Urogenital echinococcosis
Introduction
Introduction to genitourinary echinococcosis Hydatid disease, also known as echinococcosis, is a common parasitic disease in livestock areas and is a zoonotic disease. It is more common in various provinces and regions in western China. The echinococcosis mainly invades the kidney in the genitourinary system, and a small number invades the bladder, spermatic cord and testis. Bladder echinococcosis is caused by a ruptured cyst of the renal hydatid disease or a rupture of the pelvic cyst into the bladder. basic knowledge The proportion of the disease: the disease is rare, the incidence rate is about 0.001% -0.005% Susceptible people: no special people Mode of infection: fecal spread Complications: malnutrition, anemia, abdominal pain, jaundice, renal colic, peritonitis, anaphylactic shock
Cause
The cause of urogenital echinococcosis
(1) Causes of the disease
Echinococcus granulosus is parasitic in the small intestine of the dog, and the eggs are discharged with the feces, polluting the water source, grassland, etc. After the person eats the food contaminated by the eggs, the eggs are hatched in the duodenum to six hooks, six hooks. The sputum penetrates the intestinal mucosa and sneak into the capillaries. The portal vein enters the liver and develops into a worm. If the scorpion sinus passes through the hepatic sinus, it can reach the lungs with the blood flow and develop into a hydatid. Therefore, the incidence of liver and lung hydatid disease is high. If there are still a few six hooks passing through the pulmonary veins, they can reach the whole body with the body circulation, and all organ tissues can be affected. The incidence of genital male reproductive system echinococcosis accounts for about 2% to 5% of the systemic echinococcosis in the endemic areas. , kidney, bladder, spermatic cord, testis can occur.
(two) pathogenesis
The six hooks develop into early hydatid vesicles, gradually increasing and forming an inner capsule with a germinal layer and a stratum corneum. The outer part of the hydatid forms a thick and tough fibrous tissue envelope from the proliferating tissue of the intermediate host. The sac, the inner sac layer can produce a large number of hair sacs, which fall off into the sac fluid and become ascospores. The sacs can also produce sun sacs, and the germinal layer can also produce sacs, each of which contains 10 to 40 original horns. Free in the sac fluid called the sac sand, if the hydatid rupture or surgical operation is inadvertent, sac sand leakage into the abdominal cavity can occur secondary echinococcosis.
Prevention
Urogenital echinococcosis prevention
"Prevention first" is the fundamental method for prevention and treatment of echinococcosis. Propaganda and education is the basis for prevention work. The life history of Echinococcus granulosus is mainly in the dog-sheep cycle chain. The sheep in the popular area suffer from Echinococcus granulosus. The detection rate is 30% to 60%, and the prevalence of infection of the worms in the flock is as high as 40% to 90%. Therefore, it is necessary to kill the wild dogs in the popular areas. For the shepherd dogs, the praziquantel is administered according to the weight of the dogs. 50 to 100 mg of drug sputum, once a month, can die before the mature stage (40 to 50 days) of Echinococcus granulosus, thereby destroying the eggs of the infected intermediate host.
For slaughtered sheep, beef should be quarantined. If there is a blister-like viscera to be buried deeply, don't feed the dog to block the chance that the terminal host will infect the original head section, prevent the dog feces from polluting the grassland, the water source, and not drinking raw water. Wash hands before meals, wash dishes, clean up personal hygiene and environmental hygiene, and persist in scientific prevention work to achieve the goal of controlling echinococcosis in the population.
Complication
Urogenital echinococcosis complications Complications, malnutrition, anemia, abdominal pain, jaundice, renal colic, peritonitis, anaphylactic shock
Concomitant infection
Due to the long history of echinococcosis, the senescence of the hydatid or the degeneration, the malaria of the hydatid; the excessive ascus, the too little cystic fluid or the secondary infection of the hydatid cyst due to the rupture of the hydatid, etc. A purulent parenchyma that forms an acute renal abscess or other tissue. If the inflammation is covered by the fibrous outer tissue of the hydatid, the patient's systemic and local inflammatory response is mild, and the main symptoms are general weakness. Low-heat, weight loss, anemia and other chronic consumption performance, severe infection may have obvious systemic symptoms of toxemia and local symptoms of acute abscess. The clinical manifestations of renal hydatid infection are similar to those of pus or large hydronephrosis. Pay attention to the identification.
2. The cyst is worn out
The hydatid cyst of the liver and the like may be ruptured due to trauma, puncture, and may cause severe abdominal pain and allergic symptoms when broken into the abdominal cavity. Due to the overflow of the cyst fluid, a secondary hydatid cyst may be generated. If the cyst breaks into the intrahepatic bile duct, It can produce biliary colic and jaundice.
