Caracterización y evolución temporal de la mortalidad por zoonosis bajo declaración obligatoria, entre los años 1997 y 2018 / Characterization and temporal evolution of mortality due to zoonoses under mandatory declaration, between the years 1997 and 2018

INTRODUCCIÓN: Las zoonosis son enfermedades transmitidas desde un hospedador animal al ser humano o viceversa. En Chile, las zoonosis de Notificación Obligatoria (NO) son: brucelosis, carbunco, triquinosis, hidatidosis, leptospirosis, dengue, enfermedad de Chagas, hantavirosis y rabia. OBJETIVO: Evaluar la tendencia y caracterizar la mortalidad por zoonosis de NO en Chile entre 1997-2018. METODOLOGÍA: Estudio ecológico de la mortalidad por zoonosis de NO. Se utilizaron bases de mortalidad y población oficiales. Se describió la mortalidad relativa, general y específica, según variables sociodemográficas. Se calcularon tasas de mortalidad anuales brutas (TMb) y ajustadas (TMa, método directo). Se evaluó la tendencia temporal con modelos de regresión de Prais-Winsten. Resultados: Entre 1997 y 2018 la mortalidad por zoonosis de NO correspondió al 0,12% (2.359 muertes) de la mortalidad total, siendo las principales causas la enfermedad de Chagas (59,8%), hidatidosis (23,9%) y hantavirosis (13,8%). La TMa general disminuyó significativamente (B: -0,017; IC95%: -0,024; -0,009) al igual que hidatidosis (B: -0,011; IC95%: -0,013; -0,008), sólo hantavirosis mostró un aumento (no significativo). CONCLUSIÓN: La mortalidad por zoonosis de NO disminuyó durante el período estudiado; solo la hantavirosis mostró un aumento en su tendencia. Se sugiere enfocar estrategias para prevenir la transmisibilidad y mortalidad por hanta, así como mejorar el acceso a tratamiento para las otras zoonosis.

BACKGROUND: Zoonoses are diseases transmitted from an animal host to humans or vice versa. In Chile, the zoonoses of mandatory notification are brucellosis, anthrax, trichinosis, hydatidosis, leptospirosis, dengue, Chagas disease, hantavirosis and rabies. AIM: To assess the trend and characterize the mortality from zoonoses of mandatory notification in Chile between 1997-2018. METHODS: An official mortality and population data were used. Relative, general and specific mortality rates were described according to sociodemographic variables. Crude and adjusted annual mortality rates (direct method) were calculated. Temporal trend was evaluated with the Prais-Winsten regression model. RESULTS: Between 1997 and 2018, the mortality rate due to zoonosis of mandatory notification corresponded to 0.13% (2152 deaths) of the total mortality, being Chagas disease (59.2%), hydatidosis (24.6%) and hantavirosis (13.5%) the main causes. The general adjusted mortality rate decreased significantly (B: -0.017; IC95%: -0.024; -0.009) as did hydatidosis (B: -0.011; IC95%: -0.013; -0.008), and only hantavirosis showed an increase trend (not significant). CONCLUSION: Mortality due to zoonoses decreased during the period; only hantavirosis showed an increasing trend. It is suggested to focus on strategies to prevent contagion and mortality by hantavirosis, as well as to improve access to treatment for the other zoonoses.

The Relationship Between Preoperative Systemic Immune Inflammation Index and Prognostic Nutritional Index and the Prognosis of Patients With Alveolar Hydatid Disease.

