Echinococcosis of the lungs: causes, symptoms and treatment

Echinococcus of the lung is a cystic stage of the time of the tapeworm

(Echinococcus granulosus), the ultimate host of which is the domestic

(dogs, cats) and some wild animals.

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

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

Band-worm embryos enter the lungs from the stomach and small intestine

lymphogenous via the thoracic duct or hematogenously via short

gastroesophageal veins serving anas between the portal and vena cava.

Hydatidosis echinococcus. The vast majority of pain echinococcus lung

It occurs in the form of a hydatidose (single or multi-chamber) form. By frequency

lesions of echinococcus of the lungs take second place after liver damage and

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

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

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

as it were a shell and consists of elastic fibers with patches of hyaline. Of

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

their scolexes. This layer has an unlimited path to reproduction and

contamination of the body. It secretes echinococcal fluid

In response to the local response caused by the parasite, around the chitinous membrane

a connective tissue membrane called a fibrous capsule is formed. WITH

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

Under certain conditions, the death of the parasite occurs. Such conditions may

to be: suppuration of a cyst, hemorrhage in it, trauma and rupture, sometimes aging.

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

partially turning into a putty mass, the shell is saturated with salts

lime. Small cysts sometimes turn into scar tissue.

Clinic and diagnosis: as a rule, echinococcus once slowly, sometimes in

for several years without giving Kli manifestations, more often begins in

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

Stage I - asymptomatic, can last for years. The disease is detected

by chance during an X-ray examination.

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

initially dry and caused by irritation of the nerve receptors of the pleura and bronchi.

Then, with the development of a perifocal inflammatory process, deformation of the bronchi and

behind the secretion, mucous sputum appears, sometimes with

blood streaks due to 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 getting into the bronchi of a healthy lung department

echinococcal fluid and membranes of the bladders can on asphyxiation. Echinococcus

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

severe shock due to toxic effects on the receptor apparatus and

absorption of toxic echinococcal fluid during this period do not appear

urticarial rashes on the skin. Afterwards

seeding of the serous surface and the development of inflammation. Break

echinococcal cysts may be accompanied by severe bleeding.

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

body caused by perifocal inflammation. With suppuration of echinococcal

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

When a suppurative cyst ruptures, its purulent contents with residues

membranes of echinococcal cysts, scolexes and hooks.

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

sometimes it is possible to see a bulging of one or another department, a change in intercostal

gaps compared to health. With percussion in the area

diligence of the echinococcus bladder indicates 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 you to detect one or

several round or oval shaped homogenous shadows with smooth contours.

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

contours. Often they change due to perifocal inflammation,

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

interpretation of detected changes.

With the death of the parasite and partial absorption of fluid between the chitinous membrane and

a fibrous capsule forms a free space that, when

radiography is detected in the form of a sickle of air ("symptom of exfoliation"). At

bronchography is about filled with contrast medium (phenomenon

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

with an abscess of the lung - detected by with smooth inner walls and

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,

Diagnosis to a large extent (in more than 75% of patients) helps

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 another forearm for

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

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

fluids appear hyperemia, edema and skin itching, which are kept from several

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

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

on the surface of which antigen is adsorbed.

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

an X-ray and a positive Cazoni test or Latex test

With a negative test, a differential diagnosis of provo between echinococcus,

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

spherical formation in the lungs. Use the whole range of special methods

is excluding puncture. The latter with suspected echinococcus

unacceptable due to the possibility of rupture of the cyst, the danger of getting echinococcal

fluid in the pleura with the development of severe anaphylactoid reaction and seeding

Treatment: only surgical. Can be performed:

1) echinococcectomy after preliminary aspiration of the contents

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

punctured with a thick needle, suck the contents out of it and dissect the fibrous

capsule. Remove the chitin shell with its contents, wipe the cavity 5-10%

formalin growth, carefully open the holes opening into it

bronchial fistulas and sutured cavity. With deep large

cavities when suturing presents great difficulties and sharply deforms

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

fistula maximally excise the fibrous capsule and sheathe its edges separately

hemostatic sutures. After that, the lung is inflated until it is

will come in contact with the parietal pleura, 2) the ideal method

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

lumen After otgora cysts with wet gauze napkins dissect

lung tissue and fibrous membrane. Increasing pressure in the anesthesia system

apparatus, inflate the lung, while the echinococcal cyst is extruded through

incision in a fibrous capsule. After its removal, the bronchial

fistulas and the resulting cavity in the lung. An ideal echinococcectomy is feasible with

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, 0.5-1%, relapses

observed in approximately 1% of patients.

