Blood tests for the diagnosis of opisthorchiasis. How accurate is the test for opisthorchiasis?

After infection, after a few days (sometimes weeks), the disease begins to develop. First comes the acute stage, which is characterized by sharp increase temperature, symptoms of poisoning, allergic reactions on the skin, severe malaise. Such symptoms last for several weeks, then begin to gradually weaken.

Then comes the chronic stage of the disease. The main symptoms of the acute form of opisthorchiasis disappear, but the infection continues to develop in the body and affect internal organs. In the chronic stage, against the background of opisthorchiasis, various diseases of the liver, pancreas, gastrointestinal tract in general, skin, lungs, of cardio-vascular system.

Important! It is worth preparing for the fact that a number of tests will have to be taken several times.

Since identifying an infection is often difficult, several various groups studies that will help establish a more accurate picture of the lesion. The specialist must first send for a general and biochemical blood test, stool and urine analysis. This list can be supplemented by examining the contents of bile.

There are several various techniques blood tests. The most accurate is linked immunosorbent assay, however, it is worth considering that it is not always available. The accuracy of this method reaches 90%, so if possible, you should undergo this type of diagnosis.

The price of blood tests can vary and depends on the location and diagnostic method. With a referral from a government doctor, tests can be done for free; in various laboratories, the test can cost from 500–1500 rubles or more.

How to take it

Before any blood tests you should not eat, especially sweet and heavy foods, so they are recommended to be carried out in the first half of the day: the earlier, the better. The day before the test you should not drink alcoholic drinks and take any medications.

There are no restrictions after taking blood for testing. Sometimes it is advised to limit physical exercise for a couple of hours. In general, a blood test does not require special preparation.

In how many days will the result be ready?

The duration of the study depends on the type of analysis and the place where it was carried out. It usually takes several days to get the results, but there are laboratories where, for an additional fee, they can issue a transcript faster.

At positive analysis To identify opisthorchiasis, you need to urgently consult a doctor. It should also be remembered that a blood test is not 100% accurate - in addition to it, you must also provide feces and, possibly, bile.

It should be remembered that this method makes it possible to detect the disease only 3–4 weeks after infection, when the infection has developed sufficiently. For reliability, the analysis can be carried out several times, at regular intervals.

Feces or collected duodenal contents are examined for the presence of fluke eggs. At chronic opisthorchiasis they are almost always present, false results are more likely at the very beginning of the disease, immediately after infection.

How to take it

It is better to collect material for research in the morning. The day before, you should not take medications or drink alcoholic beverages. Keep collected feces It’s not worth it - it’s advisable to immediately take it to the laboratory. IN as a last resort The material should be placed in the refrigerator. The container for collecting stool must be sterile; it is best to use special containers for analysis.

Is parasitic disease, which primarily affects the liver and pancreas. According to statistics, the number of cases of opisthorchiasis is about 21 million people.

The causative agent of the disease is the Siberian fluke, scientific name which is a helminth. The main route through which the disease is transmitted is through eating poorly processed fish.

How does opisthorchiasis manifest itself and what modern methods diagnostics it can be detected, we will consider further.

When is the examination scheduled?

Opisthorchiasis is dangerous because its symptoms appear only 2 or 4 weeks after a person becomes infected. Then, when it's already time acute period diseases.

Those infected with opisthorchiasis usually complain of the following signs of the disease:

• weakness, fatigue;
• pain under the right rib;
• muscle pain;
• rash of unknown origin;
• problems with bowel movements;
• heat;
• indigestion;
• change in skin color.

The listed symptoms are usually accompanied by an acute period of opisthorchiasis disease. At chronic course symptoms of the disease are mild, sometimes they can worsen chronic pathologies Gastrointestinal tract, but usually there are almost no signs.

General blood analysis

Diagnosing this disease in an adult is quite difficult, but first of all, doctors prescribe blood test for opisthorchiasis.

At the first stage of identifying the disease, a general blood test is prescribed. Moreover, if a person really falls ill with opisthorchiasis, the analysis results should contain the following data:

1. Eosinophils should be observed in large quantities, since they are indicators of a person’s allergic reaction to external stimuli, V in this case, for helminths.
2. White blood cells, red blood cells that are involved in the immune response, are elevated.
3. ESR, an indicator that tells you that the immune system gives a reaction to the stimulus, also at a high level.

Here are three main indicators when detected improved results in a general blood test which can indirectly suggest the presence of the disease opisthorchiasis.

