Kapillyarioz – the helminthosis caused by roundworms (nematodes). Most often parasitic damage of intestines meets prevalence in clinic of a diarrheal syndrome. The damages of lungs and a liver which are shown fever, cough, icteric coloring of skin and a skler respectively are also possible. The only method of the confirming diagnostics is microscopic detection of the activator in Calais, a phlegm or a bioptata of hepatic fabric. Therapy of a parasitic infection consists from etiotropny (antigelmintny) and symptomatic (dezintoksikatsionny, spazmolitichesky, antihistaminic medicines) components.
Kapillyarioz treats the nematodoza affecting mainly small intestine of the person. For the first time causative agents of a disease (kapillyariya) were described in 1963 at the patient with a heavy enteropatiya. Philippines and Thailand are considered as the main areas of distribution, cases of a pulmonary kapillyarioz are recorded in the territory of the CIS and Europe, the hepatic form is registered in the USA, the countries of Africa and Asia. Men of middle age (30-39 years) are ill most often. Accurate seasonality of helminthosis is not described. There are assumptions that infection most often happens at fishermen, tourists and inhabitants of the coast because of contact with the infected lagunny fishes.
Reasons of a kapillyarioz
The causative agent of an infection – a roundworm a kapillyariya (types of Capillaria philippinensis, S. of aerophilia, C. hepatica) which adult individuals reach 2-4 mm. Sick people and animals (mammals, fishes) in whose organism there is a reproduction of a parasite can be sources of an infection. Getting to the environment with excrements, urine, vomiting, a phlegm, and also owing to decomposition of a body of an organism owner in case of natural or violent death, helminth eggs within 30-45 days turn into a larval form and keep viability over a year. Fishes and earthworms act as intermediate owners.
The way of infection mainly alimentary (dirty berries, vegetables and fruit), less often infection occurs by direct contact with the patient (at kisses, sneezing, cough, during the games and care of homeless and domestic cats and dogs). Risk groups are fishermen, employees of fish processing plants, the food industry, children, veterinarians, the staff of services on catching of homeless animals.
After hit in a human body of a larva settle mainly in a small (lean) intestine. Being attached to a mucous membrane, kapillyariya break natural absorption of nutrients, make the mechanical damaging impact, cause inflammatory changes of a mucous membrane. At hit in blood vessels of intestines helminths can spread on an organism, having tropism to hepatic and pulmonary fabrics. The caused necrotic changes in fabrics lead to malfunction of bodies; at a long invasion the damaged sites can be replaced with connecting fabric. Fibrous changes promote decrease in lightness of lungs and violation of gas exchange; in a liver process of a fibrozirovaniye reduces ability of body to regeneration, elimination of waste products and development of components of the curtailing system of blood.
Clinical classification of a kapillyarioz is based on division of a disease according to the struck body. Primary localization of helminth is digestive tract, as a result, perhaps classification of the given nematodoz on dehydration degree (the I-IV degrees: from moderate thirst to an anury). Allocate the following clinical forms of a disease:
- Intestinal. The most frequent localization of a parasite – a lean gut. In clinic the phenomena of the expressed gastroenteritis with resistance to reception of antidiarrheal means and a diet prevail. Temperature reaction of an organism usually within norm; weight loss is observed.
- Pulmonary. Proceeds with long fever and clinical displays of tracheitis, later – pneumonia. It is dangerous by possible infection of the larvae surrounding in view of high content and eggs of helminth in a phlegm.
- Hepatic. Seldom found, adverse form of a disease with a long subfebrilitet, increase of jaundice, formation of fibrosis of a liver and insufficiency of functions of body.
Symptoms of a kapillyarioz
The incubatory period of a nematodoz makes 1-6 months. The disease debuts from a loss of appetite, nausea, episodes of vomiting, weakness, unpleasant feelings in a stomach without accurate localization – rumbling, morbidity, a meteorizm. Through two and more than a week the plentiful liquid chair of watery character without pathological impurity appears, the frequency of acts of defecation can reach 10-20 and more per day. Patients lose weight, note emergence of hypostases, at a long current – thinning of a muscular layer (especially noticeable it becomes on extremities). Serve as terrible symptoms of dehydration dryness mucous, skin, nagging pains in gastrocnemius muscles, spasms of extremities, a voice osiplost, strong thirst, decrease in amount of urine.
At defeat of a respiratory path there is fever to 38 °C and more, pains behind a breast, dry rough cough, then the phlegm, attacks of shortage of air, short wind appears. Dangerous symptoms are , aggravation of short wind and increase in attacks of suffocation. Hepatic manifestations of a kapillyarioz – low long fever (to 37,5 °C), increase of icteric coloring of skin and mucous membranes, weight, pressure sense, a raspiraniye in the right podreberye, urine darkening, a loss of appetite, drowsiness. Urgent consultation of the doctor is necessary at complaints to severe headaches, change and violation of consciousness, a tremor of brushes, inversion of a dream, emergence of desnevy, nasal bleedings.
