Hakan SALMAN, Zeliha SALMAN, Yeliz KART, Mustafa AKÇAM

Çocuklarda Kistik Ekinokokkoz: On Yıllık Tecrübe ve Rüptüre Olguları Değerlendirmede Hangi Laboratuar Sonucu?

Amaç Kist hidatik hastalığı (Echinococcosis) Türkiye gibi hayvancılıkla uğraşan ülkelerde yaygın olan bir zoonozdur. Bölgemizde son 10 yılda görülen çocuk kist hidatik olgularını değerlendirip, rüptüre kist hidatik olgularını ayırt etmede başlangıç klinik ve laboratuvar bulgularının önemini belirlemektir. Gereç ve yöntem Ocak 2011-Aralık 2020 tarihleri arasında hastanemizde tedavi edilen ve düzenli olarak takiplere gelen kist hidatikli çocukların demografik özellikleri, başvuru şikayeti, fizik muayene, laboratuvar, radyolojik bulguları ve tedavileri geriye dönük incelendi. Bulgular Çalışmaya dahil edilen kırk iki olgunun 19’u kız (%45,2), ortanca yaşları 125,5 (34-209) aydı. En yaygın belirti %50 ile karın ağrısı, en yaygın fizik muayene bulgusu ise %23,8 ile solunum seslerinde azalmaydı. Hastaların 35’inde de (%83,3) tek organ, 7’sinde (16,7) çoklu organ tutulumu vardı. Karaciğer kist hidatiklerinin 24’ünde (%75) kist karaciğerin sağ lobunda, akciğer kist hidatiklerinin ise 7’si (%58,3) sol lobunda tespit edildi. Kistlerin ortanca boyu 57,5 mm (12-140 mm) idi. Rüptüre kisti olan hastalarda başlangıç İHA titresi, eozinofil sayısı, eozinofil yüzdesi ve sedimantasyon değeri rüptür olmayan hastalara göre istatistiksel olarak anlamlı yüksekti (sırasıyla p=0,002, p=0,003, p=0,003, p=0,02). Sonuç İlk başvuruda patolojik muayene bulgusu ve yüksek İHA titresi, eozinofil sayısı, eozinofil yüzdesi ve sedimantasyon değeri rüptür olgularını ayırt etmek için kullanılabilir.

Anahtar Kelimeler:

Akciğer, karaciğer, kist, pediatri

Cystic Echinococcosis in Children: Ten Years of Experience and Which Laboratory Result in Evaluating Ruptured Cases?

Aim Hydatid disease (Echinococcosis) is a common zoonosis in countries that are involved in livestock such as our country. Our study aims to evaluate pediatric cases with hydatid disease over the last decade in our region and to determine the significance of initial clinical and laboratory findings in distinguishing ruptured hydatid cyst cases. Materials and Methods A retrospective analysis was made on demographic characteristics, presenting symptoms, physical examination, laboratory and radiological findings, and treatments of children with hydatid disease who were treated in our hospital and followed up regularly between January 2011 and December 2020. Results The study sample of 42 cases included 19 (45.2%) girls, with a median age of 125.5 (34-209) months. The most common symptom was abdominal pain (50%), and the most common physical examination finding was decreased breath sounds (23.8%). Thirty-five (83.3%) patients had single organ involvement and 7 (16.7) patients had multiple organ involvement. Cysts were detected in the right lobe of the liver in 24 (75%) of hepatic hydatid cysts and the left lobe in 7 (58.3%) of pulmonary hydatid cysts. The median size of the cysts was 57.5 (12-140) mm. The initial IHA titer, eosinophil count, eosinophil percentage, and sedimentation value were statistically significantly higher in patients with ruptured cysts than in those without rupture (p= 0.002, p= 0.003, p= 0.003, p= 0.02, respectively). Conclusions Initial pathological examination findings and at initial laboratory findings such as high IHA titer, eosinophil count, eosinophil percentage, sedimentation value can be used to distinguish rupture cases.

