How to avoid echinococcosis of the pulmonary system? In addition, infection can occur with.

Hydatid echinococcosis

Etiology and pathogenesis. Hydatid is the cystic stage of development of the tape form of the helminth Echinococcus granulosis. Its final hosts are dogs, wolves, foxes, jackals and other predatory animals, intermediate hosts are large and small cattle, deer, pigs, monkeys, more than 60 species of mammals in total, as well as humans.

clinical picture. There are three stages of development of lung echinococcosis: asymptomatic, clinical manifestations and complications.

The first stage lasts for years. The presence of lung echinococcosis in this period is established during a preventive examination.

In the second stage, cough, hemoptysis, shortness of breath, general weakness, fever, night sweats, urticaria appear. The pain is usually aching, localized in the chest or back on the affected side of the lung. The cough is initially dry, associated with irritation of the pleura and bronchial receptors, and then, with the addition of an infection, with the separation of mucopurulent sputum. Hemoptysis appears either due to destructive changes in the small vessels surrounding the cyst, or as a result of necrosis and rupture of the vessels of the alveoli of the lung during its growth. General weakness, fever, night sweats are due to the toxic effect of echinococcus on the body, urticaria - with allergization phenomena.

Diagnosis of echinococcosis of the lung. When echinococci reach large sizes, smoothness of the intercostal spaces on the side of the lesion can be observed. Percussion above the echinococcal cyst is dull, auscultatory - hard breathing with a bronchial tone, pleural friction noise, dry and wet rales.

Eosinophilia is found in the blood of patients with echinococcosis. Most patients (70-80%) have a positive anaphylactic Cazzoni reaction. It is based on the introduction of 0.1 ml of sterile echinococcal fluid into the skin of the forearm of one hand, and in the other hand, as a control, the same amount of isotonic solution will be rubbed with chloride. In the presence of echinococcus, 30 minutes - 3 hours after infection of the antigen, itching, hyperemia, and skin appear in this place. The latex test is also informative (accompanied by agglutination of latex particles by antigens, on the surface of which the antigen is adsorbed).

In difficult cases of diagnosis, especially when layering the shadow of a cyst on the shadow of the mediastinum, diaphragm, chest wall, conventional, computed or magnetic resonance imaging is performed. Ultrasound scanning of the lungs is also used to detect echinococcal cysts.

Treatment of echinococcosis of the lung. With echinococcosis of the lung, surgical treatment is performed. Ideal echinococcectomy, echinococcectomy, pericystectomy, lung resection are used as methods.

Lung resection (lobectomy, wedge-shaped, segmental, atypical resection) is performed according to strictly limited indications in persons with multiple echinococcosis, a thick fibrous capsule with a large number of bronchial fistulas, perifocal inflammation, pneumofibrosis with impaired function of the affected area of ​​the lung.

With bilateral echinococcosis, surgical intervention is performed first on one lung (on the side of the complication), and after 2-3 months. on the second. However, single-stage bilateral operations are also used:

In case of cyst rupture, intensive multicomponent pathogenetic therapy is indicated, aimed at removing the patient from a critical state and normalizing disturbed body functions: stopping anaphylactic or allergic reaction(glucocorticoid hormones, substances, etc.); improvement of microcirculation (plasma substitutes of hemodynamic anti-shock action - polyglucin, reopoliglyukin \ creation of moderate hemodilution, etc.); detoxification therapy (low-molecular flame substitutes of detoxification action - hemodez, rheomacrodex, forced diuresis, etc.); sanitation of the bronchial tree (bronchoscopy) and the pleural cavity (puncture, with washing, therapeutic with the removal of child bubbles, fragments of the chitinous membrane from the pleural cavity); symptomatic treatment, etc.

In order to prevent aspiration complications during the operation before anesthesia, temporary endoscopic occlusion of the lung lobar bronchus draining the affected area is indicated.

Postoperative mortality in lung echinococcosis ranges from 0.3-1.1%. Relapse of the disease occurs in 0.7 - 1.5% of cases.

Also for pets:

• cats;
• sheep;
• horses;
• goats;
• cows.

AT human body only larvae can live without further development, but they are in the oncosphere with two shells, in which the capsules mature, growing and increasing the size of the cyst.

Helminth larvae enter the child's body due to the lack of basic hygiene. The entrance gate is always oral cavity baby. Children tend to bite their nails, take into their mouths various objects that they can pick up on the street, and also eat unwashed fruits, berries and vegetables. You can not drink water from natural reservoirs, even tap water is best boiled.

Children become infected through contact with pets. Getting into the esophagus and digestive organs, echinococcus larvae spread throughout the body, forming capsules, which, in turn, can remain in any organ and gradually grow. Their number depends on how many oncospheres have entered the body.