Alveolar echinococcus of the lungs. It occurs in humans several times less

hydatidosis - single chamber echinococcus. The lesion usually extends to

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

with single chamber echinococcus. X-ray examination of the lesion

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

impossible. Diagnosis helps thoracotomy, in which part is removed

affected lung. Histological examination clarifies the diagnosis.

1. Research methods for patients with mediastinal diseases (fluoroscopy and radiography, tomography and computed tomography, pneumomediastinography, diagnostic pneumothorax, pneumoperitoneum, pneumopericardium, esophagography, angiography, mediastinoscopy, biopsy).

The main diagnostic method is a comprehensive radiological

research (fluoroscopy, polypositional radiography, tomography).

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

the patient's age and features of the anamnesis allow you to put the correct

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

helps in most cases, computed tomography. It provides an opportunity

Get an image of a cross section of the chest at any given level.

With difficulty in evaluating computed tomography data, lack of opportunities

for its implementation, the need for biopsy material for clarification

nature of the process patolo shows the use of special metopes

research These methods can be divided into two groups depending on

the goals they pursue.

To clarify the localization, size, contours of education, its relationship with neighboring

the mediastinal organs can be applied the following methods

Pneumomediastinography - X-ray examination of the mediastinum after

introducing gas into it. Depending on the race of the tumor, gas is injected through

a puncture of the skin over 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

near it. First, the gas spreads through the fiber of the anterior

mediastinum, after 45-60 minutes penetrates into the posterior

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

strain following tumor invasion

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

on the side of the lesion After the lung subsides it becomes possible

X-ray to distinguish opu from tumors and mediastinal cysts.

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

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

vessels, revealing surrendering junior superior vena cava.

To obtain biopsy material and establish diagnosis windows

the following research methods performed under the conditions

Overbronchial puncture is most often used for biop lymphatic

nodes causing 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

lymph nodes of the mediastinum or tumor, races directly

under the mediastinal pleura.

Transthoracic aspiration biopsy is used for mediastinal tumors,

located in the immediate vicinity of the chest wall.

Mediastinoscopy - through a small skin incision above the sternum handle

trachea, along its course with a stupid finger make a channel in the anterior mediastinum for insertion

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

nodal nodes of the mediastinum The effectiveness of this method reached 80%.

Parasternal mediastinotomy parallel to the edge of the chest makes an incision long

5-7 cm, cross the cartilage of one rib, stupidly excrete a tumor or lymph

anterior mediastinum node for morphological examination Parasternal

IU shown in the presence of a tumor or damage to the lymph nodes

Development mechanisms

Once in the human digestive system, the echinococcus membrane is destroyed and a larva is released from it, which is introduced into small blood vessels and spreads through the body with a blood stream. Most often, it settles in the liver and lungs, less often - in other organs.

After a few months, a fibrous capsule forms around the larva, it begins to grow, squeezing the surrounding tissue.

The structure of the echinococcal bladder is quite complex:

  • Outside, it is covered with a shell consisting of many concentrically arranged plates, and does not contain cells on its surface.
  • Inside is the germ layer, which gives rise to all the constituent elements of the parasite.

As the primary echinococcal bladder grows, daughter cysts (secondary and tertiary) often appear in it.

In the affected organ, one cyst can develop, as well as several with a size of 10 mm to 30 cm, and sometimes more.

At the same time, the immunity organs are not able to completely neutralize the parasite, which is associated with the presence of some adaptive mechanisms:

  • the production of substances that suppress the immune system,
  • lack of receptors on the outer shell.

Parasite antigens have a sensitizing effect on the human body, which underlies the development of anaphylactic reactions in violation of the integrity of the cyst.

With the death of a parasite, it can develop:

  • bacterial contamination of the cyst cavity,
  • maturation of the abscess.

Echinococcosis of the lungs

Echinococcosis of the lungs - This is a form of anthropozoonosis infection caused by a larva of an echinococcus tapeworm and leading to a specific cystic lesion of the lung tissue. The manifestations of pulmonary echinococcosis can be chest pain, shortness of breath, persistent cough, urticaria rash and itching, with a complicated course - profuse sputum with an admixture of blood and pus, fever, respiratory distress, severe anaphylactic reactions. Diagnosis is by X-ray and CT of the lungs, sputum microscopy, and blood serology. With echinococcosis of the lungs, a parasitic cyst is removed, a lung resection, a lobectomy in combination with antiparasitic therapy are performed.

