{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T18:05:55Z","timestamp":1775844355459,"version":"3.50.1"},"reference-count":76,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Peru has the highest incidence of human cystic echinococcosis (CE) in South America, and most cases are reported in the central and southern Peruvian Andes, including the Cusco region. We reviewed medical records of patients with CE admitted between 2010 and 2019 to a level 2 hospital in Sicuani. We collected data on surgical management and recurrence. Records from 115 patients were included; their median age was 25 years old (interquartile range [IQR], 16\u201346), and 60% were female. Most patients (68.7%) presented with a single liver cyst. The Gharbi classification was used in 75 of 107 patients (70.1%) with an ultrasound and 91 of 142 cysts (64.8%). Thirty-one (34.1%) were classified as Gharbi I, 33 (36.3%) were classified as Gharbi II, 21 (23.1%) were classified as Gharbi III, and 6 (6.6%) were classified as Gharbi IV. Presurgical complications were reported in 41.7%; 102 patients underwent surgery. In 51.5%, one secondary CE prevention measure was documented, and 9.3% had two. Postsurgical cyst recurrence was reported in 16.5% at a median of 32.3 months (IQR, 3.9\u201346.6), and readmission was reported in 12.7%. In the multivariable analysis, having three or more cysts (odds ratio, 6.26; 95% CI, 1.10\u201339.85) was associated with postsurgical recurrence. Advanced and complicated CE and postsurgical recurrence were common in Sicuani. Standardization of ultrasound staging-guided clinical management along with secondary CE prevention measures could effectively decrease the disease burden linked to clinical care, improving outcomes and decreasing costs.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0241","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:57:27Z","timestamp":1764874647000},"page":"253-261","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Management, Epidemiology, and Recurrence of Human Cystic Echinococcosis in a Secondary-Level Hospital in Cusco, Peru"],"prefix":"10.4269","volume":"114","author":[{"given":"Roberto","family":"Pineda-Reyes","sequence":"first","affiliation":[{"name":"One Health Group, Human and Animal Health Unit, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Allschwil, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel M.","family":"Cabada","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas;"},{"name":"Cusco Branch, Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria L.","family":"Morales","sequence":"additional","affiliation":[{"name":"Cusco Branch, Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Hattendorf","sequence":"additional","affiliation":[{"name":"One Health Group, Human and Animal Health Unit, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Allschwil, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Vergaray","sequence":"additional","affiliation":[{"name":"Departamento de Cirugia, Hospital Alfredo Callo Rodriguez - Sicuani, Cusco, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruben","family":"Bascope","sequence":"additional","affiliation":[{"name":"Programa de Control de Enfermedades Zoonoticas, Gerencia Regional de Salud de Cusco, Cusco, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob","family":"Zinsstag","sequence":"additional","affiliation":[{"name":"One Health Group, Human and Animal Health Unit, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Allschwil, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"385","article-title":"Prevention and control of cystic echinococcosis","volume":"7","author":"Craig","year":"2007"},{"key":"b2","series-title":"Adv Parasitol","first-page":"315","article-title":"Global distribution of alveolar and cystic echinococcosis","volume":"95","author":"Deplazes","year":"2017"},{"key":"b3","article-title":"Equinococosis: Informe Epidemiol\u00f3gico en la Regi\u00f3n de Am\u00e9rica Del Sur\u20142018, n.4, 2020.","year":"2020"},{"key":"b4","article-title":"Equinococosis qu\u00edstica en ni\u00f1os y adolescentes en los hospitalales Regional del Cusco y Adolfo Guevara Velasco, Cusco a 3400 msnm, 2010\u20132014.","author":"Flores Quispe","year":"2015"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"1472","article-title":"Prevalence and risk factors for human cystic echinococcosis in the Cusco region of the Peruvian highlands diagnosed using focused abdominal ultrasound","volume":"96","author":"Tamarozzi","year":"2017"},{"key":"b6","series-title":"Acta