Symptoms and treatment of chronic opisthorchiasis in humans. Why does chronic opisthorchiasis develop?

Residents of the CIS countries who live in the basins of the Irtysh, Ob, Dnieper, Northern Dvina, Biryusa, Don, Ural, Volga, and Kama rivers can become infected with Opisthorchis felineus worms. The maximum number of patients is registered among people living on the banks of the Irtysh and Ob.

Opisthorchis viverrini infects populations in Southwest Asia. Very rarely the disease can be found in countries North America and Western Europe.

The largest number of victims are residents of Russia. Almost 80% of the population suffers from this type of helminthiasis. On the territory of Ukraine and Kazakhstan, invasion is registered in 7-10%. In Belarus - about 5%.

Development of opisthorchid worms

The life cycle of opisthorchis is special in that it requires a change of hosts, within which certain phases of helminth development take place. In shellfish and fish, the worm develops to an invasive state, which means that it is capable of infecting humans.

Is it possible to recover from chronic opisthorchiasis?

No matter what stage of the disease a person is at, he can be cured. The advanced condition is characterized by numerous complications, so therapy can be lengthy. Chronic opisthorchiasis causes a variety of symptoms, which require the use of several drugs at the same time to combat them. These are antihistamines that relieve an allergic reaction, as well as choleretic drugs and hepatoprotectors that will restore the normal functioning of the digestive organs.

What could be the consequences of the disease?

At the first manifestations of the disease, it is necessary to seek qualified advice. medical care, this will help avoid the development of complications.

Chronic opisthorchiasis in pregnant women and children

In children, chronic opisthorchiasis has the same symptoms as in adults. However, there are some differences:

• young patients are more likely to develop severe allergies, which can develop into asthma;
• Permanent peripheral cyanosis develops, which is characterized by blue discoloration of the extremities.

Lack of nutrients causes dull skin, hair and nails become brittle. For children, in case of illness in early age and long-term course of the disease, a lag in physical development is characteristic.

Signs and symptoms of chronic opisthorchiasis

• a constant feeling of fatigue, which is accompanied by “unreasonable” headaches,
• dizziness, VSD, tachycardia;
• allergic rashes of unknown etiology;
• frequent colds, hyperthermia, cough;
• pain in the hypochondrium, often the right;
• increased sweating;
• disturbed sleep;
• tremor of hands, eyelids, tongue;
• enlarged lymph nodes;
• poor condition of skin, hair, nails.

Symptoms of chronic opisthorchiasis often resemble typical manifestations, which are characteristic of pathologies of the pancreas, liver and intestines. The invasion significantly affects the central nervous system, as a result of which the person suffers chronic fatigue, irritability with headaches and poor sleep.

External signs and laboratory diagnosis of the disease

Examination by a specialist

Determine opisthorchiasis by external signs impossible. However, with acute opisthorchiasis, the patient looks like he has a cold, he is worried about:

• low-grade fever;
• runny nose;
• cough.

Allergic rashes, abdominal pain and enlarged lymph nodes may also occur.

In chronic opisthorchiasis, there may be various diseases internal organs: pancreatitis, gastritis, stomach ulcers, liver tumors and others. The patient looks tired. Complaints of fluctuations in body temperature, skin rash, abdominal pain, weight loss. So, the patient is worried about:

• yellowish skin color;
• swollen eyelids, sometimes with small rash on them;
• cracks in the tongue;
• enlarged liver;
• allergies;
• stomach ache.

Analysis for opisthorchiasis

To identify opisthorchiasis, the following is carried out:

• General blood test - shows high content eosinophils (indicates an allergic reaction) and leukocytes (indicates reduced immunity).
• Blood chemistry. Direct and indirect bilirubin, liver transaminases, sublimate and thymol tests are increased. This means that the internal organs are affected.

IN in rare cases do the patient duodenal intubation to collect bile for analysis, however, this diagnostic method, in in this case, is ineffective.

Blood for opisthorchiasis

• In acute opisthorchiasis, you can notice IgM antibodies - this is a protein that is produced by the immune system when foreign bodies enter the body. During the chronic phase, their levels first decrease and then disappear. In chronic opisthorchiasis, IgG is increased - this is a protein that means the response immune system.
• Since this diagnostic method often gives false-positive and false-negative results, it is necessary to repeat the analysis after a month, if IgM is detected, and IgG - immediately.

Treatment regimen

Opisthorchiasis is a disease that causes various complications, therefore it is necessary to get rid of not only the cause (helminths), but also to restore the normal functioning of the body. This can be done both on an outpatient basis (at home) and in a hospital (in the somatic department). Inpatient treatment is prescribed for those who experience complications due to significant damage to internal organs.

