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Abstract：
OBJECTIVE: Superinfection of cystic echinococcosis (CE) is a life-threatening complication with significant morbidities, which can be prevented with early diagnosis and treatment. This study aims to examine the clinical characteristics, diagnostic methods, and treatment options for superinfected CE, as there is currently limited information available on the differences between superinfected and non-infected CE in terms of clinical features, serological and radiologic findings.
METHODS: This cross-sectional study was conducted on hospital records of patients who were diagnosed with hydatid cysts in a 15-year period (2004 to 2018) in two main university-affiliated referral centers in Fars province, southern Iran. Patients\' information regarding the demographical and clinical features related to CE, age, sex, previous history of CE or recurrence, size and location of CE, and length of hospital stay were collected. Moreover, the characteristics of concurrent infections with hydatid cysts were recorded.
RESULTS: A total of 586 surgeries due to CE were performed on 501 patients, of which 67 (11.43%) had reoperations due to the recurrence of the disease. A total of 30 (5.99%) incidences of superinfection were observed. There were no statistically significant differences in terms of laboratory and imaging findings between CE patients with concurrent infections and other CE patients (p-value > 0.05). Among the patients with super-infection, four had fungal infections of the lungs. Aspergillus fumigatus was the causative pathogen in all four patients that were diagnosed with fungal superinfection. All patients underwent surgical excision with favorable long-term outcomes.
CONCLUSIONS: Our study revealed a 5.99% incident rate of CE superinfection. Regarding the concurrent fungal infections in hydatid cysts, the patient\'s symptoms and laboratory and imaging findings are inconclusive and histopathological evaluation seems to be the most reliable option. Surgical resection is the gold-standard treatment option with favorable outcomes and potentially can be curative.
METHODS: This cross-sectional study was conducted on hospital records of patients who were diagnosed with hydatid cysts in a 15-year period (2004 to 2018) in two main university-affiliated referral centers in Fars province, southern Iran. Patients\' information regarding the demographical and clinical features related to CE, age, sex, previous history of CE or recurrence, size and location of CE, and length of hospital stay were collected. Moreover, the characteristics of concurrent infections with hydatid cysts were recorded.
RESULTS: A total of 586 surgeries due to CE were performed on 501 patients, of which 67 (11.43%) had reoperations due to the recurrence of the disease. A total of 30 (5.99%) incidences of superinfection were observed. There were no statistically significant differences in terms of laboratory and imaging findings between CE patients with concurrent infections and other CE patients (p-value > 0.05). Among the patients with super-infection, four had fungal infections of the lungs. Aspergillus fumigatus was the causative pathogen in all four patients that were diagnosed with fungal superinfection. All patients underwent surgical excision with favorable long-term outcomes.
CONCLUSIONS: Our study revealed a 5.99% incident rate of CE superinfection. Regarding the concurrent fungal infections in hydatid cysts, the patient\'s symptoms and laboratory and imaging findings are inconclusive and histopathological evaluation seems to be the most reliable option. Surgical resection is the gold-standard treatment option with favorable outcomes and potentially can be curative.
摘要：
目的：囊性包虫病（CE）的过度感染是一种危及生命的并发症，具有明显的发病率，可以通过早期诊断和治疗来预防。这项研究旨在检查临床特征，诊断方法,以及过度感染CE的治疗选择，由于目前关于超感染和未感染CE在临床特征方面的差异的信息有限，血清学和放射学发现。
方法：这项横断面研究是在法尔斯省两个主要大学附属转诊中心的15年期间（2004年至2018年）诊断为包虫囊肿的患者的医院记录中进行的。伊朗南部。与CE相关的人口统计学和临床特征的患者信息，年龄,性别,既往有CE或复发史，CE的大小和位置，并收集住院时间。此外，记录包虫囊肿并发感染的特征。
结果：对501例患者进行了586例因CE引起的手术，其中67人（11.43%）因疾病复发而再次手术。总共观察到30例（5.99％）重复感染的发生率。合并感染的CE患者与其他CE患者在实验室和影像学检查方面无统计学差异（p值>0.05）。在超级感染的患者中，其中4人肺部真菌感染.在所有四名被诊断为真菌双重感染的患者中，烟曲霉是病原体。所有患者均接受手术切除，长期预后良好。
结论：我们的研究显示CE重叠感染发生率为5.99%。关于包虫囊肿并发真菌感染，患者的症状以及实验室和影像学检查结果尚无定论，组织病理学评估似乎是最可靠的选择。手术切除是金标准治疗选择，具有良好的结果，并且可能是治愈的。
方法：这项横断面研究是在法尔斯省两个主要大学附属转诊中心的15年期间（2004年至2018年）诊断为包虫囊肿的患者的医院记录中进行的。伊朗南部。与CE相关的人口统计学和临床特征的患者信息，年龄,性别,既往有CE或复发史，CE的大小和位置，并收集住院时间。此外，记录包虫囊肿并发感染的特征。
结果：对501例患者进行了586例因CE引起的手术，其中67人（11.43%）因疾病复发而再次手术。总共观察到30例（5.99％）重复感染的发生率。合并感染的CE患者与其他CE患者在实验室和影像学检查方面无统计学差异（p值>0.05）。在超级感染的患者中，其中4人肺部真菌感染.在所有四名被诊断为真菌双重感染的患者中，烟曲霉是病原体。所有患者均接受手术切除，长期预后良好。
结论：我们的研究显示CE重叠感染发生率为5.99%。关于包虫囊肿并发真菌感染，患者的症状以及实验室和影像学检查结果尚无定论，组织病理学评估似乎是最可靠的选择。手术切除是金标准治疗选择，具有良好的结果，并且可能是治愈的。
