Insights into Human Cystic Echinococcosis in the Kurdistan Region, Iraq: Characteristics and Molecular Identification of Cysts

Overview

Journal Pathogens

Date 2022 Apr 23

PMID 35456083

Authors

Araz Ramadhan Issa

Sardar Hassan Arif

Ayad Ahmad Mohammed

Federica Santolamazza

Azzurra Santoro

Wijdan Mohammed Salih Mero

Adriano Casulli

Affiliations

Soon will be listed here.

Abstract

Cystic echinococcosis (CE) is a neglected worldwide distributed parasitic disease caused by the Echinococcusgranulosus sensu lato (s.l.) species complex. For a better understanding of the pathways of transmission of this parasite, clinical and molecular epidemiological studies are particularly needed from endemic areas where data are scant, such as in the Middle East. The study aimed to identify the characteristics, location, cyst stage and species/genotypes of E. granulosus s.l. complex in humans from the Kurdistan region, Iraq. To this aim, from June 2019 to February 2021, 64 echinococcal cysts were surgically removed from 62 patients in Azadi and Vajeen reference Hospitals at Duhok city, Duhok governorate (Kurdistan region, Iraq). The results confirmed the liver as the most common anatomical site of CE with 72.58% of the cases, followed by the lungs in 19.35%, while 66.13% of CE cases were females. The highest rate of infections occurred in the age class 21−30 (27.42%). High rates of CE were reported among patients living in rural areas and housewives, which were 54.84% and 43.55% of the CE patients, respectively. The fertility of echinococcal cysts was 82.81%, and the viability of fertile protoscoleces was 70.53%. Cysts were staged with ultrasound according to the WHO-IWGE classification as 32.8% CE1, 32.8% CE2, 7.8% CE3a, 9.4% CE3b, 15.6% CE4 and 1.6% CE5. Molecular analyses using mitochondrial NAD5 gene showed that all analyzed samples (n = 59) belonged to the genotypes G1 or G3 of E. granulosussensu stricto (s.s.), thus, confirming sheep−dog−human transmission in the Kurdistan region, Iraq. No statistically significant correlation was found between the genotypes G1−G3 of E. granulosus s.s. and variables, such as the fertility, location and cyst stage classification. Based on the present findings, it is necessary to implement monitoring and control programs in sheep and dog populations to decrease the odds of human infections. Public health education campaigns are required to be implemented at the community level to reduce the risk of acquiring CE in humans in the Kurdistan region, Iraq.

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References

Gottstein B, Reichen J . Hydatid lung disease (echinococcosis/hydatidosis). Clin Chest Med. 2002; 23(2):397-408, ix. DOI: 10.1016/s0272-5231(02)00007-2. View

Deplazes P, Rinaldi L, Alvarez Rojas C, Torgerson P, Harandi M, Romig T . Global Distribution of Alveolar and Cystic Echinococcosis. Adv Parasitol. 2017; 95:315-493. DOI: 10.1016/bs.apar.2016.11.001. View

BEARD T . Evidence that a hydatid cyst is seldom "as old as the patient". Lancet. 1978; 2(8079):30-2. DOI: 10.1016/s0140-6736(78)91336-3. View

Metwally D, Qassim L, Al-Turaiki I, Almeer R, El-Khadragy M . Gene-based molecular analysis of COX1 in Echinococcus granulosus cysts isolated from naturally infected livestock in Riyadh, Saudi Arabia. PLoS One. 2018; 13(4):e0195016. PMC: 5905957. DOI: 10.1371/journal.pone.0195016. View

Al-Hizab F, Mohamed N, Wassermann M, Hamouda M, Ibrahim A, El-Ghareeb W . Three species of Echinococcus granulosus sensu lato infect camels on the Arabian Peninsula. Parasitol Res. 2021; 120(6):2077-2086. PMC: 8184555. DOI: 10.1007/s00436-021-07156-1. View

Nakao M, Yanagida T, Okamoto M, Knapp J, Nkouawa A, Sako Y . State-of-the-art Echinococcus and Taenia: phylogenetic taxonomy of human-pathogenic tapeworms and its application to molecular diagnosis. Infect Genet Evol. 2010; 10(4):444-52. DOI: 10.1016/j.meegid.2010.01.011. View