During the acute phase, the following treatment regimen is followed:

1. Provide good drainage of the bile ducts.
2. Fight allergic manifestations.
3. Improves liver function.
4. Take anthelmintic drugs.

Treatment should be supplemented with drugs that enhance immunity.

The prognosis is favorable. However, a person can be registered with a dispensary for up to six months.

Diet

Immediately after identifying the disease, it is advisable for the patient to adhere to a diet that helps normalize the functioning of the liver and pancreas.

Conclusion

During the acute phase, a person complains of symptoms of ARVI, rashes, abdominal pain, and during the chronic phase, a person experiences weakness and may not even be aware of various pathological changes in his internal organs. To identify opisthorchiasis, it is necessary to take a blood test or undergo duodenal intubation. Invasion can be cured at all stages, but it must be taken into account that it may take a lot of time to restore the functioning of internal organs.

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General information

Causes of opisthorchiasis

Opisthorchiasis is caused by two types of fluke helminths: Opisthorchis felineus and Opisthorchis viverrini. The pathogen O. felineus, the Siberian or cat fluke, is widespread in Russia. This is a flat helminth 4–20 mm long, 1–4 mm wide, having a lanceolate body equipped with oral and ventral suckers. Opisthorchiasis caused by O. viverrini occurs in Southeast Asia.

The development of opisthorchis occurs with a three-fold change of hosts: the first intermediate host is mollusks, the second intermediate is freshwater fish of the carp family (bream, carp, tench, dace, ide, roach, etc.) and the final is mammals (cat, dog, fox, otter, arctic fox, sable, human) feeding on fish. The definitive hosts release eggs with larvae into the external environment along with feces. Once in a body of water, the eggs are swallowed by freshwater mollusks of the genus Codiella, whose bodies undergo changes: first, a miracidium emerges from the egg, which successively turns into a sporocyst, redia and cercaria. The tailed larva (cercaria) emerges from the body of the mollusk and in a reservoir attaches to the body of carp fish, penetrates into the connective and muscle tissue, where it encystes, turning into a metacercaria. While in the body of the fish, after 6 weeks the larvae become invasive, i.e., they acquire the ability to cause opisthorchiasis in the definitive hosts.

Pathogenesis of opisthorchiasis

The nature and severity of pathological processes characterizing the course of opisthorchiasis depend on the massiveness and duration of the invasion and the state of the immune system. Depending on these factors, the course of opisthorchiasis can be subtle or manifest; light, medium and heavy. The pathogenesis of opisthorchiasis is divided into early (acute) and late (chronic) stages.

The acute phase of opisthorchiasis manifests itself 2-4 weeks after infection. Light form helminthiasis begins with a sudden jump in body temperature to 38°C and the subsequent persistence of low-grade fever for 1-2 weeks. At this time, patients experience weakness, abdominal pain, and note unstable stools. IN peripheral blood at mild flow opisthorchiasis reveals moderate leukocytosis and eosinophilia up to 15 - 20%.

The moderate form of opisthorchiasis occurs with fever (up to 39°C and above), which lasts about 3 weeks. Characteristic are myalgia and arthralgia, urticarial skin rashes, catarrh of the upper respiratory tract, enlarged liver and spleen, vomiting, diarrhea, asthmatic bronchitis. Leukocytosis and eosinophilia increase up to 25 - 60%, ESR increases.

Severe forms of acute opisthorchiasis develop in 10 - 20% of patients and can occur in typhus-like, gastroenterocolitic, hepatocholangitic and respiratory variants. Symptoms of the typhus-like variant of opisthorchiasis include high fever, chills, lymphadenitis, polymorphic skin rash, dyspepsia. The clinic is dominated by the phenomena of intoxication and allergization; Possible toxic-allergic damage to the central nervous system or myocardium. With the gastroenterocolitic form of opisthorchiasis, a clinical and pathomorphological picture of gastritis (catarrhal, erosive), gastroduodenitis, gastric and duodenal ulcers, and enterocolitis develops. These conditions are accompanied by loss of appetite, nausea, pain in the epigastrium and right hypochondrium, and diarrhea. During the hepatocholangitis variant of acute opisthorchiasis, jaundice, hepatosplenomegaly, and abdominal syndrome such as hepatic colic or shingles prevail. Pathological syndromes may include hepatitis, cholangitis, cholecystitis, pancreatitis. When the respiratory organs are involved (respiratory variant of opisthorchiasis), tracheitis, asthmatic bronchitis, pneumonia, pleurisy, and fever develop.

