Journal of Parasitic Diseases

, Volume 41, Issue 3, pp 883–887 | Cite as

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

  • Mohammad EbrahimipourEmail author
  • Christine M. Budke
  • Mohsen Najjari
  • Kambiz Yaghoobi
Original Article


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.


Cystic echinococcosis (CE) Complete blood count (CBC) Surgery Iran 



The authors would like to express their gratitude to the personnel of Ghaem Hospital in Mashhad County for their useful collaboration.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. Ahmadi NA, Hamidi M (2008) A retrospective analysis of human cystic echinococcosis in Hamedan province, an endemic region of Iran. Ann Trop Med Parasitol 102:603–609. doi: 10.1179/136485908X337517 CrossRefPubMedGoogle Scholar
  2. Ahmadi NA, Hamidi M (2010) Unusual localizations of human hydatid disease in Hamedan province, west of Iran. Helminthologia 47:94–98. doi: 10.2478/s11687-010-0015-x CrossRefGoogle Scholar
  3. Andalib Aliabadi Z, Berenji F, Fata A, Jarahi L (2015) Human hydatidosis/echinococosis in north eastern Iran from 2003 to 2012. Iran J Parasitol 10:658–662PubMedPubMedCentralGoogle Scholar
  4. Budke CM, Deplazes P, Torgerson PR (2006) Global socioeconomic impact of cystic echinococcosis. Emerg Infect Dis 12:296–303. doi: 10.3201/eid1202.050499 CrossRefPubMedPubMedCentralGoogle Scholar
  5. Cappello E, Cacopardo B, Caltabiano E, Li Volsi S, Chiara R, Sapienza M, Nigro L (2013) Epidemiology and clinical features of cystic hydatidosis in Western Sicily: a ten-year review. World J Gastroenterol 19:9351–9358. doi: 10.3748/wjg.v19.i48.9351 CrossRefPubMedPubMedCentralGoogle Scholar
  6. Chalechale A, Hashemnia M, Rezaei F, Sayadpour M (2015) Echinococcus granulosus in humans associated with disease incidence in domestic animals in Kermanshah, west of Iran. J Parasitic Dis. doi: 10.1007/s12639-015-0681-1 Google Scholar
  7. Chaya D, Parija S (2013) Evaluation of a newly designed sandwich enzyme linked immunosorbent assay for the detection of hydatid antigen in serum, urine and cyst fluid for diagnosis of cystic echinococcosis. Trop Parasitol 3:125–131. doi: 10.4103/2229-5070.122131 CrossRefPubMedPubMedCentralGoogle Scholar
  8. Cicioglu Aridogan B, Kaya S, Sesli Cetin E, Tas T, Demirci M (2009) Evaluation of eosinophil cationic protein levels with clinical symptoms and laboratory findings of patients with cystic echinococcosis. Mikrobiyol Bul 43:285–292PubMedGoogle Scholar
  9. Conchedda M, Antonelli A, Caddori A, Gabriele F (2010) A retrospective analysis of human cystic echinococcosis in Sardinia (Italy), an endemic Mediterranean region, from 2001 to 2005. Parasitol Int 59:454–459CrossRefPubMedGoogle Scholar
  10. Craig PS et al (2007) Human echinococcosis: a neglected disease? Trop Med Health 35:283–292CrossRefGoogle Scholar
  11. Ćulafić DJ, Katić-Radivojević S, Kerkez M, Vukčević M, Ranković V, Stefanović D (2007) Liver cystic echinococcosis in humans: a study of 30 cases. Helminthologia 44:157–161. doi: 10.2478/s11687-007-0025-5 Google Scholar
  12. Dubey M, Malla N, Khurana S, Sunita T (2011) Immunodiagnosis of cystic echinocooccosis by antigen detection in serum, urine, and saliva samples. Trop Parasitol 1:33–38. doi: 10.4103/2229-5070.72107 CrossRefPubMedPubMedCentralGoogle Scholar
  13. Ebrahimipour M, Budke CM, Najjari M, Cassini R, Asmarian N (2016) Bayesian spatial analysis of the surgical incidence rate of human cystic echinococcosis in north-eastern Iran. Acta Trop 163:80–86. doi: 10.1016/j.actatropica.2016.08.003 CrossRefPubMedGoogle Scholar
  14. Eckert J (2001) WHO/OIE manual on echinococcosis in humans and animals: a public health problem of global concernGoogle Scholar
