Treatment of pulmonary echinococcosis after surgery. Echinococcosis of the lungs: features of the course, principles of treatment

B67.1 Lung infection caused by Echinococcus granulosus

General information

Pulmonary echinococcosis can be primary and secondary (metastatic), developing in any part of the lung, but mainly affects the lower lobes. In this case, unilateral or bilateral, single or multiple echinococcal cysts can be formed, having a small (up to 2 cm), medium (2-4 cm) or large (4-8 cm or more) size. An echinococcal cyst is limited by a dense membrane, consisting of an outer (cuticular) and inner (germinative) layer, and is filled with yellowish liquid content. Pulmonary echinococcosis usually has a single-chamber (hydatid) form, rarely a multi-chamber form.

Causes

A person becomes infected with Echinococcus eggs excreted in the feces of sick animals, usually through contact with wool, milking, sheep shearing, skinning, and through the nutritional route when consuming unwashed, contaminated vegetables, herbs, and water. Rarely does aerogenic infection occur when dust is inhaled during hay harvesting and agricultural work. From the intestine, Echinococcus germs spread hematogenously to the liver, lungs and throughout the body. During respiratory infection, oncospheres are fixed on the walls of the bronchi, then penetrate into the lung tissue, forming vesicular structures.

Echinococcus is capable of growth and endless reproduction due to the brood capsules of the inner layer, reproducing the scolex and forming daughter blisters in the cyst cavity. Due to the high elasticity of the lung tissue, the cyst gradually grows, reaching a large volume within a few years. Giant cysts with a diameter of 10-20 cm can contain several liters of fluid. In the lung, the larva of echinococcus can remain viable for many years and even decades (20 years or more). Echinococcosis of the lungs can occur uncomplicated and with complications (calcification, suppuration and rupture of the cyst).

Pathogenesis

Diagnostics

In the diagnosis of pulmonary echinococcosis, radiography and CT of the lungs, sputum microscopy, general blood test, and serological testing are used. When collecting anamnesis, the facts of stay in regions that are epidemically unfavorable for echinococcosis, the presence of work related to animal husbandry, hunting, and processing of animal skins are important. With a very large bubble of echinococcus, you can notice a protrusion of the affected part of the chest wall with flattening of the intercostal spaces. In the area of projection of the hydatid cyst, dullness of percussion sound is determined. With perifocal inflammation, moist rales are detected; When the cyst empties, breathing becomes bronchial. Physical findings are more pronounced as complications develop.

During the latent period of echinococcosis in the lungs, one or several large, round, homogeneous, clearly defined shadows are radiologically determined, changing configuration during respiratory movements. CT scan reveals the cystic nature of the lesion, the presence of a cavity with a horizontal level of fluid and perifocal infiltration (strongly expressed during suppuration), and sometimes calcification. Differential diagnosis of echinococcosis is carried out with tuberculosis, benign lung tumors, bacterial abscesses and pulmonary hemangioma.

Treatment of pulmonary echinococcosis

The prognosis for pulmonary echinococcosis with timely radical surgery is usually favorable. The formation of intraoperative metastatic foci is fraught with relapse of helminthiasis with multiple lesions. Prevention of pulmonary echinococcosis consists of observing the rules of personal hygiene, deworming domestic animals, sanitary control of living conditions and slaughter of livestock, and catching stray animals.

According to the observations of specialists, liver tissue is damaged in 70-80% of cases with echinococcosis, and pulmonary echinococcosis is detected only in 15-20% of patients infected with Echinococcus granulosus. Why and how does this helminthic infestation develop? In which countries and regions is it common? What are the symptoms of pulmonary echinococcosis? How is it detected and treated? You will find answers to these questions in this article.

A person becomes infected with echinococcosis due to the entry into his body of helminth eggs excreted in the feces of infected animals. Typically, infection occurs through dirty hands during milking, shearing, caring for animals, tanning hides, cleaning the barnyard, when eating unwashed vegetables, herbs, fruits or water contaminated with animal feces. In more rare cases, helminth eggs are inhaled along with dust during agricultural work or haymaking.

Echinococcus oncospheres released by animals can tolerate temperatures from – 30 to + 38 °C.
In the shade on the soil surface and at temperatures from 10-26 ° C, they can survive for 30 days.
At a temperature of 18-50 ° C and under sunlight, they die in 1-5 days.
In grass at 14-28 °C they remain viable for up to 45 days.

Echinococcus oncospheres do not tolerate drying well, but are resistant to low temperatures and under such conditions persist for several years.

An echinococcal cyst is a bubble with a complex structure. It is covered with a thick (up to 5 mm) layered capsule (cuticle), under which there is a thinner germinal membrane, which participates in the growth of the outer membrane and produces daughter bladders and brood capsules with scolex.