Blood chemistry

Clinical picture

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Biochemistry is a more detailed blood test that can identify and confirm the presence of the disease. In the results of a blood test for opisthorchiasis during biochemical diagnosis, the presence of opisthorchiasis disease is indicated by the following data:

• bilirubin, which is transformed by the liver, is increased;
• ALT and AST transaminases, which are used to detect liver pathologies, are elevated;
• milas, which are active substance in the pancreas, increased.

A high level of these indicators may also indicate opisthorchiasis. These indicators indicate that internal organs such as the liver and pancreas - the organs that primarily infect helminths - are damaged, their functions are impaired, which means that the disease opisthorchiasis develops.

Complete blood count and biochemistry serve mainly as additional methods diagnostics of this disease to the main ones.

Linked immunosorbent assay

At initial stage disease, the method is considered the only reliable one, but if the disease opisthorchiasis has progressed to the chronic stage, enzyme-linked immunosorbent assay is already used as an additional one.

Sensitivity of enzyme immunoassay for helminths in acute form disease is almost 100%, and in chronic cases only 70%.

Despite this, the ELISA test can give false-positive or false-negative results in some cases.

False-positive results, that is, those that allegedly confirm the presence of the disease, in addition to the reaction to opisthorchiasis itself, can appear when:

• specific diseases respiratory system(allergosis);
• diseases of the gastrointestinal tract;
• pathologies of the liver, gall bladder and its ducts;
• toxoplasmosis;
• toxocariasis, etc.

False negative results, denying the presence of the disease, can occur with:

• chronic diseases;
• human immunodeficiency states;
• taking some medications, for example, antibacterial or chemotherapy drugs.

Normal blood values

In order to understand which indicators are elevated and which are the norm, we will provide normal values blood parameters during diagnosis in an adult.

The table shows normal indicators, that is, those in which the presence of the disease is not confirmed. A deviation from the specified norm data upwards in all indicators means the possibility of the presence of opisthorchiasis in the body.

Preparing for a blood test for opisthorchiasis

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No special preparation is required at all. Rules for delivery general analysis blood and biochemistry are the same as usual.

A general blood test must be taken on an empty stomach in the morning.

Before biochemical analysis You should refrain from eating 8 to 12 hours before the test for greater accuracy. It is necessary to donate blood in the morning and on an empty stomach, and before that day, have dinner in the evening light food, avoiding flour, fried, fatty, carbonated and strong drinks.

Blood for ELISA for serological studies It is also taken on an empty stomach from a vein. Two or three days before the analysis, it is necessary to exclude products that cause increased gas formation(legumes, cabbage, grapes, etc.). You should not eat 12 - 13 hours before the test.

Other diagnostic methods

• stool analysis for the presence of cat fluke eggs;
• PCR diagnostics;
• Analysis of urine;
• ultrasonography abdominal cavity(ultrasound);

Ultrasound of the intra-abdominal cavity will allow you to see the thickening of the thickness of the walls of the gallbladder and its ducts, the separation of the walls of the liver ducts, in which helminths accumulate.

Duodenal intubation is a method in which different types irritants in order to stimulate contraction of the gallbladder, as a result of which bile flows into the duodenum and is taken for analysis. The method allows you to determine the state biliary tract and ducts, as well as identify helminth eggs. The study of duodenal juice is an alternative to stool analysis. If it is impossible to examine stool, this diagnostic method is used.

Opisthorchiasis is quite dangerous disease. If you notice any symptoms, you should immediately contact medical care. Doctors will conduct examinations that will allow timely determination of the stage and severity of the disease, and prescribe treatment. The disease develops very quickly and can cause irreparable damage, so you should not put off going to the hospital. It is also important to follow one preventive recommendation– fish should be bought in trusted stores, and cooked very carefully, since it is from this that the most Great chance get infected.

It is impossible to find out about the presence of helminths initially, so an analysis for opisthorchiasis will confirm suspicions or dispel doubts. You should not refuse various studies, since a late-diagnosed disease can cause the most serious disruptions in the body.

If the patient suffers from nausea, pain in the right side, weakness, allergic manifestations, an increase in the size of the liver, then tests must be taken.

Diagnosis is carried out using direct and indirect methods.

If we talk about indirect methods, then we use serological methods, thanks to which it is possible to determine the existing antibodies to a hostile antigen:

• enzyme immunoassay (ELISA);
• indirect agglutination reactions (IRGA) and the like.

But as the disease progresses, this titer will decrease. And if you take a blood test for opisthorchiasis, then only in half of the cases you can get a negative result.

And if a person’s blood is taken for opisthorchiasis, and a negative result is revealed, then it is impossible to say with complete confidence that he has recovered. No one knows how long the antibodies will remain inside the body.

