of Opisthorchosis (Opisthorchis felineus) - two species of trematodes: cat fluke and fluke helminth civet .. length 8 to 13 mm and a width of 1.2-2.5 mm.small parasite eggs (0,011-0,023 mm long and 3.2 microns wide, of pale yellow color with gentle dual-shell).
characterized by chronic course with primary liver disease, gall bladder and pancreas.For other types of helminthic invasion, see here.
Under puberty opisthorchis parasites in the bile ducts of the liver, gallbladder and pancreatic ducts of humans and animals.
in puberty stage, the parasite lives in the intra- and extrahepatic bile ducts, gallbladder, pancreatic ducts man and a number of carnivorous mammals (cats, dogs, foxes, fox, sable, mink, muskrat, water vole, steppe polecat, swine).
helminth eggs, excreted in the feces of patients opisthorchiasis humans and animals when released into the water swallowed mollusk Bithynia leachi.The shellfish is the development and propagation of the helminth larvae, which then go back into the water.For
Opisthorchis larvae are killed when cooked piece of fish after 20 minutes, minced fish - 10 minutes from the beginning of boiling;at salting of small fish - 4 days, large - 10 days, hot smoking kills larvae, cold - no.
reservoir and source of the pathogen: opisthorchis definitive hosts are cats, dogs, pigs, the man, releasing the eggs of the pathogen in the faeces: the first intermediate hosts are freshwater shellfish, swallow eggs.From the body of mollusks in 2-10 months out cercariae that penetrate into the body of the second intermediate host - cyprinids (ide, roach, carp, tench, crucian carp, and others.), Which are converted into metacercariae.
last entering the human or animal body, in 10-15 days ripen to a mature stage.
pathogen transmission mechanism: fecal-oral;pathway - food;transfer factor - raw, insufficiently cooked, salted, dried fish of the carp family.Metacercariae opistorhisov live in the tissues of fish up to 2 years.
metacercariae - mature larvae Opisthorchis, where people eat with improperly treated fish.Basically metacercariae infected fish of the carp family: ide, bream, roach, European, roach, tench, rudd, carp, bream, nase, chub, bleak, bunting, blue bream, gudgeon, carp, barbel.
main epidemiological characteristics: natural foci opisthorchiasis caused by trematode feline are found in Asia and Europe (in Russia - in the river basins of the Ob, Irtysh, Kama, Volga, and others);opistorhoz civet is common in Southeast Asia, mainly in Thailand, in some provinces, which affected about 80% of the population.
Currently CIS opistorhoz distributed mainly in areas adjacent to the river basins of the Ob and Irtysh (West-Siberian and Kazakh centers), as well as in the Pechora basin, Kama, Northern Dvina, the Dnieper, the Southern Bug, the Volga, the Don,Neman and other Russian rivers.In some Asian countries (Thailand, India, China, Japan) found opisthorchiasis other species.
In Russia opistorhoz prevalence ranks fifth among the parasitic diseases, and it accounts for about 2% of diagnosed cases of helminth infections.The highest index of incidence observed among the indigenous coastal populations.The incidence found among children aged 1-3 years, increasing to 14-15 years and at this level is kept up to 50-60 years.Professionally most affected fishermen, rafters forest, sailors, agricultural workers.
main foci opisthorchiasis caused by feline fluke, located on the territory of Russia.Parasitologists long been convinced that opistorhisov confined to river systems, it has a range "belt-type".To analyze the distribution of opisthorchiasis better not within the same Russia and in the territory of the former Soviet Union.It turns out more accurate and convincing.So, let us imagine that we are moving from west to east in the former USSR.
Best Western - Dnestrovsk and Neman - opisthorchiasis pockets are located on the territory of Moldova, western Ukraine, Lithuania and Belarus.They are relatively small in size, low intensity.Prevalence opisthorchiasis people in them ranges from fractions of a percent to 10%.
Further, in the Dnieper and its left tributaries: Gums, Vorskla, PSUL, Sula, Diet, on the territory of Ukraine and Russia in part (for example, in the Bryansk region) is DNIPROVS'KYI center.He has a larger area and more intense.The affection of the people in it, too, varies greatly, however, reaches in some areas (eg, in the Vorskla River Basin in the Sumy region) of 20-40%.More recently, sometime before 1970, in the village of Sumy region Dobriansky prevalence population opisthorchiasis reached 60-70%.
