The pattern of cystic echinococcosis in children in an endemic area in Morocco

  • Omar AmahmidEmail author
  • Youssef El Guamri
  • Khalid Zenjari
  • Souad Bouhout
  • Mohamed Ait Moh
  • Fatima Boraam
  • Abdelaziz Ait Melloul
  • Hilal Benfaida
  • Khadija Bouhoum
  • Driss Belghyti
Original Article


Cystic echinococcosis is a parasitic infection of major public health concern. The infection is generally acquired during childhood and the disease incubation period can last many years. The occurrence and characteristics of the disease in children were not well studied. The present study aimed to explore the pattern and features of cystic echinococcosis in children in rural and urban environments in Morocco. A total of 338 children diagnosed and treated for cystic echinococcosis were investigated. The trend of the infection, risk and exposure factors and the distribution of the anatomic locations of cysts were studied. A non-uniform decrease in proportions of infected children was found. Children from rural environs had significantly higher infection rates than children from urban environs (p < 0.001). Males were significantly more infected than females. Children aged 7–11 years were the most affected. For cysts locations, single organ involvement was found in 94.4% of the children versus 5.6% with multi-organ localization. Despite control program, active transmission of echinococcosis still occurred in children and remains a major public health problem. The infection in younger population may have some features that need to be considered in the prevention and control programs in endemic areas.


