Opisthorchiasis in adults the symptoms and treatment of the causes in adults

GENERAL

The main distribution area of ​​flatworms Opisthorchis kind is the territory of Russia. The largest number of cases is recorded in the pool Ob and Irtysh. Opistorhozom morbidity in these areas is about 26 cases per 100 000 population. People infected by eating improperly cooked fish is an additional host for flatworms. This infection mechanism has been proven in the early twentieth century German professor Max Askanaz. In addition to the human, this infection can get sick carnivorous mammals.

CAUSES

Pathogens are two types flatworms: Squirrel and cat fluke (Opisthorchis viverrini and Opisthorchis felineus, respectively). The parasite has 2 suckers, by which is attached to the walls of the gastrointestinal tract.

flukes development cycle occurs in two intermediate hosts:

• In freshwater molluscs living in small reservoirs with clayey or silty bottom of fluke egg for 8 weeks produced cercariae. They leave the body bitiniid and move into the second intermediate host organism - cyprinids.
• Further development of flatworms occurs in the muscles of fish. After 6 weeks, the parasite becomes invasive properties - it is able to infect the final carrier, which may be human. When used properly cooked raw or cysts fish pathogen ingested and released in the intestine from the containment. Active forms of flukes penetrate into the biliary system and pancreatic ducts, which reach sexual maturity age, and then begin to lay eggs.

Adults can live in the human body for many years. The eggs are stored in the soil for weeks in the water - up to a year.

Flatworms, being in the gall bladder duct and mechanically injure the mucosa of these organs. This process is accompanied by breach outflow pancreatic and bile secretions to form extensions and cystic neoplasms in the liver. Besides traumatization of the digestive tract, flukes secrete waste products that cause rapid allergic reactions.

CLASSIFICATION

The disease is characterized by staging and clinical 2 embodiment.

Opisthorchiasis stage:

• acute, which come to the fore expressed allergic manifestations;
• Chronic flowing in the form of cholecystitis (Holepatichesky embodiment) or to the further formation gastroduodenitis, erosive ulcerous process (gastroduadenopatichesky embodiment).

SYMPTOMS

Complaints of the patient and clinical manifestations of the disease depend on the stage and course of the infection embodiment.

The acute stage opisthorchiasis

The main complaints of the patient are:

• fever from mild to severe, which may persist for 10-20 days;
• violation of the general well-being;
• lethargy;
• lack of appetite;
• weight loss;
• fast fatiguability;
• headache and muscle pain;
• violation of physiological functions;
• vomiting;
• insomnia.

Symptoms appear abruptly on the background of relative prosperity. In cases of massive infection appear signs of internal organ involvement. In violation of the hepatocyte changes the color of the skin, the patient may be concerned discomfort in the liver projection. The defeat of the digestive tract is accompanied by flatulence, Dyspeptic disorders. There are cases of cough caused by flatworms were.

Chronic stage opisthorchiasis

For this step, helminthiasis polymorphism characteristic clinical manifestations. In addition to the deterioration of the functioning of the nervous system, manifesting dizziness, sleep disorder, rhythm, headaches of varying intensity, affects the digestive organs during the chronic stage of infection tract.

current options:

• Holepatichesky option accompanied by a feeling of heaviness and painful sensations in the projections of the gallbladder. Pain can be intense, reminiscent of the attacks of biliary colic.
• Gastroduodenopatichesky option It characterized by diffuse localization of pain. In addition to pain, patients often disturb constipationSignificantly reduced appetite.

There is gender dependent options opisthorchiasis flow. Hepatobiliary system lesions are more common in women, gastroduodenopatichesky option infection - men. There are cases of asymptomatic opisthorchiasis.

DIAGNOSTICS

In diagnostics opisthorchiasis besides careful anamnesis and complaints used instrumental and laboratory methods. Preference is given to non-invasive procedure that allows to determine the nature of the defeat of the digestive tract.

Instrumental methods of diagnosis:

• Ultrasound examination of the abdominal cavity allows you to see the size of the liver, biliary system organs, the pancreas. When opistorhoze sometimes observed symptoms of biliary dyskinesia, which consist in insufficient reduction of the volume of the gallbladder after the test with a fatty food.
• Computer and magnetic resonance tomography allows visualization of intrahepatic bile ducts, liver structure, extrahepatic biliary system, focal changes in most internal authorities.

Laboratory diagnosis opisthorchiasis:

• General blood analysis It shows changes inherent in the inflammatory process. Patients with infection accelerates erythrocyte sedimentation, is an increase in the number of white blood cells. In some cases, the anemia observed.
• AT Biochemical analysis of blood there are signs of lesions of the biliary system and pancreatic insufficiency. The most significant increase is considered aminotransferase, alkaline phosphatase, glucose and digestive enzymes.
• immunological methods can detect antibodies and their increase in titer to antigens of the pathogen opisthorchiasis. For this purpose, an enzyme immunoassay. Currently actively developed methods for detecting antigens directly flukes, which can determine the stage of disease.
• The gold standard for diagnosis remains opisthorchiasis parasitological methodBy which determine parasite eggs in the faeces or gall. It is advisable to study paired with an interval of one week. It is worth remembering that the release of eggs does not occur immediately. This process starts at least one month after the infection, so in the early stages of the disease parasitological method is not indicative.

The totality of the clinical signs and the use of existing hardware and laboratory research methods allow us to opisthorchiasis giardiasis or diseases of the hepatobiliary system noninfectious etiology.

TREATMENT

Treatment of patients with opisthorchiasis can be performed on an outpatient basis. Complicated course of disease requires constant supervision of specialists, so in such cases, patients are hospitalized. The basis of the therapy up anthelmintic drugs. They are appointed by short courses with re-admission after 4-6 months. Many antiparasitic drugs act only on the mature form of worms, so their use before 1.5-2 months after infection impractical.

The therapy is also used Opisthorchiasis:

• antispasmodics, reduces muscle tone of the sphincter of the biliary system and improving the passive flow of bile;
• cholagogue drugs that normalize the rheological properties of bile and help to enhance the contractile function of the gallbladder;
• nonsteroidal anti-inflammatory drugs decrease the activity of the inflammatory process;
• antihistamines reduce allergic tension from flatworms waste products.

To assess the effectiveness of treatment using parasitological method. The absence of eggs in the feces and duodenal contents 3-4 subsequent research demonstrates the effectiveness of the therapy.

Patients with cured opisthorchiasis need medical observation for at least 6 months.

COMPLICATIONS

There is evidence that infection of Opisthorchosis increases the risk of oncological diseases of the digestive tract by enhancing mucosal cell proliferation shell. In addition, the most dangerous complications of infection are:

• exacerbation of the inflammatory process with addition of bacterial flora of purulent diseases, such as liver abscesses or purulent cholangitis;
• development peritonitis due to rupture of cystic altered bile ducts.

PREVENTION

Preventive measures:

• early detection and complete treatment of infected persons;
• treatment of helminth infections in animals;
• water sources protection against faecal contamination;
• sanitary control of fish at the point of sale;
• heat treatment of freshwater fish;
• observance of technological rules on smoking, salting fish production;
• health education among the population;
• preventing animal feeding raw fish.

FORECAST FOR RECOVERY

uncomplicated opisthorchiasis It has a favorable prognosis and an adequate amount of treatment is completely curable. Accession bacterial infection or the development of cancer pathology significantly worsens the disease. The prognosis for these patients is between serious and adverse.

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