Background: To explore the relationship between the preoperative immune inflammation index (SII) and the prognostic nutritional index (PNI) and the overall survival rate (OS) of patients with alveolar hydatid disease. Methods: The clinical data of patients with hepatic alveolar echinococcosis treated by surgery in the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qinghai University from January 2015 to January 2019 were analyzed retrospectively, and the SII, PNI, PLR and NLR were calculated. Spearman correlation analysis was utilized to analyze the correlation among SII, PNI, PLR and NLR. Receiver operating characteristic curve (ROC) was utilized to determine the best intercept values of SII, PNI, PLR and NLR, and Chi-square test was used to evaluate the relationship between SII, PNI and various clinicopathological features in patients with hepatic alveolar echinococcosis. The kaplan-Meier method was used to draw survival curves and analyze the relationship between them and the total survival time of patients. A cox regression model was used to analyze the relationship between SII, PNI and the prognosis of patients with hepatic alveolar echinococcosis. Finally, ROC curve was used to estimate the predictive efficacy of SII, PNI and COSII-PNI for the prognosis of patients with hepatic alveolar echinococcosis. Results: A total of 242 patients were included, including 96 males and 146 females, aged 11.0-67.0 (36.6 ± 11.7) years. The values of SII, PNI, PLR and NLR are calculated, and the best truncation values of SII, PNI, PLR and NLR are given in ROC curve. The kaplan-Meier survival curve was used to analyze the relationship between SII, PNI, PLR, NLR and the overall survival time of patients with hepatic alveolar echinococcosis. The results showed that the median follow-up time was 45 months (95%CI: 39.484-50.516), and the average survival time was 49 months (95%CI: 47.300-51.931), which was low p<0.001); The 5-year OS rate of low PNI was significantly lower than that of high PNI group (37.7% vs 71.6%; p<0.001); The 5-year OS rate in low PLR group was significantly higher than that in high PLR group (70.4% vs 24.3%; p<0.001); The 5-year OS rate in low NLR group was significantly higher than that in high NLR group (67.2% vs 28.8%; p<0.001). Cox unifoliate analysis showed that SII, PNI, PLR and NLR were important prognostic factors related to OS. Cox multivariate analysis showed that SII(HR=4.678, 95% CI: 2.581-8.480, P<0.001) and PNI(HR=0.530, 95%CI: 0.305-0.920, P<0.05) were identified as independent risk indicators of OS, while NL was identified as independent risk indicators of OS ROC curve analysis showed that AUC of SII, PNI, PLR, NLR and COSII-PNI were 0.670(95%CI: 0.601-0.738), 0.638(95%CI: 0.561-0.716) and 0.618(95% CI: 0.541-0.694), respectively COSII-PNI is superior to SII and PNI in evaluating prognosis (P < 0.05). Conclusions: SII and PNI can be regarded as independent risk factors reflecting the prognosis of patients with hepatic alveolar echinococcosis. The lower SII and the higher PNI before operation, the better the prognosis of patients, and the combined application of SII and PNI before operation can improve the accuracy of prediction.

Outcomes of Radiotherapy for Osseous Echinococcosis of Meriones meridianus.

BACKGROUND: Osseous cyst echinococcosis (CE) is an infectious disease that causes disability and deformity in patients, yet there is still no satisfactory treatment. Focusing on the feasibility and prognosis of radiotherapy as an adjuvant or palliative treatment for osseous CE, this study investigated the outcome of Meriones meridianus with osseous CE after radiotherapy. METHODS: The study utilized a comparison control group design with three groups of gerbils, and 240 osseous CE gerbils were randomly divided into control, 40Gy/5times, and 50Gy/5times groups. Different doses of radiotherapy were given to the gerbils, and then, the effects of radiotherapy on gerbils and lesions were observed at 3 and 6 months after radiotherapy. Statistical analysis was done using χ 2 test, unpaired t-test, and one-way ANOVA. RESULTS: Significant changes (P < 0.05) were achieved between the three groups in terms of seven parameters at 3 and 6 months, including the number of dead gerbils and lesion sites with ulceration and infection, number of dead scolices, protein content, Ca2+ concentration, the maximum diameter of lesion site, and wet weight of cysts. Except for the number of dead gerbils and lesion sites with ulceration and infection, all other parameters were observed a big difference between 3 months and 6 months in the 50Gy/5times group. CONCLUSION: Radiotherapy at a dose of 50 Gy has inhibitory and therapeutic effects on osseous CE in gerbils, and radiotherapy could probably be a treatment option for persistent or recurrent osseous CE.

Contribution of Anthropogenic Factors and Climate Variables to Human Cystic Echinococcosis Mortality in Chile (2001-2011).

Here we assess the effect of weather and anthropogenic environmental variables, particularly urbanization, on cystic echinococcosis mortality in Chile from 2001 to 2011 using a nonparametric regression model, multivariate adaptive regression splines, and Poisson nonlinear regression models. This study integrated data from various sources on weather and anthropogenic variables. The canine population had the greatest influence on human cystic echinococcosis mortality during the period analyzed. Urbanization among anthropogenic variables and temperature and precipitation among the weather-related variables were the main factors related to cystic echinococcosis deaths. Deaths decreased with urbanization level. Temperature showed a nonlinear impact on mortality, with an optimum value ∼11°C. Public policies aimed at improving safe management of companion animal populations are crucial in controlling the spread of this disease. Effective animal management strategies would have wide-ranging public health benefits, advance the welfare of companion animals and livestock, and decrease the number of human cystic echinococcosis cases.