Children Cystic echinococcosis Cyst location Environment Risk factors 



Thanks to the Director of the Provincial Ambulatory Outreach Service (SIAAP), Marrakesh, Morocco, for their collaboration. The assistance of Mr. Mohamed Essarafy and comments of Dr. Anthony Grimason are greatly appreciated.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. Alghoury A, El-Hamshary E, Azazy A, Hussein E, Rayan HZ (2010) Hydatid disease in Yemeni patients attending public and private Hospitals in Sana’a City, Yemen. Oman Med J 25(2):88–90CrossRefGoogle Scholar
  2. Amahmid O, Bouhoum K (2005) Assessment of the health hazards associated with wastewater reuse: transmission of geohelminthic infections (Marrakesh, Morocco). Int J Environ Health Res 15(2):127–133CrossRefGoogle Scholar
  3. Budke CM, Deplazes P, Torgerson PR (2006) Global socioeconomic impact of cystic echinococcosis. Emerg Infect Dis 12(2):296–303CrossRefGoogle Scholar
  4. Chakarova B, Kichukova K, Rasheva G, Naneva Z, Kaneva E, Perchemlieva T et al (2015) A short overview of the cystic echinococcosis among people in Bulgaria and Stara Zagora region during the period 2006–2014. Trakia J Sci 13(2):110–116CrossRefGoogle Scholar
  5. Chaouachi B, Ben Salah S, Lakhoua R, Hammou A, Gharbi HA, Saied H (1989) Les kystes hydatiques chez l’enfant, Aspects diagnostiques et thérapeutiques: a propos de 1195 cas [Hydatid cysts in children, diagnostic and therapeutic aspects: about 1195 cases]. Ann Pediatr 36(7):441–449 (French) Google Scholar
  6. Chebli H, Laamrani El Idrissi A, Benazzouz M, Lmimouni BE, Nhammi H et al (2017) Human cystic echinococcosis in Morocco: ultrasound screening in the Mid Atlas through an Italian–Moroccan partnership. PLoS Negl Trop Dis 11(3):1–20CrossRefGoogle Scholar
  7. Craig PS, Larrieu E (2006) Control of cystic echinococcosis/hydatidosis: 1863–2002. Adv Parasitol 61:443–508CrossRefGoogle Scholar
  8. Da Silva AM (2010) Human echinococcosis: a neglected disease. Gastroenterol Res Pract 2010(1):1–9CrossRefGoogle Scholar
  9. Djuricic SM, Grebeldinger S, Kafka DI, Djan I, Vukadin M, Vasiljevic ZV (2010) Cystic echinococcosis in children—the 17-year experience of two large medical centers in Serbia. Parasitol Int 59(2):257–261CrossRefGoogle Scholar
  10. Dopchiz MC, Elissondo MC, Andresiuk MV, Maiorini E, Gutierrez AM, Muzulin PM et al (2009) Pediatric hydatidosis in the south-east of the Buenos Aires province, Argentina. Rev Argent Microbiol 41(2):105–111Google Scholar
  11. Dowling PM, Abo-Shehada MN, Torgerson PR (2000) Risk factors associated with human cystic echinococcosis in Jordan: results of a case control study. Ann Trop Med Parasitol 94(1):69–75CrossRefGoogle Scholar
  12. Durakbasa CU, Tireli GA, Sehiralti V, Sander S, Tosyali AN, Mutus M (2006) An audit on pediatric hydatid disease of uncommon localization: incidence, diagnosis, surgical approach and outcome. J Pediatr Surg 41:1457–1463CrossRefGoogle Scholar
  13. ECDC (2014) Annual epidemiological report: food and waterborne diseases and zoonoses. ECDC, Stockholm, p 96Google Scholar
  14. Eckert J, Deplazes P (2004) Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 17(1):107–135CrossRefGoogle Scholar
  15. El Berbri I, Ducrotoy MJ, Petavy AF, Fassi Fihri O, Shaw AP et al (2015) knowledge, attitudes and practices with regard to the presence, transmission, impact, and control of cystic echinococcosis in Sidi Kacem province, Morocco. Infect Dis Poverty 4(48):1–12Google Scholar
  16. Fahimzad A, Karimi A, Tabatabae SR, Armin S, Ghanaei RM, Fallah F et al (2015) Overview of hydatid disease in Iranian children. Arch Pediatr Infect Dis 3(3):1–5Google Scholar
  17. Grimason AM, Masangwi SJ, Morse TD, Jabu GC, Beattie TK, Taulo SE et al (2014) Knowledge, awareness and practice of the importance of hand-washing amongst children attending state run primary schools in rural Malawi. Int J Environ Health Res 24(1):31–43CrossRefGoogle Scholar
  18. Grosso G, Gruttadauria S, Biondi A, Marventano S, Mistretta A (2012) Worldwide epidemiology of liver hydatidosis including the Mediterranean area. World J Gastroenterol 18(13):1425–1437CrossRefGoogle Scholar
  19. Hezarjaribi HZ, Fakhar M, Esboei BR, Soosaraei M, Ghorbani A, Nabyan N et al (2017) Serological evidence of human cystic echinococcosis and associated risk factors among general population in Mazandaran province, Northern Iran. Ann Med Surg 18(C):1–5CrossRefGoogle Scholar
  20. Jairajpuri ZS, Jetley S, Hassan MJ, Hussain MB (2012) Hydatid disease in childhood: revisited report of an interesting case. J Parasit Dis 36(2):265–268CrossRefGoogle Scholar
  21. Jordanova DP, Harizanov RN, Kaftandjiev IT, Rainova IG, Kantardjiev TV (2015) Cystic echinococcosis in Bulgaria 1996–2013, with emphasis on childhood infections. Eur J Clin Microbiol Infect Dis 34(7):1423–1428CrossRefGoogle Scholar
  22. Kohansal MH, Nourian A, Bafandeh S (2015) Human cystic echinococcosis in Zanjan area, Northwest Iran: a retrospective hospital based survey between 2007 and 2013. Iran J Public Health 44(9):1277–1282Google Scholar
  23. Mirshemirani A, Khaleghnejad A, Kouranloo J, Sadeghian N, Rouzrokh M, Hasas-Yeganeh S (2011) Liver hydatid cyst in children (a 14-year review). Iran J Pediatr 21(3):385–389Google Scholar
  24. Morrongiello BA, Midgett C, Shields R (2001) Don’t run with scissors: young children’s knowledge of home safety rules. J Pediatr Psychol 26(2):105–115CrossRefGoogle Scholar
  25. Ok UZ, Ozkol M, Kilimcioglu AA, Dinc G, Bayindir P, Ostan I et al (2007) A province-based study using sampling method to investigate the prevalence of cystic echinococcosis among primary school children in Manisa, Turkey. Acta Trop 103(2):116–122CrossRefGoogle Scholar
  26. Pierangeli NB, Soriano SV, Roccia I, Giménez J, Lazzarini LE, Grenovero MS et al (2007) Heterogeneous distribution of human cystic echinococcosis after a long-term control program in Neuquén, Patagonia Argentina. Parasitol Int 56(2):149–155CrossRefGoogle Scholar
  27. Sanaei Dashti A, Kadivar MR, Alborzi A, Sadeghi E, Pouladfar GR, Bagherian N et al (2017) Analysis of hospital records of children with hydatid cyst in south of Iran. J Parasit Dis 41(4):1044–1048CrossRefGoogle Scholar
  28. Sundarka MK, Bansal R, Talwar V, Jindal R, Saini M, Gupta HL (2000) Disseminated hydatid cyst disease presenting as acute respiratory distress. J Ind Acad Clin Med 1(3):257–259Google Scholar
  29. Talaiezadeh AH, Maraghi S (2006) Hydatid disease in children: a different pattern than adults. Pak J Med Sci 22(3):329–332Google Scholar
  30. Tantawy IM (2010) Hydatid cysts in children. Ann Pediatr Surg 6(2):98–104Google Scholar
  31. Todorov T, Boeva V (2000) Echinococcosis and in children adolescents in Bulgaria: a comparative study. Ann Trop Med Parasitol 94(2):135–144CrossRefGoogle Scholar
  32. Torgerson PR (2013) The emergence of echinococcosis in Central Asia. Parasitology 140(3):1667–1673CrossRefGoogle Scholar
  33. Torgerson PR, Oguljahan B, Muminov AE, Karaeva RR, Kuttubaev OT, Aminjanov M, Shaikenov B (2006) Present situation of cystic echinococcosis in Central Asia. Parasitol Int 55(Suppl):207–212CrossRefGoogle Scholar
  34. Tsaroucha AK, Polychronidis AC, Lyrantzopoulos N, Pitiakoudis MS, Karayiannakis J, Manolas KJ, Simopoulos CE (2005) Hydatid disease of the abdomen and other locations. World J Surg 29(9):1161–1165CrossRefGoogle Scholar
  35. Veit P, Bilger B, Schad V, Schäfer J, Frank W, Lucius R (1995) Influence of environmental factors on the infectivity of Echinococcus multilocularis eggs. Parasitology 110(1):79–86CrossRefGoogle Scholar
  36. Vlad DC, Neghina AM, Dumitrascu V, Marincu I, Neghina R, Calma CL (2013) Cystic echinococcosis in children and adults: a 7-year comparative study in western Romania. Foodborne Pathog Dis 10(2):189–195CrossRefGoogle Scholar
  37. Wang Q, Qiu J, Schantz P, He J, Ito A, Liu F (2001) Investigation of risk factors for development of human hydatidosis among households raising livestock in Tibetan areas of western Sichuan province China. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 19(2):93–96Google Scholar

