Taeniasis and cysticercosis in children
Introduction
Introduction to tsutsugamushi and cysticercosis in pediatric pigs The taeniasissuis is a disease caused by the parasitic worms in the human small intestine; cysticercosis, also known as cysticercosis, is caused by the parasitic larvae Disease can cause serious clinical damage. It is a common zoonotic parasitic disease in China. basic knowledge The proportion of illness: 0.0006% Susceptible people: children Mode of infection: digestive tract spread Complications: epilepsy, hydrocephalus, ataxia, cerebral palsy
Cause
Pediatric pig with tsutsugamushi disease and cysticercosis
(1) Causes of the disease
1. Taenia solium is also known as chain aphid, pork aphid, and hookworm. The worm is similar to the locust mites. The difference is that the worm is smaller and about 2 to 4 m long. Thin and transparent, the head section is approximately spherical, with a diameter of 0.6 to 1 mm. In addition to the four suction cups, the top end also has a top protrusion, and there are 25 to 50 small hooks arranged in two inner and outer rings, and the inner ring has a larger hook. The outer ring is slightly smaller, so the name is hookworm, the number of chain segments is about 700-1000 knots, the ovary is divided into 3 leaves, and the other is a central leaflet; the uterus branches are not neat in the pregnancy, about 7-13 on each side. Branches, eggs and cattle are similar to aphid eggs.
2. Life history: Human is the final host of the swine locust, but it can also serve as the intermediate host. The adult parasitizes in the small intestine of the human body. The head section is deeply buried in the intestinal mucosa. The gestational section is often separated from the chain by 5 or 6 knots. The body falls off and is discharged with the feces. After the eggs or the gestational section are swallowed by the intermediate host such as pigs, the six hooks escape and penetrate into the intestinal wall. They reach the body through the blood circulation or lymphatic system, and the pork is the most. For "rice pork" or "bean pork", when a person accidentally eats raw or unripe pork with cysticercosis, the head section of the cysticercosis is turned out and adsorbed on the intestinal wall, and develops into adult worms in about 2 to 3 months. See Figure 1, the life expectancy can be more than 25 years.
(two) pathogenesis
1. Swine tsutsugamushi disease: similar to burdock worm disease, mainly through mechanical damage, taking human nutrition and other harm to the human body, due to the apex and small hooks on the head section, the damage to the intestinal mucosa is heavier, even a few Cases of peritonitis that pass through the intestinal wall also have reports of ectopic parasitic subcutaneous and thyroid tissue.
2. Cysticercosis: commonly known as cysticercosis, caused by the parasitic human body of the cysticercosis, the damage is far more serious than the adult, mainly due to the mechanical stimulation and toxin action of the worm body, cysticercosis occupy a certain volume in the tissue, causing Space-occupying lesions, oppression, destruction of local tissues, if there is a cavity system, obstruction changes; as a heterosexual protein, causing local tissue reactions and systemic reactions, elevated eosinophils in the blood.
The risk of cysticercosis varies depending on the number of cysticercosis and parasitic parts. The number of parasitic species can vary from one to several thousand. The size and shape vary with the location and tissue response, and are mostly round in connective tissue and ventricles. , about 0.5 ~ 0.8cm, slightly elongated in the muscle, the bottom of the brain can reach 2.5cm and can be grape-like branches, the predilection site is subcutaneous tissue, muscle, brain, eye, followed by heart, tongue, liver, lung , peritoneum, upper lip, breast, uterus, ganglion sheath, bone, etc.
3. Pathological changes: The pathological changes caused by cysticercosis in the body can be divided into three stages:
1 stimulate tissue to produce cell infiltration: mainly neutrophils, eosinophils, lymphocytes, plasma cells and giant cells;
2 fibrosis: visible fibroblasts, epithelial cells, multinucleated giant cells, lymphocytes;
3 Calcification: The death of the worm is gradually calcified, and the pathological changes of the parts are slightly different.
(1) subcutaneous and muscular cysticercosis: cysticercosis is distributed in the trunk, head and limbs, the number varies from a few to a thousand, and the pathological tissue section can be seen as a skirt-like unevenness in the cystic cavity. There are epidermis layers outside, with blue-violet-stained calcified bodies underneath, visible suction cups on the head, small hooks, and obvious host tissue reactions around the insects, forming cysts, and the old ones can be changed into a layer of fibrous tissue. The membrane is clearly demarcated from the peripheral tissue. It is a surgical indication line. The cysticercosis parasitic in the muscle is mostly oval, and its long axis is consistent with the muscle fiber. When a large number of parasitic, the muscle tissue is squeezed, denatured, and atrophied. The patient's limbs are compensated for non-muscle fiber thickening, that is, pseudo-muscle hypertrophy, and the limbs are weak and weak, and even walking is difficult.