  15. Esfandian B, Youssefi MR, Ziapour SP, Fard SH, Abouhosseini M, Espeh-Kolaie MA (2010) Evaluation of hydatid cyst surgeries in Northern Iran (Mazandaran Province) during 2001–2007. J Anim Vet Adv 9:1128–1130. doi: 10.3923/javaa.2010.1128.1130 CrossRefGoogle Scholar
  16. Fallah M, Taherkhani H, Sadjjadi M (1995) Echinococcosis in the Stray Dogs in Hamadan, West of Iran. Iran J Med Sci 20:170–172Google Scholar
  17. Fasihi Harandi M, Budke CM, Rostami S (2012) The monetary burden of cystic echinococcosis in Iran. PLoS Negl Trop Dis 6:e1915. doi: 10.1371/journal.pntd.0001915 CrossRefPubMedPubMedCentralGoogle Scholar
  18. Giri S, Parija S (2012) A review on diagnostic and preventive aspects of cystic echinococcosis and human cysticercosis. Trop Parasitol 2:99–108. doi: 10.4103/2229-5070.105174 CrossRefPubMedPubMedCentralGoogle Scholar
  19. Group WIW (2003) International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 85:253–261CrossRefGoogle Scholar
  20. Hernández-Pomi A, Borras-Salvador R, Mir-Gisbert A (1997) Analysis of cytokine and specific antibody profiles in hydatid patients with primary infection and relapse of disease. Parasite Immunol 19:553–561CrossRefPubMedGoogle Scholar
  21. Kakkos S, Mouzaki A, Vagianos C (2007) Modifications of the immune system caused by the cestode. Echinococcus granulosus: a review. Ann Gastroenterol 14:91–98Google Scholar
  22. Karadam SY, Ertabaklar H, Sari C, Dayanir Y, Ertug S (2009) Should cystic echinococcosis be investigated in patients having high eosinophil counts? Turkiye Parazitol Derg 33:203–206PubMedGoogle Scholar
  23. Karim MF et al (2015) Abdominal cystic echinococcosis in Bangladesh: a hospital-based study. J Infect Dev Ctries 9:070–075. doi: 10.3855/jidc.4934 CrossRefGoogle Scholar
  24. Mansour-Ghanaei F, Joukar F, Soati F, Javadi M (2012) Clinical features of hydatid disease in Guilan (the North Province of Iran): a ten-year study. Arch Clin Infect Dis 7:119–123CrossRefGoogle Scholar
  25. McManus DP, Gray DJ, Zhang W, Yang Y (2012) Diagnosis, treatment, and management of echinococcosis. BMJ. doi: 10.1136/bmj.e3866 PubMedCentralGoogle Scholar
  26. Moosazadeh M, Abedi G, Mahdavi SA, Shojaee J, Charkame A, Afshari M (2016) Epidemiological and clinical aspects of patients with hydatid cyst in Iran. J Parasitic Dis 1–5. doi: 10.1007/s12639-016-0803-4
  27. Muhtarov M, Rainova I, Marinova I, Harizanov R, Jordanova D (2015) Human cystic echinococcosis: current diagnostic methods and therapeutic approaches. Gen Med 17:46–54Google Scholar
  28. Muller R (2002) Worms and human disease, vol 2. CABI publishing, CambridgeCrossRefGoogle Scholar
  29. Panaitescu D (1970) Eosinophilia in hydatidosis. Arch Roum Pathol Exp Microbiol 29:447–452PubMedGoogle Scholar
  30. Pautrizel R, Gosman T (1953) Studies on the variations of eosinophilia in the diagnosis of human echinococcosis. Bulletin de la Societe de pathologie exotique et de ses filiales 46:721–723PubMedGoogle Scholar
  31. Pezeshki A, Kia EB, Gholizadeh A, Koohzare A (2007) An analysis of hydatid cyst surgeries in Tehran Milad Hospital, Iran, during 2001–2004. Pak J Med Sci 23:138–140Google Scholar
  32. Prakash M, Khandelwal N, Mehta P (2016) Radiological manifestations of hydatid disease and its complications. Trop Parasitol 6:103–112. doi: 10.4103/2229-5070.190812 CrossRefPubMedPubMedCentralGoogle Scholar
  33. Razmi GR, Sardari K, Kamrani A (2006) Prevalence of Echinococcus granulosus and other intestinal helminths of stray dogs in Mashhad area. Iran Arch Razi 61:143–148Google Scholar
  34. Rokni M (2009) Echinococcosis/hydatidosis in Iran. Iran J Parasitol 4:1–16Google Scholar
  35. Sadjjadi SM, Ardehali S, Noman-Pour B, Kumar V, Izadpanah A (2001) Diagnosis of cystic echinococcosis: ultrasound imaging or countercurrent immunoelectrophoresis? East Mediterr Health J 7:907–911PubMedGoogle Scholar
