Strongyloidosis

Description:

Strongyloidosis (Latin strongyloidosis; Xing.: ангвиллюлёз, diarrhea kokhinkhinsky) — the helminthosis from group of nematodoses proceeding with a gastrointestinal tract disease and allergic manifestations.

Strongyloidosis symptoms:

In an early migratory stage (up to 10 days) a strongyloidosis there is fever, a skin itch, a small tortoiseshell or papular rashes, local hypostases, in lungs eosinophilic infiltrates, mialgiya, arthralgias, a hypereosinophilia, a leukocytosis, increase in SOE appear.

Skin manifestations: the pink and reddish, extended, oval form blisters tower over the surface of skin, change a form, are followed by a severe itch and "creep" for raschesy therefore are formed a linear form of a rash which are most often localized on a stomach, buttocks, a back, a waist, a breast, hips. Rash keeps from several hours to 2 — 3 days and disappears, without leaving marks. Traces can be only at strong injuries of skin in time having combed.

Rashes, as a rule, repeat from several times a month, to several times a year and less often without a certain recurrence. In most cases a small tortoiseshell is followed by a high eosinophilia that does necessary consultation of the hematologist.

During this period patients complain of bystry fatigue, weakness, dizzinesses, headaches, irritability quite often there are bronchitis phenomena with an astmoidny component, pneumonia, suffocation attacks.

Radiological find flying infiltrates in lungs, the pneumonic centers. In 2-3 weeks after an onset of the illness there are abdominal pains and the dispepsichesky phenomena — appetite disturbance, nausea, vomiting, a liquid chair, sometimes with blood impurity, the tenesmus, symptoms reminding a gastroenteritis, dysentery is more rare. The hepatomegalia with yellowness of skin and scleras is in certain cases noted.

Quite often symptoms of an early phase of a strongyloidosis are poorly expressed, and in some cases the invasion passes under other diagnosis.

It is necessary to know that presence of a small tortoiseshell, eosinophilias with displays of a disease of gastrointestinal or cholecystis pathology is an important diagnostic indicator for special inspection.

Gradually sharpness of clinical manifestations smoothes out, the disease passes into a chronic, late phase of a disease, accepts a long current. Existence of many clinical classifications depending on dominance of symptoms of defeat of these or those bodies or systems testifies to a considerable polimorforizm of clinical manifestations of a strongyloidosis in this phase.

The duodeno-cholecystis or bilious and hepatic, gastrointestinal, neuroallergic or allergo-toxic and mixed disease forms are the most characteristic of a strongyloidosis.

The slow monotonous current is characteristic of a duodeno-cholecystis form. Its main manifestation is to a different measure the expressed pain syndrome with functional and the organic lesions of a gall bladder, diskinetichesky frustration established by results of the cholecystography (deformation of a shadow of a gall bladder, disturbance of a smeshchayemost and mobility, etc.). Patients complain of bitterness in a mouth, a bitter eructation, loss of appetite, pain in right hypochondrium, periodically arising nausea and vomiting.

The leading symptoms at patients with a gastrointestinal form of a strongyloidosis are the dispepsichesky phenomena and frustration of a chair which are expressed in alternation of ponos with locks with a frequency of chair of 3-4 and more once a day. The chair is watery, sometimes with impurity of slime and blood. At objective inspection at patients the coated tongue, morbidity at a palpation of various departments of a stomach is defined. Quite often symptoms of gipoatsidny gastritis, enteritis, a coloenteritis are registered. At some patients symptoms of a peptic ulcer of a duodenum, stomach are shown. Sometimes patients with suspicion of dysentery go to infectious departments of hospitals.

The main manifestations of a neuroallergic form is the allergic syndrome — the small tortoiseshell which is followed by a sharp itch of skin and an eonozofiliya. The nature of rashes can be various, but is typical for a strongyloidosis that elements of rashes tower over the surface of skin, are located in places of compression of skin with clothes (a belt, a bodice, a belt) more often, are localized preferential on skin of a stomach, a back, buttocks, hips, as a rule do not rise by head skin and do not fall below knees. They have "creeping" character, creep for raschesy, quite often accept "linear" character — "a linear small tortoiseshell". Rashes stick to 12 — 48 hours, more rare longer and disappear completely. At the same time functional frustration of a nervous system, an astheno-nevratichesky syndrome are observed. Patients are suppressed, they complain of the general weakness, headaches, dizzinesses, frustration of a dream, an acrimony, tearfulness, perspiration. Minyer's syndrome, unconscious states, etc. symptoms can be observed.

