Echinococcus

Echinococcus is a parasite that causes a life-threatening disease in humans.

Let's consider its life cycle and routes of infection, symptoms of the disease and methods of treatment.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Epidemiology

As a rule, areas of echinococcus infection are various livestock and poultry farms, vegetable farms. The risk group includes people working in such areas. First of all, these are shepherds, sheep shearers, veterinarians and anyone who has contact with these people. The incidence of biohelminths is associated with the abundant consumption of garden greens, fruits and vegetables. Some epidemiologists claim that in semi-desert and desert areas, the parasite eggs are scattered and contaminate vegetables due to the winds that are typical there.

Scientists compare the extent of the worm's spread with natural and climatic factors, household characteristics, and the number of dogs and sheep. Most cases of infection have been registered in Australia. This is due to the climate and the intensity of livestock farming. A high incidence rate has been noted in Kazakhstan. This is due to landscape zoning and sheep farming. In Ukraine, worm infestation is noted in the southern regions, i.e. Odessa, Kherson, Nikolaev and Crimea. The sheep strain predominates in the steppe zone, and the swine strain predominates in the forest-steppe and forest zones.

Infection occurs through the alimentary route, most often when eating meat from infected animals, infected vegetables and fruits. Once in the body, the larvae affect the internal organs, disrupting their functioning. The worm attaches itself to the organ and forms a cyst that grows slowly. Timely diagnosis of infection minimizes the destructive effect of the worm.

[ 6 ], [ 7 ], [ 8 ], [ 9 ]

Causes echinococcus

The parasite is a tapeworm and develops in the intestines of animals. In humans, the worm larvae cause a complex disease called echinococcosis. The size of the biohelminth is 2.5-5 mm, the main source of infection is animals. Most often, it is found in adults, children get sick much less often. The worm affects internal organs, most often the liver. Medicine knows of cases when it was found in the pericardium. Such cases require urgent surgical intervention.

The tapeworm is a close relative of the beef and pork tapeworm, but differs in its size and life cycle. It has an irritating effect on the human body, causing allergic reactions. If a parasitic cyst ruptures, it threatens sepsis and anaphylactic shock. Large cysts have a negative effect on the functioning of internal organs, causing their atrophy. Parasitic liver damage can lead to fibrosis of the organ. Infection of the lungs leads to compaction of the lung tissue and sclerosis.

Structure

Echinococcus granulosus is the causative agent of echinococcosis, the larval stage of the tapeworm Echinococcus. The structure of the parasite depends on the stage of development. Let's consider its structure:

• A small cestode up to 1 mm wide and 2.5-5 mm long. It consists of 3-4 segments, a pear-shaped scolex and a neck.
• The scolex has four suckers with a crown in two rows of hooks.
• Short neck and segments - 1 and 2 immature, 3 hermaphroditic, and the fourth mature. The length of the mature segment is 1.2-3.2 mm, it is filled with a stretched uterus (a wide trunk with lateral protrusions). The uterus is filled with eggs (about 600 pcs.), which in their structure do not differ from the eggs of the bovine and pork tapeworm.

The tapeworm echinococcus is a sexually mature form that parasitizes only animals (dogs, foxes, wolves, jackals), i.e. the final hosts. The larval stage (echinococcal cyst) parasitizes only intermediate hosts - humans, herbivores and omnivores (cattle, horses, sheep, pigs, goats).

An echinococcal cyst is a bubble with a complex structure. The outer shell has a layered cuticle, the thickness of which is up to 5 mm. Under the multilayered shell is the germinal membrane, the task of which is to produce brood capsules with scolexes and daughter bubbles. Brood capsules are bubble formations on the embryonic membrane, connected to it by a thin stalk. They have the same structure as the main bubble, but with the reverse arrangement of the membranes. The bubble is filled with liquid, which acts as a protective nutrient medium for the scolexes and brood capsules.

The structure of the worm can be either single-chamber or multi-chamber. Multi-chamber echinococcus consists of a group of fused bubbles. The larval form of multilocularis has a multidimensional structure. Bubbles multiply from the outside, quickly growing into the surrounding tissues. Due to the infiltrative nature, this form is invisible to ultrasound and X-ray, which leads to exacerbation and complication of the pathology.

[ 10 ], [ 11 ], [ 12 ]

Echinococcus eggs

The causative agent of echinococcosis is the larvae and eggs of the parasite. Echinococcus eggs are resistant to the environment, they tolerate temperatures from -30 °C to +38 °C. If they are on the soil surface, their viability is maintained for a month. In grass, the lifespan of oncospheres increases to 1.5 months. The eggs tolerate low temperatures well and can be preserved for many years, as they are resistant to drying out.

Eggs get into water and food in different ways, but most often these are the following methods of distribution:

1. By air from dried animal feces. The most common method. When in southern regions and eating food that has been out in the open for some time, there is a risk that parasite eggs have been carried into it by the wind. They get into water with animal feces, so drinking untreated liquid is very dangerous.
2. From dirty hands after handling animals and eating unwashed vegetables and fruits. This is possible in endemic areas where the worm eggs are carried through the air on animal fur, fruits and vegetables.