A specialized laboratory (for example, Invitro) can carry out diagnostics that help determine circulating immune complexes. Thus, the diagnosis is finally confirmed.

The person is sent to donate blood for opisthorchiasis in order to check, based on the results of the analysis, whether infection is present or not.

The diagnosis is confirmed when:

• leukocytosis;
• increasing the erythrocyte sedimentation rate;
• higher level eosinophilia.

Biochemical blood tests for opisthorchiasis will show how low the protein level is and how the liver enzymes have changed.

By examining stool, you can find out about the presence of helminth eggs in the human body. But feces submitted for opisthorchiasis will rarely show accurate results. Therefore, such analyzes are carried out repeatedly.

Ultrasound diagnostics will reveal certain symptoms. It's about O diffuse changes in the liver, dilated ducts and hepatomegaly.

The most informative diagnostics– duodenal sounding.

There is no need for special preparation for the upcoming examination. Blood is donated on an empty stomach for serological tests.

Abstaining from food will be necessary to carry out duodenal intubation. Before the procedure, you need to avoid foods that cause gases: legumes, cabbage, beets, whole milk, carbonated drinks, confectionery. The procedure as a whole is harmless. In addition, it provides specific information.

Features of stool examination

Thus, diagnosis will be appropriate only after 4-6 weeks. There is nothing complicated about carrying it out. A small amount of feces are mixed with glycerin. Then the resulting material is covered with glass. Preliminary flotation is mandatory.

The degree of the disease will be determined by the number of eggs in 1 g of feces. If there are more than 30 thousand, then the disease is characterized by a severe stage.

The Goryachev method can be used: the prepared biomaterial is diluted in distilled water and then mixed with a solution of potassium nitrate. Next, the sediment is examined.

The Fulleborn technique is also effective, when feces are mixed with a salt solution. As soon as the particles float to the surface, they are removed and the material is left for an hour. Afterwards, a film is taken and several preparations are made.

How are survey results interpreted?

If an infection has occurred in the human body, this can be known for sure only after helminth eggs are detected.

The situation can be explained in different ways:

Most likely, a person will be referred for repeat tests if certain signs of illness are observed.

If the need arises, both the doctor and the patient are required to be more persistent, since the disease can seriously disrupt the functioning of organs and systems.

Immunodiagnostics is used quite often if a patient comes in with complaints of health. Thanks to enzyme immunoassay, it is revealed increased concentration immunoglobulins. After a possible infection has occurred, a week or two must pass for the concentration of antibodies to reach its maximum.

Analysis for opisthorchiasis is prescribed for characteristic clinical symptoms at the patient. Research can be both general and in-depth. It is important to know how to properly prepare for the procedure, how it goes and how the results are interpreted.

Indications for use

Diagnosis of opisthorchiasis begins with a trip to the doctor. Typically, patients consider the symptoms of the disease to be a consequence of fatigue, colds, digestive disorders and simply a general malaise of the body. But a specialist, having studied the picture of symptoms, can prescribe the necessary tests.

Indications for use:

1. A significant increase in temperature that does not subside for a long time.
2. Stomach problems, vomiting, nausea.
3. Acute colic in the liver region.
4. Joint and muscle pain.
5. General weakness and malaise.
6. Heavy sweating.
7. Frequent colds.
8. The skin takes on a yellowish tint.
9. Poor appetite.
10. Unpleasant sensations in the right side.

This is a list of the main symptoms that a doctor should pay attention to when prescribing a test for opisthorchiasis. To confirm the guesses, the specialist needs to find out whether the patient eats raw river fish. You will also need to ask whether the patient could have been in places with high probability infection with opisthorchiasis.

Can be avoided serious illnesses, if you do a test for opisthorchiasis in time. This could be purulent cholangitis or phlegmon of the gallbladder. Often the disease causes hepatitis, stomach ulcers, cancer diseases, biliary peritonitis.

If a person is constantly in contact with fish or the agricultural industry, then once every 3 months it is necessary to donate blood and feces for opisthorchiasis. In addition, catering and medical workers are being appointed. The analysis is relevant for children, especially if they live in a village. The diagnostic frequency is once every 3 months.

Patient preparation

After the appointment, it is necessary to properly prepare for the analysis. Factors that may affect the result are excluded from life. As a rule, the attending physician warns the patient about all prohibitions in advance. It is better to come to the laboratory in the morning, on an empty stomach.

Rules for preparing for analysis:

If all requirements are met, diagnostic errors are minimized. False readings were recorded in only 2%. Typically, these people are chronically ill or immunocompromised. The results are also affected by medication use.

