And whether you know...
Opisthorchosis at children
The opisthorchosis is the disease which in essence is chronic helminthosis at which generally bilious courses of a liver and a pancreas are surprised. On medical statistics, in the world there are about 21 million people infected with opistorkha. The opisthorchosis is very eurysynusic among animals who eat mainly fish. However in the local centers the main source of infection is the person. The disease-producing factor is found in dogs, cats, wildings. The causative agent of an opisthorchosis – a parasite, which name a fluke Siberian, or cat's.
The illness is found in the countries of Europe, but most widely the opisthorchosis is widespread in Western Siberia and East Kazakhstan (the basin of Ob and Irtysh), and also in the territory of basins of other rivers, in particular, in the Dnieper basin.
As there is infection
The person catches a parasite during the use crude, dried, light-salted, fish who belongs to family of cyprinid. This is the bream, chebak, an ide, small fry, a sazan, etc. Also parasites can be given to the person from animals. But most often a source of infection is the person.
In some regions the indigenous people is infected with an opisthorchosis in 80-100% of cases. Such situation follows from traditions – the uses in food of the fish who is not processed thermally. In such regions already to eight-year age the illness affects practically all children. The mechanism of infection is similar to process of infection with an ascaridosis.
In the course of digestion of the infected fish in a stomach and a duodenum of the person there is a release of metacercarias from their covers. For several hours they move to the bilious intra hepatic courses. During movement the parasite allocates metabolites which toxic influence an organism. The children's opisthorchosis is shown clinically depending on that how massive was an invasion, how many years to the child, and also from the level of its immunity.
In development of a disease in an organism there are products of antibodies that, in turn, provokes allergic reaction. In a liver and a myocardium of the infected person there are dystrophic processes.
The opisthorchosis at children who live in the high-endemic centers of an invasion, as a rule, has a primary and chronic current. Where average endemicity takes place, opisthorchosis symptoms at children are shown sharply. It is more characteristic of children aged from 1 till 3 flyings. The acute form of an illness is shown by pain in epigastriums, in right hypochondrium, rashes on integuments, frustration of a chair, Qatar of upper respiratory tracts sometimes can. Temperature rises to 38 °C., at an acute form of a disease it can grow also to 39 — 39,5 °C. The liver increases, the lymphadenopathy, a hypoalbuminemia is shown. The blood picture changes. As a result, at such children lag in development is observed. Therefore treatment of an opisthorchosis at children has paramount value.
At children at 4-7-letnrem age allergic symptoms at infection with an opisthorchosis are shown more brightly. Symptoms of a disease at children of advanced age are expressed also: approximately in two-three weeks after a massive invasion at them fever, rash on skin, a pulmonary syndrome or pneumonia can be shown. Also expressed changes of a myocardium are noted. If the illness proceeds hard, at children allergic hepatitis of szheltukhy can develop. Development of acute manifestations happens gradually, their maximum manifestations are observed in 1-2 weeks.
At a chronic stage of a disease at children the expressed cholepathia is noted, the gastroenteropatichesky syndrome is less often noted, and at a third of children the asthenic syndrome is noted. As a result, children at younger school age develop physically more slowly, badly eat, they regularly observe frustration of a chair. They often note moderate increase in a liver without morbidity. At the same time there is a weight, pain in right hypochondrium, nausea, a small appetite as hypertensive dyskinesia of a gall bladder passes into hypotonic. Approximately by 15 years there is compensation of clinical manifestations of an invasion, at the teenager laboratory indicators are normalized. Normalization of a state is provided by immunity which is developed on antigens of a parasite by this time.
As complications of an illness bilious peritonitis, cirrhosis, primary pancreatic cancer and a liver can develop. Also existence of an opisthorchosis complicates treatment of the accompanying illnesses.
At development of an acute opisthorchosis in children it is accepted to distinguish the asymptomatic, erased and clinical forms of an illness which can have holangitichesky, typhus-like, gepatokholangitichesky, bronchopulmonary options. At a chronic opisthorchosis clinically expressed and latent forms of an illness are allocated. In such states the cholepathia and a gastroduodenopatiya can be observed. After the postponed viral infection at children with an opistorkhozny invasion cirrhosis can develop.
