Paediatric Respiratory Reviews 43 (2022) 1
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Editorial to Mini-symposium: Helminths and respiratory health
Zoonotic parasitic lung infections
The majority of emerging human diseases are zoonotic [1]. The
complex nature of zoonotic diseases, infections that can be shared
between humans and animals, has become sadly obvious in the era
of coronavirus infections including Severe Acute Respiratory Syn-
drome [SARS], Middle East Respiratory Syndrome [MERS] and of
course Covid-19 infections. However, older zoonotic infections
remain prevalent and problematic for clinicians. This mini-sympo-
sium entitled: Hydatids and other helminths invading children’s lungs
will focus on the respiratory manifestations of two of these peren-
nials: hydatid disease and actinomycosis.
Hydatid disease or echinococcosis is a zoonosis caused by the
tapeworm which has been well recognised for centuries as
subsistence agriculture moved to pastoralism with more organised
farming arrangements. Sheep and cattle pass the tapeworms onto
dogs who, like humans, can act as intermediate hosts when the
embryonic tapeworm cysts are ingested. Typically, a child on a
farm will be infected from a dog [unaffected by the tapeworm in
its intestine] who has passed the embryonic tapeworms in their
stool and the child has ingested these products in the stool inad-
vertently from playing with the dog [faecal–oral transmission] or
after ingested contaminated food or water. Hydatid disease
remains a significant public health disease in many endemic set-
tings, affecting the lungs, liver, kidneys, spleen, bones and brain.
Unlike in adults, where hepatic involvement is common, pul-
monary hydatid disease is the dominant site of infection in the
paediatric population [2]. Most people acquire the infection in
childhood in a rural setting, but it may remain dormant for many
years. Hydatid lung disease is often overlooked as a diagnosis with
cystic lung abnormalities appearing on chest radiographs, espe-
cially in countries with high rates of HIV related immunosuppres-
sion and opportunistic infections. As discussed in the article by
Goussard and colleagues [3], most reports emanate from North
Africa and the Middle East, with sporadic cases reported in coun-
tries where sheep farming is common. The article provides a com-
prehensive review of the clinical presentation, investigation,
pathology and treatment pathways for this uncommon but
https://doi.org/10.1016/j.prrv.2022.07.002
1526-0542/Crown Copyright Ó 2022 Published by Elsevier Ltd. All rights reserved.
challenging condition to manage, especially in resource limited
settings.
In the second paper in this mini-symposium, Goussard and col-
leagues review the consequences of rare but important pulmonary
infections with actinomycosis in children [4]. Chest radiograph
findings in pulmonary actinomycosis are mostly nonspecific and
can overlap with pulmonary tuberculosis, foreign body aspiration
and malignancy. Patients may present with cough, weight loss
and fever and a chest mass may be evident on imaging. Removal
or biopsy of these large endobronchial masses must be done with
care, because of the risk of bleeding and large airway obstruction.
Actinomyces species are highly susceptible to beta lactam antibi-
otics, penicillin G, and amoxicillin, typically for a period of
3–6 months. With early and appropriate management, the out-
come is usually very good.
References
[1] Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, et al. Global
trends in emerging infectious diseases. Nature 2008;451:990–3.
[2] Recep T, Sema O, Nuri S, Refik A, Ibrahim A, Hasan O, et al. Pulmonary hydatid
cysts in children. Ann Med Sci 2000;9:59–62.
[3] Goussard P, Eber E, Mfngwana L, Nel P, Schubert P, Jansen J, et al. Paediatric
pulmonary echinococcosis: A neglected disease. Paediatr Respir Rev
2022;43:11–23.
[4] Goussard P, Eber E, Rabie H, Nel P, Shubert P. Paediatric pulmonary
actinomycosis: A forgotten disease. Paediatr Respir Rev 2022;43:2–10.
Dominic A. Fitzgerald
The Children’s Hospital at Westmead, Sydney, NSW, Australia
Discipline of Child & Adolescent Health, Faculty of Medicine, University
of Sydney, Australia
E-mail address: dominic.fitzgerald@health.nsw.gov.au