Ascariasis

Introduction to tsutsugamushi Ascariasis is the most common parasitic disease caused by parasitic nematodes (Ascarislumbricoides) parasitic in the human small intestine or other organs. It is widely spread in the country and has many childhood diseases. The clinical manifestations vary greatly depending on the parasitic or invasive site, and the degree of infection varies greatly. It is called intestinal ascariasis only in the intestinal tract. Most intestinal ascariasis has no symptoms, and children often have varying degrees of gastrointestinal symptoms. When aphids enter the bile duct, pancreas, appendix and liver, or when the aphids migrate to the lungs, eyes, brain, thyroid and spinal cord, they can cause corresponding atopic lesions. In severe cases, cholangitis and pancreatitis can be caused. Complications such as appendicitis, intestinal obstruction, intestinal perforation and peritonitis. basic knowledge The proportion of children: the incidence rate of children is about 5% -10% Susceptible people: good for children Mode of infection: fecal-mouth transmission Complications: biliary ascariasis acute cholecystitis peritonitis aphid intestinal obstruction aphid acute pancreatitis biliary bleeding sepsis subgingival abscess insomnia epilepsy coma

The cause of tsutsugamushi disease

Dietary factors (60%):

Often caused by eating cold vegetables, melons, or other unclean things that are contaminated with locust eggs. The mites are parasitic in the small intestine, disturbing the spleen and stomach, and sucking the water valley. Because aphids have a warm temperature, aversion to cold, heat, good sputum, good at drilling, so when the spleen and stomach dysfunction, or systemic febrile illness, the mites are easy to smash in the abdomen and cause a variety of illnesses . If the mites are drilled into the biliary tract, the cardia, or the number of mites are large, and tangled in the intestine, a variety of lesions and symptoms appear.

Living habits (20%):

Other factors (10%):

Ascaria prevention

1. Control the source of infection: Expelling the mites in the human intestine is an important measure to control the source of infection. It should be actively discovered to treat patients with intestinal ascariasis, and regularly treat and treat susceptible people, especially kindergartens, primary schools and rural residents. If more than half of the infected people are found, they can be treated with general rule. 2 to 3 months after the peak of infection (such as winter or autumn), the body can be taken with deworming drugs, and the worms and feces should be treated in time to avoid polluting the environment.

2, pay attention to personal hygiene: develop good personal hygiene habits, wash hands before and after meals, do not drink raw water, do not eat unclean fruits; diligent nail cutting, no stool, etc., for restaurants and restaurants, etc., should be regular Carry out hygienic standardization inspections, and prohibit the production of beverages such as raw water.

3, strengthen the management of manure: do a good job of environmental sanitation, harmless treatment of manure, do not use manure to fertilize, do not graze pigs, use harmless human dung as fertilizer, prevent fecal contamination of the environment is an important measure to cut off the transmission of aphids In the area where water manure is used as fertilizer, the five-story three-storage method can be used to make the majority of the eggs in the feces settle at the bottom of the pool. Due to the action of free ammonia in the manure and anaerobic fermentation, the eggs can be killed. At the same time, it will also increase fertilizer efficiency, and use the biogas tank to ferment, which can not only solve the lighting of farmers, cook rice, but also facilitate the harmless treatment of manure. It can remove the dung residue once every six months. At this time, most of the eggs have lost their ability to infect. In areas where manure is used as a fertilizer, mud-filling composting can be used. After three days, the temperature in the manure can rise to 52 ° C or higher, which can kill the eggs.

Ascariasis complications Complications biliary ascariasis acute cholecystitis peritonitis aphid intestinal obstruction aphid acute pancreatitis biliary bleeding septic subgingival abscess insomnia epilepsy coma

Due to fever, spicy diet, anesthesia or improper use of anthelmintic drugs, parasitic environment changes, aphid activity increases, kinks into a mass can block the intestine, or drill into other organs and cause a variety of complications, half of which are fatal The main reason.

1. Biliary ascariasis: When the intestinal environment or the host's systemic condition changes, the aphid is stimulated to drill into the biliary tract and cause biliary ascariasis. This disease is one of the main complications of intestinal ascariasis, second only to appendicitis. Cholecystitis and perforated peritonitis, adults and children are more common, especially in young adults, more women than men, the common part of the mites is the common bile duct, followed by the left and right hepatic ducts, the least in the gallbladder, clinical Can be divided into the following types:

1 biliary colic type, the most common, caused by the aphid drilling into the ampulla of the duodenal wall caused by the biliary sphincter and common bile duct.

2 acute cholecystitis, aphid invading the gallbladder can cause gallbladder inflammation due to secondary bacterial infection or obstruction of the cystic duct due to aphid entering the gallbladder.

