Helminthiasis (worm attack): causes, symptoms, diagnosis and treatment.
Helminthiases are diseases of humans, animals and plants caused by parasitic worms (helminths).
Causes of the appearance of helminthiasis
Currently in our country there are more than 70 species of 250 known helminths that are parasitic in the human body. The most common are tapeworms (tapeworms, cream worms, trichinella, whip worms), tapeworms (pig tapeworms, cattle and dwarfs, tapeworms, echinococcus), worms (liverworms and cats).
Helminths are characterized by developmental stages: eggs → larvae → sexually mature forms.
Infection with helminths most often occurs after ingestion of their eggs and / or larvae. Depending on the mechanism of infection and the route of transmission, helminthiases are divided into: geohelminthiases, biohelminthiases and contact helminthiases. Geohelminths grow without intermediate hosts, biohelminths - with successive changes of one, two or three hosts, contact helminths are transmitted through contact.
Porcine tapeworms, bovine tapeworms, echinococcus and other types of worms develop with successive changes of one, two or three hosts. Intermediate hosts can be fish, mollusks, crustaceans, insects. A person is infected with these helminths by eating food that has not undergone full heat treatment:
- beef infected with the fins (larvae) of bovine tapeworm;
- pig tapeworms affected by Finland;
- light and raw salted fish with opisthorchis larvae or tapeworms;
- raw water or vegetables, fruits processed with this water.
Vlasoglav, ringworms, hookworms, necators thrive without intermediate hosts. The eggs and larval forms of this parasite enter the soil along with the feces. If the rules of personal hygiene are not observed, it penetrates the body of the new owner.
Through contact - that is, when a healthy person comes into personal contact with an infected person, when using common utensils, toiletries, linens, when inhaling dust in the room where the infected person is - enterobiasis (the causative agent - cream worms) and hymenolepiasis (causative agent - pygmy tapeworm) is sent. In cases of enterobiasis, self -infection often occurs.
Helminths are certain types of parasites in certain organs, causing various helminthiases:
- in the large intestine - pork, beef, dwarf tapeworms, nematodes (shell worms, ringworms, strongyloids), pin worms, whip worms. From the intestinal lumen, tapeworm larvae can enter the bloodstream and spread throughout the body, settling in adipose tissue, muscle ducts, eye space, and brain;
- in the liver and bile ducts - trematodes (opisthorchis, clonorchis, fasciola). Echinococcal cysts are mainly located in the liver, and after rupture, daughter bubbles can be found in the mesentery, peritoneum, spleen and other organs;
- in the respiratory system - echinococci, alveococci, pulmonary flukes that cause paragonimiasis;
- in the nervous system - schistosomiasis, paragonimiasis, echinococcosis and alveococcosis;
- in the organs of vision - oncoscosis, loiasis, complicated forms of teniasis;
- in the circulatory organs - necatorosis, schistosomiasis, diphyllobothriasis;
- in the lymphatic system - filariasis, trichinosis;
- in the skin and subcutaneous tissues - mine worms, oncoscosis, loiasis, larval stage of schistosomiasis;
- in the skeletal system - echinococcosis;
- in skeletal muscle - trichinosis, cysticercosis of muscle tissue.
The lifespan of helminths in the body of the last host can vary, depending on the type of parasite, and ranges from a few weeks (pin worms) to several years (tapes) and decades (fasciolae).
Classification of diseases
Humans are parasitized by two types of worms:
- Nemathelminthes - ringworm, class Nematoda;
- Plathelminthes are flatworms that belong to the class Cestoidea - tapeworms, Trematoda - class flukes.
Depending on the mode of distribution of parasites and their biological characteristics, there are:
- contact helminthiases.
Symptoms of helminthiasis
Helminths have various effects on the human body:
- antigenic effects when local and general allergic reactions develop;
- toxic effects (waste products of helminths cause malaise, weakness, dyspeptic symptoms);
- traumatic effects (when parasites attach to the intestinal wall, blood supply is disrupted with necrosis and subsequent atrophy of the mucous membranes; the absorption process may be disrupted; mechanical compression of tissues by helminths);
- secondary inflammation due to bacterial penetration after migrating helminths larvae;
- violation of metabolic processes;
- as a result of the absorption of blood by some helminths, anemia occurs;
- neuro-reflex influence-irritation of nerve endings by helminths provokes bronchospasm, intestinal dysfunction, etc . ;
- psychogenic effects, indicated by neurotic conditions, sleep disorders;
- immunosuppressive action.