Chronic opisthorchiasis most often occurs as dyskinesia biliary tract, cholangiohepatitis, cholangiocholecystitis, cholelithiasis, chronic pancreatitis, gastritis, duodenitis. There are signs of asthenovegetative syndrome: weakness, fatigue, irritability, emotional instability, headache, sleep disturbance, increased sweating. May develop dystrophic changes myocardium, manifested by chest pain, tachycardia, arterial hypotension. A long course of chronic opisthorchiasis can be complicated by cirrhosis of the liver, purulent cholangitis, phlegmon of the gallbladder, bile peritonitis, primary cancer of the liver and pancreas.

Diagnosis of opisthorchiasis

When diagnosing opisthorchiasis, epidemiological information is taken into account, indicating the patient’s presence in endemic foci, consumption of fresh frozen, lightly salted, insufficiently heat-treated fish. Characteristic changes in biochemical tests of the liver and pancreatic enzymes are increased bilirubin, transaminases, amylase and lipase. Data instrumental studies(FGDS, ultrasound of the hepatoduodenal zone and pancreas, cholecystography, CT, MRI of the liver and biliary tract) detect signs of gastroduodenitis, biliary dyskinesia, cholecystitis, cholangitis, hepatitis, pancreatitis.

Treatment of opisthorchiasis is carried out in stages. At the first stage, preparatory therapy is prescribed, including choleretic and antispasmodics, H1-histamine receptor blockers; according to indications - short courses of antibiotics. Except drug therapy, physiotherapeutic treatment is carried out (electrophoresis of magnesium sulfate, magnetotherapy, microwave therapy). The purpose of the preparatory stage is to normalize bile secretion and outflow of bile, stopping the inflammatory process in the gastrointestinal tract and biliary tract.

Forecast and prevention of opisthorchiasis

With mild and moderate forms of opisthorchiasis, the prognosis is usually favorable, although cases of repeated helminth infestation are possible. Whenever purulent cholecystitis

Chronic opisthorchiasis is a serious disease that can lead to very serious consequences. Therefore, timely diagnosis, and therefore timely treatment, play a very important role in maintaining health. Chronic opisthorchiasis is a helminthiasis that primarily affects the hepatobiliary system and pancreas, characterized by a long course, occurring with frequent exacerbations, contributing to the occurrence of primary cancer of the liver and pancreas.

In the treatment of chronic opisthorchiasis it is very important A complex approach. Therapy for chronic opisthorchiasis is carried out in stages and includes three main stages.

Even after a course of deworming in chronic opisthorchiasis, irreversible changes may remain in the form chronic hepatitis, cholangitis, cholecystitis, gastritis, imbalance in the immune system.

The causative agent of the disease is the Siberian (cat) fluke - opisthorchis, the symptoms of infection of which are not difficult to recognize.

What is opisthorchiasis

Sometimes it happens that a patient is treated for years by an allergist, gastroenterologist, oncologist and other specialists, without any chance of recovery due to undetected helminths.

After a few weeks, the larva inside the mollusk turns into a miracidium (the first stage of development), and then, as it grows, it transforms into a redia and caudate cecaria.

The main route of infection with helminths is the consumption of infected fish of the carp family. It is worth understanding that metacercariae can be present in almost any freshwater fish, therefore it is prohibited to consume fish without proper heat treatment.

Doctors define several types of invasion:

1. Including lightly salted, smoked and dried fish in the diet.
2. Eating fish that are not cooked or cooked enough.
3. The source of infection may be an animal that has eaten contaminated fish.
4. Living in regions with a high epidemiological risk for invasion.

The main sources of infection are carp fish: crucian carp, roach, rudd, bream, etc. You can also get infected from others predatory fish who had eaten contaminated fish the day before. These include, for example, pike perch and pike.

Diagnosing the disease is quite difficult, since the incubation period for the development of opisthorchis is about two months.

Clinical picture of invasion

This type of invasion is insidious, as it may have vague symptoms, depending on the presence of existing diseases and the resistance of the immune system. Opisthorchiasis can manifest itself as classic dysbacteriosis, colds, pancreatitis or cholecystitis. Any clinical manifestations may be confused with other ailments, especially in acute cases.

During the incubation period of 7-40 days, an infected person may experience the following symptoms:

1. Muscle pain, headaches, increased fatigue, restless sleep, slight increase in body. These symptoms are most often mistaken for a cold and are treated with conventional antiviral drugs.
2. 2 weeks after infection the patient notes painful sensations in the stomach and right side. Symptoms are similar to cholecystitis and gastroduodenitis.
3. After a month the patient, if available listed symptoms, should go for examination, since worm eggs may appear in the stool and duodenal fluid.

