Askaridoz – a helminthic disease as which etiologichesky agents roundworms – the ascarids parasitizing in a small intestine of the person act. The early phase of an askaridoz proceeds with the phenomena of a general malaise, fever, skin rash, a gepatosplenomegaliya, lymphadenitis, dry cough. In a chronic phase to the forefront there are symptoms of damage of a GIT: loss of appetite, nausea, diarrhea, belly-aches. For the purpose of identification of an askaridoz serological reactions, a research a calla on eggs of helminths are carried out. Therapy of an askaridoz is performed by antivermicular medicines (, decarice, pyranbodies); antihistaminic, fermental medicines, a probiotics are in addition appointed.
Askaridoz – intestinal , caused by an ascarid of human (Ascaris lumbricoides). Askaridoz is the widespread antroponozny helminthosis conceding on frequency only an enterobioza. The disease meets everywhere, in various climatic latitudes (except for zones of permafrost and dry deserts); strikes children (65%) more often. According to WHO, askaridozy about 1 billion people on the planet are infected; among the population of regions with a warm and humid climate comes to light in 30-90% of cases. In view of a high susceptibility of the population and possible risk of development of heavy, including surgical complications, is a subject of special attention of an infektsiologiya, parasitology, pediatrics.
Reasons of an askaridoz
The activator of an askaridoz - Ascaris lumbricoides (ascarid) belongs to a class of roundworms. Ascarids have the extended spindle-shaped form, flesh-colored color. Helminths are diclinous: length of a female of an ascarid makes 20-40 cm, a male - 15-25 cm, width – 4-6 mm. Daily polovozrely individual of an ascarid is capable to lay more than 200 thousand not invasive eggs which are allocated with excrements to the external environment. In the soil, under favorable temperature and moist conditions within 12-14 days there is a maturing of eggs to an invasive stage, i.e. to the state capable to cause a disease.
The person infected with helminths acts as a potential source of distribution of an askaridoz. The invasion is implemented by means of the fecal and oral mechanism, an alimentary way. It means that the eggs allocated to the external environment and ripened in the soil to an invasive stage get to an organism of the new owner through a mouth from dirty hands, use objects, and also at consumption of the polluted vegetables, berries, fruit etc. at non-compliance with measures of hygiene. Incidences askaridozy are subject children, workers of treatment facilities, agricultural workers, gardeners to a large extent, etc. The season of the increased danger of infection lasts from spring to fall.
Further development of ascarids happens in the owner's organism where pass early (migratory) and late (intestinal) askaridoz of a phase. In a GIT of the person, namely in a small intestine, eggs leave ascarid larvae which get into venous vessels, with current of blood get into a vorotny vein and further on blood vessels - in capillary network of lungs. There larvae get into alveoluses, tracheas and drinks rise in a gleam of bronchial tubes. Together with a bronchial secret and saliva they are swallowed and again come back to a small intestine where from them polovozrely individuals develop. The full cycle of transformation of invasive egg into a polovozrely ascarid makes about 2,5-3 months.
In an early phase of an askaridoz there is an organism sensitization products of metabolism of larvae, and also a mechanical travmatization of tissues of intestines, liver, vessels, bronchopulmonary system. In a late phase of an askaridoz toxic influence on an organism of waste products and disintegration of adult ascarids, a trauma of a small intestine, violation of absorption of nutrients, immunity suppression is more expressed.
Symptoms of an askaridoz
The clinical symptomatology of an askaridoz is various and depends on massiveness of an invasion, age of patients, a disease phase. The allergic, infectious and toxic, hepatic and pulmonary syndrome can develop in a phase of migration of larvae. This stage of an askaridoz at children quite often proceeds asymptomatically.
Allergic manifestations are characterized by vesicular or urtikarny rashes on a trunk, brushes or feet, a severe itch. The infectious and toxic syndrome at an askaridoza is followed by febrilny fever, weakness, an indisposition, perspiration, a limfadenopatiya. Increase in a liver and spleen, moderate morbidity in the right podreberye, increase in activity of hepatic enzymes and so forth can be signs of a hepatic syndrome. Practically in all cases the syndrome (eozinofilny pneumonia, Lyoffler's syndrome) develops in a migratory phase of an askaridoz bronchopulmonary. It proceeds with dry or damp cough, short wind, breast pains, rattles in lungs. Quite often on this background ekssudativny pleurisy develops. At a research of the pleural exudate received as a result of a torakotsentez in a large number eosinophils are found, it is rare – larvae of ascarids.