Please note that raw meat does not contain larvae or eggs that can cause infection. Infection occurs only through larvae that enter the environment from the intestines of infected animals. The feces of such predators dry out, and the eggs are carried away by the wind, settling on the fur of stray and domestic animals, fruits and trees.

[ 13 ], [ 14 ]

Echinococcus larva

Unlike the larvae of the beef and pork tapeworm, the larva of the echinococcus has the ability to reproduce asexually by budding. The parasite's bladder is a dense ball with a colorless liquid and smaller bubbles inside, which can also contain bubbles filled with liquid. On their inner surface, brood capsules grow, in which the heads of future worms are laid. That is, inside one echinococcal bladder there are many future worms.

In order for the parasitic larvae to die and their life cycle to be completed, the infected animal must eat part of the bladder with live heads. This happens when eating the carcasses of dead animals. After 2-3 months of infection, the worms become sexually mature.

A human is optional in the worm's life cycle. In the early stages of infection, the disease is asymptomatic, serious manifestations make themselves known a couple of months to years after infection. Larvae growing in internal organs disrupt their functioning and press on surrounding tissues. This can lead to rupture of the echinococcal bladder and multiple infections. Pieces, tissues and heads of the large bladder that enter the body give rise to new ones. Rupture of the bladder with future larvae can lead to death of both the main and intermediate hosts.

Finna echinococcus

The biohelminth tapeworm is considered the most dangerous parasite for living organisms. A mature specimen reaches 5 mm in length and consists of 3-4 segments, which, when entering the body, form neoplasms - finns. The echinococcosis finn is a bubble that can reach enormous sizes, both in volume and weight. Inside, they contain liquid with countless brood chambers. The parasite larvae take root well in almost all organs and tissues.

The life cycle of a worm goes through several stages:

• Egg
• Primary larva – oncosphere
• Secondary larva - finna
• Sexually mature individual

Finna is the penultimate stage of development. It grows and feeds on the tissues of the organ in which it parasitizes. Each of the bubbles in the secondary larva has an internal and external membrane with liquid. In the internal membranes there are special chambers in which the worms mature.

The development of embryos is very slow, only 30 days after infection the capsule of the finna grows to 1 mm in diameter and after 5-6 months to 1 cm. Finna grows and develops for years, forming daughter vesicles with numerous heads on its internal walls. Based on this, we can conclude that treatment is best carried out in the early stages, when the capsule is small in size and does not have a pathological effect on the functioning of the body.

[ 15 ], [ 16 ]

Echinococcus scolex

The head of the biohelminth or the scolex of the echinococcus is a part of the worm with four suckers. The living parasite has two rows of hook-like teeth, which it uses to bite into tissue. With the help of suckers, the worm absorbs nutrients and destroys blood vessels. Gradually, the scolex turns into an adult worm: a 3-5 mm neck with proglottids grows. As it matures, the last segment is filled with eggs. The maturation of the queen segments is gradual.

After maturation, the proglottids break away from the mother parasite and begin to spread pathogenic eggs. The eggs are excreted with the feces of the intermediate host, get into the soil, on vegetables and fruits and infect a person. Scolexes are resistant to external influences, if they are in a bladder, they can survive for 4-6 days at a temperature of 17-22 ° C.

When entering the human body, mature segments and individual eggs dissolve and release scolexes under the action of digestive enzymes. After this, another cycle of parasite development begins. With the blood flow, the scolexes can enter any organs and systems: the spinal cord and brain, liver, lungs, kidneys, uterus, eye sockets.

Echinococcus oncosphere

The primary larva of the parasite enters the human body in different ways, but most often it is contact with infected animals. The oncosphere of the echinococcus after infecting a person enters a new stage of development. Each helminth egg produces a larva, which penetrates the blood vessels through the thin walls of the gastrointestinal tract. With the blood flow, the worms are carried throughout the body, but most often they affect the liver, lungs, brain, bone and muscle tissue.

Oncospheres that have overcome the liver barrier enter the pulmonary circulation and head to the lungs, where they settle. Parasites that have entered the systemic circulation can enter any organ. Having settled and attached to the tissues, they transform into a larva cyst (a single-chamber bladder) with a complex structure and large dimensions (more than 15 cm in diameter).

Like all tapeworms, echinococcus goes through a certain life cycle from larva to adult. Development occurs according to this scheme:

• Oncosphere, that is, the release of larvae and segments of the parasite with the feces of the main host.
• Infection of an intermediate host.
• Infection of the definitive host.

A person becomes infected through careless handling of dogs. Parasite eggs can be found on the tongue and fur of the animal. Infection can occur through dirty fruits, berries and vegetables that have worm eggs on them. After the eggs enter the body, they produce oncospheres, that is, six-hooked embryos that penetrate the blood vessels through the intestinal walls. With the blood flow, the embryos penetrate into various organs.

The embryo develops slowly. After a month, the finna bubble reaches 1 mm in diameter and only after 5-6 months - 1 cm. The development cycle lasts until the larva turns into a sexually mature individual. The final host is infected by eating the organs of intermediate hosts that are affected by echinococcal cysts. With such an infection, the cystic membrane dissolves in the human body and releases a huge number of scolexes. With the help of suckers, they attach to the intestinal mucosa and develop into adult individuals. That is, a person is the final point in the life cycle of the worm.

