Echinococcosis lung - Causes, Symptoms, Diagnosis and Treatment
Echinococcosis light - A form of zoonotic infection caused by larval tapeworm echinococcus and leads to a specific cystic lesions of the lung tissue. Manifestations of pulmonary echinococcosis may be chest pain, shortness of breath, persistent cough, urticaria, and pruritus; in complicated - copious sputum mixed with blood and pus, fever, respiratory distress, severe anaphylactic reactions. The diagnosis is established by means of X-ray and CT scan, sputum microscopy, serological blood test. When lung echinococcosis conduct removal of parasitic cysts, lung resection, lobectomy in combination with anti-parasitic treatment.
Echinococcosis light
helminthiasis infection develops when eggs tapeworm - echinococcus, accompanied by the formation of parasitic cysts in the lung parenchyma. Infestation is easily observed in 15-20% of all cases of echinococcosis, 70-80% are liver (hydatid disease of the liver), the rest - the heart, brain and other internal organs. Echinococcosis lungs most often recorded in regions with dry, hot climate and developed cattle breeding: South America, North Africa, Australia, N. Zealand, in the southern part of Europe, USA, Russia, Ukraine, Moldova, North Caucasus, Central Asia and South Asia.
Echinococcosis light can be primary or secondary (metastatic), develop in any part of the lung, but predominantly affects the lower lobes. This can form single or double sided, single or multiple hydatid cysts with small (up to 2 cm), medium (2-4 cm) or large (4-8 cm) or greater size. Echinococcus cyst is limited by a dense shell, consisting of an outer (cuticle) and inner (germinal) layers, and filled with the liquid contents of a yellowish color. Echinococcosis light usually has a single chamber (hydatid), rarely - multi-chamber, form.
Echinococcus is capable of infinite growth and reproduction by brood capsules inner layer, reproducing and forming subsidiaries scolexes bubbles in the cyst cavity. Due to the high elasticity of the lung tissue cyst is gradually growing, in a few years, reaching a large volume. Giant cyst with diameter of 10-20 cm can contain several liters of fluid. In light tapeworm larvae can survive for years and even decades (20 years and over). lung Echinococcosis may occur uncomplicated and with complications (calcification, suppuration and rupture of the cyst).
urticaria, anaphylaxis), with multiple late-stage larvae - immunosuppression. Compression cyst bronchial tubes substantially impairs their function, leading to the formation of atelectasis of the lung, bronchus atrophy. Around the cyst develops lung tissue fibrosis.
Suppuration hydatid cyst causes the death of the larvae and the destruction of bladder inflammation in the surrounding tissues. Draining the cysts in the bronchus (90%), blood vessel, pleural or peritoneal cavity, pericardium promotes colonization and development of multiple metastatic lesions in healthy parts of the lungs and other organs, the development of local and general toxic and anaphylactic reactions. A break in the bronchus parasite cysts often dies, and the fragments of the capsule are allocated via the airways with mucus and pus when coughing. The end result can be a complete healing of fibrotic lung cavity, the formation of resistant lung cysts, chronic purulent inflammation. A breakthrough in the pleural cavity leads to the collapse of the lung, rise of respiratory failure. Calcification of Echinococcus usually observed in violation of its development, the death of the larva and the full recovery of the patient.
Pulmonology distinguish 3 stages of lung echinococcosis. In the initial period of the disease, from the time of fixation of the larvae in the lungs until the first signs of helminthiasis, there is latent within. The slow growth of cysts does not bother the patient, it may sometimes be unclear nature malaise, fatigue.
Stage Clinical manifestations of lung echinococcosis is usually observed after 3-5 years after the invasion with a significant amount of cysts. There is pain in the chest blunt nature, possible shortness of breath, persistent cough (at first dry, then wet, streaked with blood), dysphagia. In patients with lung echinococcosis may be allergic phenomena in the form of itching, urticaria, bronchospasm. When echinococcosis may develop pulmonary atelectasis.
End-stage lung echinococcosis is characterized by severe and life-threatening complications. Suppuration of the cysts occurs with symptoms of lung abscess. Break bubble in the bronchus characterized by severe paroxysmal cough with profuse watery sputum mixed with blood and /or pus, cystic shell fragments and small subsidiaries capsules; cyanosis, apnea, severe allergic reactions. Breakthrough cyst into the pleural cavity is accompanied by the development of pleurisy, a sharp deterioration in health, acute pain in the affected area, fever, temperature jump, respiratory disorders, risk of pneumoempyema and empyema, anaphylactic shock and death. When emptying the cyst in the pericardium of the heart tamponade occurs. Clinical symptoms of lung echinococcosis can be combined with disorders caused by extrapulmonary localization of parasitic cysts.
X-ray and CT scan, sputum microscopy, complete blood count, serological testing.
When collecting history important facts stay in epidemic unfavorable in relation to endemic regions, the existence of work associated with animal husbandry, hunting, processing of animal skins. For very large bladder diverticulum echinococcus may notice the affected part of the chest wall with flattening intercostal spaces. In the projection hydatid cysts determined dullness. When perifocal inflammation detected crackles; when emptying the cyst becomes bronchial breath. Physical findings are more pronounced in the development of complications.
The latent period of echinococcosis in the lungs radiologically determined one or more large round homogeneous, well-defined shadows, changing the configuration of the respiratory movements. CT obvious cystic nature of the lesion, presence of cavity with a horizontal fluid level and perifocal infiltration (strongly expressed with festering), sometimes - calcification. The differential diagnosis of echinococcosis spend tuberculosis, benign tumors of the lungs, bacterial abscesses and lung hemangioma.
In the blood revealed eosinophilia, with festering cysts - leukocytosis, increased erythrocyte sedimentation rate. Microscopy of sputum sediment, allowing to detect scolexes fragments cyst cyst membrane in the breakout, confirmed the nature of the parasitic disease. Serodiagnosis (IHA, ELISA) is performed in order to detect in the blood of specific antibodies to echinococcus. Perhaps a diagnostic bronchoscopy and thoracoscopy.
segmentectomy, lobectomy.
For small (3 cm) cysts, as well as before and after surgery for lung echinococcosis applied antiparasitic (skoletsidnye) drugs. Prediction of lung echinococcosis with timely radical surgical intervention is usually favorable. Education intraoperative recurrent metastatic lesions helminthiasis fraught with multiple lesions. Prevention of pulmonary hydatidosis is in compliance with the rules of personal hygiene, deworming of pets, sanitation conditions and slaughter cattle, catching stray animals.