How does echinococcosis proceed?

The oncosphere grows for a long time, forming vesicles filled with toxins, such a formation is called an echinococcal cyst. Growing, cysts begin to put pressure on internal organs if the lungs are affected, fibrous tissue for cysts is the most favorable environment for reproduction.

The most dangerous thing is that the cyst, with intensive growth, can burst and release a poisonous fluid into the child's body. In this case, severe intoxication occurs, and the baby risks dying.

There are four stages of echinococcosis:

• I - asymptomatic, lasts a long time from the moment the infection occurred.
• II - the first signs of helminthic invasion, very weakly expressed, almost invisible.
• III - bright symptoms, if you see a doctor, you can start timely treatment.
• IV - complications of the affected organs develop, a fatal outcome is possible.

Symptoms

In children, the symptoms of the disease differ from adults and develop faster. Parents should contact the clinic at the first sign of infection. The symptoms depend on the affected organ. In children, the liver and lungs are usually affected.

The complexity of timely diagnosis lies in the fact that echinococcosis in children passes latently for a long time, nothing bothers the child. He has no pain, body temperature is within normal limits. The disease is very insidious, the symptoms appear at the last stage, when the cyst can only be removed promptly.

Alarming symptoms and a reason to consult a doctor are:

The longer the disease lasts, the brighter the symptoms become, at the last stage of lung echinococcosis, when coughing, the patient experiences severe pain, and sputum acquires a putrid odor and contains blood. Signs resemble the course of lung cancer.

Children's effect anatomical structure as the cyst grows, the chest can become deformed and bulge forward, causing pain to the child and making it difficult to breathe. Such symptoms are characteristic of the last stage of the disease, which is life-threatening. At any time, the cyst can burst if it is not provided Ambulance the patient may die.

Echinococcosis of the lungs is more often diagnosed with fluorography, which allows you to start treating the disease at an early stage of development and limit yourself to medicines. If the treatment has not been carried out, and the cyst continues to grow, there is a risk of its rupture, at which the temperature may rise sharply, the patient will feel a sharp severe pain in the chest. In the worst case, if a large cyst ruptures, anaphylactic shock may occur.

Echinococcosis of the lungs on fluorography

Gradually increasing in size, the cyst can provoke pneumonia or pleurisy, which is also fraught with serious consequences. Echinococcus in children causes complications in a more severe form than in adults. Symptoms and treatment entirely depend on the location of the cysts and the stage of the disease. For the timely detection of invasion, it is necessary to conduct annual checks of the child.

Diagnostics

Diagnosis of echinococcosis includes laboratory and instrumental research. When the first symptoms appear, the doctor prescribes a blood test, which can not only reveal the invasion, but also determine its degree. A number of other studies are also underway:

• an immunological test for the presence of a specific protein in the blood, which confirms infection with echinococci;
• laboratory blood test for the presence of antibodies;
• microscopic examination of sputum, which may contain particles of the cystic membrane;
• if necessary, carry out bronchoscopy;
• other blood tests determine the degree of organ damage;
• Ultrasound of the liver (done in order to confirm or rule out liver invasion);
• x-ray chest(the image itself determines the lesion of the lungs and the size of the cyst);
• computed tomography of the respiratory organs;
• laparoscopy of the abdominal organs (performed after ultrasound confirmation of the disease).

If the disease is found in early stage, which rarely happens, can be cured with drug therapy, lung echinococcosis does not go away on its own.

Treatment

Usually, an operative method of removing cysts is used for treatment. Medical treatment gives a result very rarely, only at the earliest stage of echinococcosis. For this, anthelmintic drugs are used - Nemozol or Vermox.

The dosage and treatment regimen should be determined by the doctor. Taking these drugs slows down the growth of the cyst, but they have a number of contraindications, which include pregnancy and lactation.

With the surgical method of treatment, the cyst is removed, as well as adjacent affected tissues, especially the lungs. Oncospheres are more often localized in the lower lobes of the lungs, with large sizes or many cysts, a lung resection is performed.

If the cyst cannot be removed, or if it could rupture at any time, surgeons use another way to remove it. The cyst shell is carefully pierced with a long needle and the contents are suctioned out with a special tool.

After that, the cyst is treated and sutured. If doctors do not recognize a cyst in a state of rupture in time, its contents can poison the entire body and infect any internal organ.

Treat lung echinococcosis with traditional medicine not recommended, home remedies can only be used for the prevention and healing of the body. For this it is recommended:

• drink a decoction of tansy or wormwood;
• prepare infusions with the addition of ginger and lemon;
• a tablespoon a day to eat a mixture made from garlic, honey and lemon;
• eat black peppercorns.

