Trichinosis
Description:
Trichinosis - acute helminthosis of the person and mammals which important medico-social value is caused by weight of clinical manifestations, frequent disability, and in some cases a lethal outcome. Fever, muscular pains, a face edema, skin rashes, a high eosinophilia is characteristic of an invasion, and at a heavy current - damage of a myocardium, lungs, the central nervous system.
Symptoms Trichinosis:
Characteristic clinical displays of trichinosis are fever, preferential remittiruyushchy type, face edemas, muscular pains, skin rashes, a high eosinophilia.
At low intensity of an invasion perhaps subclinical, its asymptomatic current when the only sign testimonial of infection, eosinophilic reaction of blood is.
Clinically expressed options of a trichinosis are various on weight of a current, duration of an incubation interval of duration of fever and an outcome. According to it in the standard clinical classification the following four forms of an invasion are allocated: erased, easy, moderately severe and heavy.
During an invasion allocate the periods: incubatory, acute manifestations, complications, reconvalescence and recurrence.
The incubation interval of a trichinosis averages 10 - 25 days. However at infection with natural strains of the activator the incubation interval is extended up to 40 - 45 days. It is established that duration of an incubation is inversely proportional weights of disease: at a heavy current it makes 7-10 days, and at especially malignant is reduced to 3 - 1.
At the erased trichinosis form the incubation interval proceeds from 4th to 5 weeks. This form of an invasion proceeds without pronounced symptoms and is difficult for diagnosis. Main symptoms of a disease: subfebrile fever, slight muscular pains, pastosity of the person, indisposition. In peripheral blood an eosinophilia to 7 - 12% against the background of the normal maintenance of leukocytes. Disease duration no more than one week, during this time all manifestations, except an eosinophilia, is passed.
The erased and subclinical current of an invasion is registered at 20 - 30% which caught a trichinosis in each flash.
At an easy form of a trichinosis the incubation interval proceeds 4 - 5 weeks.
The disease begins sharply with increase in temperatures to 38 - 39 °C, a headache, an indisposition. Temperature quickly decreases to subfebrile and remains for 1 week. Pains in sural, lumbar, masseters, the century swelled, puffiness of the person ("odutlovatka") appear from the first days of a disease and are more expressed. An eosinophilia of peripheral blood within 10 - 20%.
All painful phenomena can independently pass within 1 - 2 weeks. The moderate eosinophilia of blood remains up to 1 - 3 months.
At moderately severe a trichinosis the incubation interval proceeds from 2 to 3 weeks. This form of an invasion differs in more expressed symptomatology corresponding to a syndrome of the general allergic manifestations.
The acute onset of the illness from temperature increase to 39 - 40 °C is characteristic. At the high level it remains several hours, then at the level of 38 - 38,5 °C keep for the first week, passing in subfebrile to the second. The feverish period is followed by megalgias in sural, lumbar, occipital, masseters.
As characteristic symptoms the expressed hypostases a century of the person, puffiness, conjunctivitis are noted. A part of patients against the background of fever has skin rashes of makulo-papular or hemorrhagic character.
Approximately 1/3 patients have a bronchopulmonary pathology. The clinical symptomatology at such patients is shown by an inflammation of upper respiratory tracts, bronchitis, pneumonia, pleurisy. Feature of pulmonary pathology at a trichinosis, as well as at other helminthoses, is the migrating character of "flying" infiltrates at radiological and auskultativny inspections.
During fever symptoms of defeat of cardiovascular system accrue: tachycardia, dullness of cordial tones, systolic noise on a top. The changes reflecting disturbances of exchange or dystrophic character are defined on an ECG. Patients complain of the heartbeat and short wind developing at any physical tension.
At some patients the disease is followed by symptoms of a gastrointestinal tract disease. Abdominal pains, nausea, vomiting, ponosa note 20 - 25% of patients.
The hyperadenosis, spleens more often observed at children confirms involvement in process of reticuloendothelial system.
The disproteinemia comes to light: on the one hand, the general hypoproteinemia and a hypoalbuminemia, with another - increase alpha 2 - globulins and gamma-globulins is noted. A characteristic symptom is the aldolazemiya to 25 - 40 E, SOE which is slowed down in initial the disease period at height of fever the eosinophilia to 25 - 40% against the background of a leukocytosis accrues.
