cysticercosis
Introduction
Introduction to cysticercosis Cysticercosis (also known as porcine cysticercosis) is a disease caused by the aphids of pork aphids parasitic in various tissues and organs of the human body. The cysticercosis is an endogenous autoinfection of pig swine worms or contaminated by humans. Water and food, the eggs are infected into the stomach and small intestine by the mouth. After the action of the digestive juice, the six hooks come out, pass through the blood vessels of the intestinal wall, spread the whole body through the blood circulation, and parasitize the subcutaneous tissue, muscle and central nervous system of the human body. It is called cysticercosis for cysticercosis. Among them, cerebral cysticercosis is the most serious. The lifespan of cysticercosis can be as long as ten years, so early diagnosis, early treatment, and reduction of complications should be done. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: optic atrophy vitreous opacity retinal detachment cataract glaucoma hearing impairment dementia hemiplegia
Cause
Cause of cysticercosis
Cysticercus cellulosae, commonly known as cysticercosis, is a larva of swine mites. When its larvae parasitize the human body, humans become the intermediate host of swine mites, causing people to suffer from cysticercosis.
Bad living habits (45%)
Poor living habits such as people, pigs sharing water or toilet management are not in place, causing water pollution, if the patient is infected with water contaminated by eggs, or some people have the habit of eating raw pork, eat with eggs Pork can also cause the disease.
Pig with aphid infection (30%)
Infection due to parasitic mites in the body. If the patient's nausea and vomiting cause the intestinal tube to reverse peristalsis, the pregnancy in the intestinal contents is returned to the stomach or the duodenum, and the aphid eggs are infected by hatching the six hooks, which is called infection in the body. Infections in the body are often the most serious.
Pathogenesis
From the results of light microscopy and electron microscopy, it is proved that the cerebral cysticercosis can be divided into three stages: active period, metamorphosis and calcification. The sacral sac of the cysticercus, the head section, the disintegration of the worm, and the release of allogeneic protein Causes cerebral edema, inflammatory reaction, glial fibrosis, brain tissue softening, and even the formation of small abscess in the brain. In the past, the amount of allogeneic protein antigen in the cystic fluid of the cerebral cystic scorpion was small, the brain tissue reaction was light, and the toxicity to the human body was small. Recently, domestic research has shown that the total protein antigen in the cyst fluid can reach a fairly high level, and the allergic protein released by the brain tissue after disintegration can produce obvious inflammatory reaction. The lime corpuscle is important for the formation of abscess after cysticercosis disintegration. According to the diagnosis, as long as the lime body is found, the diagnosis of cerebral cysticercosis can be made.
Microscopic examination showed a small amount of glial cells and fibroblasts around the live cysticercus; neutrophils, lymphocytes and plasma cells around the cysticercosis, followed by foreign body reaction and fibrosis.
Domestic reports of autopsy of patients with epidemic encephalitis in the epidemic area of the disease found that about one-third of the cases were complicated by cerebral cysticercosis, while in other cases, only autopsy was seen from 0.014% to 0.46%. The difference was significant, indicating cerebral cysticercosis The patient is susceptible to epidemic encephalitis virus and the mortality rate is increased.
The cysticercosis is subcutaneously subcutaneous, and the muscle produces subcutaneous cysticercus nodules; parasitic eyes often in the retina, vitreous, anterior chamber of the eye, eye muscles, conjunctiva, etc., causing lesions and dysfunction.
Prevention
Cysticercosis prevention
1. Eliminate the source of infection: on the basis of the census, timely deworming treatment for patients, pigs with tsutsugamushi disease is the only source of infection of this disease, so the patient's complete deworming treatment can not only prevent infection, but also avoid infection. Moreover, the incidence of cysticercosis in pigs is reduced.
2. Manage the toilet pigsty: mobilize the masses to manage the toilets, build pigs in the circle, and control the infection of humans and animals.
