Liviococcia (synonym: alveolar echinococcosis, multi Echinococcus) - helminthiasis with primary liver disease. The causative agent of liviococcia tape worms Alveococcus multilocularis (alveolar), in Mature stage parasites in the small intestines of polar Fox, Fox, dog, wolf (definitive owners), at the stage of larva in wild rodents, man (intermediate hosts). Mature alveolar has a length of 1.3-2.2 mm; on the front end of his body head with 4 suction cups and whisk hooks; head followed by 2-4 segment. The larva of helminth has the appearance of a site, consisting of many small cells containing the yellowish liquid and scolex (head) of the parasite.
Epidemiology. Alveolar has a certain geographical distribution. In the USSR it occurs in Siberia, Yakutia, Kazakhstan, Bashkiria, Tataria, Kyrgyzstan.
People and rodents infected with liviococcia through food contaminated with the faeces of the final owners of helminths (Arctic Fox and others), containing eggs and segments of alveoli. Infection is also possible in contact with dogs, striping and processing of skins of wild beasts, drink unboiled water from natural reservoirs, eating wild herbs and berries.
Pathological anatomy and pathogenesis. The liver when alveolate, as a rule, increased sharply cushioned tumor nodes. Assemblies are the foci of the productive-necrotizing inflammation with many bubbles helminth. Inside the site there is often a fusion of necrotic tissues with the formation of cavities filled pussy fluid. In the pathogenesis of liviococcia play a role sensitization of an organism products of metabolism and decay of helminths, mechanical impact on the fabric, secondary bacterial infection.
Prevention. Treatment of infested alionochka dogs and hygienic their content. Implementation of hygiene rules when removing the skins with Fox, Fox. Thoroughly wash before eating wild berries and herbs.
The clinical picture. Liviococcia sick people more often in the age of 20-35 years. The disease for many months and even years flows asymptomatic until the patient will not notice in the right upper quadrant or Epigastric painless mass education, forcing him to turn to the doctor usually already at advanced process. At a palpation in these cases is very thick, bumpy liver, smooth or slightly painful. Parasitic "tumor"under the big sizes, appears only when complications arise. The most frequent of them - necrosis and decay in the center of the site, occurring due to compression of blood vessels scars. Possible sudden bleeding into the cavity of decay caused by the destruction of a small vessel. In these cases, pain, malaise, sometimes fever due to infection in the affected area. In other cases, the host, and sometimes not reached a considerable size, but located near major bile ducts or portal vein, can compress them, which leads to the development of jaundice, or (very rarely) of ascites. Other complications of liviococcia (usually higher) - sprouting parasitic "tumor" in the adjacent organs (right kidney, diaphragm, stomach , and so on) and metastasis in lung, brain.
Diagnosis liviococcia usually put in a late stage of the disease, and is often mistaken for cancer of the liver. In natural foci of liviococcia and in areas of the greatest distribution of this invasion, where periodically carry out the survey of the population on liviococcia may and early detection. Laboratory diagnosis is crucial and is based on serological diagnostic samples that detect the disease even before the appearance of clinical signs.
Much assistance is provided by special allergic diagnostic specimens. The most reliable of them the reaction of Casoni. An allergen is used sterile filtrate of fluids if Echinococcus bubble of infected lung or liver of cattle. The sample spend intradermally. If the result is positive reaction occurs within 20 minutes) at the injection site appears whitish bubble surrounded by a wide area hyperemia skin. In 24-48 hours. this place is formed infiltration. As repeat test of Casoni development can cause anaphylactic shock, more often applied reaction Fishman (see Echinococcosis). It is absolutely safe for the patient.
When alveolate quite often observed eosinophilia. Using radiological research vessels of the liver and radioisotope investigations (scan) is possible in some cases to determine the localization of the site liviococcia, and at peritoneoscopy (see) to see it and take pathological material for histological examination.
Forecast when alveolate serious. Dying patients due to the development of mechanical jaundice, liver, rarely from metastases of alveoli in the brain.
Surgical treatment. Radical removal of nodes because usually late diagnosis can be performed only in some cases. If radical surgery is impossible, shown emptying of decay cavities, palliative resection of the liver, jelcheotdelenia operations. Chemotherapy antiparasitic drugs (injection formalin, triplewin and others) are not effective enough.

