Treatment of pulmonary echinococcosis from beginning to end. Echinococcal cyst of the lung: treatment of echinococcosis

Pulmonary echinococcosis

What is pulmonary echinococcosis -

Pulmonary echinococcosis represents the cystic stage of development tapeworm(Echinococcus granulosus).

Pulmonary echinococcosis occurs in the hydatid (single-chamber) form. Lung lesions rank second in frequency (15-20%) after liver lesions (80%).

Echinococcosis is widespread throughout the world. According to statistics, the population and animals of the southern countries are most intensively affected: countries South America(Uruguay, Paraguay, Argentina, Chile, Brazil), Australia and New Zealand, North Africa (Tunisia, Algeria, Morocco, Egypt), Southern Europe(Italy, Greece, Cyprus, Turkey, Spain, Yugoslavia, Bulgaria, France), then the southern part of the USA, Japan, India, the former USSR. As you move from south to north, the incidence decreases. In the territory former Union echinococcosis is common in those republics and regions where livestock farming is developed, mainly sheep farming - the North Caucasus, Transcaucasia, Kazakhstan, Kyrgyzstan, Uzbekistan, Moldova (the incidence of the population is 1.37 - 3.85 per 100,000), in Russia - Bashkortostan, Tatarstan , Stavropol, Krasnodar, Altai, Krasnoyarsk, Khabarovsk territories, Volgograd, Samara, Rostov, Orenburg, Chelyabinsk, Tomsk, Omsk, Kamchatka, Magadan, Amur regions and Chukotka Autonomous Okrug.

In Ukraine, echinococcosis is more often registered in the southern regions - Odessa, Crimea, Kherson, Nikolaev, Donetsk, Zaporozhye, in the rest - sporadic cases.

On the territory of Ukraine, 2 types of outbreaks are registered: in the southern steppe zone the “sheep” strain circulates, in the Polissya and forest-steppe zones it is predominantly the “pork” strain. The incidence of sheep in the Odessa region was 32%, a large cattle- 20%, pigs - 9%.

What provokes / Causes of pulmonary echinococcosis:

The causative agent of human echinococcosis is the larval stage of the tapeworm echinococcus - Echinococcus granulosus.

The sexually mature form of echinococcus is a small cestode 2.5 - 5.4 mm long, 0.25 - 0.8 mm wide. It consists of a pear-shaped scolex, a neck and 3 to 4 segments.

The scolex is equipped with four suckers and a crown of two rows of hooks (28 - 50).

Goes for the scolex short neck and segments, the first two are immature, the third is hermaphroditic and the fourth is mature. The mature segment (length 1.27 - 3.17 mm) is filled with a stretched uterus, which is a wide longitudinal trunk with lateral protrusions. The uterus is filled with eggs (400 - 600 pieces), which do not differ in structure from the eggs of bovine and pork tapeworms (teniids), containing a six-hooked oncosphere inside.

Hydatid cyst is a bubble of a very complex structure. Outside, it is surrounded by a layered shell (cuticle), the thickness of which sometimes reaches 5 mm. Under the multilayer cuticular membrane lies a thin internal embryonic (germinative) membrane, which produces brood capsules with scolex, daughter vesicles, and also gives rise to the layered membrane.

Brood capsules are small bubble-like formations scattered on the embryonic membrane and connected to it by a thin stalk. They have the same structure as the main bladder, but with the reverse arrangement of the membranes (germinative on the outside, layered on the inside). Each brood capsule contains scolex attached to its wall, screwed inward and having a structure typical of tapeworms. The bladder is filled with liquid, which plays the role of a protective nutrient medium for brood capsules and scolex.

The liquid may contain freely suspended, detached scolex and brood capsules, the so-called hydatid sand.

The bladder is gradually covered with a connective tissue membrane. Often, such a maternal cyst, in addition to the above elements, also contains so-called daughter blisters, which have the same structure, and inside them are grandchild blisters.

Such cysts are observed in humans. Sometimes daughter blisters form not inside the mother cyst, but outside. Such bubbles are called exogenous.

Echinococcal cysts that form in animals, as a rule, do not contain brood capsules and scolex; they are called acephalocysts. This form is not found in humans.

In the sheep-breeding areas of the southern zone, the circulation of echinococcus follows the scheme: sheep -› watch dogs, accompanying a flock -› sheep.

In the western regions of intensive pig farming, the circulation of echinococcus follows the pattern: pigs -› dogs -› pigs. Lack of active motor function in members of the “pork” strain, it reduces contamination of dog hair and soil, thereby limiting the conditions for infection of people and animals.

The intensity of transmission of invasion is determined, first of all, by the number of sources of invasion of the definitive hosts and the amount of invasive material released by them - oncospheres and segments.

Oncospheres tolerate temperatures from -30°C to +38°C; on the soil surface in the shade at a temperature of 10 - 26°C they remain viable for a month, but in the sun at a temperature of 18 - 50°C they die after 1-5 days. In grass at a temperature of 14 - 28°C they die no earlier than after 1.5 months. Oncospheres are well tolerated low temperature, in which they can persist for a number of years, but are very unstable to drying out.

Humans, the intermediate host, are a biological dead end.

In human echinococcosis, the dog occupies the primary position as the definitive host. Dogs become infected by eating meat waste from slaughterhouses, slaughterhouses, kitchens, or by feeding them confiscated goods from slaughterhouses or organs infected with larvocysts from animals slaughtered at home. Dogs can also become infected by feeding them hunting products - damaged organs or carcasses of wild herbivores.

