Vukhererioz

Description:

Vukhererioz (wuchereriosis, elephantiasis, elephantiasis, элефантиазис)  - helminthosis, is called by threadlike helminths - filarias which circulate in blood.

According to estimates, around the world vukhereriozy about 80 million people are infected.

Vukhererioz's symptoms:

The asymptomatic incubation interval lasts 3-18 months.

Allergic manifestations can develop approximately in 3 months after infection. Microfilarias come to light in blood not earlier than in 9 months. The disease begins with various allergic manifestations. On skin, especially on hands, painful elements like an exudative erythema appear, lymph nodes in inguinal areas, on a neck increase and in axillary hollows, often there are painful limfangita, a funiculitis, an orchiepididymitis, a synovitis from the outcome in a false ankylosis, women have a mastitis. At a long recurrent current of a funiculitis and an orchiepididymitis arises to a gidrotsela. Fever is characteristic, bronchial asthma and bronchial pneumonia quite often develop. In 2-7 years after infection the disease enters the second stage which is characterized generally by defeats of skin and deep absorbent vessels with development of a varicosity, disturbance of a lymph flow, ruptures of these vessels. There are painful limfangita with regional lymphadenitis. At this time within several days at the patient the expressed phenomena of the general intoxication against the background of high temperature of a body and severe headaches are noted. Vomiting is often observed, the delirious state sometimes develops. The attack usually comes to an end with plentiful sweating. As a result of ruptures of absorbent vessels the expiration of a lymph and reduction of intensity of lymphadenitis is observed.

Phases of relative wellbeing periodically are replaced by the next exacerbations of a disease. On site limfangit there are dense tyazh, the affected lymph nodes are also exposed to fibrous consolidation. Increase in inguinal and femoral lymph nodes is characteristic Initial swelling of lymph nodes of pain does not cause, however at the subsequent development of limfangit severe pains in nodes develop. Defeat can be one - or bilateral, the sizes of nodes from small to 5-7 cm in the diameter. Often in parallel the so-called lymphoscrotum (chyle treatment of tunica vaginalis) and a chyluria develop. The lymphoscrotum is clinically shown by increase in a scrotum. At palpation of skin of a scrotum expanded absorbent vessels easily are defined. At ruptures of these vessels a large number of quickly coagulated lymph follows. The expiration of a lymph from the damaged vessels can continue several hours.

In the countries of North Africa, India and China the chyluria or a lymphuria often occurs at patients vukhereriozy. The patient notices that urine got a milky-white shade. In certain cases urine becomes pink or even red, sometimes it happens white in the morning and red in the evening or on the contrary. Presence at blood urine along with a lymph is explained, obviously, by ruptures of small circulatory expanded absorbent vessels. Microfilarias come to light in urine only at night. Sometimes it is preceded by small pains over a pubis or in inguinal areas. The ischuria owing to coagulation of a lymph and formation of flakes in uric ways is characteristic. At a lymphuria in urine there are an impurity of a lymph, protein in a significant amount, blood impurity is possible, but there are no fat traces. In an urocheras lymphocytes are found.

Bodies of the dead of filarias resolve usually completely or calcinated. However in certain cases the died parasites are the reason of development of abscesses which lead to heavy complications, such as an empyema, peritonitis, a purulent inflammation of genitalias.

Due to the damage of walls of absorbent vessels at a vukhererioza microbes can get to surrounding fabrics and to blood that can lead to development of sepsis. In blood of such patients the hemolitic streptococcus often is found.

The third (obstructive) stage of a disease is characterized by elephantiasis. Elephantiasis of the lower extremities develops in 95% of cases, is slightly more rare - upper extremities, generative organs, certain sites of a trunk and very seldom than the person. Clinically elephantiasis is shown by quickly progressing lymphangitis with accession of dermatitis, cellulitis in combination with fever which in certain cases can serve as the main symptom of a disease and is a consequence of accession of a bacterial infection. Skin becomes covered by warty and papillomatous growths over time, sites of ekzemopodobny change of skin, not healing ulcers appear. Legs can reach the huge sizes, they take a form of shapeless blocks with thick cross folds of the affected skin. Scrotum weight usually makes 4-9 kg, and in some cases to 20 kg, the case when scrotum weight at the patient reached 102 kg is described. In case of elephantiasis of the person the upper eyelid is surprised more often.

Vukhererioz's reasons:

The activator of a vukhererioz - Wuchereria bancrofti nitchatka widespread in tropics and subtropics. In the former USSR elephantiasis is found in isolated cases in Central Asia. Adult nitchatka most often meet in lymphatic glands and vessels. The blockage of absorbent vessels is resulted by an inflammatory thickening of their walls, and also stagnation of a lymph. The struck places strongly increase in sizes.

Females make enormous quantity of larvae, each about 0,3 mm long. They received the name of "night microfilarias" as they appear in peripheral blood at night, per day go to depth of a body and keep in pulmonary vessels, heart and kidneys. Such frequency is connected with features of transfer of parasites which happens through intermediate owners, namely various blood-sicking mosquitoes. When mosquitoes suck in the evening or at night blood of carriers of filarias, larvae get into a stomach of a mosquito and then get into a cavity of his body. There they grow up a little and eventually skoplyatsya at the basis of the pricking proboscis of an insect. At suction of blood of the healthy person such mosquito sticks the pricking bristles of the proboscis into skin; at this time larvae of filarias leave a proboscis and vburavlivatsya actively in skin, getting then to blood.

Wuchereria bancrofti is most widespread among the filarias parasitizing at the person. The parasite meets in tropics and subtropics - Asia, Oceania, Africa, places in South America and in Caribbean countries.

The person - the only final owner of Wuchereria bancrofti. Adult worms live in a human body up to 17 years, a larva in a blood channel - up to 70 days. By the available estimates, vukhereriozy 120 million people are infected.

On the terminology accepted by Committee of experts in filariases of WHO distinguish periodic and subperiodic strains of microfilarias. Microfilarias of Wuchereria bancrofti of a periodic strain (Microfilaria nocturna) are in vessels of lungs in the afternoon, and move ahead in peripheral vessels at night. Microfilarias of Wuchereria bancrofti of the subperiodic strain revealed in a zone of the Pacific Ocean and therefore received the name W. pacifica, are in peripheral blood round the clock, but in the afternoon their number considerably increases.

Vukhererioz's treatment:

For treatment of a vukhererioz (destruction of puberal stages) outside the USA anthelmintic drug of a wide range, in combination with ivermectin is recommended албендазол (albendazole). Effectively also a combination of an albendazol with dietilkarbamaziny.

Since 2003 for treatment of a vukhererioz also the antibiotic доксациклин which kills sort Wolbachia bacteria - symbionts of filarias is used that leads to their death or decrease in pathogenicity.