Brood capsules are scattered on the embryonic membrane, connected to it by a thin stalk and look like small vesicles. Each capsule contains a scolex attached to it, and the bladder is filled with a yellowish liquid, which is necessary to nourish and protect the brood capsules and scolex. The same liquid medium may contain components of hydatid sand - detached scolex and brood capsules. The surface of the bladder gradually becomes overgrown with connective tissue and forms a maternal cyst. Often it contains smaller daughter and grandchild bladders with a similar structure.

The growth of an hydatid cyst causes a number of negative effects on the body:

injury, compression and irritation of surrounding tissues;
allergization by metabolic products.

Compression of the tissues surrounding the cyst leads to dysfunction of the affected lung, and the location and size of this formation determines the nature and severity of the symptoms that appear. In addition, the formation constantly irritates nearby tissues and causes their chronic inflammation.

Classification

Pulmonary echinococcosis occurs:

Hydatid cysts are:

single;
multiple;
one-sided;
double-sided.

The size of an hydatid cyst is characterized as follows:

small – up to 2 cm;
average – from 2 to 4 cm;
large – from 4 to 8 cm;
giant – from 10 to 20 cm.

Echinococcal cysts are often single-chamber, sometimes multi-chamber.

Prevalence

More often, the disease discussed in this article is detected in residents of regions with developed cattle breeding and a hot, dry climate. As you move from south to north, the incidence rate decreases. The main distributors of this helminthiasis are usually cattle, sheep and pigs.

Echinococcosis is more often detected in Transcaucasia, Tatarstan, Bashkortostan, Crimea, Altai, Krasnoyarsk, Krasnodar, Khabarovsk territories, the North Caucasus, Samara, Volgograd, Rostov, Chelyabinsk, Amur, Omsk, Tomsk, Magadan and Kamchatka regions, Chukotka Autonomous Okrug. Cases of morbidity are registered in Moldova, Kyrgyzstan, Uzbekistan and in the Kherson, Odessa, Zaporozhye, Donetsk and Nikolaev regions of Ukraine.

According to statistics, the following countries are most affected by echinococcosis: Chile, Brazil, Paraguay, Uruguay, Argentina, the southern part of the USA, Morocco, Tunisia, Algeria, Egypt, New Zealand, Italy, Turkey, Bulgaria, Greece, Cyprus, Spain, France, Serbia, Montenegro, India and Japan.

Symptoms

The disease at stage I is asymptomatic and is discovered accidentally - during a routine fluorographic examination.

During pulmonary echinococcosis, experts distinguish 3 main stages:

I (asymptomatic) - due to the slow growth of the cyst, this stage of echinococcosis can last several years after infection; at this stage, the disease can be detected by chance when performing;
II (clinical manifestations) - due to an increase in the size of the cyst, the patient develops chest pain, sometimes a cough occurs and, without detailed diagnosis at this stage, manifestations of helminthiasis are often mistaken for symptoms of other diseases (, etc.);
III (complications) – due to infection and suppuration, the cyst breaks into the bronchus, pleural or abdominal cavity, blood vessels, pericardium.

At the stage of asymptomatic echinococcosis, the patient may only feel periodic mild weakness and notice a decrease in performance. Typically, symptoms appear only 3-5 years after the invasion and when the cyst that appears is large. Initially, the patient complains of a dull pain in the chest. Some patients develop a persistent cough (initially dry, then wet with blood in the sputum), difficulty swallowing, and shortness of breath. In addition, due to the entry into the blood of waste products of Echinococcus larvae, allergic manifestations develop in the form of urticarial rashes and bronchospasm. Some patients develop lung disease (collapse of the alveoli in a certain area of the organ).

If left untreated, pulmonary echinococcosis leads to the development of severe complications. Suppuration of the cystic cavity is manifested by signs. When it breaks into the lumen of the bronchus, the patient develops an intense cough with the release of a large volume of watery sputum with admixtures of pus and/or blood, fragments of daughter capsules and the membrane of the cyst. The cough is accompanied by asphyxia, cyanosis of the skin and mucous membranes, and severe allergic reactions.

If the contents of the cyst spill into the pleural cavity, the patient’s health sharply worsens due to the development of pleurisy. Acute pain appears in the affected area, the temperature rises abruptly, chills and signs of respiratory distress occur. In the future, this complication can lead to the development of pleural empyema and anaphylactic shock and death. When an echinococcal cyst is opened into the pericardial cavity, signs of cardiac tamponade appear.