The routes of infection of intermediate hosts are also different; herbivorous farm animals become infected by ingesting eggs, helminth segments with grass, hay, water, contaminated with the feces of infested dogs. Pigs, being coprophages, become infected by eating dog feces. The main role in human infection through dirty hands plays a role in communicating with infested dogs, on whose fur and tongue there may be eggs and segments of Echinococcus tapeworms. Healthy animals can also transmit the infection to humans as mechanical carriers of eggs, which contaminate their fur and tongue when licking an infected dog.

Human infection cannot be ruled out by eating unwashed vegetables, berries, fruits contaminated with dog feces containing oncospheres.

A person can also become infected from wild carnivores during hunting, cutting skins, making fur clothing, as well as by eating unwashed wild berries, and drinking water from natural bodies of water.

In sheep-breeding areas, where the circulation of the pathogen occurs mainly between dogs and sheep, risk groups include shepherds, shepherds accompanying flocks, as well as sheep shearers and family members.

Pathogenesis (what happens?) during pulmonary echinococcosis:

Echinococcosis develops in connection with the introduction and growth in various organs larvae of tapeworm - echinococcus.

A person becomes infected with echinococcosis mainly orally, and due to the hematogenous route of spread, oncospheres can affect any organ, any tissue, but most often the liver (44 - 85%), then the lungs (15 - 20%) in more rare cases by big circle blood circulation - kidneys, bones, head and spinal cord and other organs.

In the affected organs, one cyst or multiple echinococcosis may develop, depending on the oncospheres introduced.

The pathological influence of echinococcus is due to the mechanical and sensitizing influence of the growing larva. Cysts range in size from 1 - 5 cm in diameter to giant cysts containing several liters of fluid. The mechanical impact of such a cyst leads to dysfunction of the affected organ. Localization and size determine the main symptomatology and severity of the disease.

After 5 months the resulting bubble has a diameter of 5 mm. Subsequently, the bubble grows slowly, over the years, and gradually, after 20-25 years, reaches large sizes, with a capacity of 10 liters or more: connective tissue capsule with chitin walls. The cavity of this cyst is filled with a slightly yellowish neutral liquid containing sodium chloride, grape sugar, tyrosine, succinic acid, albumin, etc. The chitinous shell consists of two layers: the outer dense (cuticular) up to 0.5 cm thick and the inner (germinative) embryonic, from which they are formed large quantities, sometimes up to 1000, daughter bubbles.

Symptoms of pulmonary echinococcosis:

Pulmonary echinococcosis- the second most common manifestation of invasion, can simulate any lung disease of a different etiology.

Usually there are three stages of disease development.
Stage I - asymptomatic - can last for many years from the moment of infection. An hydatid cyst grows slowly, without causing any problems. The disease is discovered accidentally when x-ray examination.
Stage II - stage clinical manifestations. During this period of illness, patients are worried dull pain in the chest, sometimes shortness of breath, cough. Symptoms of the disease develop when the cyst size is significant.
Stage III- stage of development of complications. Patients experience infection and suppuration of the cyst, its breakthrough into the bronchus (about 90%), pleura, abdominal cavity, biliary tract, pericardial cavity.

When a suppurating cyst breaks into the bronchi, purulent contents, fragments of cyst membranes, and scolex (small daughter blisters) are coughed up. Entry into the bronchi of echinococcal fluid, membranes of blisters and small daughter cysts can cause asphyxia. Breakthrough of the cyst into the bronchi is accompanied by severe anaphylactic shock due to the absorption of toxic echinococcal fluid and its effect on the receptor apparatus.

Urticarial rashes on the skin often appear. The fluid released from the cyst cavity contains scolex, which, if it enters the pleural cavity, can cause contamination of the pleura and the appearance of new blisters.

With pulmonary echinococcosis, there is often an increase in body temperature due to perifocal inflammation. When the cyst suppurates, the body temperature rises to 38-39 ° C and lasts a long time.

Upon examination chest at large cysts sometimes its bulging on the affected side and widening of the intercostal spaces are determined. In the area where the echinococcal bladder is located, dullness of percussion sound is detected. Auscultatory data are very diverse: with perifocal inflammation, wheezing is heard; in the presence of an empty cavity and filling it with air - bronchial, sometimes amphoric breathing. Cysts located at lung root, as well as cysts small sizes are not accompanied by these symptoms.

Diagnosis of pulmonary echinococcosis:

Main method diagnosis of pulmonary echinococcosis are: radiographic, ultrasound examinations, tomography, scanning, laparoscopy, serological methods. In identifying pulmonary echinococcosis, mass fluorographic examination of the population plays a very important role. It is preventive examination that currently makes it possible to recognize the disease before the appearance of any clinical symptoms.

An X-ray examination reveals one or more homogeneous shadows of round or oval shape with smooth, clear contours. Sometimes calcification of the fibrous capsule is determined. Due to perifocal inflammation, the contours of the cyst shadow become less clear. Compression of the adjacent bronchi by a large cyst can cause atelectasis of the lung tissue.

When a suppurating echinococcus breaks through into the bronchus X-ray picture similar to the picture observed with lung abscess, i.e., a cavity with smooth internal walls and a liquid level is revealed. IN clinical analysis eosinophilia is determined in the blood, increase in ESR, leukocytosis with shift leukocyte formula to the left.