General information

Echinococcosis of the lungs is the most dangerous helminthiasis that develops with infection of tape worm eggs - echinococcus, accompanied by the formation of parasitic cysts in the pulmonary parenchyma. Lung invasion is observed in 15-20% of all cases of echinococcosis, 70-80% is due to liver damage (echinococcosis of the liver), the rest is from the heart, brain and other internal organs. Echinococcosis of the lungs is most often recorded in regions with a dry hot climate and developed livestock breeding: countries in South America, North Africa, Australia and N.Zealand, in the southern part of Europe, the USA, Russia, Ukraine, Moldova, the North Caucasus, Central and South Asia.

Echinococcosis of the lungs can be primary and secondary (metastatic), develop in any part of the lung, but mainly affects the lower lobes. In this case, unilateral or bilateral, single or multiple echinococcal cysts can be formed, having a small (up to 2 cm), medium (2-4 cm) or large (4-8 cm or more) size. Echinococcus cyst is limited by a dense membrane, consisting of the outer (cuticular) and inner (germinative) layers, and is filled with yellowish liquid contents. Echinococcosis of the lungs usually has a single-chamber (hydatidous), rarely - multi-chamber, shape.

The causative agent of pulmonary echinococcosis is the larva of the tapeworm of echinococcus (Echinococcus granulosus), which belongs to cestodes. Mature individuals parasitize in the small intestine of canine and feline animal orders - dogs, wolves, foxes, arctic foxes, etc. In the larval stage (parasitic cyst), echinococci live in the tissues of intermediate hosts - paired and artiodactyl (sheep, cows, horses, deer, pigs ) and man.

A person becomes infected with echinococcus eggs, which are excreted in the feces of sick animals, usually by contact with wool, milking, shearing, skinning and alimentary consumption of unwashed, infected vegetables, herbs, water. Aerogenic infection is rarely realized when inhaling dust during haymaking and agricultural work. From the intestines, Echinococcus embryos are hematogenously scattered into the liver, lungs and throughout the body. With respiratory infection, the oncospheres are fixed on the walls of the bronchi, then penetrate into the lung tissue, forming vesiculate structures.

Echinococcus is capable of growth and endless reproduction due to brood capsules of the inner layer, which reproduce scolexes and form daughter bubbles in the cyst cavity. Due to the high elasticity of the lung tissue, the cyst gradually grows, reaching a large volume over several years. Giant cysts with a diameter of 10-20 cm may contain several liters of fluid. In the lung, the echinococcus larva can remain viable for many years and even decades (20 years or more). Echinococcosis of the lungs can proceed uncomplicated and with complications (calcification, suppuration and rupture of the cyst).

The effect of a growing echinococcal cyst on the body is associated with a traumatic effect on the surrounding tissues, the irritating and sensitizing effect of antigens and metabolic products of the parasite. For echinococcosis of the lungs, the development of delayed and immediate allergic reactions (eosinophilia, urticaria, anaphylaxis) is characteristic, with multiple larvae at a late stage - immunosuppression. Compression by the cyst of small bronchi significantly violates their function, leads to the formation of lung atelectasis, bronchial atrophy. Around the cyst, fibrosis of the lung tissue develops.

Suppuration of an echinococcal cyst causes the death of the larva and destruction of the bladder, an inflammatory process in the surrounding tissues. Emptying the cyst in the bronchus (90% of cases), a blood vessel, pleural or abdominal cavity, and pericardium contributes to the seeding and development of numerous metastatic foci in healthy lobes of the lungs and other organs, the development of local and general toxico-anaphylactic reactions. When a cyst breaks into the bronchus, the parasite often dies, and fragments of the capsule are released through the respiratory tract with sputum and pus when coughing. The outcome may be complete healing of the fibrous cavity in the lungs, the formation of a persistent lung cyst, chronic purulent inflammation. A break in the pleural cavity leads to a collapse of the lung, an increase in respiratory failure. Calcification of echinococcus is usually observed in violation of its development, death of the larva and complete recovery of the patient.

Symptoms of pulmonary echinococcosis

In clinical pulmonology, 3 stages of pulmonary echinococcosis are distinguished. In the initial period of the disease, from the moment of fixation of the larva in the lungs to the first signs of helminthiasis, a latent course is noted. The slow growth of the cyst does not bother the patient, sometimes there may be a malaise of an unclear nature, increased fatigue.

