Parasitic arthritis

Introduction to parasitic arthritis Parasitic diseases are endemic in many developing countries and are also distributed in developed countries. After infection with parasites, clinical manifestations vary, and some patients are asymptomatic, but some have a variety of clinical manifestations. Parasitic arthritis is clinically less common in bone and joint diseases caused by parasitic infections. To date, at least 20 parasites have been able to directly or indirectly damage the human bones and joint system, causing lesions in bone tissue, joints, and bone marrow, or hindering the normal growth of bones, or causing skeletal malformations in the fetus. In parasitic infections, the incidence of joint involvement is low. Diagnosis mainly depends on: 1 having a history of living or traveling in an infected area; 2 having clinical manifestations of parasite invading the intestine or tissue causing infection; 3 acute or chronic onset, single or multiple joint arthritis; 4 ineffective in treating with antibacterial inflammation After 5 parasites, the joint symptoms were eliminated. Joint inflammation can be caused directly by parasites living in the muscles surrounding the joints, by metabolites of parasites, and by immune responses. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: parasitic infection Complications: hydatidosis neurosis suppurative osteomyelitis periostitis

Cause of parasitic arthritis

(1) Causes of the disease

Clinically, bone and joint diseases caused by parasitic infections are rare. To date, at least 20 species of parasites can directly or indirectly damage human bones and joint systems, causing lesions in bone tissue, joints and bone marrow. Or hinder the normal growth of bones, or cause skeletal malformations in the fetus. These parasites include the genus Echinococcus granulosus, vesicular mites, Cysticercus cellulosae, Paragonimus sinensis, Filaria, snail, Medica nematode, Trichinella, etc.; Protozoa protozoa belonging to protozoa, amoeba, Toxoplasma gondii, Plasmodium; Dendrolimus punctatus belonging to insects.

(two) pathogenesis

Broadly invading the parasites of the skeletal system; the larvae of the echinococcosis (Echinococcus) are parasitic in the bones, causing echinococcosis.

Parasitic arthritis prevention

Thoroughly treat patients, eliminate the source of infection, eliminate the intermediate host, the infected area should eliminate the storage host, and carry out the detention and killing of the walls of rural houses, barns and toilets every year, killing mosquitoes, treating patients in time, and in the livestock areas. Extensive environmental health promotion, good hygiene practices during childhood, and avoid contact with sick animals.

Parasitic arthritis complications Complications hydatidosis neurosis suppurative osteomyelitis periostitis

A cystic echinococcosis of the echinococcosis, spine, humerus, etc. can compress the spinal nerve or horsetail, produce obvious neurological symptoms and signs, and even paraplegia, advanced, can cause secondary chronic suppurative osteomyelitis, if Involved joints, can cause pathological dislocation, filaria infection can be complicated by rubber swelling, secondary bacterial infection, repeated attacks can lead to periostitis or osteo- periostitis, late stage of Dendrolimus punctatus arthritis has different degrees of joint dysfunction, joints Malformation and rigidity.

Parasitic arthritis symptoms Common symptoms Pharyngeal periostitis slow growth Fingernails have white spotted cysts Bacterial infection Muscle atrophy

1. Parasitic echinococcosis

(1) The larvae of Echinococcus granulosus (Echinococcus granulosus) are parasitic in the bones, causing echinococcosis. The bone echinococcosis is often characterized by painless swelling, and the lesion progresses very slowly, often in childhood. Infection, symptoms appear in adulthood, generally divided into 4 phases:

1 incubation period: due to the slow growth of larvae in the bone, it can be asymptomatic for a long time, and a few cases may have mild pain.

2 limited period: as the disease progresses, pain, numbness, lameness and limb muscle atrophy can occur.

3 expansion period: the symptoms are heavier, the bone is extensively damaged by the cyst, the pain is intensified, the affected bone is swollen and thickened, deformity, slight trauma can cause pathological fracture, and the cyst of the spine, tibia can compress the spinal nerve or the horsetail. Significant neurological symptoms and signs, even paraplegia.

4 late stage: obvious signs, cysts penetrate the cortical bone, invade the surrounding soft tissue, there is a huge mass, can form long-term unhealed fistula, outflow pus and hydatid debris, can cause secondary chronic suppurative osteomyelitis, if Involving the joint can cause pathological dislocation.

