This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features!
Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

NIH NLM Logo
Log in
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 1;11(3):e0005384.
doi: 10.1371/journal.pntd.0005384. eCollection 2017 Mar.

Human cystic echinococcosis in Morocco: Ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership

Affiliations

Human cystic echinococcosis in Morocco: Ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership

Houda Chebli et al. PLoS Negl Trop Dis. .

Abstract

Background: Cystic echinococcosis (CE) is a neglected parasitic zoonosis with considerable socioeconomic impact on affected pastoral communities. CE is endemic throughout the Mediterranean, including Morocco, where the Mid Atlas is the most prevalent area for both human and animal infection. The highest hospital annual incidence of human CE is recorded in the provinces of Ifrane and El Hajeb. However, hospital-based statistics likely underestimate the real prevalence of infection, as a proportion of cases never reach medical attention or official records.

Methodology/principal findings: In 2012, a project on clinical management of CE in Morocco was launched with the aims of estimating the prevalence of human abdominal CE in selected rural communes of the above mentioned provinces using ultrasound (US) screening and training local physicians to implement US-based focused assessment and rational clinical management of CE according to the WHO-IWGE Expert Consensus. A total of 5367 people received abdominal US during four campaigns in April-May 2014. During the campaigns, 24 local general practitioners received >24 hours of hands-on training and 143 health education sessions were organized for local communities. We found an overall CE prevalence of 1.9%, with significantly higher values in the rural communes of Ifrane than El Hajeb (2.6% vs 1.3%; p<0.001). CE cysts were predominantly in inactive stage, especially in older age groups. However, active cysts were present also in adults, indicating acquisition of infection at all ages. Province of residence was the only risk factor consistently associated with CE infection.

Conclusions/significance: Our results show a high prevalence and on-going, likely environmental transmission of CE in the investigated provinces of Morocco, supporting the implementation of control activities in the area by national health authorities and encouraging the acceptance and divulgation of diagnosis and treatment algorithms based on imaging for CE at both national and local level.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Map of Morocco and the survey area.
The survey area is indicated in black. This includes the rural communes of Timahdit and Ain Louh in the province of Ifrane, and the rural communes of Bouderbala and Sebt Jehjouh in the province of El Hajeb, Meknes-Tafilalet region (designated as such until December 2014). Modified from Di Hanhil [Public Domani] Wikimedia Commons.
Fig 2
Fig 2. Examined people and CE cases observed during the screening campaigns.
*One patient reported previous surgery for pulmonary CE.
Fig 3
Fig 3. Distribution of CE lesions.
A. Number of subjects with untreated and previously treated CE cysts (bars; left Y axis) and overall prevalence of CE in the screened population (dotted line; right Y axis) according to gender and age group (X axis). M = males; F = females. Age groups are expressed in years. Three children (aged 3, 8 and 9 years) and 19 adults (aged 81–94 years) were outside the target age range target; none of these subjects were infected with CE. B. Number of hepatic CE cysts in different stages. C. Percentage of CE cyst stages in patients never previously treated for CE within age groups. D. Percentage of CE cyst stages in patients never previously treated for CE within gender groups.
Fig 4
Fig 4. Percentage of untreated and previously treated CE patients with ELISA positive serology according to cyst stage.

References

    1. Possenti A, Manzano-Roman R, Sanchez-Ovejero C, Boufana B, La Torre G, Siles-Lucas M, et al. Potential Risk Factors Associated with Human Cystic Echinococcosis: Systematic Review and Meta-analysis. PLoS Negl Trop Dis. 2016;10(11):e0005114 10.1371/journal.pntd.0005114 - DOI - PMC - PubMed
    1. Craig P, Budke C, Schantz P, Li T, Qiu J, Yang Y, et al. Human Echinococcosis: A Neglected Disease? Tropical Medicine andHealth. 2007;35(4):283–92.
    1. Brunetti E, Garcia HH, Junghanss T, International Ce Workshop in Lima P. Cystic echinococcosis: chronic, complex, and still neglected. PLoS Negl Trop Dis. 2011;5(7):e1146 10.1371/journal.pntd.0001146 - DOI - PMC - PubMed
    1. Azlaf R, Dakkak A. Epidemiological study of the cystic echinococcosis in Morocco. Vet Parasitol. 2006;137(1–2):83–93. 10.1016/j.vetpar.200601003 - DOI - PubMed
    1. Derfoufi O, Akawa E, Elmaataoui A, Miss E, Esselmani H, Lyagoubi M, et al. Epidemiological profile of cystic echinococcosis in Morocco from 1980 to 2008. Ann Biol Clin. 2012;70(4):457–61. - PubMed

Publication types

LinkOut - more resources

Full text links
Public Library of Science full text link Public Library of Science Free PMC article
Cite

AltStyle によって変換されたページ (->オリジナル) /