The stage of clinical manifestations of pulmonary echinococcosis is usually observed 3-5 years after invasion with a significant volume of the cyst. There is a dull chest pain, shortness of breath, persistent cough (first dry, then wet, with streaks of blood), dysphagia is possible. In patients with echinococcosis of the lungs, there may be allergic phenomena in the form of itching, urticaria rash, bronchospasm. With echinococcosis, atelectasis of the lung may develop.

The terminal stage of pulmonary echinococcosis is characterized by severe and life-threatening complications. Suppuration of the cyst occurs with symptoms of lung abscess. A bladder breakthrough in the bronchus is characterized by a sharp paroxysmal cough with copious watery sputum mixed with blood and / or pus, scraps of the cystic membrane and small daughter capsules, cyanosis, asphyxia, and severe allergic reactions. A breakthrough of a cyst in the pleural cavity is accompanied by the development of pleurisy, a sharp deterioration in well-being, acute pain in the affected area, chills, a jump in temperature, respiratory distress, the risk of pyopneumothorax and pleural empyema, anaphylactic shock and death. When the cyst is emptied into the pericardium, cardiac tamponade occurs. Clinical symptoms of pulmonary echinococcosis can be combined with disorders caused by extrapulmonary localization of parasitic cysts.

Diagnostics

In the diagnosis of pulmonary echinococcosis, X-ray and CT of the lungs, sputum microscopy, general blood count, and serological examination are used. When collecting an anamnesis, the facts of staying in regions that are epidemically unfavorable for echinococcosis, the presence of labor activity related to animal husbandry, hunting, and processing of animal skins are important. With a very large bladder of echinococcus, protrusion of the affected part of the chest wall with a flattening of the intercostal spaces can be noticed. In the area of ​​projection of an echinococcal cyst, dulling of percussion sound is determined. With perifocal inflammation, moist rales are detected, with empty cysts, breathing becomes bronchial. Physical data are more pronounced with the development of complications.

In the latent period of echinococcosis in the lungs, one or more large, round, homogeneous, clearly defined shadows that change configuration during respiratory movements are determined radiologically. With CT, the cystic nature of the lesion is obvious, the presence of a cavity with a horizontal level of fluid and perifocal infiltration (strongly pronounced during suppuration) is determined, sometimes a calcification. The differential diagnosis of echinococcosis is carried out with tuberculosis, benign lung tumors, bacterial abscesses and hemangioma of the lungs.

Eosinophilia is detected in the blood, with suppuration of the cyst - leukocytosis, increased ESR. Microscopy of the sputum sediment, which allows the breakthrough of the cyst to detect scolexes, fragments of the cyst membrane, confirms the parasitic nature of the disease. Serodiagnosis (RNGA, ELISA) is performed to detect specific antibodies to echinococcus in the blood. It is possible to conduct bronchoscopy and diagnostic thoracoscopy.

Treatment of pulmonary echinococcosis

The main method of complete cure is surgery. With small superficial cysts, an “ideal” echinococcectomy is performed without opening the parasite capsule. The cavity formed in the fibrous membrane in the lung is treated with formalin solutions, a hypertonic and alcoholic solution, antiseptics, and then sutured.

In the case of a large or deeply located cyst, its preliminary puncture and careful maximum aspiration of the contents are carried out using a closed system with an electric pump. After antiseptic treatment, the chitin capsule is excised separately or together with the fibrous membrane (the so-called “radical” echinococcectomy). The large cavities in the lung remaining after the operation are eliminated by taking capitals or using cyanoacrylate glue. With echinococcosis of the lungs, it is possible to perform a wedge-shaped resection of the lung, segmentectomy, lobectomy. For small (up to 3 cm) cysts, as well as before and after surgery for pulmonary echinococcosis, antiparasitic (skolecid) drugs are used.

Forecast and Prevention

The prognosis of pulmonary echinococcosis with timely radical surgery is usually favorable. The formation of intraoperative metastatic lesions is fraught with a relapse of helminthiasis with multiple lesions. Prevention of pulmonary echinococcosis consists in observing the rules of personal hygiene, deworming of domestic animals, sanitary control of livestock conditions and slaughter, trapping of stray animals.

