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Abdominal paragonimiasis

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[Intro]

Overview: abdominal paragonimiasis (celiac paragonimiasis) and yield due to trematode infection caused by autoimmune diseases, is the paragonimus metacercariae through the intestinal tract into the abdominal cavity, lungs and central nervous system tissue and organ growth, parasites of different developmental stages of antigen-induced immune responses in the body to produce the corresponding and immune pathology. As the parasite paragonimus mainly to the lungs, so it is known as paragonimiasis.

1930, China's scholars, orchid Pavilion, shaoxing County, Zhejiang Province, the first report of two paragonimus infection. 1952 domestic scholars and paragonimus infections etiology, epidemiology, pathology and clinical etc made a lot of research and found many new species and new epidemic, and in the prevention and treatment has made great achievements.

[Cause]

abdominal paragonimiasis is what causes?

(a) causes

pathogens of abdominal paragonimiasis paragonimus metacercariae. paragonimus major parasites in the human lung, with its eggs after the first sputum or feces develop into miracidia in the water, and then invade the first host (freshwater snails) develop into cercariae, cercariae invaded 2 host (crustaceans animals) develop into metacercariae. People with eating undercooked freshwater crabs, and metacercaria

[Sign]

early symptoms of abdominal paragonimiasis what?

abdominal paragonimiasis is a lung disease based systemic diseases, clinical manifestations of a complex of symptoms and the severity of invasive insect species, organ involved, the extent of infection, the body response and other factors. Onset and more slowly, because many do not know who exactly the date of infection, it is difficult to extrapolate the incubation period, the elderly over 10 years, who only a few short days, but most in the 6 to 12 months. Patients may have fever, cough, cough and bloody sputum sputum samples rotten peach, fatigue, night sweats, loss of appetite, abdominal pain, diarrhea or other clinical manifestations of urticaria, according to different violations of the major organs, can be divided into four clinical types.

1. lung lung fluke paragonimus is the most common site of parasite, symptoms of cough, hemoptysis, chest pain the most common, typical of sputum was jam-like mucus such as necrotic tissue is associated with the lungs were rotten peach-like bloody sputum. 90% of patients can be repeated hemoptysis, after years of continuous, sputum, or can be found in eggs. When the migration into the chest of paragonimiasis, often causing chest pain, exudative pleural effusion or pleural thickening and other changes. Sichuan paragonimus infection, cough, bloody sputum and chest pain rare, pleural effusion more. A few patients may have hives or asthma attacks.

2. especially the right lower quadrant abdominal pain is more common, uneven, may also have diarrhea, liver, bloody stools, or sesame, or which can be found in adults or eggs, tenesmus obvious. Examination of abdominal tenderness, occasional liver, spleen, lymph nodes and abdominal nodules, lumps or ascites. palpable abdominal mass in the capsule seems sexy, ranging from the number, diameter of 1 ~ 4cm. Sichuan paragonimus often eosinophilic abscess formation in the liver, causing liver and liver dysfunction.

3. cerebral often caused by paragonimus flukes, common in children and young adults in endemic areas the incidence may be as high as 2% to 5%. Its performance:

(1) increased intracranial pressure symptoms: such as headache, vomiting, slow, optic disc edema, common in patients with early.

(2) brain tissue destructive symptoms: such as paralysis, aphasia, hemianopia, ataxia, etc., usually in late.

(3) irritating symptoms: such as seizures, visual hallucinations, abnormal physical sense, are caused by lesions close to the cortex.

(4) inflammatory symptoms: such as chills, fever, headache, meningeal irritation, etc., common in early disease.

4. nodules caused by paragonimus Sichuan and more common, the incidence rate of 50% to 80%, can occur in the abdomen, chest, back, groin, thigh, scrotum, neck, eyes and other parts of soybeans to the big duck. nodules typical eosinophilic granuloma, there Charcot crystals or worms can be found, but no eggs. About 20% of patients with paragonimus flukes may have the signs, nodules in the lower abdomen and thigh deep subcutaneous or intramuscular, 1 ~ 6cm size, isolated or clusters exist within the Charcot crystalline nodules, parasites or eggs.

1. epidemiological data where growth in the endemic area of ​​paragonimiasis endemic areas or have been to have the consumption of raw or undercooked crabs or clam mantis, etc., or drink had a history of health of the stream, there may be infected with this disease.

2. the early clinical manifestations of diarrhea, abdominal pain, followed by cough, fever, cough with rust-colored sputum pleural effusion, or migratory subcutaneous nodules or mass, are should consider this disease. If headache, epilepsy, paralysis, etc., should consider the possibility of this type of brain disease.