Surgical Management and Outcomes of Cardiac and Great Vessels Echinococcosis: A 16-Year Experience.

BACKGROUND: Cardiac involvement is an uncommon presentation of hydatid disease. In this study, we aim to analyze the experience of surgical treatment of cardiac and great vessels echinococcosis in our cardiovascular and thoracic surgery department. METHODS: Through a 16-year period, from 2000 to 2015, 27 patients underwent surgery for cardiac and great vessels hydatid disease. The clinical, operative, and postoperative data were analyzed through this retrospective and descriptive study. RESULTS: Most of our patients came from a rural area. The most common symptom was chest pain. The diagnosis was mainly made by transthoracic echocardiography, which has shown the right ventricle as the most frequent location of the disease. All patients received surgical treatment under cardiopulmonary bypass, and only six surgeries were performed without cross-clamping the aorta. Inhospital mortality rate was 7.4%. CONCLUSIONS: Cardiac hydatidosis is a rare but potentially serious condition whose treatment is mainly surgical even for asymptomatic patients owing to its possible fatal complications. The surgery outcomes are usually satisfactory. Follow-up examinations are highly recommended to detect recurrences.

Sudden death and hydatid cyst: A medicolegal study.

The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures. This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017). In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years. Most victims were from rural zones (18 cases). In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case. Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.

[Epidemiological characteristics of echinococcosis death cases in China from 2008 to 2016].

OBJECTIVE: To understand the epidemiological characteristics of death cases of echinococcosis in China from 2008 to 2016, so as to provide an important reference for the prevention and control of echinococcosis. METHODS: The death information registration and management system data were selected to analyze the epidemiological characteristics of the death cases of echinococcosis. The data were analyzed by SPSS 21.0 and the map was drawn by ArcGIS 10.1 software. RESULTS: From 2008 to 2016, a total of 367 death cases of echinococcosis were reported in China, and the number of deaths in turn was 33, 30, 21, 32, 35, 54, 55, and 81 in each year, with an annual average crude mortality of 129.29 /105. The average age of death was (56 ± 18) years; the sex ratio of male to female was 100∶94. There was no statistical difference between the male and female death cases (χ2 = 0.33, P > 0.05).The death cases of echinococcosis were mainly distributed in endemic areas of Qinghai, Sichuan, Ningxia, Xinjiang, Gansu, Inner Mongolia, Yunnan and non-endemic areas of Heilongjiang, Jiangsu, Henan and Shandong. The death cases in the first eleven provinces accounted for 87.5% (321/367) of the total death cases, among which the highest proportions of the nationality, occupation, educational level, highest diagnostic units, and the place of death were Han (52.0%, 191/367), farmer (46.6%, 171/367), junior high school or below (57.2%, 210/367), provincial or three-level hospitals (46.6%, 171/367), and at home (59.9%, 220/367). CONCLUSIONS: Since 2014, the death cases of echinococcosis in China have been increasing year by year, indicating that the prevention and treatment of echinococcosis is still very serious. The causes for the rise of the fatality rate remain to be further studied.

Management of cystic echinococcosis in the last two decades: what have we learned?

Background: Management options for cystic echinococcosis (CE) remain a serious problem. The main aim of this study was to examine the selection and complications of treatment applied in patients with CE. The second aim was to evaluate the mortality rate and causative factors. Methods: A retrospective descriptive study of patients diagnosed with CE between 1998 and 2015 was conducted, according to ICD-9 (code 122·0 to 122·9) criteria in the Complejo Asistencial Universitario of Salamanca, Spain. Results: Four-hundred-ninety-one (491) patients were diagnosed with CE disease and the treatment applied in these patients were: 166 (33.8%) patients received only surgery, 176 (35.8%) surgery and drugs, 17 (3.5%) drugs alone, in 131 (26.7%) patients the strategy was 'watch and wait', and only one patient (0.2%) was applied puncture-aspiration-injection-respiration (PAIR). Thus, a total of 342 patients received surgery, either alone (166) or combined with drugs (176), and a total of 193 (39.4%) patients were medically treated, either alone (17) or combined with surgery (176); 123 (63.7%) patients used albendazole alone; and 70 (36.3%) patients used a combination of albendazole and praziquantel. Sixty-five patients (19.0%) had complications after surgery and seven of them (2%) died. Only 15 (7.8%) cases had side effects from anthelmintics. Throughout the study period, 80 (16.3%) patients died, 14 (2.9%) of them due to CE disease. Conclusions: Complications of CE are one of the most common causes of mortality in CE patients, with size, location, and number of cysts, and the 'watch and wait' treatment strategy being the main factors associated with mortality.