Copyright information

© Indian Society for Parasitology 2019

Authors and Affiliations

  • Omar Amahmid
    • 1
    • 2
    Email author return OK on get
  • Youssef El Guamri
    • 1
    • 3
  • Khalid Zenjari
    • 4
  • Souad Bouhout
    • 5
  • Mohamed Ait Moh
    • 6
  • Fatima Boraam
    • 6
  • Abdelaziz Ait Melloul
    • 7
  • Hilal Benfaida
    • 7
  • Khadija Bouhoum
    • 2
  • Driss Belghyti
    • 3
  1. 1.Biology Unit, Department of Life and Earth SciencesRegional Centre for Careers of Education and Training (CRMEF-Marrakech)MarrakeshMorocco
  2. 2.Parasitology Unit, Department of BiologyLaboratory of Hydrobiology, Ecotoxicology and Sanitation (LHEA), Faculty of Sciences-SemlaliaMarrakeshMorocco
  3. 3.Department of BiologyLaboratory of Biotechnology, Environment and Quality (LABEQ), Faculty of SciencesKenitraMorocco
  4. 4.Regional Direction of Health Marrakesh-SafiMarrakeshMorocco
  5. 5.Service of Parasitic DiseasesDirection of Epidemiology and Diseases Control (DELM)RabatMorocco
  6. 6.Service of Public Health and Epidemiological SurveillanceRegional Direction of HealthMarrakeshMorocco
  7. 7.Regional Laboratory of Epidemiological Diagnostic and Environmental Hygiene (LRDEHM)MarrakeshMorocco

Personalised recommendations