Opisthorchosis

Description:

Opisthorchisis — the disease from group of trematodoz affecting a liver and a pancreas. Activators — parasitic flat worms from the sort Opisthorchis.

Opisthorchosis symptoms:

Acute phase. The disease begins in 5-42 days after infection. The incubation interval averages 21 days. The acute onset of the illness prevails, is more rare - the gradual beginning with manifestation of an indisposition, weakness, perspiration, subfebrile condition. Further the opisthorchosis can proceed subclinically is, malosimptomno, followed by short-term rise in temperature to 38 °C, an eosinophilia to 15 - 20% against the background of a moderate leukocytosis. The moderately severe acute opisthorchosis (40 - 50% of patients) is characterized by high fever with gradual increase of temperature to 39 - 39,5 °C, the catarral phenomena of upper respiratory tracts. The eosinophilia reaches 25 - 60%, the leukocytosis accrues, SOE to 20 - 40 mm/hour moderately raises.

At patients easy and moderately severe currents in 1 - 2 weeks there occurs improvement, disease stage of latency which passes further into a chronic form.

At the heavy course of an acute opisthorchosis (10 - 20% of patients) allocate typhus-like, gepatokholangitichesky, gastro-enterokolitichesky options and option with preferential damage of airways in the form of astmoidny bronchitis, pneumonia.

The acute beginning, high temperature with a fever, a lymphadenopathy, skin rashes is characteristic of typhus-like option most of which brightly reflects the allergic nature of an acute phase. Quite often note cardialgias, with diffusion changes of a myocardium on an ECG, intoxication phenomena. From the first days of a disease sharp weakness, severe headaches, mialgiya and arthralgias, dispepsichesky manifestations, cough and other symptoms of an allergy is observed. The eosinophilia reaches 80 - 90% at a leukocytosis to 20 - 30 - 109/l, increase in SOE to 30 - 40 mm/hour. The acute phenomena proceed 2 - 2,5 weeks.

The Gepatokholangitichesky option proceeds with high fever, an eosinophilia and the phenomena of diffusion damage of a liver: jaundice, a gepatosplenomegaliya, functional disturbances - increase in content of bilirubin in blood serum in forward reaction, increase in level of protein for the account a2 - at - globulins, change of indicators of sedimentary tests (sublimate, timolovy and др). The symptomatology of a holangiokholetsistit includes a pain abdominal syndrome: the dull aches aching, pressing sometimes as hepatic colic.

In more hard cases symptoms of gepatobiliarny pathology are aggravated with displays of pancreatitis with disturbance of functions of a pancreas. Patients complain of pains of the surrounding character, in right and left hypochondrium and dispepsichesky manifestations.

The Gastroenterokolitichesky option is shown clinically in the form of catarral, erosive gastritis, a coloenteritis, stomach ulcer and a duodenum. The brightest symptoms of a disease are pains in epigastriums, the right hypochondrium, a loss of appetite, nausea, vomiting, disturbance of a chair is more rare. At a fibroskopiya - erosive and hemorrhagic gastroduodenit, sometimes ulcer niches. Fever and intoxication are expressed more weakly, an eosinophilia to 30 - 40%.

At one third of patients a respiratory organs in the form of an inflammation of upper respiratory tracts, astmoidny bronchitis, pneumonia, pleurisy is involved in process. As a rule, takes place astheno - a vegetative syndrome in the form of weakness, bystry fatigue, irritability, a sleep disorder.

The long current of an acute stage is in certain cases noted. Fever drags on up to two and more months, signs of damage of a liver, a pulmonary syndrome remain.

In process of subsiding of manifestations of an acute stage the condition of the patient improves, the disease passes into a chronic phase more often with displays of dyskinesia of bilious ways, chronic holangiokholetsistit, chronic pancreatitis.

Dyskinesia of bilious ways and cholestasia promote accession of a consecutive bacterial infection. In these cases development of severe defeat of gepatobiliarny system as a cholangiohepatitis with the expressed pain syndrome, increase in a liver, jaundice, disturbance of functional trials is possible. More often it is persistent hepatitis with symptoms of "a small liver failure" and astheno - a vegetative syndrome.

In defeat accession cases pancreatic glands come to light pancreatitis symptoms.

Among forms of a gastrointestinal tract disease chronic gastritis at which depending on extent of defeat of the ferruterous device disturbances of secretory, acid-forming, pepsinoobrazuyushchy and belkovydelitelny functions come to light is registered more often.

