Helminthiasis: causes, symptoms, diagnosis and treatment.
Helminthiasis is a disease of humans, animals and plants caused by parasitic worms (helminths).
Causes of helminthiasis
At present, more than 70 species of the 250 known worms live in the human body in Hungary. The most common are tapeworms (tapeworms, needles, trichinella, whipworms), tapeworms (swine, bovine and dwarf tapeworms, broad tapeworms, echinococcus), and tapeworms (liver and catworms).
Hem samples are characterized by developmental stages: eggs → larvae → mature forms.
Infection with helminth samples most commonly occurs after ingestion of their eggs and / or larvae. Depending on the mechanism of infection and transmission routes, helminthiasis can be divided into geohelminthiasis, biohelminthiasis, and contact helminthiasis. Geohelm samples develop without intermediate hosts, biohelm samples - with the successive changes of one, two or three hosts, contact helmets spread through contact.
Porcine tapeworms, bovine tapeworms, echinococcus, and other types of worms develop by sequential changes in one, two, or three hosts. Intermediate farmers can be fish, molluscs, crustaceans, insects. A person becomes infected with these helminths if they eat food that has not undergone a complete heat treatment:
- beef infected with the fins (larvae) of bovine tapeworms;
- swine fever worm affected by the Finns;
- lightly salted and raw fish with larvae of opisthorchis or broad tapeworm;
- raw water or vegetables, fruit processed with this water.
Vlasoglav, tapeworm, hookworm, necator develops without intermediate farmers. Eggs and larval forms of these parasites are excreted in the soil. If personal hygiene rules are not followed, they will break into the body of a new owner.
By contact - ie when a healthy person comes into personal contact with an infected person, when using common utensils, toiletries, bedding, inhaling dust in a room where the infected person is present - enterobiasis (pathogen - fungal worm) and hymenolepiasis (pathogen - dwarf tapeworm). Self-infection is common in enterobiasis.
Certain types of helminths parasitize certain organs and cause various helminthiasis:
- in the colon - pigs, cattle, dwarf tapeworms, nematodes (hookworms, spindleworms, strongyloids), needle worms, whipworms. From the intestinal cavity, tapeworm larvae can enter the bloodstream and spread throughout the body, settling in adipose tissue, isomers, ventricles, and the brain;
- in the liver and bile ducts - trematodes (opisthorchis, clonorchis, fasciola). Echinococcal cysts are found primarily in the liver, and after rupture, the daughter bubbles are found in the intestinal vein, peritoneum, spleen, and other organs;
- in the respiratory system - echinococcus, alveococcus, lung metastases that cause paragonimiasis;
- in the nervous system - schistosomiasis, paragonimiasis, echinococcosis and alveococcosis;
- in the organs of vision - oncocercosis, loiasis, complicated forms of teniasis;
- in the circulatory system - necatorosis, schistosomiasis, diphyllobothriasis;
- in the lymphatic system - filariasis, trichinosis;
- in the skin and subcutaneous tissue - the larval stage of hookworm, oncocercosis, loiasis, schistosomiasis;
- in the skeletal system - echinococcosis;
- skeletal muscle - trichinosis, muscle tissue cysticercosis.
The lifespan of worms in the body of the final host can vary depending on the type of parasite and can range from several weeks (pinworms) to several years (ribbons) and decades (fasciolae).
Classification of the disease
Humans are parasitized by two types of worms:
- Nemathelminthes, nematodes;
- The platelet samples are flatworms belonging to the class Cestoidea tapeworms, Trematoda.
Depending on the ways in which the parasites spread and the characteristics of their biology, the following are:
- contact helminthiasis.
Symptoms of helminthiasis
Helminths have a number of effects on the human body:
- antigenic effects in the development of local and general allergic reactions;
- toxic effect (waste products of helminths cause malaise, weakness, dyspeptic symptoms);
- traumatic effect (if the parasites are attached to the intestinal wall, the blood supply is disrupted by necrosis and subsequent atrophy of the mucosa; absorption processes can be disrupted; mechanical compression of tissues by intestinal worms);
- secondary inflammation due to bacterial infiltration after migrating larvae of helminths;
- violation of metabolic processes;
- anemia is absorbed by the absorption of blood by some helminths;
- neuro-reflex effect - irritation of nerve endings by helminths, bronchospasm, intestinal disorders, etc.
- psychogenic effects manifested in neurotic states, sleep disorders;
- immunosuppressive effect.
