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Paediatric pulmonary echinococcosis: A neglected disease
Pierre Goussard1, Ernst Eber2, Lunga Mfingwana1
1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
Insights
Cystic echinococcosis (CE) primarily affects the lungs in children, unlike adults. Diagnosis requires imaging, serology, and histology, especially in high-burden infectious disease areas.
Area of Science:
- Parasitology
- Pediatric Medicine
- Radiology
Background:
- Echinococcosis is a global health concern, particularly impacting children in endemic regions.
- Cystic echinococcosis (CE) presents differently in children versus adults, with pulmonary involvement being predominant in pediatric cases.
- Pulmonary cysts in children are often discovered incidentally on chest X-rays or due to complications like rupture or infection.
Purpose of the Study:
- To highlight the unique presentation and diagnostic challenges of pulmonary cystic echinococcosis in children.
- To emphasize the importance of a multidisciplinary diagnostic approach for pediatric pulmonary CE.
- To discuss the management strategies for pulmonary CE in the pediatric population.
Main Methods:
- Review of clinical presentations and diagnostic modalities for pulmonary cystic echinococcosis in pediatric patients.
- Analysis of differential diagnoses for pulmonary cysts in children, considering co-endemic infections like AIDS and TB.
- Evaluation of treatment outcomes combining surgery and chemotherapy.
Main Results:
- Pulmonary involvement is the most common manifestation of CE in children, contrasting with hepatic predominance in adults.
- Diagnosing pulmonary CE in children necessitates integrating imaging, serological tests, and histological findings.
- Diagnostic complexity is increased in regions with high burdens of other infectious diseases, requiring consideration of atypical presentations.
Conclusions:
- Pulmonary cystic echinococcosis is a significant pediatric health issue in endemic areas.
- Accurate diagnosis of pediatric pulmonary CE relies on a comprehensive approach combining various diagnostic tools.
- Effective management involves a combination of surgical intervention and antiparasitic chemotherapy.
Abstract:
Echinococcosis is a worldwide public health problem causing considerable paediatric morbidity and mortality in endemic areas. The presentation of cystic echinococcosis (CE) varies by age. Unlike adults, where hepatic involvement is common, pulmonary CE is the dominant site in the paediatric population. Pulmonary cysts are typically first seen on chest X-ray, either as an incidental finding or following respiratory symptoms after cyst rupture or secondary infection of the cyst. In children, pulmonary cysts have a broad differential diagnosis, and a definitive diagnosis relies on the combination of imaging, serology, and histology. In countries with high infectious burdens from diseases such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), the diagnosis is additionally challenging, as atypical infections are more common than in developed countries. Pulmonary CE is treated with a combination of surgery and chemotherapy.
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