Alveococcosis

Alveococcosis - serious chronic disease of progressive flow characterised by development in a liver solitary or, much more often, plural parasitogenic cystic formations, capable to infiltrative growth and an innidiation in or organs.

Aetiology. Alveococcosis originators - a larval stage alveococcus tapeworm Echinococcus multilocularis (Leucart, 1863, Abuladse, 1960), and also Echinococcus vogeli and Ech. oligarthrus. Puberal form Ech. multilocularis-tsestoda in length 1-4,5 mm, consisting of a head, a neck and 2-6 segments. The human is mediate master. The larval stage of this helminth represents a conglomerate of fine blisters growing exogenously and infiltrative of a tissue of master. The lumen of blisters is filled by viscous fluid in which scolexes are sometimes found.

Epidemiology. An alveococcosis - disease is natural focal. Precinctive locuses are Central Europe, Alaska, Norrn Canada. Ech. vogeli and Ech. oligarthrus meet in Central and South America. The definitive master alveococcus tapeworm are foxes, polar foxes, dogs, cats in which small bowel puberal forms parasitize. Mature eggs and segments filled with eggs, are excreted in an external environment with excrements of animals. The human is infested at hunting, processing of skins of killed animals, care of dogs, collecting of baccas and grasses.

Pathogenesis. Pas of diffusion of oncospheres to a human body same, as at an echinococcosis. Features of alveococcus are infiltrative growth and ability to an innidiation that pulls toger given disease with malignant tumours. Initially liver is always amazed, knot is more often localised in its right lobe. The knot dimensions vary from 0,5 to 30 sm and more in diameter, probably solitary and multinodal lesion of a liver. The parasitogenic knot sprouts in cholic ducts, a diaphragm, a nephros, bones. In amazed organ dystrophic and atrophic changes, a stroma fibrosis educe. Indemnification of function of an organ is reached at expense of a hypertrophy of unaffected departments of a liver. The mechanical icterus, in serotinal stages - a biliary cirrhosis educes. In a case necrotisation parasitogenic knot in its central departments lumens with ichorous or purulent contents are formed. In a disease pathogenesis play a role, besides mechanical factors, immunologic and immuno - pathological mechanisms (formation of autoantibodies, an immunosuppression).

Symptoms and flow. Alveococcosis is taped mainly at persons young and middle age (30 - 50 years). Sometimes many years disease proceeds asymptomatically (a preclinical stage), that can be caused slow growth of a parasite, genetical features of immunodefence of indigenous population in precinctive locuses.

In clinically expressed stage semiology is not specific and is defined by volume of a parasitogenic lesion, its localisation and presence of complications. Excrete an early, uncomplicated stage, a stage of complications and a disease end-stage.

In an early stage periodic aching pains in a liver, sense of gravity in right hypochondrium, in epigastriums are observed. At superficial strains-positions parasitogenic knot is palpated in form of a dense field of a liver. Early appear a hyperproteinemia with a hypergammaglobulinemia, acceleration Erythrocyte Sedimentation Rate. In an uncomplicated stage of an alveococcosis painful syndrome slowly progresses, join dyspeptic disorder. The liver is enlarged, at a palpation fields of petrous density can be defined. Unaffected fields of a liver it is compensatory are enlarged, have densely - elastic consistence. Are taped a changeable eosinophilia (to 15 %), sharp acceleration Erythrocyte Sedimentation Rate. Indicators of a thymol turbidity test, S-jet protein are enlarged, disproteinemia is expressed: a hyperproteinemia (to 100-110 gramme/litre), a hypoalbuminemia, a hypergammaglobulinemia to 35-60 %. Hemorrhagic implications on a type vasculitis are quite often observed. In a stage of complications mechanical icterus more often educes, is a little bit more rare (at knot germination in portal pots or inferior, a vena cava) - a portal or caval hypertensia. At formation in knot of lumens of disintegration re are cold fits, a fever, liver abscess, a purulent cholangitis can educe. At lumen dissecting can be formed bronhco - hepatic, pleuro - hepatic fistulas, to educe a peritonitis, a pleuritis, a pericarditis. The innidiation of alveococcus testifies to far come process and its malignant flow. More often metastasises are found in lungs, a brain, is more rare - in a nephros, bones.

More than at 50 % of patients renal syndrome - a proteinuria, a hematuria, a pyuria, a cylindruria is observed. Genesis of lesions of nephroses is bound to an organ prelum from outside or at expense of growth of metastasises, disturbance of a renal blood flow and a passage of urine with development of an infection contamination of urinary pas. Apposition of immunopathological processes conducts to formation of a chronic glomerulonephritis, a system amyloidosis with chronic renal insufficiency.

In an illness end-stage irreciprocal metabolic disturbances, a cachexia educe. Excrete slowly progressing, activly progressing and malignant clinico-morphological forms of illness. More hardly and quickly disease at visitors in precinctive locuses, persons with an immunodeficiencyy (primary and secondary), in pregnancy proceeds and at its discontinuing, at serious intercurrent diseases.

Diagnosis and differential diagnosis. Diagnosis is based on analysis of epidemic anamnesis, given clinical - laboratorian and tool researches. Radiological, ultrasonic methods, a computer tomography, NMR allow to estimate degree of a lesion of organs. The parenchyma state estimates by means of research tracer techniques. The laparoscopy can be used for an aim biopsy of knot of alveococcus. The differential diagnosis is spent with an echinococcosis, a liver polycystosis, a neoplasm, a cirrhosis, a hemangioma. The definitive diagnosis is established on basis of an assessment of results of histological and serological researches. Are used reaction latex - agglutinations, IHA, ELISA.