Clinical Management, Epidemiology, and Recurrence of Human Cystic Echinococcosis in a Secondary-Level Hospital in Cusco, Peru

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], 16-46), 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, 3.9-46.6), and readmission was reported in 12.7%. In the multivariable analysis, having three or more cysts (odds ratio, 6.26; 95% CI, 1.10-39.85) 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.