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Clinical Presentation, Management and Outcome of Cerebral Echinococcosis in Children: A Systematic Review and
Roberta Leonardi1,2, Alessandra Curatolo3, Manuela Lo Bianco4
1Postgraduate Training Program in Pediatrics, University of Catania, 95125 Catania, Italy.
Insights
Pediatric cerebral echinococcosis diagnosis and treatment have improved outcomes. Advances in imaging and albendazole therapy are key, though more research is needed for specific guidelines.
Area of Science:
- Neurology
- Parasitology
- Pediatrics
Background:
- Cerebral echinococcosis is a rare but severe parasitic infection in children.
- It can cause serious complications like intracranial hypertension and neurological deficits.
Purpose of the Study:
- To systematically review and analyze diagnostic and therapeutic approaches for pediatric cerebral echinococcosis.
- To evaluate treatment outcomes in affected children.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, and Web of Science.
- 100 studies involving 462 pediatric patients were included, analyzing clinical, imaging, surgical, and pharmacological data.
- Statistical analyses were performed using Fisher's exact and chi-square tests in R.
Main Results:
- High-resolution imaging, particularly MRI, is now preferred over invasive diagnostics, correlating with better outcomes.
- Surgical cyst removal is the primary treatment, with albendazole therapy showing a higher probability of good outcomes (p < 0.001).
- Common symptoms include headaches, vomiting, papilledema, seizures, and hemiparesis. Mortality was 8.9%, with approximately 2/3 achieving good outcomes.
Conclusions:
- Improvements in non-invasive imaging, surgical techniques, and antiparasitic therapies have enhanced patient outcomes.
- Limited evidence and heterogeneous reporting necessitate further multicenter studies for pediatric-specific guidelines.
- Refining treatment strategies and developing standardized guidelines are crucial for managing pediatric cerebral echinococcosis.
Background:
Cerebral echinococcosis is a rare, potentially serious parasitic disease in children, that can lead to intracranial hypertension, focal neurological deficits, seizures, and severe complications. We conducted a systematic review and meta-analysis on diagnostic, therapeutic approaches, and outcomes in pediatric cerebral echinococcosis.
Methods:
A systematic search was performed on PubMed, Scopus, and Web of Science, selecting English studies on children (0-18 years). Studies describing clinical, imaging, surgical, pharmacological, and outcome data were eligible. Statistical analyses (Fisher's exact and chi-square tests) were performed in R.
Results:
A total of 100 studies with 462 pediatric patients met the inclusion criteria. High-resolution imaging has largely replaced invasive diagnostics; MRI-based diagnosis correlated with better outcomes. Headaches, vomiting, papilledema, seizures, and hemiparesis were common. Surgical cysts' removal remained the main therapy. Additional treatment with albendazole was associated with a higher probability of good outcome (p < 0.001). A greater number of cyst localizations was significantly associated with a worse prognosis (p < 0.001). Overall mortality was 8.9%, while approximately 2/3 of patients achieved a good outcome.
Conclusions:
Advances in non-invasive imaging, refinement of surgical technique, and targeted antiparasitic therapy improved outcomes. Nevertheless, heterogeneous reporting and the prevailing paucity of evidence limit definitive recommendations. Prospective multicenter studies are needed to refine treatment and develop pediatric-specific guidelines.
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