The clinical burden of human cystic echinococcosis in Palestine, 2010-2015
Date
2017-07-03
Authors
Al-Jawabreh, Amer
Ereqat, Suheir
Dumaidi, Kamal
Nasereddin, Abdelmajeed
Al-Jawabreh, Hanan
Azmi, Kifaya
Al-Laham, Nahed
Nairat, Moath
Casulli, Adriano
Maqboul, Husni
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS
Abstract
Background
Cystic echinococcosis (CE) is classified by the WHO as a neglected disease inflicting economic
losses on the health systems of many countries worldwide. The aim of this caseseries
study was to investigate the burden of human CE in Palestine during the period
between 2010 and 2015.
Methodology/Principal findings
Records of surgically confirmed CE patients from 13 public and private hospitals in the
West Bank and Gaza Strip were reviewed. Patients' cysts were collected from surgical
wards and formalin-fixed paraffin-embedded (FFPE) blocks were collected from histopathology
departments. Molecular identification of CE species /genotypes was conducted
by targeting a repeat DNA sequence (EgG1 Hae III) within Echinococcus nuclear genome
and a fragment within the mitochondrial cytochrome c oxidase subunit 1, (CO1). Confirmation
of CE species/genotypes was carried out using sequencing followed by BLAST
analysis and the construction of maximum likelihood consensus dendrogram. CE cases
were map-spotted and statistically significant foci identified by spatial analysis. A total of
353 CE patients were identified in 108 localities from the West Bank and Gaza Strip. The
average surgical incidence in the West Bank was 2.1 per 100,000. Spot-mapping and
purely spatial analysis showed 13 out of 16 Palestinian districts had cases of CE, of which
9 were in the West Bank and 4 in Gaza Strip. Al-Khalil and Bethlehem were statistically
significant foci of CE in Palestine with a six-year average incidence of 4.2 and 3.7 per
100,000, respectively.
Conclusions/Significance
To the best of our knowledge, this is the first confirmation of human CE causative agent
in Palestine. This study revealed that E. granulosus sensu stricto (s.s.) was the predominating
species responsible for CE in humans with 11 samples identified as G1 genotype and 2
as G3 genotype. This study emphasizes the need for a stringent surveillance system and
risk assessment studies in the rural areas of high incidence as a prerequisite for control
measures.
Description
Keywords
Citation
Al-Jawabreh A, Ereqat S, Dumaidi K, Nasereddin A, Al-Jawabreh H, Azmi K, et al. (2017) The clinical burden of human cystic echinococcosis in Palestine, 2010-2015. PLoS Negl Trop Dis 11(7): e0005717.