Alveolar echinococcosis

The etiology and pathogenesis. Alveolar hydatid cyst (Echinococcus alveolaris; synonym: Echinococcus Multicam, alveolar) has a wide geographical distribution. Pockets of his detected in Germany, Switzerland, Austria, Siberia, on the island of SV. Lawrence island, Alaska in the North. Canada, the island Rebun in Japan, the commander Islands.
In the tape stage alveolar parasitizes mainly with foxes and Arctic foxes and considerably less common among wolves, Korsakov, dogs and cats. Larva of alionochka built on a special type that is very different from parvocysta cystic (Galatenko) Echinococcus; the parasite in the larval stage affects rodents (mice, voles, muskrats, Ob lemmings, slepushenko, ground squirrels, hamsters and other) and man. The question about the possibility of electric ervalstos of alionochka farm animals are not fully understood. Tsepni Echinococcus and alionochka similar to each other, but in their structure there are differences (Fig. 5). At the tapeworm alionochka lower body length, the greater number of segments, relatively smaller length of the last
antennal segment. Mature segment at alionochka is the third from the end, and Galatenko Echinococcus - the second from the end, the testes from alionochka half. The uterus at alionochka without side processes, while at Galatenko Echinococcus outgrowths mostly clear. The hooks alionochka thinner hooks Galatenko Echinococcus. Eggs of alveoli (Fig. 6) do not differ from eggs Galatenko Echinococcus.
Infected people directly from foxes, polar foxes and wolves in the processing of their hides, skins or by eating contaminated by their faeces berries, mushrooms, vegetables and drink water. Somewhat less often the source of infection is a dog eating rodent. Infection occurs as and when Galatina the echinococcosis (see). Germ alionochka often settle in the liver (approximately 95% of cases). Primary extrahepatic liviococcia exceptionally rare.
The main feature of the growth of alveoli is the formation of the parasite, exogenous infiltrating the growth of bubbles, which resembles the growth of malignant neoplasms. Parvocysta of alveoli in rodents contains quite a large number of scolokov. In sites of alionochka a person koleksi found very rarely.

Fig. 5. Tsepni from the intestines of dogs: 1 - uluocak, 2 - heatedly Echinococcus.
Fig. 6. Eggs of alionochka: 1 and 2 - with shells, 3 - free ecosfera.

Pathological anatomy. Site alionochka is a hotbed of productive-necrotizing inflammation, riddled with numerous puzinkevich larva parasite and reminiscent of the tumor site. During the operation, and at showdown with no experience very often make erroneous diagnosis of malignant neoplasms, especially because the nodes are not pushing liver tissue, and grow it. If the autopsy found metastases in the lungs or in the brain, the diagnosis of malignant neoplasms seems more likely; the error is detected only by histological examination. Tumor nodes are often in both lobes of the liver, less often - in the left, may be single or multiple and, merging with each other, to achieve the big sizes and weight (several kilograms). Portions of the liver, are not affected by alionochka, vicar hyperplasias, especially among young people.
Hosts very hard and when dissection often crunch (fibrous tissue). In the context node alionochka reminds fine cheese. Blood vessels in the heart of the nodes are squeezed fibrous tissue, resulting often formed areas of necrosis and caverns larger or smaller sizes. The contents of the caverns reminds liquid pus, but when sowing often turns out to be sterile. Nodes alionochka not surrounded by a fibrous capsule, on the periphery have uneven line and is particularly rich in living budding bubbles; as germination site to the surface of the liver pisanova capsule thickens, becomes whitish-yellowish; site pulls her. Sometimes formed Union with neighbouring authorities; they serve as a bridge over which alveolar can germinate in the abdominal wall, abdominal cavity, in the diaphragm through her. During germination in large veins may occur hematogenous transfer its germinative elements liviococcia node in the lungs, often in the brain and, as an exception, in other organs large circulation. Ascites due to the strangulation nodes alionochka portal vein is rare.
Histological examination shows that the bubbles of alionochka consist of cuticular shell, the internal surface of which nesesarily. In the lumen of the bubbles is colorless or yellowish liquid. Child bubbles and koleksi very rare. When implementing bubbles unchanged in the liver parenchyma about them immediately appear neutrophilic and eosinophils and macrophages, and liver cells die, growing granulation, and then the scar tissue. Often around the dead bubbles parasite can discover a giant cells. Larvae of alionochka develop active hyaluronidase, which contributes infiltrative growth alveolectomy nodes.

Over and symptoms. During liviococcia in the first months, and sometimes years, almost asymptomatic. The first sign of the disease is the increase in the liver, find sometimes by accident. However, and enlarged liver patient may feel quite satisfactory and no complaints are not present. Later the feeling of pressure in the right upper quadrant or epigastric pain, and later - heavy and dull aching pain. By that time manages to feel unusually dense ("iron") liver with a rough surface. Palpation of its morbidity is absent or insignificant. In a few years the liver increasing becomes lumpy and painful, in patients with a weakness, they lose weight, decreased appetite, and further develop jaundice and very rarely ascites. But with significant limitations process expressed a common disorders in patients may not be.
From complications most often occur perihepatitis, sprouting in neighboring organs and tissues, the collapse in the nodes of the parasite, germination gate liver tumor or their jaundiced and metastasis (mainly in the lungs and brain).
The disintegration of parasitic tumors often is sequestered her, and sometimes profuse bleeding into the cavity of decay.

