Lambliasis

Description:

Lambliasis - the protozoan invasion proceeding preferential with defeat of a small bowel and which is followed at a part of patients allergic and neurologic and symptoms.

Lambliasis symptoms:

Clinical symptomatology at the persons infected with lyambliya, very a poliformna that is the reason of existence of numerous classifications. It is necessary to agree with T. V. Kucher's opinion et al. (2002) which provide E. A. Pavlova (1979) conclusion - "two authors describing a similar picture of symptoms of a lambliasis are absent except for cases when one author takes on trust that he wrote another".

Considering the last WHO classification (MKB 10, No. A.07.1 code), analyzing many classifications of domestic and foreign authors, the most reasonable should recognize the following classification:

  1.lyamblionositelstvo (asymptomatic lambliasis);
  2.lyamblioz (clinically expressed form):

    * intestinal form (dyskinesia of a 12-perstny gut, duodenitis, enteritis, coloenteritis);
    * gepatobiliarny form (dyskinesia of bilious ways, cholecystitis);
    * lambliasis as sopustvuyushchy disease.

T. L. Zalipayeva (2002), studying clinical symptomatology and a functional condition of the alimentary system at children of various age groups against the background of infection with lyambliya, allocated 4 main clinical syndromes: dispepsichesky, painful, asthenoneurotic and allergodermatologichesky. Conducting in a clinical picture of a disease were dispepsicheskiya (81,5%) and painful (76,9%) syndromes. Asthenoneurotic reactions in the form of irritability, fatigue, an uneasy dream, a headache and dizziness are revealed at 64,8% of patients.
In 31,5% of cases clinical and laboratory signs of a sensitization - increase in eosinophils in peripheral blood to 5 - 7% are revealed.
The Allergodermatologichesky syndrome in the form of atopic dermatitis is noted in 15,7% of cases.
The syndromic symptomatology was registered at various clinical forms of a lambliasis.

The intestinal form of a lambliasis is naturally shown in the form of a duodenitis, dyskinesia of a 12-perstny gut and enteritis.
Patients complain of diffuse morbidity in the right half of an anticardium. The sharp attacks of pains which are followed by nausea are noted. Complaints to a loss of appetite, an eructation, heartburn, an unstable chair, ponosa which are replaced by locks are frequent.
The constant moderate pains in a navel most of which often are not connected with food, feeling of overflow of a stomach, abdominal distention, liquid, sometimes a foamy chair to 3 - 5 times a day, a steatorrhea are characteristic of enteritis. At survey of the patient - the stomach is blown moderately up, at a deep palpation is painful in a navel.
At the persons infected with lyambliya the gepatobiliarny pathology most often expressed by cholecystitis symptoms quite often comes to light.

Some authors deny a possibility of parasitizing of lyambliya in a gall bladder and channels of a liver, however acknowledge the possibility of development of gepatobiliarny and biliary and pancreatic pathology at a lambliasis. Such patients complain of pains in right hypochondrium, bitterness in a mouth, a bitter eructation, morbidity at a palpation of a gall bladder. Positive cholecystis symptoms, results of fractional duodunalny sounding demonstrate diskinetichesky frustration of biliary system with spasms or an atony of sfinkternopapillyarny area in the presence of lyambliya.

Results of ultrasound examination of abdominal organs at children with a giardiac infection also testify to pathology of biliary and pancreatic system in the form of a hypotone and a hyper tone of a sphincter of a gall bladder, the cholestasia phenomena (T. L. Zalipayeva, 2002). The author noted basic distinctions of pathological changes of the alimentary system in various age groups of the children infected with lyambliya. So, in younger group (age 2-3 years) dispepsichesky and allergodermatologichesky syndromes whereas painful and asthenoneurotic syndromes were observed extremely seldom prevailed.
At the age of 4-7 years the dispepsichesky syndrome prevailed too, however at 75% of children also the pain syndrome, at 50% - reactive changes of a pancreas was noted, at 37,5% of patients organic pathology of a gastroduodenal zone was created.
At the age of 8-12 years to similarly previous groups the dispepsichesky syndrome was leading, at 81,7% of patients the pain syndrome was more brightly expressed, in 75% diskinetichesky frustration of biliary system are revealed, at 70% of patients functional changes of a pancreas were observed. Organic changes of a gastroduodenal zone at 98,3% prevailed, including 4 patients have erosive and ulcer defects of a mucous membrane of a duodenum.
At the age of 13 - 15 years dispepsichesky frustration (77,8%) remained, however the pain syndrome was the leader, i.e. the author established weighting of clinical symptoms in the senior age groups and formation at them to organic pathology of the alimentary system.
The lambliasis at persons of young age (19 years - 24 years) most often proceeds with clinical manifestations preferential from digestive tract (a duodenitis, enteritis, a coloenteritis).
Long parasitizing of lyambliya is followed by neurotic symptoms: weakness, bystry fatigue, irritability, tearfulness, headaches, dizzinesses, pains in heart, especially at children. In certain cases these symptoms are prevailing. Against the background of an invasion lyambliya development of the neurosises which do not have specific clinical features is possible (A. Ya. Lysenko, etc., 2002).