Suspect helminthic infestation It is possible if symptoms characteristic of other ailments do not go away even with proper drug treatment.

Acute stage of opisthorchiasis

Opisthorchiasis often manifests itself as weakness, fatigue, night sweats and low-grade fever. This form is called mild, and is observed in 20% of infected people. Medium severity manifests itself in 60%, and is accompanied by body temperature up to 40 degrees, diarrhea, nausea, and allergic manifestations.

In most cases, patients with mild to moderate disease experience relief after 2 weeks, indicating transition to chronic stage.

The severe acute stage is noted by 20% of patients, which manifests itself in several ways:

• Typhoid-like form: myalgia, coughing, heat, severe weakness body and loss of strength, intoxication.
• Hepatocholangitic form: fever, hepatic colic, yellowing of the complexion, painful abdomen, loose stool. A blood test shows elevated bilirubin and protein.

• Gastroenterocolitic form: loss of appetite, stool disturbance, pain in the right hypochondrium, nausea, fever, intoxication of the body.
• Respiratory tract damage: pneumonia, bronchial asthma, pleurisy. Patients complain of irritability, fever, weakness, and insomnia.

As a rule, the acute phase lasts 2-3 weeks, fever and body weakness can last up to 2 months.

Chronic stage of opisthorchiasis

Patients are interested in what symptoms of opisthorchiasis can be observed if the disease has progressed to chronic form? Often the chronic phase has symptoms that can be confused with gastrointestinal and liver diseases. The disease can be diagnosed by the following characteristic signs:

• intense pain in the right hypochondrium;
• chest pain;
• gallbladder infections;
• nausea when eating fatty foods;
• intestinal dysfunction: flatulence, loose stools.

During exacerbations chronic course patients with opisthorchiasis report the following symptoms:

• depression, neuroses, irritability;
• headaches and dizziness;
• fatigue, loss of strength, decreased performance;
• night sweats, tremors of the limbs and eyelids;
• skin allergies such as urticaria, itching, swelling, dermatitis.

Opisthorchiasis is dangerous because it can aggravate the course of existing diseases and contribute to the development of new ones. Most often in patients with advanced stage invasion, gastritis, cholecystitis, pancreatitis, gastroduodenitis are diagnosed.

If opisthorchiasis is not detected and treated at these stages, then irreversible processes in the body may occur, leading to death.

How to recognize pathology in women

The female body reacts sensitively to any disturbances in the functioning of important organs. With opisthorchiasis infestation, women may notice disturbances menstrual cycle, which becomes irregular, with changes in the intensity of discharge.

Infection contributes to the manifestation of severe pain during menstruation, which is not eliminated by the usual antispasmodics.

Opisthorchis causes the greatest harm to pregnant women who suffer from severe toxicosis that accompanies the entire pregnancy.

Such pathological abnormalities can also be dangerous for the baby, who will experience a lack of nutrients and oxygen. In addition, opisthorchiasis causes lactation disorders, as women often note the absence or lack of milk.

Symptoms of opisthorchiasis in women generally have a common clinical picture, with individual characteristics:

1. Excessive hair loss and disruption of hair structure.
2. The condition of the skin worsens, acne, swelling of the face.
3. The patient suffers from increased blood pressure and pain in the heart.
4. Enlarged lymph nodes.
5. Attacks of suffocation and hot flashes.

The consequences of opisthorchiasis for men and women are almost the same, so at the first signs of the disease you should consult a doctor.

How to recognize the disease in men

According to statistics, men are more susceptible to infection with opisthorchiasis, and often have a sluggish acute form, smoothly turning into chronic.

During an exacerbation, the patient may experience paroxysmal pain in the right quadrant of the abdomen, enlargement of the liver and spleen, flatulence, diarrhea, persistent fever, uneven pulse, and periodic increases in body temperature.

When infected with opisthorchiasis, men may experience respiratory failure, which is accompanied by a severe bronchial cough, shortness of breath, chest pain, and the development of pneumonia.

Symptoms of opisthorchiasis in men are also manifested by a decrease in sexual activity and the development of prostatitis against the background of primary diseases.

Patients facing similar symptoms must understand that opisthorchiasis can develop over three decades with latent exacerbations that are mistaken for simple ailments.

Giardia cholecystitis: treatment of infectious infection in an adult

Their active development inside the gallbladder causes serious inflammation mucous membrane of the organ and can lead to its complete failure.

But this is not the only danger of this disease. With giardia cholecystitis, severe damage to the liver and pancreas is often observed, which disrupts the normal functioning of the entire digestive system sick.