3. Pay attention to personal hygiene: we must vigorously publicize the harmfulness of this disease, remove bad habits, not eat raw meat, wash hands before and after meals, in order to prevent accidental consumption of eggs, cooking must be cooked, the sac in the meat is in 54 °C can be killed in 5 minutes, and the cut broiler and cutting board should be separated.
4. Strengthen meat inspection: Do a good job in the hygiene inspection of urban and rural meat products, especially to strengthen the meat inspection sold by individual traders in the farmer's market. Before the supply market, the meat must undergo strict inspection and treatment. Pork is -12~ In the environment of -13 ° C, after 12 hours, the cysticercosis can be completely killed.
In the prevention and control, it is necessary to strengthen leadership, agriculture, animal husbandry, health, and commercial departments to closely cooperate with each other, pay close attention to the implementation of comprehensive measures, and effectively achieve effective control.
Complication
Cysticercosis complications Complications optic atrophy vitreous opacity retinal detachment cataract glaucoma hearing impairment dementia hemiplegia
Common complications cysticercosis.
1. Subcutaneous and muscular cysticercosis: When the infection is light, it can be asymptomatic. When the amount of parasitic is large, it can be conscious of muscle soreness, swelling, numbness or pseudo-pregnancy.
2. Cerebral cysticercosis: seizures, increased intracranial pressure, mental symptoms are the three main symptoms of cerebral cysticercosis, neurological disorders and symptoms of cerebral blood flow disorders such as memory loss, decreased vision and mental symptoms, others may have headaches Dizziness, vomiting, unconsciousness, aphasia, limb numbness, local convulsions, hearing impairment, mental disorders, dementia, hemiplegia and blindness, etc., often complicated by basal arteritis causing ischemic cerebrovascular disease.
3. Eye cysticercosis: mild symptoms manifested as visual impairment, often visible worm peristalsis, severe blindness, sometimes optic nerve head edema, optic atrophy, etc., cysticercosis death, can cause vitreous opacity, retinal detachment, optic nerve Atrophy, cataracts, secondary glaucoma and other eyeball atrophy and blindness.
Symptom
Symptoms of cysticercosis Common symptoms Dementia convulsions, redness, low heat, sudden death, tinnitus, nausea
The incubation period is about 3 months. The clinical manifestations should be based on the number of cysticercosis, parasitic parts and human reactivity. The infection may be asymptomatic. Only when the autopsy is found, the cysticercosis is divided into cerebral cysticercosis, eye capsule. Three kinds of cercariae and cutaneous muscle cysticercosis.
Cerebral cysticercosis
The clinical manifestations vary in severity, with seizures being the most common, accounting for 52% to 85%. According to the cysticercosis and pathological changes, there are the following types:
(1) Cortic type: accounting for 84% to 100% of cerebral cysticercosis, cysticercosis is parasitic at the junction of gray matter and white matter at the center of the movement. If the number of insects is small and inactive, it can be asymptomatic. If parasitic in the exercise area, Epilepsy is a prominent symptom, which may have localized or systemic short-term convulsions or status epilepticus. The incidence of epilepsy in cerebral cysticercosis is 50% to 93.5%, often the complaint of patients at the time of treatment, severely infected intracranial Increased pressure, headache, nausea, vomiting, long-term increased intracranial pressure, brain tissue atrophy can occur dizziness, memory loss, visual impairment, visual distortion, hallucinations, mental disorders, dementia, etc., the course of disease for several months to several Years vary.
(2) ventricle type: the fourth ventricle is more common, the six hooks circulate through the blood to the choroid plexus of the ventricle, and with the cerebrospinal fluid to the fourth ventricle, the cysticercosis obstructs the ventricle, so the early intracranial hypertension syndrome, capsule The cercariae hangs on the wall of the chamber and is in the shape of a flap. The patient's head can be suddenly dizzy, headache, vomiting or respiratory disorder, or cerebellar tonsil, which is called Brun sign, or postural change syndrome. Patients often have stiff neck and forced head position.