  36. Salama AA, Othman AA, Zayed HA (2014) Cystic echinococcosis in the middle region of the Nile Delta, Egypt: Clinical and radiological characteristics Egypt J Radiol Nucl Med 45:641-649 doi: 10.1016/j.ejrnm.2014.05.004
  37. Sarkari B, Sadjjadi SM, Beheshtian MM, Aghaee M, Sedaghat F (2010) Human cystic echinococcosis in yasuj district in southwest of Iran: an epidemiological study of seroprevalence and surgical cases over a ten-year period. Zoonoses Public Health 57:146–150. doi: 10.1111/j.1863-2378.2008.01200.x CrossRefPubMedGoogle Scholar
  38. Schantz PM, Shanks D, Wilson M (1980) Serologic cross-reactions with sera from patients with echinococcosis and cysticercosis. Am J Trop Med Hyg 29:609–612CrossRefPubMedGoogle Scholar
  39. Spotin A, Mahami-Oskouei M, Harandi MF, Baratchian M, Bordbar A, Ahmadpour E, Ebrahimi S (2016) Genetic variability of Echinococcus granulosus complex in various geographical populations of Iran inferred by mitochondrial DNA sequences. Acta Trop. doi: 10.1016/j.actatropica.2016.03.002 PubMedGoogle Scholar
  40. Stojkovic M, Rosenberger K, Kauczor H-U, Junghanss T, Hosch W (2012) Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound? PLoS Negl Trop Dis 6:e1880CrossRefPubMedPubMedCentralGoogle Scholar
  41. Swarna S, Parija S (2012) Evaluation of Dot-ELISA and enzyme-linked immuno-electrotransfer blot assays for detection of a urinary hydatid antigen in the diagnosis of cystic echinococcosis. Trop Parasitol 2:38–44. doi: 10.4103/2229-5070.97238 CrossRefPubMedPubMedCentralGoogle Scholar
  42. Teke M et al (2015) Imaging features of cerebral and spinal cystic echinococcosis. Radiol Med 120:458–465. doi: 10.1007/s11547-014-0475-z CrossRefPubMedGoogle Scholar
  43. Vahedi MA, Vahedi ML (2012) Demographics of patients with surgical and nonsurgical cystic Echinococcosis in east Azerbaijan from 2001 to 2012. Pak J Biol Sci 15:186–191. doi: 10.3923/pjbs.2012.186.191 CrossRefPubMedGoogle Scholar
  44. Wuestenberg J et al (2014) Diagnostics in cystic echinococcosis: serology versus ultrasonography. Turk J Gastroenterol 25:398–404. doi: 10.5152/tjg.2014.7112 CrossRefPubMedGoogle Scholar
  45. Yolasigmaz A et al (2006) Comparison of serological and clinical findings in turkish patients with cystic echinococcosis. Helminthologia 43:220–225. doi: 10.2478/s11687-006-0041-x CrossRefGoogle Scholar
  46. Zhang W, Li J, McManus DP (2003) Concepts in immunology and diagnosis of hydatid disease. Clin Microbiol Rev 16:18–36CrossRefPubMedPubMedCentralGoogle Scholar
  47. Zhang W, Ross AG, McManus DP (2008) Mechanisms of immunity in hydatid disease: implications for vaccine development. J Immunol 181:6679–6685CrossRefPubMedGoogle Scholar
  48. Zibaei M, Azargoon A, Ataie-Khorasgani M, Ghanadi K, Sadjjadi SM (2013) The serological study of cystic echinococcosis and assessment of surgical cases during 5 years (2007–2011) in Khorram Abad, Iran. Niger J Clin Pract 16:221–225. doi: 10.4103/1119-3077.110156 CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society for Parasitology 2017

Authors and Affiliations

  • Mohammad Ebrahimipour
    • 1
    Email author
  • Christine M. Budke
    • 2
  • Mohsen Najjari
    • 3
    • 4
  • Kambiz Yaghoobi
    • 3
  1. 1.Department of ParasitologyKerman University of Medical SciencesKermanIran
  2. 2.Department of Veterinary Integrative BiosciencesTexas A&M UniversityCollege StationUSA
  3. 3.Department of Parasitology and Mycology, School of MedicineShiraz University of Medical SciencesShirazIran
  4. 4.Ghaem Educational, Research and Treatment CenterMashhad University of Medical SciencesMashhadIran

Personalised recommendations