Echinococcus infection

The parasite releases larvae into the environment, which enter the organisms of animals and humans. Infection with echinococci causes the formation of an echinococcal cyst. It is a bubble with a complex multilayer structure. The cyst contains scolexes, daughter bubbles and nutrient fluid. The outer shell consists of dense connective tissue, which allows the worms to remain in a living organism for years.

Once the oncospheres have entered the body, their shells are destroyed and the worm larvae are released. They gradually penetrate the mucous membrane of the small intestine and blood vessels. The life cycle continues in the affected organs, most often the liver, lungs, kidneys, muscles, bones, and central nervous system. An echinococcal cyst forms in the organ, which slowly increases in size and causes a disease called echinococcosis.

The main host of Echinococcus

When diagnosing the disease, special attention is paid to the epidemiological anamnesis. That is, it is necessary to know the factors and routes of infection, the life cycle of the parasite. The main host of echinococcus is animals (dogs, wolves, foxes). That is, in the human body, the larvae only live and develop, but do not infect others. Livestock can act as an intermediate host.

The worm's development cycle is simple. The host releases eggs into the environment, which end up in water and soil. Infection occurs through the following methods:

• Alimentary – through water, dirty and poorly processed fruits, vegetables, berries.
• Contact – through contact with a sick animal, cutting up skins.

Infection of predatory animals occurs when they eat infected herbivores (hares, squirrels, pigs). After the eggs enter the body, larvae emerge from them and enter the general bloodstream. The larvae grow in a special bladder, the diameter of which is about 5-7 cm. If there are many such bladders, they form an echinococcal cyst. Inside, they contain liquid - a nutrient medium. Proglottids can separate from the mature parasite, which move independently and are excreted with animal feces.

Pathogenesis

The mechanism of biohelminth development depends on its type and structure. Pathogenesis is associated with the localization of the worm in a living organism. As a rule, infection occurs orally, that is, by the hematogenous route, oncospheres can settle on any organ or tissue. In 50-85% of cases, this is the liver, 15-20% of lungs, less often the kidneys, brain and spinal cord, spleen, muscles, bones. In the affected organs, one or more cysts are formed, that is, single or multiple echinococcosis.

The clinical picture of the lesion is characterized by polymorphic symptoms. Signs of the disease depend on the rate of cyst growth, its location and size. Of particular importance is the presence of concomitant diseases and the body's reactivity. In any case, the pathology develops very slowly. In many patients, the first signs of the disease appear several months or even years after infection.

Pathogenic action of echinococcus

The pathological effect of the parasite on the human body is due to the sensitizing and mechanical properties of the larva. The pathogenic effect of echinococcus leads to disruption of the functioning of the affected organ and the body as a whole. The tapeworm cyst can reach gigantic sizes, and its localization determines the symptoms and severity of the disease.

Human sensitization to the tapeworm's metabolic products causes immediate and delayed hypersensitivity. This manifests itself as allergic reactions, i.e. urticaria and eosinophilia due to the leakage of echinococcal fluid. In particularly severe cases, the worm's activity can lead to anaphylactic shock.

The further fate of the biohelminth varies. Very rarely does the body recover, that is, the immune system destroys the parasite, and the necrotic remains remain in a neutralized state in the host's body. But most often the worm grows, forming large cysts with many larvae. In this case, the patient will have to undergo surgery and a long course of drug therapy.

[ 17 ], [ 18 ], [ 19 ], [ 20 ]

Symptoms echinococcus

Signs of parasite infection depend on the size and location of its bladder, growth rate. Symptoms are complicated by various complications, i.e. pathological changes in the organ affected by worms. The latent period - the time from infection to the first symptoms varies. It can be several months and even decades. In some cases, the pathological process is asymptomatic, and the helminth is discovered accidentally during instrumental examination or surgical intervention.

Early symptoms may be non-specific. In this case, allergic and general toxic reactions are observed, i.e. weakness, malaise, fever, headaches, skin rashes. Their severity with a single cyst is insignificant, but with multiple lesions is acute. As the disease progresses, more distinct signs of the disease appear, which depend on the localization of the worm.

Let's look at the main symptoms of echinococcosis depending on the affected organ:

• Liver

Most often, parasites are localized in this organ, since the liver is the primary filter for blood. As a rule, the bladder is located in the right lobe of the organ. The main symptoms are toxic-allergic reactions. The disease can make itself known by jaundice, difficult breathing. As soon as the cyst begins to grow, pain appears in the right hypochondrium.

• Lungs

Shortness of breath, chest pain when breathing, coughing appear. Exacerbation of chronic respiratory diseases is possible. If the cyst is located in the lower parts of the lung, then severe, excruciating pain appears, which leads to limited mobility of the chest. Unpleasant sensations are accompanied by compression of the intercostal nerves.

• Brain

The symptoms correspond to a tumor lesion of the brain. Clinical signs change quickly and depend on the size of the cyst, its growth rate and localization.

The helminth can also affect other tissues and organs, disrupting their functioning. Although worms are most often localized in the above-mentioned organs, the doctor should not forget about the possibility of extensive damage during diagnosis.