Clinical forms of a lambliasis with dominance of allergic manifestations are described: an unrestrained skin itch, a small tortoiseshell, an erythema of integuments, bronchial asthma and an asthmatic bronchitis, rhinitis, arthralgias, arthritis, conjunctivitis, a persistent blepharitis, etc. which passed at once or in 1 year after specific treatment (metronidazole).

At a considerable part infested a lambliasis proceeds without any clinical manifestations (carriage) or at the subclinical level when the patient of complaints does not show, and symptoms of a disease can be revealed only at tool researches (disturbance of absorption in a small bowel, changes of content of intestinal enzymes in blood serum, etc.). Frequency of a manifest lambliasis makes 13 - 43%, subclinical - 49%, asymptomatic - 25 - 28% of number infested by lyambliya.

Pilot studies on volunteers showed that at identical doses of the cysts of lyambliya entered with food the clinical picture developed at 60% of people. Diarrhea, an abdominal syndrome, a meteorism, fever and other symptoms developed for 3 - 10 day after inoculation of cysts, at the same time they had cyclic character, appearing and disappearing through different periods at different persons. The quantity of cysts in excrements of the infested people also varied. Emergence of symptoms of a lambliasis could advance allocation of cysts for 1-2 weeks. The invasion lyambliya could disappear spontaneously in 6 weeks, and could persistirovat for years. At the same time allocation of cysts happened to 10 - 20 day intervals.

Lambliasis reasons:

The activator of a lambliasis is the intestinal flagellar elementary - Lamblia intestinalis (Lambl, 1859; Blanchard, 1888). In foreign literature apply the terms Giardia lamblia, Giardia intestinalis and Giardia duodenalis.
In a development cycle of a lyambliya distinguish vegetative (trofozoit) also cystic stages. The vegetative phase of a pear-shaped form, is symmetric, actively mobile, 10 in size - 18 x 6 - 12 microns, the average size of 9 x 12 microns. Lyambliya has 2 kernels and 4 couples of plaits which are organellas of the movement. The front end of a body wide, rounded off, back (tail) - pointed. On a ventral body surface there is a prisasyvatelny disk by means of which the lyambliya is fixed to epithelial cells of an intestinal wall. Across the average line of a body of a lyambliya there pass two basic threads-aksostili which divide a cell into two half, symmetric, identical on a structure. In each of them there is about one kernel. Cytoplasm is transparent. The back surface and the tail end of a lyambliya are covered with an unary cytoplasmic membrane. Lyambliya have no mitochondrions, Golgi's device, there is an endoplasmic reticulum where in a cell most intensively there is a process of synthesis of substances.
Cysts oval (size of 8-14x7-11 microns, on average 12 x 8 microns). Their cytoplasm contains 2 or 4 kernels and the curtailed flagellar device. In liquid or semi-fluid excrements the intermediate stage of development of a lyambliya - a precyst sometimes is found.
Lyambliya in places of their greatest accumulation by pair division breed. According to M. M. Solovyov (1963) process of division takes 15 - 20 minutes that promotes intensive settling of intestines protozoa. In external environment are allocated with excrements generally in the form of cysts. Trofozoita it is possible to find only in liquid excrements no more than in 5% of the persons infested by lyambliya.
The place of parasitizing of lyambliya - upper parts of a small bowel. The lyambliya is attached to a mucous membrane by a front part of a body, and the back end free. On one place of a trofozoita remain fixed short time. They often unfasten from fibers and are again attached to them, but already in other place or pass into a stand-at-ease. At an intensive invasion can get into fabrics of fibers.
The trofozoita which are periodically unfastening from a mucous membrane intsistirutsya or degenerate. By pilot studies on dogs it is established that in 10 - 15 days after infection the bulk of trofozoit is localized in a jejunum and occasionally in duodenal. Further population of lyambliya moves from proximal to averages or to average and distal departments of a small bowel. Formation of cysts (encystment) in the first 10-15 days happens in a jejunum, is rare - in duodenal, and in later terms - on average and distal departments of a small bowel. It depends on the number of population of lyambliya, expressiveness of pathological shifts in the place of parasitizing and prescription of invasive process. Tsistovydeleniye at a lambliasis has discontinuous character.
In 1959 A. E. Karapetyan received culture of lyambliya of in vitro that allowed to study features of biology of protozoa in more detail. In particular, character the symbiotic nature of relationship of lyambliya with sort Candida fungi was established that found reflection in approaches to medical tactics.
It was also established that the culture of lyambliya maintains short-term freezing, without losing ability to share. At the same time water temperature is higher + 50 °C cause instant death of protozoa.
Lyambliya treat the most widespread parasites of the person living in upper parts of small bowels. Modern data on morphological and biological features of lyambliya confirm their exclusive fitness to dwelling in this site of digestive tract.
Unsuccessful attempts of experimental infection of animals with introduction of lyambliya directly in a gall bladder (Vinnikov M. E., 1943; Gnezdilov V. G., 1953; Karapetyan A. E., 1960) and data on toxicity for lyambliya of not divorced bile (Karapetyan A. E., 1964) convincingly demonstrate impossibility of dwelling of lyambliya in a gall bladder and a liver.
Strong evidences of extreme fitness of a lyambliya to dwelling are given in a brush border of an epithelium of small bowels by M. M. Solovyov (1968).
Lyambliya live on an epithelium surface. The drift of single copies in a stroma of fibers established to Dekhkan-Hodzhayeva (1960) is possible only at intensive settling by intestines lyambliya. Such indicators as lack of signs of reproduction of vegetative lyambliya in a fiber, sharp disturbances of their structure and lack of reaction of surrounding fabric deny a possibility of adaptation of these simplest to interstitial parasitizing.