(2) Filaria: Humans may cause filarial osteoarthrosis due to infection with the filaria worm or the male worm, and the filariasis may cause lymphatic obstruction and a rubber edema. Due to the reduced resistance, the bacteria are easily invaded, causing Secondary bacterial infection of the local tissue, recurrent episodes can lead to periostitis or bone-periostitis. In addition, filaria chylomicroarthritis is also more common, chyle is visible in the joints, more common in the knee joint, followed by ankle joint, small The joints are not tired, often unilateral, generally benign process, short duration, joint painless swelling, sometimes acute attack, knee joint exudate, swelling and pain, limited activity, increased body temperature, 1 ~ 2 Week can be relieved, but after repeated attacks can be converted to chronic arthritis.

(3) Others: Bubble sputum and cysticercosis can also invade bone tissue, invade the maxilla, vertebrae, etc. The bulb is called parasitic cancer, which is more likely to invade long bones and cause pathological fractures. The principle of removing the diseased bone and removing the cysticercosis is to take praziquantel and albendazole.

2. Parasites that invade bones and joints - Dendrolimus punctatus

Because of contact with the living body of pine caterpillars, corpses or worms can cause bone and joint diseases mainly caused by allergic reactions. When the human body contacts caterpillars, the virus in the worms comes into contact with the skin or directly enters the body, causing allergic reactions due to pathological changes. Similar to rheumatoid arthritis, it is speculated that the pathogenesis of the disease may be related to allergies.

Examination of parasitic arthritis

Echinococcosis

The echinococcal test (Casoni test) can be positive. Serological tests include detection of specific antibodies in the patient's serum and circulating antigens of the hydatid. The test methods include indirect hemagglutination test, latex agglutination test, and enzyme-linked immunosorbent assay (ELISA). Etc. Peripheral blood routine examination showed increased eosinophils, X-ray examination showed varying degrees of bone changes, including osteopenia, bone defects, cortical bone thinning, bone expansion, irregular contours, can be formed in the paravertebral Hairy hydatid cysts, X-ray changes similar to benign tumors in the spinal canal. Late cysts penetrate the cortical bone and invade the surrounding soft tissue, forming a circular or curved cyst calcification in the soft tissue, and forming a chronic due to secondary infection. Suppurative osteomyelitis and sinus, pathological examination can be confirmed, surgical exploration can also be confirmed.

2. Filaria

Blood smear examination, some patients can find microfilaria at night, synovial fluid examination is milky yellow, no bacteria, high lipid content.

X-ray examination showed localized periosteal thickening, which may have periostitis changes, cortical bone thickening, localized bone-periostitis, lesion invasion of periosteum and bone, periosteal new bone formation and varying degrees of cortical destruction, lymph Tube angiography showed lymphatic obstruction and varicose veins.

3. Dendrolimus punctatus: X-ray findings show that the soft tissue around the joint is swollen, the level is blurred, the joint cyst is enlarged, the density is increased, the osteoporosis, the bone destruction is mostly end-to-end, and the joint may have joint space stenosis, dislocation or subluxation. Occasionally, eosinophilia increases and erythrocyte sedimentation rate increases.

Diagnostic identification of parasitic arthritis

Diagnostic criteria

The allergic symptoms of this disease include pain, lumps, auricular inflammation, ophthalmia and osteoarthrosis. The clinical classification is skin type, osteoarthritis type, mass type and mixed type, in which the bone and joint lesions are single joints, especially the wrist and Joints such as ankles are most common, but pubic symphysis, ribs, etc. can also occur at the same time, mainly as pain and swelling.

1. Fine-grained echinococcosis: According to epidemiology, exposure history of the affected area, clinical manifestations, X-ray examination and other auxiliary examinations, the diagnosis can generally be confirmed.

2. Diagnosis of filariasis arthritis: usually depends on serology, or microfilariae are detected in the peripheral circulation or in the skin (filaria).

3. Dendrolimus punctatus arthritis: mainly based on regional onset, exposure to pine caterpillars or their contaminant history, clinical manifestations and X-ray findings.

Differential diagnosis

Echinococcal arthritis

Because bone hydatidosis is rare, it is easy to miss diagnosis, and it needs to be differentiated from giant cell tumor of bone, fibrous cystic osteitis and chondrosarcoma. Spinal lesions should be differentiated from spinal tuberculosis and benign tumors in the spinal canal.

2. Filariasis arthritis

Should be identified with rheumatoid arthritis.

3. Dendrolimus osteoarthrosis needs to be differentiated from bone and joint tuberculosis, rheumatoid arthritis and septic arthritis.

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