Alveolar hydatid disease in India (Kashmir valley) and its management: An emerging public health concern

Background: Alveolar hydatid disease (AHD), caused by Echinococcus multilocularis, poses a significant public health challenge globally, predominantly affecting the northern hemisphere. Despite its rarity, AHD is of significant concern in regions adjacent to endemic areas, including India. This study reports a recent surge in AHD Liver cases in the Kashmir Valley, North India, highlighting the epidemiological and clinical features, as well as the surgical management of these cases. Methods: This prospective study was conducted at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) from January 2022 to Dec 2024, involving 52 patients diagnosed with AHD liver. Diagnostic assessments included ultrasound, contrast-enhanced computed tomography (CECT), and Magnetic Resonance Cholangiopancreatography (MRCP). Surgical interventions were performed on resectable cases, while unresectable cases were managed conservatively. Follow-up data were collected bi-weekly for two months, then monthly for two years. Results: Out of 52 patients, 33 were resectable and underwent various liver resections. The demographic breakdown showed equal distribution between male and female patients, with 87.8 % under 50 years of age. Most patients (90 %) were from rural areas and 75 % from low socioeconomic background. The clinical presentation varied, with some patients showing symptoms like abdominal pain and jaundice, while others were asymptomatic. A significant number (53.8 %) were from the district Ganderbal of the valley. Postoperative recovery protocols included early oral intake and ambulation. Complications were minimal, with no instances of hepatic failure. Follow-up showed no recurrence of AHD. Conclusion: The data from this study provides an insight into the epidemiology, clinical presentation, management strategies, and outcomes of this complex condition. This study highlights the recent novice arrival and abrupt surge of alveolar hydatid disease in India and highlights the importance of early detection and appropriate surgical management. Effective multidisciplinary management and long-term follow-up are crucial for patient outcomes.