Hymenolepiasis ( dwarf tapeworm ) - Causes, Symptoms and Treatment .MF .
draw your attention to the subject of helminthiasis caused dwarf chain saw, which is more common in the pediatric age group from 4 to 14 years, with the possibility of forming microcenters diseases in preschool and school institutions, custodial institutions, as well as a family home.This is due to the difficulty of compliance with sanitary rules of conduct, high contagious (contagious) and the characteristics of the immune system.
hymenolepiasis - is a parasitic disease of man and small rodents caused tsepnem dwarf genus Hymenolepis with a primary violation of the digestive system.
prevalence hymenolepiasis planet general, however, lead the southern regions of morbidity.The high incidence of hymenolepiasis recorded in Afghanistan, Pakistan, Iran and Latin American countries on the African continent.In the countries of the former Soviet Union - it is Armenia, Georgia, Moldova, Azerbaijan, Ukraine and the Russian Federation - Tomsk region, Amur region, the North Caucasus.
reasons for the defeat hyme
Pathogen disease - dwarf tapeworm (Hymenolepis nana) - small whitish worms, a length of about 3-5 cm
tapeworm consists of a head (scolex), neck, body.(strobila).The head of the spherical shape, has 4 suckers and hooks corolla that provides attachment to the inner wall of the patient's bowel.Like all tapeworms, the body (strobe) is made up of segments, the number of which reaches up to 300, with end segments of the largest and most mature, containing eggs of dwarf tapeworm (hexacanth).Mature segments may contain up to 180-200 eggs of the tapeworm.
Segments of tapeworm
Periodically end segments are separated from the body, are destroyed by enzymes in the gut lumen and, accordingly, there is the release of huge quantities of eggs.Then the larvae tapeworm education (cysticercoid or larvotsisty).
Eggs transparent, spherical, up to 50 microns in diameter, inside hexacanth with embryo.On the environment subjects the dwarf tapeworm eggs remain viable for 2 days, the fingers are infectious agents within 2-4 hours.
inactivation (decontamination) eggs is possible at elevated temperatures (up to + 60 ° C and above) for 15-20 minutes at a low temperature (up to -4 ° - refrigerator temperature) for 45 minutes.Also detrimental to them to ultraviolet rays and the lack of humidity.
cycle of the dwarf tapeworm begins and ends in the human body.
Eggs fall through the mouth with dirty fruits, vegetables, water in the small intestine, where they are located hexacanth that introduced in the villi of the intestinal mucosa, there are developing to cysticercoid or larvae (it takes 5-7 days) - it tissue stage of development.
larvae then go back into the intestinal lumen and re-attach to the mucosa, which develop into mature individuals - it intestinal stage of development.
After 14 days of the end segments of mature individuals of dwarf tapeworm appear ripe eggs.
whole cycle can last for about 1-1.5 months.Sometimes entire life cycle within the host passes without leaving out into the environment.
should not forget about the possibility at hymenolepiasis autoinvaziya (or peculiar superinvazii) when the intestinal villi capture hexacanth released eggs and the cycle of development continues without going outside of eggs.There autoinvaziya in immunodeficiency no more than 15% of individuals.
hymenolepiasis, the development cycle of the dwarf tapeworm
infection Source (final and intermediate host) - the man in the gut which are parasitic dwarf tapeworm mature specimens, and is the selection of eggs with the faeces into the environment.Also, the intermediate host of the dwarf tapeworm can be and rodents (hamsters, mice, rats).
mechanism of infection - fecal-oral.Infection occurs by contact and alimentary.transfer factors for alimentary way - dirty vegetables, fruits, berries, water, and when the contact path - dirty hands, various household items (toys, dishes, towels, linens, door handles, etc.).Also a role in the spread of infection play conventional fly on their legs tapeworm eggs may enter the environment as the objects, and so on products.
Susceptibility to hymenolepiasis general, however, more common in children from 4 to 14 years, often recorded foci in preschool and school institutions, boarding schools, as well as a family home.Most urban residents ill.Often dwarf tapeworm found in the centers of enterobiosis.
Immunity after suffering hymenolepiasis unstable and lax, and that means being able to re-infection and autoinvaziya (re self-infection).
Pathogenic action of the dwarf tapeworm in the human body.
- mechanical damage to the intestinal wall, necrosis of the villi of the intestinal mucosa (necrosis, ulceration in places of attachment, sometimes up to the muscular layer) due to the impact of scolex hooks and tapeworm parasitism;
- sensitizing effect (the allergic disposition of the body and toxic-allergic reactions) due to metabolic products of the parasite and decay;
- intestinal mikrokrovopoterya with the development of anemia;
- development of intestinal dysbiosis and vitamin C, B2, PP.
