Cystic echinococcosis in children — The seventeen-year experience of two large medical centers in Serbia Slavisa M. Djuricic a, ⁎, Slobodan Grebeldinger b , Dejan I. Kafka a , Igor Djan b , Miroslav Vukadin a , Zorica V. Vasiljevic a a Mother and Child Health Institute of Serbia “Dr. Vukan Cupic”, 8 R. Dakića Street, 11070 Belgrade, Serbia b Institute for Child and Youth Health Care of Vojvodina, Clinic of Pediatric Surgery, 10 Hajduk Veljkova Street, 21000 Novi Sad, Serbia abstract article info Article history: Received 11 September 2009 Received in revised form 23 February 2010 Accepted 24 February 2010 Available online 3 March 2010 Keywords: Echinococcosis Epidemiology Child Anatomic distribution Surgery Serbia Cystic echinococcosis (CE) is a public health problem in countries having such endemic areas. Epidemiological studies of CE, especially pediatric, are rare. The aim of this study was to evaluate epidemiological and clinical characteristics of CE in children in Serbia. Data were obtained retrospectively from the case records of patients under the age of 18 years admitted for surgical treatment of CE at two large pediatric medical institutions in the period 1990–2006. Patients' age, number of cysts and their anatomic location were evaluated in relation to differences by patients' gender and socio-geographic status (urban or rural origin). The study included 149 children with 272 hydatid cysts. The mean age of patients was 10.1 ± 3.8 years. There were no significant differences in the number of patients in relation to gender and urban: rural origin. There were no significant differences in patients' age at the time of surgery or the number of cysts per patient when patients’ gender or socio-geographic status was evaluated. The anatomic location of cysts was as follows: liver (N = 165; 60.7%), lungs (N = 82; 30.1%), and other locations (N = 25; 9.2%). Multiple cysts, and combined liver/lung involvement were identified in 34.2% (N =51), and 6.0% (N =9) of patients, respectively. Hepatic cysts were significantly more common in girls than in boys. There were no significant differences in anatomic location of cysts between socio-geographic groups. The large number of infected children during a long period of investigation indicates an active transmission of disease and a lack of program for control and prevention of CE in Serbia. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Cystic echinococcosis (CE), a zoonotic disease, also known as hydatid disease, is the most common manifestation of the larval stage infestation with the Echinococcus granulosus tapeworm. Adult E. granulosus tapeworms infect the intestine of canids (e.g., dogs, foxes, and wolves). Infective eggs are shed in the feces of canids, so sheep and cattle usually ingest them. Humans can serve as interme- diate hosts by accidentally ingesting E. granulosus eggs shed by dogs [1,2]. The most common routes of infection in people are ingestion of contaminated water or uncooked food, or direct hand-to-mouth fecal transmission—the latter mode being especially common in children [1,3]. Once ingested by an intermediate host, eggs develop into oncospheres in the upper gastrointestinal tract. The oncospheres penetrate the intestinal wall, enter the portal vein and reach the liver. A few oncospheres may pass the liver and become trapped in the lungs, or more rarely, in other organs and tissues [1,4,5]. The cysts grow expansively into healthy host tissues as tumor-like, space-occupying masses lined by a laminated, germinative membrane that allows asexual budding to form “daughter” cysts within the primary cyst [2]. Important risk factors for human CE include socio-economic and cultural factors, such as unrestrained dogs living closely with people, uncontrolled slaughter of livestock, and unsanitary living condi- tions [6,7]. CE is a public health concern in endemic areas, especially in countries and regions with extended sheep breeding (e.g., China, Africa, Mediterranean and Balkan countries, the Middle East, Australia, and South America) [1,2,7–9]. The annual incidence rate of CE per 100,000 population ranges from b 1 in some European countries to 9.2 in Uruguay [9]. According to several ultrasound studies, with and without additional serological tests, the prevalence of abdominal echinococcosis commonly ranges from 0.9% to 6.8% [6,7,9–15]. CE may be detected at any age with the prevalence increasing with age [7,11,13,16–18]. Studies of CE in children are rare. In the study of CE in children in a rural endemic Argentinean region, the initial prevalence of asymptomatic children in the period 1984–1986 was 5.6% [10]. Another study in a Turkish region demonstrated a pediatric prevalence of 0.15% [19]. In several studies, CE was more frequent in female than in male adults, but this difference was not statistically signi ficant [8,14,15,18,20,21]. Studies of CE in children did not show any significant Parasitology International 59 (2010) 257–261 Abbreviations: CE, cystic echinococcosis. ⁎ Corresponding author. Tel.: +381 11 3108 231; fax: +381 11 269 7232. E-mail address: djurisla@sezampro.rs (S.M. Djuricic). 1383-5769/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.parint.2010.02.011 Contents lists available at ScienceDirect Parasitology International journal homepage: www.elsevier.com/locate/parint