3 acute cholangitis, aphid drilling into the bile duct after abdominal pain is not relieved, and there is chills, high fever, suggesting secondary bile duct infection and acute cholangitis.

The clinical manifestations of typical biliary ascariasis include:

1 acute onset, the prominent symptom is paroxysmal severe pain in the upper abdomen, showing pain or colic, can be radiated to the back, shoulder, pain can basically disappear and there is a significant remission period.

2 often accompanied by severe nausea and vomiting, most patients can vomit bile and aphids.

3 Symptoms and signs do not match, that is, abdominal pain is not obvious when the pain is severe, and there is no obvious muscle tension.

4 A small number of patients do not relieve pain, and may be followed by bacterial suppurative infection.

5 Astragalus is rare, even if it has jaundice.

2, ascaris intestinal obstruction (ascaris intestinal obstruction): more than 10 intestines can be entangled in the small intestine and cause mechanical intestinal obstruction, this disease is more common in children with severe infection, more than 60% are under 10 years old Among them, the incidence rate is the highest in those under 2 years old, the intestine obstruction is mostly incomplete intestinal obstruction, the obstruction is mostly in the lower part of the ileum, and the aphid intestinal obstruction is usually abdominal pain, vomiting, abdominal distension, stopping the stool and exhausting, dehydration. Acidosis and electrolyte imbalance, etc., are the same as general intestinal obstruction. About 30% of patients may have abdomen and abdominal mass, and strangulated intestinal obstruction, secondary intestinal perforation and peritonitis may endanger the life of the patient.

3, aphid appendicitis: due to improper deworming caused by aphids drilling into the appendix, causing obstruction of the appendix cavity, due to the stimulation of the body and the secretion of toxins on the appendix mucosa, so that the appendix muscle layer and blood vessels contract, blood supply is blocked, Causes mucosal damage, causing acute appendicitis. If the appendix obstruction is progressively aggravated, the intracavitary pressure will increase, which may lead to perforation of the appendix and secondary peritonitis. It is reported that the incidence of appendicitis perforation is 25%-65%. The incidence of aphid appendicitis is second only to biliary ascariasis and aphid intestinal obstruction. It plays an important role in the etiology of appendicitis in children. The aphids that drill into the appendix are often 1-3, more than 30, the disease and the general Appendicitis is similar. It often occurs after 3 to 6 hours after taking anthelmintic drugs. It has severe abdominal cramps, cold sweat, pale complexion, nausea, vomiting and abdominal distension. It may have localized abdominal muscle tension.

4, aphid pancreatitis: aphid invasion of the pancreatic duct can lead to partial obstruction of the pancreatic duct, due to mechanical damage of the worm, egg deposition and stimulation, secondary bacterial infection, toxin action, and bile reflux can activate pancreatic enzyme Acute pancreatitis, aphid pancreatitis and general acute pancreatitis similar performance, often sudden paroxysmal upper abdominal pain, nausea, vomiting; followed by abdominal pain is persistent, paroxysmal aggravation, chills, fever, upper abdomen Hypertonic, high abdominal muscle tension, blood, urine amylase activity increased, followed by bloody necrotizing pancreatitis, may appear high fever, pulse rate, blood pressure, abdominal distension and abdominal mobility dullness, etc., if not diagnosed, active rescue, Often can endanger the lives of patients.

5, aphid liver disease: a small number of patients with biliary ascariasis can enter the liver due to aphids into bacteria, secondary infections form bacterial liver abscess, abscess is most common in the right lobe of the liver, less left lobe, can be single or multiple, The size is different, aphids and eggs can be found in the pus; the foreign body reaction caused by the eggs and the worm body can be detected on the wall of the abscess. The aphid liver abscess is similar to the general liver abscess, but the complication is more, the clinical process Extremely serious, easy to cause liver damage, and even acute liver failure, cholangitis, biliary bleeding, sepsis, empyema, underarm abscess, etc., the mortality rate can reach 80%.

6, mites granuloma: mites granuloma granuloma is located on the surface of the abdominal organs, manifested as fever, abdominal pain, abdominal mass, clinically less common, because of no characteristic performance, diagnosis is difficult, the literature reports The cases were confirmed by surgical biopsy. The disease is easily misdiagnosed as mesenteric lymphadenitis, intestinal tuberculosis, tuberculous peritonitis and abdominal tumors.