Helminthiasis is characterized by developmental stages. Each stage is characterized by clinical symptoms.
In the initial acute stage, helminths most often do not yet release eggs, the body becomes sensitized (antibody production, release of inflammatory mediators, increased vascular wall permeability) and traumas reach the organs through which the larvae migrate. Clinical signs may be absent, but in some cases the disease may present with severe clinical manifestations. The acute stage lasts 1-4 months, sometimes 8-10 months or more.
Patients' complaints in the acute stage:
- fever from a few days to two months (subfebrile or above 38ºС, accompanied by chills, severe weakness and sweating);
- itchy recurrent skin rash;
- local or generalized edema;
- enlargement of regional lymph nodes;
- muscle and joint pain;
- cough, asthma attacks, chest pain, prolonged catarrhal symptoms, bronchitis, bronchitis, symptoms simulating pneumonia, asthmatic syndrome, hemoptysis;
- abdominal pain, nausea, vomiting, stool disorders.
At the end of this stage of helminthiasis, the acute allergic phenomena gradually disappear and the clinic of the chronic stage has not yet had time to develop.
The acute phase passes into the subacute as the "young" helminths gradually reach. Then comes the chronic phase, which corresponds to the development of the parasites into mature individuals. etc. ), mechanical effects (ankylostomiasis, trichocephalosis, etc. ), mechanical effects (echinococcal cyst grows in the liver, compresses adjacent organs; cysticerci - in the liver) develops. brain), secondary inflammatory process (strongyloidiasis, duodenitis)), metabolic disorders (hypo- or avitaminosis), gastrointestinal dysfunction, secondary immunodeficiency, etc.
The symptoms depend on the size and number of organs in which the helminths parasitize.
Becauseintestinal helminthiasisthe following syndromes are typical:
- dyspeptic (abdominal discomfort, fullness after a meal, premature satiety, bloating, nausea);
- astenoneurotic (feeling very tired, increased nervous irritability and irritability).
Enterobiasis is characterized by nocturnal perianal pruritus. In the case of massive invasion, roundworms may have intestinal obstruction, inflammation of the pancreas, and obstructive jaundice.
Intestinal cestodiasis(for taeniarin, diphyllobothriasis, hymenolepiasis, teniosis and others) asymptomatic or with a small number of symptoms (symptoms of dyspepsia, pain, anemia).
Liver trematodesCauses (fascioliasis, opisthorchiasis, clonorchiasis):
- chronic inflammation of the pancreas;
- Neurological disorders.
Ankylostomiasisasthenovegetative syndrome (weakness, fatigue, pallor of the skin) due to the development of iron deficiency anemia.
Filariasis is characterized by allergic syndrome of varying severity and regional lymphadenitis.
Urogenital schistomiasismanifests in the appearance of blood at the very end of urination, a frequent urge to urinate, pain during urination.
Alveococcosis, cysticercosis, echinococcosismay be asymptomatic for a long time. At a later stage, the swelling or rupture of cysts containing parasites leads to anaphylactic shock, peritonitis, pleurisy, and other serious consequences.
For diseases caused by parasitic migratory larvaezoo patternswhen a person is not a natural farmer, to distinguish between skin and visceral shapes. The shape of the skin is caused by the penetration of some animal worms under the human skin: schistosomatids of waterfowl (trematodes), ankylostomatids of dogs and cats, strongylids (nematodes). When a person comes in contact with soil or water, helminth larvae penetrate the skin. There is a burning sensation, tingling or itching at the site of the helminth insertion. Signs of short-term fever and general malaise may occur. After 1-2 weeks (rarely 5-6 weeks) healing occurs.
The visceral shape is formed by swallowing helminth eggs with water and food. At the onset of the disease, you may feel unwell and have an allergic exanthema (skin rash). In the human gut, larvae emerge from the eggs of the intestinal worm, which penetrate the blood through the intestinal wall, reach the internal organs, where they grow and reach a diameter of 5-10 cm, compress the tissues and disrupt the functioning of the organs. When the larvae of tapeworms (cysticerci, cenura) are located in the membrane and material of the brain, headache, signs of cerebral hypertension, paresis and paralysis, epileptic seizures are observed. The larvae are found in the spinal cord, eyeball, serum membranes, intramuscular connective tissue, and so on.
Helminthiasis can result in complete recovery from the elimination of the intestinal worm or the development of irreversible changes in the host.
