver and possibly various other internal organs developing into hydatid cysts (metacestode). As these cysts grow slowly, this first phase of CE occurs asymptomatically [3, 9, 9]. Other taxa having significant contribution in human CE are genotypes G6 and G7 which usually transmit through camels, goats, and pigs, respectively, in areas where these genotypes have predominant occurrence in animals [13]
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