Thompson R . The taxonomy, phylogeny and transmission of Echinococcus. Exp Parasitol. 2008; 119(4):439-446. DOI: 10.1016/j.exppara.2008.04.016. View

Macin S, Orsten S, Samadzade R, Colak B, Cebeci H, Findik D . Human and animal cystic echinococcosis in Konya, Turkey: molecular identification and the first report of E. equinus from human host in Turkey. Parasitol Res. 2021; 120(2):563-568. PMC: 7813620. DOI: 10.1007/s00436-021-07050-w. View

Hassan Z, Meerkhan A, Boufana B, Hama A, Ahmed B, Mero W . Two haplotype clusters of Echinococcus granulosus sensu stricto in northern Iraq (Kurdistan region) support the hypothesis of a parasite cradle in the Middle East. Acta Trop. 2017; 172:201-207. DOI: 10.1016/j.actatropica.2017.04.028. View

10.

McManus D, Thompson R . Molecular epidemiology of cystic echinococcosis. Parasitology. 2004; 127 Suppl:S37-51. DOI: 10.1017/s0031182003003524. View

11.

Kim H, Yong T, Shin M, Lee K, Park G, Suvonkulov U . Phylogenetic Characteristics of Echinococcus granulosus Sensu Lato in Uzbekistan. Korean J Parasitol. 2020; 58(2):205-210. PMC: 7231821. DOI: 10.3347/kjp.2020.58.2.205. View

12.

Abdulhameed M, Habib I, Al-Azizz S, Robertson I . A retrospective study of human cystic echinococcosis in Basrah province, Iraq. Acta Trop. 2017; 178:130-133. DOI: 10.1016/j.actatropica.2017.11.011. View

13.

Nakao M, Yanagida T, Konyaev S, Lavikainen A, Odnokurtsev V, Zaikov V . Mitochondrial phylogeny of the genus Echinococcus (Cestoda: Taeniidae) with emphasis on relationships among Echinococcus canadensis genotypes. Parasitology. 2013; 140(13):1625-36. DOI: 10.1017/S0031182013000565. View

14.

Khan A, Ahmed H, Simsek S, Liu H, Yin J, Wang Y . Molecular characterization of human Echinococcus isolates and the first report of E. canadensis (G6/G7) and E. multilocularis from the Punjab Province of Pakistan using sequence analysis. BMC Infect Dis. 2020; 20(1):262. PMC: 7118937. DOI: 10.1186/s12879-020-04989-6. View

15.

Piccoli L, Bazzocchi C, Brunetti E, Mihailescu P, Bandi C, Mastalier B . Molecular characterization of Echinococcus granulosus in south-eastern Romania: evidence of G1-G3 and G6-G10 complexes in humans. Clin Microbiol Infect. 2012; 19(6):578-82. DOI: 10.1111/j.1469-0691.2012.03993.x. View

16.

Possenti A, Manzano-Roman R, Sanchez-Ovejero C, Boufana B, La Torre G, Siles-Lucas M . Potential Risk Factors Associated with Human Cystic Echinococcosis: Systematic Review and Meta-analysis. PLoS Negl Trop Dis. 2016; 10(11):e0005114. PMC: 5098738. DOI: 10.1371/journal.pntd.0005114. View

17.

Al-Mutairi N, Taha H, Nigm A . Molecular characterization of in livestock of Al-Madinah (Saudi Arabia). J Helminthol. 2020; 94:e157. DOI: 10.1017/S0022149X20000395. View

18.

Santolamazza F, Santoro A, Possenti A, Caccio S, Casulli A . A validated method to identify Echinococcus granulosus sensu lato at species level. Infect Genet Evol. 2020; 85:104575. DOI: 10.1016/j.meegid.2020.104575. View

19.

Romig T, Ebi D, Wassermann M . Taxonomy and molecular epidemiology of Echinococcus granulosus sensu lato. Vet Parasitol. 2015; 213(3-4):76-84. DOI: 10.1016/j.vetpar.2015.07.035. View

20.

Akalin S, Sayin Kutlu S, Caylak S, Onal O, Kaya S, Bozkurt A . Seroprevalence of human cystic echinococcosis and risk factors in animal breeders in rural communities in Denizli, Turkey. J Infect Dev Ctries. 2014; 8(9):1188-94. DOI: 10.3855/jidc.4343. View