Due to accidental trauma, infiltration of inflammation after infection or misdiagnosis of diagnostic puncture at the time of treatment may lead to rupture of the wall of the capsule. The clinical manifestations vary greatly depending on the degree of rupture of the wall and the location of the rupture. which performed.
If only the internal capsule is ruptured, the cystic fluid that overflows is limited by the tough outer capsule. The inner capsule peels off and collapses and floats in the cyst fluid. At this time, the necrosis is necrotic due to the lack of nutrient supply of the hydatid, and finally a secondary infection is formed.
If the outer capsule is ruptured, the inner capsule can be swelled because the pressure inside the capsule is too high, causing the contents of the capsule to overflow and enter the surrounding tissue. According to the different parts of the capsule wall, the cyst fluid leakage pathway can be divided into three categories:
(1) If the kidney hydatid breaks into the urinary tract and allows a large amount of cyst contents to enter quickly, it can cause sudden renal colic and frequent urination, urgency, dysuria and other bladder irritation. In severe cases, the ureter can be blocked and the kidney can be twisted. Pain is exacerbated and there is radiation pain in the perineum. When the proximal ureteral pressure is increased to a certain level, the contents of these capsules can be discharged by themselves. If the hydatid breaks into the bladder, it can cause bladder irritation and discharge a large number of white packets visible to the naked eye. Insect sac and small ascus.
(2) If the hydatid breaks into the abdominal cavity, it can cause sudden acute peritonitis, and anaphylactic shock occurs due to the absorption of a large number of heterologous proteins, although the intraperitoneal fluid is aspirated through timely anti-shock treatment and surgical treatment. The removal of the hydatid can temporarily save the patient's life, but due to the implanted dissemination of the original sputum in the abdominal cavity, hundreds of secondary multiple peritoneal echinococcosis can be formed in a few months, causing extensive adhesion of the abdominal organs. Finally, due to chronic consumption, the echinococcosis is cachectic.
(3) If the hydatid breaks into the peritoneum, the cystic fluid can fall along the psoas muscle at the waist, forming a secondary echinococcosis or secondary infection.
Symptom
Urinary genital echinococcosis symptoms common symptoms urinary frequency urinary urinary cyst dysuria pus urinary hematuria secondary infection peritonitis
There is a history of living and living in areas where echinococcosis is endemic, especially in dogs and sheep.
1. The main symptoms of patients with renal hydatid disease are kidney mass, low back pain, hematuria and pyuria, often occurring in the unilateral kidney, and occur mostly in the inferior pole of the kidney, which can be accompanied by liver and pulmonary hydatid disease. When the capsule breaks into the renal pelvis and the renal pelvis, the powdery skin contains the ascus and the inner layer of debris into the urine, which may cause acute renal colic, frequent urination, urgency, dysuria and other symptoms. After secondary infection, it may show fever and increase back pain. Hematuria and pyuria, severe peritonitis can occur when the cyst ruptures into the abdominal cavity.
2. Bladder hydatid is mainly characterized by frequent urination, dysuria, urgency, turbid urine and discharge of urine containing powdery sacs and inner layers of debris.
3. In patients with spermatic cord or testicular echinococcosis, a spherical mass may appear locally, and the light transmission test is positive, like hydrocele.
The typical sign of a hydatid cyst is that the surface is smooth, the toughness and elasticity of the palpation, the tremor of the sputum, the kidney worm in the upper abdomen or the waist can be smooth and smooth, the edges are neat, and the boundary is clear and painless. Lump.
Examine
Examination of genitourinary echinococcosis
Blood test
Eosinophilia.
2. Urine check
When the hydatid breaks into the urinary tract, white powdery-like fragments are seen in the urine, and the head of the hydatid is detected.
3. Serological examination
Such as indirect red blood cell agglutination test (IHA), enzyme-linked immunosorbent assay (ELISA) is helpful for diagnosis.
4. Carson Pioneer Test (ID)
It is a valuable diagnostic method by injecting 0.1~0.2 ml of specially treated cystic fluid into the forearm to observe the redness and induration of the skin. The positive rate can be as high as 90%. The indirect red blood cell agglutination test has Highly specific and sensitive, with fewer false positive reactions.
5.B Ultra
B-ultrasound can detect the anechoic zone with clear edges, sometimes it can detect petal-like separation or honeycomb light band; sometimes "double wall sign" can be seen, bladder B-ultrasound shows round-shaped echo-free reflective liquid dark area The rough wall of the border is clear, and the larger echinococcosis cyst can be seen as "double wall sign".
