Retrospective Analysis of Cystic Echinococcosis: Clinical Characteristics and Treatment Outcomes in patients in Bahir Dar and Gondar Cities, Ethiopia

Retrospective Analysis of Cystic Echinococcosis: Clinical Characteristics and Treatment Outcomes in patients in Bahir Dar and Gondar Cities, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retrospective Analysis of Cystic Echinococcosis: Clinical Characteristics and Treatment Outcomes in patients in Bahir Dar and Gondar Cities, Ethiopia Muluken Yayeh, Mastewal Birhan, Ambay Kenubih, Endalkachew Sisay, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9263427/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Cystic echinococcosis (CE), caused by Echinococcus granulosus and transmitted through contact with infected dogs or contaminated feed and water, is a neglected zoonotic disease that could lead to serious, often fatal, liver or lung cyst development. It causes severe health issues with over $ 3 billion in annual livestock economic losses. Aim The aim of this study was to assess the clinical characteristics and treatment outcomes of patients diagnosed with CE from selected hospitals in Bahir Dar and Gondar cities, Ethiopia. Methods A five-year retrospective study was carried out at Felege Hiwot, University of Gondar, and Tibebe Ghion Specialized Hospitals from January 2021 to January 2025. We examined the demographics, cyst features, organ involvement, diagnostic techniques, course of treatment, and clinical outcomes of 157 CE patients in their records. Trends were analyzed using linear regression and ARIMA (1), with projections for 2035 and 2050. A chi-square test was used to observe the association of variables with clinical outcomes. Results Of the 157 patients, 113 (72%) were males while 44 (28%) were females, with an average age of 43.2 ± 11.1 years. Eighty percent (n = 126) were rural dwellers. The most affected organ was the liver (82.8%, n = 130), followed by the lung (11.5%, n = 18). Among the participants, 110 (64%) had a single cyst, while 51 (36%) had multiple cysts. The most common diagnostic technique used was a CT scan (69%, n = 109). One hundred fifteen patients (73%) received non-surgical care, while 42 patients (27%) had surgery. A linear regression analysis of cystic echinococcosis cases from 2021 to 2025 showed a slight but non-significant increasing trend (β = 1.1, p = 0.653) with low explanatory power (R² = 0.076), and forecasts suggest a gradual rise that should be interpreted cautiously due to limited data. Of 42 surgically treated patients, 78.6% (33/42) were cured, 16.7% (7/42) exist with the problems, and 4.8% (2/42) died. Multiple cysts and older age (> 65 years) were linked to worse outcomes (p < 0.05). Conclusion Cystic echinococcosis predominantly affects rural adult males with hepatic involvement. Younger ages and solitary cysts correlated with improved outcomes, whereas older ages and multiple cysts increased the likelihood of complications and mortality. Early detection, preventive approaches, and careful perioperative care were suggested as important to improving outcomes. Clinical Trial Registration Not applicable. This study did not involve a clinical trial and therefore was not registered. Clinical outcome cystic echinococcosis surgery Ethiopia retrospective study Figures Figure 1 Figure 2 Figure 3 Figure 4 BACKGROUND Cystic Echinococcosis (CE) is a chronic, neglected zoonotic disease caused by the larval stage of Echinococcus granulosus , primarily impacting the liver and lungs of intermediate hosts (livestock) and humans, who act as accidental hosts (Pal et al., 2022 , Maher and Shaapan, 2025 ). The World Health Organization (WHO) classifies it as a priority neglected zoonosis, advocating for "One Health" approaches combining medical, veterinary, and environmental controls to manage this disease that causes widespread morbidity and economic losses (Samanta et al., 2024 ). Cystic Echinococcosis is a cosmopolitan parasite, present on all populated continents, with high prevalence in regions with poor sanitation and low economic development (Christofi, 2022 ). The estimated pooled prevalence in accidental and intermediate hosts in Ethiopia is about 22% (Aregawi et al., 2024 ). Larvae of the parasite mostly affect the liver and lungs, and humans contract the infection by consuming contaminated food or drink (Pal et al., 2022 ). Depending on the size and location of the cyst, different clinical symptoms may appear (Paduraru et al., 2023 , Hogea et al., 2024 ). Cystic Echinococcosis thrives in rural, agricultural areas with high dog populations, particularly in the Mediterranean, Central Asia, China, Australia, South America, and North and East Africa (Christofi, 2022 , Pal et al., 2022 ). The disease results in substantial morbidity and economic loss, including livestock production losses and treatment costs (Aftab et al., 2025 ). Management options include surgery, PAIR (puncture, aspiration, injection, and re-aspiration), anti-parasitic therapy, and watchful waiting, with surgery being the main approach for large or complicated liver cysts (Tamarozzi et al., 2022 , Organization, 2025 ). Close human-animal contacts, especially in pastoral and rural areas, inadequate slaughterhouse hygiene, and restricted access to veterinary and healthcare services all have an impact on the epidemiology of CE (Karshima et al., 2022 ). In Ethiopia, the disease is more common in rural areas where people live in close proximity to domestic dogs and cattle (Fayisa et al., 2025 ). In many regions of the nation, human CE is still inadequately documented despite its acknowledged impact, and there is a dearth of clinical and demographic data to support focused interventions. Designing successful One Health control initiatives, improving patient care, and guiding public health policy all depend on an understanding of regional disease trends, including cyst distribution, treatment outcomes, and demographic traits. The aim of this study was to assess the clinical characteristics and treatment outcomes of patients diagnosed with CE through a five-year retrospective review of cases from selected hospitals in Bahir Dar and Gondar cities, Ethiopia. MATERIAL AND METHODS Study Area This study was conducted in three purposefully selected major referral hospitals in the Amhara region of Ethiopia: Tibebe Ghion, Felege Hiwot Comprehensive, and University of Gondar Comprehensive Specialized Hospitals. Tibebe Ghion Specialized Hospital is the flagship teaching hospital of Bahir Dar University College of Medicine and Health Sciences and provides specialized and patient-centered healthcare services to more than 10 million people in the region. The College of Medicine and Health Sciences, was established in 2007 and has become one of the leading institutions for medical training and healthcare delivery in Ethiopia. Felege Hiwot Comprehensive Specialized Hospital is a major government referral hospital serving the Amhara region and surrounding areas. It delivers comprehensive healthcare services, including pediatric, neonatal, and multidisciplinary specialized care, and plays a central role in Ethiopia’s four-tier healthcare system. University of Gondar Comprehensive Specialized Hospital is a premier teaching and tertiary referral hospital affiliated with University of Gondar. Established in 1954, it provides advanced medical services and serves as a major training center for health professionals in Ethiopia. Study Design and Period To evaluate the clinical features and treatment outcomes of patients with CE, a hospital-based retrospective study was carried out. Patients who received treatment for CE between January 2021 and December 2025 were included in the study. All eligible patients' healthcare records were examined throughout the course of these five years in order to gather information on socio demographic traits, epidemiological risk factors, clinical presentations, diagnostic results, treatment approaches, and treatment outcomes. After gaining access to patient charts and hospital registries from the relevant institutions, data extraction from medical records was carried out. Study Population and sample size All patients treated for Cystic Echinococcosis (CE) at three specific referral hospitals were included in the study. All individuals who received medical and/or surgical care in these hospitals in the study period and whose medical records showed a verified diagnosis of CE were included. For the study, patient charts and hospital data from discharge registries, surgical wards, and medical wards were examined. A total of 157 individuals with CE over the course of the five-year study period were included. Forty two patients with hepatic Cystic Echinococcosis (CE) who had surgery were evaluated. Based on postoperative follow-up data, clinical outcomes were classified as either cured, complications, or death. To examine their relationship with clinical outcomes, pertinent patient information such as age, sex, kind of cyst, and treatment hospital were collected. Inclusion and Exclusion Criteria All patients who received treatment for CE at the selected Specialized Hospitals, between January 2021 and December 2025 and whose medical records included comprehensive details about the diagnosis, clinical features, course of treatment, and results were included for this study. Patients with inadequate medical records, uncertain diagnoses, suspected but unconfirmed cases of CE, or missing or unavailable charts during the data collection period were excluded. Data Collection Medical records of patients with Cystic Echinococcosis (CE) who were hospitalized to particular hospitals in Bahir Dar and Gondar over a five-year period were examined in this retrospective analysis.. Age, sex, residence, organ involvement, number and kind of cysts, diagnostic procedure, type of treatment, and clinical results (cure, complications, or death) were gathered using a standardized form. Hospital records were used to determine clinical outcomes: death was defined as in-hospital mortality, complications as any postoperative adverse events, and cure as recovery without difficulties. Data extraction was done by qualified staff after training, and all entries were verified for accuracy by cross-referencing them with surgical records and discharge summaries. To ensure secrecy, patient identification was removed and distinct codes were assigned. Statistical Analysis The data were cleaned, coded and entered into an Excel spread sheet and exported to Stata version 17 for analysis.. Clinical variables, treatment results, and patient characteristics were summarized using descriptive statistics. Depending on the distribution, continuous variables like age were reported as mean ± standard deviation (SD) and median. Frequencies and percentages were used to describe categorical information, such as sex, residence, organ involvement, number of cysts, and clinical outcomes. The Chi-square test was used to evaluate associations between categorical variables (such as sex, age group, number of cysts, hospital) and clinical outcomes. Statistical significance was determined as a p-value of less than 0.05. Tables were used to present the results. To evaluate temporal trends, annual situations of cystic Echinococcosis (CE) from 2021 to 2025 were examined. Changes over time were assessed using linear regression, and possible temporal dependence was investigated using an ARIMA(1) model. Additionally, trends were visualized using a moving average smoothing technique. Future CE cases were estimated for 2035 and 2050 using the linear regression model. Ethical Approval and Consent to Participate The University of Gondar Research and Collaboration Vice President Office Research Ethics Committee provided ethical approval with a Ref. No. VP/RC/05/630/2025). The ethics committee disregarded the need for individual informed permission because this study examined hospital records of patients with cystic Echinococcosis. Prior to analysis, all patient data was anonymised to protect privacy and confidentiality. The study was carried out in compliance with the Declaration of Helsinki's ethical guidelines. RESULTS Demographic Characteristics For 157 study patients’ the age ranged from 13 to 72, suggesting that a wide age range was impacted by the disease. The majority of instances were found in middle-aged people, especially those between the ages of 40 and 49. In terms of gender distribution, 44 patients (28.03%) were females and 113 patients (71.97%) were males. The majority of patients (80.25%, n = 126) were from rural, whereas 19.75% (n = 31) were from metropolitan areas. Of the participating hospitals, the University Of Gondar Comprehensive Specialized Hospital reported 61 cases (38.9%), Felege Hiwot Comprehensive Specialized Hospital 52 cases (33.1%), and Tibebe Ghion Specialized Hospital 44 cases (28.0%) as indicated in Table-1 . Clinical Characteristics The most common organ involved was the liver, which accounted for 82.8% (n = 130) of all cases. The lung was the second most (11.46% (n = 18), affected organ. The abdominal cavity (3.18%), spleen (1.91%), and kidney (0.64%) were among the other less commonly affected locations. In terms of the characteristics of the cysts, 100 patients (63.69%) had a single cyst, while 57 patients (36.31%) had multiple. Most single and multiple cyst instances were found in male patients. Male patients presented at older ages than female patients, with the highest mean ages observed in those with multiple cysts ( Table-1 ). Diagnostic Methods Computed tomography (CT) scans were done in 69.43% (n = 109) of patients, making them the most frequently used diagnostic modality. Thirty point fifty seven percent (48/157) of the patients underwent ultrasound. Confirming the existence and location of hydatid cysts was made possible in large part by these imaging methods as indicated in Table-1 . Treatment Patterns In terms of treatment, 73.3% (n = 115) of the patients received non-surgical management, whereas 26.7% (n = 42) had surgery ( Table-1 ). Table 1: Socio-Demographic and Clinical Characteristics of CE Patients in Selected Hospitals of Bahir Dar and Gondar Cities, January 2021–December 2025 (n = 157) Variable Category Frequency (n) Percentage (%) Sex Male 113 71.97 Female 44 28.03 Residence Rural 126 80.25 Urban 31 19.75 Organ involved Liver 130 82.8 Lung 18 11.46 Abdominal cavity 5 3.18 Spleen 3 1.91 Kidney 1 0.64 Cyst type Single cyst 100 63.69 Multiple cysts 57 36.31 Diagnosis method CT scan 109 69.43 Ultrasound 48 30.57 Treatment Non-surgical 115 73.3 Surgical 42 26.7 Distribution of Cysts by Organ and Cyst Type An examination of the distribution of cysts in various organs revealed that the liver had the highest number of cysts, with 45 multiple cysts and 85 single cysts. The second most commonly affected organ was the lung, which encompasses seven multiple cysts and eleven single cysts. Less often affected organs included the kidney (one single cyst), spleen (one single and two multiple cysts), and abdominal cavity (two single and three multiple cysts). In general, most organs had more single cysts than multiple cysts (Table -2 and Table-2 ). Age Distribution by Sex and Cyst Type The three hospitals; Felege Hiwot Comprehensive, University of Gondar Comprehensive, and Tibebe Ghion Specialized Hospitals had somewhat different age distributions based on sex and cyst type. There were fewer female patients with multiple cysts at each of the three hospitals 7 at Felege Hiwot, 7 at the University Of Gondar, and 3 at Tibebe Ghion Hospitals. Their mean ages were 40.3 ± 9.4 years, 41.3 ± 8.8 years, and 39.0 ± 1.7 years, respectively. Six female patients at Felege Hiwot 12 at the University Of Gondar, and 9 at Tibebe Ghion Hospitals had solitary cysts; with a mean ages of 36.8 ± 9.2, 37.8 ± 11.3, and 37.2 ± 10.6 years, respectively( Table-2 and figure-1) . Among male patients 11 at Felege Hiwot, 17 patients at the University Of Gondar, and 12 patients at Tibebe Ghion Hospitals had multiple cysts; their corresponding mean ages were 52.9 ± 9.6, 45.2 ± 10.9, and 45.0 ± 9.4 years. With 28 instances at Felege Hiwot, 25 at the University Of Gondar, and 20 at Tibebe Ghion Hospitals, male patients with solitary cysts were more common with mean ages of 43.5 ± 11.7, 44.9 ± 7.2, and 48.5 ± 10.9 years, respectively. In general, male patients especially those with many cysts tended to arrive older than female patients ( Table-2 and figure-1 ). Table 2: Distribution of Age by Sex, Cyst Type, and Hospital among CE Patients in Selected Hospitals of Bahir Dar and Gondar Cities, January 2021–December 2025 (n = 157) Sex Cyst Type Hospital Count Mean-Age SD- Min- Max- Median Female Multiple FH 7 40.3 9.4 22 53 42 Female Multiple UoG 7 41.3 8.8 25 49 45 Female Multiple TG 3 39 1.7 37 40 40 Female Single FH 6 36.8 9.2 23 49 38.5 Female Single UoG 12 37.8 11.3 25 65 39.5 Female Single TG 9 37.2 10.6 13 52 40 Male Multiple FH 11 52.9 9.6 29 64 55 Male Multiple UoG 17 45.2 10.9 17 65 45 Male Multiple TG 12 45 9.4 26 61 45 Male Single FH 28 43.5 11.7 19 65 45 Male Single UoG 25 44.9 7.2 32 62 44 Male Single TG 20 48.5 10.9 26 72 48 FH; Felege Hiwot; TG: Tibebe Gion; UoG: University of Gondar. Figure-1 : Demographic Characteristics and Cyst Type Distribution of Patients with CE A) Age distribution of patients diagnosed with CE. The histogram shows the frequency of patients across different age groups, with a density curve illustrating the overall distribution pattern. Most cases were concentrated in middle-aged adults, particularly between 40 and 50 years. (B) Sex distribution of patients. The bar chart shows that male patients (n = 113) constituted the majority of cases compared with female patients (n = 44). (C) Distribution of cyst types among patients. The horizontal bar chart indicates that single cysts (n = 100) were more frequently observed than multiple cysts (n = 57) among the study population. Figure-2 : Cyst Distribution, Treatment, and Age Patterns in Patients with Cystic Echinococcosis (A) Distribution of single and multiple cysts by organ. The liver was the most affected organ (85 single, 45 multiple cysts), followed by the lung. Other organs were less frequently involved. (B) Treatment types by diagnostic method. Among patients diagnosed by CT scan, 27 underwent surgery and 82 received non-surgical treatment. For ultrasound-diagnosed patients, 10 had surgery and 38 were managed non-surgically. (C) Age distribution by cyst type. Box plots show similar age ranges for patients with single and multiple cysts, mostly in their 40s and 50s. Temporal Trend of CE Cases From 2021 to 2025, the annual distribution of CE cases among hospitalized patients varied. In 2021, there were just 22 cases, the lowest record. In 2022, the number raised to 37 cases, the highest yearly count throughout the study period. The number of cases decreased slightly to 34 in 2023, and then to 36 in 2024. As shown in the chart, there was another decline in 2025, with 28 instances reported. Throughout the study period, single cysts were continuously more common than multiple cysts when cyst types were evaluated by year. For instance, 24 single and 13 multiple cysts were observed in 2022 compared to 15 single and 7 multiple cysts in 2021. As seen in the image, a comparatively balanced distribution of 19 single cysts and 17 multiple cysts were noted in 2024 as showed in Fig. 3. Figure 3 : Temporal Trends in CE Patient Distribution and Cyst Type Patterns in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 157) Linear Regression Analysis of CE Cases (2021–2025) with Future Projections A linear regression model was fitted to Cystic Echinococcosis (CE) case data from 2021 to 2025 to assess temporal trends. The analysis showed a small, non-significant increasing trend in CE cases over time (β = 1.1 cases per year, p = 0.653), with a low coefficient of determination (R² = 0.076), indicating that year explained only a small proportion of the variability in case counts. Year-to-year changes demonstrated notable fluctuations, with an increase of 15 cases from 2021 to 2022, followed by a decrease of 3 cases in 2023, a slight increase of 2 cases in 2024, and a further decrease of 8 cases in 2025. These variations suggest the absence of a consistent temporal pattern. To further explore the trend, a moving average smoothing approach was applied, which revealed only minor variations over time without a clear sustained increase or decrease. Similarly, time series modeling using an ARIMA (1) model showed that the autoregressive parameter was not statistically significant (p = 0.297), indicating limited evidence of temporal dependence, likely due to the small number of observations. Forecasting based on the linear regression model suggested a gradual increase in CE cases over time. The projected number of cases was approximately 44.6 in 2035 and 61.1 in 2050. However, given the limited sample size and low explanatory power of the model, these projections should be interpreted with caution. Additional data over a longer time period are required to improve the reliability of future predictions Table-3 . Table 3 : Linear Regression Analysis of Cystic Echinococcosis Cases over Time with Predicted Cases for 2035 and 2050, Selected Hospitals of Bahir Dar and Gondar Cities, January 2021–December 2025 Table 3 Linear Regression Analysis of Cystic Echinococcosis Cases over Time with Predicted Cases for 2035 and 2050, Selected Hospitals of Bahir Dar and Gondar Cities, January 2021–December 2025 Variable / Year Coefficient / Cases Std. Error t P-value 95% CI Year 1.1 2.21 0.5 0.653 -5.95–8.15 Constant −2193.90 4479.63 −0.49 0.658 −16450.07–12062.27 Predicted 2035 cases Predicted 2050 cases 44.6 61.1 – – – – Association between Organ Involvement and Sex Sex had a significant impact on the distribution of hydatid cyst location (χ² = 11.03, p = 0.026). With 100 cases (88.5%) in males and 30 cases (68.2%) in females, liver involvement was the most common site in both genders. In comparison to men (8.0%), lung involvement was proportionately larger in women (20.5%). In both sexes, hydatid cysts in the kidney, spleen, and abdominal cavity were comparatively rare. These results showed a statistically significant correlation between the anatomical distribution of hydatid cysts and sex as showed in Table-4 . Association between Organ Involvement and Residence There was no statistically significant correlation found between the patients' location of residence and organ involvement (χ² = 6.51, p = 0.164). For both rural (84.1%) and urban (77.4%) inhabitants, liver cysts continued to be the most common location. 22.6% of patients in urban areas and 8.7% of patients in rural areas had lung involvement. Other organ localizations were uncommon and mostly affected those living in rural areas. In general, there was no discernible difference in the distribution of hydatid cyst location between rural and urban individuals as showed in Table-4 . Table 4 : Distribution of Cystic Echinococcosis Cases by Organ Involvement, Sex, and Residence in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 157) Table 4 Distribution of Cystic Echinococcosis Cases by Organ Involvement, Sex, and Residence in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 157) Organ involved Female n (%) Male n (%) Total Rural n (%) Urban n (%) Total Abdominal cavity 3 (6.8) 2 (1.8) 5 5 (4.0) 0 (0) 5 Kidney 1 (2.3) 0 (0) 1 1 (0.8) 0 (0) 1 Liver 30 (68.2) 100 (88.5) 130 106 (84.1) 24 (77.4) 130 Lung 9 (20.5) 9 (8.0) 18 11 (8.7) 7 (22.6) 18 Spleen 1 (2.3) 2 (1.8) 3 3 (2.4) 0 (0) 3 Total 44 113 157 126 31 157 Clinical outcomes Of the 42 patients who had surgery for hepatic Cystic Echinococcosis (CE), 78.6% were cured, 16.7% experienced postoperative problems, and 4.8% passed away as showed in figure- 4 , suggesting generally good surgical outcomes. Female patients had no recorded deaths, fewer complications (11.1% vs. 18.2%), and a better cure rate (88.9%) than male patients (75.8%). On the other hand, male patients accounted for all deaths (6.1%), indicating comparatively worse results in this group as showed in Table-5 . The outcome was significantly influenced by age. With a cure rate of 92.3%, few complications (7.7%), and no mortality, patients between the ages of 25 and 44 showed the best results. The cure rates was slightly lower (80.0%) while the complication rates were greater (20.0%) for those between the ages of 45 and 64, but no deaths were observed. With just 25.0% of patients over 65 being cured, 25.0% experiencing problems, and a significantly high mortality rates of 50.0%, patients over 65years had the worst outcomes, underscoring advanced age as a potential significant risk factor as showed in Table-5 . Surgical results were also affected by the number of cysts. Compared to patients with many cysts, who had a lower cure rate (60.0%) and a much higher complication rate (40.0%), patients with a single cyst had a greater cure rate (88.9%) and fewer issues (7.4%). Clinical results from the three hospitals Felege Hiwot, Tibebe Ghion and University Of Gondar were largely similar, with cure rates ranging from 76.9% to 81.3% and comparatively minor variations in complication and death rates. This implies that the surgical and postoperative care standards are uniform throughout the facilities as showed in Table-5 . Table 5 : Clinical Outcomes of CE Patients by Demographic Characteristics, Cyst Features, and Hospital in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 42) Table 5 Clinical Outcomes of CE Patients by Demographic Characteristics, Cyst Features, and Hospital in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 42) Variable Category Cure n (%) Complications n (%) Death n (%) Total n Sex Male 25 (75.8) 6 (18.2) 2 (6.1) 33 Female 8 (88.9) 1 (11.1) 0 (0.0) 9 Age group 25–44 12 (92.3) 1 (7.7) 0 (0.0) 13 45–64 20 (80.0) 5 (20.0) 0 (0.0) 25 > 65 1 (25.0) 1 (25.0) 2 (50.0) 4 Number of cysts Single (1) 24 (88.9) 2 (7.4) 1 (3.7) 27 Multiple (0) 9 (60.0) 6 (40.0) 0 (0.0) 15 Hospital Felege Hiwot 10 (76.9) 3 (23.1) 0 (0.0) 13 Tibebe Ghion 10 (76.9) 2 (15.4) 1 (7.7) 13 University of Gondar 13 (81.3) 3 (18.8) 0 (0.0) 16 Association of variables Of the 42 patients treated surgically for liver hydatid cysts, 78.6% (n = 33) were fully cured, 16.7% (n = 7) developed postoperative complications, and 4.8% (n = 2) died. The cure rate among male patients was 75.8%, compared to 88.9% among female patients. However, there was no statistically significant association between sex and clinical outcome (p = 0.600) . In contrast, age group showed a significant association with clinical outcome (p < 0.001). Patients aged over 65 years had the poorest outcomes, with a cure rate of 25% and accounting for all recorded deaths. Meanwhile, the youngest age group (25–44 years) had the highest cure rate (92.3%) and no mortality. Patients aged 45–64 years demonstrated intermediate outcomes, with a cure rate of 80.0% and no deaths. Patients with a single cyst had better outcomes, achieving a cure rate of 88.9%, compared to 60.0% among those with multiple cysts, and this difference was statistically significant (p = 0.034). There was no significant difference in clinical outcomes among the three hospitals (p = 0.884), suggesting a comparable standard of surgical and postoperative care across all institutions. Figure 4 : Proportion of Clinical Outcomes (Cure, Complications, and Death) among Surgically Treated Liver Cyst Patients in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 42) DISCUSSION Several significant outcome trends were found in this five-year retrospective examination of 157 patients with Cystic Echinococcosis (CE) treated at three major referral hospitals in Northwest Ethiopia. In addition to offering fresh perspectives on demographic risk factors and surgical outcomes in the Ethiopian setting, these data support current understanding of CE in endemic areas. The study's age distribution showed that CE affects adults across a wide age range, with the highest concentration