Between 2021 and 2023, information on the disease's prevalence in the city was collected from Fallujah Teaching Hospital, Ramadi Teaching Hospital, and a number of private facilities. During procedures to remove cysts from various organs in patients of both sexes, 52 infected patients' cysts were collected according to approval obtained from the ethical committee at Fallujah Teaching Hospital. Furthermore, information quality may differ based on hospital location, treatment standards and the quality of treatment service. However, the majority of data came from each population's yearly number of cases relevant to this model of study and from patients who have severe clinical diseases but are typically unable to acquire early diagnosis. Such cases were not formally identified and did not receive medical care [13,14]. Due to a lack of access to healthcare and poverty, early treatment was not possible in these patients. In Iraq, human CE cases may not be consistently reported by the healthcare facility, and hospital diagnoses are not often recorded in regional or national databases or public reporting [15,16]. As a result, there is a fundamental lack of information in World Health Organization reports on the epidemiology and severity of the disease's spread throughout Iraq, not only in the city of Fallujah but in all of Iraq, either in terms of reporting known treated cases or documenting them.

Statistical Analysis

In order to evaluate the data using SPSS 16 with a significance threshold of less than 0.05, descriptive statistics and the Chi-square test were used.

Results

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The data provides a comprehensive overview of the distribution of hydatid disease cases across various demographics, organ involvement, and time periods.

In terms of organ infection, the liver is the most commonly affected, with 46.2% of cases (24 patients). This is followed by the lungs, which account for 23.1% of cases (12 patients). A smaller percentage of patients (5.8%, or 3 patients) exhibited infection in both the liver and lungs. Kidneys and spleen were affected in 25% of the cases (13 patients), rounding out the total of 52 patients affected by hydatid disease (Table 1).

When looking at the age distribution, the most affected group was between 20 and 40 years old, comprising 44.2% (23 patients) of the cases. Patients under 20 years of age represented 34.6% (18 patients), while those over 40 accounted for 21.2% (11 patients). This suggests that young to middle-aged adults are more susceptible to hydatid disease (Table 2).

Gender-wise, there is a higher prevalence of infection among females, who made up 59.6% (31 patients) of the cases, compared to males, who represented 40.4% (21 patients). This indicates that hydatid disease is more common in females in this sample (Table 3).

Finally, the study period reveals a sharp increase in infection rates from 2021 to 2023. During 2021–2022, 38.5% of cases (20 patients) were recorded, but in 2022–2023, the number of infections surged to 61.5% (32 patients). This substantial rise highlights the growing prevalence of hydatid disease over the course of the study (Table 4).

According to statistics collected during the time period, the infection rate in 2022–2023 was exceptionally high, reaching 61.5% as opposed to rates in 2021–2022, which reached 38.5%.

