Diagnosis and treatment of children echinococcosis

Анотація

The problem of echinococcosis, despite the progress made in its diagnosis and treatment, currently remains poorly understood and highly relevant in pediatric Parasitology. Studies of many authors show that in recent years the number of patients with echinococcosis not only universally recognized endemic foci, but also among people in the European region, including in countries such as Romania, Germany, Austria. However, studies on the prevalence and structure of echinococcosis among children in Ukraine, are not held. Despite the large number of papers devoted to the treatment of echinococcosis, the problem of the treatment of this disease in children is still far from its final decision. Usually offered surgical treatment, which is not possible with multiple lesions of the liver or other organs. All this shows the relevance and importance for practical public health issues for further study of diagnosis and treatment of echinococcosis in children.

The purpose of the study. A comparative analysis of the diagnostic efficacy of X-ray and ultrasound method in the diagnosis of echinococcosis in children.

Material & methods. This work is based on a survey of 39 children with hepatic echinococcosis, were examined at the Department of Medical Parasitology and Tropical Diseases Kharkiv Medical Academy of Postgraduate Education from 2005 to 2015. Boys was 1.5 times greater (59.5%) than girls - 40.5%. Children under five years of age accounted for only 4.0% of all patients, due to their limited contact with the environment when compared with older age. The greatest risk of disease was in the 10-13 years of age, the number of children in the group reached 40.3% of the patients. The vast majority of patients (89.6%) lived in rural areas. In this case, the parents of sick children from the village were engaged in farming, were in personal use livestock, dogs, which probably contributed to the invasion. Very often ill children pas¬tuhov, shepherds. 78% of patients had close contact with dogs. Study of the structure of morbidity showed that among children with hydatidosis in 90.8% were found isolated liver, 9.1% - together. In 7.0% of the patients were diagnosed with combined lung and liver.

Results & discussion. Clinical examination of children was carried out by the standard method of inspection and collection history. When collecting anamnestic data have focused on the identification of contact with pets, dates of onset of symptoms. The clinical picture of hepatic echinococcosis diverse and largely depend on the size, location and number of cysts, and the nature of complications. Depending on the stage of parasite development and complications of liver hydatid cysts in our study had a different echographic image. Uncomplicated cyst of the liver in 85.8% of cases was introduced liquid (anehogennoe) form a round or oval with clear smooth contours having at the periphery of the double hyperechoic circuit: inwards - chitin shell echinococcus, outwards from it - the fibrous sheath of the liver; shells separated from each other hypoechoic space. In 7 cases, ultrasound cyst of the liver characterized by the presence in the lumen of the crimped hyperechoic structure - detached shell chitin (floating diaphragm). 3 children under ultrasound liver cyst had a typical double loop around the periphery. In their lumen defines a large number of child cysts. Indicators diagnostic efficacy of ultrasound in the diagnosis of liver echinococcosis were: sensitivity 98.0%, specificity 100%, accuracy 97.6%, which confirms the value of the ultrasonic method in the diagnosis of this pathology.

Conclusion. Children with signs of chronic endotoxemia (weakness, loss of appetite, malaise, fatigue, retarded physical development), as well as allergic reactions in various forms, is necessary to conduct surveys using a minimum of safer and more effective diagnostic methods in order to avoid echinococcosis. This method, in our opinion, is ultrasound, which is available for in outpatient and inpatient settings.