Strongyloidosis - Causes, Symptoms and Treatment .MF .
Strongyloidiasis - a fairly common human disease, occurring in many countries with a humid climate, and having a certain infectiousness in people with non-observance of rules of personal hygiene, which can be seen in the outbreaks in boarding schools, psychiatric hospitals and other institutions closed.Urgency strongyloidiasis become high due to its frequency of occurrence in HIV-infected patients.
Strongyloidiasis - a chronically leaking geohelminthiasis caused intestinal ugritsey circulated among humans (anthroponosis) with a primary lesion of the gastrointestinal tract and general allergic reactions.
Geographical distribution strongyloidosis
disease has spread in countries with relatively humid climate as the subtropical and tropical regions.This and North America, and Southeast America, Europe, the former Soviet Union - Moldova, Georgia, Ukraine, Azerbaijan and others.
causative agent is Escherichia ugritsa - Strongyloides stercoralis, relating to the type of nematodes
Strongyloidiasis egg intestinal ugritsy
development cycle: being optional (absolute), parasites, pathogens can develop in an environment entirely, sometimes partially or completely in the host organism.That is, can parasitize or may be free-living.Free-worms live in the soil.Under favorable conditions the eggs into larvae, which molt after turning into mature individuals.Maturation of some larvae is on a different path, and in the process of molting, they turn into larvae fillyarievidnye then succeeding generation becomes parasitic (ie. E. For their development requires the host organism).Most transdermal (perkutantny path) occurs their penetration into the host, then the blood vessels, pulmonary circulation - lungs (where moulting occurs, a new generation of parasites), adults fall into the throat, and then the gastro-intestinal tract.Ugritsy They live in the small intestine, there lay eggs from which larvae emerge here.
Strongyloidiasis, development cycle
A person can be infected, and by the oral route, but then the larvae are introduced in the oral mucosa, and migrate again, as before when perkutantnom way than to get into the intestine.Migration larvae irrespective pathways takes 17 to 27 days.
possible superinvaziya (part larvae embedded in the intestinal mucosa) or autoinvaziya (through the perianal skin with scratching).Some of the larvae in the faeces get into the environment and more mature in two ways.One female lays up to 50 eggs mature (optimum conditions - t = 10-40 °, humidity 18-20%).Before invasive stage can develop 1-2 days, and survive in the soil for up to 4 weeks.
source of infection - a sick man, are excreted in the feces in the environment of the parasite eggs.
- perkutantny (transdermal, where the larvae pierce the skin or penetrate
sebaceous and sweat glands, hair follicles) and then getting into the bloodstream and the pulmonary circulation;dangerous to walk barefoot, relaxing on the grass, agricultural work;
- oral (transfer factors - water, food - vegetables, berries, fruits, eggs, contaminated
- autoinvaziya (molt eggs in the intestine with the subsequent release of the larvae and the launch
process of their development).
pathogenic effect on the human body in the early
(migratory) phase highlight the pathological action ugritsy is the sensitization of the organism waste products and the collapse of helminths (allergic reactions) and mechanical effects on tissues and organs during larval migration.Numerous damage the intestinal wall cause an inflammatory response, infiltration of the wall of cells (mostly eosinophils), swelling of the follicles, the formation of granulomas.May be formed erosion, ulcers, bleeding.Increased mesenteric lymph nodes.When injected into the various organs can form granulomas, abscesses, degenerative changes.With reduced resistance of the host organism (oncology, the use of cytotoxic drugs, immunosuppressants, corticosteroids) possible generalization of infection to death.It is also possible secondary bacterial microflora.When expressed immunodeficiencies (cancer, AIDS stage of HIV-infection) may develop a generalized form of parasitosis with a lesion of many organs and systems, including vital.
chronic phase of the disease is manifested serious dysfunction of the digestive system due to the atrophy of the mucosa, and digestive disorders, protein deficiency, severe weight loss, exhaustion.
Strongyloidiasis, intestinal ugritsa
Clinical symptoms of strongyloidiasis
The incubation period (time from infection to onset of symptoms) from 2-3 weeks to several years.
The early phase is characterized by the lack of specific symptoms.Characterized by the development of allergic reactions.In patients observed:
- general asthenia (weakness, irritability, headaches, dizziness),
- fever febrile nature (temperature over 38 °), intoxication symptoms (sweating, chills, fatigue, dizziness and headaches),
- pulmonary syndrome(bronchitis, pneumonia, volatile eosinophilic infiltration),
- the phenomenon of acute gastroenteritis (diarrhea with mucus and unpleasant smell, nausea and vomiting), hepatomegaly (enlarged liver), jaundice (first appears dark urine, then turn yellow sclera eyes, handsand then fully limbs and torso).
later stage (chronic), depending on the defeat of those or other bodies are divided into several forms:
1) Gastrointestinal manifested by acute onset with the development of gastritis (vomiting, nausea, abdominal pain), enteritis (loose, waterychair), enterocolitis (abdominal pain, scanty stool with blood and mucus);may develop a peptic ulcer 12 duodenal ulcer, biliary dyskinesia phenomenon.Loose stools can vary a tendency to constipation.
