Echinococcosis is a helminthiasis from the class of cestodoses, as a result of which an echinococcal cyst occurs in the lungs, kidneys, liver and other organs or tissues. Echinococcosis of the liver is caused by the introduction and maturation of tapeworm larvae in it.
Causes of the disease
The determining factor in the infection of a person with echinococcosis is his contact with a dog (a carrier of parasites), which can get the disease when eating meat waste. Another potential culprit for infecting dogs can be hunting results - affected organs or carrion of wild animals.
In humans, infection mainly comes from unwashed hands. Infection from a dog can occur through its coat or tongue. Other animals, similarly, can be spontaneous egg transmitters and they also acquire them from contact with a sick dog.
It is also likely that a person may acquire echinococcosis by eating fruits, vegetables and wild berries that have not been washed or have not undergone initial processing. Water from natural lakes also serves as a source of infection.
Echinococcal cyst may also appear in people working in sheep breeding areas. Sheared sheep, shepherds, shepherds and those who are in contact with these people (members of their family).
Signs of echinococcosis
Indicators of this disease are pain in the right hypochondrium, bloating, nausea. From the onset of infection to the detection of the first symptoms, several years, sometimes even decades, pass. Manifestations of echinococcosis are determined by the location, volume, rate of increase of the cyst and its effect on nearby organs and tissues.
In some cases, the malaise can go away without any signs, and it can be accidentally detected when an ultrasound scan or x-ray is taken. The disease often begins with the usual symptoms - long low-grade fever, weight loss, general weakness, allergic reactions.
For the most part, an echinococcal cyst is initially located in the liver. The factor is the properties of blood circulation: the outflow of blood from the intestine goes into the portal vein, the blood is cleaned by the liver. The ingress of echinococcus into an organ is called liver echinococcosis.
Indicators of liver echinococcosis are:
- difficulty breathing as a result of localization of diaphragm mobility;
- pain in the right side;
- nausea and vomiting;
- spontaneous jaundice (when squeezing bile ducts);
- enlarged liver.
How is echinococcal liver cyst eliminated?
Internal treatment of a disease such as liver echinococcosis is simply not possible. Although in very rare cases, self-healing occurs associated with the death of larvae. If a cyst born of echinococcus is found, then there is no drug therapy that would eliminate the parasite. Cyst rupture indicates the need for immediate surgery.
By surgery, the entire cyst is removed. If it is in the layer of liver tissue, then it is impossible to completely remove it because of the possibility of organ damage. In this situation, the chitin wall of the cyst is removed and its contents are pulled. Then the cyst itself is removed, since there is no likelihood of its rupture and separation of the parasite. Upon successful removal of the cyst, the area of ββits binding is disinfected and sutured.
An operation on the liver is carried out in order to completely remove the cyst with its shell and contents, so that there is nothing in the organ itself, the abdominal and chest cavity. With a deep location or a serious lesion, the membrane remains. The operation and its scope of work are determined by the size of the cyst and the problems that it caused. If the regional placement of the cyst is detected, then it is removed with the capsule. In such a surgical intervention, laser removal of an echinococcal cyst can be used.
Types of operations
If there is multiple echinococcosis of the liver, large cysts, then its resection is done. If one huge cyst is detected, an operation is performed according to Spasokukotsky or Bobrov, in which there is an internal echinococcectomy.
In order not to encounter infection of the cyst, the membrane is not removed, and its cavity is treated with parasite preparations, for example, formalin, iodine or alcohol.
If the cyst is located under the diaphragm and a huge cavity appears due to surgery, then it is tightened using the Pulatov or Delbe method or covering the formed cavity with a piece of the diaphragm.
If a cyst breaks into the bile ducts, an emergency operation is performed. The walls and cysts are removed from the affected areas of the biliary tract. In such a situation, drainage of the bile ducts is inevitable.
If the cyst ruptures into the abdominal cavity, then an urgent operation is performed. During this process, cysts and capsules that are in the bronchi, abdominal cavity and pleural region are removed. A semi-closed and closed echinococcectomy is performed. In severe situations, an open echinococcectomy is performed.
With massive echinococcus of the liver, it is important to perform surgical intervention before problems arise. Surgery on the liver can be performed in 2-3 processes with an interval of two weeks to three months.
Echinococcus mortality ranges from 1 to 5% of infected people. Relapses may also occur if the cyst bursts.