(3) subarachnoid or skull base type: the main lesion is cystic sacral meningitis, often confined to the posterior fossa of the skull base, with low fever at the beginning, clinically more subacute or chronic meningitis and arachnoid adhesions Symptoms mainly, headache, vomiting, neck stiffness and other increased intracranial pressure syndrome, as well as dizziness, hearing loss, tinnitus, ataxia, facial nerve paralysis, etc., poor prognosis.
Cerebrospinal fluid examination: cerebrospinal fluid pressure is usually increased from 1.96 to 3.92 kPa (20 to 40 cm H2O) or above, with 1.96 to 2.45 kPa (20 to 25 cm H2O), and the number of cells is (10 to 100) × 106 / L; Increased degree, sugar, chloride in the normal range, Wibler (1980) reported 5 cases of cerebral cysticercosis cerebrospinal fluid, usually lymphocytosis, accompanied by abnormal lymphocytes, 2 cases of eosinophilia, considered characteristic .
(4) Mixed type: The above types exist in a mixture, such as cortical type and ventricle type, and the symptoms are the heaviest.
In addition, occasional cysticercosis parasitic in the spinal canal, oppressing the spinal cord, resulting in paraplegia.
2. Eye cysticercosis
Accounted for 1.8% to 15% of cysticercosis, cysticercosis can be parasitic in the eye, outside the place, more common in the vitreous and subretinal, parasitic in the retina can cause vision loss, retinal detachment, blindness; parasitic in the vitreous and front In the room, the patient feels that there are black spots or black shadows in front of the eyes; parasitoids in the outer eye can be seen in the subconjunctiva or in the orbital nodules, and cystic sacral parasites often cause iridocyclitis, choroiditis, increased intraocular pressure and Secondary glaucoma, etc., ophthalmoscope, slit lamp examination can be seen under the subretinal or vitreous cysticercosis, a light gray round or oval vesicles, surrounded by a red halo, visible worm movement.
3. Subcutaneous tissue and muscle cysticercosis
Cysticercus parasitic in subcutaneous tissue and muscle, less one or two, more than a thousand, a nodular mass, soy bean size, round or oval, texture is hard and elastic, with more head and neck and trunk, Less limbs, rare hands and feet, cystic sac nodules and skin non-adhesive, no pain or itching, can appear in batches, disappear on their own, intramuscular nodules can cause muscle swelling, individual pseudo-muscle hypertrophy, shape muscle bundle full, The patient feels tired and weak, calcification occurs after the cystic tail is dead, and calcification shadows are seen on the X-ray examination.
B-ultrasound examination of the subcutaneous cysticercus nodules showed a circular or elliptical liquid dark area with clear outline and complete and smooth capsule wall. The largest one was 2.3cm×1.2cm, the smallest was 0.6cm×0.3cm, and the average size was 1.18cm×0.68. Cm, a strong echo light cluster is visible in the capsule, located at the center or one side, with a maximum of 0.4 cm x 0.2 cm, a minimum of 0.09 cm x 0.09 cm, and an average of 0.18 cm x 0.18 cm.
In addition, cysticercosis can also be parasitic in the tongue, mouth, vocal cords, if a large number of cysticercosis infection can also be found in the heart, liver, lungs, kidneys and abdominal cavity, etc., but difficult to diagnose before birth, often found at autopsy.
Examine
Examination of cysticercosis
1. The number of white blood cells in the peripheral end of the acute period increased, among which the proportion of acid granulocytes increased significantly, the erythrocyte sedimentation rate increased rapidly, the cerebrospinal fluid pressure increased, the protein increased, and the number of cells increased slightly. The diagnosis of acid granulocytes was found. There is also a certain value.
