Epidemiology of Hydatid Disease in Riyadh: A Hospital-Based Study
1999; King Faisal Specialist Hospital and Research Centre; Volume: 19; Issue: 5 Linguagem: Inglês
10.5144/0256-4947.1999.450
ISSN0975-4466
Autores Tópico(s)Amoebic Infections and Treatments
ResumoBrief ReportsEpidemiology of Hydatid Disease in Riyadh: A Hospital-Based Study Awatif A. AlamMSc, ABCM Awatif A. Alam Address reprint requests and correspondence to Dr. Alam: Department of Community Medicine (34). King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia. From the Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia. Search for more papers by this author Published Online::1 Sep 1999https://doi.org/10.5144/0256-4947.1999.450SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionHydatid disease (echinococcosis) is a zoonotic infection of humans caused by Echinococcus granulosus. The disease poses an important public health problem in many areas of the world, particularly among populations that practice sheep husbandry.1 The prevalence of the disease is reported to be high in Middle Eastern countries, including Saudi Arabia, due to the presence of sheep and dogs living in close contact with humans, especially among the Bedouins.2Studies of the disease in the Kingdom have shown multi-organ involvement, including the heart.3 A relatively high frequency of pulmonary hydatid disease has been reported, presumably because of airborne spread, with the lungs acting as the first filter instead of the liver.2,4Most published studies on hydatid disease address clinical and/or management experiences, most which are comparable in many instances. However, this study describes the epidemiology of hydatid disease among diagnosed patients admitted to a major hospital in Riyadh, Saudi Arabia.MATERIALS AND METHODSA descriptive study of patients suffering from hydatid disease between 1988 and 1997 was carried out at a major specialized hospital, which provides secondary and tertiary care services. The medical records department provided a computer-generated print-out of all patients admitted or discharged with a diagnosis of Echinococcus granulosus infection. Seventy-three charts were reviewed, but six cases were excluded because the diagnostic and other relevant data were insufficient. This study is, therefore, based on the presenting features of 67 patients.Data compiled for each patient included demographic information (age, sex, education, occupation, nationality and area of residence). A past and present history of intimate contact with dogs, presenting symptoms, and clinical findings, was also considered.The diagnosis in all the patients was confirmed by serological tests, including indirect hemagglutination test (IHA), Casoni skin test (in 11 patients), and radiological tests, such as plain radiography (in 15 patients), ultrasound (in 34 patients), and computerized tomography (in 57 patients). The diagnosis was based on the characteristic ultrasonic findings, calcification of the cyst wall and on endoscopic findings (n=12). Specimens obtained at surgery were subjected to histology for confirmation of the diagnosis. Routine autopsies were not carried out. The treatment modalities, as well as the outcome, were documented for each patient. The data on each patient were collated, and frequency counts were used for all the variables.RESULTSDemographic FeaturesThe 67 patients included 36 males (53.7%) and 31 females (46.3%). Their ages ranged between 4 and 85 years (mean age 39.2, SD 18.2). The peak frequency was between 20 and 39 years for the whole group and included 50% of the male patients, while 38.7% of the females were between 40 and 59 years of age. The studied sample included 51 Saudi patients (76.1%) from various areas of the Kingdom, and 16 non-Saudis (23.9%), who were all residents of Riyadh city. The majority of the patients (56.7%) were from the Central Province, which includes Riyadh, Qassim and Hail, 22.4% from the Northern Province, 14.9% from the Southern Province, and about 3% from the Eastern and Western Provinces.Of the 67 patients, 43 (64.2%) were illiterate, 13 (19.4%) could read and write, and only 11 (16.4%) had had education beyond primary school. Among the patients, housewives were the most frequently affected occupational group with 26 (38.8%), 13 (19.4%) were military employees and 8 (11.9%) were agricultural workers and shepherds. Data regarding history of intimate contact with dogs was not available in the files of 30 patients. However, 25 (37.3%) had present and/or past contact with dogs, while 12 patients (17.9%) denied such contact either at home or at work.Clinical FeaturesAbout half (49.3%) of the patients presented with gastrointestinal tract-related symptoms. The other systems involved were respiratory (32.8%), genito-urinary (11.9%) and musculoskeletal (3%). Two patients (3%) were asymptomatic. Forty patients had hepatic involvement, four of them were considered secondary, and the majority of patients had cysts in the right lobe. The sites involved and the proportion of primary and secondary infestation with hydatid disease in the studied cases are shown in Table 1. One female patient had hydatid disease of the spleen and the tail of the pancreas. Another patient had a cyst in the