{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:17:03Z","timestamp":1784099823271,"version":"3.55.0"},"posted":{"date-parts":[[2025,8,2]]},"group-title":"Public and Global Health","reference-count":53,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Peru is endemic for\n                  <jats:italic>Echinococcus granulosus sensu lato (s.l.)<\/jats:italic>\n                  , a cestode that causes cystic echinococcosis (CE) in humans. Epidemiological and clinical research has focused extensively on the central and southern highlands, where the parasite is hyperendemic. However, the region of Arequipa, with active transmission of the parasite, has received much less attention. In 2011, a state clinical-surgical program for CE patients was launched in the city of Arequipa. Over less than two years, before program funds were reallocated, surgeons treated 177 patients. This volume underscores the urgent need to prioritize and include Arequipa in CE control programs in Peru. This study characterizes patients who underwent surgical treatment during the program\u2019s duration and investigates evidence of active\n                  <jats:italic>E. granulosus s.l.<\/jats:italic>\n                  transmission in Arequipa. We extracted socio-demographic, epidemiological, and clinical data from 129 records of CE patients treated between December 2011 and November 2013. We compared frequencies across variables, including the patient\u2019s age, sex, residence, education level, and occupation. We also mapped patient origins, with 40.3% being autochthonous to the Arequipa region. Patients\u2019 median age was 26 (IQR: 16-45), 55% were men, and 69% were students, farmers, or housemakers. In contrast to other reports, where hepatic cases are predominant, 70% of the cases were pulmonary. The southern highlands of Peru, including Arequipa, suffer from endemic transmission of\n                  <jats:italic>E. granulosus s.l.<\/jats:italic>\n                  Limited access to healthcare hinders timely diagnosis and treatment, exacerbating the public health burden. While implementing or reinstating clinical-surgical units in Arequipa and other endemic areas would improve care and case monitoring, these measures alone are not sufficient. Effective control requires integrated One Health approaches and intersectoral collaboration across human, animal, and environmental health sectors.\n                <\/jats:p>\n                <jats:sec>\n                  <jats:title>Author summary<\/jats:title>\n                  <jats:p>\n                    Cystic echinococcosis (CE) is a neglected parasitic disease caused by\n                    <jats:italic>Echinococcus granulosus sensu lato<\/jats:italic>\n                    (\n                    <jats:italic>s.l.<\/jats:italic>\n                    ), which significantly impacts human and animal health in endemic regions, including southern Peru. This study analyzed medical records of patients diagnosed with CE at a major hospital in Arequipa, Peru, aiming to describe its epidemiology and clinical characteristics, and to highlight Arequipa as a historically overlooked region in CE research and control efforts. The findings reveal that CE disproportionately affects younger populations and rural communities, with men, students, farmers, and housemakers being at higher risk. Pulmonary involvement was notably more frequent than hepatic involvement, diverging from trends reported in other studies. The results underscore the importance of strengthening clinical- surgical units in the southern highlands and the necessity of including Arequipa in national control programs. Moreover, limited access to healthcare in rural and migrant populations underscores the importance of equitable resource allocation and sustained efforts to address health disparities. We emphasize the urgency of implementing integrated control strategies that combine human, animal, and environmental health approaches within a One Health framework. These findings provide valuable insights to inform policy and guide the development of cost-effective, interdisciplinary interventions focused on reducing the burden of CE in vulnerable populations.