Ways of infection and developmental features

The rate of transmission of the invasion depends on the total number of sources of the final carriers, as well as the amount of infected biological material secreted by them. The general scheme of cestode circulation looks like this: source - ›external environment -› intermediate carrier organism - ›final host that has not yet been infected. If the human body acts as an intermediate host, then its body is a kind of biological dead end for cestode larvae. Allocate the main methods of invasion:

  1. Indirect and direct paths. It is carried out through the penetration into the gastrointestinal cavity of untreated thermally or poorly washed products or through dirty hands after contact with animals. After infection, helminth larvae penetrate the intestinal mucous membranes and connect to a single blood stream. Blood flow allows the spread of parasites throughout the body, which leads to the formation of a hydroactive form of pulmonary echinococcus.
  2. Aerogenic path. The parasite transmission mechanism is characterized by invasion by airborne droplets (through dust, while sneezing an infected person or animal).
  3. The metastatic path. Echinococcal cysts are introduced into the lungs and liver by blood flow from the lymph nodes of other organs. A parasitic cyst already 1 month after the invasion (sometimes earlier) reaches 1 mm. The progressive growth of the cystic component is rapid. There are cases when the size of the cyst reached a volume of 3 liters.

With echinococcosis of the lungs, cysts can appear in both single and multiple quantities. A person can become a carrier of cestodes after cutting the skins of domestic animals, when working on a livestock farm, when training dogs and after other contacts with animals. There have been cases of infection with cestodes after eating wild plants and unwashed berries, drinking spring water.

The clinical picture of pulmonary echinococcosis

Echinococcosis of the lungs among other pulmonary pathologies occupies a leading place and often complicates the diagnostic process due to the frequent similarity of symptoms with other diseases of any etiology. Symptoms of echinococcosis are classified according to the main stages of development:

  • I stage. It has a latent (asymptomatic) character. The invasion may not manifest itself for many years. Echinococcal cystic component grows for a long time, so it does not cause discomfort to its owner. Often the disease is detected during the diagnosis of any other ailment (for example, x-ray examination, ultrasound).
  • II stage. Patients note the first signs of infection. Often they are manifested by dull pains in the sternum, cough begins, shortness of breath with minor physical exertion. As the cystic cavity grows, the intensity of the manifestation of symptoms only increases.
  • III stage. It is characterized by the onset of a period of complications. The contents of the cyst become infected, its suppuration occurs. Then it ruptures and pus enters the bronchi (more than 80% of cases), the abdominal cavity, bile ducts and pericardial cavity.

Important! In the initial stages, the disease is much easier to defeat than when it reaches the terminal stage. Surgery in the final stages of the disease poses a particular risk to the patient's further health and quality of life.

Symptoms of complications on the bronchi

The bronchi are located in close proximity to the lung tissue, therefore, with inflammatory processes in the lungs, the infection passes to the bronchial system. Complications occur at the final stage of the development of the disease and are expressed in the following symptoms:

  • purulent discharge when coughing,
  • particles of cyst walls, scolexes and other invasion elements are visually determined in mucus,
  • signs of general intoxication,
  • anaphylactic shock (characteristic of the generalized spread of sepsis).

Important! Complications occur equally in children and adult patients. A fundamental difference exists only in the clinical prognosis. In any case, it is categorically impossible to bring to the complications of pulmonary echinococcosis.

Common symptoms of infection

The diagnosis is made not only on the basis of laboratory data and the results of instrumental research. An important aspect is the questioning of the patient regarding the external manifestations of the disease. With echinococcosis of the lungs, doctors distinguish a number of signs that can talk about the growth of an echinococcal cyst:

  • skin rashes from local to extensive,
  • an increase in body temperature (to high values ​​with perifocal inflammation),
  • swelling of the chest from the localization of the focus of infection,
  • the appearance of wheezing when listening to the chest (for example, bronchial in nature).

Severe symptoms appear only in case of cyst overgrowth. At the initial stage of infection or with a slow growth of the echinococcal cystic component, the symptoms of the disease do not appear.

Functional Diagnostic Methods

Diagnostic measures for the detection of pulmonary echinococcosis include the following types of studies:

  • ultrasound procedure, x-ray diagnostics,
  • serological research methods (study of antigens in blood serum),
  • computed tomography, fluorography.

Conducting mass fluorography for the purpose of prevention allows you to identify the disease in the initial stages of its development. Echinococcosis of the lungs on an X-ray is visualized by homogeneous shadows in the pulmonary cavity, which have smooth contours and an oval shape. With the onset of perifocal inflammation, the outlines of the shadow become blurred. With an expanded cyst of the lungs, compression of the bronchi occurs, which provokes the onset of atelectasis of the lung tissue.