Causes

1. When drinking poorly purified drinking water;
2. Along with dirty or poorly washed fruits and vegetables;
3. Through insects (flies, cockroaches) and rodents (rats, mice);
4. Due to non-compliance with hygiene standards ( bad washing hands, dishes, etc.);
5. From a sick person.

The course of this disease is complicated by the fact that during the inflammatory process in the gallbladder, favorable conditions for the development of pathogenic microflora.

This further worsens bile stagnation and aggravates organ damage.

Symptoms

Giardia cholecystitis is a disease that develops rather slowly. At the beginning of the disease, it is practically asymptomatic, the patient does not feel severe pain, and inflammation of the organ remains insignificant. During this period, exacerbations of lamblia cholecystitis pass without a significant deterioration in well-being and rarely cause an increase in temperature.

In some patients, this latent form of lamblia cholecystitis persists for quite a long time. a long period. However, in most cases, over time, a person infected with Giardia begins to experience symptoms characteristic of this disease, namely:

• Pressing, mild pain in the right hypochondrium;
• Feeling of heaviness or fullness in the abdomen;
• Bitter taste in the mouth;
• Belching of air or bile;
• Decreased appetite;
• Abnormal stool, frequent diarrhea;
• Constant nausea, urge to vomit;
• Loss of strength, weakness throughout the body;
• Low blood pressure;
• Abdominal cramps in the area of ​​the gallbladder;
• On palpation in the area of ​​the right hypochondrium, pain and slight enlargement of the liver may be felt.

Frequent exacerbations of the disease. With giardia cholecystitis, exacerbation occurs for no apparent reason.

Damage to the liver and pancreas. With time inflammatory process from the gallbladder spreads to neighboring organs, most often affecting the tissue of the liver and pancreas. This can lead to the development of hepatitis and even cirrhosis of the liver.

The appearance of anemia. Disturbances in the functioning of the digestive system do not allow the body to absorb all necessary nutrients. Against this background, the patient often develops anemia.

With giardia cholecystitis, the level of these particles in the blood is unusually high.

Diagnostics

Few severe symptoms diseases prevent its timely detection. Therefore, it is very important for the patient to diagnose the disease in time. Diagnosis of giardia cholecystitis is carried out by duodenal intubation. It is performed by a gastroenterologist.

To do this, a rubber probe is inserted into the patient through oral cavity and esophagus in duodenum. From there, a bile sample is taken, which is subsequently sent for laboratory testing. This procedure quite complicated for both the patient and the doctor. It usually takes quite a long time, about 1.5 hours. During a laboratory test in a person infected with an infection, Giardia is detected in a bile sample.

Other signs indicating the presence chronic inflammation in the gallbladder are the presence of a large amount of mucus and leukocytes in the bile sample.

Treatment

If the patient has been diagnosed with giardia cholecystitis, he is sent for inpatient treatment to the hospital. This is necessary not only to quickly cure the patient, but also to prevent further dissemination infections.

At the same time, all household items with which the patient came into contact, his bed and personal belongings are subject to mandatory disinfection.

Treatment for giardiasis cholecystitis is carried out using drug therapy and special therapeutic diet. Another group of medications helps normalize the functioning of the gallbladder and eliminate all the consequences of the disease.

A therapeutic diet is necessary to improve the functioning of the digestive system and general maintenance of the body.

Drugs

For complete cure for illness, after a week's break it is recommended to repeat the course of treatment antibacterial drugs. At severe course The disease may require three courses of treatment.

For achievement best result It is possible to change the drug with each new course.

Treatment of hypoglycemic cholecystitis must necessarily include choleretic medicines, which help relieve inflammation in the vein bladder and eliminate bile stagnation.

• Various cereals;
• Pasta;
• Bread and other baked goods;
• Any sweets.

Also, treatment of giardia cholecystitis involves avoiding the consumption of protein products, as they place a large burden on the gallbladder, namely: Milk and fatty dairy products; Sausages, sausages; Smoked meats; Non-dietary meats.

For this disease, it is useful to eat not heavy products, rich in vitamins and microelements, the diet for giardiasis is as follows:

• Juices, fruit drinks;
• Baked apples and pears;
• Dried fruits;
• Sour berries – cranberries, lingonberries;
• Rose hip decoction;
• Dairy products;
• Vegetables;
• Vegetable oils;
• Buckwheat porridge cooked in water.

In the future, to avoid reinfection, it is very important to adhere to everyone sanitary standards, namely, don’t drink raw water, wash vegetables and fruits thoroughly, do not touch with dirty hands to your face, do not use someone else’s dishes and towels.

Fascioliasis is the scourge of modern man: from detection to treatment

Most often, foci of pathology occur in South America, countries of Central Asia, in the Transcaucasus. The cause of the disease is helminths of the genus Fasciola.

