2 English References Alveolar Hydropathy
3 Classification of diseases Gastroenterology
4 disease overview Echinococcus multilocularis is similar to Echinococcus granulosus in morphology and life history, but the adult is mainly parasitic in foxes, the intermediate host is rodents or insectivores, and the larval stage is Echinococcus multilocularis (also known as Echinococcus multilocularis). It causes serious alveolar echinococcosis, also known as alveolar echinococcosis or multilocular echinococcosis.
Due to the slow growth of echinococcosis, the incubation period after infection is generally longer. The main clinical manifestation is a slowly growing mass or hepatomegaly in the right upper abdomen. Many patients have pain, tenderness and swelling in the liver area similar to Echinococcus granulosus, but the lump is hard and palpated with a nodular feeling. There are also abdominal pain, jaundice and portal hypertension. Almost all patients have liver function damage, such as loss of appetite and indigestion. Even advanced patients have cachexia. The symptoms of this disease are similar to those of liver cancer, but its course is usually longer.
Prevention and control measures: Killing foxes and wild rats is the main measure to eradicate the source of infection. In the process of implementation, we should pay attention to burning or burying animal carcasses, killing or controlling wild dogs, and regularly expelling insects for domestic dogs. ? * * * health education, make people know and understand the harm of echinococcosis and prevention methods. In epidemic areas, people should be investigated, and patients should be found early by means of immunological detection, X-ray and B-ultrasound, so as to be cured in time. ? Pay attention to personal protection, personal and food hygiene, and prevent egg pollution in production and life. Because eggs are cold-resistant and afraid of heat, contaminated utensils and articles can be heated and disinfected. ? The treatment of echinococcosis mainly depends on surgery, so early diagnosis is needed. Drug therapy can use prothiobendazole, mebendazole and praziquantel.
5 disease description Echinococcus multilocularis [Echinococcus? Echinococcus multilocularis (Leuckart, 1863)Vogel,1955) is similar to Echinococcus granulosus in morphology or life history, but there are differences. Its adults are mainly parasitic in foxes, larvae, rodents or insect-eating animals and human bodies, causing alveolar echinococcosis, also known as alveolar echinococcosis or multilocular echinococcosis.
Morphology and life history:
The adult is very similar to Echinococcus granulosus, but the worm is smaller, with a body length of 65,438+0.2-3.7 mm, 4-5 nodes, 4 suckers in the first node, 65,438+03-34 small hooks in the apical process, segmented reproductive holes in front of the node line, and a small number of testes (65,438 on average). It contains 187-404 eggs, which are similar in shape and size to Echinococcus granulosus eggs and difficult to distinguish under light microscope.
6 Symptoms and signs Echinococcus alveolaris grows slowly and the incubation period is generally long. The most important clinical manifestation is a slowly growing mass or hepatomegaly in the right upper abdomen. Many patients have pain, compression or swelling in the liver area, jaundice and portal hypertension. Almost all patients have manifestations of liver function damage, such as loss of appetite and indigestion, and even cachexia in advanced patients. This disease is similar to liver cancer, but the course of disease is usually longer.
The ultimate host of the disease is mainly foxes, followed by dogs, wolves, badgers and cats. Echinococcus granulosus can be parasitic in the final host of Echinococcus multilocularis, and the intermediate host is wild rodents, such as voles, muskrats, lemmings, hamsters, gerbils, cotton rats, weasels, zokor, gerbils, house mice, pikas, yaks, sheep, etc. Echinococcus multilocularis scarlet worm? When the organs of mice or animals with echinococcosis in their bodies are swallowed by final hosts such as foxes, dogs and wolves. After about 45 days, protocercaria can develop into an adult and expel pregnant nodules and eggs. Adults parasitize in definitive host's small intestine, pregnant nodes and eggs are excreted with feces, and rats are infected by feeding on definitive host's feces. Eupolyphaga sinensis can transport eggs, rodents can be infected by the predation of Eupolyphaga sinensis, and people can also be infected by eating eggs by mistake.
Echinococcus is mainly parasitic in the liver, and it is a yellowish or white vesicular mass, which is often formed by the interconnection of numerous vesicles. The size of each vesicle is basically the same, and the vesicle is round or oval with a diameter of 0.1-5 mm. Some vesicles contain transparent liquid and many primary scoliosis, while others contain colloid without primary scoliosis. The outer wall of the vesicle is thin but often incomplete, and the whole alveolar cyst is connected with the surrounding tissues. Echinococcus multilocularis germinates and reproduces outward, constantly producing new vesicles, which grow into tissues, and a few of them can germinate and separate new vesicles. Generally, in 1~2 years, almost all parasitic organs are occupied by large and small vesicles. Grape vesicles can also spread to the surface of organs and enter body cavities, similar to malignant tumors. Man is an unsuitable intermediate host of Echinococcus multilocularis. At the time of infection, human vesicles only contain colloid, but scoliosis is rare.