3. laboratory examination of sputum, feces and eggs found within the various body fluids is the basis for diagnosis of this disease. Subcutaneous nodule or mass on a patient, can Zuohuo histopathology. Immunological tests such as skin test and serology, have the value of diagnosis. Especially for Sichuan (or Steinmann) and the diagnosis of paragonimiasis more.

4.X ray and CT examination for lung and brain-based type of patients.

[Aftertreat]

abdominal paragonimiasis ate?

suitable food: fresh raw fish, raw and cooked food, regardless of treatment, metacercariae by chopping boards, knives, dishes and other contaminated food, sashimi, sashimi, sashimi style porridge. Fiber foods and gas production more and more foods such as celery, chives, bean sprouts, sweet potatoes, dry beans. alcohol and all the spicy and pungent foods.

suitable food: low-fat foods such as cereals porridge, buckwheat, taro, starchy dishes such as steamed sweet potatoes, sweet corn, potatoes, etc., drinking beverages containing vinegar , such as World No. One, low fat, low cholesterol diet, eat more zinc, magnesium-rich foods, vitamin C, should be light, soft, easy to digest, no stimulation of food.

diet: (1) black sesame porridge Poria: black sesame seeds 10 g, poria 15 grams, ginger, 3, 100 grams of rice. The ginger slices, poria mashed, soaked for half an hour later Jianqu concoction of fried twice. The two soup mixture, then cooked with rice and sesame seeds to porridge.

(2) lily porridge: lily 60 grams, 100 grams of rice, ginger, 3. The lily washed, chopped, with rice porridge.

(3) jen duck soup lotus medicine: lotus 50 grams, 500 grams of fresh duck, drug ren 100 grams. wash the fresh duck chopped into pieces, together with drugs jen leaves, add boiling water to rotten meat, no salt and other condiments, 2 times a day, each 250 ml, even for 10 to 14 days , a diuretic, swelling effect, the blood line of the water.

(4) elsholtzia porridge: elsholtzia 10 grams, rice 50 to 100 grams. elsholtzia first wash, dextrose water, to the residue, then add rice porridge.

(5) chixiaodou carp melon soup: fresh carp a treaty 500 grams, 100 grams red bean, melon 200 grams. Fresh carp to the scales will be gutted to the post with half-cooked red bean cooked with added melon 200 g, then cook until the white meat, rotten soup, no salt and other spices, cooked with a gauze filter to the residue. 2 times a day, 250 ml each time, even for 10 to 14 days. Can increase the plasma protein, has strong water swelling effect.

(6) garlic steamed watermelon: 60 to 90 grams of garlic, watermelon 1 about 1500 to 2000 grams. First in the watermelon rind with a knife dug holes in a triangle, into the watermelon, peeled garlic inside, and then digging a hole blocking melon Pusey, to hole up steam cooked. Eat garlic and West rang, hot dose, garlic has anti-bacterial and anti-inflammatory effect, eliminate watermelon hot hot weather, favorable water swelling function.

(7) steamed frog: frog 250 g, Onion, ginger and 3 grams, rice wine, salt, a little MSG. Skinning the frog to the internal organs, into the bowl, add water, add rice, onion, ginger, salt, cook until thoroughly cooked with fire. decoction and food, there is tonic diuresis effect.

(8) Fort wolfberries Nanzao eggs: date 10 South, West, medlar 30 grams, 2 eggs. The wolfberry, Nanzao wash, add water, simmer 1 hour into the eggs, cook for a moment, made of egg and serve. 2 times a day decoction and eggs. liver and kidney for AIDS.

(9) longan turtle stew yam: yam tablets 30 grams of dried longan meat 20 grams, a turtle (about 500 grams). First turtle at 45 ℃ warm water to drain urine, after being burnt to death to intestinal mixed and head claw; then with a band of meat, add water, and yam, longan meat, fried well-done. decoction and meat, yin deficiency is appropriate.

(10) Shouwu jujube boiled eggs: radix 20 grams, jujube 10, 2 eggs. The Radix, date, amount of water cook eggs, cooked eggs, peeled and cook, will cook to a bowl, seasoning to dregs again. 1 day, decoction eggs, and even served 15 days to 20 days. liver and stomach.

[Prevent]

abdominal paragonimiasis should be how to prevent?

1. to prevent human infection in endemic areas of extensive publicity and education, get rid of eating raw or undercooked crabs, clam mantis habits, not to drink unboiled water streams.

2. 控制传染源 thorough treatment of patients and animals suffering from this disease. Kill harmful to people or animal reservoir hosts.

3. cut off the transmission management manure, kill sputum, fecal eggs, to prevent the eggs into the water. Not raw crabs, raw clam mantis feeding dogs, cats, livestock to prevent infection.

