Ascariasis - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Ascariasis - helminthiasis, caused by Ascaris lumbricoides, with high susceptibility, ubiquity, with a primary lesion of the digestive tract, the development of allergic reactions, chronic course and the possibility of serious complications.

Ascariasis is quite a common disease in the territory of Russia.On average, the incidence rate varies from 60 to 85 cases per 100 thousand. Population.Most cases of ascariasis detected among urban residents (60% in the total structure), the child population (up to 65% of patients) prevails among the age groups.Geographically, the highest incidence recorded in the Far Eastern region (Sakhalin and Primorye).The increased incidence observed in the North Caucasus and West Siberian regions.Markedly lower than the average level of prevalence of ascariasis in the Volga and Central Black Earth regions.According to WHO, the world is infected with Ascaris more than 1 billion..

Pathogen ascariasis is a type Roundworms, Hookworms class.This round worms (Ascaris lumbricoides).

Ascaris - a large worm-like parasite, elongated spindle-shaped, reddish-zheltovatogogo color, which after death becomes white.The female is wider and has a length of 20-40 cm., Male 15-25 cm.

Eggs large oval-shaped, with a lumpy brown coat protein or dual circuit with a smooth colorless shell.

reasons Ascaris infestation

source of infection - people.However, the sick man of immediate danger to others is not as eggs, which he identifies with the feces, must undergo a process of maturation in the soil (which is why ascariasis called geohelminthiasis).In the external environment with faeces sick ascariasis allocated immature eggs, where they mature for 10-40 days under certain conditions (t - 30º, O2 available soil moisture content of 8% or more).Eggs can be stored in the soil for up to 7 years (thanks to a five-layer protein and a lipid shell).

infection occurs when a healthy person ingested mature eggs of Ascaris (contaminated berries, fruits and vegetables).In the small intestine larvae from eggs that are approximately 3-4 hours pass through the intestinal mucosa, penetrate into blood vessels and further by intestinal veins with blood system to the liver;then through the inferior vena cava are in right heart and the pulmonary artery into the lungs.In the lungs the larvae of the vessels penetrate into the alveoli and enter the tracheobronchial tree to the pharynx, are swallowed and ripen in the small intestine to the adult forms.This migratory phase is 10-12 days.The interval is from ingestion of eggs to the development of mature forms is about 8 weeks.Sexually mature females of Ascaris day lays up to 240,000 eggs.By the 7th month of parasitism ovulation ends, and the selection of eggs stops.Without treatment, life expectancy roundworm reaches 12-18 months.

susceptibility of the population to high ascariasis.In infected areas may become ill up to 80% of the population.This is due to the fact that the disease does not leave persistent immunity.

symptoms of ascariasis (Ascaris infestation)

Allocate:

1) early (migratory) phase .The basis of increasing the body's sensitivity to a "foreign agent" exchange of products and the collapse of the larvae.Allergens ascarids are a group of the most powerful parasitic allergens.Also holds a toxic effect on the human body of the larvae themselves.In case of intensive infection is important mechanical bowel injury, blood vessels, liver, lungs.

and 2) late (intestinal) phase .In the late phase of the allergic disposition of the body weaker.Pathogenic influence due to the toxic effect of food and activity decay at the death of adult ascarids.There have been injuries and mechanical adult parasites of the small intestine up to it through injury.Ascarids parasitism leads to a deficiency of vitamins - pyridoxine (B6), retinol (A), ascorbic acid (C).It marked immunosuppression under the influence of Ascaris.

symptoms early (migratory) phase varied.In children, this phase is often asymptomatic.When expressed forms of the disease are characterized by the following syndromes:
1) acute infectious-toxic syndrome (high temperature to 39-40 ° for 1-8 days, malaise, weakness, sweating, fatigue, decreased performance) in the first weeks after infection;
2) allergy syndrome (the appearance of bubble rash on the body or only on the hands and feet, accompanied by severe itching);
3), some patients may develop liver syndrome (mild pain in the right upper quadrant, abdominal discomfort, enlargement of the liver, can change the biochemical analysis of blood - increased liver enzymes ALT, AST, bilirubin);
4) is most typical for the early phase of the broncho-pulmonary syndrome, or the so-called transient pneumonitis (Leffler syndrome).The patient has a cough, dry or with phlegm, which may be streaked with blood, there are complaints of shortness of breath, chest pain, when viewed listened dry or wet large bubbling rale, shortening of percussion sound with rapping light;may develop pleural effusion - in exudation: red blood cells, and eosinophils, in rare cases the larvae.
on chest radiograph: infiltration areas (inflammation) 2-4 cm in size - it is eosinophilic infiltration.These centers are changing their location, as the larva moves, in connection with what are called "volatile infiltrates Leffler."Outbreaks can disappear in 3-5 days, but sometimes it can hold up to 20-30 days.During this period it is necessary to distinguish between ascariasis with pneumonia, tuberculosis, oncology.

process of turning the larva into an adult determines the appearance of symptoms late (intestinal) phase.The patient having 2 syndrome: GI (gastrointestinal) and nervous.
Gastrointestinal syndrome is characterized by loss of appetite, nausea morning, vomiting, abdominal pain, stool disorder.
Nervous syndrome is characterized by poor health, sleep disturbances, headache, decreased performance, fatigue.In children, delayed psychomotor development, sometimes recorded epileptiform seizures, meningism phenomenon (pronounced headaches, nausea, vomiting, pain in the neck).
in all patients, even in cases that occur without symptoms of the disease, there is weight loss, sometimes significantly.

prognosis for most patients with timely treatment favorable.

What symptoms should cause you to seek medical attention, parasitologist (infectious diseases)?