Pathophysiology Human echinococcosis is usually more serious than Echinococcosis granulosus, with higher mortality. Its course of disease is mostly 1~5 years, which is relatively slow. Most patients are young adults aged 20-40, and almost 100% of the primary lesions are in the liver. Echinococcus multilocularis can be single block type, diffuse nodular type or a mixture of the two. The harm of echinococcosis to human body includes direct erosion, mechanical compression and toxic damage. Echinococcus multilocularis spreads in the liver parenchyma and gradually spreads to the whole liver, directly destroying and replacing the liver tissue, and its center often undergoes ischemic necrosis, disintegration and liquefaction, resulting in cavities or calcification; The surrounding tissues are atrophied, degenerated or even necrotic due to compression, and the toxins produced further damage the liver parenchyma, which can cause liver failure and lead to liver coma, or induce cirrhosis and lead to portal hypertension, complicated with gastrointestinal bleeding and death. Jaundice can be caused by the compression and erosion of bile ducts inside and outside the liver. If echinococcosis invades the portal vein branch of the liver, it will spread widely in the liver along the blood stream; If it invades the hepatic vein, it can spread to all parts of the body with blood circulation, such as lungs, brains and other organs, thus producing corresponding symptoms and signs.
9 Diagnostic examination asks about medical history. If the patient comes from an epidemic area, it should be considered first.
Various diagnostic methods of echinococcosis granulosus are suitable for patients with multilocular echinococcosis. Because of the lack of fibrous tissue envelope around echinococcosis, the antigen of echinococcosis is easy to enter the blood, so serological methods have good diagnostic effect and value.
In addition, we should pay attention to the differentiation from liver cancer, cirrhosis, liver abscess, icteric hepatitis, cavernous hemangioma of liver, lung cancer and brain tumor.
10 differential diagnosis should be differentiated from liver cancer, liver cirrhosis, liver abscess, icteric hepatitis, cavernous hemangioma of liver, lung cancer and brain tumor.
Treatment plan 1 1 albendazole, mebendazole and praziquantel can be used for drug treatment.
Complications of 12 lack this information for the time being.
13 prognosis and prevention 1. Pay attention to personal protection, personal hygiene and food hygiene to reduce the chance of infection.
2. Wild rats are the main intermediate hosts, and killing wild rats is an important measure to reduce the source of infection.
3. Strengthen the construction of health and quarantine regulations. It is forbidden to feed dead yak, sheep and other animal carcasses and internal organs to dogs, and burn or bury them all. Domestic dogs should be regularly dewormed.
4. Conduct a general survey of people in epidemic areas, so as to find patients early and treat them early. The treatment of echinococcosis mainly depends on surgery, and early diagnosis should be made. Many patients do not see a doctor until they have obvious symptoms, and often miss the opportunity of radical surgery.
14 epidemiology 1. The geographical distribution of Echinococcus multilocularis is relatively limited, and it is mainly prevalent in high latitudes and frozen soil areas in the northern hemisphere, from northern Canada and Alaska in the United States to Hokkaido in Japan and Siberia in Russia, all over North America, Europe and Asia. China has reported 690 cases, distributed in 69 counties (cities) in Ningxia, Xinjiang, Qinghai, Gansu, Heilongjiang, Tibet, Beijing, Shaanxi, Inner Mongolia, Sichuan and other provinces (cities, districts). There are three obvious epidemic areas in China. One is Xinjiang, with 88 cases distributed in 23 counties (cities), mostly in northern Xinjiang. Second, the central and western regions, with 595 cases distributed in 6 provinces (regions) 4 1 county (city); The third is Northeast China, with 4 cases in 3 counties (cities) of Heilongjiang and 2 cases in Inner Mongolia 1 city. In addition, 1 case was also found in Pinggu County, Beijing. In Qinghai Province, the prevalence rate of zeku county is 0.29%, and that of Yudu County is 1.52%. The infection rates of yak and sheep were 4.7% and 5.4%, respectively. The infection rate of dogs in many counties is as high as 13.3%. Echinococcosis granulosus is also prevalent in these areas. The disease has become one of the diseases that seriously endanger the health of farmers and herdsmen in western China. 2. Epidemic factors (1) Echinococcus multilocularis, an animal-derived parasite, forms a natural focus because it exists in wild animals. (2) definitive host has a wide range of intermediate hosts, which can spread among wild animals and between humans and animals. (3) Eggs have strong resistance and are still contagious in frozen soil, ice and snow. Eggs pollute food and water sources, leading to human and animal infections. (4) The particularity of production and living activities of residents in epidemic areas, such as fox hunting, fox breeding, processing, trading and trafficking of fur products, is one of the reasons for the epidemic spread of the disease.
Pay special attention to personal protection, personal and dietary hygiene, and prevent egg pollution in production and life. Because eggs are cold-resistant and afraid of heat, contaminated utensils and articles can be heated and disinfected.
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