Trichocephalosis ( whipworm ) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Parasitizing whipworm is an important aspect of the health problems of the working population due to the chronic course of the disease, significant intestinal damage and long term infestations - up to 5-6 years.Trihotsefaleze prevalence in our country most often affects the North Caucasus, the Central Black Earth and has the character of sporadic illness (flares).The number of cases in endemic areas trichocephalosis puts into second place after ascariasis in general nematosis list.

Trichuriasis - it geohelminthiasis, meets a man (anthroponosis), characterized by a chronic course with a primary lesion of the gastrointestinal tract (GIT), and toxic damage to the nervous system.

The disease is common in moist areas of temperate or subtropical climate.

Causes trihotsefaleze

The causative agent is a round worms - whipworm (Trichocephalus trichiuris).From the title, the front end of his thin, Trichomanes and rear thickened.Body Color helminth from grayish-white to reddish with transverse striations.The

female reaches a length of up to 30-55 cm, male - 30-45 cm in the male rear end is curved in the shape of a spiral.Whipworm We have a mouth, esophagus, intestinal tube and the anus.

Trichuriasis, male

whipworm whipworm eggs ovlnoy (barrel-shaped) shape, in color from light brown to yellowish, up to 23h54 m, there is a shell that protects against damage.

infection Source - people with faeces which are allocated parasite eggs in the environment.A person can be contagious for those who have close contact (family members).

mechanism of infection - fecal-oral.Infection occurs by ingestion of mature eggs whipworm.transfer factors may be dirty hands, fruits, berries, vegetables, herbs, contaminated soil or feces, without proper treatment (washing, heat treatment).

cycle of whipworm: when released into the gastrointestinal tract from the eggs into larvae, which the head end embedded in the mucous membrane of the small intestine and parasitic 3-10 days.Then the larvae go into the intestinal lumen and slide to the cecum, which is embedded in the mucous membrane again.At 30-40 days after ingestion of eggs larva reaches sexual maturity and begins to lay eggs.Adult parasites in the cecum and in adjacent parts of the colon.The female lays up to 3500 eggs per day, which in the faeces get into the environment, where under certain conditions (temperature, plus 26-30 ° C and high humidity of air and soil, the access of oxygen) occurs before an invasive larvae maturation stage (3-4 months).In the external environment, the eggs retain their viability and infectivity of up to 2 years.The lifespan of the parasite reaches 5 years.

Whipworm, development cycle

susceptibility of the population to trihotsefaleze general, but more often occur among children as well as persons decreed (in contact with the soil, workers housing and utilities, sewerage networks, gardeners and others).The most favorable period for the infection trihotsefaleze - end of March to the beginning of October.

Pathogenic action whipworm:

1) The main impact - is trauma of the intestinal mucosa (sometimes submucosal and muscle layer).Formed infiltration, hemorrhage, erosion, necrosis.Parasites release specific secret, making the mucous membrane cells in semi-liquid substrate, and eat them.By the process may start with the development of secondary microflora tiflita (inflammation of the cecum).Whipworm irritate nerve endings of the intestine, which leads to disruption of motility or intestinal motility throughout its duration.
2) Violation of the process of water absorption in the large intestine that leads to diarrhea (loose stool).
3) Allergic effects - sensitizing effects (the occurrence of allergic reactions due to the parasite metabolic products).Also whipworm toxins may affect several organs and systems, including the nervous system.
4) Whipworm - hematophagous damages the small vessels, therefore, when trihotsefaleze may develop iron deficiency anemia.