Clinical manifestations at a moderately severe trichinosis reach a maximum by the end of the first week, the disease in 3-4 weeks comes to an end. The residual phenomena in the form of astenisation of muscular pains can remain for 1-2 months, and the eosinophilia is even longer. After treatment by glucocorticoid hormones duration of an acute phase is reduced, but the period of recovery drags on up to 4 - 6 months.
The easy and moderately severe course of trichinosis is registered at 50-60% which caught in each flash.
At a severe form of a trichinosis an incubation interval short - 7-10 days, at especially heavy current are reduced to 3-1 days.
The disease quite often begins atypically, reminding flu, ORZ, food poisoning, sypny or a typhoid. From the first days of a disease the phenomena of the general intoxication, damage of the central nervous system are expressed. Temperature, gradually raising to 40-41 °C, keeps for 2-3 weeks. Severe headaches, nonsense, excitement, sleeplessness, the meningism phenomena against the background of the accruing muscular pains and the expressed hypostases accompany fever.
Muscular pains gain widespread character. They arise in sural, eye, masseters, and further extend to muscles of a waist, a shoulder girdle, gain intensive character and quite often in these cases are followed by contractures, restriction of mobility to full immobilization of the patient.
Hypostases extend to a trunk and extremities, and also friable cellulose of internals, covers of a brain and a parenchyma. It leads to functional disturbances of the central nervous system, a hemoz, an exophthalmos, diplopia and other manifestations.
On face skin, trunks, extensor surfaces of nechnost appear polymorphic rashes of erythematic and papular character, and in especially hard cases - gemorragichy as a hemorrhagic vasculitis.
Of this form of a trichinosis it is characteristic various, heavy, it is frequent with the bad forecast organ and system pathologies.
Often there is cardiovascular pathology that is shown by hypotonia, tachycardia and disturbance of a rhythm. Muting of cardiac sounds, symptoms of heart failure - a myocarditis picture is noted. The ECG almost at all patients shows diffusion changes of a myocardium, coronary disturbances with development of a circulatory unefficiency.
Respiratory organs suffers: bronchitis with an asthmatic component, focal bronchial pneumonia with flying character of infiltrates and other disturbances comes to light at such patients quite often.
One of options of a heavy course of trichinosis is the abdominal syndrome at which against the background of fever and other displays of a disease there are abdominal pains, nausea, vomiting, a liquid chair with mucosanguineous impurity. Ulcer and necrotic damages of a stomach and intestines with perforation and bleeding can become a cause of death. Dystrophic disturbances of a liver have high-quality character, they completely take place at corrective therapy. Function of kidneys is, as a rule, not broken, the proteinuria and a cylindruria as reaction to fever comes to light.
Quite often there are symptoms of damage of the central nervous system characteristic of an encephalomeningitis, encephalomyelitis. Patients are disturbed by severe headaches, sleeplessness, in hard cases nonsense, spasms, mental disorders, epileptic seizures.
Organ and systemic lesions can be a cause of death. Acute allergic myocarditis is the main reason of a lethal outcome at a trichinosis. In these cases the patient suddenly has attacks of an acute disorder of cordial activity with tachycardia, arrhythmia, hypotonia, and the ECG reflects diffusion damage of a myocardium and coronary pathology.
Among the lethality reasons at a trichinosis the pneumonia which sometimes is followed by astmoidny bronchitis, pleurisy is on the second place. Rezistentna infiltrates to antibiotics, but quickly disappear at purpose of glucocorticoid hormones.
The terrible complication taking the third place among causes of death of patients with a trichinosis is damage of the central nervous system. This complication, as well as a pulmonary syndrome, meets at men more often. Psychoses, heavy hysteria, epileptiform attacks, paresis and paralyzes demonstrate the deep diffusion and focal damages of a head and spinal cord connected with development of a nonspecific vasculitis is more rare with fibrinferments of large vessels.
At some patients as a result of disturbances is a hemostasis, systems of coagulability, intravascular coagulation arise phlebitis, fibrinferments of vessels of extremities.
Organ defeats develop on the 3-4th more often, is more rare on the 2-5th weeks after infection.