The diagnosis is usually put in a late stage, when radical treatment is impossible. Doctors familiar with this type of echinococcosis and knows the place of his natural focality, it is possible to put and early diagnosis. The most difficult to differentiate alveolar from Galatenko echinococcosis, because all the symptoms last (reaction of Casoni, eosinophilia, and others), can be with both diseases, and trial puncture invalid. The symptom of iron-density" may occur when alveolate, and when obezvozhivani Kista Galatenko Echinococcus. Diagnosis helps the study of endemic foci.
It is easier to differentiate liviococcia from cirrhosis, as in the past, usually early in violation of the liver, there is no eosinophilia, and the reaction of Casoni negative. When differentiation with malignant neoplasms, be aware that liviococcia a longer period, the tumor is much denser, no cachexia, and specific reaction yield positive results.
For timely surgical treatment of liviococcia you must specify the localization of sites, their size, and so on, For this purpose apply peritoneoscopy, x-ray (gepatopatia on the background of pneumoperitoneum, splenoportography, arteriography) scan of the liver. Review x-rays often show foci of calcification.

Treatment. To perform radical surgery when alveolate liver possible only in 15-20% of patients. Most patients are brought to the surgical Department's too late.
A node can be issachen in healthy tissues, wilmsen or part of resected, and part wilmsen. If there are two or more sites, and General condition of the patient is not possible to remove them at one point, operation make two or even treatable. Often the gallbladder is spread on parasitic tumors in these cases, it is removed along with the host alionochka. If radical surgery is not possible (for example, when seeds germinate into the inferior Vena cava), and parasitic tumor has reached gigantic proportions and squeezes neighboring organs, shown palliative resection, which also produce to prevent compression extrahepatic bile duct progressive "tumor". Abandoned sites liviococcia site are subject to the local impact of anti-parasitic drugs (formalin injection, triplewin and others).
Technique palliative resection is not much difficulty, because parasitic sites, as a rule, do not bleed. Bleeding from a single large vessels to stop the samples of the gland. After opening the abdominal cavity excised piece of a large gland to produce biological pads. Pieces of packing 0,5x0,5cm pripudrivayut dry thrombin and fixed two nodes to the center of ligatures. At the time bleeding from the gaping in dense stroma vessel into the lumen of its produce vCal steeply curved needle with threaded into her ear a ligature with biological wool. By pulling ligatures can clog the lumen of the vessel and stop the bleeding. In the presence of decay cavities in the centre neudalimye parasitic node produce drainage cavity followed systematic washing her antiparasitic drugs, and in the presence of the infection with antibiotics. In obstructive jaundice caused by sprouting gate liver, produce different jelcheotdelenia operations. Try to use chemotherapy for inoperable forms. Used intramuscular injection thymol ester of palmitic acid (CEPAL) ineffective. There are attempts of treatment of liviococcia radiotherapy and vaccine therapy.
Forecast when alveolate very serious, but due to the very slow growth of parasitic growths and happy during this time compensatory rebuild liver patients can live for quite a long time (average of 8-9 years); die more often from obstructive jaundice, rarely from metastases in the brain. Timely radical surgery significantly improves the prognosis.
If radical surgery is impossible, it should not be limited to a trial by laparotomy. The condition of patients can be improved palliative interventions in complex with local and General anti-parasitic therapy, treatment with steroids, vitamins and diet.
Prevention. The main attention in places of natural focality of liviococcia should be paid to prevention of disease. Wolves and small rodents should be killed; skins foxes and Arctic foxes to capture and store (up to manufacture) in a special (non-residential) premises where must not be food. To eat in these areas is strictly prohibited, you can work only bathrobes, after work wash hands thoroughly. Carcass muskrats, hamsters and other rodents after removing them skins burn.
In places, troubled by liviococcia, not only vegetables, and berries before eating should be rinsed thoroughly.
Important in the prevention of both forms of echinococcosis has sanitary-educational work among the population. In places of natural focality recommended prophylactic medical examination for early detection and timely rational surgical treatment.
The international organization for combating echinococcosis. In 1941 in Uruguay was founded the international Association for struggle against echinococcosis, which from time to time convene international congresses. Periodically gathering Committee of the International epizootic Bureau in 1956 adopted a special recommendation on the prevention and combating of echinococcosis. Publishes journal "Archivos internacionales de la hidatidosis".