Hydatid Cyst Among Patients Attending Al-Jamhoory Teaching Hospital in Mosul, Epidemiology and Clinical Profile

Background: Hydatid disease is a zoonosis induced by Echinococcus tapeworms. Humans are infected by ingestion of Echinococcus eggs by eating contaminated food. Objective: To Investigate the epidemiology of hydatid cyst first and final diagnosis in patients find out its clinical profile. Method: The current study is a Case-series retrospective study for the patients attending Al-jamhoory Teaching Hospital between January 1, 2019, and July 1, 2021. The information was gathered from medical records. The data were analyzed using the frequency index, relative frequency and SPSS (Statistical Package for the Social Sciences). Results: One-hundred eleven patients underwent during the study period. Sixty-three percent of them were males. unemployment state was 81.98%. The commonest ages of infection were 41-50 years as constitute 38.73%. About Fifty-nine percent of the patients were affected in the liver and about four percent of the patients were injured in the lungs. Villagers made up 57.65% of the patients. We found a total of (65.76%) patients had cats or dogs at home. The diagnosis of hydatid infection by Ultrasound of abdomen, Chest Xray, and CT of the chest were (47.74%), (42.34%) and (9.9%) respectively. About Ninety percent of patients eat at restaurants on a regular basis. About Twenty-eight percent of patients have a hydatid cyst in their family. Conclusion: The study indicate that diagnostic instruments are fundamental in diagnosis of hydatid as its diagnosis through clinical or preclinical are uncertain. Further education program is recommended to decrease its occurrence in Mosul city.

. Humans, as intermediary hosts, become infected by mistake, either by drinking contaminated water, eating contaminated vegetables, or coming into direct contact with dogs 4 . The clinical and epidemiological symptoms of hydatid cyst infection vary depending on the degree of infection, size, and location of hydatid cyst development 5 . Infection of humans with this illness has been documented in several parts of Iraq 6 . Hydatid cyst illness is extremely important; it affects vital organs in humans, particularly the liver and lungs, and it causes considerable economic losses in animals 7 . Furthermore, despite the availability of novel therapeutic options, surgery remains the most prevalent treatment option for this condition, resulting in significant economic and health consequences for nations 8 . Hydatid cysts, according to certain research, have distinct clinical-radiological features and treatment approaches. As a result, clinicians frequently struggle to make a solid diagnosis for this condition 9 . As a result, getting an appropriate diagnosis is critical for treating this condition and avoiding its consequences. Given the annual rate of this disease, relapse cases, and the serious consequences of an incorrect diagnosis, the current study aimed to investigate the epidemiology of hydatid cyst first and final diagnosis in patients admitted to the surgery unit of Al-jamhoory teaching hospital in Mosul from January 1, 2019 to July 1, 2021 with its clinical profile.
Hydatid disease is diagnosed using a variety of serological testing. Indirect hemagglutination (IHA) and Immunoelectrophoresis are two common tests (IEP). IHA has a 60 % sensitivity in calcified or lung lesions and an 88 % sensitivity in peritoneal or liver disease, with a 90-95 %specificity 1,2 . Although IEP is considered a very specific test, cross-reactivity with other illnesses such as Taenia Solium (Cysticercosis) or, in rare cases, liver cirrhosis or malignancy, may occur (cross-reactivity with P1 antigen).
Treatment of HC of the liver can include medical therapy, percutaneous drainage, or surgical intervention (via a conventional or laparoscopic approach). 7

MATERIALS AND METHODS
The current study is a Case-series retrospective study. The study's statistical population included all hydatid cyst patients who admitted to Aljamhoory Teaching Hospital and had surgery between January 1, 2019 and July 1, 2021. The information for this study gathered by consulting the patients' medical records. They then documented in the checklists that had been created specifically for this reason. Demographic information (gender, age, occupation, residence, and nationality), information about hydatid cysts (infected organ and number of cysts), and questions about symptoms, clinical symptoms, date of referral, date of discharge, length of stay in hospitals, primary diagnosis, serological tests performed, test results, infected area, and final diagnosis are all included. The data analyzed using the frequency index, relative frequency, and SPSS (Statistical Package for the Social Sciences).

