Current Perspectives on Cystic Echinococcosis: A Systematic Review

Abstract Introduction: Hydatidosis, a zoonotic disease caused by the larval stage of Echinococcus granulosus, is a significant public health concern with notable economic impact. It leads to morbidity and mortality worldwide, particularly in endemic regions. This study systematically reviews recent literature on cystic echinococcosis (CE) to provide updated insights into its prevalence, impact, and management.Methods: A systematic review was conducted using PubMed to find original articles on hydatid cysts published betweenSeptember 1, 2019, and September 1, 2024. Data extracted included the first author's name, country, publication year, study type, number of cases, clinical presentation, diagnostic methods, cyst location and quantity, cyst status, treatment type and medications, follow-up details, recurrence, and mortality rates. Data were organized and qualitatively analyzed.Results: A total of 398 articles were identified, of which 229 articles with 1,002 patients met the inclusion criteria. Spain reported the highest number of CE cases at 362 (36.13%). Asia accounted for 487 cases (48.60%), and Europe contributed 460 cases (45.91%). The liver was the most frequently affected organ, accounting for 731 cases (72.95%), followed by the lungs with 110 cases (10.98%), and the kidney with 43 cases (4.29%). The age distribution of the cases showed that 63 (6.29%) were aged between 3 and 18 years.Conclusion: Hydatidosis remains a significant global public health concern, impacting developing and developed countries. The liver and lungs remain the primary sites of infection. Preventive strategies, including regular animal screening and enhanced public health education, are essential for controlling the spread of the disease. Introduction Cystic echinococcosis (CE), also known as hydatid disease (HD) or hydatidosis, is a well-known zoonotic disease caused by the larval stage of the tapeworm Echinococcus granulosus. Humans usually act as intermediate hosts, contracting the infection through direct contact with primary hosts like sheep, goats, cattle, dogs, and other canines or consuming food and water contaminated with the parasite's eggs [1, 2]. To date, HD is a serious public health problem that carries considerable economic implications. It leads to morbidity and mortality in various regions, notably in Mediterranean countries, the Middle East, New Zealand, Australia, India, and South America, mainly due to the close connections between sheep, dogs, and humans. It remains a neglected disease in many regions, necessitating concerted efforts for prevention and control, especially in rural areas where it is more prevalent [3, 4]. Hydatidosis can affect nearly any part of the body, but the liver is the organ most frequently impacted (75%), followed by the lungs (15%) and other organs like the brain (2%) and spine (1%) [3]. Hydatidosis is marked by a prolonged asymptomatic incubation period, often lasting several years. Clinical symptoms appear when the cysts grow large enough to compress nearby tissues. Additionally, cyst rupture into the peritoneal cavity can result in secondary cyst formation and the development of daughter cysts within them [3, 4]. This study systematically reviews recent literature on CE to provide updated insights into its prevalence, impact, and management. Methods Study design This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources and search strategy A systematic review was performed using PubMed to identify original articles on hydatid cysts. The search strategy targeted recent, peer-reviewed clinical studies on echinococcosis in human populations, published from September 1, 2019, to September 1, 2024, and restricted to English-language research. The search was limited to the literature of the last five years to shed light on the current disease situation. Eligibility criteria This systematic review included only original studies and case reports. Exclusion criteria were as follows: 1) articles not in English, 2) abstract only, 3) studies on alveolar echinococcosis, 4) studies unrelated to humans, 5) inadequately peer-reviewed articles, and 6) any study types that did not meet the inclusion criteria. All references in this study were evaluated for eligibility [5]. Study selection and data extraction The titles and abstracts of the selected studies were initially screened, followed by an in-depth full-text review to assess eligibility. Data extracted from each included study encompassed the first author’s name, country of