Analysis of hospital records of children with hydatid cyst in south of Iran

Cystic Echinococcosis in Hospitalized Children from Western Romania: A 25-Year Retrospective Study

Cystic echinococcosis (CE) is a cosmopolitan parasitic disease caused by Echinococcus granulosus. We aimed to assess the epidemiological aspects of the disease in hospitalized children from Western Romania, a well-known endemic area for CE. We retrospectively investigated the medical records of children hospitalized between 1998 and 2022. A total of 144 patients were included, and 58.3% were from rural areas. The number of cases increased with age, from 9% in the age group 3-5 years to 59.7% in the age group 11-17 years. The liver was more frequently affected (65.3%), and a significant association between gender and the affected organ was noted; liver cysts were more frequently diagnosed in girls, while lung cysts were recorded mostly in boys. Complications were more frequently reported in patients with pulmonary CE compared to hepatic CE (p = 0.04). Boys had more complications (16/23, 69.6%) compared to girls (7/23, 30.4%) (p = 0.03). A third of the children were hospitalized for more than 14 days, and multiple hospitalizations were recorded in 31.3% of the patients. This paper provides new insights into the epidemiologic features of cystic echinococcosis in children from Western Romania. Our findings indicate that exposure to the parasite starts in childhood, and the rate of hospitalization increases with age. Public health strategies should be implemented and permanently improved in order to lower the prevalence of CE in children.

Predictive Factors of Liver Hydatid Cyst Recurrence in Children

BACKGROUND

Liver hydatid cyst affects approximately 95% of the world's echinococcosis cases. Despite advances in treatment, the recurrence rate remains high and is influenced by several factors that are yet to be determined. The objective of this study was to identify the predictive factors of liver hydatid cyst recurrence following surgery in children and to establish a treatment regimen aimed at preventing this postoperative morbidity.

METHODS

A bi-centric retrospective descriptive and analytic study was conducted involving 122 children who underwent surgery for liver hydatid cysts between January 1st, 2009, and December 31st, 2017. All factors that could potentially contribute to recurrence were thoroughly investigated. The data was processed using SPSS.v21, and a significant level of p-value 0.05 was applied.

RESULTS

Out of the 122 children, 20 patients experienced cyst recurrence (16.39%). Among them, there were nine girls and eleven boys. The median time of recurrence was 16.5 months. Abdominal ultrasonography demonstrated efficacy in detecting recurrence. Several factors were identified as predictors of postoperative recurrence, including intimate contact of the hydatid cyst with the large vessels (p = 0.031), intraperitoneal effusion (p = 0.042), bile duct dilation (p = 0.032), and postoperative spontaneous discontinuation of medical treatment (p = 0.010). Among these factors, two independent risk factors for recurrence were identified: intimate contact of the hydatid cyst with the large vessels (p = 0.011) and the presence of an intraperitoneal effusion (p = 0.018).

CONCLUSION

Our study has identified several predictors of postoperative recurrence, including two previously undocumented risk factors in the literature. Awareness of these risk factors can assist surgeons in implementing preventive measures to avoid the recurrence of hydatid cysts.

LEVEL OF EVIDENCE

Prognosis study Level II.

Multivesicular hepatic human hydatid cyst from Iran: First genotyping-based confirmation

Cystic echinococcosis is one of the most important zoonotic parasitic diseases caused by the tapeworm Echinococcus granulosus. To date, the genotype of multivesicular CE has not been identified. In this regard, the genotyping of multivesicular types of CE could help clinicians understand and manage the disease effectively.

An unsolved problem in developing countries: hydatid cysts in children

PURPOSE

Hydatid cyst (HC) is a serious health problem in developing countries. The aim is to discuss the clinical information, surgical and puncture-aspiration-injection-re-aspiration (PAIR) treatments, and results of patients with HC in a developing country.

METHODS

Patients were analyzed in terms of gender, age, presenting complaint, misdiagnosed HC, cyst location, cyst number, cyst size, liver HC type according to the World Health Organization Informal Working Group Echinococcosis (WHO-IWGE) classification, pulmonary HC, hemithorax locations, treatments and interventions, duration of hospitalization, follow-up period, postoperative complications, and recurrence.

