Askaridoz - Causes, symptoms and treatment. MF.
Askaridoz is helminthiasis caused by human ascaris, with high susceptibility, ubiquity, with a predominant lesion of the digestive tract, the development of allergic reactions, the possibility of chronic course and the development of severe complications.
Askaridoz is a fairly widespread disease in the territory of Russia. On average, the incidence rate varies from 60 to 85 cases per 100 thousand population. The majority of cases of ascariasis are detected among urban residents( up to 60% in the general structure), among the age groups the child population predominates( up to 65% of patients).Geographically, the maximum incidence is recorded in the Far Eastern region( Sakhalin and Primorye).Increased morbidity was noted in the North-Caucasian and West-Siberian regions. Significantly lower than the average Russian level, the incidence of ascariasis in the Volga and Central Chernozem regions. According to WHO in the world ascarids infected more than 1 billion people.
The causative agent of ascariasis is of the type Roundworms, class Nematodes. This is a round helminth( Ascaris lumbricoides).Ascaris - a large parasite like a worm, elongated spindle-shaped, reddish-yellowish color, which after death becomes white. The female is broader and has a length of 20-40 cm, male 15-25 cm.
Eggs large oval in shape, with a hulled brown protein coat or a two-loop with a smooth, colorless shell.
Causes of infection with ascarids
The source of infection is a person. However, the patient does not present an immediate danger to others, since the eggs that he emits with feces must necessarily undergo maturation in the soil( that is why ascariasis is called geogelmintosis).Unripe eggs are excreted in the external environment with feces of the patient with ascariasis, where they mature for 10-40 days under certain conditions( t-30º, access O2, soil moisture content 8% and more).Eggs can remain in the soil for up to 7 years( thanks to a five-layer protein-lipid coat).
Infection of a healthy person occurs when ingrown mature eggs of ascaris( with contaminated berries, vegetables and fruits).In the small intestine larvae emerge from the eggs, which after about 3-4 hours pass through the intestinal mucosa, penetrate into the blood vessels and then enter the liver through the system of intestinal veins with blood flow;then through the lower vena cava are in the right heart and through the pulmonary artery penetrate into the lungs. In the lungs, larvae from the vessels penetrate the alveoli and through the tracheobronchial tree fall into the pharynx, swallow and mature in the small intestine to adult forms. This migration phase is 10-12 days. The interval from the swallowing of eggs to the development of sexually mature forms is about 8 weeks. Sexually mature female Ascaris lays up to 240,000 eggs a day. By the 7th month of parasitization, ovulation is complete, and egg release stops. In the absence of treatment, the life span of ascarids reaches 12-18 months.
The susceptibility of the population to ascariasis is high. Up to 80% of the population can fall ill in infected areas. This is due to the fact that the disease does not leave behind a persistent immunity.
Symptoms of ascaridosis( invasion of ascarids)
Allocate:
1) early( migration) phase of .The basis is an increase in the sensitivity of the organism to "foreign agents" products of metabolism and decay of larvae. Askerid allergens are among the most powerful parasitic allergens. There is also a toxic effect on the human body of the larvae themselves. When intensive infection is important, mechanical trauma to the intestine, blood vessels, liver, lungs.
and 2) the late( intestinal) phase of .In the late phase, the allergic mood of the body is weaker. Pathogenic effect is associated with the toxic effect of products of activity and decay in the death of adult ascarids. There are also mechanical injuries of adult parasites of the small intestine up to its through damage. Parasitizing ascaris leads to a deficiency of vitamins - pyridoxine( B6), retinol( A), ascorbic acid( C).Suppression of immunity under the action of ascarids was noted.
