Pericardial effusion in pediatric paragonimiasis: Surgery may not be necessary in cases of moderate to large effusion-a retrospective study.

Abstract

Background: Pericardial effusion is a severe complication of pediatric paragonimiasis, necessitating a careful approach to diagnosis and treatment. Traditionally, the management of pericardial effusion pericardial effusion due to paragonimiasis has involved surgical intervention to drain the accumulated fluid, especially in severe cases. However, the use of non-surgical treatment approaches, such as praziquantel and corticosteroids, have shown promise in certain cases, potentially avoiding the need for invasive procedures.

Objective: To analyze the clinical features and treatment outcomes of pediatric patients with paragonimiasis complicated by moderate to large pericardial effusion, with particular emphasis on comparing surgical and non-surgical treatment approaches, thereby providing clinical evidence for non-surgical treatment in such cases.

Methods: We conducted a retrospective analysis of clinical data from patients diagnosed with paragonimiasis at Kunming Children's Hospital between January 2014 and April 2023. The patients were divided into pericardial effusion group and thoracopulmonary group. Then the pericardial effusion group was further subdivided into surgical and non-surgical groups. The clinical data were compared between the two groups. Categorical variables were compared using the χ² test, while continuous variables were compared using the t-test or Mann-Whitney U test. Further follow-up was conducted to assess the treatment outcomes in both the surgical and non-surgical groups.

Results: Compared to the thoracopulmonary group (n = 61), patients with pericardial effusion (n = 35) were more likely to present with dyspnea, weak heart sounds, abdominal pain/bloating, and vomiting, and a shorter pre-admission disease course, but significantly longer hospital stays and higher costs. There were no statistically significant differences in clinical presentation, white blood cell count, eosinophil count, pre-admission disease course, or oral praziquantel course between the surgical and non-surgical groups. Notably, pericardial effusion resolved in both groups, but the surgical group had significantly higher hospital costs and longer stays.

Conclusion: In the endemic areas of paragonimiasis,in cases of moderate to severe pericardial effusion a thorough epidemiological history should be taken, and paragonimiasis should be considered. In the absence of life-threatening conditions, early praziquantel treatment, combined with low-dose corticosteroids and regular echocardiography follow-up, can avoid unnecessary surgical intervention if effusion absorption is observed. However, the conclusion of this study is based on limited evidence, and further multicenter, prospective randomized controlled trials are needed to validate the findings.