Case presentation on hydatid cyst pediatrics

Hydatid cyst pediatrics case presentation

1. CASE PRESENTATION DR Zaira Hussain FCPS II RESIDENT GMMMC Civil hospital SUKKUR

2. 13 Year old male child,Ali murtaza R/O Sukkur( rohri ) admitted via OPD with complaints of: Fever -1 month Abdominal pain - 20 days.

3. HOPC According to statment of my patient mother, child was in usual state of health one month back then he develop fever which was gradual in onset low to high grade,intermetent,relieved by taking antipyretics, associated with chills and night sweats ,fever was not associated with sore throat,cough or burning micturition. Now from last 20 days my patient develop dull pain over right upper hypochondriac region and epigastric region, gradual in onset ,dull type , moderate in intensity not radiating not shifting , occasionally associated with nausea and vomiting. For these complains Patient visited multiple times on opd basis ,treated symptomatically but no relived and diagnosed properly

4. Systemic history GIT : no any hx of hematemasis and melena or pica.
No hx of jaundice,abdominal distension and altered bowel habits.
Respiratory: no hx of cough ,chest infections or ear discharge.
Cardiovascular : no hx of cynosis ,shortness of breath and edema .
CNS: no hx of fits ,headache or weakness of limbs.
Genitourinary : no hx of dysuria , hematuria and increased frequency .
Musculoskeletal :no hx of arthritis or rashes or bone pain.

5. Past history No hx of chronic illness No hx of hospital admission or blood transfusion

6. Family history Child is a product of consanguineous marriage having two siblings No hx of similar illness in sibling No hx of TB contact in family

7. Birth history Atenatal hx booked case at local hospital, regular ultrasound scan done,no drug hx other than iron and multivitamins vaccinated for tetanus during pregnancy,no hx of HTN,GDM,PROM during pregnancy Natal full term via NVD at hospital uneventful delivery Postnatal immediate cry,no hx of jaundice,fever ,fits after birth

8. Developmental Upto date School going child with Good academic score

9. Immunisation Vaccinated according to EPI schedule

10. Nutrition Decrease Appetite with good sleep normal bowel habits adequate.

11. Socioeconomic Living in rented house Father is shopkeeper Drinks boring water,no any pet history.

12. GENERAL PHYSICAL EXAMINATION: Active alert male child sitting on bed with,canula on left hand with following vitals: -HR= 90bpm -RR= 32bpm -TEMPERATURE= Afebrile -BP= 90/60(50 th centile) A- C- CY-D- L- J- E-

13. ANTHROPOMETRIC MEASUREMENTS WEIGHT= 30KG(-2.00Sds) HEIGHT=140cm(-2.02Sds)

14. ABDOMINAL EXAMINATION INSPECTION : scaphoid shape abdomen with centrally places umbilicus with inverted margins, no scar mark, striae , visible veins or pulsation. PALPATION : Soft non tender on superficial palpation ,but on deep palpation mild tenderness in right upper quadrant. Liver was palpable 2cmbelow right costal margin, left lobe not palpable,soft in consistency with clear margins, total liver span 12cm. A well circumscribed mass palpable in epigastrium with smooth surface, regular margins and hard consistency measuring 2*2cm PERCUSSION : Fluid thrill and shifting dullness – ve AUSCULTATION : Gut sounds audible

15. Rest of systemic examination was unremarkable

16. Case summary 13 year old male Ali murtaza R/O Sukkur admitted via ops with the complain of fever for one month and abdominal pain for 20 days,fever was gradual in onset low to high grade intermetent relieved by taking antipyretics associated with chills and night sweats,fever was not associated with sore throat or burning micturition. From last 20 days pt develop dull pain over right hypochondrium and epigastric region,pain was gradual in onset dull type, moderate in intensity not radiating or shifting sometimes associated with nausea and vomiting, multiple opd visits done for the same complain oral medication were given O/E on superficial palpation soft nontender but on deep palpation mild tenderness in right upper quadrant,liver was 2 cm BCM, soft in consistency with clear margins,total liver span is 12cm,the left lobe of liver is not palpable, A well circumscribed mass palpable in epigastrium with smooth surface, regular margins and hard consistency measuring 2*2cm

