Pediatric Echinococcosis Clinical Presentation

Updated: Dec 21, 2020
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Presentation

History

Patients with echinococcosis often remain asymptomatic for many years. This asymptomatic incubation period can last many years until hydatid cysts grow to a size that triggers clinical signs. For CE, 20 years has been the reported time frame for asymptomatic incubation. For AE, 5 to 15 years is cited.

Routine imaging may incidentally reveal echinococcosis’ hydatid cysts.

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Physical Examination

Echinococcosis can present as non-specific clinical signs such as anorexia, weight loss and weakness. Other clinical indicators depend on the location of the hydatid(s) and the pressure they exert on the surrounding tissues. [1]

Hepatic involvement causes abdominal pain, anorexia, nausea and vomiting. An abdominal mass may be palpated and/or biliary obstruction can occur. Patients with pulmonary involvement may have respiratory symptoms such as chronic cough, chest pain and shortness of breath. The bodily locations of hydatid cysts determines the presence of other symptoms. Clinical manifestations occur very early in nervous system infection. [11, 1]  In bone infections, necrosis may occur and produce thin and fragile bones, that can serve as nidi for spontaneous fracture. Secondary bacterial infections may occur due to pyogenic abscess formation within the cyst. Cyst leakage or rupture may cause an allergic response, such as urticaria.  

AE is characterized by the slow development of a primary tumor-like lesion usually located in the liver. This lesion can resemble a hepatic neoplasm, with local destruction, to hepatic tissue and cause biliary obstruction. Clinical signs include weight loss, abdominal pain, general malaise and clinical indicators of hepatic failure. Larval metastases may spread either to organs adjacent to the liver (eg, the spleen) or to more distant organ locations, such as the brain and lungs. Spread of the parasite occurs via the circulatory and lymphatic systems. If left untreated, AE is progressive and fatal. [1]

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