Whipworm on slizitoy shell bowel

Clinical symptoms trihotsefaleze

Symptoms depend on the intensity of infection.Sometimes the disease is asymptomatic.Most often the first signs occur in 1-1.5 months after infection (where the parasite reaches sexual maturity).Basically complaints associated with disorders of the gastrointestinal tract (poor appetite, nausea and sometimes vomiting, flatulence, diarrhea, abdominal pain, spastic (cramping) character in the right iliac fossa (the lower abdomen on the right), epigastric (stomach area) or withoutand localization).One of the symptoms is the constant violation of the chair (a long loose stools, do not respond to conventional means).

isolated typhlitis (segmental colitis or inflammation of the cecum) may occur when low intensity of infestation.At high intensity of infestation - heavy haemocolitis (chronic diarrhea with severe tenesmus (nagging pains and desires in a toilet), abdominal pain, loose bloody stools).Children may be rectal prolapse.

patients may also observe general weakness, insomnia, headaches, irritability and unmotivated aggression, weight loss, excessive salivation, decreased performance in children seizures, fainting.

Complications:

appendicitis, rectal prolapse.

Diagnostics trihotsefaleze

For diagnosis requires a number of important points:
1) Clinical data, similar to trihotsefaleze.Moreover, due to non-specific symptoms of the disease requires careful differential diagnosis.At the stage of preliminary diagnosis should be excluded: bacterial and viral gastroenteritis, enterocolitis, appendicitis, ascariasis, diphyllobothriasis and other helminth infections, acute intestinal pathology.
2) Epidemiological data (patient decreed belonging to a group of persons having contact with soil, workers housing and utilities, sewerage networks, gardeners and others).
3) Paraclinical methods: in the general analysis of blood: eosinophilia up to 10-20%, hypo- and normochromic anemia may be leukocytosis and increased ESR;- At small invasions - increase in activity of alkaline phosphatase and enterokinase more than 50% of patients.
4) Sigmoidoscopy or RRS: edematous mucosa, friable, hyperemic, infiltrated can be seen in her whipworms;
5) scatoscopy - whipworm eggs in the feces (for small infestations need to use enrichment techniques - Fyulleborna, Kalantaryan).

Trichuriasis, whipworm eggs

Treatment trihotsefaleze

1) Organizational-regime activities: treatment can be carried out both in the hospital and as outpatients.Indications for hospitalization may be severe concomitant diseases of the gastrointestinal tract, kidneys, liver and nervous system.The reason - the particular selection and prescribing these categories of patients with minimal consequences for the patient.

2) antiparasitic therapy: held mebendazole (Vermoxum) 200 mg / day for 3 days;can be administered kvantrel (combination telopara and kombantrina) 10-20 mg / kg every 2-3 days once the drug, as well as difezil (domestic product derived naftamona) appointed 1 time per day for an hour before a meal on an empty stomach: children up to 5 years - 25 g, more than 5 years and adults - 5 g per 5 days.

3) concomitant drug therapy: B vitamins, iron supplements, probiotics for intestine.Antispasmodics not prescribed to avoid possible trouble diagnosing appendicitis.
treatment monitoring is carried out using koproskopicheskih studies - 3-4 weeks after completion of treatment.In the absence of the effect - re-treatment is not earlier than after 2-3 months of another drug.

In respect of contact: 3-fold study of feces for the presence of whipworm eggs.Positive samples carried deworming.Without survey antiparasitic treatment of the patient's family members not appointed!

Clinical examination after the treatment is carried out for 2 years with a 3-fold study of feces in the spring and autumn of the patient and his family members.The family is considered microcenters, so medical examination is required.On account is removed in the absence of positive samples within 2 years from the date of treatment.

forecast

forecast generally favorable.When intense infestations develop complications (anemia, and others.)

Prevention trihotsefaleze

1) Strict observance of rules of personal hygiene (washing hands after using the toilet and before eating), thoroughly wash fruits and vegetables before eating, boiling water from open sources.
2) Regular inspection decreed trades persons (employees of housing and communal services, wastewater treatment plants, sewer networks, gardeners, florists and others).
3) Timely detection of patients with similar symptoms with trihotsefaleze.Their timely deworming and conduct of follow-up.

infectious disease doctor Bykov NI