7. Aphid peritonitis: Aphids can be perforated into the peritoneal cavity through abdominal organs such as small intestine or appendix. Because of the chemical stimulation and bacterial infection caused by intestinal contents flowing into the abdominal cavity, peritonitis is reported. Peritonitis is reported in surgical complications caused by intestinal ascariasis. Accounted for 12.75%, its performance is the same as other causes of suppurative peritonitis, mainly for persistent severe abdominal pain, abdominal distension, fever, shortness of breath, rapid pulse, abdominal tenderness, rebound tenderness, liver dullness shrinks or disappears.

8. Ascaris encephalopathy: This disease is mainly found in young children, fatty aldehydes secreted by aphids, anticoagulants and hemolysin, which are absorbed into the nervous system after absorption. The neurological dysfunction caused by aphids is called aphid toxic encephalopathy or ascaria encephalopathy. , headache, excitability, lack of energy, insomnia, mental retardation, etc., in severe cases, epilepsy, meningeal irritation, coma and dilated pupils, etc., if the mites enter the brain tissue through the blood circulation can form cerebral embolism And local brain lesions, symptoms can be quickly reduced after deworming treatment.

9. Other aphid diseases: After the aphids are stimulated, they can enter various channels and cause disease. It is reported in the literature that aphids can cause exudative pleurisy, a small amount of pleural effusion, or secondary empyema, and the trachea is drilled to cause respiratory tract. Obstruction and suffocation, drilling through the eustachian tube into the middle ear canal, drilling into the small intestine diverticulum to cause diverticulitis, and cases of aphid excreting Meckel's diverticulum and discharging aphids from the urethra, entering the bladder through the bladder rectum, ureter Or enter the urinary system through the renal pelvis, can discharge aphids from the urethra, aphids can enter the bloodstream to cause metastatic tsutsugamushi, if the blood flows to the right heart to the pulmonary artery, thrombosis can cause thromboembolic obstruction, which is also biliary tract Rare complications of ascariasis and liver ascariasis can often be diagnosed by autopsy.

Symptoms of tsutsugamushi Common symptoms Loss of appetite, bloating, dizziness, umbilical pain, mites, black stool, abdominal pain, diarrhea, high fever, sudden upper right abdominal cramps

Clinical manifestation

1, larval disease caused by: can appear fever, cough, asthma, blood stasis and increased proportion of eosinophils in the blood and other clinical symptoms.

2, the adult stage of the disease: a. patients often have loss of appetite, nausea, vomiting, and intermittent umbilical pain. b. There may be urticaria, itchy skin, angioedema, and conjunctivitis. c. Sudden right upper quadrant cramps and radiation to the right shoulder, back and lower abdomen, the pain is intermittently increased, accompanied by nausea and vomiting.

The main symptoms

1. Juvenile pneumonia: A small number of aphid larvae may have no symptoms when they move in the lungs. For example, if they eat vegetables or other foods containing a large number of infected locust eggs in a short period of time, after 7 to 10 days of incubation period, the whole body and lungs may appear. Symptoms, manifested as cough, cough, hemoptysis, fever, chills, fatigue, chest tightness, shortness of breath and similar symptoms of acute upper respiratory tract infection, severe cases may have asthma-like episodes, manifested as chest pain, pharyngeal foreign body sensation, Asthma, sitting and breathing, a few can have blood in the sputum, nosebleeds, hoarseness, abdominal pain and diarrhea, physical examination can be heard of dry and wet voices of both lungs, occasional local lung consolidation, X-ray Examination shows that the shadows of the double hilar are deepened and the lungs are increased. It often disappears within 1 to 2 weeks. The granulocytes and Charcot-Leyden crystals can be found. Even the larvae can be found. Acidic granulocytes can be significantly increased. After the disease lasts for 7 to 10 days, the above symptoms gradually disappear, acute sputum pneumonia, asthma and eosinophilia, etc., clinically known as pulmonary ascariasis, ie simple pulmonary eosinophil infiltration disease.

2, intestinal ascariasis: adult intestinal ascariasis no specific performance, can also appear emotional instability, irritability, dizziness, decreased ability to work, etc., a large number of intestinal mites can appear different degrees of gastrointestinal symptoms, such as multi-food Or anorexia, partial eclipse, even ecstasy, etc., children often have loss of appetite and nausea, and many sudden onset of umbilical hernia on Monday or colic, often repeated recurrent episodes, without abdominal muscle tension and tenderness, a small number of children Patients may have symptoms similar to peptic ulcer, but the symptoms disappear after deworming treatment. Infants and young children have dyspepsia. A small number of children may vomit aphids due to high fever or other reasons, or discharge aphids from the anus. Children can cause malnutrition, developmental retardation, mental retardation, itchy skin, molars or convulsions, and very few patients may have neurological vomiting, refractory rash, visual impairment, hearing loss, muscle paralysis, cutaneous angioedema and platelets Reduce sexual purpura and so on.