6.X line
KUB plain film can be seen with enlarged kidney shadow, with a contour of the tumor protruding from the kidney edge, sometimes visible linear calcification shadow at the edge of the tumor, excretion and retrograde urography to show renal pelvis, renal pelvis compression deformation, displacement, renal pelvis funnel Thinning and elongation, when the capsule breaks into the renal pelvis, the contrast agent overflows into the capsule and shows multiple circular filling defects. The contrast agent flows along the ascus gap and presents a rain-like sign, and the hydronephrosis is also visible. Poor development or no development.
7.CT shows multiple cystic changes in the kidney
The wall of the capsule is thick and the edge is clear. There may be a "capsule in the capsule". Sometimes the unique honeycomb-shaped image is visible, which is helpful for diagnosis. If the ascus is too much, it is squeezed and contained in the mother capsule. CT shows the shape of the wheel. Or the honeycomb arrangement is a unique image of renal hydatid disease. The bladder CT shows that the bladder wall has a clear cystic space, and the density is uniform. When the ascus contains the capsule, it is a "capsule" sign.
Diagnosis
Diagnosis and identification of urogenital echinococcosis
diagnosis
The diagnosis of this disease should be based on the history of exposure, clinical manifestations and signs, combined with laboratory tests, immunological examinations and imaging results.
Differential diagnosis
Simple renal cyst
There may be symptoms of back pain, sometimes touching the upper abdomen and lumbar cystic mass, but the patient has no history of living and life in the epidemic area of echinococcosis, mostly found in the health screening, B-ultrasound showed a round echo-free mass, wall Thin and smooth, X-ray examination of the wall calcification is more common, urine does not contain cystic debris, negative for Carson reaction, can be differentiated from renal hydatid disease.
2. Polycystic kidney
Also manifested as cystic mass in the upper abdomen and waist, but the disease has a family-like tendency, mostly bilateral, with progressive renal insufficiency and hypertension, physical examination of the lumbar mass boundary is unclear, softer; and B Ultra-examination found that the kidney volume increased significantly, the kidney edge was not uniform, the intrarenal cystic mass did not have "double wall sign", urinary tract angiography showed renal pelvis deformation, elongated, spider-foot shape, CT showed double kidney volume, There are numerous cysts of different sizes in the kidney section, and the cyst wall may have calcification, which may be differentiated from renal hydatid disease.
3. Hydronephrosis
There are also waist pain, hematuria and pyuria symptoms, the upper abdomen and the waist can touch the cystic mass, but the disease has obvious urinary tract obstruction, such as stones, stenosis, etc., patients without echinococcosis epidemic area living and living History, urography showed renal pelvis, dilated renal pelvis, no thinning and displacement of the funnel of the renal pelvis, no cysts in the urine, negative for Carson reaction, and can be differentiated from renal hydatid.
4. Renal tumor
There are also low back pain and lumbar and abdominal masses, but this disease has a full range of gross hematuria with cord-like blood clots, fever and weight loss. B-ultrasound shows that the kidney volume of the affected side increases, there is a substantial occupation, CT shows no kidney Homogeneous space-occupying lesions, CT value of 30 ~ 50Hu, enhanced scan showed that the CT value of the tumor is lower than normal kidney tissue, the boundary is clear, and can be differentiated from renal hydatid disease.
5. Bladder tumor
B-ultrasound can detect the space-occupying lesions of the bladder wall. Large tumors can be touched by double-conspiratory examination, but the bladder tumors have painless gross hematuria, no powdery urine, and tumor cells can be found in the urine without Sugawara section, B-ultrasound and CT examination showed that there was a substantial space-occupying lesion in the bladder, rather than a cystic mass, which could be differentiated from cystic echinococcosis.
6. Ureteral cyst
Infection can occur frequent urination, urgency, dysuria, B-ultrasound can also show cystic space-occupying lesions in the bladder, but the urine can not find the head section and ascus, cystoscopy can be seen ureteral cystic masses With rhythmic relaxation and urination, it can be differentiated from cystic echinococcosis.
7. Bladder polyps
B-ultrasound can also be expressed as a space-occupying lesion of the bladder wall, but the patient has no powdery skin-like urine, and the worm's head section and ascus can not be found in the urine. B-ultrasound and CT examination can find substantial occupying in the bladder. Instead of cystic mass, it can be differentiated from cystic echinococcosis.