RESULTS

There were 106 girls and 99 boys with a mean age of 10.7 years. The most common location was the liver (n = 170), and the second most common was the lungs (n = 67). The mean diameter for liver HC was 86.27 mm, and it was 73.90 mm for pulmonary HC. PAIR was performed on 61 patients with liver HC using interventional radiology. 109 patients underwent surgery. The most common complications were cystobiliary fistula in liver HC and atelectasis in pulmonary HC.

CONCLUSION

HC should be one of the first considerations in the differential diagnosis in all anatomical areas in the presence of suspicious radiological and clinical findings in endemic regions.

Cystic Echinococcosis in Children: High Frequency of Multiple Organs Involved in the North of Iran

INTRODUCTION

Echinococcosis, as an important zoonotic infection, has a major worldwide distribution. Pediatric echinococcosis has still become health concerning issue in developing countries, particularly, in the Middle East and Iran. The aim of this study was to investigate the human echinococcosis in children in northern Iran.

METHODS

Patients admitted to the pediatric subspecialty hospital of Amir Kala, Babol, Iran, from 2011 to 2016 with a confirmed diagnosis of echinococcosis, were reviewed. Records of the patients, including demographic data, clinical manifestations of the disease, type of cysts, and other related factors, were collected.

RESULTS

Sixteen pediatric patients, twelve (75%) male, and four (25%) female were evaluated. All cases had cystic echinococcosis. The results showed that fever (75%) following vomiting, nausea, and coughing (44%) were the most common clinical manifestations. The most common localizations of cases were determined as liver (n=10, 62.5%) and lung (n=9, 56%). The frequency of the involvement of more than one organ was 31% (5 cases). The co-occurrence of liver and lung was seen in 2 (12.5%) cases, and in one case, the co-occurrence of the liver and spleen was reported. In one case, lung, liver and, the pelvis was involved, while in another case, liver, sub diaphragm and kidney involvement were observed.

CONCLUSION

Cystic echinococcosis should be kept in mind when a cystic lesion is encountered anywhere in the body, particularly, in patients lining in the endemic regions. Since cystic echinococcosis has a considerable economic impact in Iran, the implementation of a control program and the surveillance system are highly recommended to reduce the economic burden of this disease.

Human cystic echinococcosis in southwest Iran: a 15-year retrospective epidemiological study of hospitalized cases

Background

Cystic echinococcosis (CE) is considered as a neglected disease with significant mortality and morbidity in most of the developing countries. The current study aimed to retrospectively assess the demographic and epidemiologic features of human CE surgical cases in a 15-year period in Fars province, southwestern Iran.

Methods

A 15-year (2004–2018) retrospective study was conducted to find out the epidemiological and clinical picture of CE in patients who undergone surgeries for CE in two main hospitals in Fars Province, southwestern Iran. Hospital records were reviewed, and data were retrieved from each CE patient’s record.

Results

A total of 501 CE surgical cases were recorded during a 15-year period, corresponding to an average annual incidence of 33.4 and a surgical incidence rate of 0.74/100,000 population. Of these, 242 (48.6%) were male, and 256 (52.4%) were female. Patients’ age ranged from 2 to 96 years, with a mean age of 34.92 (± 19.87) years. A significantly higher rate of CE cases was noted in subject’s ≥ 50 years of age. The highest frequency of cases (62:12.5%) was recorded in the year 2017. The most commonly involved organs were liver (339 cases; 57.8%) and lung (279 cases; 47.6%). Concurrent involvement of two organs was seen in 58 (9.9%) cases of both lung and liver, 10 (1.6%) cases of lung and other locations (but not liver), and 23 (3.9%) cases of liver and other locations (but not lung). Reoperation was noted in 67 (13.4%) of the cases. The size of the lung hydatid cyst varied, ranging between 2 and 24 cm (mean = 7.33, SD = 3.737). The size of liver hydatid cysts ranged from 1 to 26 cm (mean 9.04, SD = 4.275).

Conclusion

The findings of the current study demonstrated a nearly constant prevalence of CE during the last 15 years in southern Iran. Further studies are needed to find out the reasons behind the recurrence of the disease, which is substantial, in surgically-treated patients.