Stomach and duodenal ascariasis may have repeated abdominal fullness, belching, pain in the upper abdomen or severe pain, often lack of appetite, acid reflux, nausea, vomiting, etc., often have a history of vomiting and mites, occasionally Hematemesis and melena.

Intestinal tsutsugamushi has fewer signs. In the case of abdominal pain, there may be a lighter but less constant deep tenderness in the umbilical cord. In children with thin abdominal fat, intestinal peristalsis can be seen. Deep pressure can be caused by a cast cord-like gut type. Children, small and thin, abdominal bulging.

3, allergic reactions: allergens of aphids can cause allergic reactions in the host skin, conjunctiva, intestinal mucosa, manifested as urticaria, abdominal pain and conjunctivitis, etc., reported in the literature, aphid infection is a child with allergic to plant pollen and asthma The incentive.

Locust disease check

1. Blood routine: The number of white blood cells is mostly normal. In the early stage of acute infection and larval migration, white blood cells and eosinophils increase. It has been reported that eosinophils in acute aphid pneumonia can reach 40% to 80%. When biliary ascariasis and biliary tract complicated by bacterial infection, white blood cells and neutrophils are often significantly increased.

2, pathogen examination: direct smear method is simple, high detection rate of mites eggs, is the main method for the diagnosis of intestinal tsutsugamushi disease, the positive rate of three methods is more than 90%, the direct smear negative, using sediment collection eggs Method or saturated saline floating method or modified Kato method can improve the detection rate of eggs, but the method is more complicated. When the lung mites or aphid larvae cause allergic pneumonia, the larvae can be detected in the mites.

3, immunological examination: the positive rate of intradermal test of adult antigens can reach more than 80%, its positive may indicate early aphid infection or male parasites, which is helpful for epidemiological investigation, serum immunoglobulin test shows: IgG and IgE High level, but not specific.

4, B-mode ultrasound examination: Abdominal B-ultrasound for biliary ascariasis, can show that the mites are located in the dilated common bile duct, but the positive rate is not high.

5, X-ray examination: X-ray barium meal examination of patients with gastric ascariasis, it can be seen that there are variability round bar shadows similar in size to aphids in the stomach. If multiple aphids gather in parallel, the shadows are like "rice-like", and the cross-section of the worm body It is a "pea grain" or "beaded" image. After extrusion, the insect body stretches and spreads. The above image changes as well. For patients with duodenal tsutsugamushi disease, X-ray examination can be seen as curved, ring-shaped, "spring-shaped". "" or "8" glyph and other images.

6, fiber endoscopy retrograde cholangiopancreatography: can be found in the duodenum and bile duct aphids, the removal of the worm into the ampulla of the ampulla can quickly relieve biliary colic, and can reduce decompression and drainage of bile duct obstruction.

Diagnosis and identification of tsutsugamushi disease

diagnosis

1. Clinical diagnosis basis:

(1) Adult parasites can be diagnosed according to the recent history of worms or vomiting.

(2) Children repeatedly appear in the abdomen or umbilical cord on Monday, or with partial eclipse, night molars, abdominal distension, etc. can indicate aphid infection, if there is comorbidity, it should be judged according to the corresponding symptoms, signs and relevant examination results, Such as biliary colic, cholangitis, pancreatitis should consider the possibility of complications of intestinal ascariasis; children with abdominal pain, vomiting, abdominal distension, stop bowel movements and exhaust, sputum and abdominal cord-like mass should pay attention to aphid The possibility of intestinal obstruction.

(3) In the rural harvest season, when there is sudden fever, cough, asthma and other causes in the collective population, the possibility of pneumonia caused by acute aphid larvae can be considered in combination with medical history and physical signs.

(4) If there is only male parasite in the intestine and the feline is negative in the feces (3% to 5% of the infected person), the deworming drug can be used for diagnostic treatment.

2, laboratory and auxiliary examination: fecal smear to check the eggs is the simplest, fast and reliable basis for the diagnosis of intestinal sputum disease, as appropriate, the following checks to help diagnose, such as gastrointestinal swallowing test can show the shape and number of mites Abdominal X-ray film is of great value in the diagnosis of aphid intestinal obstruction or intestinal perforation peritonitis. Duodenal drainage fluid is a direct evidence for biliary ascariasis.

Differential diagnosis

1, biliary ascariasis needs to be differentiated from acute cholecystitis and acute pancreatitis.

2, aphid intestinal obstruction must be differentiated from acute abdomen such as intussusception.

3, is also easy to be confused with stomach, duodenal ulcer, chronic gastritis and mesenteric lymphadenitis and other diseases.

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