of cases occurring in patients aged 40–49 years. Studies from other endemic regions, such as Iran (Alavi-Kakhki et al., 2025 ) and china (Gu et al., 2024 ) where adult working populations are mostly impacted, are consistent with this pattern. The comparatively low frequency among the elderly may be the result of underreporting because of comorbidities in older people or decreased exposure to transmission vectors (such as dogs or livestock). The observed male predominance (71.97%) is consistent with a number of Ethiopian and African series ((Karshima et al., 2022 , Govindasamy et al., 2024 ), which postulate that male agricultural and pastoral occupations raise the risk of transmission by increasing contact with infected dogs and livestock. Contrasting data from various Mediterranean regions (such as Spain and Italy) indicate a more equal sex distribution (Casulli et al., 2023 , Joanny et al., 2022 ), indicating that sociocultural and vocational differences have a substantial impact on the epidemiology of CE. Due to the zoonotic and environmental nature of CE transmission, the majority of cases (80.25%) involved rural residents. According to earlier research from different parts of the world (Sharma et al., 2023 , Kumaresan et al., 2024 ) and Ethiopia, close contact with cattle, poor veterinary care, and home slaughtering methods in rural Ethiopia probably favor the Echinococcus granulosus lifecycle. The necessity of focused public health initiatives in rural areas is highlighted by this distribution. Consistent with worldwide results, the liver was the most damaged organ (82.8%), followed by the lung (11.46%) (Mahmoodi et al., 2023 , Erfani et al., 2023 ). According to (Alavi-Kakhki et al., 2025 ), this preference is explained by the liver acting as the initial filter for oncospheres following intestinal absorption, with the lungs acting as a subsequent filter. Further supporting the normal anatomical distribution of CE are data from comparable in Middle East (Bhalla et al., 2023 ) and Africa (Govindasamy et al., 2024 ) that show low frequencies of cyst localization in the kidney, spleen, and abdominal cavity. Single cysts were more common than multiple cysts in our study, accounting for 63.7% of cases. Reports from other endemic areas, such as China (Wang et al., 2023 ) and Tunisia (Trigui et al., 2024 ), where solitary hepatic cysts are similarly the most common presentation, are in line with this trend. Since initial larval establishment usually results in a single lesion, the predominance of single cysts may be a reflection of the infection's normal progression. Recurrent exposure, delayed diagnosis, or variations in the host immune response, which can affect parasite growth and dispersion, can all lead to the less common development of many cysts. Nearly 70% of patients underwent CT scans, which were crucial to the diagnosing process. The high CT usage in this study indicates improved availability to advanced imaging in referral centers, even though ultrasonography is still the first-line, economical method for CE screening in resource-constrained settings (WHO Informal Working Group on Echinococcosis, 2003; (Manciulli and Brunetti, 2025 , Organization, 2025 ). As previously noted by (Semash and Voskanov, 2025 , Alpaca Rodriguez et al., 2025 ), CT provides greater delineation of cyst morphology, calcification, and extra hepatic dissemination, hence influencing surgical strategy. Non-surgical management predominated (73.3%), in line with current WHO and expert consensus recommending albendazole therapy and/or puncture-aspiration-injection-reaspiration (PAIR) for uncomplicated cysts (Umman and Akbulut, 2025 , Semash and Voskanov, 2025 ). Similar patterns have been noted in other endemic areas, where the use of conservative therapies has increased due to improved medication and minimally invasive techniques. However, complex instances or cysts with a high risk of rupture still require surgery, highlighting the necessity of tailored treatment choices based on patient risk factors and cyst features(Israfulovich et al., 2023 , Badwaik et al., 2024 ). There were significant variations in the temporal pattern of cystic Echinococcosis (CE) cases between 2021 and 2025, peaking in 2022 and then gradually declining approaching 2025. Since CE is frequently underdiagnosed because of its protracted asymptomatic course, these variances may represent changes in case identification, healthcare access, or reporting techniques rather than actual occurrence. Across all years, single cysts were consistently more common than numerous cysts, which is consistent with the disease's typical natural history in which the majority of infections manifest as solitary lesions. The comparatively even distribution seen in 2024 could be a sign of recurrent exposure or delayed presentation. Similar trends have been seen in endemic areas, where livestock husbandry and dog-human contacts impact the mechanics of transmission (Mutlu et al., 2025 , Li and Wei, 2025 ). The World Health Organization claims that gaps in surveillance and control programs lead to continued transmission, highlighting the necessity of more robust public health interventions and continual monitoring to lower the burden of disease (Eckert et al., 1984 ). The linear regression of CE cases from 2021 to 2025 revealed a very low explanatory power (R² = 0.013) and a small positive slope (0.5 cases/year) that was not statistically significant (p = 0.853), suggesting that year explains little of the variance in annual cases. The 2035 and 2050 projections (~ 44.4 and ~ 61 Instances) should be viewed cautiously because to the sparse evidence and large confidence ranges. Longer-term studies of human hydatid cyst cases, on the other hand, show varying temporal trends. For instance, a 17-year retrospective analysis in northeastern Iran revealed a non-significant declining trend over time in surgical CE cases (β = -0.95, p = 0.26), despite a persistent disease burden, highlighting fluctuating rather than steadily increasing case numbers over extended periods (Seyed-Sajjad., et al. , 2025). These findings imply that longer surveillance with larger datasets is required to identify significant changes and enhance forecasting in endemic settings, as short, 5-year clinical series may not reflect actual temporal dynamics in CE incidence. In this study, 4.8% of patients who had surgery to remove hepatic cysts died, 16.7% had postoperative problems, and 78.6% of patients were cured. Although the observed death rate is similar to results from other Ethiopian hospital-based research, it is lower than reported in previous African cohorts, perhaps due to advancements in perioperative care, surgical procedures, and postoperative monitoring. Hepatic CE surgical outcomes vary around the world; in institutions with established surgical expertise, cure rates are usually between 70 and 90 percent, and mortality is normally less than 5 to 10% (org Collaborative, 2023 , Huang et al., 2023 ). These findings demonstrate that surgery is still a safe and effective therapeutic option when carried out in well-equipped institutions with proper perioperative management. However, high-risk patients, such as those with many cysts or older adults, still require close observation. Age is a predictor of postoperative morbidity and death, according to global surgical literature (org Collaborative, 2023 , Jaén-Torrejimeno et al., 2022 ), which is consistent with the statistically significant correlation between age group and clinical result, with poor outcomes in patients over 65. Increased comorbidities and decreased physiological reserves in elderly patients underscore the necessity of improved preoperative monitoring and optimization. Compared to patients with a single cyst, those with many cysts had considerably worse results (p = 0.034). This result is in line with findings from other research (Tercan et al., 2020 , Bhat et al., 2025 , Rivadeneira et al., 2025 ) which indicate that a higher cyst burden is linked to both a higher risk of complications and more difficult surgical management. A longer operating time, a higher chance of incomplete removal, and a more complicated postoperative course can all be attributed to a higher number of cysts. There was a significant correlation between sex and organ involvement (χ² = 11.03, p = 0.026), indicating that site predilection may be impacted by exposure variations or underlying biological characteristics. Lung involvement seemed to be more common in females in this group, which is in line with findings from other research (Sheikhy et al., 2022 , Delgado et al., 2022 , Aydin et al., 2022 ). The precise causes of this distribution, however, are yet unknown and could have to do with differences in immunological response, hormonal effects, or behavioral and environmental factors. On the other hand, the distribution of organ involvement did not substantially correlate with place of residency, suggesting that once infection is established, cyst localization patterns are identical for patients from rural or urban areas. This observation is also consistent with other research findings (Shafiei et al., 2025 , Paduraru et al., 2023 ). Overall, these results emphasize the necessity of integrated control measures and the ongoing significance of CE for public health, especially in endemic areas. Strengthening veterinary public health systems to stop transmission at the animal level, raising community awareness of the disease's spread and preventative measures, putting in place regular dog deworming programs to lower the parasite reservoir, and expanding access to diagnostic imaging for human early detection are all important components of effective control strategies. When combined, these multi-sectorial, coordinated therapies target the cause of infection as well as its effects on human health. When used consistently and widely, such integrated approaches can dramatically lower the total burden of the disease, according to evidence from effective control programs in other areas. CONCLUSION Cystic Echinococcosis (CE) is still a major public health concern in Northwest Ethiopia, especially for rural communities that raise livestock. This five-year retrospective analysis showed that, in line with regional and global trends, the disease mostly affects the liver and primarily affects middle-aged adults, with a distinct male predominance. When compared to female patients, male patients typically presented at a little older age, especially when there were many cysts. In general, single cysts were more common than multiple cysts. For the purpose of verifying the existence of cysts and directing treatment plans, diagnostic imaging methods in particular, computed tomography (CT) and ultrasound were crucial. According to current evidence-based guidelines, non-surgical care was the most commonly used treatment modality, with surgical intervention reserved for complex or high-risk situations. Surgical outcomes were generally good, with low death and high cure rates; however, unfavorable outcomes were strongly linked to advanced age and many cysts, highlighting the significance of focused perioperative care for these high-risk patients. Significant correlations between patient demographics and illness characteristics were also found in the study, such as the relationship between age and clinical outcomes and the influence of sex on organ involvement. These results highlighted the need for specialized public health initiatives, such as preventive measures aimed at rural communities, early case detection, community education, and better access to diagnostic imaging. Enhancing integrated One Health strategies that connect environmental, animal, and human health could further lower the risk of disease transmission and burden. Although CE is still avoidable and treatable overall, in endemic areas like Northwest Ethiopia, ongoing surveillance, early diagnosis, and context-specific therapies were suggested as an essential to improving patient outcomes and lowering morbidity and mortality. Study Limitations Due to the retrospective nature of the study, accessing patient information through medical records and the small number of cases were limitations of the research. The retrospective design, which may have intrinsic data incompleteness and misclassification bias, was one of the main drawbacks. Furthermore, the investigation of parasite genotypes and their clinical correlates an area that is becoming more and more significant in CE pathogenesis was hampered by the absence of serological and genetic strain data. Declarations Acknowledgments I am deeply grateful to Tibebe Ghion Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and University of Gondar Comprehensive Specialized Hospital for their support and cooperation during the course of this research. Funding This research received no external funding. Authors’ Contributions MY, AM and MB designed the study and AM, MB supervised. AK and MY, ES was involved in data collection. MY and AK involved in data analysis. MY and AM prepared the manuscripts draft. All authors read and contribute approved the final version of the manuscript. Conflicts of Interest There no conflicts of interest Data Availability The original data used to support the findings of this study are available from the corresponding author upon request. Consent for Publication Not applicable References Aftab M, et al. Economic loss monitoring due to cystic echinococcosis (CE) infection in livestock in major cities of Punjab Pakistan. Veterinary Parasitology: Reg Stud Rep. 2025;63:101308. Alavi-Kakhki S-S et al. 2025. Long-Term Epidemiological Insights Into Human Cystic Echinococcosis in Northeastern Iran: A 17‐Year Retrospective Analysis. Journal of Parasitology Research , 2025, 8605086. Alpaca Rodriguez, et al. The many faces of pediatric hydatid disease: a pictorial review. Pediatr Radiol. 