Pulmonary echinococcosis can masquerade as other diseases of the respiratory system, and to identify it, it is important to collect data on the fact of being in areas where this invasion is widespread or in a profession related to animal husbandry. Sometimes, with very large cysts on the patient’s chest, protrusion and smoothness of the intercostal spaces may be noticeable. When tapping the lungs in the area of the hydatid cyst, a muffled sound may be detected.

The following studies help confirm the diagnosis of pulmonary echinococcosis:

radiography;
microscopy of sputum sediment;
general blood analysis;
serological blood tests (RNGA, ELISA) to detect antibodies to echinococcus.

In some cases, diagnosis may be supplemented by bronchoscopy or diagnostic thoracoscopy.

To eliminate errors, differentiation of pulmonary echinococcosis with the following diseases is carried out:

bacterial lung abscess;
benign tumors of the lungs;
pulmonary hemangioma.

Treatment

The basis of treatment is anthelmintic drugs.

To get rid of pulmonary echinococcosis, a combination of two treatment methods is usually used:

Albendazole;
Zentel;
Escasol.

The choice of method for surgical removal of an hydatid cyst depends on the clinical case. For small and superficial formations, a so-called ideal echinococcectomy can be performed, which consists in removing the cyst without violating the integrity of its membrane. After its removal from the lung, the remaining cavity in the organ is treated with alcohol and hypertonic solutions, formaldehyde and antiseptics. Next, the cavity is sutured.

Pulmonary echinococcosis is a chronic disease. It is characterized by the occurrence of multiple cystic formations. The reason for their appearance is the larvae of the tapeworm echinococcus.

In this article we will talk about the symptoms of echinococcosis that occurs in the lungs, and also learn about all existing treatment methods.

There are 3 stages of disease development:

Latent or otherwise asymptomatic. The duration is several years. The growth of the cyst is very slow. Its presence is discovered accidentally during an x-ray.
Clinical symptoms of pulmonary echinococcosis in humans. There is chest pain, shortness of breath, severe cough, and general weakness. The size of the bubble increases.
Development of complications. The cyst begins to rot. Then it can break into the pleura, bronchi, bile ducts, and abdominal cavity. The tissues begin to compress. The bile ducts and blood vessels are also affected, and nerve endings are compressed.

At the initial stage of infection, the following symptoms are noted: chest pain, dry cough. The cough becomes moist, foamy, and acquires an unpleasant odor. Without proper therapy, blood may be visible in the discharge after coughing.

At a late stage of the disease, symptoms worsen, the cyst grows, pneumonia is very likely to develop, and the lung tissue is compressed. A breakthrough is possible at any time. The patient begins to lose weight.

The diagnosis is not made only based on the results of laboratory and instrumental studies. It is mandatory to interview the patient in order to detect external signs of the disease. During examination, doctors identify some signs that indicate an increase in hydatid cyst:

skin rash (local or widespread);
increase in body temperature to high numbers with perifocal inflammation;
bulging of the chest at the site of infection;
wheezing when listening to the chest, for example, of a bronchial nature.

Clearly expressed symptoms become noticeable only as the tumor grows. At the primary stage or with very slow growth of the hydatid cyst, the disease does not manifest itself in any way.

Treatment of pulmonary echinococcosis is carried out using surgery in combination with the rehabilitation use of medications belonging to various pharmacological groups (Zentel, Eskazole, Albendazole). Therapeutic therapy should be carried out under constant medical supervision.

Conservative therapy in the treatment of the disease in question makes it possible to eliminate its symptoms and relapses. During this procedure, the patient receives analgesics and drugs that relieve pain, nausea and vomiting.

The following operating methods are used:

Resection. It is carried out in case of extensive inflammation or in the case of the simultaneous presence of this and other pathologies requiring its use.
Echinococcectomy. The contents of the cyst are sucked out. The fibrous capsule is then cut.
Radical surgery. Complete removal of the cause of the pathology.
Palliative method. The patient's condition only improves.
Eliminating complications of surgery.

Reference. In children, the disease manifests itself in the same way as in adult patients. Most often, when infected, therapy is surgical. Therefore, it is necessary to take all necessary measures to prevent infection with echinococcus in order to protect the child from it.

Important. Doctors advise that when a cyst has formed in your body, no matter in what organ, you must immediately prepare to fight it.

Today, it’s a pity, when establishing the appropriate diagnosis, medicine is powerless. In addition, laboratory tests take a lot of time, and sometimes do not provide a 100% guarantee of results. You can't wait too long for an accurate diagnosis.

After all, this can only worsen the situation. However, it's not all bad. Currently, modern medicine has already developed significant potential for the effective treatment of this helminthiasis. Although these methods do not always provide a complete guarantee of recovery.