Description of the pathogen

Fascioliasis is caused by two types tape flukes(trematodes):

1. Fasciola hepatica.
2. Fasciola gigantica.

In order for the development cycle of larval forms of trematodes to continue, the eggs must be in favorable environment. Typically this environment is warm water coastal waters. In it, the eggs transform into their first larval form, which is called miracidium. This organism is already capable of moving independently in water with the help of cilia covering its body. The first intermediate carriers are mollusks. Once in their body, miracidium becomes next stage- sporacist. While inside the mollusk, the sporacist goes through two more stages of development: redia and cercaria. After transformation into a cercaria, trematode larvae leave the body of their first intermediate host. Having attached themselves to the leaves of underwater vegetation, the cercariae wait for the second intermediate carrier, which will swallow them along with the plankton. In his body, the larvae move into their next stage - metacercaria.

The life cycle is clearly demonstrated in a short video:

Symptoms of the disease

Symptoms of this pathology are divided into two groups:

1. Intoxication syndrome.
2. Allergic manifestations.

• Headache.
• Poor appetite.
• Nausea.
• Weakness.
• Drowsiness.
• Abdominal pain, ascites.
• Skin itching, urticaria.
• Temperature increase.

Allergic reactions are associated with the destruction of the helminth's body after its death, with the release of decay products into human body. This is expressed in the form of a spontaneously appearing skin rash, which is very difficult to treat.

The incubation period of the disease ranges from 1 to 8 weeks. After that everything acute manifestations gradually acquire an erased character, and the disease passes into chronic phase, which is characterized by symptoms of gastroudenitis, obstructive jaundice, dyspeptic disorders, impaired liver function, and the development of secondary infections.

Pathogenesis

The pathogenesis of fascioliasis has many signs that are also characteristic of other trematoses. The movement of fasciolae larvae throughout the host body during their maturation determines the nature of the course. early stage infestations.

Forecast

The prognosis of the disease is favorable. With appropriate treatment, there is full recovery patient, without any serious consequences for his health.

Lethal outcomes with fasciliosis are rarely recorded, and in most cases are the result of complications with the development of secondary infectious processes.

Complications

The main complications of fascioliasis are:

• obstructive jaundice;
• purulent angiocholongitis;
• sclerosing cholangitis;
• liver abscess.

In isolated cases, cirrhosis may develop.

Diagnostics

Diagnosis of fascioliasis includes analysis of pathological history data with a comparison of clinical symptoms. The following factors are taken into account:

• The presence of foci of infection in a specific area.
• Eating poorly processed foods.
• The patient has a fever.
• Availability pain in the right hypochondrium.
• Increased leukocytosis.
• Eosinophilia.
• Allergic reactions.

Methods laboratory research for fascioliasis include:

1. Serological blood tests (RIF, ELISA).
2. Examination of stool for the presence of helminth eggs.
3. Ultrasound examination of the liver.

It is necessary to differentiate the symptoms of fascioliasis from similar manifestations of other pathologies. These include:

• viral hepatitis;
• pancreatitis;
• opisthorchiasis;
• leukemia;
• trichinosis;
• cholecystitis;
• clonorchiasis;
• cholangitis.

The cost of analysis to find the causative agent of fascioliasis is about 880 rubles.

Treatment

At acute stage illness, you should follow a diet (table No. 5). It is necessary to exclude from the diet all foods that create additional stress on the liver. This primarily applies to fatty, fried and spicy foods.

More information about the diet and additions to it:

During this period of the disease, antihistamines (Zodak, Cetrin) are indicated.

Drugs

After elimination acute symptoms manifestations of the disease, anthelmintic therapy for fascioliasis is prescribed. Triclabendazole is recommended as the main drug at a dosage of 10 mg/1 kg of body weight at a time. In severe cases of pathology development daily dose the drug is increased to 20 mg. In this case, the medicine is taken in two doses, with an interval of 12 hours.

Therapy is used until helminth eggs completely disappear from the duodenal contents. Control studies are carried out 3 and 6 months later, respectively, after completion of the course of therapeutic procedures.

Prevention and precautions

The main measure to prevent infection with fascioliasis is compliance with the rules of personal hygiene and food hygiene.

You cannot drink water taken from open reservoirs without boiling it first. Meat and fish must undergo thorough heat treatment before consumption. Greens, fruits and vegetables must be thoroughly washed in soda solutions.

Epidemiology

Human infection is especially common in regions with a large number of large and small livestock.

The main foci of infection are developing countries. Pathology occurs only in those areas where there are suitable conditions for the life of intermediate carriers. Unfortunately, medical forecasts in this area are disappointing.

