Fasciolosis ( Fasciola , liver fluke , fluke giant ) - Causes, Symptoms and Treatment .MF .
Fasciolosis - quite a dangerous disease that affects farm animals and inflicting great harm to livestock operations (destruction of livestock, loss of weight, a significant reduction in milk yields, etc.).However, it is quite a rare disease in humans, occurs more frequently in the form of isolated or sporadic cases in virtually all countries of the world.Parasitosis periodically registered in the Central Asia, Caucasus, Moldova, Belarus, France, Mexico, Peru, Chile, Cuba and many other countries.
Fasciolosis - biogelmintoz is caused by worms of Fasciola genus, mainly chronic course, with liver disease and gall bladder.
Causes fascioliasis fascioliasis
Activators are two representative types Plathelminthes (flat worms), Class Trematoda (Flukes), the genus Fasciola.This liver fluke (Fasciola hepatica) and a gigantic fluke (Fasciola gigantea).Fasciola have a flat body, various sizes: size hepatic Fasciola about 20-30 mm, a width of 10 mm and a giant - 10 mm, with 50-70 mm.The body has a tapered front p
mature individuals Fasciola
internal organs of the parasite have a branched structure.First, it is the sucking apparatus, comprising the oral sucker, predglotochnuyu cavity and pharynx.Next is a short section of the esophagus, rolling itself into two branched bowel loops.In the middle part of the body located Fasciola testes, which are also branched.Nearby are the ovary, uterus and vitellaria.Fasciola eggs have an oval shape, and they have F. gigantica more elongated, it has a yellowish-gold shell, consisting of 2 layers.egg size ranges from 120 to 145 microns 70-90, wherein at F. gigantica larger.
source of infection are the animal infestation.The final boss - herbivores (cattle - cows, bulls, horses, small cattle - goats, sheep).Man is also a definitive host.Parasite worms in the biliary tract of the definitive host for several years (up to 5 years or more).Intermediate host - freshwater clams (in particular, small truncatula).
infection mechanism - nutritional, and the way the food or water.Man is infected by eating infected wild plants (sorrel, wild onions, watercress - salad, green stuff), as well as raw water from stagnant ponds (ponds).Also, infection is possible when washing salad herbs fishpond waters.At the use of animal fascioliasis liver to the intestine transient fall eggs, which can not cause disease, however, may arise from the study of feces, so bowel movements are investigated repeatedly.
Fasciolosis, eggs F. hepatica
Susceptibility to fascioliasis general, most ill persons attending the freshwater collecting grass near water and to use it for food.Seasonality summer diseases.
development cycle Fasciola:
helminth eggs stand out definitive host of the parasite, and should fall into the water, which under favorable conditions (temperature of 22 to 29 ° C) there is a further development for approximately 18 days.Is detrimental to the development of the larvae affects both the low temperature (10 ° C and below), as well as high temperatures (30 and above).After 18 days in the light of the egg appears shaped larvae (miracidia) that floats freely in the water.Then miracidia is in the intermediate host - a small pond snail (Limnea truncatula), where the number of stages of development and in 30-70 days produced cercariae (tailed maggots) that come out of the mollusk.
Cercariae using the suction cups are attached to the plant and intsistitsiruyutsya (dropping tail, covered with a dense shell, which helps to survive).This stage is called adolescaria (invasive larva).Adolescariae perfectly preserved by the humidity (up to a year), but die quickly when dry (over several months).The final host body fall to the grass, or water, such as hay.Thus, the larva enters the lumen of the intestine.Then the bloodstream (hematogenous) gets to the liver and appears in the bile ducts, where the parasite.Also, the larvae can reach both places - the lungs, breast, skin.After 1.5-2 months from Fasciola formed hermaphrodite reproductive system.Only through 3-3.5 months parasitism Fasciola lay eggs (hermaphrodite reproductive system, but through cross-fertilization occurs).During parasitism mature individuals can defer up to 2 mln. Eggs.
Fasciolosis life cycle
Fasciola Pathogenic action on the human body
larva migrans Fasciola through the bloodstream (hematogenous) and fabric means: actively implemented through the peritoneum, Glisson capsule (fibrous capsule of the liver) and liver parenchyma.
In the early phase of the disease there is a toxic-allergic reaction to the body (allergic reactions);mechanical damage to the walls of the bile ducts of the parasite suckers (inflammation of the bile ducts);violation of the outflow of bile (stasis);attaching secondary microflora and consequently the occurrence of abscesses.
In the chronic phase may develop destructive changes of the liver tissue, the development of liver fibrosis with portal hypertension symptoms (edema, fluid in the abdomen, bleeding danger).
immunity after the disease produces durable, type-specific.
incubation period (the period from infection to onset of complaints) - 1-8 weeks after infestation.There are acute or early phase of the disease and the chronic phase.
