Helminthoses – the helminthic diseases caused by helminths – round and flat, more rare annulate and kolyuchegolovy helminths. The chronic current and system impact on an organism with development of abdominal, allergic, anemichesky syndromes, chronic toxicosis is characteristic of helminthoses; damages of lungs, liver, biliary tract, brain, organ of vision. In diagnosis of helminthoses methods are applied laboratory (gelmintoovoskopichesky, gelmintolarvoskopichesky, serological) and tool (X-ray, endoscopy, ultrasonography, etc.). Treatment of helminthoses depends on a species of a parasite and includes specific (protivogelmintny) and pathogenetic therapy.
Helminthoses – the helminthic invasions caused by different types of the lowest helminths - helminths. Helminthoses have the chronic current which is followed by exhaustion of an organism and decrease in its natural protective forces. In structure of helminthoses the leading places belong to an enterobioz, an askaridoz, an ankilostomoz, a trikhotsefalez and a toksokaroz. On official statistics, the invazirovannost of the population of Russia helminthoses makes 1-2%, however in certain regions it reaches 10% and more. The problem of growth of incidence of helminthoses is urgent not only for infectious diseases, but also pediatrics, therapy, surgery, gastroenterology, dermatology, allergology, urology and other practical medical directions.
Reasons of helminthoses
Today more than 250 causative agents of helminthoses at the person are known; them them about 50 types are most widespread. The helminths parasitizing in a human body are generally presented by roundworms (class Nematoda) and flat worms (a class of sosalshchik – Trematoda and tape-worms – Cestoidea); there is infection of the person with Annelidas (Annelida) and skrebnyam (Acanthocephala) less often. Pinworms, ascarids, trikhinella, treat representatives of roundworms; tape – bull, pork and dwarfish tapeworms, ekhinokokk, wide lentets; sosalshchik - cat's and hepatic dvuustka.
Life cycle of helminths includes stages of egg, larval and polovozrely forms. Depending on features of development of helminths and ways of infection helminthic diseases are divided into biohelminthoses, geohelminthoses and contagious (contact) helminthoses. Geohelminths are the majority of roundworms (nematodes). Stages of development of egg and a larva of geohelminths pass in the soil under certain temperature and moist conditions. Infection with geohelminthoses occurs at non-compliance with personal hygiene, consumption kontaminirovanny parasites of water, fruit, vegetables or contact with the soil polluted by excrements. Geohelminthoses include such helminthic diseases as , ankilostomidoza, , .
Sosalshchik (trematoda) and tape-worms (tsestoda), and also some types of nematodes belong to number of biohelminths. Change of one or two intermediate owners as whom fishes, Crustacea, mollusks, insects can act is necessary for them for achievement of an invasive stage. Causative agents of biohelminthoses get into a human body at consumption of the meat which did not undergo sufficient heat treatment or fish, drink of unboiled water. Representatives of biohelminthoses are , , , , , trichinosis, , echinococcosis. The invasions which are transferred from the person to the person at personal contact through the general objects of a toilet, ware, linen or by self-infection belong to contagious helminthoses. It , , , cysticercosis.
Classification of helminthoses
Helminthoses are classified depending on biological features of helminths, a way of existence in the external environment, ways of infection, dwelling in a human body. Taking into account biological characteristics of activators allocate nematodoza (, , , ankilostomidoza, , etc.); tsestodoza (, cysticercosis, , , echinococcosis); trematodoza (, , , ). On a way of existence of helminths in the environment distinguish geohelminthoses, biohelminthoses and contact helminthoses.
Infection with helminthoses can occur in the food, water, perkutanny way. Depending on localization of activators in a human body helminthoses are subdivided on intestinal and extra intestinal. In intestines of the person activators of an askaridoz, enterobioz, ankilostomidoz, trikhotsefalez, strongiloidoz, trikhostrongiloidoz, difillobotrioz, tenioz, teniarinkhoz, gimenolepidoz, etc. parasitize. Extra intestinal helminths can live in a liver, a gall bladder, vessels, hypodermic cellulose. Filyariatoza, , , , , , , trichinosis, , etc. belong to extra intestinal parazitoza. Besides, according to the localization principle, distinguish prosvetny (including intestinal) and fabric (skin and visceral) helminthoses.