2025;55:115–27. Aregawi WG, et al. Epidemiology of Echinococcus granulosus sensu lato in the Greater Horn of Africa: A systematic review. PLoS Negl Trop Dis. 2024;18:e0011894. Aydin Y, et al. Pulmonary hydatid cyst in children and adults: diagnosis and management. Eurasian J Med. 2022;54:S133. Badwaik N et al. 2024. Hydatid cyst or echinococcosis: a comprehensive review of transmission, clinical manifestations, diagnosis, and multidisciplinary treatment. Cureus, 16. Bhalla VP, et al. Hydatid disease of the liver. Visc Med. 2023;39:112–20. Bhat MY et al. 2025. Alveolar hydatid disease in India (Kashmir valley) and its management: An emerging public health concern. Asian J Surg. Casulli A, et al. Primary cerebral cystic echinococcosis in a child from Roman countryside: Source attribution and scoping review of cases from the literature. PLoS Negl Trop Dis. 2023;17:e0011612. Christofi E. 2022. Cystic Echinococcosis: an impact assessment of prevention programs in endemic developing countries in Africa, central Asia, and south America. Journal of Zoological Systematics and Evolutionary Research , 2022, 8412718. Delgado AL et al. 2022. Hydatid cysts in children. Maternal and Child Health. IntechOpen. Eckert J, et al. Guidelines for surveillance, prevention and control of echinococcosis/hydatidosis. World Health Organization; 1984. Erfani A et al. 2023. Management of liver hydatid cysts: a retrospective analysis of 293 surgical cases from Southern Iran. Journal of Tropical Medicine , 2023, 9998739. Fayisa WO, et al. Prevalence of Cystic Echinococcosis in Sheep and Goats of Ethiopia: A Systematic Review and Meta-Analysis. Veterinary Med Sci. 2025;11:e70189. Govindasamy A, et al. Liver cystic echinococcosis: A retrospective study on the demographics and clinical profile of patients managed at a single tertiary institution in central Eastern Cape Province, South Africa. South Afr Med J. 2024;114:21–6. Gu H, et al. China’s prevention and control experience of echinococcosis: A 19-year retrospective. J Helminthol. 2024;98:e16. Hogea M-O, et al. Cystic echinococcosis in the early 2020s: a review. Trop Med Infect disease. 2024;9:36. Huang L, et al. Association between radical versus conservative surgery and short-term outcomes of hepatic cystic echinococcosis in Nyingchi, China: a retrospective cohort study. BMC Surg. 2023;23:126. Israfulovich MZ, et al. Conservative Therapy Of Hydatid Disease. Res Focus. 2023;2:148–53. Jaén-Torrejimeno, et al. Surgical treatment of liver hydatid cyst in elderly patients: A propensity score-matching retrospective cohort study. Acta Trop. 2022;232:106466. Joanny G, et al. Human cystic echinococcosis in Lebanon: a retrospective study and molecular epidemiology. Acta Parasitol. 2022;67:186–95. Karshima SN, et al. Africa-wide meta-analysis on the prevalence and distribution of human cystic echinococcosis and canine Echinococcus granulosus infections. Parasites Vectors. 2022;15:357. Kumaresan M et al. 2024. A Serological Study on Hydatid Disease from a Tertiary Care Hospital in Southern India: A Retrospective Observational Study. J Clin Diagn Res, 18. Li J, Wei J. Trends in the disease burden of cystic echinococcosis in China, 1990–2044 analysis and forecasting study. Sci Rep. 2025;15:4812. Maher AM, Shaapan RM. Neglected Zoonotic Enteric Parasitic Diseases: Echinococcosis, Cysticercosis, Foodborne Trematodes, and Ttrichinellosis-Review. Egypt J Veterinary Sci. 2025;56:915–26. Mahmoodi S, et al. A 20 years retrospective descriptive study of human cystic echinococcosis and the role of albendazole concurrent with surgical treatment: 2001–2021. Iran J Parasitol. 2023;18:100. Manciulli T, Brunetti E. Cystic echinococcosis—hydatid liver disease. Treatment and Management of Tropical Liver Disease. Elsevier; 2025. Mutlu V, et al. Multivariate 25-Year Trend Analysis of Mortality Due to Liver Hydatid Cysts. Acta Parasitol. 2025;70:1–8. Org Collaborative TL. Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study. Int J Surg (London England). 2023;109:3954. Organization WH. 2025. WHO guidelines for the treatment of patients with cystic echinococcosis. Paduraru AA, et al. Cystic echinococcosis in hospitalized adult patients from Western Romania: 2007–2022. Microorganisms. 2023;11:2388. Pal M et al. 2022. Cystic Echincoccoosis: a comprehensive review on life cycle, epidemiology, pathogenesis, clinical Spectrum, diagnosis, public health and economic implications, treatment, and control. Int J Clin Experimental Med Res, 6. Rivadeneira J, et al. Impact of recurrence of hepatic cystic echinococcosis on postoperative outcomes in an endemic region of Chile: a retrospective cohort study. Trop Med Health. 2025;53:153. Samanta I, et al. Neglected zoonoses and antimicrobial resistance: impact on one health and sustainable development goals. Elsevier; 2024. Semash K, Voskanov M. Diagnostic challenges and treatment approaches for hydatid cysts in atypical localizations. World J Nephrol. 2025;14:107955. Seyed-Sajjad Alavi-Kakhki et al.,2025. Long-Term Epidemiological Insights Into Human Cystic Echinococcosis in Northeastern Iran: A 17-Year Retrospective Analysis. Journal of Parasitology Research, 2025, 8605086, 10 pages, 2025. Shafiei R, et al. Environmental and climatic risk factors of human cystic echinococcosis in the northeast of Iran. J Helminthol. 2025;99:e79. Sharma N, et al. An institutional experience of hydatidosis and cysticercosis in Nepal: a retrospective chart review. Annals Med Surg. 2023;85:2598–602. Sheikhy K, et al. Evaluation of clinical status, diagnosis, treatment and radiological findings of pulmonary hydatid cyst: 5-years' experience at tertiary lung center. Caspian J Intern Med. 2022;13:44. Tamarozzi F et al. 2022. Echinococcosis. Helminth infections and their impact on global public health. Springer. Tercan M, et al. Our clinical experience and follow-up results in hydatid cyst cases: a review of 393 patients from a single center. Brazilian J Anesthesiology (English Edition). 2020;70:104–10. Trigui A, et al. Standardized approach to the conservative surgery of hepatic cystic echinococcosis: A prospective study. PLoS Negl Trop Dis. 2024;18:e0012289. Umman V, Akbulut S. Medical Treatment of Hydatid Disease. Hydatid Disease: Diagnosis, Treatment and Follow Up Strategies. Springer; 2025. Wang H, et al. Hepatic macrophages play critical roles in the establishment and growth of hydatid cysts in the liver during Echinococcus granulosus sensu stricto infection. PLoS Negl Trop Dis. 2023;17:e0011746. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 17 Apr, 2026 Editor invited by journal 02 Apr, 2026 Editor assigned by journal 02 Apr, 2026 Submission checks completed at journal 02 Apr, 2026 First submitted to journal 30 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9263427","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627925633,"identity":"d0b3d224-5cc0-43f2-b97c-bdf76dc0028f","order_by":0,"name":"Muluken Yayeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYJACZiCWYWBvAFIGFsRr4WHgOQDSIkGKFokEEJsILQbHzxg+Lsw5zGNw8/nVDT8KJBj427sT8Gs5k2NsPHMbUMvtnLKbPUCHSZw5uwG/lgM5ZtK8EC1pN3iAWgwkcgloOf/G/DdYy80zaTf/EKXlRo4ZM1jLDfZjt4myRfLGs2Kgw9J5JM/ksN2WMZDgIegXvvPJGz/zbrOW4zt+/NnNN39s5Pjbe/FrUTjAYQBl8oAZPHiVg4B8A/sDKBPOGAWjYBSMglGACgD9QklNx22wEwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Gondar","correspondingAuthor":true,"prefix":"","firstName":"Muluken","middleName":"","lastName":"Yayeh","suffix":""},{"id":627925634,"identity":"08341fa8-b0b8-4a0e-bbe8-34f29d663531","order_by":1,"name":"Mastewal Birhan","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Mastewal","middleName":"","lastName":"Birhan","suffix":""},{"id":627925635,"identity":"b92c10a3-c21d-4607-aa23-96ebde58b840","order_by":2,"name":"Ambay Kenubih","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Ambay","middleName":"","lastName":"Kenubih","suffix":""},{"id":627925636,"identity":"2b2d72ae-e9a5-452c-b33d-321825adc71a","order_by":3,"name":"Endalkachew Sisay","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Endalkachew","middleName":"","lastName":"Sisay","suffix":""},{"id":627925637,"identity":"be428678-3b81-45d3-853d-0656f9d07cb5","order_by":4,"name":"Araya Menigstu","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"prefix":"","firstName":"Araya","middleName":"","lastName":"Menigstu","suffix":""}],"badges":[],"createdAt":"2026-03-30 07:09:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9263427/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9263427/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107838080,"identity":"c3a57574-87fc-420a-884c-8302121fe548","added_by":"auto","created_at":"2026-04-26 17:08:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":207462,"visible":true,"origin":"","legend":"\u003cp\u003eDemographic Characteristics and Cyst Type Distribution of Patients with CE A) Age distribution of patients diagnosed with CE. The histogram shows the frequency of patients across different age groups, with a density curve illustrating the overall distribution pattern. Most cases were concentrated in middle-aged adults, particularly between 40 and 50 years. (B) Sex distribution of patients. The bar chart shows that male patients (n = 113) constituted the majority of cases compared with female patients (n = 44). (C) Distribution of cyst types among patients. The horizontal bar chart indicates that single cysts (n = 100) were more frequently observed than multiple cysts (n = 57) among the study population.\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-9263427/v1/4bb5e3d968859693915bc4ff.png"},{"id":107838035,"identity":"453a4ea3-2c85-43dd-afde-f421f479ad2a","added_by":"auto","created_at":"2026-04-26 17:08:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":313658,"visible":true,"origin":"","legend":"\u003cp\u003eCyst Distribution, Treatment, and Age Patterns in Patients with Cystic Echinococcosis (A) Distribution of single and multiple cysts by organ. The liver was the most affected organ (85 single, 45 multiple cysts), followed by the lung. Other organs were less frequently involved. (B) Treatment types by diagnostic method. Among patients diagnosed by CT scan, 27 underwent surgery and 82 received non-surgical treatment. For ultrasound-diagnosed patients, 10 had surgery and 38 were managed non-surgically. (C) Age distribution by cyst type. Box plots show similar age ranges for patients with single and multiple cysts, mostly in their 40s and 50s.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-9263427/v1/900191dd4906c45aa83c7e67.png"},{"id":107838215,"identity":"099b6295-fd8f-45d3-a6bb-a0f2cbb813ab","added_by":"auto","created_at":"2026-04-26 17:09:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":89652,"visible":true,"origin":"","legend":"\u003cp\u003eTemporal Trends in CE Patient Distribution and Cyst Type Patterns in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 157)\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-9263427/v1/8d3d9185f67959ba2a81e44d.png"},{"id":107838219,"identity":"3f7de1c5-3cd3-4561-87b8-d31809631b01","added_by":"auto","created_at":"2026-04-26 17:09:09","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":15888,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of Clinical Outcomes (Cure, Complications, and Death) among Surgically Treated Liver Cyst Patients in Selected Hospitals of Bahir Dar and Gondar, January 2021–December 2025 (n = 42)\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-9263427/v1/68512553773e26a8cb72880c.png"},{"id":107870747,"identity":"29aa7da6-390e-4dbb-8cb5-236cc8370cb8","added_by":"auto","created_at":"2026-04-27 07:40:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":966878,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9263427/v1/98b7a7df-68b2-46de-beb6-13b0ba99f0fc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retrospective Analysis of Cystic Echinococcosis: Clinical Characteristics and Treatment Outcomes in patients in Bahir Dar and Gondar Cities, Ethiopia","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eCystic Echinococcosis (CE) is a chronic, neglected zoonotic disease caused by the larval stage of \u003cem\u003eEchinococcus granulosus\u003c/em\u003e, primarily impacting the liver and lungs of intermediate hosts (livestock) and humans, who act as accidental hosts (Pal et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Maher and Shaapan, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The World Health Organization (WHO) classifies it as a priority neglected zoonosis, advocating for \"One Health\" approaches combining medical, veterinary, and environmental controls to manage this disease that causes widespread morbidity and economic losses (Samanta et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Cystic Echinococcosis is a cosmopolitan parasite, present on all populated continents, with high prevalence in regions with poor sanitation and low economic development (Christofi, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The estimated pooled prevalence in accidental and intermediate hosts in Ethiopia is about 22% (Aregawi et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Larvae of the parasite mostly affect the liver and lungs, and humans contract the infection by consuming contaminated food or drink (Pal et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Depending on the size and location of the cyst, different clinical symptoms may appear (Paduraru et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Hogea et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCystic Echinococcosis thrives in rural, agricultural areas with high dog populations, particularly in the Mediterranean, Central Asia, China, Australia, South America, and North and East Africa (Christofi, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Pal et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The disease results in substantial morbidity and economic loss, including livestock production losses and treatment costs (Aftab et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Management options include surgery, PAIR (puncture, aspiration, injection, and re-aspiration), anti-parasitic therapy, and watchful waiting, with surgery being the main approach for large or complicated liver cysts (Tamarozzi et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Organization, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClose human-animal contacts, especially in pastoral and rural areas, inadequate slaughterhouse hygiene, and restricted access to veterinary and healthcare services all have an impact on the epidemiology of CE (Karshima et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In Ethiopia, the disease is more common in rural areas where people live in close proximity to domestic dogs and cattle (Fayisa et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In many regions of the nation, human CE is still inadequately documented despite its acknowledged impact, and there is a dearth of clinical and demographic data to support focused interventions. Designing successful One Health control initiatives, improving patient care, and guiding public health policy all depend on an understanding of regional disease trends, including cyst distribution, treatment outcomes, and demographic traits. The aim of this study was to assess the clinical characteristics and treatment outcomes of patients diagnosed with CE through a five-year retrospective review of cases from selected hospitals in Bahir Dar and Gondar cities, Ethiopia.