In early stage disease is characterized by pronounced allergic reactions (rash, hives), weakness, malaise, fever up to 39-40 ° C, headaches, pain in the epigastric (stomach area) pain in the right upper quadrant (liver and projectiongallbladder), nausea, vomiting, jaundice (yellow whites of the eyes first, then the mucous membrane of the mouth, upper and lower extremities, trunk), hepatomegaly (enlargement of the liver), the density of its palpation (palpation), tenderness.There may be other toxic manifestations, such as heart disease: an increase in heart rate (heart rate), unstable high blood pressure, heart sounds when listening to muffled, rhythmic, the patient may complain of chest pain.Often the symptoms go away.The general analysis of blood - eosinophilia (80%), leukocytosis (20-50 * 109 / l), increased erythrocyte sedimentation rate.
Chronic phase develops in 1,5-2 months after infection.This phase fastcioleza characteristic development gastroduodenita (nausea, loss of appetite, pariodicheskie abdominal pain of different nature, unstable chair of mushy and watery to constipation), pain in the right upper quadrant paroxysmal character, the phenomena of cholestasis (yellowing of the mucous membranes and skin, itchy skin) and functionalliver disorders.On examination revealed dense, increased in size, painful liver.The biochemical blood tests: increased activity of blood enzymes - ALT, AST, alkaline phosphatase, GGT, total bilirubin can be increased both by indirect fraction and direct bilirubin, gradually emerging violations protein spectrum of blood, decreased albumin, increased gamma globulin.In general, the analysis of the blood in patients with chronic-phase increase in eosinophils weak (10%), anemia unexpressed.
Fasciolosis, Fasciola liver
angioholangit pyogenic liver abscess, jaundice, chronic cholecystitis, liver cirrhosis, possible lung damage, subcutaneous abscesses, lesions of the breast.
diagnosis is exposed on the basis of:
1) Epidemiological data (actual bathing or consumption of water from stagnant ponds, this water washing salad herbs, used unwashed salad herbs in food).
2) Clinical data (the acute phase of the disease or symptoms of the chronic phase of the parasitosis).
3) Laboratory diagnosis is based on the stage of the disease.In the early phase - koproovoskopiya difficult, since eggs are produced through 3-3.5 months, so the basic meaning acquire serological diagnostic methods, ie blood test for antibodies - Phragmites reaction ELISA.In the chronic phase - koproovoskopiya or duodenoovoskopiya (detection of Fasciola eggs in the feces and duodenal contents).Fecal (koproovoskopiya) doubly held in intervals of 7-10 days to avoid detection is not real eggs, and transient (when used fascioliasis liver canned, pastes).Before re-examination kalasubprodukty excluded from the diet.Studies carried out enrichment method (due to a small number of eggs).
Differential diagnosis is carried out with the following diseases: allergic reactions and
state, gastroduodenitis, hepatitis, cholecystitis, cholangitis, helminth infections of different etiology (opistorhoz, clonorchiasis, trichinosis), hepatic cirrhosis, and others.
Treatment of fascioliasis
1) Organizational and regime activities: hospitalization is necessary for early (acute) phase of fascioliasis.Ex chronic phase patients are treated as outpatients.
2) In the early phase of the disease prescribe antiparasitic treatment is prohibited in order to avoid deterioration of the patient's condition due to the massive release of Fasciola waste products at their destruction.In this phase of patient care is reduced to the appointment of pathogenetic and symptomatic therapy.Appointed enzyme preparations (mezim, Creon, mikrazim, enienzim and others), gepatoprotektory and cholagogue (CARS Essliver, Heptral, ursosan, ursofalk, hofitol, gepatrin, Ovesol and others), antihistamines (Zyrtec, zodak, tsetrin, Claritin, Aerius, tavegil and others), drugs affecting the intestinal motility (Duspatalin, Noshpa, Buscopan, etc.), probiotics (bifidum, florin forte, Biovestin, bifiform, linneks, Bion 3 yogulakt etc.), infusion detoxification therapy, if necessary, antibioticson the testimony and other groups of drugs may be needed.
3) Causal antiparasitic therapy is prescribed only when symptoms subside acute stage.Appointed hloksila - 0.1-0.15 g / kg / day, biltricid - 75 mg / kg.Treatment is carried out under the strict supervision of the attending physician.
treatment monitoring should be performed at 3 and 6 months, through the examination of feces and duodenal contents.
exposure, due infection such as a parasitic fascioliasis observe a number of rules:
- Avoid eating neprokipyachenoy water from stagnant ponds.If unable to boil, and the absence of other sources of drinking water - the water filtered through a cloth.
- Thoroughly wash all salad herbs with water, followed obdavaniem boiling water or blanch in boiling water before drinking a few minutes.
- Preventive maintenance is also reduced to the sanitary and veterinary measures (preventive deworming cattle eating hay to feed livestock is not earlier than 6 months after harvesting, changing pastures), anti-Anhui Conch in reservoirs.Also preventive measures include early detection and de-worming patients with fascioliasis.
infectious disease doctor Bykov NI