Skip to main content

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

Journal of Parasitic Diseases volume 41, pages 883–887 (2017)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  • 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

    CAS  Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • Andalib Aliabadi Z, Berenji F, Fata A, Jarahi L (2015) Human hydatidosis/echinococosis in north eastern Iran from 2003 to 2012. Iran J Parasitol 10:658–662

    PubMed  PubMed Central  Google Scholar 

  • Budke CM, Deplazes P, Torgerson PR (2006) Global socioeconomic impact of cystic echinococcosis. Emerg Infect Dis 12:296–303. doi:10.3201/eid1202.050499

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 43:285–292

    CAS  PubMed  Google Scholar 

  • 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 59:454–459

    Article  PubMed  Google Scholar 

  • Craig PS et al (2007) Human echinococcosis: a neglected disease? Trop Med Health 35:283–292

    Article  Google Scholar 

  • 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 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Eckert J (2001) WHO/OIE manual on echinococcosis in humans and animals: a public health problem of global concern

  • 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

    Article  Google Scholar 

  • Fallah M, Taherkhani H, Sadjjadi M (1995) Echinococcosis in the Stray Dogs in Hamadan, West of Iran. Iran J Med Sci 20:170–172

    Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • Group WIW (2003) International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 85:253–261

    Article  Google Scholar 

  • 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 19:553–561

    Article  PubMed  Google Scholar 

  • Kakkos S, Mouzaki A, Vagianos C (2007) Modifications of the immune system caused by the cestode. Echinococcus granulosus: a review. Ann Gastroenterol 14:91–98

    Google Scholar 

  • 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 33:203–206

    PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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 7:119–123

    Article  Google Scholar 

  • McManus DP, Gray DJ, Zhang W, Yang Y (2012) Diagnosis, treatment, and management of echinococcosis. BMJ. doi:10.1136/bmj.e3866

    PubMed Central  Google Scholar 

  • 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

  • Muhtarov M, Rainova I, Marinova I, Harizanov R, Jordanova D (2015) Human cystic echinococcosis: current diagnostic methods and therapeutic approaches. Gen Med 17:46–54

    Google Scholar 

  • Muller R (2002) Worms and human disease, vol 2. CABI publishing, Cambridge

    Book  Google Scholar 

  • Panaitescu D (1970) Eosinophilia in hydatidosis. Arch Roum Pathol Exp Microbiol 29:447–452

    CAS  PubMed  Google Scholar 

  • 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 46:721–723

    CAS  PubMed  Google Scholar 

  • 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 23:138–140

    Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • Razmi GR, Sardari K, Kamrani A (2006) Prevalence of Echinococcus granulosus and other intestinal helminths of stray dogs in Mashhad area. Iran Arch Razi 61:143–148

    Google Scholar 

  • Rokni M (2009) Echinococcosis/hydatidosis in Iran. Iran J Parasitol 4:1–16

    Google Scholar 

  • 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 7:907–911

    CAS  PubMed  Google Scholar 

  • 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

  • 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

    CAS  Article  PubMed  Google Scholar 

  • Schantz PM, Shanks D, Wilson M (1980) Serologic cross-reactions with sera from patients with echinococcosis and cysticercosis. Am J Trop Med Hyg 29:609–612

    CAS  Article  PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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:e1880

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Wuestenberg J et al (2014) Diagnostics in cystic echinococcosis: serology versus ultrasonography. Turk J Gastroenterol 25:398–404. doi:10.5152/tjg.2014.7112

    Article  PubMed  Google Scholar 

  • 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

    CAS  Article  Google Scholar 

  • Zhang W, Li J, McManus DP (2003) Concepts in immunology and diagnosis of hydatid disease. Clin Microbiol Rev 16:18–36

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Zhang W, Ross AG, McManus DP (2008) Mechanisms of immunity in hydatid disease: implications for vaccine development. J Immunol 181:6679–6685

    CAS  Article  PubMed  Google Scholar 

  • 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

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Affiliations

  1. Department of Parasitology, Kerman University of Medical Sciences, Kerman, Iran

    Mohammad Ebrahimipour

  2. Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA

    Christine M. Budke

  3. Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohsen Najjari & Kambiz Yaghoobi

  4. Ghaem Educational, Research and Treatment Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Mohsen Najjari

Authors
  1. Mohammad Ebrahimipour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine M. Budke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohsen Najjari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kambiz Yaghoobi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammad Ebrahimipour.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ebrahimipour, M., Budke, C.M., Najjari, M. et al. Surgically managed human cystic echinococcosis in north-eastern Iran: a single center’s experience from 2001 to 2008. J Parasit Dis 41, 883–887 (2017). https://doi.org/10.1007/s12639-017-0911-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12639-017-0911-9

Keywords

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