Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
BMC Infect Dis. 2023 Aug 10;23(1):525. doi: 10.1186/s12879-023-08520-5.
Superinfection of cystic echinococcosis (CE) is a life-threatening complication with significant morbidities, which can be prevented with early diagnosis and treatment. This study aims to examine the clinical characteristics, diagnostic methods, and treatment options for superinfected CE, as there is currently limited information available on the differences between superinfected and non-infected CE in terms of clinical features, serological and radiologic findings.
This cross-sectional study was conducted on hospital records of patients who were diagnosed with hydatid cysts in a 15-year period (2004 to 2018) in two main university-affiliated referral centers in Fars province, southern Iran. Patients' information regarding the demographical and clinical features related to CE, age, sex, previous history of CE or recurrence, size and location of CE, and length of hospital stay were collected. Moreover, the characteristics of concurrent infections with hydatid cysts were recorded.
A total of 586 surgeries due to CE were performed on 501 patients, of which 67 (11.43%) had reoperations due to the recurrence of the disease. A total of 30 (5.99%) incidences of superinfection were observed. There were no statistically significant differences in terms of laboratory and imaging findings between CE patients with concurrent infections and other CE patients (p-value > 0.05). Among the patients with super-infection, four had fungal infections of the lungs. Aspergillus fumigatus was the causative pathogen in all four patients that were diagnosed with fungal superinfection. All patients underwent surgical excision with favorable long-term outcomes.
Our study revealed a 5.99% incident rate of CE superinfection. Regarding the concurrent fungal infections in hydatid cysts, the patient's symptoms and laboratory and imaging findings are inconclusive and histopathological evaluation seems to be the most reliable option. Surgical resection is the gold-standard treatment option with favorable outcomes and potentially can be curative.
包虫病（CE）的继发感染是一种危及生命的并发症，具有显著的发病率，通过早期诊断和治疗可以预防。本研究旨在探讨继发感染性 CE 的临床特征、诊断方法和治疗选择，因为目前关于继发感染性 CE 与非感染性 CE 在临床特征、血清学和影像学表现方面的差异，相关信息有限。
本横断面研究对伊朗南部法尔斯省两所主要大学附属医院在 15 年期间（2004 年至 2018 年）诊断为包虫囊肿的患者的病历进行了分析。收集了与 CE 相关的人口统计学和临床特征、年龄、性别、CE 既往史或复发、CE 的大小和位置以及住院时间等患者信息。此外，还记录了并发包虫囊肿感染的特征。
共对 501 例 CE 患者进行了 586 例手术，其中 67 例（11.43%）因疾病复发而再次手术。共观察到 30 例（5.99%）继发感染病例。并发感染的 CE 患者与其他 CE 患者在实验室和影像学检查结果方面无统计学差异（p 值>0.05）。在继发感染患者中，有 4 例肺部真菌感染。所有 4 例真菌继发感染患者均为曲霉菌感染。所有患者均行手术切除，预后良好。
本研究显示，CE 的继发感染发生率为 5.99%。鉴于包虫囊肿并发真菌感染，患者的症状、实验室和影像学检查结果不确定，组织病理学评估似乎是最可靠的选择。手术切除是金标准治疗方法，具有良好的疗效，且可能具有根治性。