Help in making a diagnosis:
indirect hemagglutination reaction (IRHA) - reliable diagnostic titer 1:200-250 and above;
linked immunosorbent assay(ELISA) - the reaction is considered positive with a score of 2-3 pluses.

Identification of a round shadow with smooth contours on a lung x-ray, CT or MRI, combined with positive serological reactions(RNGA, ELISA), makes it possible to accurately diagnose the disease.

An hydatid cyst should be differentiated from tuberculoma, peripheral carcinoma and other diseases in which spherical shadows are detected in the lungs. If echinococcosis is suspected, a round spherical shadow in the lung should not be punctured due to the possibility of rupture of the cyst, the danger of echinococcal fluid entering the pleura with the development of a severe anaphylactoid reaction and contamination pleural cavity germinal elements of echinococcus.

Traditionally used combination treatment, which includes surgery with repeated courses of treatment with germicides. For disseminated lesions of one or more organs and cyst sizes up to 3 cm, encouraging results were obtained with chemotherapy without surgery. Most Applications received carbomamidazole preparations (albendazole, escazole, zentel). The drugs are prescribed in doses of 10-50 mg. per 1 kg. body weight per day. A course of treatment lasting 3 weeks, repeated after 4 weeks, must begin at early dates after operation. When carrying out chemotherapy, it is necessary to monitor the functions of the liver, red and white blood cells.

Prevention of pulmonary echinococcosis:

A set of veterinary medical measures for echinococcosis is aimed primarily at identifying and eradicating the source of invasion. In accordance with official recommendations we're talking about on reducing the number of guards service dogs, their accounting, registration and destruction of stray animals.

Farm veterinary specialists carry out preventive deworming of service dogs every 45 days from December to April, every 30 days from May to November, and once a quarter for the rest. These measures should also be taken with regard to personal dogs. Deworming is carried out at special sites, where the excreted feces are collected in a metal container and neutralized: (boil for 10 - 15 minutes, pour in a 10% solution of bleach for 3 hours, the soil is treated with a 3% solution of carbation (4 liters per 1 m2 ).

To prevent infection of dogs, it is necessary to follow the rules for the slaughter of farm animals and ensure the destruction of affected organs, as well as to prevent dogs from accessing the territory of meat processing plants, slaughterhouses, and cattle burial grounds.

Measures to prevent infection of dogs also include such mandatory recommendations as: increasing the veterinary and sanitary level of farms; construction of disposal pits, cattle burial grounds; compliance with the rules for storing and transporting animal corpses; slaughter of animals only in appropriate places, etc.

Medical measures include identifying those infested by examining decreed groups (hunters, people who have contact with dogs, those involved in fur processing, production fur products, shepherds) and survey on clinical indications; deworming and dispensary observation. Important has health education work.

Personal prevention of echinococcosis is to limit contact with dogs, children playing with them, wash your hands thoroughly after contact with animals, before eating, after working in the garden, playing in the yard, in the garden, picking mushrooms, not eating unwashed wild berries, not drinking unboiled water from natural reservoirs.

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The main ones are the consumption of raw or undercooked meat, contact with infected pets.

Echinococcosis of the lungs refers to chronic illnesses. The disease is characterized by the formation of tumors in the lungs. The causative agent is Echinococcus glanulosus.

Echinococcus larvae can penetrate organs located near the liver, for example, the spleen. Often a cyst develops in the lungs, liver, kidneys, brain, after the larvae enter the lymphatic and circulatory systems.

When localized in the lungs, the larvae can be located near:

Bronchial trunk. Characterized by the appearance wet cough. Sputum has bad smell and streaks of blood. In some cases, shortness of breath appears, and disorders of the vascular system are observed.
Pleura. This is a thin membrane that covers the lung. is the occurrence of pain.

Reasons for the development of echinococcosis in the lungs

At risk are people whose profession is related to agriculture or animals. Flies are also carriers.

Echinococcus glanulosus larvae can survive long time and live in soil, grass, and animal fur.

Symptoms

The danger is that several cysts can form in the lungs. When multiple tumors form, signs appear much earlier.

Pulmonary echinococcosis exhibits the following symptoms:

Pain in the chest;
Dry cough.

Over time, the cough becomes moist, foamy, and the sputum that comes out acquires an unpleasant odor.

Blood streaks in the mucus appear if there is no proper treatment.

The late stage of pulmonary echinococcosis is manifested by worsening symptoms due to enlargement of the cyst. It increases significantly in volume and begins to put pressure on the lining tissue of the lungs and other surrounding organs. The main symptoms are:

periodic severe headaches;
weakness;
decreased performance;
fatigue;
the appearance of a rash in the form of small red spots;
short rise in temperature.

This stage is dangerous for human life because the tumor can rupture at any time. If not accepted urgent measures, death may occur.

Treatment of echinococci in the lungs

Implies complex therapy, which includes surgery with secondary courses. If there are several cysts up to 3 cm or damage to various organs, chemotherapy is used.

In addition, Albendazole, Escazole or Zentel are used. The course of treatment with drugs is about three weeks, depending on the degree of development of the disease. After a month, repeated therapy is indicated. When prescribing chemotherapy, monitoring of liver function is necessary.

