Echinococcosis - causes, symptoms, diagnosis and treatment
Echinococcosis - Parasitic infestation of the larval stage of Echinococcus tape helminth flowing with the defeat of the internal organs (liver, lung, heart, brain, and others.) And form a cyst in them. Non-specific symptoms of echinococcosis include weakness, urticaria, transient rise in temperature; It depends on the specific localization of the parasite and can be represented by local pain, nausea, jaundice, cough, focal neurological symptoms, cardialgia, arrhythmia and so on. Diagnosis of echinococcosis relies on instrumental research data (X-ray, scintigraphy, ultrasound, CT) and serological tests. surgical treatment of echinococcosis.
Echinococcosis
helminthiasis found in the Volga region, the Urals, the Stavropol and Krasnodar region, Western Siberia, in the Far East. In endemic areas the incidence of echinococcosis population reaches 5-10%. The prevalence of echinococcosis is closely linked with the development of animal husbandry. Given the fact that the echinococcosis may be affected by various internal organs, and the only radical method of treatment is surgery, the disease is in the interests of thoracoabdominal surgery, neurosurgery, cardiac surgery.
anaphylactic shock. Increases in size cyst presses on surrounding structures, disrupting the function of the affected organ. In some cases, developing a cyst abscess; perhaps less spontaneous destruction echinococcus and recovery.
urticaria, pruritus, and specific symptoms associated with cystic forms of Echinococcus parasitism in a given organ. Under the complicated echinococcosis cyst rupture can occur and expiration of content into the peritoneal or pleural cavity with peritonitis, pleurisy. When festering hydatid cysts join high fever, severe intoxication. Compression cyst organs and tissues can cause the development of jaundice, ascites, dislocations, pathological fractures.
For echinococcosis liver characterized by complaints of nausea, loss of appetite, diarrhea occurring periodically, heaviness and pain in the right upper quadrant. Objectively reveals hepatosplenomegaly; sometimes cyst of the liver is palpated as a dense rounded education. In the case of compression of the bile duct cyst develops jaundice; during compression of the portal vein appears ascites, portal hypertension. Joining a secondary bacterial flora can lead to the formation of liver abscess. The most serious complication of liver echinococcosis is a perforation of the cyst with the development of acute abdomen clinics, peritonitis and severe allergic reactions. Thus there is a dissemination echinococcus, causing secondary hydatid disease develops with multiple localization.
Echinococcosis lungs occurs with fever, intoxication syndrome, chest pain, cough, hemoptysis. cyst pressure on lung tissue leads to the formation of atelectasis of the lungs. A break in the bronchi bubble develops coughing, cyanosis, often - aspiration pneumonia. It is a dangerous complication of pulmonary echinococcosis cyst is a breakthrough in the pleura and pericardium, which can lead to anaphylactic shock, a dramatic shift of the mediastinum, cardiac tamponade and sudden death. Infection with hydatid cysts accompanied by the formation of lung abscess.
Blade brain echinococcosis is characterized by hypertensive syndrome and focal neurological symptoms (sensory disturbances, paresis of limbs, epileptiform attacks). At the heart echinococcosis bother chest pain resembling angina. Compression cysts coronary arteries can cause myocardial infarction. Often there are rhythm and conduction disturbances: ventricular tachycardia, incomplete and complete bundle branch block, complete transverse heart block. The reasons for the death of a patient with heart echinococcosis can become malignant arrhythmia, heart failure, cardiac tamponade, cardiogenic shock, pulmonary embolism, pulmonary hypertension postembolic and others.
IFA, RNIF, Phragmites) to detect specific antibodies to echinococcus. The specificity and sensitivity of the tests reaches 80-98%. Approximately 2/3 of the cases it is informative skin-allergy test - reaction Casoni.
Range of instrumental diagnosis of echinococcosis includes ultrasound, X-ray, tomography, radioisotope methods. When liver echinococcosis informative hepatobiliary ultrasound, angiography of the celiac trunk, liver MRI, scintigraphy, a diagnostic laparoscopy, and others. Recognize pulmonary hydatid enables radiography of the lungs and chest CT, bronchoscopy, diagnostic thoracoscopy. The leading methods of diagnosis of brain hydatidosis are CT or MRI. If you suspect a heart failure is performed echocardiography, coronary angiography, ventriculography, cardiac MRI. At the break of hydatid cysts in the lumen of hollow organs scolexes parasite can be detected in the test duodenal contents, sputum. Also in these cases resort to perform bronhografii, holetsistografii, puncture cholangiography. Cyst must be differentiated from alveococcosis, bacterial abscesses, cysts, non-parasitic etiology of tumors of the liver, lungs, brain and so on.
echinococcectomy - husking cyst without disturbing the integrity of the chitin shell. In the presence of a large bubble made its first intraoperative puncture with aspiration of contents. The remaining cavity is carefully processed with antiseptic solutions, plugging, drained and sutured tightly. During operation it is important to avoid entering the bubble content of the surrounding tissue to prevent dissemination Echinococcus. In the case of impossibility in lung echinococcosis cyst excision is performed wedge resection, lobectomy, pneumonectomy. Similar tactics are used in liver echinococcosis. If excision of liver hydatid cyst is technically impossible, it made marginal, segmental, lobar resection, hemihepatectomy. In the pre- and postoperative period assigned antiparasitic therapy with praziquantel, albendazole, mebendazole.
In the case of radical removal of hydatid cysts and lack of reinfection favorable prognosis, echinococcosis relapse does not occur. In the case of intraoperative dissemination scoleces in 1-2 years may be a recurrence of the disease with the formation of multiple hydatid bladders and poor prognosis. Measures to prevent human infestation are veterinary control and improvement of animals (dogs conduct periodic deworming, vaccination of sheep, improving hygiene conditions of livestock and so on. D.). The hunters, breeders, dog breeders should be informed about the risk of contracting echinococcosis, the need for personal hygiene measures. Patients with a history of hydatid disease, are on dispensary observation for 8-10 years with annual serological tests, ultrasound and X-ray examination.