Fascioliasis in children
Introduction
Introduction to pediatric schistosomiasis Fascioliasis is caused by fasciolahepatica and fasciolagigantica in the hepatic bile duct of a herbivorous mammal, or the human body to cause parasitic diseases. It is cattle, sheep, etc. One of the serious parasitic diseases of animals, the infection rate is as high as 20% to 60%. The clinical manifestations are mainly caused by the acute phase manifestation of the larvae in the abdominal cavity and liver and the chronic phase mainly caused by adult bile duct inflammation and hyperplasia. basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: fecal mouth spread Complications: jaundice, liver cirrhosis, anemia
Cause
Causes of pediatric schistosomiasis
(1) Causes of the disease
The size of the flukes of the liver fluke (2.0 ~ 5.0) cm × (0.8 ~ 1.3) cm, flat back and abdomen, like a leaf shape, dark reddish brown, the front end of the body is a conical protrusion, called the cone, the head cone The body width is called the shoulder peak, the mouth suction cup is small, and it is located at the top of the worm body. The abdominal suction cup is slightly larger and is located at the base of the head cone. The eggs are very large (130-150) m × (63 ~ 90) m, elliptical, yellowish Brown, egg shell thin, divided into two layers, with a small cover at one end, the egg is filled with many yolk cells.
Life history of Fasciola hepatica: Adults lay eggs in the end-host hepatic bile duct, enter the intestine with bile, excrete in the feces, excrete in the water at 22 ~ 26 ° C, develop into hairy eggs after 9 to 14 days, and quickly Drilling into the cone snail, developing into a scorpion through the cellulite and thunder in the snail, then escaping from the snail, floating under the water surface, and then removing the tail after contacting the animal body (plant or saprophytic organism) The capsule is attached to an object in the water (such as water grass), and its shape resembles a straw hat. When the host eats aquatic plants containing cystic mites, the cystic sac is released from the small intestine digestive juice, and then escapes into a cercaria. Into the abdominal cavity to develop into a child worm, in the abdominal cavity for about 48h, the child worm breaks through the liver capsule into the liver parenchyma, continues to develop with the liver tissue as a nutrient, swims in the liver for about 6 weeks and finally enters the hepatic bile duct parasitism, about 4 The week develops into adult worms, and the eggs are found in the sacs from the infected sacs. The shortest is 10 to 11 weeks. Each adult can lay about 20,000 eggs per day. The adult life span can reach 12 years.
(two) pathogenesis
The damage of the liver fluke to the human body can be roughly divided into two aspects: the child and the adult. The early childhood insects pass through the intestinal wall and enter the abdominal cavity. In the process, the tissue can be destroyed, and the hemorrhage remains on the insect path. The child is in the liver parenchyma. When moving, hepatocytes are used as food to damage liver tissue. With the development of children's worms, liver damage is more extensive, and fibrinous peritonitis may appear. The liver is obviously congested with the milk, and the milky white pattern (hard knot) is mirrored. The liver lesions were found to be filled with hepatocyte debris, eosinophils, neutrophils, lymphocytes and macrophages. There were occasional small abscesses on the surface of the liver tissue, and the abscess was filled with eosinophils and a large amount of summer-ray crystals. After about 6 weeks of swimming in the liver, the worm enters the bile duct and develops into an adult worm. The adult parasitizes in the bile duct, causing the lumen to increase significantly, protruding from the surface, the suction of the worm body and the mechanical stimulation of the skin spine. Causes inflammatory changes, and is prone to secondary infections leading to cell cholangitis or liver abscess, the body can produce a large amount of proline, can induce bile duct epithelial hyperplasia, so the main lesion caused by adults is gallbladder Tube inflammation and epithelial hyperplasia, resulting in narrowing of the bile duct lumen, thickening of the wall, fibrous tissue hyperplasia around the bile duct, severe cases of large bile ducts also have chronic obstruction and cholestasis, resulting in biliary cirrhosis.
Prevention
Pediatric schistosomiasis prevention
Strengthen livestock management, graze in areas, avoid pollution of water sources, separate drinking water (including livestock) from general water use, disinfect water should be disinfected regularly, strengthen health education, and do not drink or eat raw water and aquatic plants that may be contaminated to cut off way for spreading.
Complication
Pediatric complication Complications jaundice liver cirrhosis anemia
Blockage of the worm causes cholestasis, jaundice and biliary colic; enlarged bile duct compression can cause liver tissue atrophy and necrosis, and further cirrhosis occurs. In chronic critically ill patients, chronic anemia can cause severe anemia.
