Helminthoses
Description:
Helminthoses – group of the diseases caused by helminths – helminths. At the person parasitizing over 250 types of helminths which belong preferential to two types of worms is registered: roundworms – Nemathelminthes (class Nematoda) and flat worms – Plathelminthes (a class of tape-worms – Cestoidea and flukes – Trematoda).
Symptoms of Helminthoses:
Acute phase.
At clinically expressed forms of various helminthoses the first signs appear in different terms after infection: at an ascaridosis of manifestation of an acute phase are observed for the 2-3rd day, at the majority of other helminthoses in 2-3 weeks, at a filariosis the incubation interval lasts 6-18 months. Manifestations of all-allergic reactions are characteristic: fever, a recurrent pruritic enanthesis, hypostases (from local to generalized), a hyperadenosis, a mialgiya, an arthralgia, in peripheral blood - a leukocytosis with a hypereosinophilia. On this background quite often develop a pulmonary syndrome (from the insignificant catarral phenomena to astmoidny states, pneumonia and pleurisy) and an abdominal syndrome (abdominal pains and dispepsichesky frustration). The liver and a spleen increase in sizes, symptoms of the central nervous system (CNS) are possible different degree of manifestation.
In an acute phase different helminthoses have similar clinical manifestations: fever, rashes, lymphadenopathy, mialgiya, pulmonary and abdominal syndromes.
Due to the pathogeny community different helminthoses in an acute phase have similar clinical manifestations, however there are also specific signs. At a trichinosis in typical cases from the first days of a disease fever, muscle pains are observed, the century and persons swelled; at liver trematodoza (an opisthorchosis, a fascioliasis) jaundice, increase in a liver and spleen are expressed to a thicket, at an ascaridosis – pulmonary and abdominal syndromes.
Chronic phase.
In a chronic phase of helminthoses the nature of clinical manifestations, weight of a current and outcomes depend on intensity of an invasion and a habital of a parasite, sometimes his sizes. At the majority of intestinal helminthoses parasitizing of single individuals proceeds usually asymptomatically, and only in the presence of helminths of the large sizes (a tape-worm wide, teniida, etc.) any symptoms are observed. For each type of helminth there is a certain level of number of parasites at which there are clinical manifestations.
In a chronic phase the symptoms and syndromes reflecting dysfunction of body or system in which the activator or which are under the influence of its pathogenic factors parasitizes prevail.
At intestinal helminthoses the dispepsichesky, painful and quite often asthenoneurotic syndromes which were more expressed at children prevail. At an enterobiosis the leader is the perianal itch in evening and night time; the trichuriasis in cases of an intensive invasion can be followed by hemorrhagic colitis, and children sometimes have a prolapse of the rectum. The ascaridosis when parasitizing a large amount of helminths can be complicated by intestinal impassability, mechanical jaundice, pancreatitis.
At patients of an ankilostomidozama even at moderate intensity of an invasion the iron deficiency anemia connected with a gematofagiya of the activator and blood loss from the injured mucous membrane of intestines naturally develops. Big polymorphism characterizes a strongyloidosis: along with various allergic and dispepsichesky symptoms quite often observe dysfunctions of biliary tract.
At liver trematodoza (an opisthorchosis, a clonorchosis, a fascioliasis) naturally develop chronic holetsistokholangit, hepatitis, pancreatitis, are possible defeats of various departments of a digestive tract, also neurologic disturbances are observed.
Shistosomoza within Russia meet only in the form of brought in cases of chronic forms. A characteristic sign of an urinogenital schistosomiasis is the terminal hamaturia - emergence of a droplet of blood at the end of an urination and dysuric frustration. In a clinical picture of an intestinal schistosomiasis colitis symptoms prevail, and during the periods of an aggravation of process of a hemocolitis, the gepatosplenomegaliya, symptoms of portal hypertensia develop eventually.
At the patients with a filariosis who are also registered in our country in the form of brought in pathology the allergic syndrome, a limfoadenopatiya in a varying degree is expressed; characteristic of a lymphatic filariosis (вухерериоз and бругиоз) in endemic regions the lymphangitis and a lymphostasis are observed seldom, as well as serious damages of eyes at patients with a brought in onchocercosis.
Intestinal tsestodoza (a diphyllobotriasis, тениаринхоз, a teniosis, a hymenolepiasis) in many cases proceed asymptomatically, being shown only by an otkhozhdeniye of mature joints of helminth independently (at a teniarinkhoza) or at defecation. At a part of infested dispepsichesky frustration and a pain syndrome are observed; at patients with a diphyllobotriasis the anemia caused by deficit of B12 vitamin develops.
Among helminthoses a specific place is held by larvaceous tsestodoza: echinococcosis, alveococcosis, cysticercosis. They can is long to proceed asymptomatically even in the presence of enough large cysts. At the same time the gap or suppuration even of a small echinococcal bubble conducts to serious consequences: to development of an acute anaphylaxis, purulent peritonitis, pleurisy, etc. As a result of a prelum the growing bubble or alveokokky a portal and lower vena cava portal hypertensia develops. Cysticercosis of TsNS proceeds in the form of cerebral, spinal defeats with various symptomatology, localization of helminth in cerebral cavities is followed by symptoms of intracranial hypertensia. Toksokaroz is expressed abdominal, pulmonary by syndromes, neurologic disturbances, damage of eyes, a blood eosinophilia.