Before taking folk remedies it is necessary to consult a doctor, the child may be allergic to herbs or honey.

Complications caused by echinococcosis

The disease can have a number of severe consequences, and they can also develop due to improper treatment or late diagnosis. These complications include:

Parents should monitor the well-being of the child and show it to the doctor in a timely manner. Even if the patient was cured, he is observed for another 4 years, laboratory blood tests are regularly carried out. If throughout the entire period of observation, a blood test did not reveal the presence of antibodies, the patient can be considered cured.

Preventive measures

In a family with children, much attention should be paid to the prevention of helminthic invasion, first of all, such measures include:

• hand hygiene and compliance general rules hygiene;
• when cooking, it is necessary to follow the rules of heat treatment of meat;
• kitchen utensils after raw meat must be carefully processed;
• it is necessary to ensure that the child does not come into contact with stray cats and dogs;
• if animals live in the house, measures should be taken to eliminate worms;
• need to inform the child about possible consequences non-compliance with hygiene measures;
• it is better to drink boiled water, and pour boiling water over berries, vegetables and fruits.

A disease such as echinococcosis is much easier to prevent. It is not always possible to start timely treatment, especially in young children. Moreover, it is extremely rare to cure a child with medication.

According to the observations of experts in echinococcosis in 70-80% of cases, liver tissue is damaged, and echinococcosis of the lungs is detected only in 15-20% of patients infected with Echinococcus granulosus. Why and how does this helminthic invasion develop? In which countries and regions is it common? What are the symptoms of pulmonary echinococcosis? How is it detected and treated? You will find answers to these questions in this article.

A person becomes infected with echinococcosis due to the ingestion of excreted with stool infected animal helminth eggs. Usually, infection occurs through dirty hands during milking, shearing, caring for animals, dressing skins, cleaning the barnyard, eating unwashed vegetables, herbs, fruits, or water contaminated with animal feces. In more rare cases, helminth eggs are inhaled along with dust during agricultural work or haymaking.

• Echinococcus oncospheres excreted by animals can tolerate temperatures from -30 to + 38 °C.
• In the shade on the soil surface and at a temperature of 10-26 ° C, they are able to persist for 30 days.
• At a temperature of 18-50 ° C and under the sun's rays, they die in 1-5 days.
• In the grass at 14-28 ° C, they remain viable for up to 45 days.

Echinococcus oncospheres do not tolerate desiccation, but are resistant to low temperatures and under such conditions persist for several years.

Echinococcal cyst is a bladder with a complex structure. It is covered with a thick (up to 5 mm) layered capsule (cuticle), under which there is a thinner germinal membrane, which participates in the growth of the outer shell and produces child blisters and brood capsules with scolexes.

The brood capsules disperse on the embryonic membrane, are connected to it by a thin stem and look like small vesicles. Each capsule contains scolexes attached to it, and the bladder is filled with a yellowish fluid, which is necessary to nourish and protect the brood capsules and scolexes. In the same liquid medium, there may be components of hydatidosis sand - detached scolexes and brood capsules. The surface of the bubble is gradually overgrown with connective tissue and forms a maternal cyst. Often it contains smaller child and grandchild bubbles with a similar structure.

The growth of echinococcal cysts causes a number of negative effects on the body:

• injury, compression and irritation of surrounding tissues;
• allergization by metabolic products.

Compression of the tissues surrounding the cyst leads to dysfunction of the affected lung, and the localization and size of this formation determines the nature and severity of the symptoms that appear. In addition, the formation constantly irritates nearby tissues and causes their chronic inflammation.

Classification

Echinococcosis of the lung is:

Echinococcal cysts are:

• single;
• multiple;
• unilateral;
• bilateral.

The sizes of an echinococcal cyst are characterized as follows:

• small - up to 2 cm;
• medium - from 2 to 4 cm;
• large - from 4 to 8 cm;
• giant - from 10 to 20 cm.

Echinococcal cyst is more often single-chamber, sometimes multi-chamber.

Prevalence

The disease considered more often in this article is detected in residents of regions with developed cattle breeding and with a hot dry climate. As you move from south to north, the incidence decreases. The main distributor of this helminthiasis usually becomes cattle, sheep and pigs.

Echinococcosis is more often detected in Transcaucasia, Tatarstan, Bashkortostan, Crimea, Altai, Krasnoyarsk, Krasnodar, Khabarovsk territories, in the North Caucasus, in Samara, Volgograd, Rostov, Chelyabinsk, Amur, Omsk, Tomsk, Magadan and Kamchatka regions, Chukotka Autonomous Okrug. Cases of morbidity are registered in Moldova, Kyrgyzstan, Uzbekistan and in Kherson, Odessa, Zaporozhye, Donetsk and Nikolaev regions of Ukraine.

