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The opisthorchosis is an illness which is included into group of helminthoses. The illness affects a pancreas and a liver. The causative agent of an opisthorchosis is the parasite called by a fluke Siberian or cat's. This helminth parasitizes not only at the person, but also at animals – dogs, cats, and also at wildings. In an organism he lives in a gall bladder, a pancreas, a liver, zhelchevyvodyashchy ways.
Prevalence of an opisthorchosis
The centers of an opisthorchosis form owing to influence of different factors: this existence of reservoirs, their pollution by sewage, eating habits of the population (use of crude fish). The main part of an area of an opisthorchosis is in the modern world in the territory of Russia and Ukraine.
Specialists note that over the last ten years the quantity of cases of an invazirovannost of citizens considerably decreased. But nevertheless dynamics of incidence demonstrates that epidemiological surveillance has to be carried out without fail.
Infection with an opisthorchosis occurs from the infected person or an animal. Eggs of a parasite with a stake get to water. Further they are swallowed by snails where larvae and breed. After that in water there are larvae of a cercaria. In turn, they get into fishes, mainly cyprinid.
As a result of people and animals catch an opisthorchosis in the course of the use of fish. It is especially dangerous to eat the crude, dried, thermally badly processed fish who may contain invasive larvae of parasites. Most often infection with this disease occurs in the endemic center.
Metacercarias possess very high resilience: so, even at a temperature near — 40 °C they can remain till six o'clock. They have smaller stability to influence of high temperatures and salt.
After hit in a stomach there is a digestion of a capsule metatserkariyev. In turn, the larva breaks off a thin hyaline cover already in a duodenum. From a gut of a larva of a parasite get into bilious canals a gall bladder, and also into pancreat ducts. About 3-4 weeks of a metacercaria later already lay eggs. That is in general the development cycle of a parasite proceeds about four months. The invasion comes in an organism of the infected person only owing to repeated infections. Opistorkhisa can live for from 20 to 25.
If at the person the opisthorchosis takes place, symptoms of a disease begin to be shown during the period between the fifth and forty second day after infection with a disease. The illness can have the easy, average and heavy forms. The incubation interval at the same time to last about 21 days. As a rule, opistrokhoz begins sharply, in more exceptional cases the disease develops gradually. At the same time the patient complains of strong weakness, periodic perspiration, an indisposition. The further course of a disease passes mainly subclinically, symptoms are expressed a little. At the patient temperature, however rise, as a rule, small – to 38 °C can rise. If at the person the opisthorchosis is shown, symptoms can be expressed by an eosinophilia against a moderate leukocytosis.
However if the acute form of a disease takes place, then at a moderately severe opisthorchosis at the patient severe fever, increase of body temperature which can reach 39 — 39,5 °C is observed. These symptoms supplement also catarral phenomena of upper respiratory tracts. The eosinophilia and a leukocytosis accrues, moderate increase of SOE is observed.
Patients with an opisthorchosis of an easy and average form of weight note that one-two weeks later their state considerably improves. In this case the latent phase of an illness which is continued by already chronic disease takes place.
If the acute opisthorchosis is shown in a severe form, (approximately at 10 — 20% of people such course of a disease is noted), then the illness can have a number of variations. So, it is diagnosed typhus-like, gastro-enterokolitichesky gepatokholangiticheskiya options, and also illness option at which respiratory tracts are surprised. In the latter case the opisthorchosis is shown by bronchitis, pneumonia.
At a typhus-like form which often shows an opisthorchosis symptoms of a disease it is most expressed display the allergic nature of an acute phase of an illness. In this case the disease begins sharply, the patient suffers from sharp increase of body temperature, it shows a fever, rashes on integuments. Cardialgias at which on an ECG diffusion changes of a myocardium are noticeable are rather often noted, organism intoxication also takes place. The acute beginning of a disease, besides, in the first days is followed by a severe headache, weakness, mialgiya, the dispepsichesky phenomena. The person at the same time can suffer from cough and other symptoms characteristic of an allergy. Acute display of an opisthorchosis usually lasts about two weeks.
Severe fever, eosinophilia is characteristic of a gepatokholangitichesky form of a disease. Besides, there are signs of diffusion damage of a liver: at the patient the gepatosplenomegaliya, jaundice is shown, bilirubin level in blood increases, protein level increases. The patient is disturbed by pain: sometimes they remind hepatic colic, are in certain cases shown as aching and stupid. If the illness takes a severe form, display of pancreatitis and disturbance of functioning of a pancreas is possible. In this case there are dispepsichesky manifestations, pains of the surrounding character.
If the opisthorchosis is shown in gastroenterokolitichesky option, then the illness takes shape of erosive catarral gastritis, ulcer of a duodenum and stomach, a coloenteritis. In this case as characteristic symptoms pain in right hypochondrium, epigastriums takes place. The person is strongly disturbed by vomiting, nausea, appetite decreases, the chair is broken. At fibrescopic research erosive and hemorrhagic is observed gastroduodenit, and in some cases — ulcer niches. Intoxication and fever is more poorly expressed.
About one third of patients suffers from involvement in process of an illness of a respiratory organs that is shown by inflammatory processes in upper respiratory tracts, pleurisy, pneumonia, astmoidny bronchitis. At the person is present at this form of an opisthorchosis astheno - a vegetative syndrome which is shown by weakness, sleep disorders, fatigue, irritability.
