Helminthosis (helminthic infestation): causes, symptoms, diagnosis and methods of treatment.
Ohdetermination
Helminthoses are human, animal and plant diseases caused by parasitic worms (helminths).
Causes of helminthiasis
Currently, more than 70 species of 250 known helminths parasitizing the human body are found in our country.The most common are roundworms (tubeworms, pinworms, trichinella, whipworm), tapeworms (pork, bovine and dwarf worms, broad tape, echinococcus) and flukes (liver and cat flukes).
Helminths are characterized by developmental stages: eggs → larvae → adult forms.
Infection with helminths most often occurs after their eggs and/or larvae enter the body.Depending on the mechanism of infection and ways of transmission, helminthoses are divided into: geohelminthoses, biohelminthoses and contact helminthoses.Geohelminths develop without an intermediate host, biohelminths develop by successive changes of one, two or three hosts, contact helminths are transmitted by contact.
Porcine, bovine, echinococcal, and other species of worms develop through successive changes of one, two, or three hosts.Intermediate hosts can be fish, molluscs, crustaceans and insects.A person is infected with these helminths by eating food that has not undergone complete heat treatment:
- beef infected with beef tapeworm larvae;
- pork affected by Finnish pork tapeworm;
- lightly salted and raw fish with opisthorchis or broad tapeworm larvae;
- raw water or vegetables and fruits processed with this water.
Whipworm, roundworm, corn and nekator thrive without intermediate hosts.The egg and larval forms of these parasites enter the soil with faeces.If the rules of personal hygiene are not followed, they penetrate the body of a new host.
Enterobiosis (pathogen - pinworm) and hymenolepiasis (pathogen - dwarf tape) are transmitted through contact - that is, personal contact between a healthy person and an infected person, using common items, toilet articles, linen, and inhalation of dust in the room where the infected person is located.In the case of enterobiosis, self-infection often occurs.
Certain types of helminths parasitize certain organs and cause various helminthoses:
- in the large intestine - pork, cattle, dwarf tapeworms, nematodes (hookworms, roundworms, strongyloids), pinworms, whipworms.From the intestinal lumen, pork tapeworm larvae can enter the bloodstream and spread throughout the body, settling in adipose tissue, muscle vessels, eye chambers and brain;
- in the liver and bile ducts - trematodes (opisthorchis, clonorchis, fasciola).Echinococcal cysts are primarily located in the liver, and after their rupture, daughter blisters can be found in the mesentery, peritoneal layers, spleen and other organs;
- in the respiratory organs - echinococci, alveococci, pulmonary flukes that cause paragonimiasis;
- in the nervous system - schistosomiasis, paragonimiasis, echinococcosis and alveococcosis;
- in organs of vision - complex forms of onchocercosis, loiasis, taeniasis;
- in the circulatory system - necatoriasis, schistosomiasis, diphyllobothriasis;
- in the lymphatic system - filariasis, trichinosis;
- on the skin and subcutaneous tissue - the larval stage of ankylosis, onchocercosis, loiasis, schistosomiasis;
- in the skeletal system - echinococcosis;
- in skeletal muscles - trichinosis, cysticercosis of muscle tissue.
The lifespan of helminths in the body of the definitive host can be different, depending on the type of parasite, and varies from a few weeks (pinworms) to several years (tapeworm) and decades (fasciola).
Disease classification
There are two types of worms that parasitize humans:
- Nemathelminthes – roundworms, class Nematoda;
- Plathelminthes are flatworms, which include the classes Cestoidea - tapeworms, Trematoda - flukes.
Depending on the ways of spread of parasites and the characteristics of their biology, they are distinguished:
- biohelminthoses;
- geohelminthoses;
- contact helminth infections.
Symptoms of helminthiasis
Helminths have different effects on the human body:
- antigenic effects when local and general allergic reactions develop;
- toxic effect (waste products of helminths cause weakness, weakness, dyspeptic symptoms);
- traumatic effect (when parasites are fixed on the intestinal wall, blood supply is disturbed with necrosis and subsequent atrophy of the mucous membrane; absorption processes may be disturbed; mechanical compression of tissues by helminths);
- secondary inflammation due to penetration of bacteria after migrating helminth larvae;
- disturbance of metabolic processes;
- anemia occurs as a result of absorption of blood by some helminths;
- neuro-reflex effect - irritation of nerve endings by helminths, bronchospasm, intestinal dysfunction, etc.
- psychogenic effect manifested by neurotic conditions, sleep disorders;
- has an immunosuppressive effect.