Symptoms of the early( migratory) phase of are diverse. Children often have this phase asymptomatically. At the expressed forms of the disease the following syndromes are characteristic:
1) acute infectious-toxic syndrome( high temperature up to 39-40 ° for 1-8 days, malaise, weakness, sweating, fatigue, decreased efficiency) in the first weeks after infection;
2) allergic syndrome( the appearance of a bubble rash on the trunk or only on the hands and feet, accompanied by severe itching);
3) in some patients hepatic syndrome may develop( moderate pain in the right hypochondrium, abdominal discomfort, liver enlargement, there may be changes in the biochemical blood test - increase in the level of hepatic enzymes ALT, AST, bilirubin);
4) is most characteristic for the early phase of broncho-pulmonary syndrome or so-called transitory pneumonitis( Löffler syndrome).The patient has a cough dry or with phlegm, in which there may be blood veins, complaints of shortness of breath, chest pains, dry or wet large bubbling rales, shortening of percussion sound when tapping lungs;may develop exudative pleurisy - in exudate: erythrocytes and eosinophils, in isolated cases of larvae.
On the chest X-ray: sites of infiltration( inflammation) 2-4 cm in size are eosinophilic infiltration. These foci change their location, since the larva moves, and in this connection was called the "flying infiltrates of Loeffler".Foci can disappear in 3-5 days, but sometimes can last up to 20-30 days. During this period, ascariasis should be distinguished from pneumonia, tuberculosis, and oncology.
The process of turning a larva into an adult determines the occurrence of symptoms of the late( intestinal) phase of .The patient has 2 syndromes: gastrointestinal( intestinal) and nervous.
Gastrointestinal syndrome is characterized by a decrease in appetite, nausea in the morning, vomiting, abdominal pain, stool disorder.
Nervous syndrome is characterized by poor health, sleep disturbance, headaches, decreased efficiency, fatigue. Psychomotor development is delayed in children, epileptiform seizures, the phenomena of meningism( pronounced headaches, nausea, vomiting, and neck pain) are sometimes recorded.
In all patients, even in cases without symptoms of the disease, weight loss is observed, sometimes even significantly.
Prognosis in most patients with timely treatment is favorable.
What symptoms should make you turn to a parasitologist( infectious disease specialist)?
Unexplained temperature and signs of intoxication without colds( without a cold and sore throat), an allergic reaction without a cause, the appearance on this background of cough and wheezing, digestive disorders( nausea, stool disorders like diarrhea and constipation, abdominal pain,bloating), general nervousness and irritability.
Diagnosis of ascaridosis
Diagnosis in acute phase
Confirmation: detection of ascarinic larvae by sputum microscopy. When examining blood for antibodies by ELISA and RLA: a positive reaction after 5-10 days from the time of infection.
UAC: eosinophilia( 20-40-60%), ESR increases to 50 mm / h, a small increase in leukocytes, may be anemia - a decrease in hemoglobin.
Diagnosis in the chronic phase of
1) detection of ascaris eggs in feces of the patient during microscopic examination( methods of Füllbörn, Kalantaryan, Krasilnikova, etc.);eggs in the feces will appear no earlier than 3-3,5 months after infection, sometimes helminths themselves.
It should also be borne in mind that when parasitizing in the intestine only males, old or immature female eggs in the study of feces may be absent. The maximum detection of infected individuals occurs in December-February;
2) in the general analysis of blood anemia - a decrease in hemoglobin, eosinophilia( in 20% of adults, in 60% of children), increased ESR;
3) during radiographic examination of the abdominal cavity: areas of enlightenment in the intestine( helminths located by tangles).
What should I do if I suspect of ascariasis?
At the exit of a mature person with feces, collect the helminth in a glassware and take it to a parasitological laboratory for a macro study( usually the direction the infectious diseaseist writes);Urgently go to a consultation with a parasitologist( infectious disease specialist) for further examination and treatment.
Treatment of ascaridosis
Organizational and Regime Activities:
1) Ascaridosis is treated at home or day hospital;patients with complications( often surgical) are subject to hospitalization;
2) diet therapy - table number 13( according to Pevzner) - appointed for the entire period of treatment and recovery. The diet is 4-5 times a day in small portions. There should not be long "hungry" intervals between meals.