By the way, you can try to be treated with folk remedies. However, it is worth knowing that this can only be effective if the infection is detected in a timely manner, while the larvae have not yet reached a sexually mature state. But the embryos of echinococcus are very sensitive to the effects of decoctions from various plants on them.

Sagebrush

Garlic, horseradish, cinnamon, radish and mustard seeds have a similar effect. Ordinary black pepper - peas - is also fatal for a weak embryo. To do this, you need to take one pea every day.

Healing herbs

To defeat this type of tapeworm in its embryonic state, you can take a powder that contains crushed cloves, tansy and wormwood. You need to take this composition one teaspoon three times a day before meals for 10 days. Such courses should be conducted once every three months.

Ginger

To prepare a folk remedy based on dry ginger, you need to grind it to a powder state. Then one teaspoon should be diluted in 50 g of water or milk. Should be taken every other day. The described remedy has long been used as an elixir of longevity.

Lemon peel

According to numerous reviews from patients, dry lemon peel can be an excellent remedy for the treatment of pulmonary echinococcus. To do this, you need to grind it to a powder and dilute one teaspoon in half a glass of hot water. This remedy should be taken every morning on an empty stomach.

Tincture of garlic, water, lemon and honey

The experience of traditional healers using herbs makes it possible to improve your health, without any side effects. But, of course, it is better to try to prevent infection. To do this, you need to adhere to veterinary standards for keeping pets, regularly carry out sanitary and veterinary control, destroy the organs of infected animals and not allow dogs to eat them.

Important. For prevention, first of all, you must adhere to the rules of personal hygiene, especially after contact with animals. First of all, you need to limit communication with street animals, do not eat unwashed fruits, vegetables, berries, and do not drink water from untested natural sources. It is also mandatory to undergo an annual medical fluorographic examination.

Echinococcosis is a serious helminth disease. That is why, if you detect even minor signs of infection, you should immediately seek qualified help.

We present our own observation of pulmonary echinococcosis in a child. A 5-year-old boy wanders with his parents in the tundra. Parents contacted a health worker in one of the villages of the Nenets Autonomous Okrug with complaints of fever up to 39 degrees and cough for 5 days. Upon admission to the district hospital: wet cough, weakened breathing in the lungs on the right in the corner of the scapula, lateral sections along the anterior surface at the level of 2-6 ribs, moist, single, variable-sized wheezing, no shortness of breath was noted. Hemodynamics are stable. Active, selective appetite. Over time, the weakening of breathing persisted, and the wheezing was intermittent. Sputum microscopy - 2-5 l. in the field of view, CD was not detected. Sputum culture (against the background of antibacterial therapy) is negative. X-ray in the projection of the middle lobe of the right lung shows a rounded shading of the lung tissue with a diameter of 7 cm. In the blood test, erythrocytes 3.68 x 1012/l, HB 117 g/l, leukocytes 7.8 x 109/l, eosinophils 0%, band neutrophils 6%, segm. 48%, lymphocytes 42%, monocytes 2%, ESR 38mm/hour. With antibacterial therapy (cefazolin, macropen), the temperature returned to normal. Radiologically, the rounded shading became more clearly defined. There was a discrepancy between the clinic and the X-ray picture. Tuberculosis was excluded. An echinococcal cyst of the right lung is suspected. The child was sent to the Arkhangelsk Regional Children's Clinical Hospital, where the diagnosis of pulmonary echinococcosis was confirmed, and surgical treatment was performed: right thoracotomy and echinococcectomy.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Invasion of another site and multiple echinococcosis caused by echinococcus multilocularis (B67.6), Invasion of another site and multiple echinococcosis caused by echinococcus granulosus (B67.3), Invasion of the lung caused by echinococcus granulosus (B67.1), Invasion of the liver caused by echinococcus granulosus (B67.0), Invasion of the liver due to echinococcus multilocularis (D67.5), Invasion due to echinococcus granulosus, unspecified (B67.4), Invasion due to echinococcus multilocularis, unspecified (B67.7), Echinococcosis of other organs and unspecified ( B67.9), Liver echinococcosis, unspecified (B67.8)

Infectious diseases in children, Pediatrics, Pediatric surgery

general information

Short description

Recommended
Expert advice
RSE at the RVC "Republican Center"
healthcare development"
Ministry of Health
and social development
Republic of Kazakhstan
dated November 27, 2015
Protocol No. 17

Protocol name: Echinococcosis in children (Echinococcosis of the liver/lungs in children).

Echinococcosis- larval or cystic stage of development of tapeworm belonging to the species Echinococcus granulosus in liver and lung tissue.