Reasons of Helminthoses:
Depending on features of biology and ways of their distribution distinguish 3 groups of helminths: geohelminths, biohelminths and contact helminths.
Nematodoses geohelminthoses are the most widespread. According to official figures WHO, in the world an ascaridosis annually is surprised about 1,2 billion people, ankilostomidozam more than 900 million, V. P. Sergiyev (1998) counts up a trichuriasis to 700 million that now prevalence of helminthoses among inhabitants of various continents of Earth a little in what differs from the assessment of the situation given by Le Riesch still in the sixties: more than 2 types of helminths, in Asia and Latin America more than 1 look are the share of each inhabitant of Africa on average, in Europe every third inhabitant is struck. In our country evidence-based fight against helminthoses which led to considerable decrease in incidence of the population in the late twenties began. In recent years again the tendency to increase in a prevalence is observed by some helminthoses, first of all nematodoses (an enterobiosis and an ascaridosis), the number of patients toksokarozy, a trichinosis grows; the epidemic situation in the centers of distribution of biohelminthoses of an opisthorchosis, a diphyllobotriasis, teniidoz, echinococcosis does not improve.
Treatment of Helminthoses:
In the acute period the basis of treatment is made by desensitization and desintoxication. Glucocorticoids apply according to indications only at the heavy course of some helminthoses (a trichinosis, shistosomoza, liver trematodoza) or for the purpose of the prevention of allergic complications of chemotherapy (an onchocercosis, a loasis). It is necessary to consider that at their wrong use there can be a generalization of an invasion (strongyloidosis) or transition of an acute phase in it is long current subacute (an opisthorchosis, trichinosis, etc.).
Specific treatment is a basis of fight against the majority of helminthoses of the person. In the last two decades such highly active and low-toxic protivogelmintny preparatoa as levamisole, thiabendazole, Mebendazolum, албендазол, medical amine, Pyrantelum were entered into practice. The chemotherapy of shistosomoz, liver trematodoz for which treatment the praziquantel was offered was successfully developed. This drug was highly effective and for treatment of intestinal tsestodoz. Successfully broad clinical tests of ivermectin in treatment of patients with a filariosis come to the end.
The levamisole which was widely applied earlier to treatment of nematodoses is appointed in recent years only at an ascaridosis on 2,5 mg to 1 kg of body weight in 1 reception. Gradually it was forced out by more effective drugs. Mebendazolum the adult is applied on 100 mg by 2 times a day within 12 days at an ascaridosis and an enterobiosis, 3 days at ankilostomidoza and a trichuriasis; to children at the rate of 2,5-5,0 mg on 1 kg of body weight. Medical amine at the same helminthoses appoint in a daily dose 10 mg to 1 kg in 3 receptions in 30 min. after food. Pyrantelum памоат is applied at an ascaridosis and an enterobiosis on 10 mg on 1 kg (no more than 1 g) once, and the patient of an ankilostomidozama in the same dose within 2-3 days. Most possesses a broad spectrum of activity албендазол which is appointed on 200 mg by 2 times or 400 mg once for treatment of patients of an ankilostomidozama and a trichuriasis, at an ascaridosis and an enterobiosis at low intensity of an invasion 200 mg there are enough. Indispensable condition of successful deworming of patients with an enterobiosis are simultaneous treatment of all family members (collective) and strict observance of the hygienic mode for a reinfestation exception, besides carry usually out repeated treatment with an interval of 10 days. Apply medical amine to treatment of patients with a strongyloidosis or албендазол. Specific therapy of patients with a trichinosis is carried out by Mebendazolum on 100 mg 3 times a day within 7-10 days, for this purpose apply also албендазол. For treatment of patients with a lymphatic filariosis and a loasis it is rather effective диэтилкарбамазин (6 mg on 1 kg a day in 3 receptions within 14-21 days).
At trematodoza and tsestodoza widely apply a praziquantel. A sick opisthorchosis, a clonorchosis, a paragonimiasis it is appointed in a daily dose 75 mg to 1 kg (in 3 receptions) 1 day, at shistosomoza depending on a form - in doses from 40 mg on 1 kg once to 60 mg on 1 kg in 2 receptions; at a fascioliasis efficiency of drug low, abroad to these purposes is recommended to apply триклабендазол.
At intestinal tsestodoza (a diphyllobotriasis and teniidoza) deworming is reached by a single dose of a prazikvantel in a dose of 20 mg on 1 kg, at a hymenolepiasis the same dose is appointed by 2 times with an interval of 10 days, at cerebral cysticercosis abroad the same drug use in a daily dose 50 mg on 1 kg in 3 receptions within 14 days and more. For the present almost specific treatment of other larvaceous tsestodoz of an echinococcosis and alveococcosis is not developed.
The complex of therapeutic events according to features of pathological influence of the specific activator and features of a course of helminthosis at the infested person is surely held.