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area\u003c/h2\u003e \u003cp\u003eThis study was conducted in three purposefully selected major referral hospitals in the Amhara region of Ethiopia: Tibebe Ghion, Felege Hiwot Comprehensive, and University of Gondar Comprehensive Specialized Hospitals. Tibebe Ghion Specialized Hospital is the flagship teaching hospital of Bahir Dar University College of Medicine and Health Sciences and provides specialized and patient-centered healthcare services to more than 10\u0026nbsp;million people in the region. The College of Medicine and Health Sciences, was established in 2007 and has become one of the leading institutions for medical training and healthcare delivery in Ethiopia. Felege Hiwot Comprehensive Specialized Hospital is a major government referral hospital serving the Amhara region and surrounding areas. It delivers comprehensive healthcare services, including pediatric, neonatal, and multidisciplinary specialized care, and plays a central role in Ethiopia\u0026rsquo;s four-tier healthcare system. University of Gondar Comprehensive Specialized Hospital is a premier teaching and tertiary referral hospital affiliated with University of Gondar. Established in 1954, it provides advanced medical services and serves as a major training center for health professionals in Ethiopia.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design and Period\u003c/h3\u003e\n\u003cp\u003eTo evaluate the clinical features and treatment outcomes of patients with CE, a hospital-based retrospective study was carried out. Patients who received treatment for CE between January 2021 and December 2025 were included in the study. All eligible patients' healthcare records were examined throughout the course of these five years in order to gather information on socio demographic traits, epidemiological risk factors, clinical presentations, diagnostic results, treatment approaches, and treatment outcomes. After gaining access to patient charts and hospital registries from the relevant institutions, data extraction from medical records was carried out.\u003c/p\u003e\n\u003ch3\u003eStudy Population and sample size\u003c/h3\u003e\n\u003cp\u003eAll patients treated for Cystic Echinococcosis (CE) at three specific referral hospitals were included in the study. All individuals who received medical and/or surgical care in these hospitals in the study period and whose medical records showed a verified diagnosis of CE were included. For the study, patient charts and hospital data from discharge registries, surgical wards, and medical wards were examined. A total of 157 individuals with CE over the course of the five-year study period were included. Forty two patients with hepatic Cystic Echinococcosis (CE) who had surgery were evaluated. Based on postoperative follow-up data, clinical outcomes were classified as either cured, complications, or death. To examine their relationship with clinical outcomes, pertinent patient information such as age, sex, kind of cyst, and treatment hospital were collected.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eAll patients who received treatment for CE at the selected Specialized Hospitals, between January 2021 and December 2025 and whose medical records included comprehensive details about the diagnosis, clinical features, course of treatment, and results were included for this study. Patients with inadequate medical records, uncertain diagnoses, suspected but unconfirmed cases of CE, or missing or unavailable charts during the data collection period were excluded.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eMedical records of patients with Cystic Echinococcosis (CE) who were hospitalized to particular hospitals in Bahir Dar and Gondar over a five-year period were examined in this retrospective analysis.. Age, sex, residence, organ involvement, number and kind of cysts, diagnostic procedure, type of treatment, and clinical results (cure, complications, or death) were gathered using a standardized form. Hospital records were used to determine clinical outcomes: death was defined as in-hospital mortality, complications as any postoperative adverse events, and cure as recovery without difficulties. Data extraction was done by qualified staff after training, and all entries were verified for accuracy by cross-referencing them with surgical records and discharge summaries. To ensure secrecy, patient identification was removed and distinct codes were assigned.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe data were cleaned, coded and entered into an Excel spread sheet and exported to Stata version 17 for analysis.. Clinical variables, treatment results, and patient characteristics were summarized using descriptive statistics. Depending on the distribution, continuous variables like age were reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and median. Frequencies and percentages were used to describe categorical information, such as sex, residence, organ involvement, number of cysts, and clinical outcomes. The Chi-square test was used to evaluate associations between categorical variables (such as sex, age group, number of cysts, hospital) and clinical outcomes. Statistical significance was determined as a p-value of less than 0.05. Tables were used to present the results. To evaluate temporal trends, annual situations of cystic Echinococcosis (CE) from 2021 to 2025 were examined. Changes over time were assessed using linear regression, and possible temporal dependence was investigated using an ARIMA(1) model. Additionally, trends were visualized using a moving average smoothing technique. Future CE cases were estimated for 2035 and 2050 using the linear regression model.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e \u003cp\u003eThe University of Gondar Research and Collaboration Vice President Office Research Ethics Committee provided ethical approval with a Ref. No. VP/RC/05/630/2025). The ethics committee disregarded the need for individual informed permission because this study examined hospital records of patients with cystic Echinococcosis. Prior to analysis, all patient data was anonymised to protect privacy and confidentiality. The study was carried out in compliance with the Declaration of Helsinki's ethical guidelines.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Characteristics\u003c/h2\u003e \u003cp\u003eFor 157 study patients\u0026rsquo; the age ranged from 13 to 72, suggesting that a wide age range was impacted by the disease. The majority of instances were found in middle-aged people, especially those between the ages of 40 and 49. In terms of gender distribution, 44 patients (28.03%) were females and 113 patients (71.97%) were males. The majority of patients (80.25%, n\u0026thinsp;=\u0026thinsp;126) were from rural, whereas 19.75% (n\u0026thinsp;=\u0026thinsp;31) were from metropolitan areas. Of the participating hospitals, the University Of Gondar Comprehensive Specialized Hospital reported 61 cases (38.9%), Felege Hiwot Comprehensive Specialized Hospital 52 cases (33.1%), and Tibebe Ghion Specialized Hospital 44 cases (28.0%) as indicated in \u003cb\u003eTable-1\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical Characteristics\u003c/h2\u003e \u003cp\u003eThe most common organ involved was the liver, which accounted for 82.8% (n\u0026thinsp;=\u0026thinsp;130) of all cases. The lung was the second most (11.46% (n\u0026thinsp;=\u0026thinsp;18), affected organ. The abdominal cavity (3.18%), spleen (1.91%), and kidney (0.64%) were among the other less commonly affected locations. In terms of the characteristics of the cysts, 100 patients (63.69%) had a single cyst, while 57 patients (36.31%) had multiple. Most single and multiple cyst instances were found in male patients. Male patients presented at older ages than female patients, with the highest mean ages observed in those with multiple cysts (\u003cb\u003eTable-1\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDiagnostic Methods\u003c/h2\u003e \u003cp\u003eComputed tomography (CT) scans were done in 69.43% (n\u0026thinsp;=\u0026thinsp;109) of patients, making them the most frequently used diagnostic modality. Thirty point fifty seven percent (48/157) of the patients underwent ultrasound. Confirming the existence and location of hydatid cysts was made possible in large part by these imaging methods as indicated in \u003cb\u003eTable-1\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Patterns\u003c/h2\u003e \u003cp\u003eIn terms of treatment, 73.3% (n\u0026thinsp;=\u0026thinsp;115) of the patients received non-surgical management, whereas 26.7% (n\u0026thinsp;=\u0026thinsp;42) had surgery (\u003cb\u003eTable-1\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eTable 1: Socio-Demographic and Clinical Characteristics of CE Patients in Selected Hospitals of Bahir Dar and Gondar Cities, January 2021\u0026ndash;December 2025 (n = 157)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"549\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e71.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e28.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e80.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e19.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrgan involved\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eLiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e82.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e11.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eAbdominal cavity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eSpleen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eKidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eSingle cyst\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e63.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eMultiple cysts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e36.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eCT scan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e69.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eUltrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.7229%;\"\u003e\n \u003cp\u003e30.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eNon-surgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6883%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.503%;\"\u003e\n \u003cp\u003eSurgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6496%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.0549%;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003c/br\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDistribution of Cysts by Organ and Cyst Type\u003c/h2\u003e \u003cp\u003eAn examination of the distribution of cysts in various organs revealed that the liver had the highest number of cysts, with 45 multiple cysts and 85 single cysts. The second most commonly affected organ was the lung, which encompasses seven multiple cysts and eleven single cysts. Less often affected organs included the kidney (one single cyst), spleen (one single and two multiple cysts), and abdominal cavity (two single and three multiple cysts). In general, most organs had more single cysts than multiple cysts (Table\u003cb\u003e-2 and Table-2\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAge Distribution by Sex and Cyst Type\u003c/h2\u003e \u003cp\u003eThe three hospitals; Felege Hiwot Comprehensive, University of Gondar Comprehensive, and Tibebe Ghion Specialized Hospitals had somewhat different age distributions based on sex and cyst type. There were fewer female patients with multiple cysts at each of the three hospitals 7 at Felege Hiwot, 7 at the University Of Gondar, and 3 at Tibebe Ghion Hospitals. Their mean ages were 40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 years, 41.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 years, and 39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 years, respectively. Six female patients at Felege Hiwot 12 at the University Of Gondar, and 9 at Tibebe Ghion Hospitals had solitary cysts; with a mean ages of 36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2, 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3, and 37.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6 years, respectively(\u003cb\u003eTable-2 and figure-1)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eAmong male patients 11 at Felege Hiwot, 17 patients at the University Of Gondar, and 12 patients at Tibebe Ghion Hospitals had multiple cysts; their corresponding mean ages were 52.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6, 45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9, and 45.