Medical treatment of pulmonary hydatid disease: for which child?
Introduction
Human hydatid disease is caused by the metacestode of Echinococcus granulosus and may result in asymptomatic infection to severe disease which may be fatal. It has a world-wide geographic range and occurs in all continents. Turkey has a high incidence of this disease in humans and the average annual incidence rate is 4.4 per 100,000 inhabitants [1]. It can be seen in almost all ages, but from the limited data available, it seems that it is more common in childhood than in adulthood [2].
To date, surgical resection of the pulmonary hydatid disease has been the primary mode of treatment with its risks, postoperative complications and recurrences [1]. On the other hand, there have been many studies on medical treatment of patients who have widespread disease impossible for surgical resection and medical treatment remains the only option for them [3], [4], [5], [6], [7], [8]. The successful and encouraging results of medical treatment of those patients with pulmonary hydatid disease led us to treat our patients who have noncomplicated pulmonary hydatid cysts with medical treatment only. However, the drug which should be preferred and duration of treatment as well as the effect of number and size of pulmonary cysts on treatment results have not been established clearly yet, especially for children. So, the aim of this study was to try to find answers to such questions, to demonstrate the safety and efficacy of medical treatment both in early and long term period, and to describe a pediatric population who would benefit from medical treatment in pulmonary hydatid disease.
Section snippets
Materials and methods
Medical records of patients with pulmonary hydatid disease who presented to Hacettepe University İhsan Doğramacı Children's Hospital in Ankara, Turkey between January 1975 and December 2002 were retrospectively evaluated. Hydatid cysts were diagnosed by clinical, serologic and radiologic studies. The size of the cysts were noted.
All patients were treated with benzimidazoles and written consent for medical treatment was taken from the parents of all these children. Patients diagnosed earlier
Results
A total of 82 patients (32 females, 50 males) with 102 pulmonary hydatid cysts were diagnosed; their ages ranged between 2 and 16 years (mean age: 8.8 ± 3.4 years). There was only one pulmonary hydatid cyst in 47 patients, more than one pulmonary cysts in 12 patients, and there were extrapulmonary cysts besides pulmonary cysts in 23 patients. Extrapulmonary cyst locations were liver in most (21 patients) patients, followed by central nervous system in 1 patient; 1 patient had disseminated disease
Discussion
This is one of the few reports on the medical treatment of pediatric pulmonary hydatid disease; we demonstrated the results of 82 patients with 102 pulmonary hydatid cysts diagnosed in a period of 27 years which is also one of the biggest series in children with a very long term follow up period, as far as we know. We found that medical treatment can be safe and successful in pulmonary hydatid disease in selected pediatric cases and size of the cyst can be a determining factor for treatment
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