Coeliac paragonimiasis

Introduction to abdominal paragonimiasis Celiacparagonimiasis is an immune disease caused by Paragonimus infection. It is the cystic sac of Paragonimus that enters the abdominal cavity, lungs, central nervous system and other tissues and organs through the intestinal tract. The antigen induces the corresponding immune response and immunopathological changes in the body. Since Paragonimus is mainly caused by lung parasitism, it is known as paragonimiasis. In 1930, Chinese scholars first reported two people infected with paragonimiasis in Lanting, Shaoxing County, Zhejiang Province. Since 1952, domestic scholars have conducted a large number of investigations on the etiology, epidemiology, pathology and clinical aspects of Paragonimus infection. Many new species and new epidemic areas have made great achievements in prevention and treatment. basic knowledge The proportion of illness: 0.0003%-0.0005% Susceptible people: no special people Mode of infection: digestive tract spread Complications: liver

The cause of abdominal paragonimiasis

(1) Causes of the disease

The pathogen of abdominal paragonimiasis is Paragonimus, which is mainly parasitic in the human lung. The eggs are released into the edulis in the water after excretion with sputum or feces, and then invade the first host (fresh snail). The scorpion scorpion, the scorpion scorpion invades the second host (crustacean) and develops into a cystic mites. People are eating uncooked freshwater crabs and crickets with sacs, prawn, or semi-cooked sacs. Wild animal meat, or raw water that is contaminated by sacs, is infected.

(two) pathogenesis

Paragonimiasis worms or adult colonization can cause mechanical damage, and antigenic substances such as worm body metabolites can cause immune pathological reactions in the body.

Basic pathology

(1) Pathological changes caused by child worms: When a person swallows a freshwater crab or cockroach containing live sac, the sac is swallowed by the action of the digestive juice, the wall of the sac is dissolved, and the cercaria escaping, with its powerful muscle contraction. The products secreted by exercise and its glands destroy human tissue, penetrate the intestinal wall and enter the abdominal cavity, and migrate in the abdominal cavity to damage the abdominal organs, tissues, and produce a wide range of inflammation and adhesion. Most of the worms pass through the scorpion and swim in The thoracic cavity stimulates the pleura to produce pleural inflammation. The larvae gradually grow into adult worms during the migration process, and finally enter the lungs to form cysts. Each cyst usually contains two adult worms. The Sichuan (or S. s.) paragonimiasis is in the process of migration. The damage caused by the larvae is significantly higher than that of Paragonimus sinensis. The local and systemic reactions are relatively strong. The insects cannot develop into sexual maturity and lay eggs in the human body, and rarely enter the lungs to form cysts. Therefore, the migratory subcutaneous mass is Exudative peritonitis, pleurisy is the main lesion.

(2) Adult-derived lesions: The number of adults parasitic in the human body is generally less than 20, or more, the adult is fixed in a certain part of the human body, and can also travel along the loose tissues to cause disturbances. The scope is enlarged and spreads to more organs. The worm body can be lifted from the mediastinum, and the loose tissue around the large blood vessels of the neck rises along the internal carotid artery, enters the cranial cavity through the ruptured hole, and invades the brain tissue, but Sichuan (or Sis) Intracranial damage caused by schistosomiasis is caused by invasion of child worms.

The basic pathological process of Paragonimus infection can be divided into three phases:

1 tissue destruction period: the worm body migrates through the tissue, which can cause linear hemorrhage and necrosis, thus causing local tissue to form cave-like lesions.

2 cyst formation period: shortly after the formation of cave-like lesions, the surrounding tissue responded, inflammatory reaction mainly caused by neutrophils, eosinophils and monocytes infiltration, local tissue necrosis, liquefaction was tan, surrounded There is granulation tissue hyperplasia, and gradually form a fibrous cyst wall, which constitutes a special lesion of this disease, called a paragonimus cyst. The capsule contains a tan-colored viscous liquid, sometimes the worm body can be found, and the eggs are visible by microscopy. Xiaco crystals, eosinophils, etc., due to the migration habits of adults, the worms can leave the cysts and form new cysts in the vicinity, becoming multi-atrial cysts, with tunnels or caves in communication with each other.

3 fiber scar period: When the cystic body moves to or disappears, the contents of the capsule are discharged or absorbed, and the surrounding granulation tissue and fibrous tissue continue to proliferate to the center, so that the entire cyst is completely replaced by fibrous tissue, forming a scar, and Calcification is rare in schistosomiasis lesions.