[ 21 ], [ 22 ], [ 23 ]

Echinococcus of the lungs

Echinococcosis is a disease that can affect any organ or system of the body. The causative agent is the larval stage of the tapeworm Echinococcus granulosus. Echinococcus of the lungs is a cystic stage of the helminth. This type of lesion has a single-chamber, i.e. hydatid form. In terms of prevalence, lung infection ranks second after liver echinococcosis. Most often, this form of the disease occurs in South America, Australia, Southern Europe, and North Africa. The disease is common in countries with well-developed livestock farming, especially sheep farming.

Symptoms depend on the size and location of the parasite. Let's look at the main clinical signs of pulmonary echinococcosis:

• The first stage is asymptomatic. It can last for many years from the moment of infection. The cyst develops slowly, so the patient does not feel discomfort. The bubble is detected by chance, during an X-ray or ultrasound examination.
• At the second stage, dull pains in the chest, shortness of breath and cough appear. The disease makes itself known when the cystic neoplasm reaches large sizes.
• The third stage is characterized by complications. The cyst may become suppurated and infected, and may break through into the bronchi, bile ducts, peritoneum, pleura, and pericardium. If the cyst is large, it can be seen during a visual examination of the chest. If the cyst ruptures, debris and contents of the cyst enter the bronchi. This can cause anaphylactic shock.
• Another characteristic symptom of the lesion is urticarial rashes on the skin. The patient complains of high temperature, the appearance of which is explained by perifocal inflammation. If the cyst fluid gets into the pleural cavity, this leads to the appearance of new blisters.

The main diagnostic procedure for detecting the parasite is fluorography. Tapeworm can be detected using X-rays and ultrasound. If echinococcosis is suspected, an enzyme immunoassay and an indirect hemagglutination test are performed. Surgical methods and antibiotic therapy are used for treatment.

Prevention consists of observing hygiene rules and fighting stray animals, which are the main source of infection. Do not forget about heat treatment of vegetables, fruits and berries, which can also cause the disease.

[ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ]

Echinococcus liver

Human infection with tapeworm larvae Echinococcus granulosus can affect any organ. Liver echinococcus is the most common, due to the fact that the organ acts as a filter for the body. The lesion can be of two types: alveolar or vesicular. The pathological effect of the parasite is associated with its toxic and sensitizing effect and mechanical pressure on neighboring organs.
Echinococcal cyst is characterized by a complex structure and a vesicular shape. The outer shell is surrounded by a thick layer of cuticle up to 5 mm. Under the shell is the inner, that is, the embryonic germinal membrane. Brood capsules with scolexes and daughter vesicles are formed in it.

Symptoms of the disease depend on the type of lesion:

• Hydatidosis (vesical)

This form has larval and cystic forms of development. Signs of the disease do not make themselves known for a long period of time. Symptoms appear when the bladder grows. The patient complains of aching pain in the right hypochondrium and epigastric region. If the cyst is very large, it is easily palpated and noticeable during visual examination. In addition, percussion increases the organ upward. This form is observed with cysts that are located deep in the liver parenchyma.

• Alveolar

The main symptom is hepatomegaly, which develops due to a tumor-like node. In addition, there is yellowing of the skin and perihepatitis, which limits the mobility of the organ. A third of patients with liver echinococcosis have an enlarged spleen. If the pathology is advanced, then functional tests are impaired.

Liver damage is also differentiated by the location of the tapeworm: anterior, abdominal (descending) and ascending (thoracic).

• The anterior cyst is large in size, which makes it suspectable upon visual examination.
• The upper cysts are determined by the X-ray method. This is due to the high state of the diaphragm on the right and the dome-shaped protrusion of the tumor.
• In case of lower localization, the cyst is palpated in the abdominal cavity. The neoplasm is mobile and has an elastic consistency. If the lesion is located in the left lobe of the liver, it is detected at late stages when pathological symptoms appear.

The condition significantly worsens due to intoxication, i.e. the body's reaction to the presence of a live parasite. This manifests itself as an elevated body temperature, allergic reactions on the skin, diarrhea. More severe symptoms appear when the tumor compresses neighboring organs.

Ultrasound and radiography are used for diagnostics. Particular attention is paid to the general blood test, which reveals eosinophilia above 20%. The intradermal Koni reaction is mandatory. Surgery and medications are used as treatment. Prevention is based on hygiene. Only washed vegetables, fruits and greens should be consumed. Drinking unboiled water from natural reservoirs and contact with stray animals is contraindicated.

[ 30 ], [ 31 ], [ 32 ], [ 33 ], [ 34 ], [ 35 ]

Echinococcus in the brain

Biohelminth is a parasite that can cause damage to the central nervous system. Echinococcus in the brain is rare, since most often the worm affects the liver and lungs. Symptoms similar to signs of a tumor process allow one to suspect infection of the brain.

Clinical manifestations of tapeworm:

• Constant headaches
• Dizziness
• Vomit
• Epileptic seizures
• Visual impairment
• Limb cramps
• Depression
• Dementia
• Delirium

The disease is characterized by a progressive course with a constant increase in discomfort and an increase in intracranial pressure. If the echinococcus has a multi-chamber structure, then remissions of painful symptoms are possible for 1-2 years.