Along with gastritis the duodenitis with the corresponding complex of symptoms often develops.

Complaints of patients to pains in heart, interruptions of pulse which are connected with dystrophic changes of a myocardium (ECG) are frequent.

The phenomena of astenisation of an organism due to oppression and even exhaustion a hypophysis - adrenal system prevail

In hard cases the forecast becomes serious. Cirrhosis, bilious peritonitis, primary cancer of a liver and pancreas are among complications of an opisthorchosis.

Signs of defeats at an opisthorchosis of a nervous system are confirmed by complaints to a headache, dizziness irritability, sleeplessness, a depression, etc.

In a chronic phase of an opisthorchosis an eosinophilia, but lower level, the leukopenia, moderate hypochromia anemia are also noted.

The opisthorchosis burdens the course of the accompanying diseases, negatively influences the course of pregnancy, the lactation period, and also promotes formation of a tifo-paratyphoid carriage. The superinvasion (repeated infection of the patient with an opisthorchosis) causes the progressing disease.

At locals of the centers of an opisthorchosis the subclinical current of an invasion with moderate manifestations astheno - a vegetative or dispepsichesky syndrome is noted, cases of an acute phase are registered seldom. The most frequent form of display of an opisthorchosis is the cholangiohepatitis.

The course of an opisthorchosis at children differs in the fact that the acute phase is registered much less often and proceeds benign.

The chronic phase at children of 1 - 3 years is shown by lag in physical development, symptoms of dyskinesia of bilious ways, a moderate eosinophilia, decrease in food. In process of a growing the sensitization phenomena accrue, and at teenage age the organ pathology characteristic of adults is defined.

Opisthorchosis reasons:

Opisthorchosis — a biohelminthosis (see helminthoses). One of activators — the Siberian fluke, or a cat's fluke, описторх (Opisthorchis felineus), parasitizes at the person, cats, dogs, pigs, etc., in a liver, a gall bladder, a pancreas. The main source of distribution of an invasion — an animal who ate the infected fish of family cyprinid including the person with whose stake, and also sick animals, egg of a parasite get to water where they are swallowed by snails of bithynia leachi in whom there is a transformation of larvae of a parasite which is coming to an end with an exit in water of larvae cercariae. Cercariae get into cyprinid fishes — a bream, an ide, Yelets, small fry, etc. The crucian is an intermediate owner of the causative agent of other disease — a clonorchosis.

The person catches at consumption of the crude, insufficiently fried thoroughly and slaboprosolenny fish. The term of life of a parasite in a human body without deworming — over 40 years.

Treatment of the Opisthorchosis:

Treatment of patients with an opisthorchosis, both in acute, and in chronic phases has to be complex with respect for the principle of a combination of pathogenetic and causal treatment.

Staging provides in the scheme of treatment: preparation, purpose of anthelmintic drug against the background of pathogenetic therapy, rehabilitation, medical examination, control of efficiency of treatment.

Treatment of patients in an acute phase is directed first of all to stopping of allergic reactions and the related organ pathology. For this purpose appoint antihistaminic drugs (Dimedrol, Suprastinum, tavegil), Calcium chloratum, sedatives (drugs of a valerian, bromine). As antiinflammatory drugs, taking into account development of vasculites, appoint salicylates, Butadionum, Ascorutinum.

Release from an invasion does not provide a complete recovery of functional and organic disturbances of gepatobiliarny system, digestive tract, system of immunity and microcirculation. In this regard patients need performing the rehabilitation treatment individualized taking into account the remained pathology.
As a rule, the recovery complex includes the fortifying treatment, drugs improving a functional condition of zhelchevydelitelny system, antiinflammatory therapy, physiotherapeutic procedures, good dietary nutrition, etc.

Within the first two months after an extract from a hospital it is desirable to carry out duodenal sounding, a tyubazha with sorbite, 25 - 33% sulfate magnesia once a week.

Medical examination provides stage observation of the patient with an opisthorchosis in the conditions of hospitals and КИЗов policlinics. Terms of dispensary observation are defined by weight of pathology and taking into account clinical indications are carried out during 2 - 3 years and more. Not less once in half a year is reasonable to conduct clinical laboratory examination.

Considering a possibility of repeated infection (a superinvasion, a reinfestation), educational and sanitary and educational work among patients is important. The doctor in conversations with patients explains measures of prevention of infection, the rule of culinary processing of fish.