• Strongyloidosis - Causes, symptoms and treatment. MF.

    Strongyloidosis is a fairly common human disease that occurs in many countries of the world with a humid climate, and has a certain infectiousness among people when the rules of personal hygiene are not respected, as can be observed with flares in boarding schools, psychiatric hospitals and other closed institutions. The urgency of strongyloidiasis has become high due to the frequency of its occurrence in HIV-infected patients.

    Strongyloidosis is a chronic course of geogelmintosis caused by intestinal ugliness, common in humans( anthroponosis) with a predominant lesion of the gastrointestinal tract and general allergic manifestations.

    Geographic spread of strongyloidiasis

    The disease is prevalent in countries with a fairly humid climate in both subtropical and tropical regions. This is North America, and South-East America, Europe, the countries of the former USSR - Moldova, Georgia, Ukraine, Azerbaijan and others.

    Causes of strongyloidiasis

    The causative agent is the intestinal ugliness -

    Strongyloides stercoralis, which is of the Nematode type( roundworms).This filamentous nematode, females from 1 mm to 2.2 mm in size, in males less - up to 0.7 mm. At the head end of the parasite is a mouth opening and lips. Sexual apparatus is paired. The acorns parasitize in the mucosa of the duodenum, the small and large intestine, and sometimes the stomach. Eggs of osier, oval, translucent, very small( up to 0.03 mm).Fertilized female can lay up to 50 eggs per day, which for further development should go out naturally( with feces) and then ripen in the environment.

    Strongyloidosis, egg of intestinal ugliness

    Development cycle: being optional( absolute) parasites, pathogens can develop entirely in the environment, sometimes partially or completely in the host organism. That is, they can parasitize, and can be free-living. Free-living helminths live in the soil. Under favorable conditions, larvae emerge from the eggs, which after moult turn into a matured individual. The maturation of some of the larvae goes along a different path, and during the moult they turn into filar-like larvae, after which the subsequent generation becomes parasitic( ie, the host's organism is necessary for their development).More often through the skin( percutaneous path), they penetrate into the host's body, then along the blood vessels, a small circle of blood circulation - into the lungs( moulting takes place, a new generation of parasites is created), adult individuals enter the larynx, then into the gastrointestinal tract. Ugric in the small intestine, in the same place lay eggs, from which there are larvae.

    Strongyloidosis, the development cycle of

    A person can get infected by the oral route, but then the larvae enter the mucous membrane of the oral cavity and again migrate, as in the percutaneous path before they enter the intestine. Migration of larvae regardless of the path of penetration takes from 17 to 27 days.

    Superinvasia is possible( some of the larvae are introduced into the intestinal mucosa) or autoinvasia( through the skin of the perianal region with combs).Some larvae with feces get into the external environment and then ripen along two paths. One female lays up to 50 mature eggs( optimal conditions - t = 10-40 °, humidity 18-20%).Up to the invasive stage, 1-2 days can develop, and persist in the soil up to 4 weeks.

    The source of infection is a sick person emitting parasite eggs to the environment.
    Mechanisms of infection:
    - percutaneous( transdermal, in which the larvae perforate the skin or penetrate through the
    sebaceous and sweat glands, hair follicles) and then enter the bloodstream and a small circle of circulation;dangerous walking barefoot, rest on the grass, agricultural work;
    - oral( transmission factors - water, food - vegetables, berries, fruits, eggs contaminated with
    - autoinvasion( molting of eggs in the intestine with the subsequent release of larvae and launch of the
    process of their development).

    Pathogenic action on the human body

    In the early( migratory) phase, the main moment of the pathological effect of the acne is the sensitization of the organism by the products of vital activity and helminth disintegration( allergic reactions) and the mechanical effect on tissues and organs during the migration of larvae. Numerous lesions of the intestinal wall cause an inflammatory reaction, infiltration of the wall by cells( mainly eosinophils), swelling of follicles, formation of granulomas. Erosions, ulcers, hemorrhages may form. Mesenteral lymph nodes increase. If you get into different organs, granulomas, abscesses, dystrophic changes can form. With a reduced resistance of the host organism( oncology, the use of cytostatics, immunosuppressants, GCS), generalization of infection with the development of a lethal outcome is possible. It is also possible to attach a secondary bacterial microflora. With severe immunodeficiencies( oncological diseases, AIDS stage in HIV infection), it is possible to develop a generalized form of parasitosis with the defeat of many organs and systems, including vital ones.

    The chronic phase of the disease manifests itself as a serious impairment of the function of the digestive system due to atrophy of the mucous membrane and digestive disorders, protein deficiency, pronounced loss of body weight, exhaustion.

    Strongyloidosis, intestinal acne

    Clinical symptoms of strongyloidiasis

    The incubation period( from the time of infection until the onset of the first symptoms) from 2-3 weeks to several years.

    The early phase is characterized by the absence of disease-specific symptoms. Characteristic development of allergic reactions. In patients,
    is a common asthenia( weakness, irritability, headaches, dizziness),
    febrile fever( temperature over 38 ° C), intoxication symptoms( sweating, chills, fatigue, dizziness and headaches),
    - pulmonary syndrome(bronchitis, pneumonia, volatile eosinophilic infiltrates),
    - the phenomena of acute gastroenteritis( liquid stool with mucus and unpleasant odor, nausea and vomiting), hepatomegaly( increase in liver size) with jaundice( first appears dark urine, then turns yellowsclera eyes, hands, torso, and then completely of course).