The size and location of the developing cysts affect the clinical signs of hydatid illness. Certain cysts, such as those that cause cirrhosis, bronchial blockage, renal outflow obstruction, elevated intracranial pressure, and hydrocephalus, may result in the malfunction of the organs they are attached to. Anaphylaxis is a side effect of the free rupture of the echinococcal cyst, and it can also release tiny cysts that can spread to other organs [17]. Cysts that are near the pleural membranes might rupture and result in pleural effusion, reactive inflammation, or secondary bacterial infection. If the contents of the cyst leak into the surrounding tissues, either naturally through rupture, extension, and invasion, or artificially through iatrogenic pleural infestation during surgery, secondary lesions may form [18,19]. Lung cysts can burst, releasing tissue fragments that can cause hemoptysis, vomiting, coughing, and chest discomfort. They can also flow into the pleural cavity, where they can cause simple or tension pneumothorax, pleural effusion, or empyema. A higher intracystic pressure is the underlying cause of the compression and necrosis of the walls of nearby bile ducts, integration of tiny biliary ducts into the pericyst, and finally rupture of the biliary ducts [20,21]. Small fissures, which are often asymptomatic, or perforation (i.e., frank communication), which may produce obstructive jaundice and cholangitis, are clinically two possible manifestations of communicating rupture within the biliary system. Hydatid cyst illness has been treated with surgery and medication [22]. According to the city’s computerized archiving system, not all surgical operations performed on patients were recorded after they left the institutions. With the exception of the Fallujah Teaching Hospital, information is written down on paper at the other hospitals. Although the percentage of operations to remove cysts from patients is partially documented, cases were not recorded in the World Health Organization’s records and reports, as in the case in Fallujah and throughout Iraq, which is why it is impossible to assess the extent of the disease’s spread in either Fallujah specifically or Iraq generally.  Depending on the procedure used, the mortality rates of surgical patients may increase significantly [23]. Since 1977, albendazole and mebendazole have been widely used to treat hydatid cysts [24]. The original treatment was mebendazole (MBZ), but over time it was shown to be less successful than albendazole (10–15 mg/kg/day, with a maximum of 800 mg orally in two doses) [25]. The medicine is ineffective because MBZ is insoluble in water and has low solubility and bioavailability [26]. The treatment response was better in pulmonary (83%) than in hepatic (18%) regions for small cysts less than 5 cm in size, according to MBZ [27]. Among 52 patients, the liver was affected in 46.2% of cases. Lungs alone (23.1%) were the second most affected organ, according to this data [28]. Following the development and proliferation in the liver, infection spreads to other organs at a 25.0% rate (Table 1), The spleen, pancreas, and other abdominal and thoracic organs may be affected by cysts that breach the liver capsule and continue exogenous growth in the peritoneal cavity [22,29,30], complications from a hepatic hydatid cyst. In around 40% of instances, liver echinococcal cysts can result in problems [31]. Infection, biliary tree rupture, peritoneal cavity rupture, pleural cavity rupture, and lung rupture are the most frequent consequences in that regard (13%). [31,32]. According to the findings, the age group of 20 to 40 had the greatest proportion of illness infection at 44.2%, with the remaining age groups following suit: According to Table 2 (34.6% of those under 20 years old and 21.2% of those over 40). According to earlier research, infection incidence can be significantly influenced by an individual’s age [33]. Data analysis of Table 3 demonstrates that incidence rates with age differences were greater in females (59.6%) than in males (40.4%). By accepting the conclusion reached by researchers examining the influence of sex hormones in mice with hydatid cysts that female hormones enhance the infection of E. granulosus , the findings may be explained. [32]. In order to maintain a favorable environment for its survival, E. granulosus  possesses a method through which it promotes the adrenal gland synthesis of estradiol and testosterone [34]. According to reports, women are more vulnerable to illness than men [9]. The sex of the host has a significant role in the susceptibility and kind of reaction to parasitism; in this situation, females are more likely than men to get infected with the metacestode of E. granulosus . The females had a greater granulomatous response than the men did, but this was insufficient to kill the parasite or stop its proliferation [35]. E. granulosus  is a member of the cestode family and mostly affects the liver and lungs. Following infection, the parasite develops a number of evasion strategies that influence how long it remains in the host organs. The infection rate in 2022–2023 was exceptionally high, reaching 61.5% compared to rates in 2021–2022, which reached 38.5%, as shown in Table (4). Age, gender, infection intensity, cyst size, and the bodily organ implicated all affect the disease's epidemiological, clinical, and pathological symptoms [36].

This study revealed that the infection predominantly affected the liver and lungs but in some cases, extended to other organs. Females were more infected, probably due to hormonal influences. The most affected age group was between 20–40 years. Infection rates were on the rise from 2021–2023. Surgical treatment is the mainstay of treatment, whereas medical therapies give variable results, especially regarding lung cysts. The important variables that define the outcome of the disease are gender, age, and location of the cysts.

Tables and Figures

Competing Interest

The author declares no conflict of interest.

Acknowledgement

Thanks, and gratitude to the Anbar Health Department / Research and Development Center for the facilities provided, as well as to the staff of surgeons in the hospitals (Fallujah Teaching, Ramadi Teaching).

Authors Contributions

The authors equally contributed to this work.​

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