Protocol code:

ICD code(s):
B 67.0 Liver invasion caused by Echinococcus granulosus
B 67.1 Invasion of the lung caused by Echinococcus granulosus
B 67.3 Invasion of other localization and multiple echinococcosis caused by Echinococcus granulosus
B 67.4 Infestation caused by Echinococcus granulosus, unspecified
D 67.5 Liver invasion caused by Echinococcus multilocularis
B 67.6 Invasion of other localization and multiple echinococcosis caused by Echinococcus multilocularis
B 67.7 Infestation due to Echinococcus multilocularis, unspecified
B 67.8 Echinococcosis of the liver, unspecified
B 67.9 Echinococcosis of other organs and unspecified

Abbreviations used in the protocol:
ALT - alanine aminotransferase
AST - aspartate aminotransferase
IV - intravenously
IM - intramuscular
ELISA - enzyme immunoassay
Gastrointestinal tract - gastrointestinal tract
CT - computed tomography
MRI - magnetic resonance imaging
CBC - complete blood count
OAM - general urine analysis
RPHA - direct hemagglutination reaction
ESR - erythrocyte sedimentation rate
CVS - cardiovascular system
FFP -- fresh frozen plasma
Ultrasound - ultrasound examination
EC - echinococcosis
ECG - electrocardiogram
EchoCG - electrocardiography
½ - one second part
¼ - one fourth part
Ig G - immunoglobulin G

Date of protocol development/revision: 2015.

Protocol users: local pediatricians, emergency medical team doctors, general practitioners, surgeons.

Note: The following grades of recommendation and levels of evidence are used in this protocol:
Level I- Evidence from at least one properly designed randomized controlled trial or meta-analysis
Level II- Evidence obtained from at least one well-designed clinical trial without adequate randomization, from an analytical cohort or case-control study (preferably from a single center), or from dramatic results obtained in uncontrolled studies.
Level III- Evidence obtained from the opinions of reputable researchers based on clinical experience.
Class A- Recommendations that have been approved by consensus of at least 75% percent of the multi-sector expert group.
Class B- Recommendations that were somewhat controversial and did not meet with agreement.
Class C- Recommendations that caused real disagreement among group members.

Classification

Clinical classification:

Classification of liver echinococcosis (Ordabekov S.O.):
By origin:
· primary
· recurrent
· residual
By the number of echinococcal cysts:
· single.
· multiple
combined
· widespread
According to the clinical course:
· uncomplicated
· complicated
By stages:
· asymptomatic
with symptoms
stage of complications
According to the nature of the complications:
· necrosis
· calcification
complete calcification
· partial calcification
Suppuration:
· perforation
sepsis
amyloidosis
· bleeding
Perforation:
· traumatic
spontaneous
Compression of neighboring organs:
· gastrointestinal tract
· urinary organs
large vessels
bile ducts
Other complications (Pulatova A.T. 1983):
· small - echinococcal cysts with a volume of up to 5-10 ml;
· small - 110-100 ml;
medium - 100-500 ml;
· more - 500-1500 ml;
· giant echinococcal cysts with a volume of more than 1500 ml.

Classification of pulmonary echinococcosis(Pulatova A.T.):
Depending on location:
isolated damage to both lungs
Damage to both lungs and another organ
Damage to one lung and other organs
According to the clinical course:
· early stage
clinical manifestations
stage of complications
Types of complications:
suppuration of echinococcal cyst
breakthrough into the pleural cavity
· breakthrough into the bronchus and pleural cavity
rupture through the diaphragm into the abdominal cavity
Depending on the size of the cysts:
small - up to 5 cm in diameter
medium - with a diameter of 5 to 10 cm
· large - from 10 to 15 cm
· giant - over 15cm

Clinical picture

Symptoms, course

Diagnostic criteria:

Complaints and anamnesis:
· in an uncomplicated course, it is asymptomatic, there may be pain of varying intensity in the right hypochondrium, in the chest area, cough, a feeling of heaviness in the epigastrium, right hypochondrium, low-grade fever, abdominal enlargement, palpable tumor formation, icterus of the skin and sclera, an allergic reaction.
· in complicated cases: pain of varying intensity in the abdominal area, in the chest area, cough with sputum, shortness of breath, tachycardia, hyperthermia, allergic reaction; if an echinococcal cyst ruptures, anaphylactic shock, hydrothorax with displacement of the mediastinal organs in the opposite direction can be observed.

