Trends in the Surgical Incidence of Cystic Echinococcosis in Uzbekistan from 2011 to 2018.

Cystic echinococcosis (CE) is a zoonosis with a cosmopolitan distribution caused by Echinococcus granulosus sensu lato tapeworms. Although Uzbekistan and other countries in Central Asia are considered endemic, estimates of disease burden are lacking. We present data regarding surgically managed cases of CE obtained from Uzbekistan's national disease surveillance registry. These data are from medical centers in Uzbekistan authorized to treat the disease and reported to the Uzbek Center for Sanitation and Epidemiology from the period 2011 to 2018. Information included patient age class (children 14 years or younger versus adults 15 years and older), but no data regarding cyst location. Incidence rates were calculated using data from the national population registry, and the Cuzick nonparametric test for trends was used to test for differences in the incidence over time at the country and regional levels. A total of 7,309 CE cases were reported. Of these, 857 (11.73%) involved pediatric patients. The mean incidence rates were 4.4 per 100,000 population in 2011 and 2.3 per 100,000 population in 2018 (P = 0.016). One region (Republic of Karalpakistan) showed a nonstatistically significant increase (P = 0.824). All other regions except three showed a statistically significant decrease. We present data showing a decrease in the overall incidence of surgically treated CE in Uzbekistan from 2011 to 2018. However, the presence of cases involving children suggests ongoing parasite transmission. The absence of clinical information (starting with cyst stage and localization) needs to be addressed to improve the national surveillance system. Field studies are also needed to further explore the epidemiology of CE in the country.

Peritoneal Hydatid Cysts in Children: A Case Series of Rare Echinococcosis Localization.

Peritoneal hydatid cysts are rare in children even in endemic areas. The primary or secondary origin of this site remains controversial, especially in children. Secondary peritoneal hydatid cysts are mainly the result of spontaneous or traumatic rupture of concomitant liver cysts or the leakage of cystic content during surgery. The purpose of our study is to present the largest case series of peritoneal hydatidosis in children. In addition, we aimed to assess the clinical and paraclinical findings as well as the management of echinococcosis at this location in children. The present case series is a study of ten children with peritoneal hydatid cysts, who underwent surgical intervention between 2013 and 2018 in the Pediatric Surgery Department, University of Monastir (Monastir, Tunisia). The mean age of the children was six years. All children presented abdominal pain, and underwent ultrasonography and contrast-enhanced computed tomography of the abdomen. Two patients had been operated on for lung hydatid cysts six months prior to the study. In two cases, radiologic investigations revealed the presence of an uncomplicated hepatic hydatid cyst located in segments II and IV. All patients underwent surgery, of which four underwent laparoscopy. Post-surgery, all patients received albendazole for three months, and the follow-up period was uneventful. Currently, all patients are in good health. Peritoneal hydatid disease is frequently secondary to the rupture of a primary hepatic cyst. Diagnosis is performed by abdominal ultrasound, computed tomography, and a positive serology result. Open or laparoscopic excision can be combined with medical treatment.

Comparison of Laparoscopic and Conventional Cystotomy/Partial Cystectomy in Treatment of Liver Hydatidosis.

INTRODUCTION: Hydatidosis is a zoonotic infection and treatment is mandatory to avoid complications. Surgery remains the first choice in the treatment especially for CE2-CE3b cysts. Open or laparoscopic approaches are available. However, comparative studies are limited. MATERIALS AND METHODS: Data of patients who underwent cystotomy/partial cystectomy for liver hydatidosis between January 2012 and September 2016 (n=77) were evaluated retrospectively. Recurrent cases and the patients with previous hepatobiliary surgery were excluded. 23 patients were operated upon laparoscopically and named as Group 1. 48 patients operated conventionally named as Group 2. Demographics, cyst characteristics, operative time, length of hospital stay, recurrences, and surgery related complications were evaluated. RESULTS: Groups were similar in terms of demographics, cyst characteristics, and operative time. The length of hospital stay was 3.4 days in Group 1 and 4.7 days in Group 2 (p=0,007). The mean follow-up period was 17.8 months and 21.7 months, respectively (p=0.170). Overall complication rates were similar in two groups (p=0.764). Three conversion cases occurred (13%). One mortality was seen in Group 2. Four recurrences occurred in each group (17% versus 8.3%, respectively) (p=0.258). CONCLUSIONS: Laparoscopy is a safe and feasible approach for surgical treatment of liver hydatidosis. Recurrence may be prevented by selection of appropriate cases in which exposure of cysts does not pose an intraoperative difficulty.

Hepatic cystic echinococcosis in Australia: an update on diagnosis and management.

BACKGROUND: Echinococcosis is an uncommonly encountered zoonotic disease caused by the taeniid Echinococcus. The only endemic species in Australia, Echinococcus granulosus, forms cysts in the liver in 70% of cases. The aim of this study was to review the literature to provide an evidence-based narrative update on the diagnosis and management of hepatic cystic echinococcosis in Australia. METHODS: We reviewed the literature, utilizing multiple research databases and citation tracking. Original research and review articles examining the diagnosis and management of hydatid disease in adults, published prior to 2016 and in the English language were included in our review. RESULTS: Ultrasound is the gold-standard screening test, whilst computed tomography has a role in emergency presentations and screening for multi-organ involvement. Magnetic resonance imaging is the preferred second-line imaging and better demonstrates biliary involvement. Medical therapy or PAIR (percutaneous aspiration, irrigation with scolicide and re-aspiration) may be appropriate in selected cases; however, surgery remains the definitive treatment for active, large (>5 cm), symptomatic or complicated cysts. A variety of surgical techniques have been described, including conservative, radical and minimally invasive procedures. There is currently no consensus approach; surgical modality should be tailored to patient factors, relevant anatomy, local facilities and surgeons' expertise. CONCLUSION: Diagnosis and therapy in hepatic hydatid cysts have been significantly advanced by imaging, interventional radiology and surgical approaches in recent years. Surgery remains the mainstay of treatment for large, active, complicated or symptomatic hepatic hydatid cysts.

