Epidemiological Characteristics of Human Hydatid Disease in The Major Hospitals of SANAA- YEMEN, 2012- 2013
Research Team Shareef Sami Abed Ahmad A.A Ayyad (presenter) Moaweh Riyad Al-dgheim Mohammad Ahmad Horani Moawiah Moh’d Bahjat Qutaiba Emad Rahmoon Abdalrahman Ali Diab Albaw Tarek Alwreikat Jaber Alkhalialeh Drar Adel Khaled Bani Hani Under the Supervision of : Dr. Majed Wadi
Outlines Background Objectives Methodology Results Discussion Conclusion Recommendation
Background Echinococcosis is a zoonotic disease caused by infection with the larval stage of tapeworm Echinococcus granulosus. The tapeworm lives in canids, which are infected by eating the viscera of sheep that contain hydatid cysts. The infected ova-containing feces of dogs (definitive host) contaminate grass and farm land, and the ova are ingested by intermediate hosts, such as sheep, cattle, pigs, and humans. The ova burrows through the intestinal mucosa and is carried by the portal vein to the liver, where it develops into an adult cyst.
Background, Life cycle of hydatid cyst
Worldwide distribution of the geographical endemicity The greatest prevalence of HD in human and animal hosts is found in countries of the temperate zones.(world J Gastroentoral 2012 April 7)
Objectives General: This study aims to describe the epidemiological characteristics of human hydatid disease cases in the major hospitals in Sana’a, Yemen (University of Science and Technology “UST’, Alkuwait, Aljoumhori and Althawra hospitals). Specific: 1. To describe hydatid disease in association to sex, age and geographical distribution 2. To determine the most affected organs 3. To determine the outcome of the hydatid disease.
Methodology A cross-sectional study was applied in this research. A modified check list was used to collect data from the diagnosed cases of hydatid disease in the major hospitals’ archives for the years of 2012-2013.
Results Male Female 27 14 10 9 5 4 4 3 USTH AL KUWAIT H AL JOMHOURI AL THAWRAH FIGURE 1: CHARACTERISTICS OF PATIENTS ACCORDING TO SEX AND HOSPITALS. Affected females were (65.8%) while affected males represent (34.2%).
Figure 2: distribution according age and sex. the majority of the infected patients are less than 30 years old, in age group (<20) represented (26.3%), and in age group (20- 29) represented (22.4%).
Figure 3: distribution according organ affected and number of cyst It is observed that the most affected organ was the liver (72.4%), followed by the lung (23.7%), 56 cases (73.7%) had a single cyst, while 20 cases (26.3%) had multiple cysts.
Table 1: distribution according organ and surgical operation Organ Operation Total laparotomy Thoracotomy Kocher craniotomy incision Count 44 0 11 0 55 liver % within 80% 0% 20% 0.0% 100% organ Count 0 18 0 0 18 lung % within 0% 100% 0% 0.0% 100% organ Count 0 0 0 3 3 brain % within 0% 0% 0% 100% 100% organ Count 44 18 11 3 76 Total % within 57.9% 23.7% 14.5% 3.9% 100% organ Table 4 shows that the liver was effected in 55 cases and the surgical interventions that were performed are of the following: laparotomy in 44 cases and Kocher incision in 11 cases. Lung was effected in 18 cases and the surgical intervention was thoracotomy in all cases. Brain was effected in 3 cases and the surgical intervention was craniotomy in all cases.
Discussion Demographic characteristics of patients In this study, infected females (65.8%) and infected males represent (34.2%). This finding is similar to the studies that were conducted in Yemen (Alghoury et al, 2010), which reported that females (67%) are more exposed to ecchinococal infections than males (34%). Additionally, in Jordan, females (60%) and males (40%) (Amr et al, 1994) In Iraq, females (80%), males (20%) and in the west bank females (66.5%) and males (33.5%). On the contrary in Saudi Arabia males (53.7%) and females (46.3%) (Awatif et al, 1999) The difference might be attributed to the difference of socioeconomic status from one country to another. In Saudi Arabia they depend more on foreign employees that may have contact with animals and agriculture.
Discussion cont’ Demographic characteristics of patients cont’ This study shows the majority of the infected patients are less than 30 years old, in age group (<20) represented (26.3%), and in age group (20- 29) represented (22.4%). This is agreed with the Jordanian study that reported that (35.8%) were in less than 20 age group, also the west bank study which reported age group (11-20) represented (27.4%) and age group (21-30) represented (21.4%). This is different from the study conducted here in Yemen that reported that patients older than 30 years old represent (40.4%).
Discussion cont’ Affected organs of hydatid disease It observed that the most affected organ was the liver (72.4%), followed by the lung (23.7%), and the brain (3.9%) there were no spleen involvement or any other organ. The higher rate of hepatic infection may be attributed to the fact that the liver acts as the primary filter in the human body and the lung is often thought to be the second filter.(6). This is also seen in other studies that showed the involvement of liver was in the highest percentage (50%-70%). followed by the lung (26%- 32%). The study shows that 56 cases (73.7%) had single cyst were as 20 cases (26.3%) had multiple cysts.
Discussion cont’ Outcome of hydatid disease This study shows that 76 cases (100%) were treated surgically, liver cysts under gone either laparotomy (80%) or Kocher incision (20%), lung cysts under gone thoracotomy (100%), brain cysts managed by craniotomy. The study been conducted in Palestine-west bank, it were limited to the surgical department. Unlike our study, KSA study have shown that 22.4% of cases been treated medically, 56.7% managed surgically, while 20.9% have under gone both medical and surgical treatment. The delay in presentation due to low socioeconomic state in Yemen may be the cause of cases to get complicated and require surgical intervention. other study were conducted in Yemen and Jordan not reported if the patients received medical treatment. None of the cases in our study required ICU admission.
Conclusions This study revealed that 65.8% of cases were females while 34.2% cases were males. The highest age group was less than 30 that represented 48.7%. The most effected organ was the liver 72.4%, followed by lung 23.7%. cysts were single in 73.7%, and multiple in 26.3% of the cases. All of the cases were treated surgically and reported no recurrence or ICU admission
Recommendations Health education should be provided about the mechanism of spread of this disease to all high risk groups. The ministry of agriculture in collaboration with ministry of health should play an active role in the control and screening of infected animals. Accurate information should be properly recorded and archived in a more accessible and organized way similar to UST-hospital archiving system. More studies should be conducted on a wider geographical area that involves the whole Republic of Yemen.
Acknowledgment We thanks all the people that have lend us their cooperative hand, without them we wouldn’t reach the end of this long hard journey. We specially give thanks to our dear doctors, the head of the UST Community Department Dr. Ahmad Qayed, our supervisor Dr.Majed Wadi.
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