학술논문
Ãocuklarda Tanidan Tedaviye Hidatik Hastaligi: On Yillik Tek Merkez Deneyimi/Hydatid Disease in Children from Diagnosis to Treatment: A 10-year Single Center Experience
Ãzgün Arastirma/Original Investigation
Ãzgün Arastirma/Original Investigation
Document Type
Clinical report
Disease/Disorder overview
Disease/Disorder overview
Author
Source
Turkish Journal of Parasitology. September 2022, Vol. 46 Issue 3, p189, 6 p.
Subject
Language
English
ISSN
1300-6320
Abstract
GIRIS Hidatik hastaligi, Echinococcus türlerinin etken oldugu zoonotik bir hastaliktir. Echinococcus granulosus için kesin konakçi köpekler, kurtlar ve tilkilerdir. Insanlar, bu döngüde tesadüfi ara konakçilardir. Enfeksiyon, parazit yumurtalari ile kontamine [...]
Amaç: Hidatik hastaligi, Echinococcus granulosus'un neden oldugu parazitik bir zoonozdur ve Türkiye'de endemiktir. Klinik bulgular çesitlidir ve anatomik yerlesimle iliskilidir. Bu raporda, çocuklarda hidatik hastaliginin tani, tedavi ve izlemini 10 yillik deneyimimizle paylasmayi amaçladik. Yöntemler: Hidatik hastaligi tanili 57 çocuk olgu, hastane kayitlarindan geriye dönük olarak incelendi. Tani, klinik, serolojik ve radyolojik bulgulara dayandirildi. Tedavi yaniti klinik, radyolojik ve serolojik bulgularla degerlendirildi. Bulgular: Toplam 57 olgunun erkek/kiz orani 2.4:1 ve yas ortalamalari 113,6[+ or -]45,9 ay idi. En sik görülen basvuru yakinmasi karin agrisiydi (%42,1). Olgularin 22'sinin (%38,6) eozinofilisi mevcutken; indirekt hemaglütinasyon test pozitifligi 27 olguda (%47,4) saptandi. Olgularin 18'inde (%31,6) çoklu organ tutulumu vardi. Ãoklu organ tutulumu olanlarda, kistlerin batin yerlesimli olma olasiligi daha yüksek bulundu (p=0,005). Tedavi amaciyla cerrahi girisim uygulanan 50 olgudan (%87,7), 45'inin (%78,9) açik cerrahi, 5'inin (%8,8) perkütan aspirasyon, enjeksiyon ve reaspirasyon yöntemi ile opere oldugu saptandi. Konservatif tedavide Albendazol verilen 52 (%91,2) olgu mevcuttu ve tedavi süreleri ortalama 15,5[+ or -]17,2 aydi. Kist rüptürü gelisen 10 olgu (%17,5) mevcuttu ve semptom süreleri, kist rüptürü gelismeyen olgulara göre daha kisaydi (p=0,017). Dispne görülen ve agizdan kaya suyu gelen olgularda kist rüptürü olma olasiligi daha yüksek bulundu (sirasiyla p=0,001, p=0,005). Izlemde bes olguda (%8,8) nüks gelistigi görüldü. Tartisma: Hastaligin endemik oldugu bölgelerde kisisel aliskanlik ve saglik egitiminden olusan önleme ve kontrol programlarina ragmen, hidatik hastaliginin aktif geçisi çocuklarda görülmekte ve önemli bir halk sagligi sorunu olmaya devam etmektedir. Endemik bölgelerde süpheli radyolojik ve klinik bulgular varliginda hidatik hastaligi mutlaka akla getirilmelidir. Tani ve tedavi prosedürleri olusmasi adina, kontrollü klinik çalismalara ihtiyaç duyulmaktadir. Anahtar Kelimeler: Hidatik hastaligi, çocuk, tani, tedavi, izlem Objective: Hydatid disease caused by Echinococcus granulosus is a parasitic zoonosis and is endemic in Turkey. Clinical manifestations vary and are related to the anatomical location. In this report, we shared the diagnosis, treatment and follow-up of hydatid disease in children with a 10-year experience. Methods: A total of fifty-seven children diagnosed with hydatid disease were analyzed retrospectively from hospital records. Diagnosis was based on clinical, serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings. Results: The male/female ratio of 57 cases was 2.4:1 and the mean age was 113.6[+ or -]45.9 months. The most common presenting complaint was abdominal pain (42.1%). While 22 (38.6%) of the cases had eosinophilia; indirect hemagglutination test positivity was detected in 27 cases (47.4%). Multiple organ involvement was present in 18 cases (31.6%). In patients with multiple organ involvement, the possibility of cysts being located in the abdomen was higher (p=0.005). Of the 50 cases (87.7%), 45 (78.9%) were operated with open surgery and 5 (8.8%) with percutaneous aspiration-injection-reaspiration method for treatment. There were 52 (91.2%) patients who were given albendazole in conservative treatment and the mean duration of treatment was 15.5[+ or -]17.2 months. There were 10 cases (17.5%) who developed cyst rupture and the symptom duration was shorter than the cases without cyst rupture (p=0.017). Cyst rupture was more common in cases with dyspnea and fluid discharge from the mouth called rock water (p=0.001, p=0.005, respectively). Recurrence was observed in five cases (8.8%) during follow-up. Conclusion: In areas where the disease is endemic, despite prevention and control programs consisting of personal habits and health education, active transmission of hydatid disease is seen in children and continues to be an important public health problem. Hydatid disease should definitely be considered in the presence of suspicious radiological and clinical findings in endemic areas. Controlled clinical studies are required for diagnosis and treatment procedures. Keywords: Hydatid disease, child, diagnosis, treatment, follow-up