Surgery

Echinococcus in the lungs at any stage of development requires surgical intervention. Used for excision of hydatid cysts different ways surgical intervention.

Echinococcectomy

Before excision of the formation, a thoracotomy is performed - a procedure that involves opening the chest for examination or performing surgical procedures. The tumor is pierced with a special needle and the contents are removed.

If there are no fistulas on the bronchi, an 80% glycerin solution in the same amount is injected into the cyst cavity and left for 5 minutes. Sodium chloride is also used, the exposure of which is from 20 to 30 minutes.

If a fistula has formed, the neoplasm is processed after opening cotton swabs, pre-moistened in glycerin solution.

Then I remove the tumor shell, which consists of chitin. After that it is processed 76% alcohol solution. Excess capsule is removed, and the formed cavity is sutured.

Then, by increasing the pressure in the anesthesia machine, air is supplied to the affected organ until it begins to touch the perinatal pleura.

Enucleation of the cyst

Ideal echinococcectomy is performed without damaging the membrane of the formation.

Before the procedure, the formation is fenced off from the peripheral parts using napkins treated with an 80% glycerin solution. A 20-30% sodium chloride solution is also used.

Then the fibrous membrane and, if necessary, the lining tissue of the organ are cut. The organ is inflated through an endotracheal tube. This is necessary so that the cyst is squeezed out without damage through the incision.

The fistulas and the resulting cavity are sutured. The operation is performed with minor formations and the absence of local inflammation.

Radical echinococcectomy

Pericystectomy for pulmonary echinococcosis involves excision of the causative agent of the disease along with the cystic formation. At the same time, they extremely spare the lining lung tissue so as not to damage nearby vessels.

Resection

The procedure is carried out only by medical indicators in the absence of extensive inflammation or combination with other ailments that require lung resection.

If a bilateral lesion is established, surgery on the other lung is performed 2-3 months after the first.

Lethal outcome after resection is established in 0.5-1% of cases of disease detection. Relapses occur in only 1% of cases.

IMPORTANT! When pulmonary echinococcosis is established, treatment is required immediately. After a detailed examination, the doctor will prescribe a course medicines and determine the method of cyst removal.

Chemotherapy

Indications for chemotherapy are:

Summary

Pulmonary echinococcus is a rather serious and dangerous disease.

When a patient has been diagnosed with pulmonary echinococcus, treatment is prescribed based on research data depending on the patient’s condition, the degree of development of the disease, and localization.

Echinococcus of the lungs does not show symptoms at the first stage of development. Often the disease is diagnosed during examinations for other diseases. It can last for several years without showing signs.

After examination and determination of the stage of development, surgery or chemotherapy will be prescribed.

In contact with

Therefore, you need to know what echinococcosis is, how this disease is transmitted and what signs can be used to suspect infection.

According to statistics, the incidence of echinococcosis does not depend on age. The pathology occurs in both children and adults. The main cause of infestation is neglect of hygiene rules after interacting with pets.

The disease code according to ICD-10 is B67.

In the development chain this helminth don't need people. For him, they become additional or intermediate hosts. Let's see what it looks like life cycle causative agents of echinococcosis:

How is the infection transmitted?

IN favorable conditions helminth eggs remain viable from 40 days to a year. When frozen, invasiveness persists for up to several years.

Infection with echinococci in humans does not occur from eating the meat of infected animals, household and sexual contacts and others possible ways transmission of the disease. In addition, the risk of intrauterine pathology is completely eliminated.

Helminth eggs enter the human body only through airborne droplets (5% of cases) or through unwashed hands after interaction with animal fur.

Symptoms

There are four known stages of echinococcosis:

latent;
moderate;
peak period;
complications caused by the disease.

Clinical symptoms in humans depend on the location of the helminth in the body.

The first symptoms of the disease become obvious provided that the neoplasm prevents the full functioning of the affected tissues against the background of compression of blood vessels and nerves. Depending on the localization of echinococcosis and the duration of the invasion, each patient requires an individual approach and treatment regimen.

Echinococcosis of the brain

The larvae, fixed in the tissues of this organ, primary stage the disease practically does not cause any symptoms. Over time, as echinococcosis continues to develop, the patient develops clinical manifestations typical of brain tumors.

These include the following signs:

epilepsy attacks;
depressive syndrome;

mental retardation;
hallucinations;
paresis of arms and legs;
intracranial hypertension.

In this organ (pictured) a single-chamber process is usually formed - hydatidosis (90% of cases). Alveolar echinococcosis develops less frequently, which is characterized by the formation of a large number of blisters.

Clinical manifestations of the disease depend on the stage of the pathological process. Let us consider in the table what symptoms may bother a person with liver echinococcosis.

Alveococcosis of the liver, unlike echinococcosis, causes a less pronounced picture of the disease, but this does not mean that this condition is not dangerous.

In general, both pathological processes are extremely difficult to diagnose in a timely manner. Only after the disease progresses to chronic stage, complications begin that are life-threatening to the patient.

Echinococcosis of the gallbladder

Symptoms of the pathology are obstructive jaundice and septic cholangitis. In both cases, we are talking about a mechanical disruption of the outflow of bile from the organ. This condition proceeds according to the type chronic cholecystitis with periods of exacerbations and remissions.

Breakthrough of cysts leads to the development of complications such as fever and sharp pains in the area of the right hypochondrium.