According to statistics, the following countries are most affected by echinococcosis: Chile, Brazil, Paraguay, Uruguay, Argentina, the southern part of the USA, Morocco, Tunisia, Algeria, ARE, New Zealand, Italy, Turkey, Bulgaria, Greece, Cyprus, Spain, France, Serbia, Montenegro, India and Japan.

Symptoms

During echinococcosis of the lungs, specialists distinguish 3 main stages:

• I (asymptomatic) - due to the slow growth of the cyst, this stage of echinococcosis can last several years after infection, at this stage the disease can be detected by chance when performed;
• II (clinical manifestations) - due to an increase in the size of the cyst, the patient develops chest pains, sometimes a cough occurs and, without a detailed diagnosis at this stage, the manifestations of helminthiasis are often mistaken for symptoms of other diseases (, etc.);
• III (complications) - due to infection and suppuration, the cyst breaks into the bronchus, pleural or abdominal cavity, blood vessels, pericardium.

At the stage of the asymptomatic course of echinococcosis, the patient may feel only periodic mild weakness and note a decrease in working capacity. Usually symptoms appear only 3-5 years after the invasion and with a large size of the emerging cyst. Initially, the patient complains of a dull pain in the chest. Some patients develop a persistent cough (initially dry, then wet with blood in the sputum), difficulty swallowing, and shortness of breath. In addition, due to the entry into the blood of the waste products of echinococcus larvae, allergic manifestations in the form of urticarial rashes, and bronchospasm. Some patients develop a lung (collapse of the alveoli in a certain part of the organ).

If left untreated, lung echinococcosis leads to the development of severe complications. Suppuration of the cystic cavity is manifested by signs. When it breaks into the lumen of the bronchus, the patient develops an intense cough with the release of a large volume of sputum of a watery nature with impurities of pus and / or blood, fragments of daughter capsules and cyst membranes. Cough accompanied by asphyxia, cyanosis skin and mucous membranes, severe allergic reactions.

If the contents of the cyst are poured into the pleural cavity, then the patient's health deteriorates sharply due to the development of pleurisy. Appears in the affected area sharp pain, the temperature rises abruptly, chills and signs of respiratory distress occur. In the future, this complication can lead to the development of pleural empyema and, anaphylactic shock and death. When opening an echinococcal cyst, signs of cardiac tamponade appear in the pericardial cavity.

Echinococcosis of the lungs can masquerade as other diseases respiratory system, and in order to identify it, it is important to collect data on the fact of being in the areas of distribution of this invasion or a profession related to animal husbandry. Sometimes with very large cysts on the patient's chest, protrusion and smoothness of the intercostal spaces can be noticeable. When tapping the lungs in the area of ​​\u200b\u200bEchinococcus cyst, a muffled sound can be determined.

The following studies help confirm the diagnosis of pulmonary echinococcosis:

• radiography;
• sputum sediment microscopy;
• general blood analysis;
• serological blood tests (RNGA, ELISA) to detect antibodies to echinococcus.

In some cases, diagnosis may be supplemented by bronchoscopy or diagnostic thoracoscopy.

To exclude errors, lung echinococcosis is differentiated from the following diseases:

• bacterial abscess of the lungs;
• benign neoplasms of the lungs;
• lung hemangioma.

Treatment

To get rid of echinococcosis of the lungs, a combination of two methods of treatment is usually used:

• albendazole;
• Zentel;
• Escasol.

The choice of method for surgical removal of echinococcal cysts depends on the clinical case. With small and superficial formations, the so-called ideal echinococcectomy can be performed, which consists in removing the cyst without violating the integrity of its membrane. After it is removed from the lung, the remaining cavity in the organ is treated with alcohol and hypertonic solutions, formalin and antiseptics. Next, the cavity is sutured.

Echinococcosis of the lungs is the cystic stage of development of the tapeworm (Echinococcus granulosus).

Echinococcosis of the lung occurs in the form of a hydatid (single-chamber) form. Lung lesions are second in frequency (15-20%) after liver damage (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, ARE), Southern Europe (Italy, Greece, Cyprus, Turkey, Spain, Yugoslavia, Bulgaria, France), further - the southern part of the USA, Japan, India, former USSR. As you move from south to north, the incidence decreases. On the territory of the former Soviet Union, echinococcosis is common in those republics and regions where animal husbandry is developed, mainly sheep breeding - 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 recorded in the southern regions - Odessa, Crimean, Kherson, Nikolaev, Donetsk, Zaporozhye, in the rest - sporadic cases.

