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Complications Associated with Initial Clinical Presentation of Cystic Echinococcosis: A 20-year Cohort Analysis

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  • 1 Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca, Spain;
  • | 2 Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Salamanca, Spain;
  • | 3 Área de Medicina Preventiva y Salud Pública, Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Salamanca, Spain;
  • | 4 Laboratorio de Inmunología Parasitaria y Molecular, Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain;
  • | 5 Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Salamanca, Spain;
  • | 6 Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Salamanca, Spain;
  • | 7 Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Salamanca, Spain;
  • | 8 Servicio de Medicina Interna, General Hospital of Palencia “Río Carrión”, C/Donantes de Sangre, Palencia, Spain;
  • | 9 Departamento de Medicina Interna. Hospital Universitario Marques de Valdecilla, Universidad de Cantabria, IDIVAL, Cantabria, Spain;
  • | 10 Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Paseo San Vicente, Salamanca, Spain
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Cystic echinococcosis (CE) is a chronic, complex, and overlooked zoonotic disease caused by Echinococcus granulosus. In humans, it may result in a wide spectrum of clinical manifestations depending on the type of complications, ranging from asymptomatic infection to fatal disease. The primary complications and risk factors associated with CE are not well defined. We performed a retrospective, observational study of inpatients diagnosed with CE from January 1998 to December 2017 in the public health-care system of western Spain. Five hundred and six cases were analyzed. More than half of the patients (302 [59.7%]) were asymptomatic, and the diagnoses were made incidentally. A total of 204 (40.3%) patients had complications associated with CE; 97 (47.5%) were mechanical, 62 (30.4%) were infectious, 15 (7.3%) were immunoallergic, and 30 (14.7%) involved a combination of complications. Mortality was higher in patients with mechanical complications (9.4%) than in patients with infectious complications (5.6%) and in patients with allergic complications (0%) (odds ratio = 19.7, 95% CI, 4.3–89.1, P < 0.001). In summary, CE frequently results in complications, especially in the liver in younger patients and, regardless of other variables, such as size or stage of cyst. Mechanical problems and superinfection are the most frequent complications. CE is an obligatory diagnosis in patients with urticarial or anaphylactoid reactions of unknown cause in endemic areas.

Author Notes

Address correspondence to Moncef Belhassen-García, Servicio de Medicina Interna, Sección de Enfermedades Infecciosas. Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Paseo San Vicente, Salamanca 37007, Spain. E-mail: mbelhassen@hotmail.com

Authors’ addresses: Javier Collado-Aliaga, Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca (CAUSA), E-mail: humanoide123@hotmail.com. Ángela Romero-Alegría, Servicio de Medicina Interna, CAUSA, Instituto de investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Salamanca, Spain, E-mail: aralegria82@hotmail.com. Montserrat Alonso-Sardón, Área de Medicina Preventiva y Salud Pública, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain, E-mail: sardonm@usal.es. Antonio Muro, Laboratorio de Inmunología Parasitaria y Molecular, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain, E-mail: ama@usal.es. Amparo López-Bernus, Servicio de Medicina Interna, CAUSA, IBSAL, CIETUS, Salamanca, Spain, E-mail: albernus@hotmail.com. Virginia Velasco-Tirado, Servicio de Dermatología, CAUSA, IBSAL, CIETUS, Salamanca, Spain, E-mail: virvela@yahoo.es. Juan Luis Muñoz Bellido, Servicio de Microbiología CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain, E-mail: jlmubel@usal.es. Javier Pardo-Lledias, Servicio de Medicina Interna, General Hospital of Palencia “Río Carrión”, C/ Donantes de Sangre, Palencia, Spain, E-mail: javipard2@hotmail.com. Moncef Belhassen-García, Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain, E-mail: mbelhassen@hotmail.com.

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