Opisthorchiasis( Vinogradov's disease) - Causes, symptoms and treatment. MF.

Opisthorchiasis is a natural focal biogelmintosis caused by a helminth of a cat litter( or it is also called a Siberian fluke).The disease is characterized by a predominant lesion of the liver, gallbladder and pancreas. Opisthorhozyavlyaetsya one of the most common parasitic diseases in Russia. For the first time opisthorchiasis was discovered in Siberia( 1884-91), Professor KNVinogradov first in cats, and later in humans - historical essays and explain the trivial names of the causative agent of the disease.

Cat's fluke is the causative agent of the opisthorchiasis

Causes of opisthorchiasis

The causative agent of the opisthorchiasis is of the type of flatworms, to the class of flukes( trematodes).The helminth form is leaf-shaped( 5-13 X 1-3 mm).Each sexually mature specimen contains about 1,000 eggs. Eggs are small, pale yellow, with a slight thickening at both poles. They get into the environment, remain on the ground for 10 days, in reservoirs - up to a year, and if they were swallowed by a fish - the flukes live in it for 2.5 years. For humans, the danger posed by infected shellfish and fish, because they are an intermediate host. When eating infected fish by a person, he becomes the ultimate master.

Causes of infection:

1. Eating weakly, slightly salted or undercooled, as well as fresh river freshwater fish( stroganina).
2. The source is a sick person or carrier, for example any carnivore - cats, foxes, dogs, arctic foxes. And also Pisces.
3. The risk of infection increases when it enters the natural endemic foci( Irtysh, Ob, Kama, Volga, Don, Western Siberia, Kazakhstan)

Symptoms of opisthorchiasis

Since the moment of entering the human body and the activation of harmful factors, the incubation period beginsabsence of symptoms, which lasts from 2 to 4 weeks from the time of infection. This period is due to the migration of larvae along the gastrointestinal tract to the small intestine and their gradual maturation, followed by the laying of eggs.

The early, or acute, phase of the opisthorchiasis lasts 3-5 months from the time of infection-this stage is characterized by manifestations of toxic-allergic reactions due to the products of the larval life and their decay, and is characterized by acute allergic manifestations( temperature increase, head / muscle and articularpain, itchy skin rash, asthmatic bronchitis, enlarged lymph nodes ).

As the larvae migrate and their toxic products accumulate, morpho-functional disorders occur with the primary lesion of target organs( liver, duodenum, bile ducts, pancreas), in the initial stages there will be increased vascular permeability, perivascular edemavessels), disruption of tissue nutrition - all this creates the conditions for the development of the next phase with functional disorders of the affected organs.

Late( chronic) phase of - as the swelling and mechanical blockage of the renal and hepatic ducts by helminth bodies increase, symptoms of pancreatitis, liver failure and gastrointestinal dysfunction will appear:

• Pankratit:
- shingles with irradiation in the left halfchest or shoulder,
- increased pancreatic size,
- symptoms of hyperglycemia( thirst, apathy, headache, frequent urination, etc).

• Liver insufficiency( damage to the hepatobiliary system):
- feeling of heaviness and raspiraniya in the epigastric region,
- loss of appetite, nausea and vomiting,
- pain in the right hypochondrium of various intensity,
- positive symptom of Georgievsky-Mussie( pain with pressure on thethe base of the right sternoclavicular muscle speaks of the defeat of the bile ducts),
- icteric( icterus) of the skin and sclera,
- pain in the right hypochondrium during palpation and in a free position( both by enlarging the liver,and due to dyskinesia biliary tract),
- symptoms of dyskinesia biliary tract( bitter taste in the mouth, belching, pain in the right upper quadrant after eating).

• Dysfunction of the gastrointestinal tract:
Is a consequence of enzymatic deficiency due to blockage of the excretory ducts of the pancreas and liver and leads to the following troubles:
- violation of the secretory and motor function of the stomach, duodenum;This is manifested by the alternation of diarrhea and constipation, in feces a person can detect streaks of undigested dietary fiber.
- pain of varying intensity, not associated with food intake, also nausea and vomiting, not associated with pain.

Diagnosis of opisthorchiasis

1. The main method is microscopic. With the help of it, it is possible to detect helminths in duodenal contents and feces.

2. Additional methods of examination: cholecystography, ultrasound, fibrogastoscopy, radiography of the stomach( to determine the ulcer niche with ulceration).With the help of these methods determine the degree of damage to target organs and the state of their compensation, because in the early stages, anatomical shifts can still not be detected, but in later stages cysts are detected both in the bile ducts and in the liver or pancreas itself, and a change in the tone of the gallbladder, pancreas.

3. Laboratory tests:
- General blood test( ↑ E - eosinophilia, anemia)
- Liver failure: ↑ direct fraction of bilirubin + ↑ α and Y globulins + change in sediment samples( sulphonic and thymol samples) + ↑ alkaline phosphatase) - all these changes will talk about liver decompensation.
- Enzymatic pancreatic insufficiency: fasting hyperglycemia( more than 6.8 mmol / l) + curve changes with sugar loading + ↑ amylase content in blood and urine + ↑ lipase and trypsin.

Treatment of opisthorchiasis

1. Nonspecific treatment: antispasmodics, cholagogue, antihistamine, table( diet) №5

2. Specific: Chloksil( total course 300mg / kg for 5 days ≈60mg / kg / day After 2 weeks, symptomsintoxication may increase due to mass death of helminths, therefore, symptomatic treatment is necessary. The drug can not be used in pregnancy, cardiac and hepatic insufficiency, compromised by other diseases, not opisthorchiasis).Prazikvantel 50-75 mg / kg / day for 3 doses during the day - treatment 1 day.

Features of nutrition during treatment:

diet number 5 includes the following principles. Fractional meals in small portions 6 times a day. It is allowed to use low-fat varieties of fish and meat in a boiled form without the addition of sharp / acidic and other sharp spices. Compotes, kissels. Soups with vegetable broth. Dairy products in limited quantities. Friable and semi-viscous cereals, pasta. Sugar, honey, jam.

It is forbidden: fatty, salty, spicy, alcoholic, fresh baked goods.

Complications of opisthorchiasis

On the part of the liver: a violation of pigment, protein metabolism and fat, a violation of the assimilation of vitamins, especially fat-soluble. Creation of predisposing factors to the development of liver cancer, the formation of cysts in the gallbladder, which can lead to the expiration of bile with the subsequent development of peritonitis, which without emergency assistance entails a fatal outcome.

From the side of the pancreas: development of type 2 diabetes with consequent consequences.

From the side of the stomach and intestines: gastritis and gastroduodenitis with risk of ulceration.

Prevention of opisthorchiasis

Sanitary-educational works, careful processing of fish. Boil and fry fish in small pieces for at least 20 minutes, bake for 60 minutes, dry for 3 weeks with a preliminary three-day salting.

Therapist doctor Shabanova I.Е.