Jul 2026· American Journal of Tropical Medicine and Hygiene· 0 citations· 50 references
Medicine
TL;DR
A substantial and previously underrecognized clinical CE burden is revealed in Arequipa, providing foundational baseline evidence for a region newly recognized as endemic.
Abstract
Peru carries the highest burden of cystic echinococcosis (CE) in South America, yet major geographic gaps persist in understanding the distribution and intensity of the disease. The Arequipa region in southern Peru has historically been considered nonendemic, with no previous systematic clinical characterization of CE, despite increasing reports. Clinical records of 129 of 177 CE surgical cases treated between December 2011 and November 2013 at a government-funded CE surgical unit at a major referral hospital were analyzed. This represents the first structured clinical assessment of CE in Arequipa. Sociodemographic, epidemiological, and clinical data were extracted, and cases were mapped at a provincial level. Statistical analysis was conducted using appropriate nonparametric and exact tests. Half of Arequipa's provinces of origin (4/8) had case rates of 7.8 to 20 per 100,000, substantially exceeding the national average. Notably, 40.3% of CE surgical cases were autochthonous to Arequipa, suggesting local transmission years before treatment, consistent with CE's prolonged incubation period. Patients had a median age of 26 years (interquartile range: 16-45 years), 55% were male, and 69% were students (35%), farmers (18%), or homemakers (16%). Pulmonary involvement predominated, accounting for 70% of cases. Comparison of patient- and cyst-level characteristics between Arequipa and established CE-endemic regions revealed no significant differences. These findings reveal a substantial and previously underrecognized clinical CE burden in Arequipa, providing foundational baseline evidence for a region newly recognized as endemic. Evidence of local transmission underscores the urgent need for sustained political support, specialized surgical units, and systematic surveillance to strengthen CE control in southern Peru.
Cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus , is a globally under-recognized zoonosis. An estimated one million people are affected at any given time, with incidence exceeding 50 cases per 100,000 person-years in endemic pockets across the Mediterranean, the Middle East, Central Asia, western China, East Africa, and South America. 1 India carries a substantial share of this burden. National incidence estimates range from 1 to 200 per 100,000 population, with classical high-prevalence foci in Andhra Pradesh and Tamil Nadu. 2 Long-recognized endemic clusters also persist in southern Rajasthan 3 and in the Kashmir Valley, where a large population-based seros-urvey of over 1,400 samples con fi rmed ongoing transmission. 4 Recent seroprevalence data from North India report anti-E. granulosus IgG positivity as high as 46% among clinically suspected patients, suggesting active and possibly intensifying transmission. 5 As elsewhere, the liver remains the most commonly affected organ in Indian series. Despite this burden, India lacks a national CE surveillance framework, leaving tertiary-center case series, such as the one published in this issue of Journal of Digestive Endoscopy from Uttar Pradesh 6 as the principal source of insight into complicated, biliary-penetrating disease in the subcontinent. For symptomatic or complicated active cysts, three broad treatment modalities coexist: benzimidazole chemotherapy (albendazole being the agent of choice, typically 10 to 15mg/kg/d), surgical resection, ranging from conservative cystectomy to formal hepatectomy, and image-guided percutaneous drainage – most commonly PAIR (puncture, aspiration, injection of a scolicidal agent, and re-aspiration
Amit Kumar, Vivek Hande· Journal of Digestive Endosco...· 0 citations
Background: Kazakhstan is among the most highly endemic countries for hepatic echinococcosis worldwide, yet no study systematically characterised the national hepatobiliary surgical burden of cystic (CE) and alveolar (AE) echinococcosis using administrative health data. Methods: National operative data from the Guaranteed Volume of Free Medical Care (GOBMP) and Compulsory Social Health Insurance (OSHI) Systems (1 January 2023–31 December 2025) were combined with institutional case series from the National Research Oncology Center (NROC), Astana (2021–2025). Cases were identified using ICD-10 diagnosis codes and ICD-9-CM procedure codes. Regional and species-specific differences in surgical approach were assessed using Pearson’s chi-square test; continuous variables were compared using the Mann–Whitney U test. Results: A total of 143 hepatic echinococcosis surgeries were performed nationally over the three-year period, with a 12.8% increase in annual volume (47 in 2023, 43 in 2024, 53 in 2025), though this year-to-year variation was not statistically significant (χ2 = 1.06, df = 2, p = 0.59). CE accounted for 74.8% of cases (n = 107), AE for 18.9% (n = 27), and unspecified hepatic echinococcosis for 6.3% (n = 9); the proportion of AE rose from 17.0% in 2023 to 26.4% in 2025. Astana performed 46.2% of all operations nationally, with its share increasing from 34.0% to 58.5% over the study period; together with Almaty, it accounted for 92.6% of all AE cases. Partial hepatic resection was the predominant procedure overall (81.1%), while AE was managed exclusively by resectional or lobar procedures (χ2 = 15.37, p = 0.004), with no percutaneous approaches used. In the NROC case series (n = 63), AE patients were older (median 43.5 vs. 33 years, p = 0.036) and had longer postoperative hospital stays (median 12 vs. 10 days, p = 0.015) than CE patients. Conclusions: Surgical management of hepatic echinococcosis in Kazakhstan is increasingly centralised in Astana and Almaty, with AE consistently requiring more extensive resectional surgery and greater healthcare resource use than CE. These findings support the development of a national echinococcosis registry and formal referral pathways to guide resource allocation and surgical planning.