(2) Cerebral cysticercosis: Cysticercosis can be parasitic in any part of the central nervous system, brain parenchyma, ventricle and pia mater, number, size, round or oval, usually 5 to 10 mm, in the ventricles, large To 3 ~ 12cm, it can be polycystic, ie, grape-like cysticercosis, the pathological reaction depends on the location, the survival state, the brain tissue reaction around the cysticercosis includes 4 layers, from the inside to the outside:
1 cell layer: visible fibroblasts, multinucleated giant cells and so on.
2 collagen fiber layer.
3 inflammatory cell layer: mainly lymphocytes, a small amount of plasma cells, eosinophils.
4 nerve tissue layer: composed of degenerated nerve tissue astrocytes and microglia.
In the ventricles, ventricular valvular occlusion often occurs, causing intermittent hydrocephalus, early, ependymal inflammation, glial cell hyperplasia, advanced, increased inflammation, adhesion of the worm and ependymal membrane, resulting in permanent mechanical obstruction In the pool between the cerebral peduncle and the spinal cord, there is inflammatory cell infiltration between the nerve fibers of the nerve roots, which leads to clinical symptoms of cranial nerve and spinal nerve involvement. The parasitism of the cysticercus of the brain can destroy the defense function of the brain. Lead to viral encephalitis, and the mortality rate is increased.
(3) ocular cysticercosis: if it occurs in the deep part of the fundus, it is vitreous (50% to 60% of ocular cysticercosis), subretinal (28% to 45%), and other subconjunctival, anterior chamber. In the eyelids and eye muscles, the pathological changes are degenerative changes of the tissue, and the inflammatory reaction may cause retinal detachment, vitreous opacity, and crystal turbidity depending on the site.
Prevention
Pediatric pig with tsutsugamushi disease and cysticercosis prevention
1. Actively treat patients.
2. Strengthen feces and pig pen management.
Complication
Pediatric pig with tsutsugamushi and cysticercosis complications Complications, epilepsy, hydrocephalus, ataxia, cerebral palsy
Can be epileptic state, causing hydrocephalus, blindness, paraplegia, pseudo-muscle hypertrophy and calcification, can be complicated by cysticercosis meningitis, traffic hydrocephalus, ataxia, and cerebral palsy.
Symptom
Pediatric pig with ascariasis and cysticercosis symptoms Common symptoms Inability to find white segmental vertigo cysts in the feces Hydrocephalus increased intracranial pressure sensory disorder subcutaneous nodules tinnitus muscle pseudo-hypertrophy
The incubation period ranges from 2 months to several years.
1. Pig tsutsugamushi disease: caused by adult worms, roughly similar to cattle tsutsugamushi disease.
2. Cysticercus cellulosae: The clinical manifestations of cysticercosis are complex and diverse due to the number of parasites, the number and the human body's response.
(1) Cerebral cysticercosis: Symptoms are extremely complex and diverse, can be asymptomatic, sudden sudden death, clinical classification, opinions are still inconsistent, epilepsy is the most prominent symptom, severe cases can be epileptic state, generally in the worm After the emergence of subcutaneous or subcutaneous capsules in the first half of the year, 1/10 can be relieved, increased intracranial pressure, mental disorders are common symptoms, headache, vomiting, dizziness, tinnitus, blindness, sensory disturbances, paraplegia and so on.
In the ventricles, often cause intermittent hydrocephalus, advanced mechanical obstruction in the late stage, clinical symptoms of cranial nerve and spinal nerve involvement, easy to cause viral encephalitis, and increased mortality.
(2) Subcutaneous and muscular cysticercosis: often no obvious symptoms, only found by accidental skin or physical examination, the subcutaneous nodules are round or oval, slightly uplifted or not raised on the skin surface, similar in size, such as soybeans Or broad bean, medium hardness, such as cartilage, non-adhesive with surrounding tissues, no tenderness, often appear in batches, can also disappear automatically, when a large number of parasitic muscles, muscle tissue is squeezed, denatured, atrophied, patients with limbs due to non-muscle fibers Reimbursement thickening is pseudo-"muscle hypertrophy", the limbs are weak and weak, and even walking is difficult, after a certain period of time, the final calcification.
