Ascaridosis

Description:

The ascaridosis is a widespread helminthosis of which allergic reactions in the acute period are characteristic (an itch, urtikalny rash, an eosinophilia, unstable infiltrates in lungs, etc.), and in late – dysfunction of digestive organs.

Ascaridosis reasons:

An etiological agent of an ascaridosis is the ascarid human (Ascaris lumbricoides). They differ in a spindle-shaped shape and a reddish-yellow shade of a body. At death the ascarid gets a whitish shade. The female is much more than male, length of its 25-40 cm, width – 4-6 mm, the bent back end of a body is characteristic. The male has a direct body 15-25 cm long, thickness of a male makes 2-4 mm.

Epidemiology:

Infection source at an ascaridosis is the person who in intestines has ascarid individuals. Mature females of an ascarid differ in high productive capacity, per day laying up to half a million eggs a day. Then there is an allocation of unripe eggs of helminth in external environment. Optimal conditions for ascarids considers temperature condition to 37C and humidity not less than 8%. At these indicators of a larva begin to ripen. The mobile larva created in egg is exposed to a molt and only after that gains invasive activity. Development of ascarids stops at a temperature below 12C, but viability of eggs and the larvae which began to develop does not suffer. At a temperature over 37-38 With all larvae irrespective of a development stage perish. The invasion occurs directly at a proglatyvaniye of mature eggs. Spread of an ascaridosis is promoted by fertilizer of the land plots human excrements which can be infected with larvae of ascarids. When watering vegetables on their leaves there are soil particles, and at insufficient respect for hygiene the proglatyvaniye is not excluded them. Northern tundra and forest-tundra territories are free from infection with an ascaridosis. Infrequently it meets also in steppe areas.

Pathogeny:

The way of advance of eggs of ascarids lies through an oral cavity in a small intestine. In a gleam of a small bowel they develop, get into gut wall vessels. Circulating in a blood-groove, eggs get into system of a portal vein. Metabolism of a larva is followed by allocation of products of exchange which eventually lead to an organism sensitization. The following stage of a pathogeny of an ascaridosis – hit of eggs in a hepatic parenchyma, hepatic segments, and further and in lower to a floor a vein, the right department of heart, pulmonary capillaries. Getting through a vascular wall, larvae of an ascarid affect bronchioles and alveoluses. The patient is disturbed by cough. At cough the phlegm containing eggs of helminths is allocated. The phlegm is swallowed, and thus, eggs get to a small bowel again. At this stage there is a maturing of larvae to puberal individuals. The described life cycle proceeds about 3 months. Cellular eosinophilic infiltrates are result of migration of larvae in an organism. Formation of similar infiltrates is not always followed by clinical symptoms, their existence quite often comes to light on increase in level of eosinophils in blood.
Development of a chronic stage of a disease it is caused by mechanical intestinal impassability a ball of ascarids and harmful influence of products of metabolism of puberal individuals of ascarids on a nervous system and other bodies.

Ascaridosis symptoms:

Clinical displays of an ascaridosis divide into early and late manifestations.
In most cases the course of an ascaridosis flows with slight manifestations: dispeptic frustration, weight loss, neurasthenia, asthenic manifestations. Happens that the current gains the expressed weight: focal defeats in lungs, a small tortoiseshell, a hyperthermia are observed, impassability of intestines, liver abscesses, appendicitis can develop.
Early displays of an ascaridosis also include cough with a mucous phlegm, increase to a spleen and a liver. Extent of development of respiratory frustration is various, up to pleurisy and respiratory impassability.
The chronic course of an ascaridosis is shown in the erased form. Appetite disturbances, abdominal pain, diarrhea or a lock are possible. Manifestations from a nervous system include memory disturbances, irritability, and sometimes and epileptiform attacks.
At penetration of ascarids into pancreatic or bilious channels are followed by the phenomena of a cholangitis, mechanical jaundice, pancreatitis and so on.

Diagnosis:

In diagnosis of an ascaridosis the ovoskopichesky method – detection of eggs of helminth in Calais of the patient takes place. This method has diagnostic value at a chronic ascaridosis. The acute invasion is distinguished by means of serodiagnosis, first of all RNGA.  The general blood test finds existence of an eosinophilia. Infiltrates in lungs are changeable, and can be revealed by a radiological method till 3 weeks of a disease.

Treatment of the Ascaridosis:

Treatment of an ascaridosis demands purpose of anthelmintic means – Vermoxum, decarice, Kombantrinum and others.
Active ingredient of drug Vermoxum – Mebendazolum. It is necessary to appoint Vermoxum with care at a massive invasion as its action consists in increase in a physical activity of ascarids, and it can lead to vomiting and hit of helminths in lungs. The daily dose of Vermoxum makes 200 mg, a course of treatment – 3-4 days. The dosage of a mintezol (active ingredient thiabendazole) is calculated according to weight: 50 mg/kg a day, a course – about one week. Decarice (levamisole) is applied on 150 mg a day to the adult of the person, the dosage for the child is calculated on a formula of 2,5-5 mg/kg.
Efficiency of purpose of anthelmintic therapy reaches up to 100%.
In fight against an ascaridosis use chrezzondovy administration of oxygen in a small bowel which is carried out by 3 days in a row. The procedure is carried out on an empty stomach or in several hours after a breakfast. The volume of the entered oxygen makes about 1,5 l. The method is considered quite effective, however its use at a peptic ulcer is contraindicated.
Additional medicines at helminthosis are vitamin complexes and fermental drugs. At the developed anemia against the background of an ascaridosis it is necessary to accept gland drugs.

At development of complications at an ascaridosis an operative measure is possible. Indications in such cases are:
- Obstruction of a gleam of a gut ball of ascarids (obturation)
- Spastic intestinal impassability as a result of a long spasm of a gut at death of ascarids
- The acute appendicitis caused by penetration of helminth into a worm-shaped shoot
- Peritonitis as a result of perforation of an intestinal wall of helminthomas.