Hospitals of SANAA- YEMEN, 2012- 2013 Research Team Shareef Sami - - PowerPoint PPT Presentation

Epidemiological Characteristics of Human Hydatid Disease in The Major Hospitals of SANAA- YEMEN, 2012- 2013

Research Team

 Shareef Sami Abed  Moaweh Riyad Al-dgheim  Moawiah Moh’d Bahjat

Abdalrahman

 Tarek Alwreikat  Drar Adel

 Ahmad A.A Ayyad (presenter)

 Mohammad Ahmad Horani  Qutaiba Emad Rahmoon  Ali Diab Albaw  Jaber Alkhalialeh  Khaled Bani Hani

Under the Supervision of :

• Dr. Majed Wadi

Outlines

Background Objectives Methodology Results Discussion Conclusion Recommendation

Background

 Echinococcosis is a zoonotic disease caused by infection with

the larval stage of tapeworm Echinococcus granulosus.

 The tapeworm lives in canids, which are infected by eating

the viscera of sheep that contain hydatid cysts.

 The infected ova-containing feces of dogs (definitive host)

contaminate grass and farm land, and the ova are ingested by intermediate hosts, such as sheep, cattle, pigs, and humans.

 The ova burrows through the intestinal mucosa and is carried

by the portal vein to the liver, where it develops into an adult cyst.

Background, Life cycle of hydatid cyst

Worldwide distribution of the geographical endemicity

The greatest prevalence of HD in human and animal hosts is found in countries of the temperate zones.(world J Gastroentoral 2012 April 7)

Objectives

 General:

 This study aims to describe the epidemiological characteristics of

human hydatid disease cases in the major hospitals in Sana’a, Yemen (University of Science and Technology “UST’, Alkuwait, Aljoumhori and Althawra hospitals).

 Specific:

• 1. To describe hydatid disease in association to sex, age and

geographical distribution

• 2. To determine the most affected organs
• 3. To determine the outcome of the hydatid disease.

Methodology

 A cross-sectional study was applied in this research.  A modified check list was used to collect data from the

diagnosed cases of hydatid disease in the major hospitals’ archives for the years of 2012-2013.

Results

9 10 4 3 27 14 4 5 USTH AL KUWAIT H AL JOMHOURI AL THAWRAH

Male Female

FIGURE 1: CHARACTERISTICS OF PATIENTS ACCORDING TO SEX AND HOSPITALS.

Affected females were (65.8%) while affected males represent (34.2%).

Figure 2: distribution according age and sex.

the majority of the infected patients are less than 30 years old, in age group (<20) represented (26.3%), and in age group (20- 29) represented (22.4%).

Figure 3: distribution according organ affected and number of cyst

It is observed that the most affected organ was the liver (72.4%), followed by the lung (23.7%), 56 cases (73.7%) had a single cyst, while 20 cases (26.3%) had multiple cysts.

Organ Operation Total laparotomy Thoracotomy Kocher incision craniotomy liver Count 44 11 55 % within

• rgan

80% 0% 20% 0.0% 100% lung Count 18 18 % within

• rgan

0% 100% 0% 0.0% 100% brain Count 3 3 % within

• rgan

0% 0% 0% 100% 100% Total Count 44 18 11 3 76 % within

• rgan

57.9% 23.7% 14.5% 3.9% 100%

Table 1: distribution according organ and surgical operation Table 4 shows that the liver was effected in 55 cases and the surgical interventions that were performed are of the following: laparotomy in 44 cases and Kocher incision in 11 cases. Lung was effected in 18 cases and the surgical intervention was thoracotomy in all cases. Brain was effected in 3 cases and the surgical intervention was craniotomy in all cases.

Discussion

Demographic characteristics of patients

 In this study, infected females (65.8%) and infected males represent

(34.2%). This finding is similar to the studies that were conducted in Yemen (Alghoury et al, 2010), which reported that females (67%) are more exposed to ecchinococal infections than males (34%).

 Additionally, in Jordan, females (60%) and males (40%) (Amr et al, 1994)  In Iraq, females (80%), males (20%) and in the west bank females (66.5%)

and males (33.5%).

 On the contrary in Saudi Arabia males (53.7%) and females (46.3%) (Awatif

et al, 1999)

 The difference might be attributed to the difference of socioeconomic

status from one country to another. In Saudi Arabia they depend more on foreign employees that may have contact with animals and agriculture.

Discussion cont’

 Demographic characteristics of patients cont’  This study shows the majority of the infected patients are

less than 30 years old, in age group (<20) represented (26.3%), and in age group (20- 29) represented (22.4%).

 This is agreed with the Jordanian study that reported that

(35.8%) were in less than 20 age group, also the west bank study which reported age group (11-20) represented (27.4%) and age group (21-30) represented (21.4%).

 This is different from the study conducted here in Yemen

that reported that patients older than 30 years old represent (40.4%).

Discussion cont’

Affected organs of hydatid disease

 It observed that the most affected organ was the liver (72.4%),

followed by the lung (23.7%), and the brain (3.9%) there were no spleen involvement or any other organ.

 The higher rate of hepatic infection may be attributed to the fact that

the liver acts as the primary filter in the human body and the lung is

• ften thought to be the second filter.(6).

 This is also seen in other studies that showed the involvement of liver

was in the highest percentage (50%-70%). followed by the lung (26%- 32%). The study shows that 56 cases (73.7%) had single cyst were as 20 cases (26.3%) had multiple cysts.

Discussion cont’

Outcome of hydatid disease

 This study shows that 76 cases (100%) were treated surgically, liver cysts

under gone either laparotomy (80%) or Kocher incision (20%), lung cysts under gone thoracotomy (100%), brain cysts managed by craniotomy.

 The study been conducted in Palestine-west bank, it were limited to the

surgical department.

 Unlike our study, KSA study have shown that 22.4% of cases been treated

medically, 56.7% managed surgically, while 20.9% have under gone both medical and surgical treatment. The delay in presentation due to low socioeconomic state in Yemen may be the cause of cases to get complicated and require surgical intervention.

• ther study were conducted in Yemen and Jordan not reported if the

patients received medical treatment.

 None of the cases in our study required ICU admission.

Conclusions

 This study revealed that 65.8% of cases were females while 34.2%

cases were males.

 The highest age group was less than 30 that represented 48.7%.  The most effected organ was the liver 72.4%, followed by lung 23.7%.

cysts were single in 73.7%, and multiple in 26.3% of the cases.

 All of the cases were treated surgically and reported no recurrence or

ICU admission

Recommendations

 Health education should be provided about the mechanism of spread

• f this disease to all high risk groups.

 The ministry of agriculture in collaboration with ministry of health

should play an active role in the control and screening of infected animals.

 Accurate information should be properly recorded and archived in a

more accessible and organized way similar to UST-hospital archiving system.

 More studies should be conducted on a wider geographical area that

involves the whole Republic of Yemen.

Acknowledgment

 We thanks all the people that have lend us their cooperative hand, without

them we wouldn’t reach the end of this long hard journey.

 We specially give thanks to our dear doctors, the head of the UST Community

Department Dr. Ahmad Qayed, our supervisor Dr.Majed Wadi.