{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:04:02Z","timestamp":1791295442664,"version":"4.1.0"},"reference-count":25,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Patients with cystic echinococcosis (CE) regularly undergo surgery in medical centers in endemic countries. Our understanding of the challenges patients face on the pathway toward the final diagnosis and treatment of CE is poor. The present study was conducted to evaluate the medical care-seeking pathway and the underlying causes of the delayed surgical treatment of CE. Information related to 68 CE patients who underwent surgery in Kerman, Southeast Iran, was collected through face-to-face visits or telephone calls. All the patients were interviewed, and the medical records of each patient were reviewed. The pathway taken by the patient to seek care, the workups performed for diagnosis and management, and the length of time between the onset of symptoms and definitive diagnosis and surgery were evaluated. The patients were visited by at least two physicians; the median number of physicians was four. A total of 47% of the patients were referred to a general practitioner on their first visit. The mean times between the first visit and CE diagnosis and surgery were 1.5 and 3.2 months, respectively. A definitive diagnosis of CE was made for 35.3% of the patients in less than 1 month after the first visit. However, it took 4 months or more for 51.4% of the patients to receive hydatid surgery. The fear of anesthesia and surgery, the cost of management, unsuccessful chemotherapy for CE patients, pregnancy, and issues related to immigrant patients and refugees are among the factors involved in the protraction of CE diagnosis and treatment. Establishing practice guidelines for CE diagnosis and treatment, continuing education for healthcare professionals, and improving access to diagnostic facilities for endemic communities are required to address challenges in the management of CE in endemic regions.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0061","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T16:41:06Z","timestamp":1738687266000},"page":"822-827","source":"Crossref","is-referenced-by-count":3,"title":["The Management Pathway of Patients with Cystic Echinococcosis in Iran Prior to Definitive Surgical Treatment"],"prefix":"10.4269","volume":"112","author":[{"given":"Fatemeh","family":"Mohtasham","sequence":"first","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Medical Parasitology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Shafiei","sequence":"additional","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Surgery, School of Medicine, Afzalipour Medical Center, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Reza","family":"Lashkarizadeh","sequence":"additional","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Surgery, School of Medicine, Afzalipour Medical Center, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrdad","family":"Farokhnia","sequence":"additional","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Internal Medicine, School of Medicine, Afzalipour Medical Center, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maysam","family":"Yousefi","sequence":"additional","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Internal Medicine, School of Medicine, Afzalipour Medical Center, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Eftekhar Vaghefi","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, Afzalipour Medical Center, Kerman University of Medical Sciences, Kerman, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Khajehasani","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, Afzalipour Medical Center, Kerman University of Medical Sciences, Kerman, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeid","family":"Nasibi","sequence":"additional","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Medical Parasitology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Ali","family":"Mohammadi","sequence":"additional","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Medical Parasitology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Fasihi Harandi","sequence":"additional","affiliation":[{"name":"Research Center for Hydatid Disease in Iran, Department of Medical Parasitology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Adv Parasitol","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"},{"key":"b2","series-title":"Adv Parasitol","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/bs.apar.2016.07.001","article-title":"Biology and systematics of Echinococcus","volume":"95","author":"Thompson","year":"2017"},{"key":"b3","series-title":"Clin Microbiol Rev","first-page":"e00290-20","article-title":"Echinococcoses in Iran, Turkey, and Pakistan: Old diseases in the new millennium","volume":"34","author":"Borhani","year":"2021"},{"key":"b4","series-title":"PLoS Negl Trop Dis","first-page":"e1915","article-title":"The monetary burden of cystic echinococcosis in Iran","volume":"6","author":"Fasihi 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patients; a case study in the cancer institute of Iran","volume":"1","author":"Pourreza","year":"2017"},{"key":"b24","series-title":"BMC Pregnancy Childbirth","first-page":"382","article-title":"Non-obstetric surgery during pregnancy - An eleven-year retrospective analysis","volume":"19","author":"Vujic","year":"2019"},{"key":"b25","series-title":"Int J Equity Health","first-page":"16","article-title":"Health condition of Afghan refugees residing in Iran in comparison to Germany: A systematic review of empirical studies","volume":"22","author":"Rahimitabar","year":"2023"}],"container-title":["The American Journal of Tropical Medicine and 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