Clinical picture, diagnosis, treatment of echinococcosis

In the course of echinococcosis there are four stages: the first is hidden from the time of infection until subjective disorders; second, weakly expressed, mostly subjective symptoms; the third is clearly expressed objective symptoms; fourth, complications. Duration of the latent stage it is difficult to establish precisely, it depends on the location of the cyst. Thus, with the liver echinococcosis the first stage can last several years. When echinococcosis of the spinal cord, on the contrary, the latent stage short. Bubble, reaching negligible size, causing the spinal cord compression, motor and sensory disorders (paresis and paralysis of the limbs, disorders of the functions of pelvic organs and others). In the first stage, until the complaints often difficult to diagnose hydatid lung during x-ray examination of the thorax, undertaken with the purpose of medical examination. Possible subclinical of echinococcosis. This is evidenced by the unexpected sectional findings obezvozhivanija if Echinococcus cysts in the liver and other bodies of people who died from other diseases. At the second stage of echinococcosis depending on the localization process, the symptoms can be different. When the liver echinococcosis marked the severity, sensitivity or pain in the right hypochondrium, when the pulmonary echinococcosis - difficulty breathing, when echinococcosis brain - headaches. In the third stage with echinococcosis of abdominal cavity organs is often possible to probe the cyst or increased the authority to state hives or phenomena of intoxication. The fourth stage is characterized by the development of complications: the rupture of a cyst with the outpouring of the content in the chest or abdominal cavity, often accompanied anaphylactic shock; possible breakthrough cysts in the neighbouring hollow organs (bronchi, stomach, biliary tract and others), festering cysts, clinically manifested as abscess of the liver, lungs. With the defeat of echinococcosis bones can be pathological fractures.
In recognition of echinococcosis take into account epidemiological anamnesis (stay in places, troubled by echinococcosis, occupation of the patient), clinical data (long relatively benign disease) and the data of x-ray studies. Much assistance is provided by special allergic and serological reactions, in particular allergic reaction of Casoni. For carrying out this reaction in the thick skin of the forearm sterile syringe with a fine needle is injected 0.1 ml specially prepared liquids if Echinococcus bubble humans or animals. In other forearm enter the same number of isotonic solution of sodium chloride (control). In case of positive reaction to the introduction of fluid appears redness, limited swelling and itching of the skin. Redness lasts several hours. The more intense and longer it lasts, the reaction dokazatelnee. When applying intradermal reaction does not exclude the possibility of anaphylactic shock. Of serological reactions to the diagnosis of hydatid apply reaction of binding complement Weinberg (see Veinberga reaction and the reaction of latex-agglutination with if Echinococcus antigen (reaction of Fishman), in which the latex is a sorbent of antigen. The reaction of this, unlike skin Allergy testing of Casoni, can be reused and therefore can be used for dynamic observation of the operated patients. Now this reaction used for mass examination of the population to detect early forms of echinococcosis.
If you suspect echinococcosis puncture diagnostic purposes invalid because after removing the needle and liquid if Echinococcus bladder, where it is under higher pressure, can pour in the chest or abdominal cavity and cause widespread echinococcosis.
In natural foci of echinococcosis in the areas of the greatest distribution of the invasion for early detection of the disease should be carried out prophylactic medical examination, hunters, pastoralists and periodic special surveys.
Treatment - operative. Make an autopsy cysts and remove content - cuticle shell subsidiary, bubbles, liquid. In some cases, cysts removed together with fibrous capsule (velushina, resection of liver, lung). After these operations, as a rule, impose deaf seam. With festering if Echinococcus cyst is marsupialization (see) or drainage. In the postoperative period used means improving liver function (40% glucose intravenous, vitamins, and methionine, lipokain inside). In the case of education after the operation purulent and biliary fistula produce washing their antiseptics and toilet skin around them, and then dressings. If fistula long is not closed, the necessary re-hospitalization for revision fistulous progress using contrast agents (fistulography) and operations.
Prevention of echinococcosis is to sanitary and veterinary supervision of slaughter of cattle, destruction of the affected organs. We can not allow eating dogs dead animals. You must destroy stray dogs. Service and other valuable dogs recommended to expose deworming. In places, troubled by echinococcosis, periodically carry out a survey of the population, to conduct a wide sanitary-educational work. Personal prevention is to wash hands before eating, after communication with dogs, thorough washing vegetables, berries; it is recommended to drink only boiled water.