Helminths are characterized by developmental stages.Each stage is characterized by its own clinical symptoms.
In the initial acute stage, helminths often do not lay eggs yet, sensitization of the body occurs (production of antibodies, release of inflammatory mediators, increased permeability of the vascular wall) and damage to the organs where the larvae migrate.There may be no clinical symptoms, but in some cases the disease may occur with obvious clinical manifestations.The acute stage lasts from 1 to 4 months, sometimes 8-10 months or more.
Complaints from patients in the acute stage:
- increased temperature from several days to two months (low-grade fever or above 38ºС, accompanied by shivering, severe weakness and sweating);
- itchy recurring skin rashes;
- local or generalized edema;
- enlargement of regional lymph nodes;
- pain in muscles and joints;
- cough, asthma attacks, chest pain, long-term catarrhal symptoms, bronchitis, tracheitis, symptoms simulating pneumonia, asthmatic syndrome, hemoptysis;
- abdominal pain, nausea, vomiting, stool disorders.
At the end of this stage of helminth infections, acute allergic events gradually decrease, and the clinic of the chronic stage has not yet had time to develop.
The acute phase becomes subacute when "young" helminths gradually mature.Then comes the chronic phase, which corresponds to the transformation of the parasites into sexually mature individuals.The clinical picture develops against the background of the toxic effect of helminth waste products, the traumatic effect of helminths on organs (ankilob, trichuriasis, etc.), mechanical effects (echinococcal cyst grows in the liver, compresses it to neighboring organs; cysticerc - in the brain), secondary inflammatory metabolic process (observed in a strong metabolite).disorders (hypo- or avitaminosis), functional disorders of the stomach and duodenum, secondary immune deficiency, etc.
Symptoms depend on the organs parasitized by helminths, their size and quantity.
forintestinal helminthiasisThe following syndromes are characteristic:
- dyspeptic (stomach discomfort, feeling of fullness after eating, early satiety, bloating, nausea);
- painful;
- asthenoneurotic (feeling of extreme fatigue, increased nervous excitement and irritability).
Enterobiasis is characterized by perianal itching at night.Intestinal obstruction, pancreatitis, and obstructive jaundice may occur with massive infestation by roundworms.
Intestinal cestodes(taeniarhynchosis, diphyllobothriasis, hymenolepiasis, taeniasis and others) are asymptomatic or with few symptoms (dyspepsia, pain, anemia).
Liver trematodes(fascioliasis, opisthorchosis, clonorchosis) causes:
- chronic pancreatitis;
- hepatitis;
- cholecystocholangitis;
- neurological disorders.
Bloodworm diseaseasthenovegetative syndrome (weakness, fatigue, pallor of the skin) as a result of the development of iron deficiency anemia.
Filariasis is characterized by allergic syndrome of various severity and regional lymphadenitis.
Urogenital schistomiasisIt is manifested by the appearance of blood at the very end of urination, frequent urge to urinate, and pain during urination.
Alveococcosis, cysticercosis, echinococcosismay remain asymptomatic for a long time.At a later stage, suppuration or rupture of cysts containing parasites leads to anaphylactic shock, peritonitis, pleurisy and other serious consequences.
For diseases caused by parasitism of migratory larvaezoohelminthswhen a person is not a natural host, distinguish cutaneous and visceral forms.The skin form is caused by the penetration of certain animal helminths under the human skin: schistosomatids (trematodes) of waterfowl, hookworms of dogs and cats, strong roundworms (nematodes).When a person comes into contact with soil or water, helminth larvae penetrate the skin.There is a burning, tingling or itching sensation where the helminth enters.There may be short-term fever and general malaise.Recovery occurs after 1-2 weeks (less often 5-6 weeks).
The visceral form develops as a result of ingestion of helminth eggs with water and food.At the beginning of the disease, there may be a malfunction, an allergic exanthema (skin rash).Larvae hatch from helminth eggs in the human intestine, enter the blood through the intestinal wall, reach the internal organs, grow there and reach a diameter of 5-10 cm, compress the tissues and disrupt the functioning of the organs.When tapeworm larvae (cysticerci, cenura) settle in the membranes and substance of the brain, headache, symptoms of cerebral hypertension, paresis and paralysis, and epileptic seizures are observed.Larvae also live in the spinal cord, eyeball, serous membranes, intermuscular connective tissue, etc.
The result of helminthosis can be complete recovery with the elimination of helminths or the development of irreversible changes in the body of the host.
Diagnosis of helminthiasis
The diagnosis of helminthosis is based on a combination of complaints, information received from the patient about the course of the disease, laboratory and instrumental examination methods.