Amaç: Hidatik hastaligi, Echinococcus granulosus'un neden oldugu parazitik bir zoonozdur ve Türkiye'de endemiktir. Klinik bulgular çesitlidir ve anatomik yerlesimle iliskilidir. Bu raporda, çocuklarda hidatik hastaliginin tani, tedavi ve izlemini 10 yillik deneyimimizle paylasmayi amaçladik. Yöntemler: Hidatik hastaligi tanili 57 çocuk olgu, hastane kayitlarindan geriye dönük olarak incelendi. Tani, klinik, serolojik ve radyolojik bulgulara dayandirildi. Tedavi yaniti klinik, radyolojik ve serolojik bulgularla degerlendirildi. Bulgular: Toplam 57 olgunun erkek/kiz orani 2.4:1 ve yas ortalamalari 113,6[+ or -]45,9 ay idi. En sik görülen basvuru yakinmasi karin agrisiydi (%42,1). Olgularin 22'sinin (%38,6) eozinofilisi mevcutken; indirekt hemaglütinasyon test pozitifligi 27 olguda (%47,4) saptandi. Olgularin 18'inde (%31,6) çoklu organ tutulumu vardi. Ãoklu organ tutulumu olanlarda, kistlerin batin yerlesimli olma olasiligi daha yüksek bulundu (p=0,005). Tedavi amaciyla cerrahi girisim uygulanan 50 olgudan (%87,7), 45'inin (%78,9) açik cerrahi, 5'inin (%8,8) perkütan aspirasyon, enjeksiyon ve reaspirasyon yöntemi ile opere oldugu saptandi. Konservatif tedavide Albendazol verilen 52 (%91,2) olgu mevcuttu ve tedavi süreleri ortalama 15,5[+ or -]17,2 aydi. Kist rüptürü gelisen 10 olgu (%17,5) mevcuttu ve semptom süreleri, kist rüptürü gelismeyen olgulara göre daha kisaydi (p=0,017). Dispne görülen ve agizdan kaya suyu gelen olgularda kist rüptürü olma olasiligi daha yüksek bulundu (sirasiyla p=0,001, p=0,005). Izlemde bes olguda (%8,8) nüks gelistigi görüldü. Tartisma: Hastaligin endemik oldugu bölgelerde kisisel aliskanlik ve saglik egitiminden olusan önleme ve kontrol programlarina ragmen, hidatik hastaliginin aktif geçisi çocuklarda görülmekte ve önemli bir halk sagligi sorunu olmaya devam etmektedir. Endemik bölgelerde süpheli radyolojik ve klinik bulgular varliginda hidatik hastaligi mutlaka akla getirilmelidir. Tani ve tedavi prosedürleri olusmasi adina, kontrollü klinik çalismalara ihtiyaç duyulmaktadir. Anahtar Kelimeler: Hidatik hastaligi, çocuk, tani, tedavi, izlem Objective: Hydatid disease caused by Echinococcus granulosus is a parasitic zoonosis and is endemic in Turkey. Clinical manifestations vary and are related to the anatomical location. In this report, we shared the diagnosis, treatment and follow-up of hydatid disease in children with a 10-year experience. Methods: A total of fifty-seven children diagnosed with hydatid disease were analyzed retrospectively from hospital records. Diagnosis was based on clinical, serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings. Results: The male/female ratio of 57 cases was 2.4:1 and the mean age was 113.6[+ or -]45.9 months. The most common presenting complaint was abdominal pain (42.1%). While 22 (38.6%) of the cases had eosinophilia; indirect hemagglutination test positivity was detected in 27 cases (47.4%). Multiple organ involvement was present in 18 cases (31.6%). In patients with multiple organ involvement, the possibility of cysts being located in the abdomen was higher (p=0.005). Of the 50 cases (87.7%), 45 (78.9%) were operated with open surgery and 5 (8.8%) with percutaneous aspiration-injection-reaspiration method for treatment. There were 52 (91.2%) patients who were given albendazole in conservative treatment and the mean duration of treatment was 15.5[+ or -]17.2 months. There were 10 cases (17.5%) who developed cyst rupture and the symptom duration was shorter than the cases without cyst rupture (p=0.017). Cyst rupture was more common in cases with dyspnea and fluid discharge from the mouth called rock water (p=0.001, p=0.005, respectively). Recurrence was observed in five cases (8.8%) during follow-up. Conclusion: In areas where the disease is endemic, despite prevention and control programs consisting of personal habits and health education, active transmission of hydatid disease is seen in children and continues to be an important public health problem. Hydatid disease should definitely be considered in the presence of suspicious radiological and clinical findings in endemic areas. Controlled clinical studies are required for diagnosis and treatment procedures. Keywords: Hydatid disease, child, diagnosis, treatment, follow-up