Insights into Human Cystic Echinococcosis in the Kurdistan Region, Iraq: Characteristics and Molecular Identification of Cysts
Cystic echinococcosis (CE) is a neglected worldwide distributed parasitic disease caused by
the Echinococcus granulosus... See more
Cystic echinococcosis (CE) is a neglected worldwide distributed parasitic disease caused by
the Echinococcus granulosus 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. granulosus sensu 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
2022-03