Another east - VOLZHSKY center, located on the territory of Russia in the Volga River basin, with its many tributaries.It is extensive but not very intensive, however, in some areas, for example, in some regions of Tatarstan, opisthorchiasis prevalence population may reach 20-30%.For a long time it was thought that opistorhoz along the river Volga, distributed more or less evenly, but now it has become clear that this is not true.The fact is that in addition to opisthorchiasis in the Volga basin common parasitic disease psevdamfistomoz, which pathogen (Pseudamphistomum truncatum) is very similar to
O. felineus, but we still do not know how much this vast river basin "of both"and something more.
The pool is a small Northern Dvina Northern Dvina hearth, where prevalence of the population varies from 3 to 10-15%.There are pockets of opisthorchiasis in the basin.Ural, and of medium intensity.
And finally, the most powerful in Russia and in the world - the Ob center.It is huge and is located in the basin of the Ob and Irtysh in 12 provinces and in Western Siberia and Kazakhstan regions.It is so vast that parasitologists still argue that, in fact, it represents, nationwide there are "drain" center, a kind of "focal area", a group of more or less contiguous along the tributaries of hearths with '' discharge zone "along theObi bed, or something else.
In this outbreak, "everything to the max."As elsewhere in the affection of the people it is not uniform, but in large parts of the Middle Ob it reaches 50-80%, and even higher.There are villages in which 100% of affected individuals was registered.Simply it means that in small towns, where at the time of the survey were not infants, all adults and children (ranging from 3-5 years of age) struck opisthorchiasis.
It is in the focus of the Ob to the maximum extent expressed in the manifest ( "painful") opisthorchiasis.It says most complications on his background.The population (mainly indigenous) have long been accustomed to eat raw and poorly (in parasitological certainly sense) cooked fish.In towns 100% prevalence of cats.In the rivers of almost 80% (and even higher) infestation of carp fish, for example, ide and dace.In numerous floodplain waters of the Ob huge focus on the population size of the first intermediate hosts - molluscs.For example, in a floodplain lake near the village of Crone in the north of the Tomsk region I had to explore kodiell population in which the number of shellfish exceeded 8000 individuals per 1 m2;the total number of shellfish in the population was more than 50 million individuals, and the number of shellfish contaminated with larvae Opisthorchis, approaching one million.This is a staggering figure when you consider that over the summer in each of contaminated clams formed to 60-100 thousand cercariae that can infect the second intermediate host Opisthorchis.About the same quantitative characteristics were obtained by me in the Tyumen region in the old channel of the Irtysh (the so-called "Savinovsky Erica") in the area of Tobolsk.
the north of Western Siberia, in the basins of the rivers Pur, Taz, Nadym foci opisthorchiasis no, there is no first intermediate host of the pathogen, but the number of so-called "imported cases" opisthorchiasis population is very large.
most eastern in Russia (known at the moment) is relatively small IRKUTSK focus in the river basin.Biryusa.
further east opisthorchiasis not.All of Eastern Siberia, apparently free from it.The reason is simple - lack of clams can play the role of the first intermediate host.There were, however, brief information regarding the location of opisthorchiasis foxes and cats in the area of Borzya (op. At Erhardt et all. 1962), but there is no certainty.
If the human body gets a lot of metacercariae of the parasite (in fact even one eaten raw ide, in almost every village of the Ob, is enough to put a few hundred or even thousands of larvae in the human body ...) and, in addition, if the personeating raw or undercooked (not cooking course in a sense parasitological ...) for fish, for example, 10-20 years or more (as is common, for example, in West Siberia), parasites are able to cause theirowner of a number of serious trouble.
Among them can be a primary cancer of the liver or pancreas (it is well known that, for example, parts of the Middle Ob region leads the world in this severe pathology).May develop other serious liver disease, complications occur lung diseases, asthma, typhoid carrier, pregnancy complications, etc.In a word - "bunch of pathologies"!
Strictly speaking, it is dangerous not so much the opistorhoz as those diseases that are associated with it, or they are initiated.Describing the social damage from opisthorchiasis, experts constantly pay attention to the fact that the number of medical consultations about a wide variety of diseases among patients opisthorchiasis 3-6 times higher than among non-parasitized people living in the same areas.
in Russia each year to 50 thousand and more patients opisthorchiasis.More about 10-15 years ago, according to expert estimates, the number of patients opisthorchiasis was about 2 million people in the Soviet Union.After the collapse of the Union, this figure has not diminished, but rather, even increased, and now, apparently, only in Russia (not including Kazakhstan, Ukraine, Belarus, Moldova, Lithuania ...) the number of patients opisthorchiasis is about two million.