Unexplained temperature and signs of toxicity without evidence of cold (no runny nose and sore throat), allergic reaction for no reason, the appearance of this background, coughing and wheezing dyspnea, digestive disorders (nausea, disorders stool as diarrhea and constipation, abdominal pain, bloating), general nervousness and irritability.

Diagnostics ascaridosis

Diagnosis in the acute phase

Confirmation: detection by microscopy of sputum of Ascaris larvae.When a blood test for antibodies by EIA and RLA: positive reaction 5-10 days after infection.
KLA: eosinophilia (20-40-60%), increased erythrocyte sedimentation rate of 50 mm / h, a small increase in white blood cells, can be anemia - a decrease in hemoglobin.

diagnosis in chronic phase

1) detection of Ascaris eggs in the faeces of the patient in the microscopic study (methods Fyulleborna, Kalantaryan, Krasilnikov, etc.).;eggs in feces will be no earlier than 3-3.5 months after infection, sometimes worms themselves.

also need to bear in mind that with parasite in the intestine only males, older females or immature eggs in the study of feces may be absent.Maximum detection of infected persons occurs in December-February;

2) in the general analysis of blood anemia - decreased hemoglobin, eosinophilia (20% adults, 60% of children), increased erythrocyte sedimentation rate;

3) X-ray of the abdomen: areas of enlightenment in the intestine (helminths located tangles).

What to do in cases of suspected ascariasis?

When exiting mature individuals with helminth feces collected in a glass dish and take in the parasitological laboratory for macroexamination (usually the direction of writing infectious diseases);urgently go to a consultation with parasitologist (infectious diseases) for further examination and treatment.

Treatment of ascariasis

Organizational-regime activities:

1) ascariasis treated at home or day care;hospitalization subject to patients with complications (mostly surgical);
2) diet therapy - table number 13 (on Pevzner) - appointed for the duration of treatment and recovery.Diet - 4-5 times a day in small portions.It should not be long "hungry" periods between meals.
General characteristics: - a diet with caloric, reduced to a large extent due to the fats and carbohydrates, with a high content of vitamins
Chemical composition and caloric (daily ration): - proteins - 75-80 g (60-70% of animals);- Fat - 60-70 g;- Carbohydrates - 300-350 g;- Caloric - 2200-2300 kcal

Recommended foods and dishes:
wheat dried bread;
low-fat meat and fish broths, soups vegetable broth, slimy decoctions of cereals;
lean meats, poultry and fish;
lactic acid drinks, cottage cheese;
pureed porridge of rice, semolina and buckwheat;
potatoes, carrots, beets, cauliflower, ripe tomatoes;
soft ripe fruits and berries, broth hips;sugar, honey, jam, jam, marmalade.

Excluded products and dishes:
rye and any fresh bread, pastries;
fatty broth, soup, borscht;
fatty meats, poultry, fish, sausage, smoked, salted fish, canned;
whole milk and cream, fat sour cream, cheese;
millet, pearl barley and cereals, pasta;
cabbage, radishes, radish, onion, garlic, cucumbers, beans;
fruits, fiber-rich;
chocolate, cakes, cocoa

Medication ascaridosis

1) antiparasitic drugs: dekaris (levamisole) Vermoxum (mebendazole), nemozol (Albendazole), pyrantel.In view of the possibility of side effects, dosage and course of treatment is prescribed only by your doctor.Self-administration of drugs can lead to chronic disease and the development of complications.
2) Enzyme preparations (Creon, mikrazim, ermital, mezim, pancreatin) to improve the digestive function of the intestine.
3) antihistamines (Claritin, Zyrtec, zodak, erius, suprastin, tavegil) - appointed by a short course along with antiparasitic agents in order to avoid sensitization in the destruction of the helminth.
4) Probiotics (Bifistim, bifiform, linneks, bifidum forte, etc.) for the correction of the normal intestinal microflora.

Complications of ascariasis

In the intestinal phase is necessary to be afraid of serious health complications for the patient:

1) ileus, which occurs due to the closure of the intestinal lumen into a ball of Ascaris.Intestinal obstruction ascariasis is 3% of all cases of such complications.
1) peritonitis (as a result of vital activity of adults may compromise the integrity of the intestinal wall).
3) liver ascariasis (zapolzaniya ascarids in the biliary liver moves lead to the development of obstructive jaundice).Patient arching boring pain in the right upper quadrant, vomiting, jaundice, enlargement of the liver.May develop suppurative cholangitis, or inflammation of the bile duct (by the addition of bacterial flora), which can lead to multiple liver abscesses.
4) askaridozny pancreatitis (migration of Ascaris in the ducts of the pancreas leads to the development of acute pancreatitis).Patient sharp abdominal pain, vomiting, collapse can increase urine diastase.
5) mechanical obstruction of the airways (roundworm creep into the stomach, esophagus, oropharynx, respiratory tract, may cause luminal filling broncho-pulmonary tree, respiratory failure).

Control examination and clinical observation

control study the effectiveness of the treatment should be carried out 2-3 weeks after treatment of 3 consecutive days and again after 2 weeks and 3 days in a row.
Clinical supervision for convalescents ascaridiasis lasts 3 years with an annual examination of stool in infectious diseases.

Prevention ascaridosis

One of the areas of prevention is early identification of patients and their treatment, care conglomerations children - ripping sandboxes (eggs of Ascaris die under the influence of sunlight in color).
Preventive measures among the population is based on hygienic education of children and adolescents - personal hygiene: washing hands after using the toilet and before eating, washing hands after street, washing fruits, vegetables, berries.

infectious disease doctor Bykov NI