(3) ocular cysticercosis: can occur in any part of the eye, but the most common in the vitreous, followed by the retina, under the ophthalmoscope visible gray-white round vesicle with blue reflection, surrounded by a golden aperture, sometimes Visible body worms, vitreous opacity, severe blindness.
Examine
Inspection of tsutsugamushi and cysticercosis in pediatric pigs
Immunological examination
(1) Intradermal test: high sensitivity, simple, but more false positives and cross reactions.
(2) Enzyme-linked immunosorbent assay and its improved method (ELISA): sensitivity and specificity are high, mainly cross-reacting with serum of patients such as hydatid disease.
(3) Indirect red blood cell agglutination test (IHA): It is also more common, and the method is simple, but the stability is slightly poor.
(4) Immunogold and silver staining (IGSS): a highly sensitive method developed in the past 10 years.
(5) Enzyme-linked immunoblotting (EITB): A specific antigen band can be identified with a sensitivity of 98% and a specificity of 100%.
(6) Indirect fluorescent antibody test (IFAT), immunoenzyme staining test (IEST), complement binding test, latex agglutination test, convective immunoelectrophoresis and the like are also used for immunological diagnosis of cysticercosis.
Various methods can detect the blood of patients, cerebrospinal fluid antibodies, antigen detection can also be tried, it is recommended that those with conditions, a variety of methods, antibodies, antigen detection combined application, can increase the positive rate.
2. Peripheral blood like eosinophils increased.
Film degree exam:
1. Computerized tomography (CT): Head CT examination is of great value in the diagnosis of cerebral cysticercosis. It can provide a basis for localization, identification of active lesions, cerebrospinal fluid channel obstruction, and assessment of curative effect, often manifested as scattered circles less than 1cm. Shaped or elliptical low-density foci, flaky low-density foci, enhanced nodular enhancement or ring-shaped foci, high-density foci or calcification, ventricular enlargement, etc.
2. Magnetic Resonance Imaging (MRI): Active lesions are more sensitive than CT, and it is easier to detect lesions in the ventricles and ventricles, showing that the head section is clearer, but the calcification is not as good as the CT scan.
3. X-ray examination: The positive rate is low, and the cysticercus calcification is later in the brain tissue. Generally, only those who have calcified for more than 10 years can find shadows.
4. Ventricular angiography: It has been replaced by CT in recent years.
Diagnosis
Diagnosis and identification of tsutsugamushi and cysticercosis in pediatric pigs
diagnosis
1. Pig with tsutsugamushi disease and cattle with tsutsugamushi disease.
2. The diagnosis of cysticercosis is often difficult.
(1) History: There is a history of swine mites, or eggs or nodules found in the feces.
(2) Clinical manifestations: For those with a history of epilepsy, they should be highly vigilant. Most patients have a history of seizures, increased intracranial pressure, other neuropsychiatric symptoms and signs, and subcutaneous nodules are helpful for diagnosis.
(3) subcutaneous nodule biopsy: surgical removal of the nodule is a white smooth cyst, containing cystic fluid and head section, can be diagnosed, is also a circumstantial evidence of cerebral cysticercosis.
Differential diagnosis
1. Subcutaneous cysticercosis should be differentiated from multiple neurofibromatosis, lipoma, and nodular sclerosis.
(1) multiple neurofibromatosis: often the skin has light brown spots and a positive family history, the nodules are beaded along the nerve trunk, and biopsy can confirm the diagnosis.
(2) lipoma: soft, lobulated, often symmetrical, with a family history, can have a huge type, biopsy can confirm the diagnosis.
(3) Nodular sclerosis: There is often a positive family history, mostly in childhood, and there are often sebaceous adenomas on the face.
(4) Nodular panniculitis: the skin is red and swollen at the subcutaneous nodules, children have fever, liver and spleen, bone marrow suppression, etc., biopsy can confirm the diagnosis.
2. Cerebral cysticercosis should be differentiated from primary epilepsy, intracranial tumor, tuberculous meningitis.
(1) Primary epilepsy: There is often a positive family history, no positive CT or MRI findings in the brain, cerebral cysticercosis often has a history of mites, subcutaneous nodules, and immunological examinations can help diagnose.
(2) Intracranial tumors: It is not difficult to identify the two by immunological examination and CT or MRI.
(3) Tuberculous meningitis: cerebrospinal fluid routine, moderate increase in protein and cell number, decreased sugar and chloride, smear may find tuberculosis, if combined with immunological examination and brain CT can determine the diagnosis.