It is very difficult to detect parasitic infection. As a rule, patients are diagnosed with a brain tumor, which is verified during surgery. Blood tests show eosinophilia, and cerebrospinal fluid shows pleocytosis with increased protein. The patient undergoes CT, MRI and a number of other diagnostic procedures.

The disease can only be cured by surgery. Special care must be taken during removal, since damage to the cystic membrane can lead to dissemination of the pathological process. In case of multi-chambered echinococcus, surgery is not performed. The prognosis for such a lesion is unfavorable.

[ 36 ], [ 37 ], [ 38 ], [ 39 ], [ 40 ]

Echinococcus in the kidneys

About 3-5% of all cases of biohelminth infection occur in the kidneys. Most often, this disease occurs in people who come into contact with dogs, cattle and sheep. Usually, only one kidney is affected, most often the left one. Echinococcus in the kidneys can occur when consuming contaminated water, raw vegetables and fruits. Getting into the digestive tract, the egg shell gradually dissolves, and oncospheres penetrate the walls of the organ with their hooks. From there, the worms enter the general bloodstream and spread throughout the body.

As a rule, one cyst is formed, which is located in a fibrous capsule in the area of one of the renal poles. The cystic walls gradually thicken and fuse with the organ parenchyma. The parasitic bladder grows rather slowly, sometimes over 10-20 years, and reaches enormous sizes. As it grows, it leads to atrophy of the renal parenchyma. The cyst is filled with fluid, which contains daughter and granddaughter cysts. It can be closed or open, i.e. communicate or not communicate with the renal pelvis or calyx.

The main symptoms of the lesion are painful sensations in the lumbar region. Palpation may reveal a lumpy enlarged kidney. If the echinococcal bladder bursts into the renal pelvis, its contents may clog the ureter, causing attacks of renal colic. The open form is characterized by secondary infection, the appearance of purulent impurities in the urine.

Only surgical intervention is used to eliminate the pathology. If the renal parenchyma is preserved, then the bladder is resected or opened with the cavity walls treated and the edges sutured. If the parenchyma is affected, then nephrectomy is performed.

[ 41 ], [ 42 ], [ 43 ], [ 44 ], [ 45 ], [ 46 ], [ 47 ], [ 48 ], [ 49 ]

Echinococcus in the heart

Cardiovascular lesions caused by tapeworms are very rare. Echinococcus in the heart accounts for 0.2-2% of all cases of the disease. As a rule, the disease is detected in patients over 20 years of age. Most often, it is secondary, that is, it occurs due to the rupture of cysts that form near the heart. Medicine knows of cases when the worm was found in the heart many years after successful treatment of cysts in other locations.

The parasite enters the heart through the coronary bloodstream. The tapeworm grows very slowly in the myocardial tissues, the cyst forms within 1-5 years. Most often, the worm's bubbles are located in the myocardium of the left ventricle, since there is a large blood supply there. The symptoms of the disease are so extensive that it is possible to diagnose the disease only after a full examination of all organs and systems.

Symptoms:

• Chest pain
• Myocardial ischemia
• Myocardial infarction
• Angina pectoris
• Heart failure
• Heart rhythm disturbances
• Ventricular tachycardia

Echocardiography, CT, and MRI are used to detect infection. Laboratory diagnostics are also performed. In some cases, serological tests determine the disease. The patient undergoes immunoelectrophoresis, eosinophilia analysis, and the Casoni and Weinberg reactions.

The only method of eliminating the parasite is surgical treatment. During the operation, direct sanitation and excision of the cyst are performed. The prognosis depends on the quality of diagnostics and preoperative preparation. There is information on the effectiveness of drug treatment using benzimidazoles and a course of chemotherapy. In any case, the prognosis for cardiac echinococcosis is unfavorable.

[ 50 ], [ 51 ], [ 52 ], [ 53 ], [ 54 ], [ 55 ], [ 56 ]

Echinococcus of the eye

Parasitic ophthalmologic diseases are rare. Echinococcus of the eye is an endemic disease. The main causes of infection are: careless handling of animals and failure to observe basic hygiene rules. The disease develops due to the finna, that is, the larval form of Echinococcus granulosis.

Clinical signs of echinococcosis of the eye do not have typical symptoms. Most often, patients complain of pain, a feeling of tension in the eye socket, and the appearance of exophthalmos. As the worm grows, the eye's mobility toward the cyst's location is impaired. Often, purulent melting of the cornea occurs due to the rapid progression of the parasite.

To identify the disease, a number of laboratory and instrumental studies are carried out. The doctor collects anamnesis for the correct diagnosis. Delay in diagnosis and treatment can lead to tragic consequences. As a therapy, a drug method is used. Patients are given a course of chemotherapy with a low level of absorption in the gastrointestinal tract. In addition, an operation is performed to remove the cyst from the orbit. It is extremely important to remove the whole capsule, since its rupture and the remains of helminth tissue in the eye can lead to relapses of the disease.

[ 57 ], [ 58 ], [ 59 ], [ 60 ], [ 61 ], [ 62 ]

Echinococcus in the spleen

The defeat of internal organs by tapeworms in humans is quite common and can occur at any age. Echinococcus in the spleen is rare and has a number of characteristic symptoms. The growth of helminthic cysts provokes an increase in the organ. Echinococcus bubbles can be localized in different areas of the organ. The affected part of the spleen acquires a dense consistency and a burgundy color. If the infection is accompanied by multi-chamber cysts, the organ is lumpy, its tissues are atrophied, and it looks like an echinococcal sac.