[Treat]

abdominal paragonimiasis precautions before treatment?

1. to prevent human infection in endemic areas of extensive publicity and education, get rid of eating raw or undercooked crabs, clam mantis habits, not to drink unboiled water streams.

2. 控制传染源 thorough treatment of patients and animals suffering from this disease. Kill harmful to people or animal reservoir hosts.

3. cut off the transmission management manure, kill sputum, fecal eggs, to prevent the eggs into the water. Not raw crabs, raw clam mantis feeding dogs, cats, livestock to prevent infection.

Chinese medicine treatment of abdominal paragonimiasis

insecticide treatment

1. unilateral prescription:

(1) pija meat 30g, betel nut 15g, the gentleman 10g, water simmer in water, 1 / , 15 days for a course.

(2) pumpkin seed 30 ~ 60g, made from powder, 1 time / day, continued for 2 weeks.

2. unilateral prescription:

(1) ebony, Poria, hawthorn 12g, agrimony 30g, woody , flavescens, atractylodes 6g, betel nut, so that a gentleman of 9g, angelica 5g, water simmer in water, a / day, and even served a few days.

(2) sophora child, sunburn 100 each 6g, licorice 1.5g, water simmer in water, 1 / day, even for 5 days.

western medicine treatment of abdominal paragonimiasis

(a) treatment

1. anti-infection treatment

(1) praziquantel (praziquantel): praziquantel treatment of paragonimiasis drug of choice for all patients, for adults, schistosomula, eggs have a role in rapid oral absorption, 0.5 ~ 1.0h peak plasma concentration, drug concentration in portal blood 10 times in the peripheral blood, no savings effect.

adult patients with acute schistosomiasis dose 30mg / (kg · d), 3 times orally, even for 4 days, total dose of 120mg/kg. Adult patients with chronic lung fluke dose of 30mg / (kg · d), even for 2 days, total dose of 60mg/kg. brain of patients should be given two treatment interval of 1 week. side effects of dizziness, fatigue, palpitations, contraction, etc., but are mild.

(2) sulfur-chlorophenol (sulfur double-dichlorophenol): also known as other small (bitin), adult day 3g, children 50mg/kg, orally 3 times , for taking 15 days or 10 days between taking 20 to 30 days for treatment. Recently the cure rate of 84% to 100%, about 5% a year after the review of recurrence, can be the first two courses. Lower cure rates of brain spinal cord, which require 2 to 3 courses. This product is the main side effects are diarrhea, abdominal pain, nausea, vomiting and anal irritation and so on. Serious heart, liver, kidney disease and pregnant women should be banned or suspended treatment.

acute abdominal symptoms such as severe paragonimiasis may be appropriate to use of steroids.

2. symptomatic treatment of cough, chest pain can be applied antitussive and analgesic agent. epilepsy can be made by phenytoin, phenobarbital (Luminal) and diazepam (stability) and oral prevention. increased intracranial pressure can be applied dehydrating agent such as hypertonic glucose solution, 20% mannitol. paralysis can be used acupuncture and physical therapy, etc.

3. surgical treatment

(1) laparotomy: Most lung symptoms can disappear after drug treatment, but Some abdominal performance, especially abdominal mass and adhesion of colic, and often requires laparotomy to confirm the diagnosis.

where drug treatment does not work, no obvious surgical contraindications, indications for laparotomy are. After laparotomy, the adhesions between the bowel loops can be properly separated, if necessary, could be considered as a shortcut between the intestinal loop anastomosis, or adhesions break down in the intestinal loop was made after plication. Large cysts can pick out individual, a chronic inflammation or adhesions of the appendix or gallbladder removal may be considered, but the organ surface numerous small nodules is no satisfactory treatment, and can not be processed.

(2) mass resection: subcutaneous mass can be removed under local anesthesia. mass cut out parasites, such as no parasites can be diagnostic biopsy for reference.

[Examine]

abdominal paragonimiasis should be how?

1. blood leukocytes (10 ~ 30) × 109 / L, the acute phase up to 40 × 109 / L; eosinophils generally increased, usually in the 5 % to 20%, the acute phase of up to 80%. However, eosinophils increased out of proportion with the severity of infection, increased in advanced cases is not obvious. paragonimus infection in Sichuan and changes in blood compared with paragonimus flukes as significant.

2. erythrocyte sedimentation rate showed a moderate or high growth.

3. pathogen check

(1) sputum smear method: paragonimus flukes infected sputum fluid often has rust-colored, microscopic examination shows eggs, eosinophils and Charcot crystals. paragonimus infection in Sichuan and how often the amount of sputum eosinophils and Charcot crystals, rarely check see eggs.