Trop","first-page":"1","article-title":"Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans","volume":"114","author":"Brunetti","year":"2010"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0006686","article-title":"Patients with cystic echinococcosis in the three national referral centers of Mongolia: A model for CE management assessment","volume":"12","author":"Bold","year":"2018"},{"key":"b8","series-title":"J Gastrointest Surg","first-page":"734","article-title":"Postoperative recurrence in hepatic hydatid disease","volume":"10","author":"Kapan","year":"2006"},{"key":"b9","series-title":"BMC Infect Dis","first-page":"455","article-title":"Recurrence of cystic echinococcosis in an endemic area: A retrospective study","volume":"17","author":"Velasco-Tirado","year":"2017"},{"key":"b10","series-title":"J Gastrointest Surg","first-page":"1121","article-title":"Does primary surgical management of liver hydatid cyst influence recurrence?","volume":"14","author":"El Malki","year":"2010"},{"key":"b11","series-title":"J Pediatr Surg","first-page":"2362","article-title":"Predictive factors of liver hydatid cyst recurrence in children","volume":"58","author":"Yosra","year":"2023"},{"key":"b12","series-title":"Bull Soc Pathol Exot","first-page":"265","article-title":"Recurrence of hydatid cyst of liver: Predictive factors: Tunisian experience","volume":"105","author":"Bedioui","year":"2012"},{"key":"b13","series-title":"Rev Peru Med Exp Salud Publica","first-page":"33","article-title":"Factors associated with pre-surgical complications in patients with cystic echinococcosis from endemic areas of Peru","volume":"38","author":"Pacifico","year":"2021"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0009365","article-title":"Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis","volume":"15","author":"Al-Saeedi","year":"2021"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0011724","article-title":"Risk factors and management of biliary leakage after endocystectomy for hepatic cystic echinococcosis","volume":"17","author":"Abbasi Dezfouli","year":"2023"},{"key":"b16","series-title":"PLoS Negl Trop Dis","first-page":"e0007516","article-title":"Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis","volume":"13","author":"Al-Saeedi","year":"2019"},{"key":"b17","series-title":"Am J Trop Med Hyg","first-page":"375","article-title":"Watch and wait approach for inactive echinococcal cyst of the liver: An update","volume":"99","author":"Lissandrin","year":"2018"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"301","article-title":"Clinical management of cystic echinococcosis: State of the art, problems, and perspectives","volume":"79","author":"Junghanss","year":"2008"},{"key":"b19","article-title":"Analisis de Situacion de Salud\u2014Canchis.","year":"2020"},{"key":"b20","series-title":"Censo 2018, Resultados Definitivos, Region Cusco","year":"2018"},{"key":"b21","article-title":"Guideline on Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations","year":"2024"},{"key":"b22","article-title":"Estadistica Poblacional.","year":"2023"},{"key":"b23","article-title":"Estadisticas Poblacionales."},{"key":"b24","article-title":"Boletin Epidemiologico del Peru.","year":"2021"},{"key":"b25","series-title":"Enferm Infecc Microbiol Clin","first-page":"232","article-title":"Epidemiological update of hydatid disease in hospitals in the public health system of Extremadura (2003\u20132012)","volume":"34","author":"Lopez-Bernus","year":"2016"},{"key":"b26","series-title":"PLoS Negl Trop Dis","first-page":"e0004154","article-title":"Surveillance of human echinococcosis in Castilla-Leon (Spain) between 2000\u20132012","volume":"9","author":"Lopez-Bernus","year":"2015"},{"key":"b27","series-title":"Acta Trop","first-page":"213","article-title":"Progress in control of cystic echinococcosis in La Rioja, Spain: Decline in infection prevalences in human and animal hosts and economic costs and benefits","volume":"83","author":"Jim\u00e9nez","year":"2002"},{"key":"b28","article-title":"Informe: Situaci\u00f3n de la Equinococosis Qu\u00edstica\/Hidatidosis en Chile, 2018\u20132022.","year":"2023"},{"key":"b29","series-title":"Am J Trop Med Hyg","first-page":"628","article-title":"Complications associated with initial clinical presentation of cystic echinococcosis: A 20-year cohort analysis","volume":"101","author":"Collado-Aliaga","year":"2019"},{"key":"b30","series-title":"Neotrop Helminthol","first-page":"69","article-title":"Caracter\u00edsticas cl\u00ednicas y epidemiol\u00f3gicas de la equinococosis qu\u00edstica registradas en un \u00e1rea end\u00e9mica en los Andes centrales del Per\u00fa","volume":"1","author":"Salgado