Physical examination:
· with uncomplicated liver echinococcosis, it is possible to detect a palpable tumor-like formation in the upper parts of the abdominal cavity;
· when a cyst ruptures into the abdominal cavity, symptoms of peritoneal irritation are observed against the background of severe pain;
· when an hydatid cyst suppurates, there is an increase in body temperature, changes characteristic of a local purulent process, and symptoms of intoxication;
· with uncomplicated pulmonary echinococcosis, dullness of percussion sound on the affected side may be observed. During ascultation, breathing may weaken;
· when a cyst breaks into the bronchial tree, there may be suffocation, cough with sputum and chitinous particles, moist rales of various sizes, and an allergic reaction;
· when a cyst breaks into the pleural cavity, symptoms of intrathoracic tension, displacement of mediastinal organs, tachycardia, shortness of breath, symptoms of respiratory failure (hydrothorax, pneumothorax) are noted;
· when an hydatid cyst suppurates, a temperature reaction, symptoms of intoxication and respiratory failure (pyopneumothorax) are observed.

Diagnostics

List of basic and additional diagnostic measures:

Basic (mandatory) diagnostic examinations performed on an outpatient basis:
· General blood analysis;
· General urine analysis;
· Blood biochemistry (urea, creatinine, total protein, AST, ALT, total bilirubin, direct and indirect bilirubin, glucose), blood electrolytes (potassium, sodium, chlorine, calcium);
· Ultrasound of the abdominal organs/pleural cavities;
· plain radiography of the chest in two projections;
· RPGA for echinococcal antibodies;
· ELISA for echinococcal antibodies;
· ECG.

Additional diagnostic examinations performed on an outpatient basis:
· EchoCG.

The minimum list of examinations that must be carried out when referring for planned hospitalization ( inpatient care): in accordance with the internal regulations of the hospital, taking into account the current order of the authorized body in the field of healthcare.

Basic (mandatory) diagnostic examinations carried out at the hospital level during emergency hospitalization and after a period of more than 10 days from the date of testing in accordance with the order of the Ministry of Defense:
· blood coagulogram;
· histological examination of biological material.

Additional diagnostic examinations carried out at the hospital level during emergency hospitalization and after more than 10 days have passed from the date of testing in accordance with the order of the Ministry of Defense:
· CT/MRI of the abdominal organs - for liver echinococcosis, allows you to assess the relationship with the biliary tract, the exact size and external contours, segmental localization of the hydatid cyst, and obtain a detailed image of its structure;
· CT/MRI of the chest - for pulmonary echinococcus, allows you to evaluate the relationship with the pulmonary structures, the exact size and external contours, segmental localization of the echinococcal cyst, and obtain a detailed image of its structure;
· diagnostic laparoscopy of the abdominal cavity;
· endoscopic thoracoscopy - in case of breakthrough of the inflammatory process of the tracheobronchial tree and pleural layers;
· endoscopic bronchoscopy - when an echinococcal cyst breaks into the bronchus.

Diagnostic measures carried out at the stage of emergency care:
· collection of complaints;
· taking anamnesis;
· physical examination;
· thermometry.

Instrumental studies:
· Ultrasound of the abdominal organs - an hydatid cyst has the appearance of single-chamber single or multiple liquid echo-negative formations with a smooth surface, devoid of internal structures. Echinococcal cysts are visualized in a certain segment of the liver as round-shaped echo-negative formations with multiple daughter cysts;
· X-ray examination of patients with liver echinococcosis can obtain the following data that helps to recognize liver echinococcosis: high standing of the diaphragm, limitation of its mobility, increase in the size and shape of the liver, calcification in the liver area;
· during diagnostic laparoscopy of the abdominal organs - the presence of fluid in the abdominal cavity with particles of the chitinous membrane and a picture of peritonitis are noted;
CT/MRI of the abdominal organs - the presence of an echinococcal cyst, size, location in the liver segment,
· Ultrasound of the chest cavity - detection of echinococcal cysts in the lungs;
· plain radiography of the chest - homogeneous, round shadows with clear contours. In complicated forms of pulmonary echinococcosis, a positive symptom of a “floating film”, a picture of a lung abscess, pneumothorax, hydropnemothorax with a displacement of the mediastinal organs in the opposite direction;
· endoscopic bronchoscopy: when an echinococcal cyst breaks into the bronchus, a chitinous membrane with a picture of endobronchitis may be detected;
· CT/MRI of the chest - the presence of an echinococcal cyst in the lungs;
· endoscopic thoracoscopy - when an echinococcal cyst breaks through into the pleural cavity.

Indications for consultation with specialists:
· consultation with a pediatrician to exclude concomitant somatic pathology;
· consultation with a gastroenterologist to exclude gastrointestinal pathologies;
· consultation with an endocrinologist to exclude endocrinological pathology;
· consultation with a cardiologist to exclude CVS pathology;
· consultation with a phthisiatrician if a specific process is suspected;
· consultation with an oncologist if an oncological process is suspected.

