Jun 20, 2018
Opisthorchiasis is a parasitic disease that can be triggered by the introduction into the body of one of the two worms of the genus trematodes - cat's or squirrel fluke.Cats( in Southeast Asia - proteins) are the natural carriers of these parasites.Getting into the human body, these helminths affect the tissues of the liver and pancreas.
Impartial statistics show that 2/3 of opisthorchosis patients live on the territory of the Russian Federation and the countries of the former USSR.The most common carrier of helminths of this genus is found in the inhabitants of Western and Eastern Siberia, as well as in the Dnieper region.This is due to the tradition of using thermally untreated fish.
The high level of infection of fish with opisthorchia is also observed in the countries of Southeast Asia - Thailand, Laos, Vietnam, India.
There are approximately 21 000 000 patients with opisthorchiasis in the world.Causes of the disease Opisthorchiasis symptoms Diagnosis of opisthorchiasis Features of opisthorchiasis of children Treatment of opisthorchiasis Complications and consequences of opisthorchiasis Prevention
As mentioned above, the main cause of opisthorchiasis is infection with hepatic trematodes.The causative agent parasitizes in the pancreas, bile ducts, gall bladder and liver of cats, dogs and squirrels.
Getting into the water along with the faeces of animals, the eggs of opisthorchia are introduced into mollusks( snails), in the body of which the appearance, growth of larvae, the formation of cercariae( encapsulated larvae) and their release back into the water.Through water cercariae enter the body of fish.
Infection of a person is caused by eating badly processed( weakly salted, not sufficiently fried or completely raw) fish of carp breeds - roach, bream, carp, dace, yazi, chebach.
Acid medium of gastric juice destroys the cercarium capsule, after which the larvae, together with the remnants of undigested food, enter the duodenum, where the final hyaline envelope is finally ruptured and the larva enters the bile ducts, liver, pancreas.Developing during 3-4 weeks, the larvae turn into sexually mature individuals, which begin to lay eggs.
Note: an increase in the number of parasites in the body of an infected person is possible only after a second infection.In this case, the life expectancy of a sexually mature specimen of the pathogen may exceed 20 years.Symptoms of opisthorchiasis
An asymptomatic form of the disease is possible.With this variant of the flow, the opisthorchias do not manifest themselves in any way and are found either with a decrease in immunity( then there are signs of the disease) or accidentally during the passage of preventive examinations.
In clinically expressed forms of the disease, its course can be acute and chronic, with varying severity.From the time of infection and to the first clinical symptoms of opisthorchiasis, 2-4 weeks pass.
In an acute period there are:
- fever of varying severity: from subfebrile to high temperatures( 40 degrees and above);
- symptoms of intoxication - increased sweating, weakness, accompanied by joint and muscle pains, nausea and vomiting, headache.
In the severe course of opisthorchiasis, confusion, delirium, and also toxic myocarditis can be observed.There may be a rash, a phenomenon of asthmatic bronchitis.This is due to a strong allergy of the body in response to parasite invasion.
Note: of the majority of patients increases the liver, somewhat less often - the spleen.This is due to the introduction of opisthorchias into the bile ducts and their obstruction with the development of hepatitis with jaundice.
In the chronic period, the symptoms of opisthorchiasis are associated with the presence of parasites in the bile ducts.In this case:
- there are pains in the pit of the stomach or in the right hypochondrium, giving in the back or the left side of the abdomen;
- can sometimes cause biliary colic;
- quite often there is dizziness, the phenomena of dyspepsia - nausea, upset of the chair, heaviness in the stomach.
Diagnosis of opisthorchiasis is based on a study of circumstances that can lead to infection, the discovery of a visit to an endemic focus( a place where cases of opisthorchiasis are frequent), a thorough analysis of all the symptoms and data of laboratory and instrumental research.
Ultrasonography, magnetic resonance imaging and computed tomography show signs of biliary tract disorders, enlargement of the bile ducts and enlargement of the liver.
In the general analysis of blood - signs of allergy and inflammation.
In the biochemical analysis of blood - an increase in the activity of hepatic enzymes, the amount of bilirubin.
The antigen of opisthorchomes is detected by the enzyme immunoassay.
Important: The most reliable sign of opisthorchiasis is the detection of parasite eggs in the feces of and the contents of the duodenum.Features of the opisthorchiasis of children
In children living in foci, endemic for opisthorchiasis( that is, where it is very often), the disease is usually of a low-symptom type.Often it is detected only after many years after infection - already in adolescence or even adulthood.
In acute form of the disease in children 1-3 years of age slightly elevated temperature, there are pains in the upper floors of the abdomen.There is an inflammatory response from the respiratory tract - pharyngitis, rhinitis, dyspepsia - upset of the chair, nausea.In some cases, in children with opisthorchiasis, an increase in the lymph nodes, the liver.
In children of middle and older age, more severe symptoms of opisthorchiasis are noted, in which:
- is characterized by a high temperature rise, weakness, skin rash;
- in the lungs there are infiltrates or pneumonia;
- suffers and myocardium - toxic myocarditis develops.
- with especially severe course joins hepatitis with jaundice, spleen increases.
With chronic opisthorchias, the signs of a lesion of the hepatobiliary system, that is, the liver and bile ducts, come to the fore.
Note: young children lose weight, their physical development slows down.The main complaints for opisthorchiasis in infants - pain in the right upper quadrant, nausea, unstable stool character, decreased appetite.There is a slight increase in the liver, the spleen is usually of normal size.Treatment of opisthorchiasis
The most important aspect of opisthorchiasis treatment is de-worming, that is, complete removal of the parasite from the body.For this purpose, use chloroxil according to a certain scheme or praziquantel.In parallel, prescribed antihistamines, calcium salts to combat allergies.
In severe cases, short courses of treatment with corticosteroid drugs are possible.In the presence of spasm of the biliary tract, treatment is complemented by antispasmodics - no-spy, platyphylline.
When the acute symptoms are suppressed, cholagogue preparations are prescribed-holosas, cholenzyme, broth of corn stigmas.
When assessing the effectiveness of treatment of opisthorchiasis, the main criterion for complete elimination of helminths is the absence of parasite eggs in bile and feces, which is confirmed three- or fourfold.
Complications and consequences of opisthorchiasis
As complications of opisthorchiasis, the following can occur:
- cholestatic jaundice;
- liver abscess;
- purulent inflammation of the biliary tract( cholangitis);
- biliary tract cancers
Prevention of opisthorchiasis is a set of measures aimed at reducing the likelihood of infection not only individuals but also the whole population.In this case:
- It is necessary to identify and treat patients in time.
- Animals should periodically undergo deworming
- Reservoirs should be protected from feces entering them.
- In them it is necessary to perform the destruction of mollusks by biological methods.
- The fish should be thoroughly heat treated.
Bozbey Gennadiy, medical reviewer