Over and symptoms. During the echinococcosis of any localization observed four stages: the first - latent - from the moment of invasion oncospheres until subjective disorders; the second is poorly defined, mainly subjective symptoms; the third is clearly expressed objective symptoms; the fourth - stage complications. The duration of the latent phase can be determined only approximately, since the time of the invasion of the parasite cannot establish for sure. However, its duration as the duration of subsequent periods of clinical course, varies considerably depending on the localization of Echinococcus. Thus, with the liver echinococcosis the first stage can be very long and frequency currents are expressed clearly. When echinococcosis of the spinal cord, on the contrary, latent stage short-lived because the bubble, reaching insignificant sizes, already has a significant pressure on the affected body; at that, immediately following the latent stage as the first clinical symptoms may develop paralysis, and disorder of functions of pelvic organs. Other containment of echinococcosis complications come late. They are very diverse: ascites and jaundice lesion of the liver, lung atelectasis, the shift of the mediastinum with hydatid lung, pathological fracture when echinococcosis bones, and so on, Other types of complications can develop, depending on the changes of the walls of the cysts. These include the gap fibrous capsule and bladder, threatening the colonization and sometimes accompanied anaphylactic, and in some cases, pain and shock, sometimes internal bleeding. There suppuration cyst after the death of the parasite that followed the break or due to other, usually by the unclear reasons. Suppuration parasitic cysts appears limited symptoms of abscess of the affected organ. The abscess may further cut in the chest or abdominal cavity and cause purulent peritonitis, or pleural effusion. Sometimes localization festering cysts creates the possibility of breaking the pus out or hollow organ. For example, at the break of festering Echinococcus light in the major bronchus get a picture of lung abscess (see the Light)connected to the bronchus, and abundantly separated purulent sputum find pieces of chitin of and even a small child bubbles.
The diagnosis. The main signs of echinococcosis are relatively slow benign course no significant overall changes in the initial phases of the disease, some changes in the blood (eosinophilia), recurrent urticaria in history.
Of great practical importance reaction of Casoni (see Allergic diagnostic tests), which gives a positive result in the living parasite in 60-90% of cases. Re-trial of Casoni to produce one should not avoid anaphylactic reactions.
It should refrain from the use of Allergy testing when echinococcosis easy as possible severe reaction and rapid local phenomena with breakthrough bladder and anaphylactic shock. High specificity and sensitivity has serological reaction of haemagglutination to the antigen prepared from liquid if Echinococcus bubble man, and the agglutination reaction to latex. Exact location and size of Echinococcus can be installed using angiography (splenoportography, chrisomilia gepatoproteguoe) or scan radioactive isotopes.
Known value for parasitological diagnosis is the anamnesis of the patient (for example, stay in the areas where the incidence of echinococcosis is endemic).
When echinococcosis of the organs available palpation, establish an increase in the body; often able to determine that the increase depends on related educational Agency that has a smooth spherical surface. Palpation is usually little painful or painless. When the cyst with the presence of numerous child bubbles floating in its cavity, occasionally find "phenomenon shake hydatid", which is felt when you put on swelling brush with widely divorced fingers and a rare but aggressive strikes to percutiebat on the middle finger. In recognition of hydatid lung great value has x-ray detecting typical blackout, spherical or oval, with a very clear boundaries that changes shape when breathing (symptom Nemenova).
The slightest suspicion of echinococcosis is an absolute contraindications to diagnostic puncture, as punctures are threatened by contamination. If you've puncture and syringe appeared colorless liquid, it is necessary immediately to investigate, not removing the needle. Typical chemical composition and the presence of hooks Echinococcus are the indication for emergency surgery, and inject the needle cannot be extracted, while containing cyst body will not be separated tampons.
During surgery for diagnosis widely used test puncture cysts.
These characteristics allow us to provide snow echinococcosis from benign tumors and cysts neproshteno nature.

