Trichocephalosis( withered) - Causes, symptoms and treatment. MF.

Parasitizing withered head is an important aspect of the health impairment of the working population due to the chronic course of the disease, significant intestinal damage and a long period of invasion - up to 5-6 years. The prevalence of trichocephalosis in our country affects more often the Northern Caucasus, the Central Chernozemye and is characterized by sporadic incidence( outbreaks).The number of cases in endemic areas puts trichocephalus in second place after ascariasis in the total list of nematodes.

Trichocephalus is geogelmintosis found in humans( anthroponosis), characterized by chronic course with a predominant lesion of the gastrointestinal tract( GI tract), as well as toxic damage to the nervous system.

Disease is common in humid areas of temperate or subtropical climate.

Causes of trichocephaliasis

The causative agent is the round helminth - withered head( Trichocephalus trichiuris).From the name, the anterior end of it is thin, hairy, and the posterior is thickened. The color of the helminth body from grayish-whitish to reddish with transverse striation. The female reaches a length of up to 30-55 cm, the male is 30-45 cm, in the male the posterior end is curved in the form of a spiral. The whipworm has a mouth, esophagus, intestinal tube and anus.

Trichocephalus, male whitewashed

Eggs of stilt-necked lamb( barrel-shaped), color from light brown to yellowish, up to 23x54 microns in size, there is a shell protecting from damage.

Source of infection is a person whose feces are secreted by the parasite's eggs in the environment. A person can be contagious for those who have close contact( family members).

The infection mechanism of is fecal-oral. Infection occurs when ingesting mature eggs of vaginal head. Transmission factors can be dirty hands, fruits, berries, vegetables, greens contaminated with soil or feces, without appropriate treatment( washing, heat treatment).

Cycle of development of whipworm: when entering the gastrointestinal tract, larvae emerge from the eggs, which are introduced into the mucosa of the small intestine by the head end and parasitize for 3-10 days. Then the larvae exit into the lumen of the intestine and slide to the cecum, where it again penetrates into the mucous membrane. On 30-40 days after ingestion of eggs, the larva reaches the sexually mature stage and starts laying eggs. Adult individuals parasitize the cecum and adjacent parts of the large intestine. The female lays up to 3.5 thousand eggs per day, which with faeces enter the external environment, where under certain conditions( temperature plus 26-30 ° C, high humidity of air and soil, access to oxygen), larvae mature to invasive stage( 3-4 months).In the external environment, eggs retain their viability and infectiousness up to 2 years. The lifespan of the parasite reaches 5 years.

Glossy, development cycle of

The susceptibility of the population to trichocephalosis is universal, but more often it is registered among children, as well as decreed persons( who have contact with the soil, workers in housing and communal services, sewer networks, truck farmers and others).The most favorable period for infection with trichocephalosis is late March to early October.

Pathogenic action of the whipworm:

1) The main effect is the trauma of the intestinal mucosa( sometimes the submucosa and the muscle layer).Infiltrates, hemorrhages, erosions, necrosis are formed. Parasites secrete a specific secret, turning cells of the mucous membrane into a semi-fluid substrate, and feed on them. Secondary microflora may develop with the development of tiflitis( inflammation of the caecum).Vlasoglavy irritate the nerve endings of the intestine, which leads to a violation of motility or peristalsis of the intestine throughout its extent.
2) Violation of the absorption of water in the large intestine, which leads to the appearance of diarrhea( liquid stool).
3) Allergic effect - sensitizing effect( occurrence of allergic reactions due to the products of vital activity of the parasite).Also, the toxins of the whipworm can affect a number of organs and systems, in particular the nervous system.
4) Vlasoglav - hematophag, damages small vessels, therefore, with trichocephalosis, iron deficiency anemia may develop.

Whitewater on the mucosa of the intestine

Clinical symptoms of trichocephalosis

Symptoms of the disease depend on the intensity of infection. Sometimes the disease is asymptomatic. Most often, the first signs appear 1-1.5 months after infection( when the parasites reach the sexually mature stage).Most complaints are related to disorders of the gastrointestinal tract( poor appetite, nausea, sometimes vomiting, flatulence, diarrhea, abdominal pain in a spastic( cramping) character in the right iliac region( lower abdomen on the right), epigastrium( stomach area) or withoutcertain localization).One of the permanent symptoms is a stool disorder( a prolonged liquid stool that is not docked by traditional means).