Helminthiases are characterized by developmental stages. Each stage is characterized by its clinical symptoms.
In the acute early stages, helminths most often have not yet laid eggs, the body becomes sensitive (antibody production, release of inflammatory mediators, increased permeability of the vascular wall) and trauma to the organs in which the larvae migrate. Clinical symptoms may not be present, but in some cases the disease may occur with severe clinical manifestations. The acute stage lasts from 1 to 4 months, sometimes 8-10 months or more.
Patient complaints in the acute stage:
- fever from several days to two months (subfebrile or above 38ºС, accompanied by chills, severe weakness and sweating);
- recurrent itchy skin rash;
- local or general edema;
- enlargement of regional lymph nodes;
- pain in muscles and joints;
- cough, asthma attacks, chest pain, prolonged catarrhal phenomena, bronchitis, tracheitis, symptoms resembling pneumonia, asthma syndrome, hemoptysis;
- abdominal pain, nausea, vomiting, bowel disorders.
By the end of this stage of helminthiases, the phenomenon of acute allergies gradually subsides, and the clinic of the chronic stage has not yet had time to develop.
The acute stage passes the subacute, when the "young" helminths gradually mature. Then comes the chronic stage, corresponding to the development of the parasite into a sexually mature individual. The clinical picture develops against the background of toxic effects of helminth waste products, traumatic effects of helminths on organs (ankylostomiasis, trichocephalosis, etc. ), mechanical effects (echinococcal cyst in the liver grows, compresses neighboring organs; cysticerci - in the brain), secondary inflammatory processes (withstrongyloidiasis, observed duodenitis), metabolic disorders (hypo- or avitaminosis), dysfunction of the stomach and duodenum, secondary immunodeficiency, etc.
Symptoms depend on the organ in which the helminth is parasitic, on its size and number.
Forintestinal helminthiasesThe following syndromes are characteristic:
- dyspeptic (stomach discomfort, feeling of fullness after eating, early satiety, bloating, nausea);
- asthenoneurotic (feeling of severe fatigue, increased nervous excitement and irritability).
Enterobiasis is characterized by perianal itching at night. With massive invasion, ringworm can become intestinal obstruction, pancreatitis, obstructive jaundice.
Cestodiasis of the intestine(taeniarinhoz, diphyllobothriasis, hymenolepiasis, teniosis etc. ) are asymptomatic or with a small number of symptoms (with symptoms of dyspepsia, pain, anemia).
Trematode liver(fascioliasis, opisthorchiasis, clonorchiasis) causes:
- chronic pancreatitis;
- nerve disorders.
Ankylostomiasismanifested by asthenovegetative syndrome (weakness, fatigue, pale skin) due to the development of iron deficiency anemia.
Filariasis is characterized by an allergic syndrome of varying severity and regional lymphadenitis.
Urogenital schistomiasismanifested by the appearance at the end of bloody urination, frequent desire to urinate, pain during urination.
Alveococcosis, cysticercosis, echinococcosismay be asymptomatic for a long time. At a later stage, pus or rupture of a cyst containing parasites leads to anaphylactic shock, peritonitis, pleurisy, and other severe consequences.
For diseases caused by parasitism of migrating larvaezoohelminthswhen one is not a natural host, distinguishes between skin and visceral forms. The skin shape is caused by the penetration of several animal helminths under human skin: waterfowl schistosomatids (trematodes), dog and cat ankylostomatids, strongylids (nematodes). When a person comes in contact with soil or water, helminth larvae penetrate the skin. There is a burning sensation, tingling or itching at the site of helminth introduction. There may be short-term fever, signs of general lethargy. After 1-2 weeks (less often 5-6 weeks), recovery occurs.
The visceral form develops as a result of ingestion of helminth eggs with water and food. At the onset of the disease, there may be discomfort, allergic exanthema (skin rash). In the human intestine, larvae emerge from helminth eggs, which penetrate the intestinal wall into the blood, reach internal organs, where they grow and reach a diameter of 5-10 cm, compressing tissues and disrupting organ function. When tapeworm larvae (cysticerci, cenura) are located in the membranes and materials of the brain, headache, signs of cerebral hypertension, paresis and paralysis, epileptiform seizures are observed. Larvae can also be located in the spinal cord, eyeballs, serous membranes, intermuscular connective tissue, etc.
The result of helminthiases can be complete recovery with elimination of helminths or the development of irreversible changes in the host organism.