    The late stage( chronic), depending on the lesion of these or other organs, is divided into several forms:

    1) The gastrointestinal form of is manifested with a sharp onset with the development of gastritis( vomiting, nausea, abdominal pain), enteritis( liquid watery stools), enterocolitis( pain in the lower abdomen, lean chair with blood and mucus);can develop a peptic ulcer 12 duodenal ulcer, the phenomenon of dyskinesia biliary tract. The liquid stool may change with a tendency to constipation.

    2) The duodenal-choleretic form is characterized by pains in the abdomen of different intensity, mostly of a noisy nature, belching, bitterness in the mouth, loss of appetite, pain in the liver( right hypochondrium), nausea and vomiting. At examination( ultrasound, cholecystography) - some increase in liver size, gallbladder torsion, deformation of the gallbladder's shadow,

    3) Nervous-allergic form in the form of urticaria rash - urticaria, pruritus, astheno-neurotic syndrome( irritability, sweating, headachespain), myalgia( muscle pain), arthralgia( joint pain);with the percutaneous pathway of infection possible the development of allergic dermatitis. Skin manifestations are recorded several times a year without a tendency to cyclic.

    4) The pulmonary form of is associated with a lesion of the respiratory system of a different nature. YAshche is a "companion" of autoinvasion. Patients may experience coughing, shortness of breath, asthmatic breathing difficulties, and a temperature reaction.

    5) Mixed form of ( those or other manifestations).

    There are light, medium and heavy forms. In severe form, some complications may develop: ulcerative bowel lesions, ending with perforated peritonitis, parenchymal dystrophy of the liver, necrotizing pancreatitis.

    Diagnostics of strongyloidiasis

    Early diagnosis of strongyloidiasis presents certain difficulties. At clinico-epidemiological or "pre-laboratory" stage in the hands of the doctor only nonspecific complaints of the patient. However, in assessing complaints and primary blood tests, it is worth paying attention to a number of features:

    1) combination of various disorders of the digestive system with frequently repeated toxic-allergic reactions of the patient's body;
    2) follow the above-described complaints of high eosinophilia and ESR in the peripheral blood test. Strongyloidosis is characterized by eosinophilia: expressed in the early phase( up to 70-80%), leukocytosis, an increase in ESR to 40-60 mm / h.

    Differential diagnostics should be performed, first of all, with other helminthiases( in particular, ankylostomiasis, and others), as well as numerous diseases of the gastrointestinal tract of infectious and non-infectious nature( gastritis, peptic ulcer, gastroenteritis, enterocolitis, intestinal obstruction, Crohn's disease andothers).

    Laboratory diagnostics of strongyloidiasis:

    1) A general blood test will show high eosinophilia, especially in the early phase( up to 60-70%), an increase in ESR to 40-60 mm / h, leukosis.
    2) Coproonoscopy( detection of eggs and larvae in feces), duodenoscopy( detection of larvae in bile).Detection of larvae in freshly excreted feces and duodenal contents is carried out by the method of Kato and by the method of enrichment( Kalantaryan, Fulleborn) is problematic, since larvae often die. Therefore, in the analysis it is better to indicate: "Strongyloidosis examination", and the study will be carried out using the Bergman method( based on the movement of heat-loving larvae toward the heat side).You can take phlegm and urine for testing.
    3) Serological reactions( EIA, RIF) are used in practice a little.

    Treatment of strongyloidiasis

    Organizational-regime measures: due to the defeat of the gastrointestinal tract for treating patients with antiparasitic therapy, hospitalization in a hospital is indicated. Antiparasitic treatment includes the appointment:

    1) Mintezola( best) - with meals or 30 minutes after meals in 2-3 divided doses: children - 25 mg / kg / day, adults - 50 mg / kg / day for 2-3 days.
    + desensitizing therapy( zirtek, claritin and others).
    2) medamin - 100 mg / kg / day in 3 divided doses immediately after meals and wash down with a small amount of water.
    Alternative drugs - albendazole, vermox. Antiparasitic therapy has side effects and contraindications, therefore it is prescribed only by a doctor! Self-medication is contraindicated.
    For the purpose of detoxification, infusion therapy is prescribed.

    Control studies are conducted 2 weeks after the treatment 3 times with an interval of 2-3 days.

    Clinical follow-up is established during the year: during the first 6 months the patient is examined monthly, then for the next 6 months - quarterly. From the recording is removed after 3x negative samples.

    Strongyloidosis prophylaxis

    - Timely detection and treatment of patients with strongyloidiasis. Examination of risk groups: workers of agricultural institutions that have contact with soil and water;employees of greenhouse enterprises, miners, excavators, road construction workers, as well as the persons of their closed institutions( boarding schools, psychiatric hospitals, colonies).All these individuals are subject to periodic examination by the Bergman method on strongyloidiasis.
    - Personal prophylaxis of persons who have contact with the soil( prevention of contamination of soil by hands and mucous membranes, timely processing, exclusion from contaminated soil of vegetables, fruits, berries).
    - Sanitary improvement of settlements( scheduled cleaning of household toilets, timely disinfection of contaminated feces).Destructive to the larvae is boiling water, as well as bleach( 200 g per serving of stool for 1 hour).
    - Hygienic education of the younger generation.

    Doctor infectious diseases Bykova N.I.