Decrease in content of albumine, increase of level alfa2-is characteristic and gamma-globulins, the content of crude protein in hard cases falls to 45-35 g/l. Indicators of sedimentary tests change. Sharply activity of zymohexase (F-1, 6-F), to 40-80 E, cholinesterase level increases.
The eosinophilia reaches 25-40% against the background of a leukocytosis. However at very severe forms in the terminal period sharply decreases to an aneosinophilia. The heavy course of trichinosis is registered at 10-30% which caught in each flash.
Clinical and datas of laboratory testify to easier course of trichinosis at children, to smaller expressiveness at them allergic manifestations, smaller defeat of cardiovascular system.
The trichinosis incubation interval at children is, as a rule, longer, than at adults. Temperature reaction is expressed more weakly, short - up to two weeks - fever meets more often than long remittiruyushchy.
The main clinical displays of trichinosis - edematous, muscular and painful syndromes - at children are expressed also more weakly, than at adults. Easy forms of a disease, a thicket erased and subclinical prevail.
Laboratory indicators at children are characterized by a smaller eosinophilia, lower interest of positive S-reactive protein. There is an opinion that easier course of trichinosis at children in comparison with adults is caused by the expressed immunological activity of an organism of the child and as a result - restriction of development of immunopathological manifestations what it is necessary to agree with. Besides, smaller intensity of infection of children matters, as a rule.
However it is impossible to exclude a possibility of a malignant current of an invasion at children with development of heavy allergic myocarditis, encephalomeningitis, even with an unsuccessful outcome at all.
There are clinical observations which testify to easier course of trichinosis at pregnant women. Such clinical criteria of weight as height and duration of fever, intensity and duration of muscular pains, prevalence, localization and time of preservation of hypostases, are less expressed. Complications meet less often and they are expressed also more weakly.
Thus, the given observations demonstrate that a trichinosis does not break the course of pregnancy and is not reflected in fetation.
Reasons Trichinosis:
The causative agent of trichinosis is Trichinella spiralis (Paget, 1835, Owen, 1835). In the nature there are also other types - T. pseudospiralis, T. nativa, T. nelsoni. Their role is less studied, specific independence is discussed.
Trichinellas - the small, almost threadlike helminths (thrix - a hair) covered cross исчерченной with a cuticle. T body. spiralis is roundish, a little narrowed by the front end. Length of a puberal male is 1,2-2 mm with a width of 0,04-0,05 mm. Length of a puberal female before fertilization of 1,5-1,8 mm, after fertilization its length increases to 4,4 mm.
The alimentary system begins an actinostome which conducts in the oral capsule, on its ventral party there is a stylet by means of which the parasite is attached to a mucous membrane of intestines of the owner. A gullet - the narrow capillary tube - in the second third of a body passes into the intestines which are coming to an end with a short rectum.
Reproductive system unpaired. At a male it comes to an end on the back end of a body with two copulative appendages. At females in a back part of a body the ovary which passes into an oviduct is located. The most part of a body is occupied with length and a wide uterus which comes to an end with a sexual opening at the end of a front quarter of a body.
Treatment Trichinosis:
Treatment of patients with all forms of a trichinosis, except erased, is carried out in a hospital as progressing of a disease and heavy side reactions on specific treatment are possible. Treatment of patients with the erased and easy forms of a trichinosis, and also the patients who arrived under observation in the reconvalescence period after a moderately severe disease is carried out by anti-inflammatory nonsteroid drugs. Specific treatment — Mebendazolum (Vermoxum) is carried out by a moderately severe sick trichinosis and the seriously ill patient. Vermoxum is appointed the adult on 0,3 g a day (to children in a dose of 5 mg to 1 kg of body weight) in 3 receptions after food within 7 — 10 days depending on weight of a disease. For the prevention of side allergic reactions in response to death of parasites specific treatment is carried out against the background of antiinflammatory therapy by Brufenum or Voltarenum. Glucocorticoids appoint together with specific drugs at a severe disease with organ defeats — Prednisolonum in a dose from 30 to 80 mg a day or 6 — 10 mg of dexamethasone a day for chemotherapy with a bystry dose decline of drug after 5 — 7 days of its use.
Forced position of the patient and his obezdvizhennost demand leaving with change of its situation in a bed, after removal from serious condition — massage, passive, and then active gymnastics.