D\u00edaz","year":"2007"},{"key":"b31","series-title":"Cochrane Database Syst Rev","first-page":"CD015573","article-title":"Treatment of uncomplicated hepatic cystic echinococcosis (hydatid disease)","volume":"7","author":"Kuehn","year":"2024"},{"key":"b32","series-title":"Eur J Radiol","first-page":"65","article-title":"Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice?","volume":"59","author":"Kabaalioglu","year":"2006"},{"key":"b33","series-title":"AJR Am J Roentgenol","first-page":"83","article-title":"Percutaneous treatment of hepatic hydatid cysts: An alternative to surgery","volume":"172","author":"Men","year":"1999"},{"key":"b34","article-title":"The Recurrence Rate after Primary Resection Cystic Echinococcosis: A Meta-Analysis and Systematic Literature Review.","author":"Alzoubi","year":"2024"},{"key":"b35","series-title":"Medicina (Kaunas)","first-page":"1696","article-title":"Analysis of complications of a neglected disease: 13 Years of experience with liver hydatid cysts in a high-volume hospital","volume":"60","author":"Azizo\u011flu","year":"2024"},{"key":"b36","series-title":"Int J Surg","first-page":"695","article-title":"Risk factors of postoperative morbidity in patients with uncomplicated liver hydatid cyst","volume":"12","author":"Manterola","year":"2014"},{"key":"b37","article-title":"One Health in Human-Environment Systems: Linking Health and the Sustainable Use of Natural Resources.","author":"Zinsstag","year":"2024"},{"key":"b38","series-title":"Nat Commun","first-page":"5370","article-title":"Benefit-cost analysis of coordinated strategies for control of rabies in Africa","volume":"14","author":"Bucher","year":"2023"},{"key":"b1","series-title":"Lancet Infect Dis","first-page":"385","article-title":"Prevention and control of cystic echinococcosis","volume":"7","author":"Craig","year":"2007"},{"key":"b2","series-title":"Adv Parasitol","first-page":"315","article-title":"Global distribution of alveolar and cystic echinococcosis","volume":"95","author":"Deplazes","year":"2017"},{"key":"b3","article-title":"Equinococosis: Informe Epidemiol\u00f3gico en la Regi\u00f3n de Am\u00e9rica Del Sur\u20142018, n.4, 2020.","year":"2020"},{"key":"b4","article-title":"Equinococosis qu\u00edstica en ni\u00f1os y adolescentes en los hospitalales Regional del Cusco y Adolfo Guevara Velasco, Cusco a 3400 msnm, 2010\u20132014.","author":"Flores Quispe","year":"2015"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"1472","article-title":"Prevalence and risk factors for human cystic echinococcosis in the Cusco region of the Peruvian highlands diagnosed using focused abdominal ultrasound","volume":"96","author":"Tamarozzi","year":"2017"},{"key":"b6","series-title":"Acta Trop","first-page":"1","article-title":"Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans","volume":"114","author":"Brunetti","year":"2010"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0006686","article-title":"Patients with cystic echinococcosis in the three national referral centers of Mongolia: A model for CE management assessment","volume":"12","author":"Bold","year":"2018"},{"key":"b8","series-title":"J Gastrointest Surg","first-page":"734","article-title":"Postoperative recurrence in hepatic hydatid disease","volume":"10","author":"Kapan","year":"2006"},{"key":"b9","series-title":"BMC Infect Dis","first-page":"455","article-title":"Recurrence of cystic echinococcosis in an endemic area: A retrospective study","volume":"17","author":"Velasco-Tirado","year":"2017"},{"key":"b10","series-title":"J Gastrointest Surg","first-page":"1121","article-title":"Does primary surgical management of liver hydatid cyst influence recurrence?","volume":"14","author":"El Malki","year":"2010"},{"key":"b11","series-title":"J Pediatr Surg","first-page":"2362","article-title":"Predictive factors of liver hydatid cyst recurrence in children","volume":"58","author":"Yosra","year":"2023"},{"key":"b12","series-title":"Bull Soc Pathol Exot","first-page":"265","article-title":"Recurrence of hydatid cyst of liver: Predictive factors: Tunisian experience","volume":"105","author":"Bedioui","year":"2012"},{"key":"b13","series-title":"Rev Peru Med Exp Salud Publica","first-page":"33","article-title":"Factors associated with pre-surgical complications in patients with cystic echinococcosis from endemic areas of Peru","volume":"38","author":"Pacifico","year":"2021"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0009365","article-title":"Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis","volume":"15","author":"Al-Saeedi","year":"2021"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0011724","article-title":"Risk