On the territory of Ukraine, 2 types of foci are recorded: in the steppe southern zone, the “sheep” strain circulates, in the Polissya and forest-steppe zone - mainly the “pork” strain. The incidence of sheep in the Odessa region was 32%, cattle - 20%, pigs - 9%.

What provokes / Causes of Echinococcosis of the lungs:

The causative agent of human echinococcosis is the larval stage of 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, neck and 3-4 segments.

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

The scolex is followed by a short neck and segments, the first two are immature, the third is hermaphrodite 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 their structure from the eggs of bovine and porcine tapeworms (taeniids), containing a six-hooked oncosphere inside.

Echinococcal cyst is a bubble of a very complex structure. Outside, it is surrounded by a layered membrane (cuticle), the thickness of which sometimes reaches 5 mm. Under the multilayered cuticular membrane lies a thin inner germinal (germinal) membrane, which produces brood capsules with scolexes, daughter bubbles, and also gives growth 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 bubble, but with the reverse arrangement of the membranes (germinal on the outside, layered on the inside). Each brood capsule contains scolexes attached to its wall, screwed inside and having a structure typical of tapeworms. The bubble is filled with liquid, which plays the role of a protective nutrient medium for brood capsules and scolexes.

Freely suspended, detached scolexes and brood capsules, the so-called hydatid sand, may be in the liquid.

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

Such cysts are observed in humans. Sometimes child bubbles are formed not inside the maternal cyst, but outside. Such bubbles are called exogenous.

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

In the sheep-breeding regions of the southern zone, the cycle of echinococcus follows the scheme: a sheep - › guard dogs, accompanying a flock - › sheep.

In the western regions of intensive pig breeding, the circulation of echinococcus follows the scheme: pigs - › dogs - › pigs. The absence of an active motor function in the segments of the "pig" strain reduces the contamination of dog hair, 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 final 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 the grass at a temperature of 14 - 28 ° C, they die no earlier than after 1.5 months. Oncospheres are well tolerated low temperature, at which they can persist for a number of years, but are very unstable to drying.

Man - the intermediate host - is a biological dead end.

In human echinococcosis, the dog occupies the main position as the definitive host. Dogs become infected by eating meat waste from slaughterhouses, slaughterhouses, kitchens, by feeding them confiscated slaughterhouses or organs of animals slaughtered at home with larvocysts. It is also possible to infect dogs when they are fed hunting products - affected organs or corpses 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 infecting a person through dirty hands is played by communication with infested dogs, on the coat and tongue of which eggs and segments of echinococcus tapeworms can be found. Healthy animals can also transmit the infestation to humans as mechanical carriers of eggs that contaminate their coat, tongue when licking an infected dog.

Human infection is not excluded when eating unwashed vegetables, berries, fruits, contaminated with dog feces containing oncospheres.

A person can also become infected from wild carnivores during hunting when cutting skins, making fur clothes, as well as by eating unwashed wild berries, drinking water from natural reservoirs.

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

Pathogenesis (what happens?) During pulmonary echinococcosis:

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

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

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

The pathological influence of echinococcus is due to the mechanical and sensitizing influence of the growing larva. Cysts range in size from 1 to 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. In the future, the bubble grows slowly, over the years, and gradually, after 20-25 years, reaches a large size, 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 fluid 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 are formed in in large numbers, sometimes up to 1000, child bubbles.

Symptoms of echinococcosis of the lungs:

Echinococcosis of the lungs- the second most common manifestation of invasion, can simulate any lung disease of another etiology.

Usually there are three stages in the development of the disease.
Stage I - asymptomatic - can last many years from the moment of infection. Echinococcal cyst grows slowly, without causing disorders. The disease is discovered by chance during x-ray examination.
Stage II - the stage of clinical manifestations. In this period of the disease, patients are disturbed by dull pains in the chest, sometimes shortness of breath, cough. Symptoms of the disease develop with a significant size of the cyst.
Stage III - the stage of development of complications. Patients have infection and suppuration of the cyst, its breakthrough into the bronchus (about 90%), pleura, abdominal cavity, biliary tract, pericardial cavity.

When a festering cyst breaks through, purulent contents, scraps of cyst membranes, scolexes (small child blisters) are coughed up into the bronchi. Entry into the bronchi of echinococcal fluid, membranes of blisters and small daughter cysts can cause asphyxia. The breakthrough of the cyst in the bronchi is accompanied by severe anaphylactic shock due to the absorption of toxic echinococcal fluid and its effect on the receptor apparatus.