From this moment on, the patient may complain of pain in the bronchi, a hacking cough without apparent reason and shortness of breath. At the same time, bulging of the cysts and persistent hyperthermia above 39°C are noted.

When the tumor breaks through, the symptoms of the fourth stage of pulmonary echinococcosis intensify. Damage to the pleural tissue, bronchi and pericardium occurs, which is often accompanied by asphyxia and anaphylactic shock.

Helminths attack organs urinary system approximately 10%. In addition, the pathological process usually affects both kidneys.

In most cases, multilocular echinococcosis occurs, less often we are talking about single neoplasms. Clinical signs manifest themselves weakly - only with a significant increase in cysts do complaints of discomfort in the lumbar region begin.

At the fourth stage of the disease, the symptoms of kidney echinococcosis proceed according to the type urolithiasis And acute pyelonephritis. In this case, a large number of cyst membranes and scolex of the causative agent of helminthiasis are found in the urine.

Kidney echinococcosis can only be treated surgically. Often it is necessary to partially remove the organ along with the cystic formation. Therefore, for this type of pathology, delaying treatment is highly not recommended.

Echinococcosis of the spleen

Helminthiasis can occur in a single- or multi-chamber type. Often the disease is combined with damage to other vital organs, for example, pulmonary echinococcosis.

Clinical signs of pathology:

pain on the left in the upper part of the peritoneum;
cystic protrusion upon palpation;
symptoms characteristic of helminth damage to other organs.

If echinococcosis of the spleen is diagnosed, surgery is performed immediately.

The fact is that in this organ the pathological process proceeds rapidly and the cyst can break into the abdominal cavity at any moment. In this case, not only irreversible changes in the spleen occur, but also massive infection of other tissues and systems by helminths.

Rupture of the cyst significantly changes the situation for the worse: myocardial tamponade and vascular embolism occur. The patient requires emergency medical care.

The disease is characterized by extreme severe course, since echinococcosis in this case affects the central nervous system. The symptoms of the pathology reflect the picture of spinal cord compression:

dysfunction internal organs;
paralysis and paresis of the limbs;
spinal column deformities;
stiffness in movements.

Echinococcosis of bone

This pathology occurs in 0.1% of cases. Echinococci that have entered the cavity bone marrow, form a cyst in it. By destroying the functions of this vital organ, the disease leads to changes in the structure of the skeleton, namely erosions and cracks. The main symptom of the pathology is frequent fractures.

Cystic echinococcosis

In this case, cysts are formed in the tissues, the size of which can vary up to 10 cm. Cystic echinococcosis differs from other types of disease in that the larva, before gaining a foothold in a particular organ, destroys others, passing through them using the systemic bloodstream. The symptoms will be general.

Echinococcosis in children

IN early age the risk of helminth infection is too high due to the fact that children do not like to follow the rules of hygiene. Because cystic formations with echinococcosis they grow slowly, the pathology is not immediately detected - often years, and sometimes decades, pass before the diagnosis becomes known.

Ultrasound of the abdominal cavity, CT and MRI can also indicate pathology, serological tests blood.

Echinococcosis in children manifests itself in the form of the following symptoms:

lack of appetite;
low body weight;
general weakness;
bruxism;
irritability;
school failure;
allergic reactions;

concomitant helminthiases;
bowel disorders;
jaundice;
dry cough of unknown etiology;
dyspnea;
chest pain.

IN laboratory research there may be an increase in the number of eosinophils and immunoglobulin E in the blood.

The fourth stage of the disease, in which the cyst ruptures, is accompanied by complications of various nature, depending on the localization of helminthiasis.

Echinococcosis in animals

Echinococcosis in dogs is detected much more often than in cats. In the body of these animals, the causative agent of the disease goes through a full life cycle, since they are its final hosts.

Echinococcosis of dogs and cats can be suspected by the following signs:

lack of appetite;
chronic diarrhea;
dull coat;
unhealthy appearance.

The animal shows no interest in its surroundings - it does not play, sleeps a lot and looks depressed. What is noteworthy is that with echinococcosis, a strange thing appears in dogs and cats: they begin to lick more zealously anus and rub it against a wall or the surface of the ground. In a blood test of a sick animal, the amount of hemoglobin and red blood cells will be reduced, but eosinophils will be increased.

Echinococcosis of pigs, cows and other livestock is often found in rural areas. For the causative agent of the disease, these animals are intermediate hosts, so the clinical picture of the pathology proceeds by analogy with humans. That is, cysts form in livestock in vital organs.

Despite this, the clinical manifestations of the pathology are known in veterinary medicine. Symptoms of echinococcosis in sheep, cows and other animals are as follows:

shortness of breath and cough;
refusal of food;
diarrhea;
weight loss;
positive test reaction to echinococci (Casoni test);
fall of livestock.

Diagnostics

Detection of this type of helminthiasis consists of interviewing the patient, conducting laboratory and instrumental research methods, including with the help of modern computer technologies.

Diagnostic work begins with a conversation in a doctor's office with a potentially infected person. The specialist finds out the patient’s life history, learns about his interaction with animals, and asks about possible symptoms diseases.

Laboratory diagnosis of echinococcosis is carried out in two stages: the first of which confirms or denies the presence of pathology, and the second - the degree of damage to internal organs.

You can accurately determine the diagnosis using enzyme immunoassay tests who do in medical institutions Invitro type.