J. Saparbay, Zhanat Spatayev, Abylaikhan Sharmenov et al.· International Journal of Env...· 0 citations
BACKGROUND
Histoplasmosis is a systemic fungal infection caused by Histoplasma capsulatum and is increasingly recognised in India, but its epidemiology, clinical spectrum, diagnosis, treatment, and outcomes remain poorly characterised. We conducted a systematic review of reported cases from India.
METHODS
A PROSPERO-registered review (CRD42024556630) was conducted using PubMed, Embase, and Web of Science for studies published up to February 2025, without language restrictions. Two reviewers independently screened records and extracted individual patient-level data. Organ involvement was defined a priori using site-specific histopathological, cytological, microbiological, or molecular confirmation, with compatible clinico-radiological involvement accepted in confirmed cases. Descriptive and exploratory individual-level comparative analyses were performed.
RESULTS
We included 320 studies contributing 508 unique cases. Reporting increased markedly after 2015. Cases were geographically widespread, with the highest numbers from Delhi (16.9%), West Bengal (13.8%), Punjab (12.0%), Haryana (9.4%), Maharashtra (8.3%), Uttar Pradesh (7.7%), and Rajasthan (7.1%). The mean age was 47.6 years (SD 16.5), and 403/493 (81.7%) were male. Immunosuppression was documented in 188/508 (37.0%), most commonly HIV infection and diabetes mellitus. Disease was frequently extrapulmonary and multisystemic, with cutaneous (31.5%), adrenal (29.9%), lymph node (29.8%), hepatic (26.0%), and splenic (25.6%) involvement most common. Pulmonary disease occurred in 15.2% and central nervous system disease in 1.6%. Diagnosis relied predominantly on microscopy, histopathology, or cytology (98.6%); culture (28.0%), antigen detection (4.3%), and PCR (3.0%) were infrequently used. Amphotericin B was used in 262/388 (67.5%) cases with available data, and itraconazole in 306/390 (78.5%). Outcome data were available for 425 patients, of whom 62/425 (14.6%) died.
CONCLUSIONS
Reported histoplasmosis in India is geographically widespread and clinically heterogeneous, with prominent extrapulmonary and disseminated disease. These findings reflect published case patterns rather than true epidemiology, given selective reporting of severe, unusual, or biopsy-confirmed disease. Limited use of culture, antigen detection, and molecular diagnostics highlights important diagnostic gaps. Improved awareness, access to non-culture-based diagnostics, and prospective multicentre studies are needed to define the full clinical spectrum and burden of histoplasmosis in India.
Background: Hydatid cyst is a neglected zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus. While Afghanistan is a known endemic country, detailed epidemiological data from specific provinces remain scarce. We aimed to describe the demographic, clinical, and cyst‑related characteristics of patients diagnosed with hydatid cyst in Baghlan Province. Afghanistan
Methods: This retrospective study reviewed the medical records of 26 patients with confirmed hydatid cyst disease, treated at four hospitals in Baghlan Province from March 2022 to December 2025. Information on demographic characteristics (including age, sex, and place of residence), cyst localization, and clinical manifestations was collected and assessed using descriptive statistical methods.
Results: Among 26 patients, the majority were female (n=17, 65.4%). The mean age was 32.5 years (range 7–80 years old). The liver was the predominant site of involvement, either as a single organ or as part of multiple organ involvement (n=25, 96.2%). Among liver cysts, the right upper quadrant was the most frequent location (n=24, 92.3%). The most common symptoms included abdominal pain (n=24, 92.3%), fever (n=20, 76.9%), nausea (n=5, 19.2%), and anorexia (n=4, 15.4%). Unusual cyst locations were observed in three patients: lung (n=1), spleen (n=1), and uterus (n=1). No patient had documented central nervous system or orbital involvement.
Conclusion: Hydatid cyst in Baghlan Province predominantly affects young to middle‑aged females and most frequently involves the liver. The presence of extra‑hepatic localizations, albeit rare, underscores the need for a high index of suspicion in endemic regions. Public health interventions should target rural farming communities where livestock rearing is common.
Sayed Hussain Mosawi, Mohammad Sharifi, M. Behrad et al.· Afghanistan Journal of Infec...· 0 citations
Background/Objectives: Cystic echinococcosis is primarily managed surgically, yet postoperative recurrence affects 2–22% of patients despite albendazole prophylaxis. This study describes the tolerability of adding praziquantel to postoperative albendazole and reports recurrence signals where efficacy cannot be inferred. Methods: In this single-centre, retrospective, two-arm cohort, 60 patients undergoing hydatid cyst surgery (2024–2026) received albendazole and 30 additionally received praziquantel. The follow-up was substantially shorter in the combination arm (median 10 versus 24 months), and recurrence was first ascertainable only from 12 months, the central limitation. Analyses used standardized mean differences, person time incidence, propensity score and inverse probability weighting, a DAG-based hepatotoxicity model, and a Bayesian Beta-Binomial re-analysis. Results: Baseline covariates were markedly imbalanced (14/15 with |SMD| > 0.10). Two recurrences occurred, both in the albendazole arm (3.73/100 person-years) and none in the combination arm’s shorter window. Adverse events were similar (43.3% vs. 50.0%), with no added hepatotoxicity after adjustment (odds ratio 1.45, 95% CI 0.49–4.37). The Bayesian posterior probability of benefit (0.88–0.93) remained below 0.95, a descriptive signal only. Conclusions: Albendazole plus praziquantel was well tolerated, but severe baseline imbalance, differential follow-up, and only two events mean efficacy cannot be assessed. The results of our study are hypothesis-generating. Further confirmation requires a prospective, multicentre randomized trial with balanced long-term follow-up.
Galya Popova-Daskalova, K. Kostadinov, Krasimira Eneva et al.· Biomedicines· 0 citations