Cystic Echinococcosis in Paediatric Refugees: A Case Series

Background

Echinococcosis is caused by an infection with a tapewormʼs larval stage of the genus Echinococcus (E.). Humans, who are accidental intermediate hosts to these parasites become infected by ingesting ova from carnivorous definite hosts. In contrast to the devastating disease of alveolar echinococcosis (AE), caused by E. multilocularis, infection with E. granulosus sensu lato (cystic echinococcosis (CE)) typically causes a chronic disease, which can be asymptomatic for decades, depending on the size, location and number of cysts (Brunetti E et al., Acta Trop 2010; 114: 1–16). Even if left untreated, the mortality is much lower in CE (2 to 4%) than in AE (up to 90%). Nevertheless, untreated CE can lead to serious complications, ranging from compression of vital organs to anaphylactic shock caused by cyst rupture. In about 70% of affected children, E. granulosus causes unilocular cysts, with the liver being the most commonly affected organ. In individuals with pulmonary disease, additional liver cysts can be found in about 20% of cases. Less frequently affected organs are the central nervous system (CNS) and bones (Wen H et al., Clin Microbiol Rev 2019; 13; 32(2)). Despite being a notifiable disease in many countries and uncommon in central and Western Europe, underreporting is highly likely. Rural or pastoral communities in Low- to Middle Income Countries (LMIC) in South- Eastern Europe, the Middle East and Central Asia are thought to have high prevalence of CE (Casulli A et al. Lancet Infect Dis 2023; 23: 95–107). For close to a decade Austria has been among the European countries receiving the highest number of asylum applications per capita. Currently, the majority of asylum seeking refugees in Austria originate from Syria and Afghanistan where the prevalence of CE is thought to be substantial (Richter J et al. Eur J Epidemiol 2019; 34(6): 611–612), (European Union Agency for Asylum (EUAA). Asylum Report 2023). A classification of cyst stage has been developed by the WHO Informal Working Group on Echinococcosis (WHO-IWGE), to guide the selection of appropriate CE therapy, which may include anti-parasitic drug treatment, surgery, puncture-aspiration-injection-reaspiration (PAIR) or “watch and wait”, based on stage and morphology of the cyst (WHO Informal Working Group. Acta Trop 2003; 85(2): 253–261). There is growing evidence that repeated preoperative treatment of lung cysts with albendazole increases the risk of cyst rupture by weakening the cyst wall (Usluer O et al., Kardiochir Torakochirurgia Pol 2014; 11(1): 26–29).

Publikationsverlauf

Artikel online veröffentlicht:
15. Oktober 2024