Keywords:

Cyst, liver, lung, pediatrics,

PDF

___

1- Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004;17:107
2- Petropoulos AS, Chatzoulis GA. Echinococcus granulosus in childhood: a retrospective study of 187 cases and newer data. Clin Pediatr (Phila) 2019;58:864-88
3- Bhutani N, Kajal P. Hepatic echinococcosis: a review. Ann Med Surg (Lond) 2018;36:99-105
4- World Health Organization. Echinococcosis. 17 May 2021 http://www.who.int/echinococcosis/en/ (Accessed on April 1, 2022)
5- Shams M, Khazaei S, Naserifar R, Shariatzadeh SA, Anvari D, Montazeri F, et al. Global distribution of Echinococcus granulosus genotypes in domestic and wild canids: a systematic review and meta-analysis. Parasitology. 2022;149(9):1147-1159. doi: 10.1017/S0031182022000658. Epub 2022 May 20. PMID: 35591776.
6- Ben Brahim M, Nouri A, Ksia A et al. Management of multiple echinococcosis in childhood with albendazole and surgery. J Pediatr Surg 2008;43:2024-30
7- Brunetti E, Kern P, Vuitton DA. Writing panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-16
8- Uysal A, Gürüz Y, Köktürk O et al. Türk Toraks Derneği Paraziter Akciğer Hastalıkları Tanı ve Tedavi Uzlaşı Raporu. Turkish Thoracic Journal 2009,10;Suppl B (in Turkish)
9- Cohen H, Paolillo E, Bonifacino R et al. Human cystic echinococcosis in a Uruguayan community: a sonographic, serologic, and epidemiologic study. Am J Trop Med Hyg 1998;59(4):620-7. doi: 10.4269/ajtmh.1998.59.620
10- Uchiumi L, Mujica G, Araya D, Salvitti JC, Sobrino M, Moguillansky S, et al. Prevalence of human cystic echinococcosis in the towns of Ñorquinco and Ramos Mexia in Rio Negro Province, Argentina, and direct risk factors for infection. Parasit Vectors 2021;14(1):262. doi: 10.1186/s13071-021-04753-y. PMID: 34011406; PMCID: PMC8136178.
11- Aslanabadi S, Zarrintan S, Abdoli-Oskouei S et al. Hydatid cyst in children: a 10-year experience from Iran. Afr J Paediatr Surg 2013;10:140-4
12- Aygün D, Yıldırım T, Başoğlu Öner Ö, Kuzdan Ö. Hydatid Disease in Childhood: A Single Center Experience. J Pediatr Inf 2020;14(2):80-86
13- Tural-Kara T, Özdemir H, Karbuz A, Kocabaş BA. Clinical characteristics of childhood hydatid disease: a single tertiary centre experience from Turkey. HK J Paediatr (new series) 2018;23:162-8
14- Amahmid O, El Guamri Y, Zenjari K, Bouhout S, Ait Moh M, Boraam F, et al. The pattern of cystic echinococcosis in children in an endemic area in Morocco. J Parasit Dis. 2019;43(2):209-214. doi: 10.1007/s12639-018-01077-0.
15- Dopchiz MC, Elissondo MC, Andresiuk MV et al. Pediatric hydatidosis in the south-east of the Buenos Aires province, Argentina. Rev Argent Microbiol 2009;41:105-1
16- Bhutani N, Kajal P. Hepatic echinococcosis: a review. Ann Med Surg (Lond) 2018;36:99-105
17- Escola-Verge L, Salvador F, Sanchez-Montalva A et al. Retrospective study of cystic echinococcosis in a recent cohort of a referral center for liver surgery. J Gastrointest Surg 2019;23:1148-56
18- Petropoulos AS, Chatzoulis GA. Echinococcus granulosus in childhood:a retrospective study of 187 cases and newer data. Clin Pediatr (Phila) 2019;58:864-88