Often there are urticarial rashes on the skin. The fluid that has poured out of the cyst cavity contains scolexes, which, if it enters the pleural cavity, can cause seeding of the pleura and the appearance of new blisters.

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

When examining the chest with large cysts, sometimes its bulging on the side of the lesion, the expansion of the intercostal spaces are determined. In the area of ​​application of the echinococcal bladder, 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 echinococcosis of the lungs:

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

An x-ray examination in the lung reveals one or more homogeneous shadows of a round or oval shape with even clear contours. Sometimes determine the calcification of the fibrous capsule. Owing to a perifocal inflammation contours of a shadow of a cyst become less accurate. Compression of the adjacent bronchi by a large cyst can cause atelectasis of the lung tissue.

With a breakthrough of festering echinococcus in the bronchus, the x-ray picture is similar to the picture observed with lung abscess, i.e., a cavity with even inner walls and a liquid level is revealed. AT clinical analysis blood determine eosinophilia, increased ESR, leukocytosis with a shift leukocyte formula to the left.

Diagnosis is helped by:
indirect hemagglutination reaction (RIHA) - reliable diagnostic titer 1:200-250 and above;
linked immunosorbent assay(ELISA) - the reaction is considered positive when assessed by 2-3 plus.

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

Echinococcal 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 rounded spherical shadow in the lung should not be punctured because of the possibility of rupture of the cyst, the danger of echinococcal fluid entering the pleura with the development of a severe anaphylactoid reaction and the seeding of the pleural cavity with germinal elements of echinococcus.

Traditionally used combined treatment which includes surgery with repeated courses of germicide treatment. With disseminated lesions of one or more organs and cysts up to 3 cm in size, encouraging results were obtained during chemotherapy without surgery. Carbomatimidazole preparations (albendazole, escazol, zentel) have received the greatest use. The drugs are prescribed in doses of 10-50 mg. per 1 kg. body weight per day. A course of treatment lasting 3 weeks with a repetition after 4 weeks should be started at early dates after operation. During chemotherapy, it is necessary to control the functions of the liver, red and white blood sprouts.

Prevention of echinococcosis of the lungs:

The complex of veterinary and 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 sentinel service dogs, their accounting, registration and destruction of stray animals.

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

To prevent infection of dogs, it is necessary to follow the rules for slaughtering farm animals and ensuring the destruction of affected organs, as well as blocking access to dogs on 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, animal burial grounds; compliance with the rules for the storage and transportation of animal corpses; slaughter of animals only in appropriate places, etc.

Medical measures include the identification of infested by examination of decreed groups (hunters, persons who have contact with dogs, engaged in the processing of furs, the manufacture of fur products, shepherds) and examination according to clinical indications; deworming and dispensary observation. Importance has health education work.

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

Which doctors should be contacted if you have Echinococcosis of the lungs:

Are you worried about something? Do you want to know more detailed information about Echinococcosis of the lungs, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors examine you, study external signs and help identify the disease by symptoms, advise you and provide needed help and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.

(+38 044) 206-20-00

If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

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ECHINOCOCCUS OF THE LUNG

Echinococcus lung is a cystic stage of the tapeworm

(Echinococcus granulosus), the definitive host of which are domestic

(dogs, cats) and some wild animals.

The intermediate host, i.e., the carrier of the cystic stage of the echo, are

large and small cattle, pigs, rabbits, monkeys and humans.

Tapeworm germs enter the lungs from the stomach and small intestine

lymphogenous route through the thoracic duct or hematogenously through short

gastroesophageal veins serving anas between the portal and vena cava.

Hydatidosis echinococcus. The vast majority of pain echinococcus lung

occurs in the form of hydatidosis (single or multi-chamber) form. By frequency

lesions of Echinococcus occupied the second place after the defeat of the liver and

I observe in 10-20% of patients affected by echinococcus.

Pathological anatomy: a mature echinococcus cyst consists of two layers --

external, or chitinous, and internal, germinal. The chitin layer is

like a shell and consists of elastic fibers with areas of hyaline. From

internal, germinal, membranes grow brood (daughter) capsules with

their scolex. This layer has an unlimited ability to reproduce and

contamination of the body. It secretes a fluid characteristic of echinococcal

a connective tissue membrane is formed, called a fibrous capsule. FROM

over time, it thickens and reaches 2--7 mm.

be: suppuration of the cyst, hemorrhage into it, trauma and rupture, sometimes aging.

When echinococcus dies, the fluid in the cyst becomes cloudy, partially absorbed,

partially turns into a putty mass; the shell is saturated with salts

lime. Small cysts sometimes turn into scar tissue.