spleen as a secondary site to her hepatic hydatidosis. A male patient who complained of back pain for several years was found to have hydatid cysts in the extensor muscles of the back and the lower limbs.Table 1. Frequency distribution of patients according to the involved organ and stage of hydatid disease.Table 1. Frequency distribution of patients according to the involved organ and stage of hydatid disease.Treatment Modalities and OutcomeThirty-eight patients (56.7%) were treated surgically and 14 (20.9%) had surgical and medical therapy. The remaining 15 patients (22.4%) received standard albendazole 400 mg therapy for variable duration. The outcome of treatment is reported in terms of patients being alive or dead. Sixty-five patients (97%) survived, with 13 (20%) of them having a disease recurrence. Two patients died, giving a case fatality rate of 3%. A 66-year-old female patient died two weeks after operation for hydatid disease of the liver and the bronchus. The other was an 85-year-old who had had surgery five years earlier, and who died of unknown causes.DISCUSSIONPrevious studies on hydatid disease among Saudis have shown a higher frequency in females.2,5,6 In this study, there was a male predominance. This probably reflects the pattern of hospital attendance, which is consistent in most studies in the Kingdom. The peak frequency of hydatid disease in the 20-39-year age-group bracket has an economic implication, because this is an active age group. The change in lifestyle over the last few decades could have reduced possible contact with animals. However, in affected females, the peak frequency was in the 40-59-year age-group, which can be attributed to domestication and increased contact with the intermediate hosts, particularly among some of the military families.This study showed that the disease was more common among illiterate population, housewives and among agricultural workers and shepherds. In addition, there was a high frequency among those coming in contact with dogs. Preventive strategies would, therefore, involve health education, reduced contacts with dogs and sheep, with effective disposal of their wastes. The work demands of the military employees involving camping in deserts and rural areas would account for the cases encountered in that group. The successful results of an evaluation study on control of hydatid disease in Wales have addressed the concern of a considerable potential for an upsurge in human cases if control measures are relaxed.7No generalization can be drawn from the present findings due to the nature of the available data and the study design. The geographical distribution of the cases may reflect referral bias, i.e., they may be due to the availability of the medical services in various hospitals as well as to the eligibility of the patients to be treated at such institutions. The prevalence of hydatid disease in various regions of Saudi Arabia has not yet been reported. Several published local studies described individual experiences of various hospitals.5,6,8,9 The sociocultural and behavioral pattern of life varies from one region to another within the Kingdom of Saudi Arabia.Due to the fact that Islam forbids the presence of dogs in homes except for the purpose of guarding, dogs are not frequently owned as pets by Saudi families. In some regions, the majority of the population are urban and rarely came in close contact with sheep and dogs. Although sheep rearing is common in the Eastern Province of Saudi Arabia, the inhabitants are not accustomed to keeping dogs. While there is a low incidence of human hydatid disease and a rarity of dogs in the Eastern District, it has been reported that 10.4% of the sheep imported from Saudi Arabia to Kuwait (mainly from the Eastern Province) were infected with hydatid cysts.10The clinical features are particularly similar to the results of other Arab and Mediterranean region studies, with a predominance of hepatic involvement followed by pulmonary manifestations.11–15 These studies addressed the need to evaluate and control the parasitic pressure of Echinococcus granulosus in humans and sheep in endemic foci.This study shows that hydatid disease is predominantly a disease of young Saudi adults and has a low mortality. Those that appear to be at risk are housewives, illiterate patients, those who have contact with dogs, and agricultural workers. Preventive measures should, therefore, target exposed and/or risky groups. Intervention field studies are needed for defining the risk factors.ARTICLE REFERENCES:1. 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Acta Trop (Netherlands). 1991; 50:1–10.14. Google Scholar14. Gabriele F, Bortoletti G, Conchedda M, Palmas C, Ecca AR. "Epidemiology of hydatid disease in the Mediterranean basin with special reference to Italy" . Parassitologia. 1997; 39:47–52. Google Scholar15. Turgnt M. "Hydatid disease of the spine: a survey from Turkey" . Infection. 1997; 25:221–6. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 19, Issue 5September 1999 Metrics History Received7 April 1999Accepted7 June 1999Published online1 September 1999 InformationCopyright © 1999, Annals of Saudi MedicinePDF download
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