Alveococcosis of the liver - strategy of surgical treatment with special focus on liver transplantation.

BACKGROUND: Echinococcosis is a zoonosis caused by infestation with any of 4 (of the 16) members of the Echinococcus genus, namely Echinococcus granulosus, Echinococcus multilocularis, Echinococcus oligarthus, and Echinococcus vogelii. The aim of this retrospective analysis was to present the outcomes of patients undergoing liver resection and liver transplantation (LT) for E. multilocularis infection. METHODS: A total of 44 patients who underwent surgical treatment of E. multilocularis infection in the period between 1989 and 2014 were included in the study cohort and retrospectively analyzed. RESULTS: LT was performed in 22 patients (50.0%), including 4 of 26 patients undergoing initial non-transplant management. Non-transplant procedures comprised liver resection in 23 patients (88.5%), diagnostic laparoscopy in 2 (7.7%), and left adrenalectomy in 1 patient (3.8%). Post-transplantation survival rates were 90%, 85%, and 75% at 1, 5, and 10 years, respectively. CONCLUSION: In conclusion, LT for E. multilocularis infection is a safe and effective treatment method.

[Head and neck localizations of hydatid cyst: A series of 17 cases]. / Localisations cervico-faciales du kyste hydatique : série de 17 cas.

INTRODUCTION: Head and neck localizations of hydatid cyst are very rare (1% of human cases) even in countries where echinococcosis is endemic (human sites). Our objective was to report the epidemiological, and clinical characteristics and the management of head and neck localizations of hydatid cyst. MATERIALS AND METHODS: A retrospective descriptive study of 17 cases of head and neck hydatid cysts taken in charge in our department between 2000 and 2014 was conducted. RESULTS: The mean age was 35 years. Male were slightly predominant (sex ratio: 1.12). Eighty-eight percent of the patients had regular contact with dogs and 53% were of rural origin. The soft tissues of the head and neck were involved in six patients, the parotid gland in 6 patients, the thyroid in 4 patients and the submaxillary gland in one patient. Complete surgical resection of the lesions was systematically done. Hydatid disease was confirmed in all the cases by histology. The outcome was uneventful in all the patients with a mean follow-up of 2 years. CONCLUSION: Given the lack of recommendations for the surgical treatment of head and neck hydatid cysts, we advocate a total resection of the affected organ if there is no functional risk. Otherwise, an excision of the cyst and of the surrounding tissues combined with an abundant washing-out of the residual cavity must be done, especially in case of intraoperative breaking of the cyst.

[Hepatopulmonary hydatidosis: pediatric case report and literature review]. / Hidatidosis hepatopulmonar: reporte de caso clínico pediátrico y revisión de literatura.

Hydatidosis is a parasitic zoonosis of the genus Echinococcus that infects herbivores and humans in its larvae stage (hydatid). Pediatric hydatidosis usually presents with involvement of the lung, in contrast to the adult clinical picture. Therefore, hepatopulmonary hydatidosis is an unusual entity in children. A clinical case is presented, along with a short review of available literature. A thirteen-year-old male child, who lives in Cauquenes, a rural area of Central Chile, presents with three months of cough, fever, malaise, and an abdominal mass. Imaging reveals multiple cystic images, located mostly in the right lung and the liver. The patient is started on albendazole (15 mg/kg/day) and transferred to the Pediatric Surgery Unit in Hospital de Talca. He underwent thoracotomy and laparotomy for the removal of the hydatid cysts. He recovered from surgery and continued his pharmacological treatment. Hydatidosis is a public healthcare problem, and a major cause of morbidity and mortality. It can be asymptomatic; thus, its diagnosis requires a high level of suspicion.

Se denomina hidatidosis a la zoonosis parasitaria que causa la infección de herbívoros o del hombre con el estado larval (hidátide) de parásitos del género Echinococcus. La hidatidosis pediátrica exhibe un patrón de presentación distinto a la adulta, el pulmón es el órgano afectado con mayor frecuencia. La hidatidosis hepatopulmonar es una entidad inusual en los niños. Se presenta un caso clínico y una breve revisión del tema en la literatura. El caso clínico es un escolar de 13 años procedente de la comuna de Cauquenes, con cuadro clínico de tres meses de evolución de tos, fiebre, compromiso del estado general y masa abdominal en el último mes. A través de imágenes se evidencian múltiples quistes pulmonares de predominio derecho y quistes hepáticos. El paciente recibe tratamiento con albendazol 15 mg/kg/día y se deriva a la unidad de cirugía infantil del Hospital Regional de Talca para resolución quirúrgica. Es sometido a toracotomía y laparotomía para extirpación de hidátides. Evolucionó favorablemente y continuó con tratamiento médico. La hidatidosis es un problema de salud pública nacional, causante de alta morbimortalidad. Su presentación puede ser asintomática, por lo que requiere de un alto índice de sospecha para diagnosticarla.