19- Çakır D, Çelebi S, Gürpınar A, Agın M, Bozdemir E. Evaluation of cases with hydatid diseases. J Pediatr Inf 2009;3:104-8
20- Jordanova DP, Harizanov RN, Kaftandjiev IT, Rainova IG, Kantardjiev TV. Cystic echinococcosis in Bulgaria 1996-2013, with emphasis on childhood infections. Eur J Clin Microbiol Infect Dis 2015;34:1423-8
21- Morar R, Feldman C. Pulmonary echinococcosis. Eur Respir J 2003;21:1069-77
22- Çay Ü, Alabaz D, Gündeşlioglu Ö, Tutuş K, Çil M, Pehlivan UA. Multi-organ/disseminated echinococcosis in children: Case series and review of the literature. J Paediatr Child Health 2022;58(7):1193-1200. doi: 10.1111/jpc.15942.
23- Djuricic SM, Grebeldinger S, Kafka DI, Djan I, Vukadin M, Vasiljevic ZV. Cystic echinococcosis in children–the seventeen-year experience of two large medical centers in Serbia. Parasitol Int 2010;59:257-61
24- Tamarozzi F, Silva R, Fittipaldo VA, Buonfrate D, Gottstein B, Siles-Lucas M. Serology for the diagnosis of human hepatic cystic echinococcosis and its relation with cyst staging: A systematic review of the literature with meta-analysis. PLoS Negl Trop Dis. 2021;15(4):e0009370. doi: 10.1371/journal.pntd.0009370. eCollection 2021 Apr
25- Kaman A, Tanır G, Çakmakçı E, Demir P, Öz FN, Teke TA, et al. Characteristics, diagnosis, and treatment modality of pediatric patients with cystic echinococcosis: a single centre experience. Turk J Pediatr. 2019;61(5):704-713. doi: 10.24953/turkjped.2019.05.009.
26- Sarkar M, Pathania R, Jhobda A, Thakur B, Chopra R. Cytic pulmonary hydatidosis. Lung India 2016;33:179-91
27- Ozyurtkan MO, Balci AE. Surgical treatment of intrathoracic hydatid disease: a 5-year experience in an endemic region. Surg Today 2010;40(1):31-7. doi: 10.1007/s00595-009-4063-0.
28- Ksia A, Fredj MB, Zouaoui A, Kechiche N, Belhassen S, Mosbahi S, et al. Capitonnage seems better in childhood pulmonary hydatid cyst surgery. J Pediatr Surg 2020;55(4):752-755. doi: 10.1016/j.jpedsurg.2019.05.009.
29- Onal O, Demir OF. Is anatomic lung resection necessary in surgical treatment of giant lung hydatid cysts in childhood? Ann Thorac Cardiovasc Surg 2017;23:286-90
30- Oral A, Yigiter M, Yildiz A, Yalcin O et al. Diagnosis and management of hydatid liver disease in children: a report of 156 patients with hydatid disease. Journal of Pediatric Surgery 2012;47:528-34
31- Doğru D, Kiper N, Ozçelik U, Yalçin E, Göçmen A. Medical treatment of pulmonary hydatid disease: for which child? Parasitol Int 2005;54:135-8
32- Brunetti E, Junghanss T. Update on cystic hydatid disease. Curr Opin Infect Dis 2009;22:497-502
33- Bozkurt B, Soran A, Karabeyoğlu M, Unal B, Coşkun F, CengizO. Follow-up problems and changes in obliteration of the residual cystic cavity after treatment for hepatic hydatidosis. J Hepatobiliary Pancreat Surg 2003;10:441-5
34- Tüz AE, Ekemen Keleş Y, Şahin A, Üstündağ G, Taşar S, Karadağ Öncel E, et al. Hydatid Disease in Children from Diagnosis to Treatment: A 10-year Single Center Experience. Turkiye Parazitol Derg 2022;46(3):189-94.