(3) lesions caused by eggs: Paragonimiasis eggs can be found in the tunnel between the cysts, and also in the tissues through which the adults walk through. Because the eggs cannot develop in the human body, they do not secrete soluble antigens, thus causing The tissue reaction is mild, only mechanical or foreign body stimulating, belonging to a foreign body granuloma reaction.

2. Major organs, pathological changes in tissues

(1) Abdominal cavity: When the worm moves in the abdominal cavity, it can cause a wide range of inflammatory reactions and adhesions, and at the same time form cysts. Many of them can have more than 200 cysts, some scattered throughout, and some aggregated. The surface of the abdominal cavity is rough and uneven. The serosal surface of the small intestine is congested, exuded, and has varying degrees of adhesion. Occasionally, a small amount of ascites may occur, and the liver may cause certain damage. The liver may be infected by Paragonimus sinensis. There are dystrophic changes, cell infiltration in the portal area, and mild hyperplasia of interstitial fibrous connective tissue. Sichuan (or S. striata) parasites often invade the liver, and the surface of the liver can be seen through the sinus or wormholes, liver tissue. Acute eosinophilic abscesses and areas of flaky or banded hemorrhagic necrosis can be seen, sometimes with worms.

(2) Thoracic cavity: After the worm enters the thoracic cavity, it often causes exudative pleurisy in the early stage. The pleural thickening is long, and scattered or agglomerated cysts can be seen in the hypertrophic pleura and pleural surface. The most invasive organ of trematode, the main lesion is the formation of cysts, most of which are located in the mediastinum or the subpleural layer of the lungs of the two lungs, as well as in the shallow lung tissue. The cysts are small, such as rice grains, and the larger ones can be up to 2 cm in diameter. Among them, eggs, worms or adults can be found. If the worm invades the bronchus, it can cause bronchiectasis, bronchopleural fistula and pneumothorax. Sichuan (or S. sinensis) infection in the lungs rarely find eggs.

(3) Brain and spinal cord: Some larvae can still go up the internal carotid artery, through the outer hole of the carotid artery, the upper part of the carotid artery and the rupture hole into the concave cavity. After the worm enters the cranial cavity, it can be moved into the brain tissue. Causes tissue destruction, hemorrhage and inflammatory cell infiltration, and the formation of multi-atrial cysts, nodules and scar tissue, etc., the worm body invades the brain from the bottom of the temporal lobe or occipital lobe, and can later invade the white matter, the inner capsule, the basal ganglia and Lateral ventricle, more common in the right brain, because the lesion is space-occupying, can block the ventricle pathway, leading to ventricular collapse or enlargement, as well as optic nerve compression, etc., a large number of eggs can be seen in the cyst, sometimes visible worms, such as When the worm enters the spinal canal and invades the dura mater, it can form an epidural or intradural cyst lesion, which is more common in the 10th thoracic plane. Individual cases can also affect the level between the neck and the chest.

In addition, some larvae can still be subcutaneous, muscle, eyelids, pericardium, etc., but ectopic parasitic larvae can not mature and lay eggs, from infection to adult spawning takes 2 to 3 months, adults survive more than 5 to 6 years The elderly can reach 20 years.

Prevention of abdominal paragonimiasis

1. Prevent human infections Extensive publicity and education in endemic areas, remove raw food or half-food crabs, habits of hail, do not drink streams and raw water.

2. Control the source of infection Thoroughly treat patients and livestock with this disease, and kill animals that are harmful to humans or host.

Complications of abdominal paragonimiasis Complications

Due to its multiple organ damage, the comorbidity of the disease is also often due to the diversity of the insects, parasitic parts and infections of the patients. The prognosis of a general infected person is not a threat to life, but the prognosis of a brain type is poor and can cause disability. The Sichuan (or S. sinensis) paragonimiasis invades the brain and is less light than Wei's and is less likely to recover from sequelae. The prognosis is better. Abdominal pain is more common in the right lower abdomen, and the severity is different. There may also be diarrhea, liver, bloody stools or sesame sauce in which you can find adult or insect eggs. Physical examination abdominal tenderness, occasional liver, spleen lymphadenopathy and abdominal nodules, lumps or abdominal abdomen lumps like sac sexy, the number varies, diameter 1 ~ 4cm. Paragonimus in Sichuan often forms eosinophilic abscesses in the liver, leading to abnormal liver and liver function.