(2) fecal smear method: fecal 50g by 100 mesh stainless steel screen filter pore size, the quantitative fecal residue fill the central hole, fill Calibrating, Remove quantitative plate, covering a saturated glycerin - malachite green solution of hydrophilic cellophane, gently flatten with a rubber stopper, so that fecal residue spread evenly to the edge of cellophane, overnight at room temperature 30 ℃ after the examination. paragonimus flukes infections, 15% to 40% positive, while the paragonimus infection in Sichuan and rarely positive.

4. humoral check

(1) CSF: cerebrospinal fluid of patients with cerebral eosinophils can check see cells, protein content increased slightly, the other normal.

(2) ascites and pleural effusion examination: ascites and pleural effusion was straw yellow or bloody, occasionally Charcot crystals, cholesterol crystals, or eggs.

5. immunology

(1) skin test: The adult paragonimus antigen 1:2000 0.1ml intradermal injection in the forearm, 15 ~ 20min observations, if the local papules diameter ≥ 1.2cm, flush greater than ≥ 2.5cm were positive.

skin test is simple, quick observation, survey patients in endemic areas for screening purposes, skin test positive, then further examination of other methods of confirmation.

(2) after the cercariae membrane test

(3) serological tests: There agar double diffusion test, indirect immunofluorescence test, convection electrophoresis test, enzyme-linked immunosorbent assay and so on.

intradermal test, after the cercariae membrane test, complement fixation test, etc. are more than 95% sensitivity, but specificity is not high, and schistosomiasis, clonorchiasis patients, fasciolopsiasis so there is cross-positive. The enzyme-linked immunosorbent assay has high sensitivity and specificity. Some scholars believe that such positive enzyme-linked immunosorbent assay together with other immunological test was positive in two of the disease can be diagnosed.

6. biopsy of subcutaneous nodule or mass in the pathological examination showed eggs or schistosomula, adults. Caused by the Sichuan paragonimus subcutaneous mass in the typical eosinophilic granuloma, some patients can be found in schistosomula, but never found the eggs.

1.X-ray examination of pulmonary symptoms, abnormal chest radiograph often.

(1) markings thickening, pleural thickening: a small egg tracheal invasion, lymphatic vessels, etc., to intimal injury, congestive expansion, wall thickening or due to fibrosis. lung markings like mesh, in order to step down within the lungs with more common lung infection in 90% of the performance.

(2) miliary, or patchy shadows: resembles hematogenous disseminated tuberculosis, but the relatively small nodules, sizes, edge blur, there are single rooms and multi- Housing translucent zone, partially integrated into the film, and more in the step down in the lungs and the inside, can be identified. This type of lung pathology is granulomatous and allergic alveolitis, more than a self-limiting, usually in 1 to 2 months subsided.

(3) patchy shadows: the migration of schistosomula in the lungs when the lungs caused due to bleeding or hypersensitivity pneumonitis, usually in 1 to 2 weeks after the absorption.

(4) chip block shadow: chronic pulmonary paragonimiasis film can have a block shadow, the edge was clear, a similar inflammatory pseudotumor for paragonimiasis granuloma caused.

2. head CT can show lesions and the site of obstruction.

3. bronchoscopy is a recent diagnosis of abdominal paragonimiasis new method, because a large number of eggs in the lung tissue and bronchial submucosal deposition, it is visible mucosal congestion , edema, ulcers, bronchial stenosis and submucosal pale miliary nodules, biopsy of lung fluke eggs can be found in tablet.

[Diff]

abdominal paragonimiasis diseases easily confused?

1. tuberculosis lungs paragonimus infection often misdiagnosed as tuberculosis, because of its early symptoms are similar and early tuberculosis, and cystic changes in the lungs but also with the period Ball is similar to tuberculosis. When violation of pleural paragonimiasis caused by pleural effusion, but also with tuberculous exudative pleurisy confused. paragonimus infection can produce a wide range of peritonitis and peritoneal adhesions, etc., should be differentiated from tuberculous peritonitis. From the above types of tb epidemiology, laboratory tests to be identified.

2. primary epileptic-type seizures paragonimus infection symptoms similar to idiopathic epilepsy. However, cerebral paragonimiasis infection no past history of epilepsy and seizures, the headache and limb weakness and other symptoms that last for several days; the primary seizures, the symptoms can disappear in a few hours. In addition, there are eggs in sputum, cerebrospinal fluid and other immunological tests positive, as both can be identified.

[Disease]

retroperitoneal fibrosis may be caused by the diseases?

retroperitoneal fibrosis-related diseases

retroperitoneal lipoma

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