RESULTS
About Sixty-three percent of the 111 patients with hydatid cysts admitted at Al-jamhoory teaching hospital and undergoing surgery from January 1 to July 1, 2021, where (%36.93) were female. Thirty-eight percent of Infections was found in the age group 41-50 (Table 1). Unemployed people infected at a rate of 81.98 %; this was a very high prevalence of infection when compared to employees (  (Table 2). Hundred and one patients eat at restaurants on a regular basis. Twenty-eight of the patients had a hydatid cyst in their family Table 4 .

DISCUSSION:
one hundred eleven individuals were hospitalized with hydatid cyst from January 1, 2019, to July 1, 2021. (63.06%) more than half of cases were males have hydatid cyst infection; the study population Similar from a study done by khamees et al 2020 9 . More male infection cases have been observed in a research done by Al-Ani et al 2020 10 . As a result of direct contact with the soil during agriculture, animal husbandry, and employment outside the house, males are more prone to develop hydatid cysts. All of the participants in this research had had surgery for a hydatid cyst. There was no statistically significant difference regarding age distribution were P-value (0.09), The prevalent age group were between 41-50 age group, followed by the age group 51-60. the infection has the potential to impose a significant impact on the villagers' home economics by lowering working hours and the amount of labor done. The results of this study are in line with those of previous study done by Bhatt et al 2019, and Akkapulu et al 2018 4,7 . who mentioned that although the age distribution of the current study is consistent with that of many other studies such study done by Al-Ani et al 2020 10 , it differs from that of Abdulhameed et al 2018 in Basrah; the main reason for this could be the age gap between more active classes of stockmen and stockbreeders in this province in their fourth and fifth decades of life 11 . Medical ultrasonography (47.74 %) and chest X-rays (42.34 %) were the most often utilized diagnostic tests in this study. CT scans, on the other hand (% 9.9). The findings of this study are congruent with those of Fallah et al 2019 12 . when it comes to CT scans and medical ultrasounds as the most widely utilized techniques of detecting abdominal hydatid cyst. When the sonographer suggests it, a CT scan is requested. Maharjan et al 2018 found that Elisa and indirect hemagglutination were the most reliable serological tests for illness initial diagnosis and recurrence in a study of 22 patients who had had hydatid cyst surgery. We did not find any statistically significant differences in our results, where the value of P-value (0.11) . Moreover, compared to other serological techniques, the dot-Elisa test has a higher level of sensitivity. Khamis' study reports the dot ELISA test to detect hydatid cyst in people as a rapid, low-cost, and 100% sensitive diagnosis 9 . It was difficult to use this test due to the lack of permanent and sufficient materials needed for this test. Because of the differential diagnosis and understanding of the cyst setting state, physicians prefer ultrasound testing over serological tests. A chest X-ray is the most commonly used method for diagnosing a hydatid cyst in the lung. According to Ahmed's 2019 research, chest x-ray sensitivity of individuals with hydatid cyst was more effective 8 . Patients from country side constitute more than half of the study population. Where we found significant statistically correlation P-value (0.05). The reason for this Because individuals in rural areas have greater direct interaction with animals than city dwellers, as Parkoohi et al 2018 discovered in his research 13 . They also ate a lot of food at restaurants (90.99%) where we found significant statistically coloration P-value (0.02) , which might be due to a lack of attention to hygiene and pollution in restaurants, which has resulted in a rise in the prevalence of illness. These findings are in line with the findings of Sarawagi et al 2018 5 . The patients that owned an animal in the house constituted (65.76%) as we found a significant statistically difference Pvalue indicating a higher infection value (0.02) among them as a consequence of direct contact with such animals, especially if there is no health knowledge and care for animal health and regular trips to the veterinarian. This finding is in line with the findings of several researches such as study done by Fallah et al 2019 12 . Including research into Joshi et al 2020 and Al-Ani et al 2020 as well as other studies 6,10 . The liver was the location of damage in 59.45 % of cases, followed by the liver and lung in 36.03 % of cases, and the lung in 4.5 % of cases. This finding is in line with the findings Al-Ani et al 2020 in their research, who reported a variety of signs and symptoms, including delusions, pallor, stomach discomfort, enlarged liver, and coughing, and shortness of breath in some cases. This is similar to the findings of Abuhajar et al 2018 and Abebe et al 2017 in their research 10,14,15 .

CONCLUSION
The study indicate that diagnostic instruments are fundamental in diagnosis of hydatid as its diagnosis through clinical or preclinical are uncertain. Further education program is recommended to decrease its occurrence in Mosul city.