\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.08.01.25332595","type":"posted-content","created":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T03:55:13Z","timestamp":1754193313000},"source":"Crossref","is-referenced-by-count":3,"title":["Hidden burden of surgical cystic echinococcosis in Arequipa, Peru: An unrecognized population at risk"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6629-2139","authenticated-orcid":false,"given":"Ricardo","family":"Castillo-Neyra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfredo Gutierrez","family":"Z\u00e1rate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Paula","family":"Requena-Herrera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizzie","family":"Ortiz-Cam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Porras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus Marcelo","family":"Manturano Lopez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Fernando","family":"Macedo Milla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge L.","family":"Ca\u00f1ari-Casa\u00f1o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier A.","family":"Bustos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2025080604400416000_2025.08.01.25332595v1.1","unstructured":"CDC. About Echinococcosis. In: Echinococcosis [Internet]. 4 Sep 2024 [cited 16 Jul 2025]. Available: https:\/\/www.cdc.gov\/echinococcosis\/about\/index.html"},{"key":"2025080604400416000_2025.08.01.25332595v1.2","doi-asserted-by":"publisher","DOI":"10.1177\/20499361231171478"},{"key":"2025080604400416000_2025.08.01.25332595v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1995-7645(12)60035-2"},{"key":"2025080604400416000_2025.08.01.25332595v1.4","first-page":"553","article-title":"Epidemiology of Echinococcus granulosus infection in the central Peruvian Andes","volume":"75","year":"1997","journal-title":"Bull World Health Organ"},{"key":"2025080604400416000_2025.08.01.25332595v1.5","doi-asserted-by":"publisher","DOI":"10.1086\/520440"},{"key":"2025080604400416000_2025.08.01.25332595v1.6","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.16-0882"},{"key":"2025080604400416000_2025.08.01.25332595v1.7","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1590\/S1726-46342010000400001","article-title":"Las zoonosis parasitarias: problema de salud p\u00fablica en el Per\u00fa","volume":"27","year":"2010","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"2025080604400416000_2025.08.01.25332595v1.8","unstructured":"OPS. Informe Epidemiol\u00f3gico en la Regi\u00f3n de Am\u00e9rica del Sur - 2019-2021. 2022. Available: https:\/\/www.google.com\/url?q=https:\/\/iris.paho.org\/bitstream\/handle\/10665.2\/56620\/equinococosisinformeoct2022_spa.pdf?sequence%3D1%26isAllowed%3Dy&sa=D&source=docs&ust=1741282007909069&usg=AOvVaw3ltEsZ6iHvQ456KZwWgVK0"},{"key":"2025080604400416000_2025.08.01.25332595v1.9","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i13.1425"},{"key":"2025080604400416000_2025.08.01.25332595v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.vetpar.2003.07.019"},{"key":"2025080604400416000_2025.08.01.25332595v1.11","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02420-15"},{"key":"2025080604400416000_2025.08.01.25332595v1.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.parepi.2019.e00104"},{"key":"2025080604400416000_2025.08.01.25332595v1.13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002249"},{"key":"2025080604400416000_2025.08.01.25332595v1.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.onehlt.2023.100595"},{"key":"2025080604400416000_2025.08.01.25332595v1.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.vetpar.2015.07.028"},{"key":"2025080604400416000_2025.08.01.25332595v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.cegh.2019.12.011"},{"key":"2025080604400416000_2025.08.01.25332595v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(22)00638-7"},{"key":"2025080604400416000_2025.08.01.25332595v1.18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0001179"},{"key":"2025080604400416000_2025.08.01.25332595v1.19","doi-asserted-by":"publisher","DOI":"10.26481\/dis.20080904dg"},{"key":"2025080604400416000_2025.08.01.25332595v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2022.100347"},{"key":"2025080604400416000_2025.08.01.25332595v1.21","unstructured":"21. GORE Arequipa. Resoluci\u00f3n Ejecutiva Regional 870-2011-GRA\/PR. 2011. Available: https:\/\/cdn.www.gob.pe\/uploads\/document\/file\/2416407\/doc.pdf?v=1636985352"},{"key":"2025080604400416000_2025.08.01.25332595v1.22","unstructured":"Gobierno del Per\u00fa . Decreto Legistativo N\u00b0 1440. 