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 years. With 28 instances at Felege Hiwot, 25 at the University Of Gondar, and 20 at Tibebe Ghion Hospitals, male patients with solitary cysts were more common with mean ages of 43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7, 44.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2, and 48.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9 years, respectively. In general, male patients especially those with many cysts tended to arrive older than female patients (\u003cb\u003eTable-2 and figure-1\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Distribution of Age by Sex, Cyst Type, and Hospital among CE Patients in Selected Hospitals of Bahir Dar and Gondar Cities, January 2021\u0026ndash;December 2025 (n = 157)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"597\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCount\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean-Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax-\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMultiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMultiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eUoG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMultiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eUoG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e39.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMultiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMultiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eUoG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMultiple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eUoG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e48.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eFH; Felege Hiwot; TG: Tibebe Gion; UoG: University of Gondar. \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e \u003cb\u003eFigure-1\u003c/b\u003e: Demographic Characteristics and Cyst Type Distribution of Patients with CE A) Age distribution of patients diagnosed with CE. The histogram shows the frequency of patients across different age groups, with a density curve illustrating the overall distribution pattern. Most cases were concentrated in middle-aged adults, particularly between 40 and 50 years. (B) Sex distribution of patients. The bar chart shows that male patients (n\u0026thinsp;=\u0026thinsp;113) constituted the majority of cases compared with female patients (n\u0026thinsp;=\u0026thinsp;44). (C) Distribution of cyst types among patients. The horizontal bar chart indicates that single cysts (n\u0026thinsp;=\u0026thinsp;100) were more frequently observed than multiple cysts (n\u0026thinsp;=\u0026thinsp;57) among the study population.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure-2\u003c/b\u003e: Cyst Distribution, Treatment, and Age Patterns in Patients with Cystic Echinococcosis (A) Distribution of single and multiple cysts by organ. The liver was the most affected organ (85 single, 45 multiple cysts), followed by the lung. Other organs were less frequently involved. (B) Treatment types by diagnostic method. Among patients diagnosed by CT scan, 27 underwent surgery and 82 received non-surgical treatment. For ultrasound-diagnosed patients, 10 had surgery and 38 were managed non-surgically. (C) Age distribution by cyst type. Box plots show similar age ranges for patients with single and multiple cysts, mostly in their 40s and 50s.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTemporal Trend of CE Cases\u003c/h2\u003e \u003cp\u003eFrom 2021 to 2025, the annual distribution of CE cases among hospitalized patients varied. In 2021, there were just 22 cases, the lowest record. In 2022, the number raised to 37 cases, the highest yearly count throughout the study period. The number of cases decreased slightly to 34 in 2023, and then to 36 in 2024. As shown in the chart, there was another decline in 2025, with 28 instances reported. Throughout the study period, single cysts were continuously more common than multiple cysts when cyst types were evaluated by year. For instance, 24 single and 13 multiple cysts were observed in 2022 compared to 15 single and 7 multiple cysts in 2021. As seen in the image, a comparatively balanced distribution of 19 single cysts and 17 multiple cysts were noted in 2024 as showed in Fig.\u0026nbsp;3.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 3\u003c/b\u003e: Temporal Trends in CE Patient Distribution and Cyst Type Patterns in Selected Hospitals of Bahir Dar and Gondar, January 2021\u0026ndash;December 2025 (n\u0026thinsp;=\u0026thinsp;157)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLinear Regression Analysis of CE Cases (2021\u0026ndash;2025) with Future Projections\u003c/h2\u003e \u003cp\u003eA linear regression model was fitted to Cystic Echinococcosis (CE) case data from 2021 to 2025 to assess temporal trends. The analysis showed a small, non-significant increasing trend in CE cases over time (β\u0026thinsp;=\u0026thinsp;1.1 cases per year, p\u0026thinsp;=\u0026thinsp;0.653), with a low coefficient of determination (R\u0026sup2; = 0.076), indicating that year explained only a small proportion of the variability in case counts. Year-to-year changes demonstrated notable fluctuations, with an increase of 15 cases from 2021 to 2022, followed by a decrease of 3 cases in 2023, a slight increase of 2 cases in 2024, and a further decrease of 8 cases in 2025. These variations suggest the absence of a consistent temporal pattern.\u003c/p\u003e \u003cp\u003eTo further explore the trend, a moving average smoothing approach was applied, which revealed only minor variations over time without a clear sustained increase or decrease. Similarly, time series modeling using an ARIMA (1) model showed that the autoregressive parameter was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.297), indicating limited evidence of temporal dependence, likely due to the small number of observations.\u003c/p\u003e \u003cp\u003eForecasting based on the linear regression model suggested a gradual increase in CE cases over time. The projected number of cases was approximately 44.6 in 2035 and 61.1 in 2050. However, given the limited sample size and low explanatory power of the model, these projections should be interpreted with caution. Additional data over a longer time period are required to improve the reliability of future predictions \u003cb\u003eTable-3\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e: Linear Regression Analysis of Cystic Echinococcosis Cases over Time with Predicted Cases for 2035 and 2050, Selected Hospitals of Bahir Dar and Gondar Cities, January 2021\u0026ndash;December 2025\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear Regression Analysis of Cystic Echinococcosis Cases over Time with Predicted Cases for 2035 and 2050, Selected Hospitals of Bahir Dar and Gondar Cities, January 2021\u0026ndash;December 2025\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable / Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient / Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5.95\u0026ndash;8.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;2193.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4479.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;16450.07\u0026ndash;12062.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredicted 2035 cases\u003c/p\u003e \u003cp\u003ePredicted 2050 cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44.6\u003c/p\u003e \u003cp\u003e61.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between Organ Involvement and Sex\u003c/h2\u003e \u003cp\u003eSex had a significant impact on the distribution of hydatid cyst location (χ\u0026sup2; = 11.03, p\u0026thinsp;=\u0026thinsp;0.026). With 100 cases (88.5%) in males and 30 cases (68.2%) in females, liver involvement was the most common site in both genders. In comparison to men (8.0%), lung involvement was proportionately larger in women (20.5%). In both sexes, hydatid cysts in the kidney, spleen, and abdominal cavity were comparatively rare. These results showed a statistically significant correlation between the anatomical distribution of hydatid cysts and sex as showed in \u003cb\u003eTable-4\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between Organ Involvement and Residence\u003c/h2\u003e \u003cp\u003eThere was no statistically significant correlation found between the patients' location of residence and organ involvement (χ\u0026sup2; = 6.51, p\u0026thinsp;=\u0026thinsp;0.164). For both rural (84.1%) and urban (77.4%) inhabitants, liver cysts continued to be the most common location. 22.6% of patients in urban areas and 8.7% of patients in rural areas had lung involvement. Other organ localizations were uncommon and mostly affected those living in rural areas. In general, there was no discernible difference in the distribution of hydatid cyst location between rural and urban individuals as showed in \u003cb\u003eTable-4\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e: Distribution of Cystic Echinococcosis Cases by Organ Involvement, Sex, and Residence in Selected Hospitals of Bahir Dar and Gondar, January 2021\u0026ndash;December 2025 (n\u0026thinsp;=\u0026thinsp;157)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Cystic Echinococcosis Cases by Organ Involvement, Sex, and Residence in Selected Hospitals of Bahir Dar and Gondar, January 2021\u0026ndash;December 2025 (n\u0026thinsp;=\u0026thinsp;157)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrgan involved\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRural n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUrban n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (88.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106 (84.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e44\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e113\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e157\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e126\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e157\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cp\u003eOf the 42 patients who had surgery for hepatic Cystic Echinococcosis (CE), 78.6% were cured, 16.7% experienced postoperative problems, and 4.8% passed away as showed in \u003cb\u003efigure- 4\u003c/b\u003e, suggesting generally good surgical outcomes. Female patients had no recorded deaths, fewer complications (11.1% vs. 18.2%), and a better cure rate (88.9%) than male patients (75.8%). On the other hand, male patients accounted for all deaths (6.1%), indicating comparatively worse results in this group as showed in \u003cb\u003eTable-5\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eThe outcome was significantly influenced by age. With a cure rate of 92.3%, few complications (7.7%), and no mortality, patients between the ages of 25 and 44 showed the best results. The cure rates was slightly lower (80.0%) while the complication rates were greater (20.0%) for those between the ages of 45 and 64, but no deaths were observed. With just 25.0% of patients over 65 being cured, 25.0% experiencing problems, and a significantly high mortality rates of 50.0%, patients over 65years had the worst outcomes, underscoring advanced age as a potential significant risk factor as showed in \u003cb\u003eTable-5\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eSurgical results were also affected by the number of cysts. Compared to patients with many cysts, who had a lower cure rate (60.0%) and a much higher complication rate (40.0%), patients with a single cyst had a greater cure rate (88.9%) and fewer issues (7.4%). Clinical results from the three hospitals Felege Hiwot, Tibebe Ghion and University Of Gondar were largely similar, with cure rates ranging from 76.9% to 81.3% and comparatively minor variations in complication and death rates. This implies that the surgical and postoperative care standards are uniform throughout the facilities as showed in \u003cb\u003eTable-5\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e: Clinical Outcomes of CE Patients by Demographic Characteristics, Cyst Features, and Hospital in Selected Hospitals of Bahir Dar and Gondar, January 2021\u0026ndash;December 2025 (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Outcomes of CE Patients by Demographic Characteristics, Cyst Features, and Hospital in Selected Hospitals of Bahir Dar and Gondar, January 2021\u0026ndash;December 2025 (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCure n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComplications n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDeath n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal n\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of cysts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiple (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFelege Hiwot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTibebe Ghion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity of Gondar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eAssociation of variables\u003c/h2\u003e \u003cp\u003eOf the 42 patients treated surgically for liver hydatid cysts, 78.6% (n\u0026thinsp;=\u0026thinsp;33) were fully cured, 16.7% (n\u0026thinsp;=\u0026thinsp;7) developed postoperative complications, and 4.8% (n\u0026thinsp;=\u0026thinsp;2) died. The cure rate among male patients was 75.8%, compared to 88.9% among female patients. However, there was no statistically significant association between sex and clinical outcome (p\u0026thinsp;=\u0026thinsp;0.600) .\u003c/p\u003e \u003cp\u003eIn contrast, age group showed a significant association with clinical outcome (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients aged over 65 years had the poorest outcomes, with a cure rate of 25% and accounting for all recorded deaths. Meanwhile, the youngest age group (25\u0026ndash;44 years) had the highest cure rate (92.3%) and no mortality. Patients aged 45\u0026ndash;64 years demonstrated intermediate outcomes, with a cure rate of 80.0% and no deaths. Patients with a single cyst had better outcomes, achieving a cure rate of 88.9%, compared to 60.0% among those with multiple cysts, and this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.034).