Diagnosis and Management of Cystic Echinococcosis in Bhutan: Current Practices, Gaps, and Recommendations (2020–2024)
1
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Allschwil, Basel-Landschaft, Switzerland
2
Infectious Disease and Tropical Medicine Unit, Heidelberg University Hospital, Heidelberg, Germany
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Cystic echinococcosis (CE) is a neglected parasitic zoonosis that poses significant public health challenges, particularly in rural areas where access to timely diagnosis and treatment facilities is limited. This study reviewed and analyzed the clinical characteristics, diagnosis, treatment, and short-term outcomes of patients with CE in Bhutan based on hospital records from to 2020-2024.
METHODS:
Medical records of 120 patients with hepatic or pulmonary CE from hospitals across Bhutan were retrospectively reviewed. Demographic data, clinical presentation, diagnostic methods, treatment approaches, and outcomes were extracted and analyzed.
RESULTS:
The patients’ age ranged from to 6 - 85 years old (median 36 years), with 60% of patients being female. The liver was the most commonly affected organ (70%), followed by the lungs (8.3%). In 82.5% of CE diagnoses, ultrasound (US) and computed tomography (CT) were used, either individually or in combination. However, CE cyst staging was performed in only 10.8% of cases. Pre-intervention complications were reported in 40% of patients. Treatment approaches included surgery (open/laparoscopic partial cystectomy, deroofing, and cyst drainage) combined with albendazole therapy (55.8%), albendazole alone (4 %), and puncture-aspiration-injection-reaspiration (PAIR) in 5.8 % of the cases. Post-treatment complications occurred in 22.9% of surgical cases. One patient died, and 91.7% of the patients were discharged with symptom improvement. 22.5 % of the cases (27/120) were re-admission cases; out of which 20 (16.7%) were hepatic CE recurrences, and 7 pulmonary CE cases (5.8%) were admitted due to complications.
CONCLUSIONS:
This study highlights the clinical complexity of CE management and identifies several gaps, including the limited use of CE cyst staging, variable albendazole regimens, and minimal PAIR application in CE treatment. We suggest the implementation of ultrasound-based CE staging as per WHO recommendation, increased adoption of minimally invasive techniques such as PAIR, and implementation of an integrated ‘One Health’ surveillance system.
Cystic echinococcosis (CE) is a neglected parasitic zoonosis that poses significant public health challenges, particularly in rural areas where access to timely diagnosis and treatment facilities is limited. This study reviewed and analyzed the clinical characteristics, diagnosis, treatment, and short-term outcomes of patients with CE in Bhutan based on hospital records from to 2020-2024.
METHODS:
Medical records of 120 patients with hepatic or pulmonary CE from hospitals across Bhutan were retrospectively reviewed. Demographic data, clinical presentation, diagnostic methods, treatment approaches, and outcomes were extracted and analyzed.
RESULTS:
The patients’ age ranged from to 6 - 85 years old (median 36 years), with 60% of patients being female. The liver was the most commonly affected organ (70%), followed by the lungs (8.3%). In 82.5% of CE diagnoses, ultrasound (US) and computed tomography (CT) were used, either individually or in combination. However, CE cyst staging was performed in only 10.8% of cases. Pre-intervention complications were reported in 40% of patients. Treatment approaches included surgery (open/laparoscopic partial cystectomy, deroofing, and cyst drainage) combined with albendazole therapy (55.8%), albendazole alone (4 %), and puncture-aspiration-injection-reaspiration (PAIR) in 5.8 % of the cases. Post-treatment complications occurred in 22.9% of surgical cases. One patient died, and 91.7% of the patients were discharged with symptom improvement. 22.5 % of the cases (27/120) were re-admission cases; out of which 20 (16.7%) were hepatic CE recurrences, and 7 pulmonary CE cases (5.8%) were admitted due to complications.
CONCLUSIONS:
This study highlights the clinical complexity of CE management and identifies several gaps, including the limited use of CE cyst staging, variable albendazole regimens, and minimal PAIR application in CE treatment. We suggest the implementation of ultrasound-based CE staging as per WHO recommendation, increased adoption of minimally invasive techniques such as PAIR, and implementation of an integrated ‘One Health’ surveillance system.
| eISSN: | 2654-1459 |
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