Symptoms of abdominal paragonimiasis Common symptoms: fatigue, night sweats, abdominal tenderness, ascites, low fever, abdominal pain, abdominal mass

Abdominal paragonimiasis is a systemic disease characterized by pulmonary lesions. The clinical manifestations are complex, the symptoms are related to the invasive species, the affected organs, the degree of infection, the body reaction and other factors. The onset is slow, due to the exact date of infection. Many do not know, so the incubation period is difficult to infer, the elderly for more than 10 years, the short is only a few days, but most of them in 6 to 12 months, patients may have low fever, cough, cough, peach-like phlegm and blood stasis, fatigue, night sweats, appetite Clinical manifestations such as lack of vibration, abdominal pain, diarrhea or urticaria may be classified into 4 types according to the main organs invaded.

Lung type

The lung is the most frequently parasitic part of Paragonimus sinensis. The symptoms are cough, blood stasis and chest pain. The typical sputum is jam-like sputum. For example, with lung necrosis, it is rotten peach-like blood stasis. 90% of patients can repeat Hemoptysis, after years, sputum can find eggs, when Paragonimus migrates into the chest, often cause chest pain, exudative pleural effusion or pleural hypertrophy, Sichuan paragonimus infection, cough, blood stasis is rare Chest pain, pleural effusion, a small number of patients may have urticaria or asthma attacks.

2. Abdominal type

Abdominal pain is more common in the right lower abdomen, light and heavy, but also diarrhea, liver, bloody stool or sesame-like stool, in which you can find adult or insect eggs, after the emergency, the weight is obvious, physical examination abdominal tenderness, occasional liver, spleen Lymph node enlargement and abdominal nodules, lump or ascites, abdominal masses like sacs are sexy, the number varies from 1 to 4 cm. Paragonimus in Sichuan often forms eosinophilic abscesses in the liver, leading to liver and liver function. abnormal.

3. Brain type

It is often caused by Paragonimus vaginalis. It is more common in children and young adults. Its incidence in epidemic areas can be as high as 2% to 5%.

(1) Symptoms of increased intracranial pressure: such as headache, vomiting, slow consciousness, optic disc edema, etc., more common in early patients.

(2) Destructive symptoms of brain tissue: such as sputum, aphasia, hemianopia, ataxia, etc., generally appear later.

(3) Irritant symptoms: such as seizures, visual hallucinations, abnormal limbs, etc., are caused by lesions close to the cortex.

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

4. Nodular type

It is more common in Sichuan paragonimiasis, and its incidence rate is 50%-80%, which can occur in the abdomen, chest, back, groin, thigh, scrotum, head and neck, eyelids, etc., soy beans to duck eggs, nodules are typical eosinophils Granuloma, which has Charcotyl crystallization or can find worms but no eggs. About 20% of patients with Paragonimus can have this sign. The nodules are mostly located in the lower abdomen and the subcutaneous or deep muscles of the thigh. 6cm in size, isolated or in series, with Charcot's crystal, worm or egg in the nodule.

Examination of abdominal paragonimiasis

1. Blood routine white blood cells (10 ~ 30) × 109 / L, acute phase can reach 40 × 109 / L; eosinophils generally increase, generally in 5% to 20%, acute phase can reach more than 80%, but addicted The increase of acid granulocytes was not proportional to the severity of infection, and the increase of late cases was not obvious. The blood changes of Paragonimus infection in Sichuan were significantly higher than that of Paragonimus.

2. The erythrocyte sedimentation rate is moderate or high growth rate.

3. Pathogen examination

(1) sputum smear method: sputum sputum infection is often rust-colored, microscopic examination of eggs, eosinophils and Charcot's crystal, Sichuan paragonimus infections are often in the sputum Eosinophils and Charcot's crystals, rarely found eggs.

(2) Fecal smear method: 50g of fecal sample is filtered through 100 mesh pore size stainless steel sieve, the feces are filled into the quantitative central hole, filled and scraped, and the quantitative plate is removed to cover a soaked glycerin-malachite green solution. Hydrophilic cellophane, gently flattened with a rubber stopper, so that the feces are evenly spread to the edge of the cellophane, and then examined at room temperature of 30 ° C overnight, and 15% to 40% of the infections of Paragonimus vaginalis are positive. Paragonimus infections are rarely positive.

4. Examination of body fluids

(1) Cerebrospinal fluid examination: Eosinophils can be seen in the cerebrospinal fluid of patients with brain type, protein content is slightly increased, and others are normal.

(2) Ascites and pleural effusion examination: Ascites and pleural effusion are grass yellow or blood color, occasionally Charcot's crystal, cholesterol crystal or egg.

5. Immunological examination

(1) Intradermal test: 0.1 ml of the adult worm antigen of 1:2000 was injected into the forearm skin, and the results were observed for 15-20 min. If the local papule diameter was 1.2 cm, the blush was greater than 2.5 cm.