The late (intestinal) phase of an askaridoz is characterized by development of 2 clinical syndromes - gastrointestinalny and astenovegetativny. From a GIT during this period the loss of appetite, nausea in the mornings, vomiting, belly-aches, diarrhea, locks, an abdominal distension, loss of weight is noted. Toxic impact on nervous system can be shown by weakness, a sleep disorder, decrease in memory (at children – a delay of psychomotor development), the meningizm phenomena, epileptiformny spasms.
The massive helminthic invasion is capable to cause complications: so, at migration of ascarids mechanical jaundice can develop in bilious and pancreatic canals, purulent holangit, multiple abscesses of a liver, sharp pancreatitis, appendicitis, peritonitis. Development of the mechanical obstruction of airways by helminths leading to sharp askaridozny asphyxia is possible. At children it is most often burdened by intestinal impassability. Askaridoz at pregnant women promotes heavy toxicosis, a fruit arrest of development, the complicated course of childbirth and the postnatal period.
Diagnostics of an askaridoz
Complaints to inexplicable and persistent temperature, cough, skin rashes, disorders of digestion, weight loss, nervousness allow to suspect presence of an askaridoz at the child or the adult. Identification of antibodies in blood serum by means of the immuno-fermental analysis and reaction latex agglutination helps to distinguish a helminthic invasion in an early phase. Changes in the general blood test are characterized by the eozinofiliya raised by SOE, a small leykotsitoz, anemia. When carrying out a X-ray analysis of lungs so-called "flying infiltrates of Lyoffler" - the infiltration centers changing the situation together with the migrating larva are found in patients with a bronchopulmonary syndrome. At a microscopic research of a phlegm larvae of ascarids can be found.
In a chronic phase as the main method of diagnostics of an askaridoz serves the research a calla on eggs of helminths. However in such a way it is possible to reveal an invasion only 3 months later after infection. Considering probability of parasitizing only of males, and also nepolovozrely females or old individuals, eggs of helminths in excrements can be absent: in this case diagnostic expulsion of helminths is carried out. At a X-ray analysis of a small intestine against the background of contrast weight it is possible to see ascarids in the form of the light tapes or balls located in a gut gleam.
In an early phase it is necessary to distinguish from pneumonia, tuberculosis, lung cancer. In a chronic phase differential diagnostics, first of all, is required with duodenity, enteritis, cholecystitis and other diseases of a gastrointestinal tract.
Treatment and prevention of an askaridoz
Treatment of an askaridoz is carried out under control of the infectiologist (the children's infectiologist or the pediatrician) and it consists of organizational and regime actions, expulsion of helminths, dispensary observation and prevention of repeated infection. The general recommendations concern, mainly, observance of a diet with the increased content of vitamins, animal protein and restriction of carbohydrates.
Medicamentous therapy is carried out by protivogelmintny medicines from which in an early phase of an askaridoz are appointed or , and in intestinal – , pyranbodies, etc. For decrease in an allergization along with protivogelmintny medicines the short course of reception of antihistamines is recommended. For the purpose of normalization of digestive function enzymes (Pancreatinum) are used. Correction of intestinal microflora is carried out by means of pro-biotic medicines.
Control of efficiency of protivogelmintny therapy is exercised in 2 weeks and 1 month after a course of treatment is triple. For the patient who had askaridozy dispensary observation for a period of 3 years with an annual koproovoskopiya is established. Prevention of an askaridoz has to be directed to timely identification and expulsion of helminths of patients, hygienic education of children, increase in level of sanitary culture among adults. Respect for elementary standards of hygiene will help to avoid infection askaridozy: washing of hands before food, after the street, visit of a toilet; careful washing under flowing water of berries, fruit, vegetables before giving on a table. At an uncomplicated current of an askaridoz the forecast favorable. In case of lack of a repeated invasion approximately in a year there is a self-healing owing to natural death of ascarids. Complications develop rather seldom, mainly, at children and at the weakened patients.