A blood test for echinococcosis using the ELISA method allows you to detect antigens to the causative agent of the disease in the biomaterial of the test subject.

Additionally, the Katsoni test can be performed. In laboratory conditions, the patient is scratched and a biological fluid artificially infected with echinococci is applied to the damaged area of skin. The essence of this analysis is to wait for the body's reaction to this manipulation: if a person experiences an inflammatory infiltrate in the form of hyperemia and swelling of the dermis, the Katsoni test is considered positive, that is, we are talking about helminthiasis.

Once the diagnosis is confirmed, diagnostic work continues, but now its task is to identify target organs and the extent of their damage.

The patient is also prescribed instrumental methods research. With their help, you can determine the localization of cystic formations, the size and degree of destruction of the affected internal organs.

Initially, the patient undergoes an ultrasound of the abdominal cavity, since in 80% of cases liver echinococcosis is detected. Then the patient is prescribed a set of additional diagnostic methods, which include:

Laparoscopy. An endoscope is inserted into the patient’s abdominal cavity, thanks to which the specialist has the opportunity to carefully examine the condition of the liver and other internal organs. The specialist sees everything that happens during the manipulation on the computer screen, so he can accurately draw conclusions about the size and number of cystic formations, tissue damage, etc.

X-ray. If a person has echinococcosis of the lungs, in the tissues bronchial tree cysts of different diameters are found, often surrounded by calcifications.
CT scan. Unlike the previous method, CT is able to detect deeper changes in organs.

Treatment

Timely initiation of therapy for this type of helminthiasis plays a significant role. This is the only way to avoid complications caused by a cyst breaking into the cavity of the internal organs.

On initial stage echinococcosis is carried out conservative treatment. But since helminths for a long time do not make themselves felt, often the diagnosis of the disease is carried out only when the pathological process has already started and it is simply impossible to avoid surgical intervention.

Days 4, 5 and 6: 1000 mg per day;

from day 7, the dosage is calculated using the formula 25 mg/kg.

The duration of the course is determined individually.

If a child has symptoms of echinococcosis, the listed anthelmintic tablets for the treatment of small patients under 6 years of age are not used due to their high toxicity. IN exceptional case When the disease affects the intellectual development of children or interferes with their normal digestion, they resort to the help of Mebendazole. The drug is prescribed at a dose of 5 mg/kg body for 3 months.

Conservative treatment of echinococcosis is not recommended for pregnant women - if a woman has cystic formations in the liver, lungs or other vital organs, taking medications should wait until the birth of the child. Until this moment, a specialist in inpatient conditions prescribes detoxification therapy and multivitamin complexes to the patient.

In advanced stages of echinococcosis, only surgery will help the patient. During this procedure, the doctor removes the cystic formations in full, trying not to disrupt the integrity of the fibrous capsules. If we are talking about multi-camera pathological process, that is, irreversible damage to the organ - a decision is often made to partially or completely resection it.

Before and after surgery, the patient must be prescribed drug therapy, Mebendazole is most often chosen for this purpose. The dosage of the drug depends on the picture of the disease.

ethnoscience

I would like to immediately note that treatment of this helminthiasis with herbal and other drugs at home is ineffective. There are no drugs that resolve echinococcosis and alveococcosis.

But the recipes traditional medicine can be used for postoperative treatment, that is, as additional method aimed at preventing relapse of the disease.

Let us list the main means effective against echinococcus.

Once a day on an empty stomach, take ¼ tbsp. spoons of wormwood, washing down the plant required quantity water. For children, it is enough to offer the product on the tip of a knife. Course 3 weeks.

Every morning on an empty stomach, eat a black peppercorn with water.
Art. Brew a spoonful of tansy with a glass of boiling water, leave for 4 hours and drink little by little throughout the day. Course 1 week. For pregnant women, the use of tansy is contraindicated for any helminthiasis.

Treatment folk remedies is not a panacea. The disease can only be dealt with A complex approach, including conservative and surgical therapy.

How to recover after surgery?

Any operation negatively affects the functioning of the damaged organ. Therefore, after surgery, it is important to normalize lost functions and avoid relapse of pathology.

After surgery for echinococcosis, treatment does not end there. The patient continues to be under the supervision of the doctor, following his recommendations. Typically they are as follows:

A course of anthelmintic therapy with Mebendazole or other equally effective drugs.
Receipt sick leave for up to four months for the recovery period.
Mandatory annual examination over the next 10 years, which includes: ultrasound of the abdominal cavity, analysis for echinococcosis using ELISA, liver tests, chest x-ray, biochemical and general research blood, CT scan of the head (if there was echinococcosis of the brain).

If a person has had surgery for liver echinococcosis, he should follow a diet corresponding to table No. 5. The doctor also prescribes drugs that restore organ cells, for example: Liv-52, Essentiale, etc.

If the disease was localized in the brain, medications are prescribed to normalize cerebral blood circulation, for example: Actovegin, Piracetam, etc. Additionally, the patient may be recommended to work with a speech therapist for problems with speech functions, or a physiotherapist for problems with motor activity and etc.

How to behave if you had to treat echinococcosis?

Avoid physical activity for six months.
For two months, protect yourself from stress and other moral shocks.
It is not advisable for women to plan a pregnancy in the future.

Prevention

No person is immune from helminths. Prevention of echinococcosis involves careful adherence to hygiene rules, which reduces the risk of infection to a minimum.