In the acute phase of helminth infections, there is a blood reaction to the presence of helminths in the body, so the following studies are recommended:
- clinical blood test: general analysis, leukoformula, ESR (with microscopy of blood smear in case of pathological changes);
- biochemical blood test:
- total protein, albumin, protein fractions;
- assessment of kidney function indicators (urea, creatinine, glomerular filtration);
- assessment of liver function indicators (bilirubin, ALT, AST, alkaline phosphatase);
- alpha-amylase pancreas;
- assessment of carbohydrate metabolism: glucose (in blood), glucose tolerance test with determination of glucose in venous blood, fasting and 2 hours after exercise.
The following biological materials can be examined for the presence of helminths: feces, blood, urine, duodenal contents, bile, sputum, muscle tissue, rectum, and perianal mucus.
Since helminths are not excreted in the feces at any stage of their development, it is recommended to pass the feces three times - every 3-4 days.
- Analysis of feces for helminth eggs.
- Test for enterobiosis (pinworm eggs), swab.
- Microscopic examination of feces to detect eggs of enterobiosis pathogen Enterobius vermicularis (pinworms).
- Test for enterobiosis (pinworm eggs), spatula.
- Analysis is necessary when pinworm infection is suspected, as well as during hospitalization and registration of medical records.
- Analyzes for kindergarten and school.
The child testing program is designed to be completed before entering kindergarten or school.The results of these studies are necessary to obtain a medical certificate in accordance with the 026U form approved by the Ministry of Health of the Russian Federation.
Conduct immunological studies - determination of specific antibodies against helminths:
- antibodies against roundworm IgG;
- anti-Echinococcus IgG;
- IgG antibodies against Toxocar antigens;
- Anti-Opistorchis felineus IgG (IgG class antibodies against cat fluke antigens);
- IgG antibodies against Trichinella antigens;
- antibodies against anisakiasis (nematodes of the genus Anisakis), IgG;
- antibodies against IgG, the causative agent of clonorchosis;
- Antibodies that cause Strongyloides stercoralis, Strongyloides stercoralis, IgG.
The test aimed at the detection of IgG antibodies against the causative agent of strongyloidosis is used in the early serological diagnosis of strongyloidosis in cases of clinical suspicion of this disease (eosinophilia, serpentine skin lesions, pulmonary or gastrointestinal symptoms).
In difficult cases, the following studies may be recommended:
- plain X-ray of chest organs;
- comprehensive ultrasound examination of abdominal organs (liver, gall bladder, pancreas, spleen);
- CT examination of the abdominal cavity and retroperitoneum;
- CT examination of the chest and mediastinum;
- CT scan of the brain and skull.
Which doctors should I consult?
If you suspect helminthiasis, you should consult a therapist or a general practitioner, and you should visit a pediatrician together with your child.
If there are indications for surgical treatment, the patient is sent to a surgeon.
Treatment of helminthiasis
Most people with helminth infections do not require hospitalization.Regardless of the degree of severity, patients with tissue helminthosis, patients with a severe and complicated course of the disease are treated in the hospital.
Therapy is carried out with anthelmintic drugs.The frequency and dosage of the drug depends on the age and body weight of the patient and is determined by the doctor.
Desensitization, detoxification therapy, and vitamin therapy may be indicated.To reduce the temperature, non-steroidal anti-inflammatory drugs are prescribed, for allergic reactions and itching - antihistamines, for severe edema - diuretics.Hormonal drugs are required in severe cases.
The presence of helminths in organs and tissues can be an indication for surgical treatment.
Complications
- Bronchial asthma.
- I have pneumonia.
- Bowel cancer.
- cirrhosis.
- Portal hypertension.
- Gastrointestinal bleeding.
- Ascites.
- Hepatitis.
- Liver abscess.
- Peritonitis.
- Allergic myocarditis.
- Meningoencephalitis.
- Chronic glomerulonephritis.
- Chronic kidney disease.
- Hemostasis disorders.
- Loss of vision.
Prevention of helminthiasis
Preventive measures aimed at preventing helminth infection include:
- observing the rules of personal hygiene (using personal towels, personal hygiene products and other accessories for daily use);
- use only high-quality water in everyday life;
- regular vaccination and deworming of pets;
- thorough washing of vegetables, fruits, and berries before consumption;
- sufficient heat treatment of meat and fish products.
IMPORTANT!The information in this section cannot be used for self-diagnosis or self-treatment.In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician.You should contact your doctor to make a diagnosis and prescribe the right treatment.