Treatment of the Lambliasis:

Recognition of legitimacy of the diagnosis "lambliasis" in all cases of detection of lyambliya in excrements or duodenal contents as in the cases which are clinically expressed, and asymptomatic, defines the positive decision on performing specific treatment.
However in all cases when in the presence of lyambliya disorders of intestines or disturbance of functions of a liver are observed, for early detection of a possible basic and associated disease it is necessary to conduct careful clinical laboratory examination of the patient.
Tinidazolum (фазижин, Ametinum, Tinoginum). Course of treatment 1-2 days. Preparation for treatment same, as at treatment by Trichopolum.
Daily doses: adult 2000 mg (4 tablets on 0,5 g); to children - 50 - 60 mg on 1 kg of body weight. The daily dose is divided into 3 - 4 one-time receptions and accepted in time or after food.
By-effects in the form of nausea, dizziness, an ataxy, a leukopenia are rare.
Treat contraindications: disturbances of a hemopoiesis, a disease of the central nervous system in an active phase, the first 3 months of pregnancy, the lactation period. Not to accept at hypersensitivity. Efficiency of 70 - 80%.
Tiberal (орнидазол) - antimicrobic and anti-protozoan drug.
It is effective at a trichomoniasis, an amebiasis and a lambliasis. One tablet contains 500 mg of an ornidazol. Possible schemes of treatment: one-day, three-day, 5 - 10-day courses.  Adults lasting treatment of 1-2-3 days and children with body weight more than 35 kg take 3 pill once in the evening. Children with body weight less - 40 mg/kg once a day. At body weight more than 60 kg appoint 4 tablets a day (according to 2 tab. in the morning and in the evening).
At 5 - a 10-day course adults and children with body weight more than 35 kg receive 2 tablets a day, till one morning and in the evening. To children with body weight to 35 kg - appoint at the rate of 25 mg/kg of body weight in one step.
Tiberal always accept after food.
By-effects are poorly expressed and nausea, in rare instances - disturbances is shown in the form of drowsiness, a headache, from TsNS, such as dizzinesses, tremor, lack of coordination, spasms, etc.
Contraindications - individual intolerance, early durations of gestation, the lactation period.
It is effective - 90 - 92,5% at a one-day course.
Makmiror "Poliindustria chimica".
According to the specified authors at purpose of a makromiror in a daily dose of 30 mg/kg of body weight in 2 receptions within 7 days full treatment comes at 96,8% of children.
By-effects are not revealed. Authors consider this drug by efficiency and portability choice drug at treatment of children.
Control parasitological examination is conducted right after the termination of a course of treatment and in 1 month.