The cystic walls consist of connective tissue with hyalinosis and petrification. The organ parenchyma is compressed, the arteries are sclerosed, and the veins are dilated. In addition, there is pulp sclerosis with necrosis and multiple foci of hemorrhage. When the bladder ruptures, helminths enter the abdominal cavity. If echinococcosis is medium or large in size, then splenectomy is performed. The prognosis after such treatment is favorable.

[ 63 ], [ 64 ], [ 65 ], [ 66 ], [ 67 ]

Forms

There are several groups of helminths: flat, round and tapeworms. Echinococcus is a tapeworm, the larvae of which infect humans. There are two types of echinococcus:

• Hydatidiform (most often affects the liver) – has a single-chamber bladder.
• Alveolar (most often affects the lungs) - has a multi-chambered bladder.

An echinococcal cyst consists of an inner and outer membrane. The bladder contains fluid, which may contain daughter and granddaughter bladders. Regardless of the type and structure, the parasite gradually develops, increases in size and compresses adjacent organs. That is, the symptoms of the disease are the same for each form. Unilocular cysts respond better to treatment, as they have a simpler structure. To eliminate the second form of parasitic infection, surgical intervention is used, the outcome of which depends on the degree of cystic growth.

Porcine echinococcus

A tapeworm parasite, reaching 2 meters in length with suckers and hooks on the body, is an armed or pork tapeworm. Pork echinococcus, as a rule, lives in the small intestine of the animal. It gets into the human body as a result of eating contaminated meat. Man is the final host of the worm. In a living organism, both larvae and sexually mature cysticerci can parasitize. Getting into the stomach, the helminth eggs are released from the membranes, penetrate the walls of the stomach and are carried with the bloodstream throughout the body.

Growing biohelminths press on tissues, causing various pathological symptoms. Signs of infection may include muscle degeneration, thyroid nodules, cardiovascular disorders, vomiting, diarrhea, and increased body temperature.

Treatment of porcine echinococcus is no different from therapy for other forms of the worm. The patient is prescribed a course of antiparasitic drugs and undergoes surgery to remove the tapeworm. To prevent infection, it is recommended not to eat pork without proper heat treatment and to maintain cleanliness in the areas of pig farms and farms.

[ 68 ], [ 69 ], [ 70 ], [ 71 ], [ 72 ]

Echinococcus granulosus

Echinococcus granulosus is a biohelminth that affects the human body. The worm parasitizes dogs, foxes, arctic foxes and wolves. Its size reaches 0.5-0.75 cm in length, and the body consists of a head with chitinous hooks and 4-8 segments. The larval stage of the worm parasitizes in various tissues and organs of humans and farm animals. It is a liquid-filled capsule. Medicine knows of cases when an echinococcal cyst in the liver of animals reached a weight of more than 60 kg.

Echinococcus granulosus is the most dangerous form of tapeworm for humans. Eggs that enter the body gradually turn into embryos, which, with the help of hooks, penetrate the intestinal walls into the general bloodstream. The development of embryos occurs very slowly. That is, the symptoms of infection may not make themselves known for many years. But as soon as the parasite begins to grow, painful symptoms appear. Treatment is long and complex, usually surgical.

[ 73 ], [ 74 ], [ 75 ], [ 76 ], [ 77 ], [ 78 ]

Diagnostics echinococcus

Several methods are used to detect parasitic infection with echinococcus. Diagnostics should be comprehensive, since the helminth can be found in any organ. Diagnostics is based on anamnesis, laboratory and instrumental methods.

Let's look at the main procedures used to detect tapeworm:

• Ultrasound examination of abdominal organs.
• Ro-graphy of the lungs is performed to detect single and multi-chamber cysts.
• Computed tomography.
• Serological studies – to detect antibodies in the blood with the reaction: ELISA, RNGA, RNIF with a specificity of 80% and increased sensitivity of 98%. In patients with suspected parasites and detection of cysts, specific antibodies are detected in the blood.
• Complete blood count and blood biochemistry.
• Helminthological tests for echinococcus are performed when the bladder breaks into hollow organs to identify the worm's scolexes.

[ 79 ], [ 80 ], [ 81 ], [ 82 ], [ 83 ], [ 84 ], [ 85 ]

Analysis for echinococcus

To detect tapeworm in the human body, many methods are used, both instrumental and laboratory. Echinococcus analysis is carried out at the slightest suspicion of infection. The human immune system reacts to a foreign organism by synthesizing specific IgG and IgM antibodies. The body is unable to cope with the parasite on its own, so it requires treatment. To confirm echinococcosis, the patient's blood is tested for the presence of IgG antibodies.

• This examination is prescribed by an infectious disease specialist, allergist, therapist or surgeon. The main reason for its implementation is non-specific complaints of the patient (headaches, discomfort in the right hypochondrium, etc.).
• A routine analysis for echinococcus is recommended for people from the risk group. Such groups include veterinarians, livestock specialists, shepherds, and dog handlers. This is due to the fact that the main source of infection is dogs and animals from the canine family.
• The analysis is performed in an immunological laboratory. For diagnostics, 3-4 ml of blood from the cubital vein is required. This study does not require specific preparation. Such an analysis should be regularly taken by patients with a confirmed disease to assess the effectiveness of therapy.

