Background and Clinical Significance
Hydatidosis, caused by Echinococcus granulosus, remains a significant public health challenge in endemic regions worldwide. While hepatic and pulmonary involvement are well-documented, splenic hydatidosis in pediatric populations is exceedingly rare, with limited data to guide clinical management. This diagnostic and therapeutic uncertainty motivated our comprehensive ten-year retrospective study at Namazi Hospital, a tertiary referral center in southern Iran.
Our findings, published in Food and Waterborne Parasitology, represent one of the largest single-center pediatric splenic hydatidosis case series to date. Between 2014 and 2024, we identified and managed ten pediatric patients (mean age: 11.3 years; six females, four males), providing valuable insights into this rare clinical entity.
Clinical Presentation and Diagnostic Findings
All patients presented with abdominal pain as the primary complaint, with symptom duration ranging from 4 to 210 days (median: 52 days). Additional symptoms included nausea and vomiting (n=5), anorexia (n=4), and fever (n=2). Notably, all patients had access to potable water, challenging assumptions about transmission routes in endemic areas.
Radiologic assessment revealed considerable variability in cyst characteristics. Cyst sizes ranged from 40 mm to 220 mm, with WHO-IWGE classification spanning active (1CE, 2CE) to transitional (CE3A, CE3B) stages. Multi-organ involvement was observed in three patients, with concurrent hepatic (n=2) and pulmonary (n=1) cysts. This pattern underscores the importance of comprehensive imaging surveillance in all suspected hydatidosis cases.
Surgical Management and Outcomes
Total splenectomy was performed in nine patients (90%), while one patient underwent partial splenectomy due to favorable cyst anatomy allowing for organ preservation. This case demonstrates that spleen-preserving surgery is feasible in selected pediatric patients, potentially reducing the lifetime risk of overwhelming post-splenectomy infection (OPSI).
Preoperative complications included cyst rupture in one patient, requiring emergency intervention, and relapsing hydatidosis in two patients despite prior albendazole therapy. These cases highlight the limitations of medical therapy alone in preventing disease progression and complications.
Medical Therapy and Prophylactic Measures
Preoperative albendazole was administered to eight patients, with postoperative therapy in nine patients. Long-term albendazole therapy (2–8 months) was provided in seven cases. Antibiotic prophylaxis included perioperative cephalosporins, with postoperative regimens tailored to clinical course.
Following splenectomy, pneumococcal vaccination was administered to six patients prior to discharge, and long-term penicillin prophylaxis was prescribed for six patients. Despite partial vaccination compliance, no cases of OPSI or hydatid recurrence occurred during a mean follow-up of approximately four years—a testament to the efficacy of combined surgical and prophylactic strategies.
Reference: Forooghi M, Hosseini H, Yousufzai Sh, et al. Ten-year experience with pediatric splenic Hydatidosis: Clinical profiles, surgical outcomes, and prognostic indicators. Food and Waterborne Parasitology. 2025;39:e00266. https://doi.org/10.1016/j.fawpar.2025.e00266
Key Takeaways and Clinical Implications
Our study offers several important insights for clinicians managing pediatric splenic hydatidosis:
First, early diagnosis and timely surgical intervention are paramount. The median symptom duration of 52 days before diagnosis suggests opportunities for earlier recognition, particularly in endemic regions where clinical suspicion should remain high.
Second, while total splenectomy remains the most frequently performed procedure, our successful partial splenectomy case demonstrates that organ-preserving surgery is achievable in carefully selected patients. This approach warrants broader consideration to mitigate long-term infectious risks.
Third, the absence of OPSI and recurrence in our cohort supports the efficacy of postoperative vaccination and antibiotic prophylaxis, even with partial compliance. Standardized protocols for post-splenectomy care are essential to optimize outcomes.
Fourth, the lack of standardized guidelines for antiparasitic therapy duration represents a critical gap. Our variable treatment protocols reflect this uncertainty and highlight the need for consensus recommendations.
Limitations and Future Directions
We acknowledge several limitations, including the small sample size inherent to studying rare conditions, the retrospective design introducing potential biases, and the variability in treatment protocols. Future prospective, multicenter studies with larger cohorts are essential to validate our findings and establish evidence-based management guidelines.
A Call for Collaboration
I invite fellow researchers, pediatric surgeons, infectious disease specialists, and global health practitioners interested in neglected tropical diseases to connect and explore collaborative opportunities. By pooling resources and data across endemic regions, we can advance our understanding of pediatric splenic hydatidosis and improve outcomes for children worldwide.