Diagnosis of helminthiasis
The diagnosis of helminthiasis is made on the basis of a series of complaints, information from the patient about the course of the disease, and data from laboratory and instrumental testing methods.
In the acute phase of helminthiasis, a blood reaction to the presence of an intestinal worm occurs in the body, so the following tests are recommended:
- clinical blood test: general analysis, leukoform, ESR (blood smear under microscope in the presence of abnormalities);
- blood chemistry:
- total protein, albumin, protein fractions;
- evaluation of renal function indicators (urea, creatinine, glomerular screening);
- assessment of liver function tests (bilirubin, ALT, AST, alkaline phosphatase);
- pancreatic alpha-amylase;
- carbohydrate metabolism assessment: glucose (in the blood), glucose tolerance test with determination of venous blood glucose on an empty stomach and 2 hours after exercise.
The following biological agents may be tested for the presence of intestinal worms: feces, blood, urine, duodenum, bile, sputum, muscle tissue, rectum, and perianal mucus.
As intestinal worms are not excreted in the faeces at any stage of their development, it is recommended that faeces be donated three to three times a day.
- Analysis of faeces for helminth eggs.
- Enterobiasis (pinworm eggs) analysis, swab.
- Stool microscopic examination for the presence of Enterobius vermicularis (pinworms) in enterobiasis.
- Analysis of enterobiasis (pinworm eggs), spatula.
- Analysis is required in case of suspicion of pinworms infection as well as in case of hospital treatment, medical book registration.
- Analyzes for kindergarten and school.
The children’s exam is designed to be successful before entering kindergarten or school. The results of these tests are required to obtain a medical certificate in accordance with Form 026U approved by the Ministry of Health of the Russian Federation.
Immunological tests are performed - determination of specific antibodies against helminths:
- antibodies to Ascaris IgG;
- anti-Echinococcus IgG;
- IgG class antibodies to toxocar antigens;
- Anti-Opisthorchis felineus IgG (antibodies of the IgG class against feline antigens);
- IgG class antibodies to trichinella antigens;
- antibodies against the anisakiasis pathogen (nematodes of the genus Anisakis), IgG;
- antibodies against IgG, the causative agent of clonorchiasis;
- Antibodies to Strongyloides stercoralis, the causative agent of strongyloidiasis, IgG.
The test for IgG antibodies against the causative agent of strongyloidiasis is used for the early serological diagnosis of strongyloidiasis when the disease is clinically suspected (eosinophilia, serpentine skin lesions, pulmonary or gastrointestinal symptoms).
In severe cases, the following tests may be recommended:
- smooth chest x-ray;
- complex ultrasound examination of the abdominal organs (liver, gallbladder, pancreas, spleen);
- CT of the abdominal cavity and retroperitoneal space;
- CT scan of the chest and mediastinum;
- CT scan of the brain and skull.
Which doctor to go to
If you suspect helminthiasis, you should contact a general practitioner or GP and a child - a pediatrician.
If surgical treatment is referred, the patient is referred to a surgeon.
Treatment of helminthiasis
Most patients with helminth infection do not require hospitalization. Patients with tissue helminthiasis, regardless of severity, and patients with severe and complicated disease are treated in hospital.
Therapy is with anthelmintic drugs. The frequency and dose of the drug depends on the age and weight of the patient and is determined by the doctor.
Detectable desensitizing, detoxifying therapy, vitamin therapy. To reduce the temperature, non-steroidal anti-inflammatory drugs are prescribed for allergic reactions and itching - antihistamines, severe edema - diuretics. In severe cases, hormonal medications are needed.
The presence of worms in organs and tissues may be an indication for surgical treatment.
- Bronchial asthma.
- Bowel cancer.
- Shrinkage of the liver.
- portal hypertension.
- Gastrointestinal bleeding.
- Liver abscess.
- allergic myocarditis.
- Chronic glomerulonephritis.
- Chronic kidney disease.
- haemostasis disorders.
- Loss of vision.
Prevention of helminthiasis
Preventive measures to prevent infection of helminth samples include:
- adherence to personal hygiene rules (use of personal towels, personal hygiene items and other everyday items);
- use only good quality water in everyday life;
- regular vaccination and deworming of pets;
- thorough washing of vegetables, fruits, berries before use;
- proper heat treatment of meat and fish products.
The information in this section should not be used for self-diagnosis or self-treatment. In the event of pain or other worsening of the disease, diagnostic tests should only be prescribed by your doctor. A doctor should be consulted for diagnosis and appropriate treatment.