Epidemiology, burden, and geographical distribution of cystic echinococcosis in Central Iran

Background and Aim: Human cystic echinococcosis (CE) is an important, neglected zoonotic disease with worldwide distribution which has been reported in different regions of Iran, including the central areas (e.g. Qom Province). The disease is caused by the Echinococcus granulosus parasite living in the intestine of dogs and other canids as definitive hosts. This study aimed to investigate the epidemiology, burden, and geographical distribution of CE in Qom Province, Central Iran. Materials and Methods: In this descriptive-analytic study, the data of patients with diagnosed CE during 2011-2018 were collected from all urban and rural areas of Qom Province. The data of the epidemiological status of CE cases were extracted from the CE surveillance system in the Centers for Disease Control and Prevention in the Qom University of Medical Sciences which is owned and run by Iran's Ministry of Health and Medical Education. In addition, the economic burden of the disease was evaluated by Azarakhsh and Roozamad financial software; the geographical distribution of CE was obtained by ArcGIS 10.3 software (IBM Corp., Chicago, USA). Results: The results reveal that the incidence rate of CE was 6.81/100,000 people over the 8-year period of the study. More than half of the cases were females (57.95%), housewives (57.47%), and residents (89.77%). The majority of the cases were Iranian (88.77%) and the rest were from the two neighboring countries: Afghanistan and Pakistan. The economic burden of the human CE in the 8 years was estimated to be 3,761,352,526 rials (75,227 $). In terms of spatial distribution, the highest incidence rate of CE was observed in Salafchegan District in the southwest of Qom Province. Conclusion: The economic burden of human CE infection provided by governmental health-care systems or as out-of-pocket expenses is relatively high, and housewives, especially those living in Salafchegan District, are more likely to be affected. More studies are recommended on different epidemiological aspects and the definitive hosts of the parasite; besides, people at risk need to be warned and educated so that the incidence rate of the disease is reduced.

Disseminated Hydatid Disease in a Child Involving Multiple Organ Systems: A Case Report

Hydatid disease is a parasitic infestation by Echinococcus granulosus, which involves the liver and lungs primarily. The authors report a case of disseminated hydatid disease involving multiple organs simultaneously in a 7-year-old child from Kabul, Afghanistan. The patient under examination had been having a complaint of cough and low-grade fever for the last one year. Computed tomography (CT) and ultrasonography (USG) demonstrated cystic lesions in his liver, lungs, spleen, and suprarenal region. The literature review showed that it was very rare for hydatid disease to involve multiple organs simultaneously, even in endemic areas, and the management of disseminated disease was very challenging, especially in the pediatric population.

Evaluation of Cystic Echinococcosis Cases in Terms of Sociodemographic, Clinical and Hospitalization Features in Karaman Province, Turkey

BACKGROUND

We aimed to investigate the cystic echinococcosis (CE) epidemiology in Karaman Province from 2010 to 2017 using data from the provincial state hospital.

METHODS

Overall, 482 cases were determined from Karaman State Hospital, Karaman Province, Turkey from 2010 to 2017. Records were investigated in terms of year, gender, age, cyst location, rural and urban households and duration of hospital stay.

RESULTS

The CE incidence was 22.40 per 100 000 people after final diagnosis with focused abdominal ultrasound. Totally, 482 people including 166 (34.4%) male and 316 (65.6%) female were with CE. The mean age of patients was 50.3±17.48 yr. More CE cases were reported in the age group of 51-60 yr than in the other age groups. CE was mostly seen in liver (470, 97.5%). Moreover, 28.4% of patients were resided in rural areas. The observed frequencies of demographic features of female gender, infected liver, residence in provincial centers, referral to general surgery policlinic and no hospitalization were significantly higher than expected frequencies (P<0.05). Sixty (12.4%) patients with CE had been hospitalized. There was a statistically significant positive relationship between age of hospitalized patients and duration of hospitalization (P<0.05). Of the patients 73.2% were admitted to general surgery.

CONCLUSION

CE is of great importance to public health considerations in the Karaman Province and we advocate the implementation of eradication programs to decrease the CE cases number.

Computer Tomography (CT) Characteristics of Pulmonary Cystic Echinococcosis

INTRODUCTION

Cystic echinococcosis (CE) is a common zoonosis worldwide. The two most frequent location of CE are liver and lung. Confirmatory diagnosis of CE is routinely performed sung imaging methods such as computer aided tomography and nuclear magnetic resonance in humans.