The complicated course of helminthosis most often arises among the persons who late asked for medical care, or self-medicating. At dehydration of the IV degree gipovolemichesky shock develops. The severe respiratory form of a kapillyarioz can be complicated by secondary bacterial purulent processes and sharp respiratory insufficiency. At damage of a liver the main hazard to life is posed by a liver failure, fibrous changes in a liver (up to a cirrhosis stage), hemorrhagic manifestations, hepatic encephalopathy.
At a stage of inspection consultations of the infectiologist, the therapist, the gastroenterologist, the hepatologist are obligatory; in the presence of symptoms of damage of lungs – the pulmonologist. Careful collecting the epidemiological anamnesis is necessary for narrowing of a circle of differential diagnostics. The diagnostic manipulations allowing to verify the diagnosis include:
- Objective survey. Fizikalny inspection can reveal increase in a liver and spleen, weakening of breath in lungs, obtusion of a perkutorny sound. There can be skin rashes of various character, jaundice, hypostases of extremities and the person, decrease in tendinous reflexes. At a palpation of a stomach also swelling, rumbling, diffusion or local morbidity is found. It is necessary to estimate the patient's chair (quantity, a consistence, availability of blood, pus, slime).
- Laboratory researches. The general blood test at this helminthosis shows (at the expense of an eozinofiliya), anemia, acceleration of SOE. Biochemical markers of a disease – increase in activity of ALT, nuclear heating plant, the general and direct bilirubin, decrease in the general protein, change of electrolytic composition of blood. Koprogramma shows existence of a kreatorea, biliverdin, a steatorea, extracellular (free) starch.
- Identification of infectious agents. The microscopy of excrements, phlegms, washouts from walls of a bronchial tree of the patient is carried out for identification of eggs of kapillyariya, larvae, adult helminths. At a research of a bioptat detection of mature individuals is possible. Serological diagnostics is not developed, IFA is carried out with anti-genes of other nematodes and parasites (a trikhinella, a vlasoglav, an ascarid, an ekhinokokk, a toksokara and others).
- Beam methods. At a X-ray analysis of lungs it is possible to find strengthening of the pulmonary drawing and focal blackouts. For the purpose of differential diagnostics liver RHPG, KT and MRT with contrasting can be appointed. Ultrasonography of an abdominal cavity reveals existence of local giperekhogenny educations in a liver with a diameter up to 1-2 mm, a gepatomegaliya, is more rare – increase in the sizes of a spleen.
- Biopsy. Carrying out a chreskozhny tonkoigolny punktsionny biopsy of a liver is shown at suspicion on defeat of this body and allows to investigate hepatic fabric on existence of a parasite. The intake of material is recommended to be carried out under OUSE control. The bronkhoskopiya with a biopsy of pulmonary fabric is less often applied.
Differential diagnostics is carried out with other helminthic invasions (, , , echinococcosis, ), viral hepatitises, tuberculosis, salmonellosis, food toksikoinfektion, flu, viral diarrheas, kriptosporidiozy, syphilis, chronic dermatitis, eczema, pancreatitis, chronic bronchitis, enteropatiya (Whipple's disease), fatty gepatoza, toxic hepatitises.
Treatment of a kapillyarioz
Patients with a heavy course of disease, a decompensation of chronic pathologies, children, pregnant women, and also the patients living in unsuccessful social conditions are subject to hospitalization. The main thing is compensation of losses of liquid and electrolytes – for the purpose of restoration of balance to the patient observance of the water mode is appointed. The diet at a kapillyarioza plays an important role, the sparing hypoallergenic food allows to reduce the damaging impact on intestines and a liver.
The bed rest is necessary before normalization of temperature within 1-2 days. As etiotropny therapy it is used and its analogs, mainly in the form of the tableted forms. Symptomatic treatment includes oral regidrant and infusion electrolytic solutions (disalt, , ), febrifugal (paracetamol), spazmolitik (), sorbents (polymethylsiloxanes polyhydrate, smektit), fermental (Pancreatinum) medicines.
Forecast and prevention
The forecast at timely detection of helminthosis and an initiation of treatment favorable. Lethal outcomes most often are registered at a hepatic form, a disease recurrence is possible. The intestinal form of a disease in the absence of treatment can end with the death of the patient in 2-3 months, at the expressed daily losses of liquid – within several days. Specific prevention of a kapillyarioz it is not developed. Nonspecific measures of prevention of infection are respect for personal hygiene, refusal of the use of dirty vegetables, fruit, dishes of doubtful preparation (street food), especially from crude fish. It is necessary to avoid contacts with homeless animals, after communication with pets, cleaning of their excrements obligatory washing of hands.