Hepatic Cystic Echinococcosis: Predictive Factors of Cyst Fluid Fertility and Viability

Abstract

BACKGROUND: Cystic echinococcosis caused by Echinococcus granulosus is a major health concern. Hepatic cystic echinococcosis management depends on cyst activity, classified by the WHO-IWGE system. However, reliable criteria to predict cyst fluid (CF) viability are lacking. This study evaluates the correlation between cyst fertility, protoscolex viability and various clinical, biological and radiological parameters. METHODS: A prospective analytical study was conducted over 70 months, analysing hepatic cystic echinococcosis cysts excised during surgery. The CF was examined microscopically to assess cyst fertility and protoscolex viability. Associated factors for fertility and viability were determined. RESULTS: A total of 126 hepatic cystic echinococcosis cysts from 70 patients were analysed. The median patient age was 39 years (range: 13-76), with a female predominance. Abdominal pain was the most common symptom (78.6%), and hydatid serology was positive in 94.3% of cases. The overall fertility rate of CF was 71.4% (90 cysts). Associated factors for fertility in bivariate analysis included age > 35 years, female gender, AST < 21 IU/L, clear CF and vascular compression. CE4 cysts and gelatinous CF were associated with non-fertility. Multivariate analysis revealed age and vascular compression as independent predictors of fertility, whilst CE4 cysts and gelatinous CF were predictors of non-fertility. The median viable protoscolex count was 1.5 per 100 μL (range: 0-146). CE1 cysts, clear CF and vascular compression predicted protoscolex viability, whereas CE3b/CE4 cysts, cyst wall calcifications and gelatinous CF were associated with non-viability. Multivariate analysis identified WHO-IWGE cyst classification as the only independent predictor of viability. CONCLUSION: Cyst fertility and viability in hepatic cystic echinococcosis are influenced by diverse factors. The WHO-IWGE classification emerged as the key predictor of viability, reinforcing its role as the basis for cyst classification.