Analysis of Lethality in Echinococcal Disease.

The information on mortality from echinococcosis is important not only for a better understanding of the severity of the disease, but also for evaluating the effectiveness of public health interventions. The aim of this research was to study the causes of mortality from echinococcosis. We have collected and analyzed the materials of 1,470 patients in 10 age - groups in the Republic of Armenia (from 2000 to 2016). To find out the causes of mortality from echinococcosis, we have analyzed the medical histories and protocols of postmortem examinations of 19 deaths from echinococcosis and 17 deaths due to other indirect causes not associated with the parasite. The average annual death rate from echinococcosis is 0.007 per 10,000 population, and the mortality is 1.29 (per 100 patients). The highest mortality occurs in people aged 70-79. Mortality from echinococcosis is also recorded among the unoperated children. The rupture of the parasitic cyst and hepatic insufficiency are major among the direct causes of mortality. Sometimes the hydatid cysts unrecognized during the life were first diagnosed at autopsy. Insufficient qualification of doctors in the field of helminthology, as well as the latent course of the disease or manifestation of minor symptoms in echinococcosis over a long period often led to medical errors. Further decline in mortality can be achieved by early diagnosis, timely hospitalization and treatment before the development of severe complications worsening the prognosis and outcomes of surgical intervention.

Recurrence of cystic echinococcosis in an endemic area: a retrospective study.

BACKGROUND: Cystic echinococcosis (CE) is a chronic, complex and neglected zoonotic disease. CE occurs worldwide. In humans, it may result in a wide spectrum of clinical manifestations, ranging from asymptomatic infection to fatal disease. Clinical management procedures have evolved over decades without adequate evaluation. Despite advances in surgical techniques and the use of chemotherapy, recurrence remains one of the major problems in the management of hydatid disease. The aim of this study was to determine the frequency of CE recurrence and the risk factors involved in recurrence. METHODS: A descriptive longitudinal-retrospective study was designed. We reviewed all patients diagnosed with CE according to ICD-9 (code 122-0 to 122-9) criteria admitted at Complejo Asistencial Universitario de Salamanca, Spain, between January 1998 and December 2015. RESULTS: Among the 217 patients studied, 25 (11.5%) had a hydatid recurrence after curative intention treatment. Median duration of recurrence's diagnosis was 12.35 years (SD: ±9.31). The likelihood of recurrence was higher [OR = 2.7; 95% CI, 1.1-7.1; p < 0.05] when the cyst was located in organs other than liver and lung, 22.6% (7/31) vs 14.2% (31/217) in the cohort. We detected a chance of recurrence [OR = 2.3; 95% CI, 1.4-6.5; p > 0.05] that was two times higher in those patients treated with a combination of antihelminthic treatments and surgical intervention (20/141, 14.2%) than in patients treated with surgical intervention alone (5/76, 6.6%). CONCLUSIONS: Despite advances in diagnosis and therapeutic techniques in hydatid disease, recurrence remains one of the major problems in the management of hydatid disease. The current management and treatment of recurrences is still largely based on expert opinion and moderate-to-poor quality of evidence. Consequently, large prospective and multicenter studies will be needed to provide definitive recommendations for its clinical management.

[Epidemiological description of human and animal hydatidosis in Los Ríos region, 1999- 2009]. / Caracterización epidemiológica de hidatidosis humana y animal en la Región de Los Ríos, 1999-2009.