\u003c/p\u003e \u003cp\u003eThere was no significant difference in clinical outcomes among the three hospitals (p\u0026thinsp;=\u0026thinsp;0.884), suggesting a comparable standard of surgical and postoperative care across all institutions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 4\u003c/b\u003e: Proportion of Clinical Outcomes (Cure, Complications, and Death) among Surgically Treated Liver Cyst Patients in Selected Hospitals of Bahir Dar and Gondar, January 2021\u0026ndash;December 2025 (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSeveral significant outcome trends were found in this five-year retrospective examination of 157 patients with Cystic Echinococcosis (CE) treated at three major referral hospitals in Northwest Ethiopia. In addition to offering fresh perspectives on demographic risk factors and surgical outcomes in the Ethiopian setting, these data support current understanding of CE in endemic areas.\u003c/p\u003e \u003cp\u003eThe study's age distribution showed that CE affects adults across a wide age range, with the highest concentration of cases occurring in patients aged 40\u0026ndash;49 years. Studies from other endemic regions, such as Iran (Alavi-Kakhki et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) and china (Gu et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) where adult working populations are mostly impacted, are consistent with this pattern. The comparatively low frequency among the elderly may be the result of underreporting because of comorbidities in older people or decreased exposure to transmission vectors (such as dogs or livestock).\u003c/p\u003e \u003cp\u003eThe observed male predominance (71.97%) is consistent with a number of Ethiopian and African series ((Karshima et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Govindasamy et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), which postulate that male agricultural and pastoral occupations raise the risk of transmission by increasing contact with infected dogs and livestock. Contrasting data from various Mediterranean regions (such as Spain and Italy) indicate a more equal sex distribution (Casulli et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Joanny et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), indicating that sociocultural and vocational differences have a substantial impact on the epidemiology of CE.\u003c/p\u003e \u003cp\u003eDue to the zoonotic and environmental nature of CE transmission, the majority of cases (80.25%) involved rural residents. According to earlier research from different parts of the world (Sharma et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Kumaresan et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and Ethiopia, close contact with cattle, poor veterinary care, and home slaughtering methods in rural Ethiopia probably favor the \u003cem\u003eEchinococcus granulosus\u003c/em\u003e lifecycle. The necessity of focused public health initiatives in rural areas is highlighted by this distribution.\u003c/p\u003e \u003cp\u003eConsistent with worldwide results, the liver was the most damaged organ (82.8%), followed by the lung (11.46%) (Mahmoodi et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Erfani et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). According to (Alavi-Kakhki et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), this preference is explained by the liver acting as the initial filter for oncospheres following intestinal absorption, with the lungs acting as a subsequent filter. Further supporting the normal anatomical distribution of CE are data from comparable in Middle East (Bhalla et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and Africa (Govindasamy et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) that show low frequencies of cyst localization in the kidney, spleen, and abdominal cavity.\u003c/p\u003e \u003cp\u003eSingle cysts were more common than multiple cysts in our study, accounting for 63.7% of cases. Reports from other endemic areas, such as China (Wang et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and Tunisia (Trigui et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), where solitary hepatic cysts are similarly the most common presentation, are in line with this trend. Since initial larval establishment usually results in a single lesion, the predominance of single cysts may be a reflection of the infection's normal progression. Recurrent exposure, delayed diagnosis, or variations in the host immune response, which can affect parasite growth and dispersion, can all lead to the less common development of many cysts.\u003c/p\u003e \u003cp\u003eNearly 70% of patients underwent CT scans, which were crucial to the diagnosing process. The high CT usage in this study indicates improved availability to advanced imaging in referral centers, even though ultrasonography is still the first-line, economical method for CE screening in resource-constrained settings (WHO Informal Working Group on Echinococcosis, 2003; (Manciulli and Brunetti, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, Organization, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). As previously noted by (Semash and Voskanov, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, Alpaca Rodriguez et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), CT provides greater delineation of cyst morphology, calcification, and extra hepatic dissemination, hence influencing surgical strategy.\u003c/p\u003e \u003cp\u003eNon-surgical management predominated (73.3%), in line with current WHO and expert consensus recommending albendazole therapy and/or puncture-aspiration-injection-reaspiration (PAIR) for uncomplicated cysts (Umman and Akbulut, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, Semash and Voskanov, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Similar patterns have been noted in other endemic areas, where the use of conservative therapies has increased due to improved medication and minimally invasive techniques. However, complex instances or cysts with a high risk of rupture still require surgery, highlighting the necessity of tailored treatment choices based on patient risk factors and cyst features(Israfulovich et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Badwaik et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere were significant variations in the temporal pattern of cystic Echinococcosis (CE) cases between 2021 and 2025, peaking in 2022 and then gradually declining approaching 2025. Since CE is frequently underdiagnosed because of its protracted asymptomatic course, these variances may represent changes in case identification, healthcare access, or reporting techniques rather than actual occurrence. Across all years, single cysts were consistently more common than numerous cysts, which is consistent with the disease's typical natural history in which the majority of infections manifest as solitary lesions. The comparatively even distribution seen in 2024 could be a sign of recurrent exposure or delayed presentation. Similar trends have been seen in endemic areas, where livestock husbandry and dog-human contacts impact the mechanics of transmission (Mutlu et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, Li and Wei, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The World Health Organization claims that gaps in surveillance and control programs lead to continued transmission, highlighting the necessity of more robust public health interventions and continual monitoring to lower the burden of disease (Eckert et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1984\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe linear regression of CE cases from 2021 to 2025 revealed a very low explanatory power (R\u0026sup2; = 0.013) and a small positive slope (0.5 cases/year) that was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.853), suggesting that year explains little of the variance in annual cases. The 2035 and 2050 projections (~\u0026thinsp;44.4 and ~\u0026thinsp;61 Instances) should be viewed cautiously because to the sparse evidence and large confidence ranges. Longer-term studies of human hydatid cyst cases, on the other hand, show varying temporal trends. For instance, a 17-year retrospective analysis in northeastern Iran revealed a non-significant declining trend over time in surgical CE cases (β = -0.95, p\u0026thinsp;=\u0026thinsp;0.26), despite a persistent disease burden, highlighting fluctuating rather than steadily increasing case numbers over extended periods (Seyed-Sajjad., \u003cem\u003eet al.\u003c/em\u003e, 2025). These findings imply that longer surveillance with larger datasets is required to identify significant changes and enhance forecasting in endemic settings, as short, 5-year clinical series may not reflect actual temporal dynamics in CE incidence.\u003c/p\u003e \u003cp\u003eIn this study, 4.8% of patients who had surgery to remove hepatic cysts died, 16.7% had postoperative problems, and 78.6% of patients were cured. Although the observed death rate is similar to results from other Ethiopian hospital-based research, it is lower than reported in previous African cohorts, perhaps due to advancements in perioperative care, surgical procedures, and postoperative monitoring. Hepatic CE surgical outcomes vary around the world; in institutions with established surgical expertise, cure rates are usually between 70 and 90 percent, and mortality is normally less than 5 to 10% (org Collaborative, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Huang et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These findings demonstrate that surgery is still a safe and effective therapeutic option when carried out in well-equipped institutions with proper perioperative management. However, high-risk patients, such as those with many cysts or older adults, still require close observation.\u003c/p\u003e \u003cp\u003eAge is a predictor of postoperative morbidity and death, according to global surgical literature (org Collaborative, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Ja\u0026eacute;n-Torrejimeno et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), which is consistent with the statistically significant correlation between age group and clinical result, with poor outcomes in patients over 65. Increased comorbidities and decreased physiological reserves in elderly patients underscore the necessity of improved preoperative monitoring and optimization.\u003c/p\u003e \u003cp\u003eCompared to patients with a single cyst, those with many cysts had considerably worse results (p\u0026thinsp;=\u0026thinsp;0.034). This result is in line with findings from other research (Tercan et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Bhat et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, Rivadeneira et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) which indicate that a higher cyst burden is linked to both a higher risk of complications and more difficult surgical management. A longer operating time, a higher chance of incomplete removal, and a more complicated postoperative course can all be attributed to a higher number of cysts.\u003c/p\u003e \u003cp\u003eThere was a significant correlation between sex and organ involvement (χ\u0026sup2; = 11.03, p\u0026thinsp;=\u0026thinsp;0.026), indicating that site predilection may be impacted by exposure variations or underlying biological characteristics. Lung involvement seemed to be more common in females in this group, which is in line with findings from other research (Sheikhy et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Delgado et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Aydin et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The precise causes of this distribution, however, are yet unknown and could have to do with differences in immunological response, hormonal effects, or behavioral and environmental factors.\u003c/p\u003e \u003cp\u003eOn the other hand, the distribution of organ involvement did not substantially correlate with place of residency, suggesting that once infection is established, cyst localization patterns are identical for patients from rural or urban areas. This observation is also consistent with other research findings (Shafiei et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, Paduraru et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Overall, these results emphasize the necessity of integrated control measures and the ongoing significance of CE for public health, especially in endemic areas. Strengthening veterinary public health systems to stop transmission at the animal level, raising community awareness of the disease's spread and preventative measures, putting in place regular dog deworming programs to lower the parasite reservoir, and expanding access to diagnostic imaging for human early detection are all important components of effective control strategies. When combined, these multi-sectorial, coordinated therapies target the cause of infection as well as its effects on human health. When used consistently and widely, such integrated approaches can dramatically lower the total burden of the disease, according to evidence from effective control programs in other areas.