Symptoms may be different, depending on the severity of symptoms of helminthiasis.Patients must meet the following complaints of varying severity:
1) low-grade fever (body temperature rise to 37.5, at least 38 °);
2) dyspeptic syndrome (nausea, salivation, belching, heartburn, diarrhea, disturbance of appetite, abdominal pain, paroxysmal character in most cases, flatulence, vomiting) appears when expressed pain in the abdomen;
3) asthenic-neurotic syndrome (weakness, irritability, decreased performance, children lagging behind in mental and physical development).
4) allergic reactions (itchy skin rash, vasomotor rhinitis, krapivnytsy symptoms may develop asthmatic bronchitis or asthma).
5) patients with a special appearance: pale skin, weight loss, dry skin and mucous membranes;
6) in the general analysis of blood: eosinophilia, low, moderate, and severe anemia normo hypochromic (decreased hemoglobin 100 g / l or less), decreased white blood cell count, increased ESR.
in 30% of patients have asymptomatic hymenolepiasis.
Pre suspected hymenolepiasis difficult and is based mainly on clinical data, as the collection of epidemiological history is very difficult (most patient states that regularly washing hands and food products).To help the doctor along with the main syndromes hymenolepiasis "allergic mood" of the body (frequent allergic manifestations without objective reasons).
Final diagnosis is based only on the laboratory confirmation, which are the main methods:
1) koproovoskopiya (feces climb 3 hkratno at intervals of 2-3 weeks because of the peculiarities of the development cycle of the dwarf tapeworm), the material should be fresh (morning fencefeces).When a massive infestation of eggs stands out a lot, so it is enough, "the native smear method."Tapeworm eggs are transparent, have a rounded-elliptical shape, opalescent.
hymenolepiasis, koproovoskopiya, tapeworm egg
2) enrichment method (for Fyulleborna, Kalantaryan, Kato) is used in a weak invasion, when eggs in the stool a little.Sometimes, before the test is carried out training fenasala reception (detection is increased by 45-50%), but this drug is given only by the attending doctor.
In order to improve the quality of the therapy, as well as taking into account the peculiarities of the development cycle of the dwarf tapeworm need to know a few simple rules of treatment:
1) Cyclical ongoing therapy.Treatment involves only affects adults mature specimens from the patient, but did not act on larvae (cysticercoid) tapeworm.This feature requires a repeated treatment after 5-7 days.
2) preparatory stage before treatment .It is held in order to prevent the side effects of antiparasitic drugs autoinvaziya reduce the risk of (re self-infection).Appointed special easily digestible diet (Table 13 Pevzdneru) podlechivat comorbidities appointed intestinal adsorbents (laktofiltrum, filtrum, white carbon, enterosgel and others), add drugs to the liver (CARS gepabene, Essliver, Ovesol and others), drugs that regulatethe patient's chair.
3) recovery phase after the treatment.It is held in order to prevent the side effects of antiparasitic drugs autoinvaziya reduce the risk of (re self-infection).Continue receiving hepatic liver, appointed probiotic preparations (bifiform, linneks, Bion 3 Biovestin, bifidum fote and many others), drugs that regulate the chair and eliminating constipation - laxative (frutolaks, microlax, Normase, Duphalac and others).
4) To avoid the development of toxic and allergic reactions to receiving antiparasitic agents can appointment antihistamines (zirtek, zodak, tsetrin, Claritin, tavegil, erius and others).
5) Actually antiparasitic therapy is fenasalom.Held on 2 courses of 4 days with a 4-7 midnevnymi intervals.The daily dose is divided into four receiving and taking every 2 h.For example, the food - 8, 13, 18 hours and tablets - 10, 12, 14, 16 hours.Another option - a daily dose of 1 reception on an empty stomach for 1.5-2 hour before meals for two days in a row.The drug is given with 2hletnego age at a dose of 1 to 2 g depending on age.
Alternative regimen fenasala - 2hdnevnye courses in the amount of 6 to 4-5tidnevnym interval.treatment monitoring is carried out not earlier than 2 weeks after the treatment - examine the stool.
Clinical supervision for recover hymenolepiasis set for up to 6 months.At this time, 1 time per month spend koproovoskopiyu.On account of the patient is removed in the case of 6 negative results of stool examination.
- Preventive measures in children's groups (hygienic education of children, instilling sanitano and hygiene practices - washing hands after using the toilet and before eating, food culture education - Wash fruits and vegetables before eating).
- Regular wet processing in areas where there is a cluster of children and in the potential of the home, in other words to achieve a high level of health, the fight against flies and other insects and rodents.
- survey again entering preschool and school groups, as well as coming to work in these institutions (koproovoskopiya), planned examination of these categories of persons twice a year.
- Timely detection hymenolepiasis patients and their timely deworming.
infectious disease doctor Bykov NI