For a general analysis, you need to provide blood from a finger; usually the ring finger is used for this. Biochemical studies are based on venous blood. The needle is inserted into a vein in the elbow. The results will be ready in a couple of hours. IN in some cases you'll have to wait a day. It all depends on the type of research.

Analysis process

First, classical tests for opisthorchiasis are performed. These include donating blood, stool and urine. The number of eosinophils and leukocytes in the blood can become a determining factor. Their increase signals the presence of the disease.

Types of tests for opisthorchiasis:

• donation of feces and urine;
• general blood test and biochemical;
• use of polymerase chain reaction;
• study of immunoenzyme indicator.

To get the most accurate results, you will have to take tests several times. Also, studies are repeated after treatment.

First you need to conduct an enzyme immunoassay, this is the most precise research. In addition, it is possible to identify the problem at an early stage.

Features of donating feces

The easiest way to detect helminths is 30 days after infection. This period marks the peak of their life activity - reproduction. They can be easily found in biological waste. On early stages It is better to examine the urine for the presence of worms.

Feces are analyzed when opisthorchiasis has already progressed. But it’s better to take juice for testing duodenum. It is there that traces of their life can be found.

Sometimes the sample may not contain helminth eggs. The reasons for this lie in the inappropriately chosen moment for the test. Also, the larvae could have already hatched or are not present in the selected area.

How material is selected for analysis:

1. Intestinal juice. The sample is placed in a centrifuge. Due to the pressure, sediment forms at the bottom of the container. This is what is being studied in detail in search of eggs.
2. Cal. The smear is mixed with glycerin and examined under a coverslip. It is important to estimate the number of eggs. If there are more than 30,000 of them in one gram, then the disease is already in a severe stage.

There are also several ways to evaluate the results obtained. The stage of determining the development of the disease depends on them. So the feces can be mixed with water, after settling, a solution is added to the mixture and placed in a centrifuge. This technique is called flotation.

A blood test for opisthorchiasis cannot be called the most precise method definitions of the disease. But as a component complex diagnostics This option is required to get a more accurate picture.

Feces can be examined using the Fulleborn method. Then you will need to add to the stool saline solution. Particles that have risen to the surface are removed and after 1.5 hours the feces are analyzed under a microscope. The Goryachev method is also known. The feces are diluted with water and mixed with potassium nitrate. Next, the sediment is placed under a microscope and studied in detail.

Features of the blood test

Enzyme immunoassay involves determining the amount of immunoglobulins of groups M and G. They will help to find out approximate time infection.

When testing blood they use different types diagnostics Each study aims to determine different stages development of opisthorchiasis.

When conducting research, the laboratory technician must take into account factors that can determine incorrect results. These include the presence chronic diseases, which the patient had before being infected with helminths. They also pay attention to gender and age.

Examination of a patient for opisthorchiasis begins with drawing up a general clinical picture at an appointment with a specialist. Only a qualified doctor can diagnose the disease. If the symptoms are suitable, then an analysis is performed for opisthorchiasis. The patient's blood, urine and feces are collected. They look for special antibodies in the blood, an increase or decrease in certain indicators. They look for helminth eggs in the feces. The price of the analysis depends on the clinic’s prices.

Infestation occurs through the consumption of fish infected with trematodes. Due to the specialization of the population of Western Siberia mainly in fishing, there is a very high percentage of opisthorchiasis diagnosed there - 85%.

What kind of disease?

The causative agents of opisthorchiasis are fluke helminths:

• Opisthorchis felineus (cat fluke);
• opisthorchis viverrini (viverrid fluke).

The cat (Siberian) fluke is common in Russia; the viverrid fluke is more common in Asian countries such as Vietnam or Thailand.

Humans (or other mammals) are their definitive hosts. In opisthorchisa complex cycle development.

It begins from the moment when helminth eggs, contained in the feces of the definitive hosts, enter water bodies. They can only develop in aquatic environment, die in the soil no later than after 7-10 days.

The initial host of helminths is the freshwater mollusk Cadiella, in its body the larvae develop into cercariae (larvae with a tail) and leave the body of the first intermediate host. The larvae are very tenacious and can survive in river water for about a year.

The next hosts of opisthorchis are fish, representatives of cyprinids. Cercariae enter the fish's body through muscle tissue and develop within 40 days. After this time, the larvae become infectious.

Human invasion occurs when eating contaminated fish that is not sufficiently salted or thermally untreated.

The reproductive system is hermaphroditic, there is a set of both male and female reproductive organs.