17. DIFFERENTIAL DIAGNOSIS ENTERIC WITH COMPLICATION LIVER ABSCESS HYDATID CYST LYMPHOMA/LEUKEMIA

18. CHEST XRAY

19. ULTRAOUND ABDOMEN SLIGHT HEPATOMEGALY WITH MILD PARENCHYMAL CHANGES. MULTIPLE CYSTIC MASSES IN THE LIVER AND SPLEEN. NORMAL GALL BLADDER,PANCREAS AND BOTH KIDNEYS. MULTIPLE CYSTIC MASSES PRESENT IN THE LOWER ABDOMEN AND LEFT LUMBAR REGION

20. CT SACN ABDOMEN AND PELVIS WITH CONTRAST

21. MultIple cystic areas of varying sizes noted, involving liver and spleen and also with in peritoneum,showing internal septations,some of them showing peripheral daughter cysts. One of the splenic cyst measuring upto 8.0*6.6cm and the hepatic cyst is in segment VI which is measuring upto 4.9*4.1cm. One of the peritoneal cyst measuring 4.8*3.7cm. Lumbar muscular spasm noted. IMPRESSION : Findings represents diffuse multiple hydatid cyst involving liver,spleen and peritoneum.correlate with echinococcal titer

22. ECHINOCOCCUS ANTIBODIES=POSITIVE

23. FINAL DIAGNOSIS CYSTIC ECHINOCOCOSIS/ HYDATIDOSIS

24. SURGICAL OPINION Treat medically for 3 months than follow patient in surgical OPD.

25. TREATMENT IN WARD Admitted in Ward Maintained IV Line Off oxygen/orally allowed Injection 0.9% D/w started. Risek sachet 20mg (1*OD half an hour before breakfast) Inj ceftriazone75mg/kg iv BD Inj provas Ivx sos

26. TREATMENT ON DISCHARGE Tab Albendazole 15mg/kg divided 12 hourly for three weeks with gap of one week. for nine consective weeks with gap of one week after each three week duration. Follow up in surgery OPD after three months.

27. HYDATIDOSIS/ECHINOCOCCOSIS the hydatic disease, caused by the larvae of Echinococcus granulosus , is a zoonotic disease potentially lethal, which can be found anywhere in the world, but especially in endemic areas. The hydatic cyst is mainly found in the liver (75% of the cases), being asymptomatic in most cases and discovered accidentally on a routine abdominal ultrasound or an ultrasound performed for diagnosing other pathologies.

28. INVESTIGATIONS Routine blood investigation are non specific-25% ( Esinophilia abd raised bilirubin ) Indirect hemagglutination tesr and ELISA are the most widely used methods for detection of anti- Echinococcus IgG antibodies

29. Imaging Chest Xray Ultraound abdomen CT-Scan MRI

30. Treatment MEDICAL; For cystic echinococcosis ( CE ) type 1 or 3a that are <5cm in diameter, albendazole chemostherapy alone(15mg/kg/day) orally divided twicw daily for 1-6 months maximamum 800mg/day may result in high rate of cure.

31. PROGNOSIS Factors predictive of success with chemotherapy are age of cyst(>2years),low internal complexity of the cyst,and small size and site of the cyst is not important,although cyst in bone respond poorly.for alveolar hydatidosis,if surgical removal is unsuccessful,the average mortality is 92% by 10 years after diagnosis.

32. PREVENTION Important measures ti interrupt transmission include aa,through handwashi, avoiding contact with dogs in endemic areas,boiling orr filtering water when camping,and proper disposal of animal carcasses. Other useful measures are control or treatment of feral dog population and regular praziquantel treatment of pets and working dogs in endemic areas. Vaccibes have been developed to prevent infection in grazing animals but are not widely used.