Clinical management, epidemiology, and recurrence of human cystic echinococcosis in a secondary care level hospital in an endemic area of the Andes in Sicuani, Cusco, Peru

Abstract

Peru has the highest incidence of human cystic echinococcosis (CE) in South America and most cases are reported in the Central and Southern Peruvian Andes, including the Cusco region. We reviewed medical records of patients with CE admitted between 2010-2019 to a level 2 Hospital in Sicuani, to collect data on the surgical management and disease recurrence in the Canchis province of Cusco. Records of 115 patients were analyzed in detail. The median age was 25 years (IQR, 16-46) and 60% were female. Most patients (68.7%) presented with a single liver cyst. The Gharbi classification was used in 75/107 (70.1%) patients with an ultrasound and 91/142 cysts (64.8%). Thirty one (34.1%) were classified as Gharbi I, 33 (36.3%) Gharbi II, 21 (23.1%) Gharbi III, and 6 (6.6%) Gharbi IV. Pre-surgical complications were reported in 41.7%. One hundred two patients underwent surgery. In 46.1%, one cyst spillage prevention measure was documented, 5.9% had two, and one had the three recommended measures. Post-surgical cyst recurrence was reported in 16.5% at a median 32.3 months (IQR, 3.9-46.6) and readmissions in 12.7%. In the multivariable analysis, having ≥3 cysts (OR 9.5, 95% CI 1.3-85.5), having two pre-surgical complications (OR 12.6, 95% CI 1.8-125.6), and receiving pre-surgical albendazole (OR 5.2, 95% CI 1.3-23.9) were associated with cyst recurrence. Advanced and complicated CE disease and post-surgical recurrence were common in Sicuani. Standardization of ultrasound staging-guided clinical management along with surgical spillage prevention measures could effectively decrease the disease burden linked to clinical care, improving outcomes and decreasing costs.