Organ-Specific Clinical Patterns of Pediatric Cystic Echinococcosis: A Multicenter Cohort from an Endemic Region

Pediatric cystic echinococcosis (CE) remains insufficiently characterized, particularly regarding organ-specific presentation and outcomes. This multicenter retrospective cohort included children aged 0–18 years with a definitive diagnosis of CE between 2013 and 2023 at six tertiary centers in Turkey. Among 119 patients (median age 10.6 years; 50.4% male), the liver was involved in 72.3% and the lungs in 36.1%, and 20.2% had two or more organs involved. Pulmonary involvement was associated with fever, higher C-reactive protein and complicated cysts (65.1% vs. 5.3%, p < 0.001). In multivariable analysis, fever (adjusted odds ratio 5.58, 95% confidence interval 1.85–16.81) and C-reactive protein (adjusted odds ratio 1.13 per 10 mg/L, 95% confidence interval 1.01–1.27) were associated with pulmonary involvement, with consistent results after multiple imputation and adjustment for center. Among patients with pulmonary involvement, fever was more frequent with complicated than with uncomplicated cysts (67.9% vs. 20.0%, p = 0.004), consistent with the recognized propensity of pulmonary cysts to rupture or become secondarily infected; fever in pulmonary CE may therefore primarily signal cyst complication. Hepatic CE was managed with albendazole alone, percutaneous treatment, surgery or watch-and-wait, and pulmonary CE mainly surgically (79.1%). During follow-up, post-index detection of CE was more frequent in patients with multiorgan involvement, including after accounting for follow-up duration. Pulmonary CE showed a more inflammatory and frequently complicated profile; fever in a child with pulmonary CE should prompt evaluation for cyst rupture or secondary infection.