If the studies are not enough, then carry out additional:

  • enzyme immunoassay analysis (the reaction will be positive when assessed in 2-3 pluses),
  • indirect hemagglutination reaction (the method consists in the ability of red blood cells to agglutinate in the presence of antigens).

Diagnosis is often difficult due to the similarity of cysts with echinococcosis with peripheral carcinoma, tuberculoma and other pulmonary pathological changes, since in the picture they can give a spherical shape. For effective diagnosis, all available methods are used with the exception of biopsy (puncture).

Tactics of the healing process

Treatment of pulmonary echinococcosis is carried out by means of a surgical operation in combination with postoperative administration of drugs of various pharmacological groups (Eskazol, Albendazole, Zentel). Conducted drug therapy requires constant monitoring by a doctor.

The main methods of the operation include:

  1. Echinococcectomy.A thick needle is immersed in the cyst cavity and its contents are sucked out. When a fistula is formed, treatment is carried out with a concentrated solution of glycerol. In the case of severe deformation of the lung tissue, the fibrous component is excised.
  2. Enucleation. The method is used when the cyst is small and there is no infection in its cavity. The structure of the chitinous membrane remains unchanged.
  3. Radical echinococcectomy. Excision of the fibrous capsule along with the body of the tapeworm. Pulmonary tissue and large vessels during surgery are not affected.
  4. Pulmonary resection. The method is used at the beginning of the inflammatory process. The operation is difficult to predict. As complications, it can provoke pulmonary failure until the death of the patient. Timely treatment of the disease will help to use alternative methods of getting rid of parasites.

Important! Echinococcosis of the lungs in children is manifested in the same way as in adult patients. The tactics of treatment is operational. It is necessary to take all preventive measures in order to protect the child from parasitic invasion.

Prevention

Large-scale preventive measures include the authorities' struggle with populations of stray and stray animals. But each person can protect himself from invasion by observing basic precautions:

  • hygienic hand washing
  • thorough cleansing of fruits, berries, fruit vegetables,
  • drinking boiled or distilled water,
  • conducting regular veterinary examinations of pets and livestock.

In the list of ICD-10, the disease is assigned code B 61.1. (lung invasion provoked by Echinococcus granulosus). Given the basic measures to protect their own health, it is hardly possible to become a carrier of cestode parasites.

Symptoms of the disease

In uncomplicated cases, pulmonary echinococcosis has been asymptomatic for years and can be detected by chance during a physical examination (routine fluorographic examination) or a targeted examination of contact persons in the outbreak. This is the so-called preclinical stage of the disease.

Echinococcosis of the face of the middle age group. The first signs may appear many years after infection. These include:

  • general weakness
  • fatigue and decreased performance
  • decreased appetite
  • periodic increase in body temperature,
  • persistent allergic diseases (urticaria),
  • frequent headaches.

In the clinical stage of the disease, the severity of symptoms depends on the size and location of the cyst, the presence of complications and the general reactivity of the host. With echinococcal lung damage, patients are worried about:

  • cough (first dry, then wet),
  • dyspnea,
  • chest pain
  • hemoptysis.

Even a small cyst near the pleural membrane early manifests itself in pain, and its location next to the large bronchus is an obsessive cough.

The severe course of the disease with a tendency to impaired cyst integrity and dissemination contributes to:

  • pregnancy,
  • intercurrent diseases
  • exhaustion.

Complications

A complicated course of pulmonary echinococcosis is quite common (in 30% of cases). Often, the disease can be detected only at this stage. The most common complications associated with pulmonary echinococcosis are:

  1. Suppuration of the cyst and the formation of an abscess (manifested by increased pain, fever, inflammatory reaction of the blood).
  2. Repeated pulmonary bleeding.
  3. Acute respiratory failure.
  4. Cyst rupture and the development of allergic reactions, including anaphylactic shock, and the spread of the pathogen through the body with the formation of new cysts.

When a bladder bursts into the bronchus, a cough intensifies, choking, cyanosis appears, fragments of the cyst and its contents are determined in sputum. These symptoms can last several days and often lead to the development of aspiration pneumonia.

If a cyst breaks into the pleural cavity or pericardium, then a fatal outcome may occur due to a shock reaction.

Conclusion

The prognosis for pulmonary echinococcosis is quite serious due to the development of complications and life-threatening conditions. That is why the earlier the disease is detected and the treatment is carried out, the better for the patient.

About echinococcosis in the program “Live healthy!” With Elena Malysheva (see from 33:15 min.):

Watch the video: Surgery , HYDATID DISEASE of LIVER , Surgery Lectures (January 2020).