Laboratory diagnostics

Laboratory research:
· UAC - moderate leukocytosis, eosinophilia, increased ESR; in complicated forms - hyperleukocytosis, neurophilia with a shift to the left, eosinophilia;
· RPGA - increased titer of antiechinococcal antibodies;
· ELISA - increasing the titer of Ig G class antibodies to echinococcal antigens.

Differential diagnosis

Differential diagnosis:

Table - 2. Differential diagnosis of pulmonary echinococcosis

Symptoms	EC uncomplicated	EC complicated	Lung abscess	Non-parasitic cyst lung	Fibrinous cavernous tuberculosis	Lung tumor
P picture - formation with clear, even contours	Yes	Yes	No	Yes	No	No
P picture - the presence of perifocal infiltration	No	Yes	Yes	No	Yes	Yes
Intoxication	No	Yes	Yes	No	Yes	Yes
Hyperthermia	No	Yes	Yes	No	May be	May be
Cough with copious phlegm	No	Yes	Yes	No	No	No
Presence of markers for ELISA and RPGA	Yes	Yes	No	No	No	No
Detection of echinococcal cysts of extrapulmonary localization by ultrasound, CT/MRI	Yes	Yes	No	No	No	No

Treatment abroad

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Treatment

Treatment goals:

removal of the chitinous shell, sanitation of the cavity.

Treatment tactics:

Surgical intervention:

Surgical intervention provided in an inpatient setting:

Surgical treatment for liver echinococcosis:
· laparotomic/laparoscopic endovideosurgical removal of the chitinous membrane, sanitation of the cavity.
Indications for surgery:
· verified diagnosis of hydatid cyst of the liver measuring more than 3 cm in diameter.

Surgical treatment for pulmonary echinococcosis:
· thoracotomy/thoracoscopy, endovideosurgical removal of the chitinous membrane, sanitation of the cavity;
Indications for surgery for pulmonary echinococcosis:
· presence of echinococcal cysts in the lungs;
· danger of rupture of a large hydatid cyst over 10 cm in diameter, rupture of the hydatid cyst into the bronchial tree, pleural cavity, suppuration.

Contraindications There are absolute and relative:
Absolute contraindications:
· serious condition of the patient due to severe somatic, congenital pathology of the cardiovascular system;
· violation of the blood coagulation system.
Relative contraindications:
· catarrhal phenomena, viral and bacterial infections;
· protein-energy deficiency of 2-3 degrees;
· anemia;
· digestive disorders;
· diseases of the respiratory organs, their catarrhal conditions; unsatisfactory condition of the skin (pyoderma, recent phenomena of exudative diathesis, infectious diseases in the acute period).

Non-drug treatment: No.

Other types of treatment:

Other types of services provided at the stationary level:
· Exercise therapy;
· breathing exercises.

Indicators of treatment effectiveness:
· clinically - healing of the postoperative wound, absence of pain, temperature reaction;
· laboratory - absence of leukocytosis, eosinophilia in the blood, normalization of RPGA, ELISA indicators;
· Ultrasound of the abdominal organs - absence of echinococcal cyst and residual cavity in the liver;
· X-ray - absence of pronounced infiltration of lung tissue.

Drugs (active ingredients) used in treatment

Albendazole
Albumin human
Glycerol
Dextrose
Insulin soluble (human biosynthetic)
Potassium chloride (Potassium chloride)
Calcium chloride
Loratadine
Mebendazole
Metoclopramide
Metronidazole
Sodium chloride
Neostigmine methylsulfate
Povidone - iodine
Prednisolone
Thrombinum
Fibrinogen
Chlorhexidine
Ceftazidime
Cefuroxime
Etamsylate

Hospitalization

Indications for hospitalization indicating the type of hospitalization:

Indications for emergency hospitalization:
For liver echinococcosis:
· breakthrough of echinococcal cysts into the abdominal cavity and biliary tract;
· suppuration of the cyst.
For pulmonary echinococcosis:
· identifying the picture of complications: breakthrough of echinococcal cysts into the bronchial tree, pleural cavity, suppuration of the cyst.

Indications for planned hospitalization:
· detection of echinococcal cysts in the liver and lungs.

Prevention

Preventive actions
· when the diagnosis of echinococcosis is confirmed, an emergency notification is submitted to the SES;
· in the postoperative period, exercise therapy and early activation of the patient are prescribed;
· Observe the rules of personal hygiene when keeping dogs and pets in the house. Routine deworming of dogs, culling and destruction of infested carcasses of domestic animals.