OBJECTIVE: To determine the prevalence of hydatidosis in humans and livestock in the Los Ríos region during the years 1999-2009. METHODS: A retrospective survey of all discharge records of patients undergoing removal of cysts produced by Echinococcus granulosus during the period 1999-2009 in the Hospital Clinico Regional of Valdivia was conducted. With the information provided incidence rate, mortality rate and fatality rate were calculated. Additionally, with the aim of determining prevalence of hydatidosis in livestock (i.e. cattle, sheep and pigs) official records of slaughtered animals for the same period from the Ministry of Health of Los Ríos region were searched. RESULTS: During the ten-year period 238 new human cases were recorded, the average incidence rate for the period was 6.1 per 100,000 inhabitants, the mortality rate was 0.1 per 100,000 inhabitants, and the fatality rate was 1.3%. The most affected class group was the 15-64 years old with a 70% of cases. The districts more affected were Valdivia and Río Bueno. Most cases (54%) were from patients from rural areas, while the occupation more affected was housekeeping (29%). The liver (56%) and lungs (33%) were the localization where cysts were most frequently found. On 55% of cases, patients did not show any complication; meanwhile, infected cyst (11%) and unspecified complicated (8%) were the more frequent complication. Overall, 89% of cases recovered totally after surgery. Finally, the average in patient time was 14.7 bed-days. Prevalence of hydatidosis in livestock was 23% in cattle, 23% in sheep and 12% in pigs. The highest prevalence was found in slaughter houses in the districts of Panguipulli and San José de la Mariquina. DISCUSSION: Human and animal hydatidosis is highly prevalent in humans and livestock in Los Ríos region compared to national and international records. Further research is recommended to assess risk factors for human infection and improving record-keeping and trazability of slaughtered animals to implement control measures at the farm level to help to stop the life cycle of the parasite and thus reduce human infections.

Caracterización epidemiológica de hidatidosis humana y animal en la Región de Los Ríos, 1999-2009 / Epidemiological description of human and animal hydatidosis in Los Ríos region, 1999- 2009

Objective: To determine the prevalence of hydatidosis in humans and livestock in the Los Ríos region during the years 1999-2009. Methods: A retrospective survey of all discharge records of patients undergoing removal of cysts produced by Echinococcus granulosus during the period 1999-2009 in the Hospital Clinico Regional of Valdivia was conducted. With the information provided incidence rate, mortality rate and fatality rate were calculated. Additionally, with the aim of determining prevalence of hydatidosis in livestock (i.e. cattle, sheep and pigs) official records of slaughtered animals for the same period from the Ministry of Health of Los Ríos region were searched. Results: During the ten-year period 238 new human cases were recorded, the average incidence rate for the period was 6.1 per 100,000 inhabitants, the mortality rate was 0.1 per 100,000 inhabitants, and the fatality rate was 1.3%. The most affected class group was the 15-64 years old with a 70% of cases. The districts more affected were Valdivia and Río Bueno. Most cases (54%) were from patients from rural areas, while the occupation more affected was housekeeping (29%). The liver (56%) and lungs (33%) were the localization where cysts were most frequently found. On 55% of cases, patients did not show any complication; meanwhile, infected cyst (11%) and unspecified complicated (8%) were the more frequent complication. Overall, 89% of cases recovered totally after surgery. Finally, the average in patient time was 14.7 bed-days. Prevalence of hydatidosis in livestock was 23% in cattle, 23% in sheep and 12% in pigs. The highest prevalence was found in slaughter houses in the districts of Panguipulli and San José de la Mariquina. Discussion: Human and animal hydatidosis is highly prevalent in humans and livestock in Los Ríos region compared to national and international records. Further research is recommended to assess risk factors for human infection and improving record-keeping and trazability of slaughtered animals to implement control measures at the farm level to help to stop the life cycle of the parasite and thus reduce human infections.

Objetivos y Métodos: Para determinar la prevalencia de hidatidosis humana y animal en la Región de Los Ríos durante los años 1999-2009, se realizó un análisis retrospectivo de las fichas clínicas de operados por esta enfermedad en el Hospital Clínico Regional de Valdivia. Se cuantificó morbilidad, mortalidad y letalidad y se determinaron algunas características epidemiológicas de la enfermedad. Adicionalmente, para determinar la prevalencia de equinococosis quística en el ganado, se analizaron los registros oficiales sobre la frecuencia de presentación de quistes en vísceras decomisadas en bovinos, ovinos y porcinos faenados en mataderos de la región durante el mismo período, obtenidos de la SEREMI de Salud. Resultados: Se registraron 238 casos nuevos en humanos con una tasa de incidencia promedio de 6,1 por 100 mil habs., una tasa de mortalidad de 0,1 por 100 mil habs. y una tasa de letalidad de 1,3%. En total, 53% de los casos fueron hombres y 47% mujeres. El grupo de edad entre 15 y 64 años fue el más afectado (70% del total). Las comunas con mayor número de casos fueron Valdivia y Río Bueno. Se detectaron más casos (54%) en zonas rurales que urbanas (46%). Por otro lado, la ocupación más afectada correspondió a dueñas de casa. La localización más frecuente fue hepática exclusiva (56%). Un 55% de los pacientes no mostró complicación de los quistes tratados. Después de la operación, 89% de los casos se recuperó totalmente, mientras que el período de hospitalización promedio fue de 14,7 días-cama por paciente. La prevalencia de equinococosis en ganado fue de 23% en bovinos, 23% en ovinos y 12% en porcinos. Las mayores prevalencias se reportaron en mataderos de Panguipulli y San José de la Mariquina. Discusión: La hidatidosis humana y animal son altamente prevalentes en la Región de Los Ríos comparadas con el resto del país y otras naciones. Se recomienda la realización de estudios avanzados para determinar factores de riesgo para la infección en humanos y realizar mejoras en la trazabilidad de los animales sacrificados para implementar medidas de control a nivel del predio y de esa forma cortar el ciclo del parásito y ayudar a reducir la infección en humanos.