origin, publication year, study type, number of cases, clinical presentation, diagnostic approaches, hydatid cyst location, cyst quantity, cyst status (intact or ruptured), treatment type, medications used, follow-up details, recurrence rate, and mortality rate. Statistical analyses Data were organized in an Excel spreadsheet (Microsoft Excel, 2021) and qualitatively analyzed using the Statistical Package for the Social Sciences (SPSS, version 27.0). Key findings were summarized as median, range, frequencies, and percentages. Results A total of 398 articles were identified through the search. After an initial review, 11 articles were excluded due to duplication and non-English language. The remaining 387 articles underwent title and abstract screening, during which 64 articles were excluded for not meeting the inclusion criteria. Consequently, 323 articles proceeded to full-text screening, and 93 were excluded due to unretrievable data, editorials, letters, or incomplete information. The remaining articles were then assessed for eligibility, resulting in 229 articles [1, 3, 4, 6-231] with 1,002 patients meeting the inclusion criteria and included in the study [Fig. 1]. Among the included studies, 217 (94.76%) were case reports, seven (3.06%) were cohort studies, three (1.31%) were case series, one (0.44%) was a cross-sectional study, and one (0.44%) was a randomized controlled trial (Table 1). Among the countries, Spain recorded the highest number of cases with 362 (36.13%), followed by China with 270 cases (26.95%) and Turkey with 128 cases (12.77%), collectively accounting for approximately 75% of the total reported cases (Table 2). In terms of continental distribution, Asia recorded 487 cases (48.60%), while Europe was not far behind with 460 cases (45.91%) (Table 3). Table 1. The details of the included studies First Author, Year Study design Country No. of cases First Author, Year Study design Country No. of cases First Author, Year Study design Country No. of cases AlRashed, 2024 [1] A Saudi Arabia 1 Mutlu, 2022 [82] A Turkey 1 Gatt, 2020 [157] A Israel 1 Amer, 2024 [6] A Iran 1 Ozgokce, 2022 [83] A Turkey 1 Giri, 2020 [158] A Bhutan 1 Babiker, 2024 [7] A Qatar 1 Passarelli, 2022 [84] A US 1 Gopivallabha, 2020 [159] A India 1 Bazzi, 2024 [8] A Lebanon 1 Pulavarty, 2022 [85] A India 1 Delgado, 2020 [160] A Spain 1 Brezeanu, 2024 [9] A Romania 1 Rodríguez-Laiz, 2022 [86] A Spain 1 Handran, 2020 [161] A US 1 Calu, 2024 [10] A Romania 2 Sezer, 2022 [87] A Turkey 1 İriz, 2020 [162] A Turkey 1 Chen, 2024 [11] A Taiwan 1 Shahid, 2022 [88] A Pakistan 1 İyigün, 2020 [163] A Turkey 1 Darestani, 2024 [12] A Iran 1 Sharma, 2022 [89] A India 1 Jarovsky, 2020 [164] A Brazil 1 Ghaedamini, 2024 [13] A Iran 1 Sozutok, 2022 [90] A Turkey 1 Johny, 2020 [165] A India 1 Gulati, 2024 [14] A US 1 Sun, 2022 [91] B China 2 Kankilic, 2020 [166] B Turkey 6 Hasnaoui, 2024 [15] A Tunisia 1 Ulusoy, 2022 [92] A Turkey 1 Kaskar, 2020 [167] A India 1 Haydar, 2024 [16] A Iran 1 Uzunoğlu, 2022 [93] A Turkey 1 Kiran, 2020 [168] A India 1 Jalayeri, 2024 [17] A Iran 1 Wang, 2022 [94] A China 1 Kırmacı, 2020 [169] A Turkey 1 Jellali, 2024 [18] A Tunisia 1 Agarwal, 2021 [95] A India 1 Kumar, 2020 [170] A India 1 Karahan, 2024 [19] A India 1 Aghajanzadeh, 2021 [4] A Iran 1 Lahdhil, 2020 [171] A Tunisia 1 Koren, 2024 [20] A Israel 1 Aili, 2021 [96] A China 1 Lapierre, 2020 [172] A Canada 1 Mahesan, 2024 [21] A India 1 Akhan, 2021 [97] A Turkey 1 Llanos, 2020 [173] A US 1 Bouhout, 2024 [22] A Morocco 1 Basne, 2021 [98] A Nepal 1 Lodhia, 2020 [174] A Tanzania 2 Manuel, 2024 [23] A Angola 1 Biswas, 2021 [99] A India 3 Lyske, 2020 [175] A Canada 1 Mierzejewski, 2024 [24] A Poland 1 Boumarah, 2021 [100] A Saudi Arabia 1 Ma, 2020 [176] E China 195 Mutlu, 2024 [25] A Turkey 1 Çankaya, 2021 [101] A Turkey 1 Mitrovic, 2020 [177] A Serbia 1 Remmerswaal, 2024 [26] A Netherlands 1 Cathomas, 2021 [102] A Switzerland 2 Mittal, 2020 [178] A India 1 Reyimu, 2024 [27] A China 1 Chatzifotiou, 2021 [103] A Germany 1 Moghtadaie, 2020 [179] A Iran 1 Sączek, 2024 [28] A Poland 1 Christodouli dis, 2021 [3] C Greece 50 Nistor, 2020 [180] A Romania 1 Thakar, 2023 [29] A India 1 Ciftci, 2021 [104] C Turkey 34 Ogul, 2020 [181] A Turkey 1 Voicu, 2024 [30] A Romania 1 Conlon, 2021 [105] A Ireland 1 Pappas, 2020 [182] A Greece 1 Aarif, 2023 [31] A India 1 Elvan-Tuz, 2021 [106] A Turkey 2 Ramia, 2020 [183] C Spain 71 Alsulami, 2023 [32] A Saudi Arabia 1 Gautam, 2021 [107] A India 1 Samadian, 2020 [184] A Iran 1 Ammar, 2023 [33] A Tu

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