AIM

to investigate CT scan imaging of patients with pulmonary CE in Masih Daneshvari Hospital from 2011 to 2017.

MATARIAL AND METHODS

This descriptive-analytic study was carried out on patients with pulmonary CE referring to Masih Daneshvari Hospital. By using the convenience sampling, 195 cases were selected from eligible patients. The data collection tool was a researcher-made questionnaire that included demographic, clinical and laboratory information. Data were analyzed using SPSS software version 20.

RESULTS

In this study, 84.1% and 15.9% of patients were diagnosed using surgical method and CT scan, respectively. Our findings indicated CE was most commonly located in liver (28.2%) and spleen was considered as the lowest location (3.1%). Furthermore, cough was the most common clinical symptom of patients. The lower right lobe opacity was found to be higher, while and Lingula was the least frequent.

CONCLUSION

According to the findings of this study, surgery is the most important diagnostic and cough method as the most common clinical symptom of the disease. Since the CE with atypical symptoms is relatively common, physicians should always consider the lung CE in differential diagnosis of localized radiological images.

Echinococcus Granulosus in Childhood: A Retrospective Study of 187 Cases and Newer Data

Echinococcus granulosus, first reported by Goeze in 1782, is the causative parasite of cystic echinococcosis (hydatidosis) especially for countries that are endemic areas. Since the 1970s, the incidence of echinococcosis in Greece has been very high. Nevertheless, with the implementation of special prevention measures in the 1980s, a large reduction in the incidence of hydatidosis meant that it reached European levels. Therefore, we analyzed the demographics, multiple organ localizations of the parasite, diagnosis, and conservative and optimal surgical treatment over a total period of 39 years, especially for pulmonary and hepatic echinococcosis in children. The higher incidence of pulmonary echinococcosis compared with other localizations, male predominance, wide range of age, and various cystic sizes were some of the main demographics. Because cystic echinococcosis remains a main public health problem, we advocate a meticulous clinical investigation and treatment methodology to bridge the gap between knowledge and awareness of this important disease.

The pattern of cystic echinococcosis in children in an endemic area in Morocco

Cystic echinococcosis is a parasitic infection of major public health concern. The infection is generally acquired during childhood and the disease incubation period can last many years. The occurrence and characteristics of the disease in children were not well studied. The present study aimed to explore the pattern and features of cystic echinococcosis in children in rural and urban environments in Morocco. A total of 338 children diagnosed and treated for cystic echinococcosis were investigated. The trend of the infection, risk and exposure factors and the distribution of the anatomic locations of cysts were studied. A non-uniform decrease in proportions of infected children was found. Children from rural environs had significantly higher infection rates than children from urban environs (p < 0.001). Males were significantly more infected than females. Children aged 7-11 years were the most affected. For cysts locations, single organ involvement was found in 94.4% of the children versus 5.6% with multi-organ localization. Despite control program, active transmission of echinococcosis still occurred in children and remains a major public health problem. The infection in younger population may have some features that need to be considered in the prevention and control programs in endemic areas.

Echinococcosis in left ventricle: a case report

INTRODUCTION

Echinococcosis, also called hydatid disease, is a common parasitic infection of the liver. However, echinococcus lesions rarely involve the heart, especially in children.

PATIENT CONCERNS

An 8-year-old child from grazing areas of northwest China was referred to our hospital for the complaint of inpersistent precordial chest pain and left upper quadrant pain for 3 years. Palpation showed hepatomegaly, abdominal palpable mass while inspection abdominal distension. Routine blood tests were within the normal ranges.

DIAGNOSIS

Combining the life history in pasture area, imaging features and serology results, it was consistent with the diagnosis of cardiac echinococcosis.

INTERVENTIONS

Surgery was performed to evacuate cyst liquid and remove the internal capsule of the cyst.

OUTCOMES

There was no cystic lesion in heart on ultrasound and her physical condition improved significantly after the surgery. The patient died of hepatic hydatid cyst rupture due to refusing high-risk surgical treatment and other treatment.

LESSONS

We presented a rare case of cystic echinococcosis involving left ventricle in a child, and surgery is an alternative and effective therapy for this lesion due to the cyst rupture or leakage that can result in anaphylaxis. The typical imaging features of the cardiac echinococcosis on cardiac magnetic resonance are presented. Patient prognosis relies on proper treatment of all lesions.