{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:01:31Z","timestamp":1787029291706,"version":"build-2736575974"},"reference-count":59,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T00:00:00Z","timestamp":1648339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["773830"],"award-info":[{"award-number":["773830"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Cystic echinococcosis (CE) is a neglected worldwide distributed parasitic disease caused by the Echinococcusgranulosus\u00a0sensu 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.\u00a0granulosus 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\u201330 (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. granulosussensu stricto (s.s.), thus, confirming sheep\u2013dog\u2013human transmission in the Kurdistan region, Iraq. No statistically significant correlation was found between the genotypes G1\u2013G3 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.<\/jats:p>","DOI":"10.3390\/pathogens11040408","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T21:29:36Z","timestamp":1648416576000},"page":"408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Insights into Human Cystic Echinococcosis in the Kurdistan Region, Iraq: Characteristics and Molecular Identification of Cysts"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1828-7188","authenticated-orcid":false,"given":"Araz Ramadhan","family":"Issa","sequence":"first","affiliation":[{"name":"Department of Biology, Faculty of Science, University of Zakho, Zakho 42002, Kurdistan Region, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7411-9707","authenticated-orcid":false,"given":"Sardar Hassan","family":"Arif","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, University of Duhok, Duhok 42001, Kurdistan Region, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7165-6427","authenticated-orcid":false,"given":"Ayad Ahmad","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, University of Duhok, Duhok 42001, Kurdistan Region, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Santolamazza","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore Di Sanit\u00e0, 00161 Rome, Italy"},{"name":"European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore Di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azzurra","family":"Santoro","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore Di Sanit\u00e0, 00161 Rome, Italy"},{"name":"European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore Di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0439-4372","authenticated-orcid":false,"given":"Wijdan Mohammed Salih","family":"Mero","sequence":"additional","affiliation":[{"name":"Department of Biology, Faculty of Science, University of Zakho, Zakho 42002, Kurdistan Region, Iraq"},{"name":"College of Science, Nawroz University, Duhok 42001, Kurdistan Region, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9183-7591","authenticated-orcid":false,"given":"Adriano","family":"Casulli","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis, Department of Infectious Diseases, Istituto Superiore Di Sanit\u00e0, 00161 Rome, Italy"},{"name":"European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore Di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/bs.apar.2016.11.001","article-title":"Global distribution of alveolar and cystic echinococcosis","volume":"95","author":"Deplazes","year":"2017","journal-title":"Advances in Parasitology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/bs.apar.2016.11.002","article-title":"Ecology and life cycle patterns of Echinococcus species","volume":"95","author":"Romig","year":"2017","journal-title":"Advances in Parasitology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.exppara.2008.04.016","article-title":"The taxonomy, phylogeny and transmission of Echinococcus","volume":"119","author":"Thompson","year":"2008","journal-title":"Exp. 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