Diagnosis of helminthiasis
The diagnosis of helminthiasis is established based on a set of complaints, information received from patients about the course of the disease, data from the laboratory and instrumental examination methods.
In the acute phase of helminthiases, there is a blood reaction to the presence of helminths in the body, so the following studies are recommended:
- clinical blood tests: general analysis, leukoformula, ESR (with blood smear microscopy in the presence of pathological changes);
- blood chemistry:
- total protein, albumin, protein fraction;
- assessment of indicators of renal function (urea, creatinine, glomerular filtration);
- assessment of indicators of liver function (bilirubin, ALT, AST, alkaline phosphatase);
- pancreatic alpha-amylase;
- assessment of carbohydrate metabolism: glucose (in the blood), glucose tolerance test with determination of glucose in venous blood on an empty stomach and after exercise after 2 hours.
The following biological materials can be examined for the presence of helminths: feces, blood, urine, duodenal contents, bile, sputum, muscle tissue, rectum and perianal mucus.
Since helminths are not excreted in feces at any stage of its development, the recommendation is to donate feces three times-every 3-4 days.
- Fecal analysis for helminth eggs.
- Analysis for enterobiasis (pinworm eggs), sweep.
- Microscopic examination of feces to detect eggs of enterobiasis -causing agents Enterobius vermicularis (pinworms).
- Analysis for enterobiasis (pinworm eggs), spatula.
- Analysis is necessary in case of suspected infection with pinworms, as well as during hospitalization, registration of medical books.
- Analysis for kindergartens and schools.
Children’s exam programs are designed to pass before entering kindergarten or school. The results of this study are required to obtain a medical certificate in accordance with form 026U approved by the Ministry of Health of the Russian Federation.
Immunological studies performed - determination of specific antibodies to helminths:
- antibodies to Ascaris IgG;
- IgG class antibodies to toxocar antigens;
- Anti-Opisthorchis felineus IgG (IgG class antibody to feline fluke antigen);
- IgG class antibodies to trichinella antigens;
- antibodies to the causative agent of anisakiasis (nematodes of the genus Anisakis), IgG;
- antibodies to the causative agent of clonorchiasis, IgG;
- Antibodies to Strongyloides stercoralis, the causative agent of strongyloidiasis, IgG.
Tests aimed at detecting IgG antibodies to the causative agent of strongyloidiasis are used for early serological diagnosis of strongyloidiasis if there is clinical suspicion (eosinophilia, serpentine skin lesions, pulmonary or gastrointestinal symptoms) for the disease.
In difficult cases, the following studies may be recommended:
- regular chest x-ray;
- complex ultrasound examination of abdominal organs (liver, gallbladder, pancreas, spleen);
- CT of the abdominal cavity and retroperitoneal space;
- CT scan of the chest and mediastinum;
- CT scan of the brain and skull.
Which doctor to contact
If you suspect helminthiasis, you should contact a general practitioner or general practitioner, and with the child - a pediatrician.
If there are indications for surgical treatment, the patient is referred to a surgeon.
Treatment of helminthiasis
Most patients with helminth infections do not require hospitalization. Patients with tissue helminthiases, regardless of severity, patients with severe and complicated diseases, undergo hospital treatment.
Therapy is carried out with anthelmintic drugs. The frequency of administration and dosage of the drug depends on the age and weight of the patient and is prescribed by the doctor.
Desensitizing, detoxification therapy, vitamin therapy may be indicated. To reduce the temperature, non -steroidal anti -inflammatory drugs are prescribed, with allergic reactions and itching - antihistamines, with severe edema - diuretics. In severe cases, hormone medication is needed.
The presence of helminths in organs and tissues may be an indication for surgical treatment.
- Bronchial asthma.
- Bowel cancer.
- Cirrhosis of the liver.
- portal hypertension.
- Gastrointestinal bleeding.
- Liver abscess.
- allergic myocarditis.
- Chronic glomerulonephritis.
- Chronic kidney disease.
- hemostasis disorders.
- Loss of vision.
Prevention of helminthiases
Preventive measures aimed at preventing infection with helminths include:
- compliance with personal hygiene rules (use of individual towels, personal hygiene items and other accessories for daily use);
- use only high quality water in daily life;
- regular vaccination and deworming of pets;
- wash vegetables, fruits, berries before use;
- adequate heat treatment for meat and fish products.
The information in this section should not be used for self -diagnosis or self -treatment. In case of pain or exacerbation of other diseases, only the attending physician should prescribe diagnostic tests. For proper diagnosis and treatment, you should contact your doctor.