Echinococcosis: A 15-year epidemiological, clinical and outcome overview / / Equinococosis: epidemiología, clínica y resultados en una panorámica de 15 años

Objective. To analyze the epidemiological and clinical characteristics and mortality of patients with cystic echinococcosis (CE) in northern Spain. Patients and methods. A retrospective study of the medical records of patients diagnosed with CE and hospitalized from 1997 to 2011 in a University Hospital. Results. A total of 76 patients (44 men) were diagnosed with CE. The mean age was 57.8 years (SD: 19.1 years; range: 14.9–92.7). The yearly average incidence was 1.08 cases/100,000 inhabitants. The highest incidence was registered in patients aged 70–79 years (22.7% of all cases). Liver was the main organ involved (92.1%), followed by lung (6.6%) and peritoneum (1.3%). Fifty-five patients (72%) received treatment: 2 (3.6%) medical treatment with albendazole, 27 (49%) surgical treatment, 3 (5.4%) medical treatment combined with cyst drainage, and 23 (42%) combined medical and surgical treatment. Eight patients had a recurrence. Twenty-four (31.2%) patients died. No patient's death was attributed directly to hydatidosis, though mortality was significantly higher in the untreated vs. the treated patient group (57% vs. 22%, p=0.003). Conclusions. Hydatidosis treatment and diagnostic approaches remain heterogeneous. The liver continues being the main organ affected. Mortality was higher in patients who did not receive treatment. However, this result might have been influenced by other factors, mainly age (AU)

Objetivos. Analizar las características epidemiológicas y clínicas y la mortalidad de los pacientes con equinococosis quística (EQ) en el norte de España. Pacientes y métodos: Estudio retrospectivo de las historias clínicas de los pacientes diagnosticados de EQ, ingresados entre los años 1997 y 2011 en un Hospital Universitario. Resultados. Se diagnosticaron de hidatidosis un total de 76 pacientes (44 varones). La media de edad fue de 57,8 años (DE: 19,1 años; rango: 14,9–92,7). El promedio de incidencia anual fue de 1,08 casos/100.000 habitantes. La incidencia más alta se registró entre los pacientes con una edad comprendida entre 70 y 79 años (22,7% de los casos). El hígado fue el principal órgano afectado (92,1%), seguido del pulmón (6,6%) y el peritoneo (1,3%). Recibieron tratamiento 55 pacientes (72%): 2 (3,6%) tratamiento médico (albendazol), 27 (49%) tratamiento quirúrgico, 3 (5,4%) tratamiento médico combinado con drenaje del quiste y 23 (42%) tratamiento médico y quirúrgico combinados. Presentaron recurrencias 8 pacientes, y fallecieron 24 (31,2%). Ninguno de los pacientes falleció por una causa atribuible a hidatidosis, aunque la mortalidad fue significativamente mayor en el grupo de los no tratados respecto al de los tratados (57% vs. 22%, p=0,003). Conclusiones. La aproximación diagnóstica y terapéutica de la hidatidosis continúa siendo heterogénea. El hígado sigue siendo el principal órgano afectado. La mortalidad fue mayor en los pacientes que no recibieron tratamiento, si bien este resultado puede estar influido por otros factores, principalmente la edad (AU)

Echinococcus infections in the Baltic region.

