Alveolar Echinococcosis in Children

Abstract

Alveolar echinococcosis (AE) is an infectious zoonotic disease that is caused by Echinococcus multilocularis. The disease is generally identified accidentally because of the long asymptomatic period, has a malignant behaviour, and mainly occurs in the liver. Usually it is diagnosed in adults and is very rare in pediatric patients. We report two cases of AE and 1 differential case between AE and cystic echinococcosis (CE) in children: two of them had lesions in the liver and one had rare extrahepatic presentation of a cyst in the spleen. All our patients received chemotherapy with albendazole because surgical treatment was not recommended. The children were followed-up from 10 to 30 months and no significant improvement was seen. In this report we discuss the difficulties we faced in the treatment and follow-up of these patients. We also review the main clinical manifestations, general diagnostic methods, and treatment options of AE according to the current literature.

Pediatric Echinococcosis of the Liver in Austria: Clinical and Therapeutical Considerations

“…It is possible, in about 25% of patients, to interrupt the benzimidazole therapy temporarily or permanently in order to minimize the side effects [ 25 ]. In children, however, experience with AE is limited, i.e., there are only case reports with different results [ 5 ].…”

“…The cysts of E. multilocularis are usually localized in the liver or lungs and spread diffusely, penetrating invasively into the affected organs. The incubation period of this ultimately life-threatening echinococcosis is between five and fifteen years [ 5 ].…”

“…AE is rarely found in pediatric patients. It usually occurs in adults because of the long incubation period [ 5 ].…”

“…Since children rarely manifest echinococcosis due to age, these diseases, which primarily affect the liver, are often not included in differential diagnoses of abdominal diseases, and missing the diagnosis can have devastating consequences. Indeed, this aspect is not trivial, because echinococcosis is a potentially life-threatening disease [ 1 , 2 , 3 , 4 , 5 ]. In this pictorial and scoping review, we highlight the significant burden of children with cystic disease, which can be differentiated between dis-ontogenetic cysts and hepato-renal fibrocystic disease with characteristic inheritance.…”

Parasites of the liver – epidemiology, diagnosis and clinical management in the European context

“…European patients are often older than 50 years and AE in children is rare. [55][56][57][58][59] Interestingly, in China, the average age at first diagnosis is significantly younger than in Europe, and disease is often advanced, requiring a more invasive treatment approach. 6 Early symptoms are mostly non-specific including fatigue, abdominal pain or jaundice.…”