Sometimes the acute stage of a disease has a long current: in that case fever can last about two months and even longer. At the same time at the patient there does not pass the pulmonary syndrome, and there are signs of damage of a liver. In the course of reduction of manifestations of an acute stage of an illness gradually general state is normalized, the form of an illness changes, passing into a chronic phase. Very often at the same time dyskinesia of bilious ways, chronic pancreatitis is shown, chronic holangiokholetsistit. Such phenomena, in turn, become the factor promoting accession of a consecutive bacterial infection. As a result at the patient defeat of gepatobiliarny system as a cholangiohepatitis at which the expressed pain syndrome, jaundice, increase in a liver takes place can develop. If the pancreas is surprised, at the person infected with an opisthorchosis pancreatitis is shown.
Owing to damage of a gastrointestinal tract rather often there is gastritis of chronic character, and also a duodenitis.
Sometimes patients complain of pain in heart, uneven pulse. Such phenomena are connected with existence of dystrophic changes of a myocardium. In development of a disease the hypophysis is oppressed and is exhausted.
The opisthorchosis at children is expressed, as a rule, benign, at the same time in an acute form the disease is shown much more less than at adults. At children aged from one till three years at a chronic phase of an illness lag in physical development, symptoms of dyskinesia of bilious ways is shown, the child badly eats. When the child matures, he more brightly shows a sensitization, at achievement of teenage age at the patient the pathology of bodies characteristic of adult patients already takes place.
Complications of an opisthorchosis
If the opisthorchosis proceeds in a severe form, then specialists speak about the heavy forecast and a possibility of complications. So, as complications of this illness cirrhosis, primary cancer of a liver and pancreas, bilious peritonitis can develop.
Also serious defeats of a nervous system are possible what display of a headache, sleeplessness, irritability, a depression testifies to.
Besides, infection with an opisthorchosis can aggravate a condition of the patients having other diseases, can badly influence pregnancy development, promote forming of a tifo-paratyphoid carriage. If the person repeatedly catches an opisthorchosis, then the course of an illness has the progressing character.
Diagnosis of an opisthorchosis
At an early stage of a disease it is very difficult to diagnose it, eggs of parasites both in bile, and in Calais it is possible to find only four-six weeks later. Therefore, "an acute opisthorchosis" the specialist makes the diagnosis, being guided by data of the epidemiological anamnesis, and also manifestation of the corresponding symptoms. So, existence of this illness can be assumed if the patient some time stayed in the center of distribution of an opisthorchosis and used the fish who is not processed thermally. Existence of a leukocytosis and an eosinophilia in a complex with the symptoms described above are also premises to statement of such diagnosis.
Also in view of high concentration of serumal specific immunoglobulins serological methods of diagnosis are sometimes applied. The diagnosis is confirmed on pro-procession about a month in case of detection of eggs of opistorkh.
In the course of diagnosis of a chronic phase of an opisthorchosis the parasitological method is applied: detection of eggs of parasites excrements of the patient or in duodenal contents is its cornerstone.
Treatment of an opisthorchosis
It is important that treatment of an opisthorchosis, both in chronic, and in acute phases, was complex. In this case it is necessary to combine methods of causal and pathogenetic treatment.
Treatment of an opisthorchosis takes place step by step: initially the doctor carries out the necessary preparation for therapy, reception of anthelmintic drug with parallel pathogenetic treatment follows further. The following stage – rehabilitation of the patient then it is left surely on dispensary accounting and control how effective was the carried-out treatment.
Patients at whom the acute phase of an opisthorchosis is observed need to carry out the therapy directed first of all to elimination of allergic reactions, and also to treatment of pathology of bodies, with them connected. In this case drugs with antihistaminic action (Suprastinum, a Dimedrol, tavegil), and also sedative drugs (drugs of bromine, a valerian) are appointed. Also the specialist appoints reception of means with antiinflammatory action.
However even after release from an invasion all functions of gepatobiliarny system are completely recovered not always. So, can take place of disturbance in work of a gastrointestinal tract, in microcirculation and in functioning of immune system. Therefore it is very important to carry out high-quality rehabilitation therapy. In this case the doctor appoints specific drugs and methods of treatment, being guided by exclusively individual condition of the patient. Special emphasis needs to be put on fortifying therapy, it is also necessary to receive medical treatment an opisthorchosis for drugs which improve a condition of zhelchevydelitelny system, treatment with use of physiotherapeutic procedures. It is also important to adhere to a diet which will be recommended by the attending physician.
For two months after the patient was written out from a hospital, it is recommended to do once a week tyubazh with sorbite with use of sulfate magnesia.
Medical examination duration after treatment is determined, being guided by that how heavy was the course of an illness. As a rule, the period of medical examination makes two-three years, and about one time in half a year examination of the patient is conducted.
Prevention of an opisthorchosis
It is necessary to apply an integrated approach to implementation of high-quality prevention of incidence of an opisthorchosis. First of all, timely detection infested and carrying out their deworming with the subsequent control of a state is very important. As sanitary and epidemiologic measures it is important to prevent infection of reservoirs with fecal pollution and to carefully control processing of fish who will be eaten.
Information on precautionary measures needs to be distributed among the population, it is especially important in the centers where the high level of infection with an opisthorchosis takes place.
Each person without fail has to follow all rules of preparation of fish dishes. So, it is necessary to cook fish not less than 20 minutes, to fry on a frying pan — not less than 15 minutes. The salted fish can be neutralized in the course of smoke-cured.
It is necessary to salt fish at a temperature of +16 — +20 °C for two weeks. At the same time it is necessary to use salt with an expense not less than 14% to the mass of fish. In canned food and smoke-cured fish cannot be viable metatserkariyev.
Section: Infectious diseases