In the Baltic countries, the two zoonotic diseases, alveolar echinococcosis (AE) caused by Echinococcus multilocularis, and cystic echinococcosis (CE) caused by Echinococcus granulosus, are of increasing public health concern. Observations from Estonia, Latvia and Lithuania indicate that the distribution of both parasites is wider in the Baltics than previously expected. In this paper, we review and discuss the available data, regarding both parasitoses in animals and humans, from the Baltic countries and selected adjacent regions. The data are not easily comparable but reveal a worrisome situation as the number of human AE and CE cases is increasing. Despite improvements in diagnostics and treatment, AE has a high morbidity and mortality in the Baltic region. For the control of both zoonoses, monitoring transmission patterns and timely diagnosis in humans as well as the development of local control programs present major challenges.

[Human hydatidosis in children: manifestation of failure in the control and prevention measures. Chile, 2001-2011]. / Hidatidosis humana en menores de edad: manifestación de fracaso en las medidas de control y prevención. Chile, 2001-2011.

BACKGROUND: Hydatidosis is mainly a slowly developing disease, so its appearance in children and adolescents means a relatively recent acquisition; its quantification at this age groups is an indirect mechanism for the evaluation of a prevention and control program. OBJECTIVE: To characterize human hydatidosis in children aged 0 to 18 years in Chile. MATERIAL: Data from the Disease Notification System (2001-2009), hospital discharges (2001-2008), Deaths (2001-2008) and Years of Potential Life Lost (2001-2008) were used. RESULTS: The incidence rate for the period was 4.4 cases per 100.000 inhabitants, male dominated. Hospital discharges rate for the period was 40.3 discharges per 100.000 inhabitants. The mortality rate for the period was 0.13 deaths per 100 000 inhabitants. CONCLUSIONS: The incidence rates of cases reported, hospital discharges and mortality tend to decrease. However, each new infection reflects the failure of prevention and control, which suggested to incorporate surveillance system tracking and monitoring of cases particularly children's domiciled contacts.

Hidatidosis humana en menores de edad: manifestación de fracaso en las medidas de control y prevención. Chile, 2001-2011 / Human hydatidosis in children: manifestation of failure in the control and prevention measures. Chile, 2001-2011

Background: Hydatidosis is mainly a slowly developing disease, so its appearance in children and adolescents means a relatively recent acquisition; its quantification at this age groups is an indirect mechanism for the evaluation of a prevention and control program. Objective: To characterize human hydatidosis in children aged 0 to 18 years in Chile. Material: Data from the Disease Notification System (2001-2009), hospital discharges (2001-2008), Deaths (2001-2008) and Years of Potential Life Lost (2001-2008) were used. Results: The incidence rate for the period was 4.4 cases per 100.000 inhabitants, male dominated. Hospital discharges rate for the period was 40.3 discharges per 100.000 inhabitants. The mortality rate for the period was 0.13 deaths per 100 000 inhabitants. Conclusions: The incidence rates of cases reported, hospital discharges and mortality tend to decrease. However, each new infection reflects the failure of prevention and control, which suggested to incorporate surveillance system tracking and monitoring of cases particularly children's domiciled contacts.

Introducción: La hidatidosis es mayoritariamente una afección de desarrollo lento y, por lo tanto, infecciones en la infancia y adolescencia traducen infecciones relativamente recientes; su cuantificación a estas edades es, indirectamente, un mecanismo de evaluación del sistema de prevención y control de la misma. Objetivo: Caracterizar epidemiológicamente la hidatidosis humana en pacientes entre 0 y 18 años de edad en Chile. Material: Se utilizaron datos del Sistema de Notificación Obligatoria (2001-2011), Egresos Hospitalarios (2001-2011), Defunciones (2001-2011) y Años de Vida Potencialmente Perdidos (2001-2011). Resultados: La tasa de incidencia para el período fue 4,4 casos por 100 mil habts., con predominio masculino. La tasa de egresos hospitalarios para el período fue 40,3 egresos por 100 mil habts. La tasa de mortalidad para el período fue de 0,13 defunciones por 100 mil habts. Conclusiones: Las tasas de incidencia de casos notificados, egresos hospitalarios y mortalidad tienden a disminuir. Sin embargo, cada nueva infección refleja el fracaso de las medidas de prevención y control. Se sugiere incorporar al sistema de vigilancia un seguimiento y monitoreo de casos contactos particularmente de menores de edad que compartan domicilio.

CYSTIC ECHINOCOCCOSIS: EPIDEMILOGICAL AND CLINICAL ASPECTS OF LATVIAN POPULATION AND REVIEW OF THE LITERATURE.