factors and management of biliary leakage after endocystectomy for hepatic cystic echinococcosis","volume":"17","author":"Abbasi Dezfouli","year":"2023"},{"key":"b16","series-title":"PLoS Negl Trop Dis","first-page":"e0007516","article-title":"Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis","volume":"13","author":"Al-Saeedi","year":"2019"},{"key":"b17","series-title":"Am J Trop Med Hyg","first-page":"375","article-title":"Watch and wait approach for inactive echinococcal cyst of the liver: An update","volume":"99","author":"Lissandrin","year":"2018"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"301","article-title":"Clinical management of cystic echinococcosis: State of the art, problems, and perspectives","volume":"79","author":"Junghanss","year":"2008"},{"key":"b19","article-title":"Analisis de Situacion de Salud\u2014Canchis.","year":"2020"},{"key":"b20","series-title":"Censo 2018, Resultados Definitivos, Region Cusco","year":"2018"},{"key":"b21","article-title":"Guideline on Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations","year":"2024"},{"key":"b22","article-title":"Estadistica Poblacional.","year":"2023"},{"key":"b23","article-title":"Estadisticas Poblacionales."},{"key":"b24","article-title":"Boletin Epidemiologico del Peru.","year":"2021"},{"key":"b25","series-title":"Enferm Infecc Microbiol Clin","first-page":"232","article-title":"Epidemiological update of hydatid disease in hospitals in the public health system of Extremadura (2003\u20132012)","volume":"34","author":"Lopez-Bernus","year":"2016"},{"key":"b26","series-title":"PLoS Negl Trop Dis","first-page":"e0004154","article-title":"Surveillance of human echinococcosis in Castilla-Leon (Spain) between 2000\u20132012","volume":"9","author":"Lopez-Bernus","year":"2015"},{"key":"b27","series-title":"Acta Trop","first-page":"213","article-title":"Progress in control of cystic echinococcosis in La Rioja, Spain: Decline in infection prevalences in human and animal hosts and economic costs and benefits","volume":"83","author":"Jim\u00e9nez","year":"2002"},{"key":"b28","article-title":"Informe: Situaci\u00f3n de la Equinococosis Qu\u00edstica\/Hidatidosis en Chile, 2018\u20132022.","year":"2023"},{"key":"b29","series-title":"Am J Trop Med Hyg","first-page":"628","article-title":"Complications associated with initial clinical presentation of cystic echinococcosis: A 20-year cohort analysis","volume":"101","author":"Collado-Aliaga","year":"2019"},{"key":"b30","series-title":"Neotrop Helminthol","first-page":"69","article-title":"Caracter\u00edsticas cl\u00ednicas y epidemiol\u00f3gicas de la equinococosis qu\u00edstica registradas en un \u00e1rea end\u00e9mica en los Andes centrales del Per\u00fa","volume":"1","author":"Salgado D\u00edaz","year":"2007"},{"key":"b31","series-title":"Cochrane Database Syst Rev","first-page":"CD015573","article-title":"Treatment of uncomplicated hepatic cystic echinococcosis (hydatid disease)","volume":"7","author":"Kuehn","year":"2024"},{"key":"b32","series-title":"Eur J Radiol","first-page":"65","article-title":"Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice?","volume":"59","author":"Kabaalioglu","year":"2006"},{"key":"b33","series-title":"AJR Am J Roentgenol","first-page":"83","article-title":"Percutaneous treatment of hepatic hydatid cysts: An alternative to surgery","volume":"172","author":"Men","year":"1999"},{"key":"b34","article-title":"The Recurrence Rate after Primary Resection Cystic Echinococcosis: A Meta-Analysis and Systematic Literature Review.","author":"Alzoubi","year":"2024"},{"key":"b35","series-title":"Medicina (Kaunas)","first-page":"1696","article-title":"Analysis of complications of a neglected disease: 13 Years of experience with liver hydatid cysts in a high-volume hospital","volume":"60","author":"Azizo\u011flu","year":"2024"},{"key":"b36","series-title":"Int J Surg","first-page":"695","article-title":"Risk factors of postoperative morbidity in patients with uncomplicated liver hydatid cyst","volume":"12","author":"Manterola","year":"2014"},{"key":"b37","article-title":"One Health in Human-Environment Systems: Linking Health and the Sustainable Use of Natural Resources.","author":"Zinsstag","year":"2024"},{"key":"b38","series-title":"Nat Commun","first-page":"5370","article-title":"Benefit-cost analysis of coordinated strategies for control of rabies in Africa","volume":"14","author":"Bucher","year":"2023"}],"container-title":["The American Journal of Tropical Medicine and 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