Symptom
Symptoms of pediatric schistosomiasis common symptoms, pain, loss of appetite, lack of energy, chills, biliary colic, nausea, eosinophilia, diarrhea, rosacea, blood stasis, jaundice
The patient has chills, fever, fever fluctuations at 38 ~ 40 ° C, lasting 1 to 2 weeks, or even up to 8 weeks; often liver pain, fatigue, loss of appetite, nausea, oil, flatulence, vomiting, diarrhea or constipation Such symptoms, eosinophilia in the blood, this period of jaundice is less common, adult parasitic in the bile duct, resulting in hepatobiliary inflammation and biliary obstruction, patients often have repeated persistent upper abdominal pain, or biliary colic, Irregular fever, jaundice, nausea, urticaria or itching, slight swelling of the liver, anemia is one of the characteristics of this period, and there is a tendency to progressively increase, biliary cirrhosis, biliary cirrhosis may occur in advanced patients.
Examine
Pediatric schistosomiasis
Laboratory inspection
1. Blood routine: Leukocytes and eosinophils are significantly increased, especially in the acute phase. White blood cells are usually at (10 ~ 43) × 109 / L, eosinophils up to 0.79, ESR is accelerated, up to 164mm /h, hemoglobin is mostly 70 ~ 110g / L, can also be lower.
2. Liver function test: There are different degrees of abnormal liver function in the acute phase, ALT, AST increased, serum bilirubin increased in the chronic phase, albumin decreased, globulin increased to 51 ~ 81g / L, albumin / globulin ( A/G) ratio was inverted, IgG, IgM and IgM were elevated, while IgA was normal.
3. Pathogen examination: The positive result of pathogen examination is the basis for diagnosis. However, the eggs are often not detected in the early stage of the acute phase. Generally, it can be found 2 to 3 months after infection. The washing and sedimentation method can be used to improve The Kato method or the mercury-aldehyde iodine concentration method is used to check the eggs from the feces, and the duodenal drainage liquid is precipitated or examined after centrifugation, and the positive rate is high.
Exploratory laparotomy found adult or eggs in the bile duct, laparoscopic biopsy or other histopathological examination found that the worm or eggs can be used as a basis for diagnosis.
4. Immunological examination: Serum immunological examination can be performed with soluble protein antigen of the worm. The method can be selected by enzyme-linked immunosorbent assay (ELISA), indirect fluorescent antibody test (IFA), indirect hemagglutination test (IHA), convective immunoelectrophoresis ( CIE) and other methods, serological test results have cross-reaction with other fluke infections, but when the eggs are not detected early in the infection, it still has important diagnostic significance, such as the detection of circulating antigen in the serum of Fasciola hepatica, compared with detection The value of the antibody is greater, and the detection of Fasciola hepatica antigen in the patient's feces is positive at the 6th week after infection, which has early diagnostic significance.
5. Ascites examination: Ascites is grass yellow, the number of cells is above 1000 × 106 / L, mainly eosinophils.
Film degree exam
1. Ultrasound examination: Ultrasound examination of the liver can be seen in the biliary tract. The flukes of the liver are 0.3~0.5cm round shadow, which is like the "Olympic Ring". When the abdomen is percussed, the shadow can move.
2. CT examination: "false liver tumor" may appear.
3. Cholangiography: In cholangiography, the shadows of the worms are different at different angles, and the side view is slender and curly rope-like. The other angles can be seen as narrow circular shadows or false wall layers disappearing defects.
Diagnosis
Diagnostic identification of pediatric schistosomiasis
diagnosis
There are raw medical aquatic plants and drinking water history and the above clinical symptoms, white blood cells and eosinophils increased significantly, erythrocyte sedimentation rate increased, anemia, ALT and AST activity increased, chronic serum bilirubin increased, albumin / globulin ( A / G) ratio is reversed, should consider hepatic schistosomiasis, found eggs in the feces, laparotomy, laparoscopic biopsy or other histopathological examination found that adults or eggs can be used as a basis for diagnosis, but generally after infection 2 In March, the eggs can be found from the feces, and the immunological examination has important diagnostic significance when the eggs are not detected in the early stage of infection.
Differential diagnosis
Hepatic schistosomiasis should be associated with clonorchiasis, shamworm disease, ginger schistosomiasis, paragonimiasis, amoebic or bacterial liver abscess, liver hydatid disease, cholecystitis caused by various causes , cholangitis and cholelithiasis, liver cancer and other hepatobiliary diseases.
Liver cirrhosis: According to the data, the incidence of cirrhosis of clonorchiasis is about 22%, liver enlargement (left lobes) and liver dysfunction, portal hypertension and other clinical manifestations of clonorchiasis If the sclerosis can be diagnosed and treated early, the prognosis is good.
Leukemia-like reactions: infection can stimulate the proliferation of host bone marrow granulocytes. Leukemia-like leukocytes can be as high as 10,000% EO% up to 65% bone penetration test, consistent with bone marrow morphogenetic syndrome, and can be restored after deworming treatment.
