Opisthorchiasis ( Vinogradova disease) - Causes, Symptoms and Treatment .MF .
Opisthorchiasis - natural focal biogelmintoz caused by helminth cat fluke (or also called Siberian fluke).The disease is characterized by a primary lesion of the liver, gallbladder and pancreas.Opistorhozyavlyaetsya one of the most common parasitic diseases in Russia.Opistorhoz first was discovered in Siberia (1884-91), professor K.N.Vinogradovym first in cats and later in humans - historical essays and explain the trivial names of the causative agent.
Cat fluke of Opisthorchosis
of Opisthorchosis refers to a type of flatworm, to the class of flukes (trematodes).The form of the leaf helminth (5-13 x 1-3 mm).Each mature individuals contains about 1,000 eggs.Eggs fine, pale yellow, with a slight thickening at both poles.They're getting into the environment is stored in the soil for 10 days in the waters - up to a year, and if they managed to swallow the fish - it flukes live 2.5 years., Because they are the intermediate host for human contaminating shellfish and fish.When
Causes of infection:
1. Eating slaboprovyalennuyu, Salted or exposed to insufficient heat treatment, as raw river freshwater fish (steak).
2. Source - a sick person or carrier, for example, any carnivorous animal - cats, foxes, dogs, foxes.And Pisces.
3. The risk of infection increases when hit by natural endemic foci (Irtysh, Ob, Kama, Volga, Don, Western Siberia, Kazakhstan)
Since getting into the human body and as the activation of harmful factors, the incubation period begins- the absence of symptoms, which lasts from 2 to 4 weeks after infection.This period is due to migration of larvae through the gastrointestinal tract to the small intestine and the gradual maturation, followed by laying eggs.
early or acute phase of opisthorchiasis lasts 3-5 months after infection - this stage is characterized by manifestations of toxic and allergic reactions caused by the larvae of life products and their decay, and is characterized by an acute manifestation allergosis ( increase in temperature, headache / muscleand joint pain, itchy skin rash, asthmatic bronchitis, swollen lymph nodes ).
As larval migration and accumulation of toxic products, there are morphological and functional disorders with a primary lesion of target organs (liver, duodenum, bile duct, pancreas), in the initial stages will be increased vascular permeability, perivascular edema (iesome vessels), malnutrition fabrics - all this creates conditions for the development of the next phase with a functional impairment of the affected organs.
Late (chronic) phase - with the growth of edema and mechanical blockage of the renal and hepatic ducts bodies of worms, will manifest symptoms of pancreatitis, liver failure, and dysfunction of the gastrointestinal tract:
- the pain of herpes character radiatingin the left side of the chest or shoulder,
- an increase in the size of the pancreas,
- symptoms of hyperglycemia (thirst, lethargy, headache, frequent urination, etc.).
• liver failure (defeat gepatobiliarony system):
- a feeling of heaviness and fullness in the epigastric region,
- loss of appetite, nausea and vomiting,
- pain in the right upper quadrant of varying intensity,
- positive symptom of St. George-Musso (pain on pressureat the base of the right sterno-clavicular muscles tells of the defeat of bile ducts),
- ikterichnost (yellowness) of the skin and sclera,
- pain in the right upper quadrant palpation and free standing (as by increasing the liver, as well as due to biliary dyskinesia),
- biliary dyskinesia symptoms (bitter taste in the mouth, belching, pain in the right upper quadrant after a meal).
• dysfunction of the gastrointestinal tract:
is the result of enzymatic deficiency due to blockage of the excretory ducts of the pancreas and liver, and entails the following troubles:
- violation of the secretory and motor function of the stomach, duodenum;This is manifested by alternating diarrhea and constipation, fecal person can detect veins undigested dietary fiber.
- the pain of varying intensity, is not related to food intake, also nausea and vomiting, are not associated with pain.
1. Basic method - microscopic.With it manages to find some helminths in duodenal contents and feces.
2. Additional examination methods: cholecystography, ultrasound, fibrogastoskopiya, radiography of the stomach (peptic niche to determine if ulceration).Using these methods, determine the degree of organ damage and the condition of their compensation, because in the early stages still can not detect anatomical changes, but in the later stages and cysts detected in the bile ducts, and in most liver or pancreasand changing the tone of the gallbladder and pancreas.
3. Laboratory tests:
- Complete blood count (↑ E - eosinophilia, anemia)
- Hepatic insufficiency: ↑ direct bilirubin fraction + ↑ α and Y globulin + Change sedimentary samples (sublimate and thymol) + ↑ ALP (alkalinephosphatase) - all of these changes will be talking about hepatic decompensation.
- Enzyme pancreatic insufficiency: fasting hyperglycemia (more than 6,8mmol / l) + change curve when the load of sugar + ↑ amylase in blood and urine ↑ + lipase and trypsin.
1. Non-specific treatment: antispasmodic, cholagogue, antihistamines, table (diet) №5
2. Specific: hloksila (general course of 300 mg / kg for 5 days ≈60mg / kg / day after 2.weeks of intoxication symptoms may worsen due to the mass death of worms, so you need symptomatic treatment. The drug should not be during pregnancy, heart and liver failure, compromised by other diseases, not opisthorchiasis).Praziquantel 50-75 mg / kg / day for 3 admission during the day - treatment of day 1.
Feeding habits during treatment:
№5 diet encompasses the following principles.Fractional meals in small portions six times a day.Permission is granted to use low-fat varieties of fish and meat boiled without adding sharp / acidic and other sharp spices.Stewed fruit, jelly.Soups in the vegetable broth.Dairy products in limited quantities.Friable and semi-viscous cereals, pasta.Sugar, honey, jam.
prohibited: fatty, salty, spicy, alcohol, fresh baked goods.
Liver: violation of the pigment, protein and fat metabolism, malabsorption of vitamins, especially fat-soluble.Creating predisposing factors to the development of liver cancer, the formation of cysts in the gallbladder, which may lead to the expiration of the subsequent development of bile peritonitis without emergency entails lethal.
the part of the pancreas: the development of type 2 diabetes with its consequences.
the part of the stomach and intestines: gastritis and gastroduodenitis with the risk of ulceration.
health education, careful handling of fish.Cooking and frying fish should be small pieces of at least 20 minutes, bake for 60 minutes, jerk 3 weeks with a three-day pre-salt.
therapists Shabanova IE