2) Duodo-zhelchnopuzyrnaya form is characterized by abdominal pain of varying intensity, predominantly aching, belching, feeling of bitterness in the mouth, loss of appetite, pain in the liver (right upper quadrant), nausea and vomiting.The examination (ultrasound, cholecystography) - a slight increase in liver size, torsion of the gallbladder, the shadow of the deformation of the gallbladder,
3) nervously-allergic form as urticaria - hives, itching, asthenic-neurotic syndrome (irritability, sweating,headaches), myalgia (muscular pain), arthralgia (joint pain);perkutantnom at ways of infection may develop allergic dermatitis.Cutaneous manifestations are recorded several times a year, with no tendency to recurrence.
4) pulmonary form associated with the respiratory system lesions of various kinds.Yaasche is a "companion" autoinvaziya.Patients can occur cough, shortness of breath, asthma attacks similar to breathing difficulties, temperature reaction.
5) mixed form (those or other manifestations).
There are mild, moderate, severe.In severe may develop some complications: ulcerative lesions of the intestine, ending perforated peritonitis, parenchymal liver, necrotic pancreatitis.
Early diagnosis of strongyloidiasis is certain difficulties.In clinical and epidemiological or "dolaboratornom" stage in the hands of the doctor only nonspecific complaints of the patient.However, when assessing the complaints and the initial blood test is necessary to pay attention to a number of features:
1) a combination of a variety of disorders of the digestive system with frequent toxic and allergic reactions of the patient;
2) support the above complaints and high eosinophilia in the peripheral blood ESR analysis.Eosinophilia is characteristic for strongyloidiasis: expressed in the early phase (70-80%), leukocytosis, increased erythrocyte sedimentation rate to 40-60 mm / h.
differential diagnosis should be done primarily with other helminth (and especially hookworm, and other), as well as many diseases of the gastrointestinal tract infectious and noninfectious nature (gastritis, peptic ulcer disease, gastroenteritis, enterocolitis, intestinal obstruction, Crohn's diseaseand others).
Laboratory diagnosis of strongyloidiasis:
1) Complete blood count shows a high eosinophilia, particularly in the early phase (60-70%), increase in ESR to 40-60 mm / h, leykotsioz.
2) Koproovoskopiya (detection of eggs and larvae in the faeces), duodenoscopy (detection of larvae in bile).Detection of larvae in freshly feces and duodenal contents spending by Kato and enrichment method (Kalantaryan, Fyulleborna) is problematic, because often the larvae are killed.Therefore, the analysis is better to specify: "Screening for strongyloidiasis," and a study will be conducted by Bergman (based on moving towards the larvae of thermophilic heat).You can pick up for sputum and urine.
3) Serological tests (ELISA RIF) little used in practice.
Organizational-regime activities: due to lesions of the gastrointestinal tract for the treatment of patients antiparasitic therapy, hospitalization in a hospital.Antiparasitic treatment includes appointment:
1) mintezola (best) - during a meal or within 30 minutes after a meal 2-3 hours: children - 25 mg / kg / day, adults - 50 mg / kg / daytechenie2-3 days.
+ desensitizing therapy (Zyrtec, Claritin and other).
2) medamin - 100 mg / kg / day in 3 divided doses after meals and washed down with a little water.
Alternative medicines - albendazole, Vermoxum.Antiparasitic therapy has side effects and contraindications, so just appointed a doctor!Self-medication is contraindicated.
the purpose of detoxification is assigned to infusion therapy.
Control studies conducted 2 weeks after treatment 3hkratno at intervals of 2-3 days.
Clinical supervision is established in the course of the year: during the first 6 months, the patient examined on a monthly basis, then for the next 6ti months - on a quarterly basis.On account removed after 3hkratnyh negative samples.
- Timely detection and treatment of strongyloidiasis.A survey of risk groups who have contact with the soil, water, workers of agricultural institutions;Workers greenhouse business enterprises, miners, diggers, road construction workers, and the exact same face of the closed type institutions (orphanages, psychiatric hospitals, prison).All these persons are subject to periodic inspection by Bergman on strongyloidiasis.
- Personal prevention of persons having contact with the soil (soil pollution prevention hands and mucous membranes, timely handling, an exception to the use of contaminated soil vegetables, fruits, berries).
- Sanitary settlements upgrading (routine cleaning of the yard toilets, timely disinfection of infected faeces).Ruinous effect on the larvae of boiling water and bleach (200 g per serving of bowel movements within 1 hour).
- Hygienic education of the younger generation.
infectious disease doctor Bykov NI