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Cutaneous fistulization of the hydatid disease: A PRISMA-compliant systematic review
Zeynep Sener Bahce1, Sami Akbulut, Ulas Aday
1Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya Department of Radiology, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey.
Insights
Cutaneous fistulization is a rare complication of hydatid disease (HD). Consider complicated HD in differential diagnoses for skin fistulas, especially in endemic areas.
Area of Science:
- Medical Literature Review
- Parasitology
- Dermatology
Background:
- Hydatid disease (HD) is a parasitic infection caused by Echinococcus species.
- Cutaneous manifestations of HD, such as fistulization, are uncommon but significant.
- Understanding these rare presentations is crucial for accurate diagnosis and management.
Observation:
- A systematic literature search identified 38 articles on cutaneous fistulization in HD patients.
- The review included 40 patients with various forms of cysto-cutaneous fistulization.
- Echinococcus granulosus was the most common causative species identified.
Findings:
- Cutaneous fistulization represents a rare complication of hydatid disease.
- The study analyzed patient demographics, cyst locations, and management strategies.
- Various presentations of fistulization were observed, including direct cysto-cutaneous and more complex multi-organ fistulas.
Implications:
- Cutaneous fistulization should be considered in the differential diagnosis of unexplained skin fistulas.
- Early recognition and diagnosis of complicated HD are essential for effective treatment.
- This review highlights the importance of considering endemic parasitic diseases in dermatological diagnostics.
Aim:
To provide an overview of the medical literature on cutaneous fistulization in patients with hydatid disease (HD).
Methods:
According to PRISMA guidelines a literature search was made in PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to cutaneous fistulization of the HD. Keywords used were hydatid disease, hydatid cyst, cutaneous fistulization, cysto-cutaneous fistulization, external rupture, and external fistulization. The literature search included case reports, review articles, original articles, and meeting presentations published until July 2016 without restrictions on language, journal, or country. Articles and abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management, were included in the study, whereas articles with insufficient clinical and demographic data were excluded. We also present a new case of cysto-cutaneous fistulization of a liver hydatid cyst.
Results:
The literature review included 38 articles (32 full text, 2 abstracts, and 4 unavailable) on cutaneous fistulization in patients with HD. Among the 38 articles included in the study, 22 were written in English, 13 in French, 1 in German, 1 in Italian, and 1 in Spanish. Forty patients (21 males and 19 females; mean age ± standard deviation, 54.0 ± 21.5 years; range, 7-93 years) were involved in the study. Twenty-four patients had cysto-cutaneous fistulization (Echinococcus granulosus); 10 had cutaneous fistulization (E multilocularis), 3 had cysto-cutaneo-bronchio-biliary fistulization, 2 had cysto-cutaneo-bronchial fistulization; and 1 had cutaneo-bronchial fistulization (E multilocularis). Twenty-nine patients were diagnosed with E granulosis and 11 had E multilocularis detected by clinical, radiological, and/or histopathological examinations.
Conclusion:
Cutaneous fistulization is a rare complication of HD. Complicated HD should be considered in the differential diagnosis of cases presenting with cutaneous fistulization, particularly in regions where HD is endemic.