Given all this, parasitology rightly referred opistorhoz among the most dangerous to humans and widely used in Russia parasitic diseases.
Doctors rightly see opistorhoze a serious medical problem, but, strictly speaking, opistorhoz - is primarily an environmental issue associated with intense biological pollution.It is also a veterinary problem, because at the stage of metacercariae opistorhisov parasitize carp fish, and in adulthood - in the body of domestic and wild carnivores, omnivores and even some herbivorous (eg, water vole) animals.This is a social problem associated with the education of the population parasitologically safety skills preparation and consumption of fish dishes.Like all social problems, it is - the most difficult.This technical problem relating to the development and implementation at fish-processing enterprises of technological modes of disinfection of fish from dangerous to the human parasite's larval stage.
Infection usually occurs in summer and autumn, however, the frequency of clinical manifestations pronounced seasonality has not.Outbreaks are characteristic of the population, a newcomer to the endemic areas.
In the course of the disease is allocated 2 periods: acute (early) and chronic (late).After 2-4 weeks after infection becomes noticeable allergic reaction to parasites - this is a direct consequence of poisoning organism products of their vital functions.The temperature may rise to 39-40 ° C and more febrile period duration - from several days to 2 months.There are pain in muscles and joints, sometimes jaundice, itchy skin rash, swollen lymph nodes, liver, spleen less;in some patients lung infiltrates occur.In the late phase there is a violation of the biliary tract patency, sometimes there are severe bouts of biliary colic;often develop chronic hepatitis and pancreatitis.With intensive invasion and aggravating factors (secondary bacterial and viral infections, alcoholism, etc.) Will develop cirrhosis.Helminthiases may be complicated by bile peritonitis, arising from the gap by parasites of the bile duct wall.Possible complications include bacterial suppurative cholangitis, primary liver cancer and pancreatic cancer, which is in the population centers of opisthorchiasis occurs 7-8 times more frequently than in areas where it is no helminthiasis.
diagnosis at an early stage is placed in view of the disease symptoms and epidemiological history (uncleared eating fish caught in the outbreak opisthorchiasis).After 1 month after infection appear flukes eggs in the feces and duodenal contents of the patient, which facilitates diagnosis.
Treatment: praziquantel (azinoks) hloksila, bithionol.Specific treatment - reception hloksila: inside 5 consecutive days at a daily dose rate of 60 mg per 1 kg of body weight (adult - about 3.5-4 grams per day).The daily dose divided into 3 doses and taken after meals, washed down with milk.You can carry out 2-day course of treatment with a daily dose of 0.15 g per 1 kg of body weight (adult - about 9-10 g).The daily dose divided into 3 doses taken after meals;drug drink 100 ml of milk.Sometimes the treatment hloksilom occur dizziness, mild intoxication, increased pain in the liver area, which do not require discontinuation of treatment and rapidly disappear after its completion.As a result of the death and decay of worms occasionally appear allergic rashes on the skin and blood eosinophilia.In these cases, appointed by antihistamines, calcium chloride.
Contraindications to the use of the drug - liver disease with abrupt disorder of its functions (non-helminth), organic diseases of the cardiovascular system in the stage of decompensation, pregnancy.hloksilom Treatment complementary symptomatic therapy: duodenal intubation and drainage of the biliary tract without probe for Dem'yanov, appointment choleretic and antispasmodic agents;with a secondary bacterial infection of the bile ducts and gall bladder used antibiotics.How to treat opistorhoz folk remedies, see here.
more than a century of studying opisthorchiasis allowed to accumulate a wealth of factual material on various aspects of the problem, which, alas, is not amenable to a radical solution.The continued interest in Opisthorchiasis at the end of XX and the beginning of the XXI century has several causes.
1. Major economic programs of development of natural resources of Siberia led to an intense inflow of population in the most intense foci of the disease and, in general, have increased migration flows in Russia.It has highlighted the economic importance of opisthorchiasis and its negative social impact.
2. In many positions opistorhoz, despite the long history of the study, still remains not well understood.For example, this applies to determine the relative roles of the various final hosts in the circulation of the pathogen, development biocenological prevention, antropopressii factors influence the parasitic pathogen system as a whole and the individual stages of the life cycle Opisthorchis etc.
3. You can clearly assert that opistorhoz caused Opisthorhis felineus, for a variety of components: the widest areal world of the pathogen, the vastness of the many hotbeds of the disease, symptomatic, a variety of host species, etc., is the basis of the so-called "globalopistorhoznoj triad "consisting of O. felineus, O. viverrini and Clonorchis sinensis.