Alveococcosis
The content of the article:
- Causes and risk factors
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Alveococcosis (multi-chamber or alveolar echinococcosis) is a parasitic disease caused by the larvae of the helminth Alveococcus multilocularis. Once in the liver, it forms a tumor-like formation with infiltrative growth, as well as the ability to metastasize to the brain, lungs and some other organs.
Alveococcosis is a relatively rare disease that affects young and middle-aged hunters. Natural foci of this helminthiasis are found in some regions of Russia (the Volga region, Western Siberia, Chukotka, Kamchatka, Yakutia), in Asia, Europe (Switzerland, France, Austria, Germany), the USA and Canada.
With alveococcosis, a parasitic tumor appears in the liver, capable of metastasizing to the lungs, brain and other organs
Causes and risk factors
Helminth Alveococcus multilocularis belongs to the flatworms of the Echinococcine subfamily. The larval stage of this parasite is dangerous for humans.
Helminth parasitizes in the intestines of cats, dogs, foxes, wolves, polar foxes (these are its main hosts). With animal feces, mature eggs of alveococcus enter the environment, after which they enter the body of nutria, river beavers, muskrats and mice (these are intermediate hosts of helminths). There he goes through the stage of larval development.
A person can also become an intermediate owner of an alveococcus. Infection occurs when eating herbs and berries contaminated with helminth eggs, communicating with pets, cutting animal carcasses during hunting.
Once in the human intestine, the larva of the alveococcus leaves the egg and enters the liver with blood flow. Here it turns into a bubble up to 5 mm in diameter. Subsequently, it is divided according to the principle of exogenous budding. Over time, this leads to the formation of a parasitic small-tuberous dense tumor in the liver; in advanced cases, its diameter can reach 35 cm or more.
General view of Alveococcus multilocularis
Parasitic formation exhibits the properties of malignant tumors. It can grow into the organs and tissues surrounding the liver (adrenal gland, right lung and right kidney, pancreas, diaphragm, omentum), as well as into blood and lymphatic vessels. Small bubbles budded from the primary tumor, getting into the vessels, break off and are carried through the body with the flow of lymph or blood. They settle in other organs (most often in the brain), where a secondary parasitic tumor develops. This process is called metastasis.
Disease stages
During alveococcosis, several stages are distinguished:
- Asymptomatic (preclinical). Can last up to 10 years. The disease is detected as an accidental diagnostic finding during the examination of a patient for another reason.
- Uncomplicated. The pathological process is localized in the liver, that is, the location of the primary tumor. Patients complain of digestive disorders.
- Complicated. It is characterized by the presence of metastatic tumors, significant dysfunction of a number of internal organs.
Symptoms
In the initial stage, which can last for many years, alveococcosis clinically does not manifest itself in anything. However, the development of the parasite is accompanied by allergization of the body, so the patient may be disturbed by frequent allergic manifestations (for example, itchy skin and skin rashes like urticaria).
Alveococcosis is characterized by pain in the liver, heaviness in the epigastrium, nausea and vomiting
As the tumor grows in the liver, the following symptoms appear:
- nausea, vomiting;
- bitterness in the mouth;
- loss of appetite;
- heaviness in the epigastrium;
- pain in the liver;
- growing weakness;
- weight loss;
- uneven abdominal enlargement associated with hepatomegaly (an increase in liver size);
- frequent attacks of hepatic colic.
When examining the liver, a dense tumor-like formation with a bumpy uneven surface is palpated.
With metastasis to the brain, the patient develops cerebral and focal symptoms:
- Strong headache;
- vomiting;
- dizziness;
- hemiparesis;
- Jacksonian seizures (Jacksonian epilepsy).
Diagnostics
Examination of patients with suspected alveococcosis begins with a thorough collection of an epidemiological history (occupational risk, living in an endemic area, processing carcasses and skins of wild animals, hunting).
At an early stage of the disease, positive allergic tests (for example, Casoni's reaction with an echinococcal antigen) play a diagnostic role, as well as an increase in the level of eosinophils in the blood. Specific tests for laboratory diagnosis of alveococcosis are different types of immunological reactions (ELISA, RLA, RIGA), PCR.
To determine the size and exact localization of the parasitic tumor in the liver, dopplerography, ultrasound of the liver, X-ray of the abdominal cavity are performed; Computed tomography has a high diagnostic value. In some cases, there is a need for diagnostic laparoscopy and liver scintigraphy.
Alveococcosis on ultrasound diagnostics
To identify the possible presence of metastatic tumors, ultrasound of the abdominal organs, MRI of the brain, and chest X-ray are performed.
Primary liver alveococcosis requires differential diagnosis with a number of other focal lesions of this organ:
- echinococcosis;
- cirrhosis;
- polycystic;
- hemangioma.
Treatment
With liver alveococcosis, surgical treatment is indicated, which must be supplemented with antiparasitic therapy.
A radical operation consists of resecting the affected area of the liver within healthy tissues. However, due to the significant prevalence of the pathological process, it can be performed in no more than 25% of cases. Therefore, in most cases, the parasitic neoplasm is excreted, followed by the infiltration of the surrounding tissues with chemotherapeutic drugs. In some cases, the destruction of the parasitic tumor by cryotherapy can be performed.
Possible complications and consequences
The most common complications of alveococcosis are:
- obstructive jaundice associated with compression of the tumor of the biliary tract;
- liver abscess resulting from the ingestion of pyogenic microflora into the cyst;
- portal hypertension, the development of which is explained by the compression of the growing tumor of the liver gate;
- peritonitis;
- purulent cholangitis;
- empyema of the pleura;
- ascites;
- gastric and esophageal bleeding;
- amyloidosis;
- chronic renal failure.
Forecast
The prognosis for alveococcosis is always serious. Without appropriate treatment, about 90% of patients die within 10 years. Lead to death:
- distant metastasis to the brain;
- infiltration of a tumor into neighboring organs with a violation of their functions;
- profuse bleeding;
- liver failure;
- purulent complications.
Prevention
Prevention of alveococcosis consists in careful veterinary supervision, deworming of domestic animals and extensive sanitary and educational work with the population of endemic areas.
Fur farm workers, hunters, herders and others at increased risk of infection should be regularly screened for alveococcosis.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
