Surgical management of pulmonary hydatid cysts in children in KwaZulu-Natal Province, South Africa

Abstract

Background. Pulmonary hydatid cyst disease is still a major problem in countries like South Africa (SA), where livestock farming is common. Hydatidosis has a variable clinical course depending on the size, location and complications of the cyst. For pulmonary cysts of any size, surgery remains the gold standard for treatment, with lung conservation surgery being the ideal. Objectives. To describe the epidemiology, clinical presentation, surgical management, and surgical outcomes of paediatric pulmonary hydatid disease in children referred to the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal Province, SA. Methods. We retrospectively reviewed and analysed the medical records of 38 children between the ages of 0 and 18 years with pulmonary hydatid cysts, who were referred to the Department of Cardiothoracic Surgery at IALCH and underwent surgical management between 1 January 2008 and 31 December 2018. The medical records were evaluated for patients' demographics, clinical evaluation, surgical management strategies and surgical outcomes. Results. Of the 38 patients, 60.5% were male, with a mean age of 6.5 years. More than two-thirds of the patients (68.4%) were from the Eastern Cape and 31.6% were from KwaZulu-Natal. The majority of the cysts (84.2%; n=32) were classified as large (5-9 cm in diameter) and giant (≥10 cm in diameter). Forty-eight surgical procedures were performed and lung preservation surgery by enucleation and capitonnage was preferred. Some patients developed postoperative complications such as prolonged air leaks from bronchopleural fistula (18.8%; n=9) and 88.9% (n=8) of these patients healed with chest tube drainage and physiotherapy. Lung resection was only required in 4% (n=2) of the patients. The mean (standard deviation) number of days spent in hospital was 7 (4) days. All children survived with no recurrences. Conclusion. Conservative surgical procedures such as enucleation of the cysts of any size are possible, safe, reliable and reproducible.

Liver cystic echinococcosis: A retrospective study on the demographics and clinical profile of patients managed at a single tertiary institution in central Eastern Cape Province, South Africa

“…[20,21,28] Owing to the blood supply of the portal venous system, the liver is the primary site affected by CE (~70% of cases), followed by the lungs and spleen. [1,15,26,29,[39][40][41] In the present study, the majority of patients (62.5%) had isolated liver involvement. It is worth mentioning that none of the patients with intraperitoneal involvement had previously undergone abdominal surgery for hydatid disease.…”

“…Dogs feeding on infected offal in the vicinity further perpetuate the life cycle and transmission of the parasite to the environment. [20,21] Similarly, Ngcobo et al [26] noted that the majority of pulmonary CE cases in their study were from rural areas of KwaZulu-Natal and Eastern Cape provinces.…”

Pulmonary Hydatid Cyst in Children: A Single-Institution Experience

“…Ngcobo et al found 52.4% IHA positivity in ruptured hydatid cysts and 41.2% in non-ruptured hydatid cysts, but they did not find a statistical difference between the two groups [ 1 ]. Özdemir et al found statistically significantly higher IHA positivity in ruptured hydatid cysts in a study of 649 patients [ 13 ].…”

“…Hydatid cyst is a zoonotic disease caused by echinococcal tapeworms. Traditionally, it has been reported in Central Asia, the Middle East, the Mediterranean region, East Africa, South America, New Zealand, and Australia due to its endemic nature related to animal husbandry [ 1 ].…”