Prevention
Infection of pets and people is based on procedures performed by medical and veterinary services. Domestic and service dogs should be constantly examined for helminths, especially in adverse places, their therapy, euthanasia of stray animals, as well as control over meat in slaughterhouses.
What is necessary?
Regularly conduct hygiene to the population (dog breeders, livestock breeders, hunters and members of their families), keep dogs clean, constantly wash their hands after talking with them, and also before meals, prohibit children from contacting stray animals, how to wash vegetables, berries, and drink only disinfected water.
Echinococcal lung cyst
The disease in the early stages is little manifested and detected during x-ray examination of the lungs in the form of an oval silhouette with precise lines. The hemogram indicates eosinophilia.
In the formed degree of non-aggravated cyst, there is a constant and severe cough, shortness of breath, relief of breathing at the location of the parasite, pain of different directions in the chest, movement of the mediastinal organs, a decrease in percussion sound is manifested. Radiography shows in the lungs a huge rounded shadow with certain contours, which changes shape during respiratory excursions of the diaphragm.
The third stage of pulmonary echinococcosis has a serious manifestation of pathological development and the process of complications. Symptoms of constriction of large vessels and organs of the mediastinum are observed, chest deformity is noted, shortness of breath and hemoptysis appear. With the death of echinococcus, inflammation of the cyst occurs with special clinical symptoms of empyema of the pleura or lung.
An autopsy of the cyst in the bronchial passage is accompanied by the discharge of a considerable number of bright discharge with daughter bladders of echinococcus with streaks of blood. With suppuration of the opened cyst, purulent-hemorrhagic sputum comes out, and manifestations of poisoning are also observed. Opening a cyst in the cavity of the membrane provokes the appearance of exudative pleurisy and anaphylactic shock. X-ray examination shows a cavity with a horizontal surface of the liquid, not very pronounced perifocal infiltration. Such an infiltration is detected if echinococcal cysts are suppurating.
Treatment
Use operational methods of therapy (remove a cyst from the cuticular capsule, remove the lung). The prognosis is quite serious, with a bilateral course and secondary echinococcosis - sad.
Renal echinococcosis
Echinococcal kidney cysts are rare today, mainly in agricultural areas. The malaise is excited by the helminth of Taenia echinococcus. Distributors of the causative agent of the disease are pets - dogs and cats. As a rule, one kidney is affected, in rare cases, two. Echinococcosis of the liver affects the population of the age category from 20 to 40 years, especially women.
The helminth egg enters the kidney by the lymphogenous or hematogenous method, most often into the cortical stratum.
Therapy and prognosis
The treatment for the most part is organ-preserving and surgical. The most reliable and effective operation is an internal simultaneous echinococcotomy. Nephrectomy is also done.
Prevention of echinococcosis requires sanitary-educational procedures to familiarize people with the threatening infection from pets, executive sanitary and veterinary monitoring of slaughterhouses.
After surgery, the prognosis is positive.
Echinococcosis of the spleen
Parasitic spleen cysts are often generated by echinococcus. The duration of ailment can last 15 years or more. By the degree of development of the parasite, the surrounding organs of the abdominal cavity are moved away, spleen tissue is dead.
This disease is not easy to detect. Echinococcal splenic cyst is accompanied by heaviness in the left hypochondrium, disorders or constipation, minor dull pain, nausea after eating, allergic reactions. On palpation, an enlarged spleen is established. Large bubbles can burst, which often leads to death from the accompanying rupture of the organ.
With an active parasite, allergy symptoms are often noted - urticaria, skin itching and others. With a complication of echinococcosis of the spleen, rupture of the cyst or its suppuration with clinical expressions of the disease can occur.
Analysis of feces, unfortunately, does not reveal the presence of parasites. The diagnosis is made based on an X-ray and ultrasound, in which multi-chamber blisters are noticeable.
Treatment
The most effective way to treat spleen cysts is considered laparoscopic surgery. Echinococcal cyst can be operated on by several methods:
- complete removal of the spleen;
- opening the cyst and extracting contents from it, cleansing the cavity;
- excision of the affected area of ββthe spleen;
- removal of the spleen cyst with its wall and contents;
- by carving a cyst membrane.
The operation of a laparoscopic view with a spleen cyst is a usual method of therapy, which makes it possible to completely remove the source of the disease. Removal of the spleen cyst is performed using ultra-precise instruments and the input of a special chamber. The duration of the operation is 1.5-2 hours. Then for some period pain remains, however, for a short period of time, the patient is fully recovering.