As for the interpretation of the results, normally this is a negative indication. If antibodies are detected, this indicates the presence of a helminth. It is worth remembering that antibodies are produced only 1.5-2 months after the suspected infection. Negative results are a reason to conduct a number of additional studies on opisthorchiasis, toxocariasis, trichinosis and other helminthiases.

[ 86 ], [ 87 ], [ 88 ], [ 89 ], [ 90 ], [ 91 ], [ 92 ]

Antibodies to Echinococcus

Laboratory analysis for antibodies to echinococcus is the main method for detecting tapeworm. The presence of IgG antibodies allows for a confident diagnosis of helminthic infection. But such analysis has a significant drawback: its sensitivity depends on the localization of parasitic bladders and the general state of the human immune system. The examination also takes into account the epidemiological history, i.e. contact with animals, living in endemic areas, and eating unprocessed foods.

To detect antibodies, a blood test is taken from the patient. The study takes 3-5 days, after which the following result can be obtained:

• Positive - this is an infection with echinococcus. But false positive results are also possible with non-specific antibodies. This occurs with liver damage, lungs or cancer. False positive results also appear in the presence of other helminthiases (opisthorchiasis, cysticercosis, fasciliosis).
• Negative – the parasite is not detected. This result is possible with a low antibody titer in the early period of the disease, when the cyst is small.

[ 93 ], [ 94 ], [ 95 ], [ 96 ]

Ultrasound

Diagnosis of echinococcosis is a long and labor-intensive process that involves multiple instrumental procedures. Ultrasound is a non-invasive examination. It can be used to identify the location of the parasitic cyst and its size. The method is used to examine organs and systems if helminthiasis is suspected.

Ultrasound diagnostics is effective in studying the condition of abdominal organs. It allows to establish enlargement of the liver, spleen, kidneys, the condition of affected organs and the presence of cystic formations. This method reveals parasitic disease at the earliest stages, when laboratory tests give false results.

Treatment echinococcus

Elimination of parasitic infection by echinococci is a complex process that requires a serious diagnostic approach. Treatment depends on the localization of the biohelminth, its size and stage of development.

Let's consider the main methods of eliminating the worm:

• Surgical is the main method of treatment, which involves removing the echinococcal cyst from the body. The parasite capsule can be removed entirely, that is, with the shell, or opened with the removal of the contents.
• Conservative - treatment is carried out with antiparasitic drugs. This is necessary to prevent the seeding of the tapeworm before and after surgery. This method is used in combination with surgery, since it is ineffective on its own.
• Symptomatic therapy – used to eliminate local manifestations of echinococcosis. Patients are prescribed antihistamines, hepatoprotectors, antitussives and others, depending on the symptoms.

Echinococcus tablets

In the treatment and prevention of helminthic infestation, special attention is paid to medicinal methods. Tablets for echinococcus are antiparasitic drugs that are prescribed in such cases:

• The presence of contraindications to surgical intervention (multiple organ damage).
• Positive serological reaction, but absence of cystic neoplasms according to the results of instrumental examination.
• Risk of contamination after or during surgery.

Tablets are selected individually for each patient. The most effective drugs are:

1. Nemozol is prescribed to adult patients weighing over 60 kg. Tablets are taken at 400 mg 2 times a day. If the patient's weight is less than 60 kg, the dosage is calculated as 15 mg per kg of body weight. The maximum daily dosage should not exceed 800 mg. The duration of treatment is three full cycles with a break of 1-2 weeks.
2. Gelmadol is one of the most powerful drugs against tapeworms. For recovery, take 10 mg/kg 2-3 times a day. The therapy consists of three cycles of 28 days each, with a break of 14 days.
3. Mebendazole is prescribed for children from one year of age and adults. Therapy is carried out according to the scheme: 1-3 days 400 mg 2 times a day, 4-6 days 500 mg 2 times a day. Subsequently, the dosage is increased to a maximum of 25 mg / kg per day. Treatment lasts 3-4 courses.
4. Akrikhin - used to treat children and adults. Tablets are taken after meals with plenty of liquid. The course of treatment lasts 4 days: 1 day 300 mg twice a day at intervals of 6 hours, 2-4 days 300 mg at a time. If the disease is complicated, the treatment lasts up to 7 days. For children, the dosage is selected individually, based on the child's weight.

When using medications, do not forget that each of them has a number of contraindications and can cause side effects. That is, treatment should be carried out only with a doctor's permission.

[ 97 ], [ 98 ], [ 99 ], [ 100 ], [ 101 ]

Folk remedies

Echinococcosis is rightfully considered the most dangerous parasitic disease with a long course. Folk remedies are effective in treating this disease. They have minimal side effects and contraindications. Such therapy can be used at the first suspicion of echinococcosis.