2018. Available: https:\/\/cdn.www.gob.pe\/uploads\/document\/file\/206025\/DL_1440.pdf?v=1594248074"},{"key":"2025080604400416000_2025.08.01.25332595v1.23","unstructured":"Municipalidad Provincial de Arequipa. Historia. 2023 [cited 21 Jan 2025]. Available: https:\/\/www.muniarequipa.gob.pe\/arequipa\/historia\/"},{"key":"2025080604400416000_2025.08.01.25332595v1.24","unstructured":"CPI. Per\u00fa: Poblaci\u00f3n 2013. 2013. Available: https:\/\/www.google.com\/url?q=https:\/\/www.cpi.pe\/images\/upload\/paginaweb\/archivo\/26\/MR_201311_01.pdf&sa=D&source=docs&ust=1737040316159960&usg=AOvVaw143uMSEI4f4mWSRDARsZKZ"},{"key":"2025080604400416000_2025.08.01.25332595v1.25","unstructured":"Banco Central de Reservas del Per\u00fa. Caracterizaci\u00f3n del Departamento de Arequipa. Available: https:\/\/www.google.com\/url?q=https:\/\/www.bcrp.gob.pe\/docs\/Sucursales\/Arequipa\/Arequipa-Caracterizacion.pdf&sa=D&source=docs&ust=1741282007985883&usg=AOvVaw1UCkatNhWuKYUQFjsmNUww"},{"key":"2025080604400416000_2025.08.01.25332595v1.26","unstructured":"26. WHO guidelines for the treatment of patients with cystic echinococcosis. [cited 16 Jul 2025]. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240110472"},{"key":"2025080604400416000_2025.08.01.25332595v1.27","unstructured":"27. R: The R Project for Statistical Computing. 2025 [cited 16 Jul 2025]. Available: https:\/\/www.r-project.org\/"},{"key":"2025080604400416000_2025.08.01.25332595v1.28","unstructured":"28. Cari Apaza DV . Prevalencia y factores de riesgo socioepidemiologicos de hidatidosis humana en pobladores de 15 - 19 a\u00f1os de Ayaviri, Puno 2013. 2015."},{"key":"2025080604400416000_2025.08.01.25332595v1.29","unstructured":"29. Ruelas Aguilar EA . Factores asociados a complicaciones perioperatorias en pacientes con hidatidosis pulmonar en el Hospital San Martin de Poerres de Macusani en el a\u00f1o 2021. 2022. Available: https:\/\/www.google.com\/url?q=https:\/\/repositorio.unap.edu.pe\/bitstream\/handle\/20.500.14082\/19160\/Ruelas_Aguilar_Edgar_Alexis.pdf?sequence%3D1%26isAllowed%3Dy&sa=D&source=docs&ust=1741282007995710&usg=AOvVaw3i0i-QWZbyvithevoRkfyF"},{"key":"2025080604400416000_2025.08.01.25332595v1.30","unstructured":"30. Zela Campos RP . Incidencia de la Hidatidosis Humana y la evaluaci\u00f3n cl\u00ednica, quir\u00fargica y complicaciones de pacientes tratados quir\u00fargicamente en el Hospital Carlos Monge Medrano de la ciudad de Juliaca enero 1990-diciembre 1997. 1998; 104\u2013104. Available: https:\/\/pesquisa.bvsalud.org\/portal\/resource\/pt\/lil-240545"},{"key":"2025080604400416000_2025.08.01.25332595v1.31","unstructured":"Montoya Lizarraga MA . Hidatidosis qu\u00edstica: carcater\u00edsticas cl\u00ednico epidemiol\u00f3gicas y sociodemogr\u00e1ficas en el Hospital Antonio Lorena del Cusco 2014-2018. 2021."},{"key":"2025080604400416000_2025.08.01.25332595v1.32","doi-asserted-by":"crossref","unstructured":"Salgado D\u00edaz S , Suarez-Ognio L , Cabrera R . CARACTER\u00cdSTICAS CL\u00cdNICAS Y EPIDEMIOL\u00d3GICAS DE LA EQUINOCOCOSIS QU\u00cdSTICA REGISTRADAS EN UN \u00c1REA END\u00c9MICA EN LOS ANDES CENTRALES DEL PER\u00da (1991\u20132002). 2007. Available: https:\/\/dialnet.unirioja.es\/descarga\/articulo\/4764356.pdf","DOI":"10.24039\/rnh2007121155"},{"key":"2025080604400416000_2025.08.01.25332595v1.33","unstructured":"33. Ortiz Sanchez N . Aspectos epidemiol\u00f3gicos y quir\u00fargicos de la hidatidosis en el servicio de cirug\u00eda general del Hospital - ESSALUD Huancayo. Periodo enero 2008 a diciembre 2009. 2010. Available: https:\/\/www.google.com\/url?q=https:\/\/repositorio.uncp.edu.pe\/bitstream\/handle\/20.500.12894\/3122\/Ortiz%2520Sanchez.pdf?sequence%3D1%26isAllowed%3Dy&sa=D&source=docs&ust=1741282007994523&usg=AOvVaw0P84AM7NcqCbPjzc3LvHDd"},{"key":"2025080604400416000_2025.08.01.25332595v1.34","unstructured":"Santivanez SJ . Lung and liver cystic echinococcosis: surgical treatment and its long-term impact on the health of infected subjects. Johns Hopkins University. 2016. Available: http:\/\/jhir.library.jhu.edu\/handle\/1774.2\/40819"},{"key":"2025080604400416000_2025.08.01.25332595v1.35","unstructured":"Cuadros Santos A . Hidatidosis pulmonar y hep\u00e1tica en pacientes menor es de 14 a\u00f1os del Hospital Honorio Delgado de Arequipa (1970 - 1988). Universidad Nacional de San Agust\u00edn de Arequipa. 1989."