At typhus-like option the illness begins sharply, temperature sharply rises and the fever appears. Also the cardialgia, a lymphadenopathy, an enanthesis is noted. Often on an ECG existence of diffusion changes of a myocardium is noted. Patients complain of headaches. From the first days of an illness sharp weakness, cough, a mialgiya, and also other displays of an allergy is observed. Duration of acute manifestations – about two weeks.
At gepatokholangitichesky option severe fever, an eosinophilia, and also symptoms which demonstrate damages of a liver is observed: jaundice, increase of bilirubin in blood. Also symptoms of a golangiokholetsistit are shown. Generally it is the pain similar to hepatic colic. In hard cases the state is aggravated with symptoms of pancreatitis.
At gastroenterokolitichesky option clinical symptoms remind catarral ierozivny gastritis, a coloenteritis, a peptic ulcer. At the same time pain in right hypochondrium, epigastriums, nausea, loss of appetite disturbs.
At bronchopulmonary option a respiratory organs is involved in pathological process. At the same time at the person it is observed astheno - a vegetative syndrome which is shown by irritability, strong fatigue, sleep disorders.
Diagnosis of an acute opisthorchosis is carried out taking into account the epidemiological anamnesis (important to know whether the use in food of crude fish of family of cyprinid took place). Also the doctor considers a characteristic clinical picture, and also existence positive serological tests. It is important to consider that detection of eggs of opistorkhis in bile and excrements is possible not earlier, than in one and a half months after infection.
Diagnosis of a chronic opisthorchosis is made similarly on the basis of the epidemiological anamnesis and a characteristic clinical picture. In this case as confirmation of the diagnosis serves also identification in excrements and duodenal contents of the child of eggs of a parasite. Ultrasonic research at which dyskinesia of bilious ways of hypertensive type is found in children at younger school age is in addition conducted, and at the senior children dyskinesia of hypotonic type takes place.
Children's opisthorchosis in an acute stage it is necessary to treat so that first of all to remove displays of severe fever. Disintoxication therapy in the course of which antihistamines, calcium salts are appointed is initially carried out. If the illness proceeds hard, then reception of glucocorticoids practices. Also cardiovascular means are appointed.
At the second stage treatment practices prazikvantely (biltritsidy). This drug is an effective antigelmintik of a wide range which influences the majority of trematodes and cestodes. However it is necessary to consider that drug affects toxic internals, in particular a liver, a pancreas which already underwent defeat by an opisthorchosis. Therefore, after its reception there can be nausea, vomiting, diarrhea and other allergic manifestations.
In the course of treatment and the recovery period the diet in which the amount of the used fats, rough cellulose decreases is shown to the patient. Also reception of ascorbic acid is recommended to children.
In process treatment is important to control carefully as far as it is effective. For this purpose through three and in six months research of excrements and duodenal contents is made. If six months of egg of a parasite later are found, then therapy azinoksy practices. On dispensary observation children stay for three years after a last year of treatment. Also antiinflammatory drugs salicylates, Ascorutinum, Butadionum are appointed. At the same time the probability of development of vasculites is considered.
After infection relief of an organism children need rehabilitation treatment which is appointed taking into account specific features of the patient. These are fortifying drugs, carrying out physiotherapeutic procedures, good nutrition. The forecast of an opisthorchosis at children on condition of in time the made diagnosis and the correct treatment is favorable.
The main method of prevention of a children's opisthorchosis – the use in food of fish of family cyprinid only after heat treatment. In regions where the invasion is fixed, it is necessary to conduct the active hygienic education of adults directed to observance of rules of food by them. It is impossible to give to small children crude fish at all. It is important not to allow hits of sewage to basins of the rivers, to control whether fish who gets on productions or to a distribution network, parasites is infected. It is required to process correctly fish, to make hot smoking after a salting of fish. Does not contain in correctly processed fish and fish canned food of a metacercaria.
Section: Infectious diseases