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eCystic Echinococcosis (CE) is still a major public health concern in Northwest Ethiopia, especially for rural communities that raise livestock. This five-year retrospective analysis showed that, in line with regional and global trends, the disease mostly affects the liver and primarily affects middle-aged adults, with a distinct male predominance. When compared to female patients, male patients typically presented at a little older age, especially when there were many cysts. In general, single cysts were more common than multiple cysts. For the purpose of verifying the existence of cysts and directing treatment plans, diagnostic imaging methods in particular, computed tomography (CT) and ultrasound were crucial. According to current evidence-based guidelines, non-surgical care was the most commonly used treatment modality, with surgical intervention reserved for complex or high-risk situations. Surgical outcomes were generally good, with low death and high cure rates; however, unfavorable outcomes were strongly linked to advanced age and many cysts, highlighting the significance of focused perioperative care for these high-risk patients. Significant correlations between patient demographics and illness characteristics were also found in the study, such as the relationship between age and clinical outcomes and the influence of sex on organ involvement. These results highlighted the need for specialized public health initiatives, such as preventive measures aimed at rural communities, early case detection, community education, and better access to diagnostic imaging. Enhancing integrated One Health strategies that connect environmental, animal, and human health could further lower the risk of disease transmission and burden. Although CE is still avoidable and treatable overall, in endemic areas like Northwest Ethiopia, ongoing surveillance, early diagnosis, and context-specific therapies were suggested as an essential to improving patient outcomes and lowering morbidity and mortality.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eDue to the retrospective nature of the study, accessing patient information through medical records and the small number of cases were limitations of the research. The retrospective design, which may have intrinsic data incompleteness and misclassification bias, was one of the main drawbacks. Furthermore, the investigation of parasite genotypes and their clinical correlates an area that is becoming more and more significant in CE pathogenesis was hampered by the absence of serological and genetic strain data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI am deeply grateful to Tibebe Ghion Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and University of Gondar Comprehensive Specialized Hospital for their support and cooperation during the course of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMY, AM and MB designed the study and AM, MB supervised. AK and MY, ES was involved in data collection. MY and AK involved in data analysis. MY and AM prepared the manuscripts draft. All authors read and contribute approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere no conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original data used to support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAftab M, et al. Economic loss monitoring due to cystic echinococcosis (CE) infection in livestock in major cities of Punjab Pakistan. 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Prevalence of Cystic Echinococcosis in Sheep and Goats of Ethiopia: A Systematic Review and Meta-Analysis. Veterinary Med Sci. 2025;11:e70189.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGovindasamy A, et al. Liver cystic echinococcosis: A retrospective study on the demographics and clinical profile of patients managed at a single tertiary institution in central Eastern Cape Province, South Africa. South Afr Med J. 2024;114:21\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu H, et al. China\u0026rsquo;s prevention and control experience of echinococcosis: A 19-year retrospective. J Helminthol. 2024;98:e16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHogea M-O, et al. Cystic echinococcosis in the early 2020s: a review. Trop Med Infect disease. 2024;9:36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang L, et al. Association between radical versus conservative surgery and short-term outcomes of hepatic cystic echinococcosis in Nyingchi, China: a retrospective cohort study. BMC Surg. 2023;23:126.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsrafulovich MZ, et al. Conservative Therapy Of Hydatid Disease. Res Focus. 2023;2:148\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJa\u0026eacute;n-Torrejimeno, et al. Surgical treatment of liver hydatid cyst in elderly patients: A propensity score-matching retrospective cohort study. Acta Trop. 2022;232:106466.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoanny G, et al. Human cystic echinococcosis in Lebanon: a retrospective study and molecular epidemiology. Acta Parasitol. 2022;67:186\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarshima SN, et al. Africa-wide meta-analysis on the prevalence and distribution of human cystic echinococcosis and canine Echinococcus granulosus infections. Parasites Vectors. 2022;15:357.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumaresan M et al. 2024. A Serological Study on Hydatid Disease from a Tertiary Care Hospital in Southern India: A Retrospective Observational Study. J Clin Diagn Res, 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Wei J. Trends in the disease burden of cystic echinococcosis in China, 1990\u0026ndash;2044 analysis and forecasting study. Sci Rep. 2025;15:4812.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaher AM, Shaapan RM. Neglected Zoonotic Enteric Parasitic Diseases: Echinococcosis, Cysticercosis, Foodborne Trematodes, and Ttrichinellosis-Review. Egypt J Veterinary Sci. 2025;56:915\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahmoodi S, et al. A 20 years retrospective descriptive study of human cystic echinococcosis and the role of albendazole concurrent with surgical treatment: 2001\u0026ndash;2021. Iran J Parasitol. 2023;18:100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManciulli T, Brunetti E. Cystic echinococcosis\u0026mdash;hydatid liver disease. Treatment and Management of Tropical Liver Disease. Elsevier; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMutlu V, et al. Multivariate 25-Year Trend Analysis of Mortality Due to Liver Hydatid Cysts. Acta Parasitol. 2025;70:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrg Collaborative TL. Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study. Int J Surg (London England). 2023;109:3954.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. 2025. WHO guidelines for the treatment of patients with cystic echinococcosis.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaduraru AA, et al. Cystic echinococcosis in hospitalized adult patients from Western Romania: 2007\u0026ndash;2022. Microorganisms. 2023;11:2388.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePal M et al. 2022. Cystic Echincoccoosis: a comprehensive review on life cycle, epidemiology, pathogenesis, clinical Spectrum, diagnosis, public health and economic implications, treatment, and control. Int J Clin Experimental Med Res, 6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivadeneira J, et al. Impact of recurrence of hepatic cystic echinococcosis on postoperative outcomes in an endemic region of Chile: a retrospective cohort study. Trop Med Health. 2025;53:153.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamanta I, et al. Neglected zoonoses and antimicrobial resistance: impact on one health and sustainable development goals. Elsevier; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSemash K, Voskanov M. Diagnostic challenges and treatment approaches for hydatid cysts in atypical localizations. World J Nephrol. 2025;14:107955.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeyed-Sajjad Alavi-Kakhki et al.,2025. Long-Term Epidemiological Insights Into Human Cystic Echinococcosis in Northeastern Iran: A 17-Year Retrospective Analysis. Journal of Parasitology Research, 2025, 8605086, 10 pages, 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShafiei R, et al. Environmental and climatic risk factors of human cystic echinococcosis in the northeast of Iran. J Helminthol. 2025;99:e79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma N, et al. An institutional experience of hydatidosis and cysticercosis in Nepal: a retrospective chart review. Annals Med Surg. 2023;85:2598\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheikhy K, et al. Evaluation of clinical status, diagnosis, treatment and radiological findings of pulmonary hydatid cyst: 5-years' experience at tertiary lung center. Caspian J Intern Med. 2022;13:44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamarozzi F et al. 2022. Echinococcosis. \u003cem\u003eHelminth infections and their impact on global public health.\u003c/em\u003e Springer.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTercan M, et al. Our clinical experience and follow-up results in hydatid cyst cases: a review of 393 patients from a single center. Brazilian J Anesthesiology (English Edition). 2020;70:104\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrigui A, et al. Standardized approach to the conservative surgery of hepatic cystic echinococcosis: A prospective study. PLoS Negl Trop Dis. 2024;18:e0012289.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUmman V, Akbulut S. Medical Treatment of Hydatid Disease. Hydatid Disease: Diagnosis, Treatment and Follow Up Strategies. Springer; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang H, et al. Hepatic macrophages play critical roles in the establishment and growth of hydatid cysts in the liver during Echinococcus granulosus sensu stricto infection. PLoS Negl Trop Dis. 2023;17:e0011746.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Clinical outcome, cystic echinococcosis, surgery, Ethiopia, retrospective study","lastPublishedDoi":"10.21203/rs.3.rs-9263427/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9263427/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCystic echinococcosis (CE), caused by Echinococcus granulosus and transmitted through contact with infected dogs or contaminated feed and water, is a neglected zoonotic disease that could lead to serious, often fatal, liver or lung cyst development. It causes severe health issues with over \u003cspan\u003e$\u003c/span\u003e3\u0026nbsp;billion in annual livestock economic losses.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe aim of this study was to assess the clinical characteristics and treatment outcomes of patients diagnosed with CE from selected hospitals in Bahir Dar and Gondar cities, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA five-year retrospective study was carried out at Felege Hiwot, University of Gondar, and Tibebe Ghion Specialized Hospitals from January 2021 to January 2025. We examined the demographics, cyst features, organ involvement, diagnostic techniques, course of treatment, and clinical outcomes of 157 CE patients in their records. Trends were analyzed using linear regression and ARIMA (1), with projections for 2035 and 2050. A chi-square test was used to observe the association of variables with clinical outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 157 patients, 113 (72%) were males while 44 (28%) were females, with an average age of 43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1 years. Eighty percent (n\u0026thinsp;=\u0026thinsp;126) were rural dwellers. The most affected organ was the liver (82.8%, n\u0026thinsp;=\u0026thinsp;130), followed by the lung (11.5%, n\u0026thinsp;=\u0026thinsp;18). Among the participants, 110 (64%) had a single cyst, while 51 (36%) had multiple cysts. The most common diagnostic technique used was a CT scan (69%, n\u0026thinsp;=\u0026thinsp;109). One hundred fifteen patients (73%) received non-surgical care, while 42 patients (27%) had surgery. A linear regression analysis of cystic echinococcosis cases from 2021 to 2025 showed a slight but non-significant increasing trend (β\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;0.653) with low explanatory power (R\u0026sup2; = 0.076), and forecasts suggest a gradual rise that should be interpreted cautiously due to limited data. Of 42 surgically treated patients, 78.6% (33/42) were cured, 16.7% (7/42) exist with the problems, and 4.8% (2/42) died. Multiple cysts and older age (\u0026gt;\u0026thinsp;65 years) were linked to worse outcomes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCystic echinococcosis predominantly affects rural adult males with hepatic involvement. Younger ages and solitary cysts correlated with improved outcomes, whereas older ages and multiple cysts increased the likelihood of complications and mortality. Early detection, preventive approaches, and careful perioperative care were suggested as important to improving outcomes.\u003c/p\u003e\u003ch2\u003eClinical Trial Registration\u003c/h2\u003e \u003cp\u003eNot applicable. This study did not involve a clinical trial and therefore was not registered.\u003c/p\u003e","manuscriptTitle":"Retrospective Analysis of Cystic Echinococcosis: Clinical Characteristics and Treatment Outcomes in patients in Bahir Dar and Gondar Cities, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 17:08:16","doi":"10.21203/rs.3.rs-9263427/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-27T14:06:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16915985231115719449002022234823854711","date":"2026-04-22T17:18:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203662063350331643926347236860822264467","date":"2026-04-17T06:47:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-17T05:58:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-02T19:11:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T12:36:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T12:35:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2026-03-30T07:04:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b3c3acd0-0c31-4fc0-abb4-e99914c5b5b7","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-26T17:08:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 17:08:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9263427","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9263427","identity":"rs-9263427","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}