Signs of the disease

Liver fluke feeds on epithelial cells, which can cause overgrowth connective tissue. As a result, a blockage of the bile ducts and pancreatic ducts occurs, which provokes the formation of stones in the gallbladder, disrupts the outflow of pancreatic secretions and leads to swelling.

There are acute and chronic stage diseases.

Chronic form clinical picture similar to gastritis, ulcers and other diseases of the gastrointestinal tract (gastrointestinal tract):

• nausea;
• lack of appetite;
• pain in the abdominal area;
• stool disorder;
• inflammatory processes in the liver;
• liver enlargement;
• skin rash;
• violations in respiratory tract: cough, shortness of breath, asthma.

The acute form, in turn, can be mild, severe and moderate.

A mild form of opisthorchiasis begins 1.5-2 weeks after invasion, it is accompanied by an elevated (up to 38°C) temperature that persists for 2 weeks, as well as:

• chills;
• weakness;
• pain in the abdominal cavity;
• bowel disorder.

2 weeks after started off easy forms, the disease worsens and enters a moderate phase. It is characterized by an increase in temperature (up to 39°C) followed by persistence (for 2-3 weeks), and:

• fever;
• arthralgia;
• rash;
• vomiting;
• diarrhea;
• enlarged liver.

Eosinophilia increases to 50-60%.

Severe form acute stage the disease may have signs various diseases with various symptoms.

The respiratory variant occurs in 30% of infected people.

The following are diagnosed as complications of opisthorchiasis:

• stone formation;
• enlargement of the spleen, liver, pancreas;
• cirrhosis of the liver;
• hepatitis;
• liver abscess;
• pancreas cancer.

Children exhibit the same symptoms as adults, but they may also experience pronounced allergies and cyanosis of the extremities.

Diagnostics

Making a diagnosis of opisthorchiasis is significantly difficult due to the lack specific symptoms. All obvious and hidden manifestations of the disease are characteristic of many diseases. In view of this, it is necessary to be specifically tested for opisthorchiasis.

Instrumental types of research include:

• X-ray;
• CT and MRI (computed tomography and magnetic resonance imaging);
• FGDS (esophagogastroduodenoscopy).

Before prescribing these studies, in most cases, the specialist first conducts an anamnesis and a manual examination. This will help determine whether the patient lives in the area of ​​the outbreak of opisthorchis infection or eats raw fish.

The inspection will also reveal skin rashes or cracks in the tongue, which, according to Paltsev’s method, are the initial signs of invasion by liver flukes.

A targeted blood test for opisthorchiasis is called ELISA.

Analyzes

If opisthorchiasis is suspected, an analysis for immunoglobulins M and G is prescribed.

Immunoglobulin M illustrates the presence of infection and the course of the inflammatory process in the body.

The presence of immunoglobulin G indicates a prolonged course of the disease, possibly a chronic form.

Appears after 4-5 weeks and confirms liver disease or inflammatory process in organism.

Often, with liver diseases that arise for other reasons, an immunoglobulin test may be false positive. In this case, it is necessary to repeat the study after 1-1.5 months. ELISA is an indirect method for diagnosing the disease.

Blood is drawn from a vein on an empty stomach. The results are ready within a few days. Based on the presence and quantity of antibodies, it can be concluded whether an invasion is taking place.

If antibodies are present in the blood in an acceptable amount (titer 1/200-1/400), this means that the person has previously suffered from opisthorchiasis and has developed a certain amount of antibodies to this disease (immunity). If the titer is 1/100, the person has not been sick before and is not currently sick, a titer of 1/600 indicates acute course diseases. About how to submit this analysis Your doctor should tell you in detail.

A blood test for opisthorchiasis and its interpretation can give unclear picture diseases.

In this case, the doctor will prescribe additional tests:

• stool examination;
• duodenal sounding.

For getting reliable result, coproscopy should be performed 3 times within 3 consecutive days. It is advisable to collect biomaterial in the morning; it is not recommended to use laxatives or enemas, as this may blur the result.

For opisthorchiasis, stool tests are a 100% diagnostic method. The diagnosis is confirmed if detected in stool helminth eggs.

Before taking the tests, you must stop taking medications for several days, do not consume spicy, smoked, fried food, carbonated drinks, legumes. You should also abstain from alcohol and smoking.

Treatment of trematode infestation is carried out in several stages. First of all, the inflammatory process is removed and neutralized allergic reactions, then an appointment is made anthelmintic drugs(Biltricide, Praziquantel) and sorbents (Polysorb, activated carbon).

Food eaten must be thoroughly washed; fish and meat must be deep frozen or processed. high temperatures to avoid invasion various types microorganisms!