Smith described a skin strongyloidosis with localization in buttocks, clinically similar to a centrifugal ring-shaped erythema. The strongyloidosis of skin can be caused as a strongilyata of cattle (strongyloididae spp.), and the strongilyata inherent to the person, for example Strongiloides stercoralis (see larva migrans).

At most of patients a blood eosinophilia to 50-70-80%.

The pulmonary form of a strongyloidosis, sometimes with an asthmatic component when the main pathology is connected with preferential defeat of bodies of respiratory system is registered.

Adverse disease with generalization of process and an autosuperinvaziya is observed at patients with the lowered resistance caused accompanying heavy to diseases (for example, oncological), at insufficiency of food, and also at treatment by immunosuppressive drugs (hormonal, cytostatics) and at HIV-positive people. Inspection on a strongyloidosis of the listed groups of patients should be considered obligatory.

From complications intestines cankers, perforative peritonitis, necrotic pancreatitis, intestinal bleedings, myocarditis, an encephalomeningitis, an asthenic syndrome, a cachexia are most often observed.

Strongyloidosis reasons:

The activator — Strongyloides stercoralis nematode (an ugritsa intestinal). Male 0,7 mm long, 0,04 — 0,06 mm wide. On the bent tail end of a body there are two spicules and houghs. Female 2,2 mm long, 0,03 — 0,7 mm wide. Eggs transparent, oval form, 0,05 x 0,03 mm in size. A life cycle proceeds with change of the free living and parasitizing generations.
The old name "kokhinkhinsky diarrhea" comes from an acute diarrheal disease at soldiers in 1876 in Indochina at infection with a strongyloidosis.

Getting into intestines, the female of the activator of a strongyloidosis lays eggs, from them larvae which are implemented into blood vessels, heart, pulmonary arteries, alveoluses, bronchial tubes, a trachea, a throat from where again get into intestines develop and complete the development, turning into puberal forms.

Adult individuals live in intestines 5-6 years.
Parasitic generation — females and males — are localized in a duodenum, and at a massive invasion — in all small bowel and peloric department of a stomach. The impregnated female lays eggs in a mucous membrane of a gut to 50 pieces a day of which rabditovidny (not invasive) larvae are formed, they are allocated in external environment where undergo further development. The rabditovidny larvae which got to the soil ripen and turn into diclinous worms. The free living impregnated females in the soil lay eggs which leave rabditovidny larvae. Part of them turns into invasive — filyariyevidny, others — are differentiated again in puberal worms.
Rabditovidny larvae can turn in filyariyevidny not only in the soil, but also in the owner's intestines that provides autoinvasion. It occurs at depression of function of immune system, and also under the conditions creating an opportunity to larvae to be late in a gut gleam more than 24 h (locks).
The strongyloidosis is widespread in wet tropics and subtropics, to a lesser extent in a zone of a temperate climate. Meets in Georgia (preferential in Abkhazia and Adjara), in Azerbaijan, in the west of Ukraine, in the Krasnodar, Stavropol regions, the Rostov region, in Priamurye.

Treatment of the Strongyloidosis:

The diagnosis is established on the basis of a clinical picture of a disease, detection of an eosinophilia of blood and data of the epidemiological anamnesis. The diagnosis confirms detection of rabditovidny larvae of helminth in duodenal contents and excrements which are investigated directly after defecation by Berman's method.

Patients are hospitalized. Treatment is carried out by medical amine in a daily dose of 10 mg on 1 kg of body weight to 3 receptions after food within 3 days, at an intensive invasion — within 5 days. Medical amine is contraindicated at pregnancy (especially in the I trimester). For decrease in side effect of medical amine treatment is carried out against the background of purpose of antihistaminic drugs. Use at a strongyloidosis of glucocorticoids is contraindicated in connection with a possibility of generalization of process.

Rehabilitation of patients is reached during 1 year. At a long current of an invasion with development of dystrophic changes in a mucous membrane of digestive tract purpose of replacement therapy is required by enzymes, fortifying means.