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Should Pediatricians Be Aware of Cystic Echinococcosis? A Literature Review

Tersigni, Chiara*; Venturini, Elisabetta; Montagnani, Carlotta; Bianchi, Leila; Chiappini, Elena; de Martino, Maurizio; Galli, Luisa

Journal of Pediatric Gastroenterology and Nutrition: February 2019 - Volume 68 - Issue 2 - p 161–168
doi: 10.1097/MPG.0000000000002182
Review Article

ABSTRACT Among parasitic hepatic cystic lesions, the most common disease is represented by cystic echinococcosis (CE), especially in high endemic countries. European epidemiology of CE in children is difficult to assess because of under-reporting but is increasing, because of high immigration flows from endemic countries and an increased awareness. Hydatidosis can be localized in every part of the body. The liver and lungs are the most common localizations in both children and adults. Multiorgan involvement is rarely reported in children. Different tests are available. Usually the sensitivity of serological screening tests is variable, ranging between 60% and 90%. The immunoblot assay is used as a confirmatory test because of its higher sensitivity and specificity. Radiological tests are the criterion standard for diagnosis of CE, with an ultrasound accuracy of approximately 90%. In case of inactive and uncomplicated cysts the watch-and-wait approach is recommended. Albendazole, currently used for 3 to 6 months consecutively represents the most commonly used drug in children even if there is limited experience in treating children younger than 6 years of age. Percutaneous treatment with the puncture, aspiration, injection, and reaspiration technique is a minimally invasive procedure. Surgery is indicated based on cyst characteristics in case of big cysts with multiple daughter cysts, single superficial cysts at risk of spontaneous or traumatic rupture, cysts related with the biliary tract in which the percutaneous treatment is contraindicated, and cysts compressing related structures.

*Postgraduate School of Paediatrics, University of Florence

Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.

Address correspondence and reprint requests to Luisa Galli, MD, Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, I-50139 Florence, Italy (e-mail: luisa.galli@unifi.it).

Received 7 August, 2018

Accepted 8 October, 2018

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,