General characteristics: - diet with energy value, reduced largely due to fats and carbohydrates, with a high content of vitamins
Chemical composition and energy value( daily ration): - proteins - 75-80 g( 60-70% animals);- fats - 60-70 g;- carbohydrates - 300-350 g;- energy value - 2200-2300 kcal
Recommended products and dishes:
wheat dried bread;
skimmed meat and fish broths, soups on vegetable broth, mucus broths from cereals;
low-fat meat, poultry, fish;
lactic acid drinks, cottage cheese;
rubbed porridge of rice, semolina and buckwheat groats;
potatoes, carrots, beets, cauliflower, ripe tomatoes;
ripe soft fruits and berries, broth of wild rose;sugar, honey, jam, jam, marmalade.
Excluded foods and dishes:
rye and any fresh bread, baking;
fat broths, cabbage soup, borsch;
fatty grades of meat, poultry, fish, sausage, smoked meat, salted fish, canned food;
whole milk and cream, fatty sour cream, cheeses;
millet, barley and barley cereals, pasta;
white cabbage, radish, radish, onion, garlic, cucumber, legumes;
fruits rich in fiber;
chocolate, cakes, cocoa
Medication for ascaridosis
1) Antiparasitic drugs: decaris( levamisole), vermox( mebendazole), nemozol( albendazole), pyrantel. Given the potential for side effects of dosing and treatment is prescribed only by a doctor. Self-administration of drugs can lead to a chronic course of the disease and the development of complications.
2) Enzymatic preparations( creon, mikrazim, hermital, mezim, pancreatin) in order to improve digestive function of the intestine.
3) Antihistamines( claritin, zirtek, zodak, erius, suprastin, tavegil) - are prescribed by a short course at the same time as antiparasitic drugs in order to avoid allergization during the destruction of the helminth.
4) Probiotics( bifystim, bifiform, linex, bifidum forte, etc.) for correction of normal intestinal microflora.
Complications of ascaridosis
In the intestinal phase, it is necessary to fear the development of serious complications for the health of the patient:
1) intestinal obstruction, which arises from the closure of the lumen of the intestine with the ball of ascarids. Intestinal obstruction with ascariasis is 3% of all cases of such complications.
1) peritonitis( as a result of the vital activity of adults, the integrity of the intestinal wall may be impaired).
3) Ascaridosis of the liver( creeping of ascaris into the bile ducts of the liver will lead to the development of mechanical jaundice).In the patient, dilating boring pain in the right hypochondrium, vomiting, jaundice, enlargement of the liver. It may develop purulent cholangitis or inflammation of the bile duct( due to attachment of the bacterial flora), which can lead to multiple liver abscesses.
4) ascariasis pancreatitis( migration of ascarids into the pancreatic duct leads to the development of acute pancreatitis).The patient has sharp pains in the abdomen, vomiting, there may be a collapse, an increase in urine diastase.
5) mechanical blockage of the respiratory tract( ascarids creep into the stomach, esophagus, oropharynx, respiratory tract, can cause filling of the lumen of the broncho-pulmonary tree, respiratory failure).
Follow-up and follow-up care
A control study of treatment effectiveness should be performed 2-3 weeks after treatment 3 consecutive days and again after 2 weeks also 3 consecutive days.
Dispensary follow-up of ill-fated ascariasis lasts 3 years with an annual feces inspection in an infectious disease specialist.
Prophylaxis of ascaridosis
One of the areas of prevention is the timely identification of patients and their treatment, care for places of congestion of children - loosening of sandboxes( ascaris eggs are killed by sunlight).
Preventive measures among the population are based on hygienic education of children and adolescents - adherence to personal hygiene rules: hand washing after toilet and before meals, washing hands after street, washing fruits, vegetables, berries.
The doctor infektsionist Bykova N.I.