Let's look at popular folk remedies:

1. To eliminate a live parasite, use dry lemon peel. Cut off a layer of peel from a fresh lemon and dry it. Grind it into powder and take 1 teaspoon per ½ glass of hot water. The medicine should be taken daily, in the morning before meals.
2. Another effective remedy for treating echinococcosis is wormwood. The parasite embryos die from this plant. Similar properties are possessed by mustard seeds, horseradish, cinnamon, black pepper (peas) and garlic.
3. Ginger has medicinal properties. Dry ginger should be ground into powder and diluted in 50 ml of milk or warm water. The medicine is taken every other day until the symptoms of the disease disappear.
4. A mixture of dried herbs of wormwood, cloves and tansy allows you to quickly and effectively cure the disease. You need to prepare a powder from the herbs and take it 3 times a day, one teaspoon before meals. The therapy lasts up to 10 days, repeated every three months.
5. The most well-known and accessible remedy for treating tapeworm is garlic and lemon with honey. To prepare the medicine, you need to grind 2 heads of garlic and a whole lemon, mix them with 50 g of honey and dilute in a liter of boiled water. The remedy is infused for 6-8 hours and taken 30 ml every morning before meals.

When using folk therapy, do not forget that such methods are suitable for destroying the parasite at the embryonic stage. Treatment of adult individuals is carried out only by surgical methods.

[ 102 ], [ 103 ], [ 104 ], [ 105 ]

Echinococcus removal surgery

The surgical method is the only effective way to eliminate parasitic infection of the human body.

1. The operation to remove echinococcus involves removing the cyst with its capsule and surrounding tissues that have undergone pathological changes. Cysts are removed if they are small and located on the surface of the organ.
2. If the cyst is located deep in the organ tissue, a different surgical approach is used to avoid complications. It involves puncturing the capsule and sucking out its contents. The cyst is carefully cleaned, treated with a formalin solution and sutured. The operation must be performed very carefully. Since when the cystic fluid flows out, many echinococcal eggs enter the body, which are ready to affect any organs and systems.

Echinococcectomy does not involve large organ resections, as this increases the risk of relapse. In case of multiple echinococcosis, the operation is performed in several stages. First, the doctor removes the most dangerous cysts. There should be an interval of 3-6 months between each stage of treatment to allow the body to recover. During this therapy, the patient is prescribed antibacterial agents to prevent suppuration of the biohelminth capsules.

In any case, surgical intervention significantly disrupts the functioning of the damaged organ. Therefore, it is very important to approach the rehabilitation process after surgery correctly and restore the affected organ as much as possible, preventing relapses of the disease. Recurrence of echinococcus is a complication of a previous disease or surgery. This happens in 15% of patients.

After the operation to remove echinococcus, the patient will have a recovery period (2-4 months), which involves following the following doctor's orders:

• Taking anthelmintic drugs.
• Regular examinations of the body (blood tests for antibodies to echinococcus, ultrasound, X-ray, CT, general blood and urine tests, blood biochemistry) for 10 years after surgery.
• Strict observance of personal hygiene.
• Eating food only after thorough heat treatment.
• Limit contact with animals that may lead to re-infection with helminths.
• Quitting smoking and drinking alcohol, daily physical activity, proper nutrition.

The recovery period is very important, so in the first 2-6 months after treatment it is necessary to avoid psycho-emotional stress and nervous experiences. Minimize heavy physical activity. After surgery, women are not recommended to become pregnant for a year.

If the patient had liver echinococcosis, then for recovery he is prescribed diet No. 5a and drugs for restoration of organ cells (Enerliv, Essentiale and other essential phospholipids). During lung surgery, special breathing exercises are indicated to improve organ ventilation. After surgical treatment of echinococcus in the brain, patients are prescribed medications that improve cerebral circulation (Piracetam, Actovegin), physiotherapy, psychotherapy.

Prevention

Infection with the tapeworm Echinococcus granulosus is easier to prevent than to cure. Prevention depends on the characteristics of a particular parasitic focus. The most effective preventive methods are those aimed at eliminating the routes of transmission of the pathogen from stray, wild and farm animals to domestic ones. Thus, if you do not feed dogs the organs of cattle infected with tapeworm, then the route of infection to humans will be stopped.

Let's look at effective methods of preventing echinococcosis:

• Washing hands after contact with animals, working on the land, picking vegetables, herbs and fruits.
• Do not allow pets, especially dogs, into the bed or kitchen where people dine. Feed the animal only from dishes designated for this purpose.
• When carrying out excavation work associated with dusty air, use respirators or gauze bandages.
• Wash vegetables, fruits, berries, and greens thoroughly if eaten raw. Do not drink water from open bodies of water or consume raw milk.

[ 106 ], [ 107 ], [ 108 ], [ 109 ]

Forecast

The outcome of the treatment of a parasitic disease depends on the timeliness of its diagnosis. If the helminth was detected at an early stage and all measures were taken to eliminate it, then the prognosis is favorable. The prognosis worsens significantly if the disease is detected at the complication stage, when the worm has affected the internal organs, and the cysts have reached large sizes. In this case, even surgical intervention does not guarantee recovery, since there is a high risk of death. If calcification of the parasitic bladder has occurred, then self-healing is possible.

Echinococcus is a dangerous parasite, infection with which can lead to death. Preventive measures and awareness of the ways of infection with helminths are the only way to avoid echinococcosis.

[ 110 ], [ 111 ]