Since infection usually occurs through dirty hands, it is strongly recommended:

use soap after visiting the toilet, before eating and in other situations;
interact less with animals;
Do not eat unwashed fruits and vegetables, even from your own summer cottage.

The risk group for the development of the disease includes people engaged in cattle breeding, breeding dogs and cats, hunting, etc. Animals with which people come into contact should periodically receive preventive treatment anthelmintics, even if they have no symptoms of the disease and look healthy outwardly.

What is pulmonary echinococcosis
Symptoms of pulmonary echinococcosis
Treatment of pulmonary echinococcosis
Which doctors should you contact if you have pulmonary echinococcosis?

What is pulmonary echinococcosis

Pulmonary echinococcosis represents the cystic stage of development of tapeworm (Echinococcus granulosus).

Pulmonary echinococcosis occurs in the hydatid (single-chamber) form. Lung lesions rank second in frequency (15-20%) after liver lesions (80%).

Echinococcosis is widespread throughout the world. According to statistics, the population and animals of the southern countries are most intensively affected: the countries of South America (Uruguay, Paraguay, Argentina, Chile, Brazil), Australia and New Zealand, North Africa (Tunisia, Algeria, Morocco, Egypt), Southern Europe (Italy, Greece, Cyprus, Turkey, Spain, Yugoslavia, Bulgaria, France), then the southern part of the USA, Japan, India, the former USSR. As you move from south to north, the incidence decreases. In the territory of the former Union, echinococcosis is common in those republics and regions where livestock farming is developed, mainly sheep farming - the North Caucasus, Transcaucasia, Kazakhstan, Kyrgyzstan, Uzbekistan, Moldova (the incidence of the population is 1.37 - 3.85 per 100,000), in Russia - Bashkortostan, Tatarstan, Stavropol, Krasnodar, Altai, Krasnoyarsk, Khabarovsk territories, Volgograd, Samara, Rostov, Orenburg, Chelyabinsk, Tomsk, Omsk, Kamchatka, Magadan, Amur regions and the Chukotka Autonomous Okrug.

In Ukraine, echinococcosis is more often registered in the southern regions - Odessa, Crimea, Kherson, Nikolaev, Donetsk, Zaporozhye, in the rest - sporadic cases.

On the territory of Ukraine, 2 types of outbreaks are registered: in the southern steppe zone the “sheep” strain circulates, in the Polissya and forest-steppe zones it is predominantly the “pork” strain. The prevalence of sheep in the Odessa region was 32%, cattle - 20%, pigs - 9%.

What causes pulmonary echinococcosis?

The causative agent of human echinococcosis is the larval stage of the tapeworm echinococcus - Echinococcus granulosus.

The sexually mature form of echinococcus is a small cestode 2.5 - 5.4 mm long, 0.25 - 0.8 mm wide. It consists of a pear-shaped scolex, a neck and 3 to 4 segments.

The scolex is equipped with four suckers and a crown of two rows of hooks (28 - 50).

Behind the scolex there is a short neck and segments, the first two are immature, the third is hermaphroditic and the fourth is mature. The mature segment (length 1.27 - 3.17 mm) is filled with a stretched uterus, which is a wide longitudinal trunk with lateral protrusions. The uterus is filled with eggs (400 - 600 pieces), which do not differ in structure from the eggs of bovine and pork tapeworms (teniids), containing a six-hooked oncosphere inside.

An echinococcal cyst is a bubble of a very complex structure. Outside, it is surrounded by a layered shell (cuticle), the thickness of which sometimes reaches 5 mm. Under the multilayer cuticular membrane lies a thin internal embryonic (germinative) membrane, which produces brood capsules with scolex, daughter vesicles, and also gives rise to the layered membrane.

The liquid may contain freely suspended, detached scolex and brood capsules, the so-called hydatid sand.

Such cysts are observed in humans. Sometimes daughter blisters form not inside the mother cyst, but outside. Such bubbles are called exogenous.

Echinococcal cysts that form in animals, as a rule, do not contain brood capsules and scolex; they are called acephalocysts. This form is not found in humans.

In the sheep-breeding areas of the southern zone, the circulation of echinococcus follows the following pattern: sheep -› guard dogs accompanying the flock -› sheep.

In the western regions of intensive pig farming, the circulation of echinococcus follows the pattern: pigs -› dogs -› pigs. The absence of active motor function in members of the “pork” strain reduces contamination of dog hair and soil, thereby limiting the conditions for infection of people and animals.

Oncospheres tolerate temperatures from -30°C to +38°C; on the soil surface in the shade at a temperature of 10 - 26°C they remain viable for a month, but in the sun at a temperature of 18 - 50°C they die after 1-5 days. In grass at a temperature of 14 - 28°C they die no earlier than after 1.5 months. Oncospheres tolerate low temperatures well, at which they can remain for a number of years, but are very unstable to drying out.

Humans, the intermediate host, are a biological dead end.

The routes of infection of intermediate hosts are also different; herbivorous farm animals become infected by ingesting eggs, helminth segments with grass, hay, water, contaminated with the feces of infested dogs. Pigs, being coprophages, become infected by eating dog feces. The main role in infecting a person through dirty hands is played by communication with infested dogs, on whose fur and tongue there may be eggs and segments of Echinococcus tapeworms. Healthy animals can also transmit the infection to humans as mechanical carriers of eggs, which contaminate their fur and tongue when licking an infected dog.