},{"key":"2025080604400416000_2025.08.01.25332595v1.36","unstructured":"Feria Vel\u00e1squez AM . Incidencia aspectos cl\u00ednico - epidemiol\u00f3gicos y tratamiento de la hidatidosis en el departamento de pediatr\u00eda del hospital Goyeneche 1993-2002. Universidad Nacional de San Agust\u00edn de Arequipa. 2003."},{"key":"2025080604400416000_2025.08.01.25332595v1.37","unstructured":"Coyla Mamani JR . Caracter\u00edsticas epidemiol\u00f3gicas, cl\u00ednicas y tratamiento quir\u00fargico de la hidatidosis pulmonar en pacientes atendidos en el Hospital Regional Honorio Delgado Espinoza de Arequipa 2012-2013. Tesis Para optar por el t\u00edtulo profesional de Medico \u2013 Cirujano, Universidad Cat\u00f3lica de Santa Mar\u00eda. 2014. Available: https:\/\/repositorio.ucsm.edu.pe\/handle\/20.500.12920\/4846?show=full"},{"key":"2025080604400416000_2025.08.01.25332595v1.38","unstructured":"MINSA. Perfil de Salud - Arequipa. 2023. Available: https:\/\/www.google.com\/url?qhttps:\/\/www.dge.gob.pe\/portal\/docs\/perfiles_epidemiologicos\/docs\/2023\/pdf\/Documento%2520Perfil%2520de%2520Salud_2023_Vers%2520Oficial_Arequipa_JCPD_Final.pdf&sa=D&source=docs&ust=1741619686002436&usg=AOvVaw2rDYZ_Izk-aTnvwdEApWQn"},{"key":"2025080604400416000_2025.08.01.25332595v1.39","unstructured":"Caribe CE para AL y el. Per\u00fa: Migraci\u00f3n interna y movilidad cotidiana para trabajar y estudiar entre las ciudades, 2007 y 2017. 7 Jul 2023 [cited 11 Mar 2025]. Available: https:\/\/www.cepal.org\/es\/publicaciones\/48977-peru-migracion-interna-movilidad-cotidiana-trabajar-estudiar-ciudades-2007-2017"},{"key":"2025080604400416000_2025.08.01.25332595v1.40","unstructured":"INEI. PER\u00da: Arequipa: Resultados Definitivos de los Censos Nacionales 2017. 2018 [cited 11 Mar 2025]. Available: https:\/\/www.inei.gob.pe\/media\/MenuRecursivo\/publicaciones_digitales\/Est\/Lib1551\/"},{"key":"2025080604400416000_2025.08.01.25332595v1.41","unstructured":"FAO. Pastoralist Knowledge Hub. In: PastoralistKnowledgeHub [Internet]. 2025 [cited 3 Jun 2025]. Available: https:\/\/www.fao.org\/pastoralist-knowledge-hub\/pastoralist-networks\/regional-networks\/latin-america\/en\/"},{"key":"2025080604400416000_2025.08.01.25332595v1.42","doi-asserted-by":"publisher","DOI":"10.1111\/avsc.12791"},{"key":"2025080604400416000_2025.08.01.25332595v1.43","doi-asserted-by":"publisher","DOI":"10.1007\/s004360100426"},{"key":"2025080604400416000_2025.08.01.25332595v1.44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005717"},{"key":"2025080604400416000_2025.08.01.25332595v1.45","doi-asserted-by":"publisher","DOI":"10.1080\/00034983.1995.11812969"},{"key":"2025080604400416000_2025.08.01.25332595v1.46","doi-asserted-by":"publisher","DOI":"10.1101\/2024.09.12.24313559"},{"key":"2025080604400416000_2025.08.01.25332595v1.47","doi-asserted-by":"publisher","DOI":"10.1157\/13074966"},{"key":"2025080604400416000_2025.08.01.25332595v1.48","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2556-9"},{"key":"2025080604400416000_2025.08.01.25332595v1.49","doi-asserted-by":"publisher","DOI":"10.4103\/0970-2113.177449"},{"key":"2025080604400416000_2025.08.01.25332595v1.50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2006.03.053"},{"key":"2025080604400416000_2025.08.01.25332595v1.51","unstructured":"OPS. Programa Regional para la eliminaci\u00f3n de la equinococosis qu\u00edstica\/hidatidosis - 2020-2029. 22 Nov 2021 [cited 3 Jun 2025]. Available: https:\/\/www.paho.org\/es\/documentos\/programa-regional-para-eliminacion-equinococosis-quisticahidatidosis-2020-2029"},{"key":"2025080604400416000_2025.08.01.25332595v1.52","unstructured":"SENASA. Lineamientos para la vigilancia, prevenci\u00f3n y control de la hidatidosis\/echinococosis. 2024. Available: https:\/\/cdn.www.gob.pe\/uploads\/document\/file\/6950993\/5996486-anexo-lineamiento-hidatidosis-equinococosis.pdf?v%3D1726593887&sa=D&source=docs&ust=1748965215083073&usg=AOvVaw1iVOe8EoJUAkCyVm_M6JMK"},{"key":"2025080604400416000_2025.08.01.25332595v1.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijidoh.2025.100078"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2025.08.01.25332595","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:42:03Z","timestamp":1768509723000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2025.08.01.25332595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,2]]},"references-count":53,"URL":"https:\/\/doi.org\/10.1101\/2025.08.01.25332595","relation":{},"subject":[],"published":{"date-parts":[[2025,8,2]]},"subtype":"preprint"}}