Clinic and diagnostics: as a rule, echinococcus times slowly, sometimes in

for several years without giving manifestations to the Kli; usually starts at

young age.

Usually there are three stages in the development of the disease.

Stage I is asymptomatic and may last for years. The disease is discovered

by accident during x-ray examination.

Stage II is accompanied by dull pain in the chest and back, shortness of breath, cough. Cough

initially dry and due to irritation of the nerve receptors of the pleura and bronchi.

Then, with the development of a perifocal inflammatory process, bronchial deformities and

mucous sputum appears behind the secretions, sometimes with

streaks of blood, which is due to the rupture of small vessels surrounding the cyst.

Stage III is characterized by the development of complications - infection and suppuration

echinococcal cyst, very often with a breakthrough in the bronchus.

Complications: as a result of entry into the bronchi of healthy lung

echinococcal fluid and membranes of the blisters may be asphyxial. Echinococcus

sometimes breaks into the pleura, peri, abdominal cavity, which is accompanied

severe shock due to toxic effects on the receptor apparatus and

absorption of toxic echinococcal fluid; do not appear during this period.

urticaria on the skin. Subsequently

seeding of the serous surface and the development of inflammation occur. Gap

echinococcal cysts may be accompanied by severe bleeding.

In the presence of lung echinococcus, patients often note an increase in temperature.

body due to perifocal inflammation. With suppuration of echinococcal

cysts body temperature up to 38--39°C and lasts for a long time.

When a festering cyst ruptures, its purulent contents are coughed up with remnants

shells of echinococcal cysts, scolex and hooks.

Diagnosis: when examining the chest of a patient with echino lung

sometimes "you can see the bulging of one or another department, a change in the intercostal

gaps compared to the back side. With percussion in the area

Echinococcus bladder adherence marks dullness. auscultatory data

very diverse: wheezing - with perifocal inflammation; bronchi, sometimes

amphoric breathing - in the presence of a cavity with air. Cysts located at

lung root, as well as small cysts do not give these changes.

X-ray examination allows to detect in lay one or

several rounded or oval homogenous shadows with even contours.

However, the diagnosis is beyond because the shadow of the cyst does not always have even

contours. Quite often they change owing to a perifocal inflammation;

compression of the adjacent bronchi causes atelectasis of the lung tissue, which makes it difficult

interpretation of the detected changes.

a fibrous capsule forms a free space, which, when

X-ray is revealed in the form of a sickle of air ("detachment symptom"). At

bronchography is about filled with a contrast agent (phenomenon

subcapsular contrast).

With a breakthrough of echinococcus in the bronchus, the x-ray picture is similar to the observed

with an abscess of the lung - it is detected along with smooth inner walls and

liquid level.

Laboratory data depend more on the stage of development of the disease. Often you can

note eosinophilia (more than 4%), with suppuration of the cyst - an increase in ESR,

leukocytosis.

Diagnosis is largely (in more than 75% of patients) helped by

Casoni anaphylactic test, in which 0.1 ml is injected into the thickness of the skin of the forearm

sterile echinococcal fluid (antigen), into the skin of the other forearm for

control enter the same amount of isotonic nat chloride solution. At

a patient with echinococcus after 30 minutes -- Zch around the injection site of echinococcus

fluids appear hyperemia, swelling and pruritus, which are kept from several

hours up to 1-2 days. A positive reaction also confirms the diagnosis of echinococcus

latex agglutination. With it, agglutination of antibodies of latex particles is observed,

on the surface of which the antigen is adsorbed.

The combination of the presence of a rounded shape of the shadow with smooth contours in the lung

x-ray and a positive Casoni or Latex test is done

the diagnosis is certain.

With a negative test, the differential diagnosis is between echinococcus,

tuberculoma, peripheral carcinoma, i.e. between diseases that give

spherical formed in the lungs. Use the full range of special methods

is with the exception of the puncture. Last for suspected echinococcus

unacceptable because of the possibility of rupture of the cyst, the danger of getting echinococcal

fluid into the pleura with the development of a severe anaphylactoid reaction and seeding

Treatment: only surgical. Can be performed:

1) echinococcectomy after preliminary suction of the contents

echinococcal cyst. With this method, after fencing off the cyst with napkins

puncture with a thick needle, suck out the contents from it and dissect the fibrous

capsule. Remove the chitino membrane with its contents, wipe the cavity with 5--10%

rast formalin, carefully sutured the holes opening into it

bronchial fistulas and sutured the resulting cavity. At deep large

cavities, when suturing presents great difficulties and sharply deforms

lung, more appropriate after treatment of the cavity and suturing of bronchial

fistulas, excise the fibrous capsule as much as possible and sheathe its edges with a separate

hemostatic sutures. The lung is then inflated until it

will come into contact with the parietal pleura; 2) ideal method

echinococcectomy consists in the removal of an echinococcal cyst without opening it

lumen After the cyst has burned off, it is dissected

lung tissue and fibrous membrane. By increasing the pressure in the anesthesia system

apparatus, inflate the lung; at the same time, the echinococcal cyst is squeezed out through

incision in the fibrous capsule. After its removal, the bronchial tubes are carefully sutured.