With low-intensity invasion, isolated tiflitis( segmental colitis or inflammation of the caecum) may occur. With high-intensity invasion - severe hemocolitis( chronic diarrhea with pronounced tenesmus( drawing pains and urge to the toilet), abdominal pain, liquid bloody stools).In children, there may be prolapse of the rectum.

Also, patients can note general weakness, sleep disorders, headaches, irritability and unmotivated aggression, weight loss, excessive salivation, decreased performance, children convulsive fits, fainting.

Complications:

appendicitis, prolapse of rectum.

Diagnosis of trichocephalus

A number of important points are required for the diagnosis:
1) Clinical data similar to trichocephalus. And due to nonspecific symptoms of the disease requires careful differential diagnosis. At the stage of preliminary diagnosis, it is necessary to exclude: bacterial and viral gastroenteritis, enterocolitis, appendicitis, ascariasis, diphyllobothriasis and other helminthiases, acute intestinal pathology.
2) Epidemiological data( the patient's belonging to the decreed group of people who have contact with the soil, workers of housing and communal services, sewer networks, truck farmers and others).
3) Paraclinical methods: in a general blood test: eosinophilia up to 10-20%, hypo- and normochromic anemia, may be leukocytosis and an increase in ESR;- with small invasions - an increase in the activity of enterokinase and alkaline phosphatase in more than 50% of patients.
4) Recto-rheumoscopy or RRS: mucous membrane edematous, loose, hyperemic, visible can be seen embedded in it whipworm;
5) Coproscopy - eggs of withered head in feces( for small invasions it is necessary to use methods of enrichment - Füllbörn, Kalantaryan).

Trichocephalosis, egg of the whip head

Treatment of trichocephalosis

1) Organizational-regime measures: treatment can be carried out both in a hospital and outpatient. Indications for hospitalization can serve as severe concomitant diseases of the gastrointestinal tract, kidney and liver, and the nervous system. The reason is the peculiarities of selecting and prescribing drugs for these categories of patients with minimal consequences for the patient.

2) Antiparasitic therapy: is performed by mebendazole( vermox) 200 mg / day for 3 days;can be assigned quantretrel( a combination of telopar and kombantinrin) 10-20 mg / kg of each drug once 2-3 days, as well as diphezil( a domestic drug, a derivative of naphthamone) is prescribed 1 time per day for an hour before meals on an empty stomach: children under 5 years - 2, 5 g, more than 5 years and adults - 5 g for 5 days.

3) Concomitant drug therapy: B vitamins, iron preparations, probiotics for the intestine. Spasmolytics are not prescribed to avoid the difficulty of diagnosing possible appendicitis.
Control of treatment is carried out with the help of co-proskating studies - 3-4 weeks after the end of the course of treatment. In the absence of effect - repeated treatment no earlier than in 2-3 months with another drug.

Regarding contact: 3-fold study of faeces for eggs with whiskers. With positive samples, deworming is carried out. Without examination, antiparasitic treatment is not prescribed for family members of the patient!

After the treatment, the examination 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 a microfight, therefore the medical examination is obligatory. From the account are removed in the absence of positive samples within 2 years from the moment of recovery.

Forecast

The forecast is generally favorable. With intensive invasion, complications develop( anemia, etc.).

Trichocephalus prophylaxis

1) Strict adherence to the rules of personal hygiene( washing hands after the toilet and before eating), thoroughly washing vegetables and fruits before consumption, boiling water from open sources.
2) Regular examination of persons of decreed professions( workers of housing and communal services, sewage treatment plants, sewer networks, truck farmers, flower gardeners and others).
3) Timely detection of patients with trichocephalus-like symptoms. Their timely de-worming and carrying out dispensary observation.

Physician infektsionist Bykova N.I.