2, X-ray examination showed calcification shadow, B-ultrasound examination of the subcutaneous cystic sac nodules showed a circular or elliptical liquid dark area, the contour is clear, the capsule wall is intact and smooth, the largest is 2.3cm × 1.2cm, the minimum is 0.6cm × 0.3 Cm, the average size is 1.18cm × 0.68cm, a strong echo group is visible in the capsule, located at the center or one side, the maximum is 0.4cm × 0.2cm, the minimum is 0.09cm × 0.09cm, and the average is 0.18cm × 0.18cm.
Diagnosis
Diagnosis and identification of cysticercosis
diagnosis
1. Epidemiological data: There is a history of eating or half-baked pork in the endemic area; those who have found strips and pigs with tsutsugamushi in the feces should ask for detailed medical history and physical examination.
2. Clinical manifestations: Anyone with seizures, increased intracranial pressure and other neurological symptoms, especially in the epidemic area should be suspected of this disease, detailed examination, with or without subcutaneous nodules, subcutaneous nodules should be confirmed by biopsy, prevalence Cysticercus infection in the area is an important cause of various neurological symptoms, and comprehensive diagnosis can make a diagnosis.
3. Laboratory examination: eosinophils can be seen in peripheral blood, cerebrospinal fluid has eosinophils and abnormal lymphocytes have reference value, and found in feces or segmental eggs have diagnostic significance.
(1) Immunological examination: Purification of cytosolic sputum sputum for antigen and patient serum or cerebrospinal fluid for indirect hemagglutination test, enzyme-linked immunosorbent assay (ELISA), etc., detection of specific IgG antibodies with high specificity and sensitivity It has practical value for clinical diagnosis and epidemiological investigation, but there are false positives and false negatives in ELISA tests, and cross-reaction with hydatid disease.
(2) monoclonal antibody (McAb) method: detection of cysticercosis circulating antigen diagnosis of cerebral cysticercosis, for cerebrospinal fluid in patients with cerebrospinal fluid, the positive rate of circulating antigen is 84.58% (192/227), including active cerebral cysticercosis The positive rate of patients was 93.57%, and that of non-active patients was 57.14%. Only one patient with other central nervous system diseases was positive, and the negative coincidence rate was 98.8%.
4. Imaging examination: including X-ray, B-ultrasound, CT and MRI examination and ventriculography, especially the latter two have important value in the diagnosis of cerebral cysticercosis. CT can confirm the active period of most cerebral cysticercosis, non- During the active and promiscuous phases, the diagnosis of calcification is superior to MRI. CT can show various types of active and metastatic death, including multiple parenchymal or monocystic cerebral parenchyma, cerebral sulcus, ventricle type, meningitis. Type, cerebral infarction type, intracranial hypertension type, encephalitis type, small abscess in cystic brain, obstructive or traffic hydrocephalus, but its resolution is inferior to MRI, if the development of cystic sacral head is not satisfactory, it cannot be A clear disease diagnosis is made during the active period or the metamorphosis death period, while blind administration can induce cerebral edema, intracranial hypertension or shock, while MRI can divide the cerebral cysticercosis into four phases: active period, metamorphosis, inactive Period and mixed period, the MRI mark of the active period is the cysticer's head section, and the wall of the capsule coexists with the cystic fluid; the death period of the metamorphosis is the disappearance of the head section, the swelling of the capsule cavity, the size varies, and cerebral edema and inflammatory reaction occur around; Period includes calcification, arachnoid fibrosis with hydrocephalus Cerebrospinal fluid tests normal; including the mix of the coexistence period, MRI is valuable for clinical treatment.
Differential diagnosis
The disease has many clinical types and complex manifestations. Cerebral cysticercosis should be differentiated from primary epilepsy, tuberculous meningitis, cerebrovascular disease, viral encephalitis, subarachnoid hemorrhage, neuropathic headache, subcutaneous nodules. Should be differentiated from sebaceous cysts, multiple neurofibromatosis, rheumatoid nodules, subcutaneous nodules of paragonimiasis, and cysticercosis should be differentiated from intraocular tumors, foreign bodies, uveitis, retinitis.
