LUNG AND LIVER CYSTIC ECHINOCOCCOSIS: SURGICAL TREATMENT AND ITS LONG-TERM IMPACT ON THE HEALTH OF INFECTED SUBJECTS
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Date
2016-12-21
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Johns Hopkins University
Abstract
Cystic Echinococcosis (CE), a zoonotic disease caused by the larval stage of the dog tapeworm, Echinococcus granulosus, is considered a serious and costly public health problem in areas where livestock are raised. The liver and lungs are the most common organs involved. The majority of subjects are diagnosed after several years of infection, and surgery is the main treatment approach used in endemic areas. Information on the prognosis of subjects after surgery is limited by the lack of prospective follow up studies and the only available information is based on clinical series that have several limitations. Using an historical cohort of subjects surgically treated by CE between 01/200 and 12/2011, the present dissertation measured the long-term impact of surgical treatment on the health of subjects with CE. This information is presented in three related studies.
The first study evaluated the long term mortality among 598 subjects. Twenty seven (4.5%) died after surgery, the mortality rate was significantly higher among patients with liver involvement; and age of subjects was the only factor associated. The second study evaluated the risk of developing a new cystic lesion after surgery for CE among 185 subjects by imaging methods (abdominal ultrasound and chest X-rays). Seventeen (9.2%) developed a new cystic lesion; and the level of specialization of the hospital was the only factor associated. Finally, the third study, using the Short Form 36 questionnaire (SF-36), evaluated the health-related quality of life (HRQoL) among 163 subjects who attended health centers for participation in the follow-up study. Results showed that CE had a long-term effect in all except for the general health domains. Disease relapse has an effect on the general health domain
Based on the results, we can conclude that surgical treatment and the development of a new cystic lesion after treatment have an important impact on the health of affected subjects. Our data also showed that liver involvement had a marginal association with long-term mortality and disease relapsing however because of the small sample this effect was no longer significant after the adjustment. Finally, our data supports the implementation of health policies to provide systematic follow up of surgically treated subjects.
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Cystic echinoccosis, surgical treatment, long-term impact.