Human infection cannot be ruled out by eating unwashed vegetables, berries, fruits contaminated with dog feces containing oncospheres.

A person can also become infected from wild carnivores during hunting, cutting skins, making fur clothing, as well as by eating unwashed wild berries, and drinking water from natural bodies of water.

Pathogenesis (what happens?) during pulmonary echinococcosis

Echinococcosis develops in connection with the introduction and growth of tapeworm larvae, echinococcus, in various organs.

A person becomes infected with echinococcosis mainly orally, and due to the hematogenous route of spread, oncospheres can affect any organ, any tissue, but most often the liver (44 - 85%), then the lungs (15 - 20%) in more rare cases throughout the systemic circulation - kidneys, bones, brain and spinal cord and other organs.

In the affected organs, one cyst or multiple echinococcosis may develop, depending on the oncospheres introduced.

After 5 months the resulting bubble has a diameter of 5 mm. Subsequently, the vesicle grows slowly over the years, and gradually, after 20-25 years, reaches large sizes, with a capacity of 10 liters or more: a connective tissue capsule with chitin walls. The cavity of this cyst is filled with a slightly yellowish neutral liquid containing sodium chloride, grape sugar, tyrosine, succinic acid, albumin, etc. The chitinous membrane consists of two layers: the outer dense (cuticular) up to 0.5 cm thick and the inner (germinative) germinal , from which daughter bubbles are formed in large numbers, sometimes up to 1000.

Symptoms of pulmonary echinococcosis

Pulmonary echinococcosis- the second most common manifestation of invasion, can simulate any lung disease of a different etiology.

Usually there are three stages of disease development.
Stage I - asymptomatic - can last for many years from the moment of infection. An hydatid cyst grows slowly, without causing any problems. The disease is discovered accidentally during X-ray examination.
Stage II is the stage of clinical manifestations. During this period of the disease, patients are bothered by dull pain in the chest, sometimes shortness of breath, and cough. Symptoms of the disease develop when the cyst size is significant.
Stage III is the stage of development of complications. Patients experience infection and suppuration of the cyst, its breakthrough into the bronchus (about 90%), pleura, abdominal cavity, bile ducts, and pericardial cavity.

With pulmonary echinococcosis, there is often an increase in body temperature due to perifocal inflammation. When the cyst suppurates, the body temperature rises to 38-39 ° C and lasts a long time.

When examining the chest with large cysts, it is sometimes determined that it bulges on the affected side and widens the intercostal spaces. In the area where the echinococcal bladder is located, dullness of percussion sound is detected. Auscultatory data are very diverse: with perifocal inflammation, wheezing is heard; in the presence of an empty cavity and filling it with air - bronchial, sometimes amphoric breathing. Cysts located at the root of the lung, as well as small cysts, are not accompanied by these symptoms.

Diagnosis of pulmonary echinococcosis

Main method diagnosis of pulmonary echinococcosis are: x-ray, ultrasound, tomography, scanning, laparoscopy, serological methods. In identifying pulmonary echinococcosis, mass fluorographic examination of the population plays a very important role. It is preventive examination that currently makes it possible to recognize the disease before the appearance of any clinical symptoms.

An X-ray examination reveals one or more homogeneous shadows of a round or oval shape with smooth, clear contours in the lung. Sometimes calcification of the fibrous capsule is determined. Due to perifocal inflammation, the contours of the cyst shadow become less clear. Compression of the adjacent bronchi by a large cyst can cause atelectasis of the lung tissue.

When a suppurating echinococcus breaks through into the bronchus, the x-ray picture is similar to the picture observed with a lung abscess, i.e., a cavity with smooth inner walls and a fluid level is revealed. A clinical blood test determines eosinophilia, increased ESR, leukocytosis with a shift in the leukocyte formula to the left.

Help in making a diagnosis:
indirect hemagglutination reaction (IRHA) - reliable diagnostic titer 1:200-250 and above;
enzyme-linked immunosorbent assay (ELISA) - the reaction is considered positive when assessed at 2-3 plus.

Identification of a rounded shadow with smooth contours on a lung x-ray, CT or MRI, combined with positive serological reactions (RNGA, ELISA), makes it possible to accurately diagnose the disease.

Traditionally, combined treatment is used, which includes surgery with repeated courses of treatment with germicides. For disseminated lesions of one or more organs and cyst sizes up to 3 cm, encouraging results were obtained with chemotherapy without surgery. The most widely used drugs are carbomamidazole (albendazole, escazole, zentel). The drugs are prescribed in doses of 10-50 mg. per 1 kg. body weight per day. A course of treatment lasting 3 weeks and repeated after 4 weeks should be started early after surgery. When carrying out chemotherapy, it is necessary to monitor the functions of the liver, red and white blood cells.

Prevention of pulmonary echinococcosis

A set of veterinary medical measures for echinococcosis is aimed primarily at identifying and eradicating the source of invasion. In accordance with official recommendations, we are talking about reducing the number of guard service dogs, their registration, registration and destruction of stray animals.

Medical measures include identifying those infested by examining decreed groups (hunters, people who have contact with dogs, those involved in fur processing, manufacturing fur products, shepherds) and examination according to clinical indications; deworming and dispensary observation. Health education work is important.

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