The intradermal test is simple and easy to operate, and the observation result is rapid. It is used for screening in patients in the epidemic area, and the skin test is positive, and further examination is confirmed by other methods.

(2) Posterior tail membrane test

(3) Serum immunological test: agar diffusion test, indirect immunofluorescence test, convection electrophoresis test, enzyme-linked immunosorbent assay, etc.

Intradermal test, posterior decidual membrane test, complement test and other sensitivities are more than 95%, but the specificity is not high, and cross-positive reaction with schistosomiasis, clonorchiasis, ginger schistosomiasis, etc., and enzyme-linked immunosorbent assay The test has high sensitivity and specificity. Some scholars believe that if the enzyme-linked immunosorbent assay is positive and the other two immunological tests are positive, the disease can be diagnosed.

6. Histopathological examination of subcutaneous nodules or masses of pathological examination showed that eggs or worms, adults, typical eosinophilic granuloma can be seen in the subcutaneous mass caused by Paragonimus in Sichuan, and some patients can find worms, but from No eggs were found.

1. X-ray examination of patients with pulmonary symptoms often have chest X-ray abnormalities.

(1) thickening of lung texture, pleural hypertrophy: insect eggs invade small airways, lymphatic vessels, etc., causing damage to the endometrium, congestion and expansion, wall thickening or fibrosis, lung texture thickening like a network, to The inner zone of both lungs is more common, and 90% of patients with pulmonary infection have this manifestation.

(2) Miliary or spotted shadows: Similar to blood-borne disseminated tuberculosis, but relatively few nodules, different sizes, blurred edges, single-room and multi-room translucent areas, some can be merged into pieces, mostly located in two The lower and middle lungs can be identified. The pathological basis of this type is pulmonary granuloma and allergic alveolitis, which are self-limiting and often resolve within 1 to 2 months.

(3) flaky shadow: caused by pulmonary hemorrhage or allergic pneumonia caused by the movement of the child's worm in the lungs, often absorbed after 1 to 2 weeks.

(4) patchy shadow: chronic paragonimiasis may have intrapulmonary lumps, clear edges, similar to inflammatory pseudotumor, caused by granulomatosis of paragonimiasis.

2. Skull CT can show lesions and obstruction.

3. Fiberoptic bronchoscopy is a new method for the diagnosis of abdominal paragonimiasis in recent years. Because a large number of eggs are deposited in the lung tissue and bronchial mucosa, mucosal congestion, edema, ulcer, bronchoconstriction and submucosal pale miliary knot can be seen. Section, biopsy tablets can be found in the paragonimiasis eggs.

Diagnosis and identification of abdominal paragonimiasis

diagnosis

1. Epidemiological data: Anyone who grows in the epidemic area of paragonimiasis or has passed the epidemic area, has eaten raw or half-lived crabs or crickets, or has a history of drinking water. The possibility of illness.

2. Clinical manifestations: early diarrhea, abdominal pain, followed by cough, fever, cough and rust color with pleural effusion, or with migratory subcutaneous nodules or masses, should consider parapneumococcal disease. If you have headache, epilepsy, convulsions, etc., you should consider the possibility of brain type of abdominal paragonimiasis.

3. Laboratory examination: The detection of eggs in cockroaches, feces and various body fluids is the basis for the diagnosis of abdominal paragonimiasis. For patients with subcutaneous nodules or masses, biopsy can be performed. Immunological tests such as intradermal tests and serological tests have the value of assisted diagnosis. Especially for the diagnosis of Sichuan (or St.) paragonimiasis.

4. X-ray and CT examination: suitable for patients with lung type and brain type.

Differential diagnosis

1. Tuberculosis Pulmonary type: Paragonimus infection is often misdiagnosed as tuberculosis because its early symptoms are similar to early tuberculosis, and the lung changes in the cystic stage are similar to those of spherical tuberculosis. When paragonimiasis invades the pleura and causes pleural effusion, it can be confused with tuberculous exudative pleurisy. Paragonimiasis infection can produce a wide range of peritonitis and peritoneal adhesions, and should be differentiated from tuberculous peritonitis. The above types of tuberculosis can be identified from epidemiology, laboratory tests, and the like.

2. Primary epilepsy: The epileptic symptoms of Paragonimus infection are similar to those of primary epilepsy. However, brain-type paragonimiasis infection has no history of epilepsy, and symptoms such as headache and limb weakness can last for several days after seizures; after primary seizures, symptoms can disappear within a few hours. In addition, there are eggs in the sputum, positive cerebrospinal fluid immunological examination, etc., can be identified as both.

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