Year after year, the problem of fascioliasis becomes more acute. Cases of the disease are increasingly being recorded in countries in Africa, Asia, Oceania, America and Europe. In more than fifty countries located around the world, there is an increase in human disease with this pathology. There is no doubt that in the coming decades the fight against fascioliasis will become one of the priorities of global health.

To consolidate the information, we offer two short lectures about fascioliasis:

• Giardiasis of the liver;
• Cycle and stages of development of the liver fluke.

The population living in the basins of large rivers (Ural, Volga, Irtysh and others) is often diagnosed with a special type of helminthiasis - opisthorchiasis. However, you can become the owner of a helminth on a trip to Thailand, Ukraine, or Kazakhstan. This is due to the fact that the source of infection is in freshwater fish.

The damaging effects of fluke worms on the human body:

Opisthorchiasis produces polymorphic symptoms; detection of the helminth often occurs already at the chronic stage of the disease. Without appropriate therapy, flatworms live in humans for up to 25 years. Even effective treatment of opisthorchiasis does not completely eliminate the damage done to the body.

Mass infection is recorded among carp fish: roach, bream, rudd, minnow, verkhovka, gudgeon, sabrefish, ide, white-eye and others.

However, cases of infection with opisthorchiasis from pike, ruffe, burbot, perch and other predatory fish that share the same habitat with the cyprinid family have been recorded.

It is absolutely impossible to become infected with opisthorchiasis by swimming in a body of water contaminated with opisthorchiasis larvae. Having penetrated the skin, the larvae quickly die and can only cause itching and a short-term rise in temperature.

opisthorchiasis photo

• Mild course - lasts 1-2 weeks, the patient complains of elevated temperature up to 38ºС, weakness, fatigue, headache.
• Moderate course - the infected person develops an itchy urticarial rash similar to urticaria (toxic effect on vascular bed), muscle and joint pain, vomiting, diarrhea, temperature up to 39ºС. Appetite decreases, weight loss is possible. Symptoms last 2-3 weeks.
• Severe course - against the background of extremely serious condition due to severe intoxication, the patient experiences retardation or psychomotor agitation, signs of damage to certain parts of the gastrointestinal tract, and insomnia. The development of acute epidermal necrosis (Lyell's syndrome), acute myocarditis, Steven-Johnson syndrome, and Quincke's edema is possible.

Forms of acute opisthorchiasis:

• Hepatocholangitis - associated with extensive damage to the gallbladder and liver. The patient complains of spastic pain localized in the right hypochondrium and simulating hepatic colic. Signs of bile stagnation are recorded: yellowness of the skin and sclera.
• Pancreatic-like - signs of pancreatitis often accompany the lesion bile ducts. Girdle pain, flatulence, and dyspepsia occur.
• Gastroenterocolitic - the symptoms of opisthorchiasis are dominated by signs of inflammatory and ulcerative lesions of the duodenum and, often, the stomach. In this case, intoxication is most often mild.
• Typhoid-like - skin rashes, hyperthermia come to the fore in the symptomatic picture, and sometimes a cough appears.

In residents of regions of Western Siberia that are unfavorable in terms of the epidemiology of opisthorchiasis, the disease often occurs in a latent form, without producing clear symptoms.

symptoms in an adult

Gradually, the pronounced symptoms of opisthorchiasis subside, and the disease enters the chronic stage: against the backdrop of normalization of temperature, symptoms of bile duct dyskinesia, cholecystitis, hepatitis, and pancreatitis periodically appear.

Often patients are diagnosed with gastroduodenitis or stomach ulcers. And only data from laboratory and instrumental studies make it possible to identify.

Chronic opisthorchiasis is also characterized by toxic damage to other organs:

• central nervous system- constant headaches, eyelid twitching, hand tremors, irritability and depression;
• heart - heart pain, arrhythmia, signs of myocardial dystrophy appear on the ECG;
• adrenal exhaustion - astheno-vegetative syndrome.

Lack of treatment is fraught with the development of cirrhosis or liver cancer, pancreatic cancer, and peritonitis.

Tests and diagnosis of opisthorchiasis

Making a diagnosis of opisthorchiasis early stage development of the disease is quite difficult: helminth eggs in stool and bile are detected after 4-6 weeks. after infection. Diagnostic methods, revealing the presence of flatworms in the body:

• Blood test with determination leukocyte formula- eosinophilosis (indicates the presence of any helminths and the development of sensitization to foreign protein);
• - increase in liver enzymes (ALT, AST), changes in protein parameters;
• Feces for worm eggs - carried out repeatedly (eggs are released sporadically), up to 100 eggs per 1 g - mild degree, over 30 thousand - massive invasion;
• Immunological analysis - blood for opisthorchiasis reveals antibodies to the opisthorchiasis protein;
• - detection of helminth DNA in feces;
• Instrumental studies confirming opisthorchiasis;
• Ultrasound abdominal cavity, CT, MRI - detection of damage to the liver and biliary tract;
• Duodenal intubation - detection of opisthorchis eggs in the collected bile;
• Retrograde pancreatic cholangiography and percutaneous cholangiography - endoscopic techniques can identify clusters of helminths.