Sources and literature

Minutes of meetings of the Expert Council of the RCHR of the Ministry of Health of the Republic of Kazakhstan, 2015
1. List of used literature: 1) Pulatov A. T. // Echinococcosis in childhood. - M. Medicine, 2004. – P. 224. 2) Ordabekov S.O., Akshulakov S.K., Kulakeev O.K.//Human echinococcosis: textbook. - Almaty: Evero, 2009. – P. 512. 3) Sattar A, Khan AM, Anjum S, Naqvi A. // Role of ultrasound guided fine needle aspiration cytology in diagnosis of space occupying lesions of the liver. /J Ayub Med Coll Abbottabad. 2014 Jul-Sep; 26(3):334-6. 4) Vuitton D.A., Millon L., Gottstein B., Giraudoux P// Proceedings of the International Symposium/ Innovation for the Management of Echinococcosis Besançon, March 27–29, 2014./Parasite. 2014; 21: 28. Published online 2014 Jun 25. 5) Ren B, Wang J, Liu W. Comparative study between diffusion weighted imaging and histopathological features in hepatic alveolar echinococcosis. Chin J Radiol 2012;46(1):57–61. 6) Pulatov A.T., Petlakh V.I., Bryantsev A.V. and others // Breakthrough of an echinococcal liver cyst into the pleural cavity // Pediatric surgery. 2002. - No. 1. - P. 41-44. 7) Shamsiev A.M., Shamsiev A.Zh., Gaffarov U.B. “Long-term results of treatment of echinococcosis of the liver and lungs in children” Pediatric surgery, No. 5, 2008. Pages 46-48. 8) Dzhenalaev D.B.//Endovideosurgery in the treatment of echinococcosis of the liver and lungs in children.//Pediatrics and pediatric surgery. – 2009. No. 1. – P. 48-50. 9) Chetverikov S.G., Akhmad Z.M.// The problem of residual cavity and local recurrences in surgical treatment of hepatic echinococcosis./Klin Khir. 2014 Jun ;(6):31-3. 10) Tenguria R.K., Naik M.I.//Evaluation of human cystic echinococcosis before and after surgery and chemotherapy by demonstration of antibodies in serum./Ann Parasitol. 2014;60(4):297-303. 11) Vikas D. G., Sanjay S., Shelly R., Sumeet P.// Single-stage management of large pulmonary and hepatic hydatid cysts in pediatric age group: Report of two cases./ Lung India. 2014 Jul-Sep; 31(3): 267–269. 12) Skuhala T., Trkulja V., Runje M., Vukelic D., Desnica B//. Albendazolesulphoxide concentrations in plasma and hydatid cyst and prediction of parasitological and clinical outcomes in patients with liver hydatidosis caused by Echinococcus granulosus./Croat Med J. 2014 Apr;55(2):146-55. 13) Bedioui H., Bouslama K., Maghrebi H., Farah J., Ayari H., Hsairi H., Kacem M., Jouini M., Bensafta Z.// Predictive factors of morbidity after surgical treatment of hepatic hydatid cyst ./Pan Afr Med J. 2012;13:29. Epub 2012 Oct 12. 14) Grozavu C., Ilias M., Pantile D. // Multivisceral echinococcosis: concept, diagnosis, management. /Chirurgia (Bucur). 2014 Nov-Dec; 109(6):758-68. 15) Nugmanov N.N., Dzhanzakov B.B., Utetleuov A.M., Yesenaliev G.K.//Surgical treatment of pulmonary echinococcus in children./Bulletin of KazNMU. – 2012. – P. 23-25.

Information

List of protocol developers with qualification information:
1) Dzhenalaev Bulat Kanapyanovich - Doctor of Medical Sciences, Professor, RSE at the West Kazakhstan State Medical University named after. Marata Ospanova”, head of the department of pediatric surgery.
2) Karabekov Agabek Karabekovich - Doctor of Medical Sciences, Professor, RSE at the South Kazakhstan State Pharmaceutical Academy, Head of the Department of Pediatric Surgery.
3) Botabaeva Aigul Saparbekovna - Candidate of Medical Sciences, acting as Associate Professor of the Department of Pediatric Surgery of JSC Astana Medical University.
4) Kalieva Sholpan Sabataevna - candidate of medical sciences, associate professor of the RSE at the Karaganda State Medical University, head of the department of clinical pharmacology and evidence-based medicine.

Disclosure of no conflict of interest: No.

Reviewer: Mardenov Amanzhol Bakievich - Doctor of Medical Sciences, Professor of the Department of Pediatric Surgery. RSE on REM "Karaganda State Medical University".

Indication of the conditions for reviewing the protocol: Review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

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