fistulas and the resulting cavity in the lung Ideal echinococcectomy is feasible when

small echinococcal cysts and the absence of perifocal inflammation; 3)

lung resection with echinococcus is performed according to strictly limited indications,

mainly with extensive secondary inflammatory processes or a combination

echinococcosis with other diseases requiring lung resection.

With bilateral lesions, the operation is performed in two stages with an interval of 2-3

Mortality after surgery for echinococcus composition 0.5--1%, relapses

observed in approximately 1% of patients.

Alveolar echinococcus of the lungs. Occurs less frequently in humans

hydatidosis - single-chamber echinococcus. The damage usually extends to

lung from the liver through the diaphragm and pleura. The current is heavier and faster than

with single-chamber echinococcus. On x-ray examination, the lesion

appears in the form irregular shape shadow, the nature of which is usually determined

impossible. Diagnosis is aided by a thoracotomy, in which part of the

the affected lung. Histological examination clarifies the diagnosis.

DISEASES OF THE MEDIASTONE

1. Methods of examination of patients with diseases of the mediastinum (fluoroscopy and radiography; tomography and computed tomography; pneumomediastinography, diagnostic pneumothorax, pneumoperitoneum, pneumopericardium; esophagography; angiography; mediastinoscopy; biopsy).

The main method of diagnosis is a complex X-ray

examination (fluoroscopy, polypositional radiography, tomography).

Sometimes already characteristic locales, shape, size of the tumor, taking into account gender,

the age of the patient and the characteristics of the anamnesis allow you to put the correct

Clarify the localization of the mediastinal tumor, its relationship with surrounding organs

computer tomography helps in most cases. It makes it possible

obtain an image of a transverse section of the chest at any given level.

If there is difficulty in assessing computed tomography data, lack of opportunities

for its implementation, the need to obtain biopsy material to clarify

the nature of the pathological process, the use of special metopes is shown

research These methods can be divided into two groups depending on

the goals they are pursuing.

To clarify the localization, size, contours of the formation, its connection with neighboring

mediastinal organs can use the following methods

Pneumomediastinography - X-ray examination of the mediastinum after

injection of gas into it Depending on the races of the tumor, gas is injected through

puncture of the skin above the jugular notch of the sternum, under the xiphoid process, or

parasternally so that the end of the needle does not enter the tumor and

located near it. At first, the gas spreads through the fiber of the anterior

mediastinum, after 45-60 minutes it penetrates into the back. Against the background of the injected gas

the tumor is well contoured, its adhesion to the vessels or their

deformity following tumor growth

Artificial pneumothorax - the introduction of gas into the pleural cavity - impose

on the side of the lesion After the collapse of the lung, it becomes possible to

X-ray to distinguish opus from tumors and cysts of the mediastinum.

Angiography is a contrast study of the heart, large arterial and venous

trunks Angiography makes it possible to exclude aneurysms of the heart and large

vessels, reveal having passed the union of the superior vena cava.

To obtain biopsy material and establish windows of diagnosis

the following research methods can be used, performed under conditions

operating room.

Transbronchial puncture is most often used for lymphatic biop

nodes that cause compression of the bronchus Under the control of a fibrobronchoscope, determine

the place of compression of the bronchus and produce a puncture of the pathological formation.

Thoracoscopy allows you to examine the pleural cavity, take a biopsy from

mediastinal lymph nodes or tumors, races directly

below the mediastinal pleura.

Transthoracic aspiration biopsy is used for tumors of the mediastinum,

located in close proximity to the chest wall.

Mediastinoscopy - through a small skin incision above the handle of the sternum, they expose

trachea, along its course, a canal is made stupidly with a finger in the anterior mediastinum for the introduction

rigid optical system Mediastinoscopy allows you to take a biopsy from the lymph

mediastinal nodes The effectiveness of this method has reached 80%.

Parasternal mediastinotomy parallel to the edge of the chest, an incision is made with a length

5--7 cm, cross the cartilage of one rib, bluntly secrete a tumor or lymphatic

anterior mediastinal node for morphological examination

IU is indicated in the presence of a tumor or lesions of the lymph nodes

anterior mediastinum.