INTRODUCTION: Cystic echinococcosis is an infection caused by the tapeworm Echinococcus granulosus, this form of echinococcosis is chronic, complicated, however, there is restricted knowledge about it. METHODS: Medical records of a total of 127 patients were used, of which 44 patients were selected for analysis. These were the patients with a fully verified diagnosis, a parasitic lesion located in the liver and a detailed documented ultrasound description of the condition of the liver at diagnosis. The following information was collected from the clinical records: demographic data (age, sex), diagnostic method (ultrasound (US) examination and parasitological serology), clinical data (symptoms), cyst details (number, localization, and size) and treatment. Parasitic cysts of the selected patients were analysed and the disease was classified according to World Health Organisation recommendations. RESULTS: Out of 44 selected patients, 32 were female and 12 were male. Patients' age varied from 27 to 83 (mean--55.34 15.33) years. Time until diagnosis ranged from the absence of complaints to a period of 180 months; the median time was 6 ± 6 months. The most common complaints were pain or discomfort in the abdomen (n=20). The analysis of the stage of the cyst at the moment of the diagnosis showed that most often the 3rd (n = 9) and the 4th stage (n = 20) cysts were found. The parasitic lesion was localised in the right hepatic lobe (n = 29), it was solitary (n = 24) and of average size 6.49 ± 3.73 cm. Results indicated that the cysts which were initially in the 5-10 cm size group were progressing more rapidly. Chemotherapy lasting for 3 years resulted in finding statistically important changes of the cysts in 20% of the patients--degenerative processes attesting the death of the parasite. CONCLUSIONS: It is necessary to develop a system that would allow identifying of patients at as early stages of the disease as possible, in order to ensure more efficient treatment and to avoid major impact on patients' quality of life by the disease.

[Characterization of human hydatidosis mortality: Chile, 2000-2010]. / Caracterización de la mortalidad por hidatidosis humana: Chile, 2000-2010.

BACKGROUND: Hydatidosis as a worldwide zoonosis with a high socio-economic impact in Chile and other countries for which it is a notifiable human disease in our country. OBJECTIVE: To characterize death rates by hydatidosis and whether there are differences according to the region of residence. MATERIAL: A descriptive analysis using Data System Deaths (2000-2010) was performed. RESULTS: The total number of deaths was 293 (56% male). The mortality rate changed from 0.16 in 2000 to 0.11 in 2010 per 100.000 inhabitants. The main diagnosis corresponded to B67.9 (Echinococcosis, other and unspecified). Most fatal cases had a basic level of education and the Araucanía Region had the highest mortality rate. There was a loss of life of 5022.04 years by the premature death of 293 people, with a ratio of 0.31 PYLL years lost per 1000 inhabitants. In the Araucanía Region this ratio increased to 1.03 PYLL years lost per 1000 inhabitants. CONCLUSIONS: The mortality rate tends to decrease, however this trend might mask regional differences. It should be noted that deaths caused by hydatidosis are preventable deaths and therefore unjust. Finally, the mortality analysis is important to better understand the burden of the disease and evaluate the effectiveness of public health interventions.

Study of hydatidosis-attributed mortality in endemic area.

BACKGROUND: Cystic hydatid disease is still an important health problem in European Mediterranean areas. In spite of being traditionally considered as a "benign" pathology, cystic echinococcosis is an important cause of morbidity in these areas. Nevertheless, there are few analyses of mortality attributed to human hydatidosis. OBJECTIVE: To describe the epidemiology, the mortality rate and the causes of mortality due to E. granulosus infection in an endemic area. METHODOLOGY: A retrospective study followed up over a period of 14 years (1998-2011). PRINCIPAL FINDINGS: Of the 567 patients diagnosed with hydatid disease over the period 1998-2011, eleven deaths directly related to hydatid disease complications were recorded. Ten patients (90.9%) died due to infectious complications and the remaining one (9.1%) died due to mechanical complications after a massive hemoptysis. We registered a case fatality rate of 1.94% and a mortality rate of 3.1 per 100.000 inhabitants. CONCLUSIONS: Hydatidosis is still a frequent parasitic disease that causes a considerable mortality. The main causes of mortality in patients with hydatidosis are complications related to the rupture of CE cysts with supurative collangitis. Therefore, an expectant management can be dangerous and it must be only employed in well-selected patients.