Treatment - only online. Cases of healing through the death of the parasite, suppuration cysts and prosperous emptying her at the break out or aseptic resorption and calcification of the dead bubbles are extremely rare. Delay in operation increases the complexity of the intervention and worsens its results. Depending on the location, size and condition Echinococcus can be applied to different operational methods.

Echinococcectomy (or rather hiterectomy) - opening of the fibrous capsule and destruction of chitin bubble with all its contents. There are two variants of this operation. When open echinococcectomy, which is now very rare, before or after the removal of bubbles produce podselenie fibrous capsule to the peritoneum, pleura or to the muscles and aponeurosis in the walls of the wound (see Marsupialization). Plugging the cavity of the fibrous capsule with gauze and then treated as deep festering wound, trying to fill the cavity granulations.
When closed echinococcectomy, removing the bladder, fibrous bag tightly sewn in per losing cavity and the fusion of its walls. This technique is often used in the hydatid lung, in which the cavity well subsided and can be completely eliminated by svorachivanie edges of the fibrous capsule. Before stitching cavity wall it wipe 5% aqueous solution of formalin and glycerin and then pripudrivayut powder penicillin and streptomycin. Wiping 5% formalin solution necessarily and open echinococcectomy, as aimed at the destruction of scolokov and minor child of bubbles, which can always remain on the walls of fibrous cavity (chitinous shell fragile and extract maternal bubble, not breaking it, almost impossible). Closed echinococcectomy reduces postoperative period and prevents long and rich suppuration. The latter inevitably in the open procedure; in cases of echinococcosis of the liver to greecenew can join a significant loss of bile from the cavity wall, possibly threatening profuse bleeding (especially in the presence of jaundice). Therefore, to open echinococcectomy have to resort, if the closed technically impossible, and especially when available already festering cysts, regardless of its location. The main lack of both methods is the possibility of relapse.

Extirpation cysts, i.e. fibrous capsule with its contents (Fig. 4)more often is in the nature of economical resection of the affected organ - segmentectomy or even lobectomy with echinococcosis of the lung. In the case of other localization process (e.g. liver) method implemented mainly at the surface location of the cysts in the body, especially if she stuck out on a more or less pronounced leg.

Fig. 4. Two cysts Galatenko Echinococcus removed completely with the fibrous capsule.

The removal of the affected organ together with the cyst can be carried out with the echinococcosis kidneys, spleen, ovaries, thyroid, etc. These operations (and extirpation cysts) are in the greatest guarantee of relapse if performed without opening the fibrous capsule. Radical surgery for echinococcosis is usually applied in cases when the disease is detected early, when the cyst is still small and the General condition of the patient little disturbed.
Prevention is carried out by public and private events.
Social prevention is the job of veterinary surveillance in slaughterhouses and in cattle-breeding farms and aims to avoid eating Dogs and related predatory animals affected echinococcosis bodies slaughter or dead animals. Part of the carcasses found to contain bubbles Echinococcus, burn or subjected to technical processing with indispensable heat treatment. The task of the veterinary surveillance also includes systematic deworming dogs in pastoral areas, nurseries of service dog breeding, hunting farms. In the latter should be accompanied by the veterinary inspection of carcasses produced or fallen wild ungulates (elk, deer, ROE deer and others). The hunting of predators (wolves, jackals) is also known preventive value.
Individual prevention measures required first of all to the owners of hunting, watch and other dogs, especially those contained in the rooms. These measures are limited to compulsory periodic deworming dogs arecoline (which requires at least 1 time per year to apply for the veterinary Station) and a constant monitoring by her stool.