Treatment of opisthorchiasis in adults, drugs

Preparatory Course

With the beginning of treatment for opisthorchiasis, the symptoms are eliminated first, as are the developing pathological processes:

• Ensuring the outflow of bile - choleretic agents (Cholenzim, Holosas, Tsikvalon, Galstena), traditional antispasmodics (No-shpa, Buscopan, the best - Duspatalin), cholespasmolytics (Platifillin, Atropine);
• Restoration of digestion - enzymes (Mezim forte, Pancreatin, Creon), prokinetics (Motilium, Motilak);
• Elimination of cholestasis - Heptral, Ursofalk, Urososan;
• Elimination of sensitization - antiallergic drugs (Tavegil, Suprastin), for severe allergic manifestations Corticosteroids (Dexamethasone) are appropriate;
• Detoxification of the body - sorbents (activated carbon, Prolisorb, Enterosgel, Laktofiltrum), hepatoprotectors (Karsil), infusion therapy;
• Leveling inflammatory phenomena- antibiotics (Amoxicillin, Ampicillin), Metronidazole, course - no more than 10-14 days.

Well drug preparation takes 10-20 days.

Deworming

The destruction of flatworms is carried out by taking a course of toxic anthelminthic drugs: Albendazole, Chloxyl, Praziquantel (the best). The treatment regimen for opisthorchiasis in adults - the dosage of medications, the frequency of administration per day, and the duration of the course - is determined individually.

Antihelminthic chemotherapy drugs are prescribed with caution to elderly people and patients with severe damage to the heart, kidneys and liver. These medications are contraindicated in pregnant women (1st trimester), nursing mothers and children under 4 years of age.

Against the background of deworming, pain occurs in the right hypochondrium, headache, nausea, increased weakness and dyspepsia. Sometimes in the first 2-3 weeks of taking anthelmintic drugs, there is a deterioration in liver tests, and a skin rash may appear.

On the 2nd day of deworming, blind duodenal intubation with xylitol or mineral water to remove worm decay products into the intestines. Increasing the outflow of bile is achieved by using electrical stimulation and a pulsed magnetic field.

The use of home remedies (popular - garlic with celandine) at the stage of deworming and replacement of anthelmintic drugs prescribed by a doctor are unacceptable!

Rehabilitation stage

Drug therapy restores the normal functioning of damaged parts of the gastrointestinal tract. Antispasmodics, hepatoprotectors, and choleretic drugs are used for 3-4 months.

It is at this stage that it is permissible to treat opisthorchiasis with folk remedies: decoctions of St. John's wort, plantain, calendula, elecampane.

• Successful cure for opisthorchiasis is confirmed by negative studies of stool and duodenal contents 1, 3 and 6 months after completion treatment course. In each of the specified periods, the study is carried out three times.

Prevention of opisthorchiasis

To avoid infection with opisthorchiasis, the following recommendations for the preparation and consumption of freshwater fish should be strictly followed:

• It is strictly forbidden to eat poorly processed fish, and, moreover, to try raw product to taste.
• Avoid lightly salted freshwater fish and stroganina.
• Thoroughly wash utensils (cutting board, knife) that come into contact with raw fish.
• Effective freezing: -28ºС - 32 hours, -35ºС - 14 hours, -40ºС - 7 hours.
• Cooking fish: in pieces - 20 minutes, semi-finished fish products (dumplings) - 5 minutes. From the beginning of boiling.
• Frying: whole small fish - 15-20 minutes, large pieces and minced fish cutlets - 20 minutes, fish pies - in the oven for 1 hour.
• Salting in strong saline solution: large - 40 days, fish up to 25 cm in size - 21 days, small fish - 10 days.
• Salting before drying (2 kg of salt is required for 10 kg of product): 2 weeks. pickling and drying as desired, 3 days of pickling and drying for 3 weeks.
• Smoking: hot +70-80ºС - 2-2.5 hours, cold smoking - pickling for 2 weeks or freezing.

In view of possible infection Animals should avoid contact with wildlife (foxes, arctic foxes). Pets (cats, dogs) should be fed only well-boiled fish.