Complications Associated with Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis

Abstract

Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3-89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause in endemic areas.

Factores asociados a complicaciones prequirúrgicas en pacientes con equinococosis quística de áreas endémicas del Perú

“…En el análisis bivariado de la edad categorizada, se encontró que se asoció en los estratos ≥40 años y <40 años y entre ≥60 años y <60 años, pero no se observó un incremento en la magnitud de la asociación. En España, el promedio de la edad en una cohorte retrospectiva de pacientes con complicaciones fue 59 años ± 20,3 años (26) y fue un factor de riesgo, lo que evidencia que el punto de corte que se tomó en este análisis tiene una base epidemiológica.…”

“…Este estudio aporta en la identificación de factores de riesgo para presentar complicaciones o morbilidad prequirúrgica lo que permitiría una hospitalización oportuna de los pacientes (21) , manejo apropiado y acceso al diagnóstico por imágenes. Se ha postulado que la cirugía en la práctica clínica se asocia frecuentemente a complicaciones, en los adultos mayores o en aquellos que tienen comorbilidad (26) . Asimismo, las complicaciones posoperatorias son una de las causas más comunes asociadas a la mortalidad (22) ; por ello, la cistectomía no es considerada como un método de cura definitiva (28) .…”

The role of helminths in the development of non-communicable diseases

“…Patients with Echinococcus cysts are typically asymptomatic until the lesions create a mass effect on surrounding tissue or rupture causing a systemic inflammatory response ( 201 ). The clinical course of echinococcosis in different organ compartments is associated with a wide spectrum of complications that can lead to chronic disease in the liver, lungs, brain and kidneys ( 201 , 202 ). In a cohort of 506 patients with cystic echinococcosis, 204 developed long-term complications as a result of their illness ( 202 ).…”

Comment on: “Complications Associated with Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis”

“…We read with interest the article by Collado-Aliaga et al 1 published in the recent 101(3) issue of Am J Trop Med Hyg. The authors tried to identify risk factors for complications of cystic echinococcosis (CE) using retrospective hospital data retrieved through ICD-9 codes from a single tertiary hospital in Spain.…”