Symptoms of helminthoses
The clinical picture of helminthoses very motley also consists of the general reaction of immune system in response to an invasion of parasites and organospetsifichesky defeats. During helminthoses allocate sharp or early (from 2-3 weeks to 2 months) and chronic phases (up to several years). The main pathological effects of helminths on a human body include toksiko-allergic reactions, mechanical damage of bodies and fabrics, an alimentary and vitamin deficiency, decrease in immunological competence.
In the sharp period of helminthosis the main manifestations are caused by toksiko-allergic influence of helminths on an organism. At patients fever, skin rash, muscular pains, a limfadenopatiya is noted. Often the abdominal syndrome (dyspepsia, belly-aches), a pulmonary syndrome (dry cough, a bronchospasm, short wind), a gepatoliyenalny syndrome (increase in a liver and spleen), an astenovegetativny syndrome (apathy, fatigue, sleep disorders, irritability) develops.
In a chronic phase of helminthosis the organospetsifichesky defeats caused, mainly, by a mechanical travmatization of the place of parasitizing of helminth prevail. So, dispepsichesky frustration and abdominal pains are defining during intestinal helminthoses. Violation of processes of absorption in intestines is followed by polyhypovitaminosis, the progressing decrease in body weight. As the frequent satellite of intestinal helminthosis serves iron deficiency anemia. At a massive helminthic invasion loss of a rectum, development of hemorrhagic colitis, intestinal impassability is possible.
In a chronic phase of the helminthoses proceeding with primary defeat of gepatobiliarny system there can be mechanical jaundice, hepatitis, cholecystitis, holangit, pancreatitis. In case of migration of pinworms at an enterobioza development of persistent vaginit, an endometritis, a salpingit is possible. The chronic stage of a strongiloidoz proceeds with formation of stomach ulcers and a 12-perstny gut. At trichinosis the cardiovascular system (myocarditis, heart failure), respiratory organs (bronchitis, bronchial pneumonia), TsNS (an encephalomeningitis, encephalomyelitis) can be surprised. Owing to an invasion filyariya of lymphatic vessels at a filyariatoza quite often develops limfangit, a limfedema of extremities with hypostasis of mammary glands and genitals. At an ekhonokokkoza there are cysts of a liver and lungs at which suppuration complications in the form of purulent peritonitis or pleurisy are possible.
Against the background of helminthoses at children and adults efficiency of preventive vaccination and a revaccination therefore the necessary protective level of immunity is not reached decreases. In the presence of associated diseases helminthoses alter and make heavier their current. Recovery (at natural death or exile of helminth) or the residual phenomena quite often with invalidiziruyushchy consequences can be an outcome of helminthosis.
Diagnosis of helminthoses
On the basis of kliniko-epidemiological data helminthoses are generally diagnosed already in a chronic stage. For identification of the causative agent of helminthosis special laboratory methods are used: mikrogelmintoskopichesky (scrape on ), gelmintoovoskopichesky (a research a calla on eggs of worms), gelmintolarvoskopichesky, serological (IFA, RIF, RSK, RNGA), a histologic koprologiya. As the studied material for detection of eggs, larvae or fragments of mature individuals of helminths excrements, the emetic masses, duodenal contents, a phlegm, urine, blood, skin bioptata, etc. can serve.
At intestinal helminthoses skin and allergic tests with anti-genes of helminths can be informative. For the purpose of identification and assessment of weight of organospetsifichesky defeats tool diagnostics is widely applied: Ultrasonography of a liver, pancreas, FGDS, kolonoskopiya, endoscopic biopsy, X-ray analysis and KT of internals, liver stsintigrafiya.
Treatment and prevention of helminthoses
Complete approach to treatment of helminthoses consists of performing etiotropny and posindromny therapy. Specific treatment assumes purpose of antigelmintny medicines taking into account a type of helminth and a stage of an invasion. For etiotropny therapy of helminthoses the following groups of medicines are used: protivonematodozny (, , befeniye , piperazin, pyranbodies, etc.), protivotsestodozny (, ), protivotrematodozny (tetrachlorethylene, hexachlorparaxylol, ), and also medicines of a broad spectrum of activity (, ). Efficiency of expulsion of helminths is estimated by results of repeated parasitological inspection.
At intestinal helminthoses antibacterial medicines, enterosorbents, enzymes, a probiotics, etc. are added to the main treatment. Symptomatic therapy of helminthoses can include purpose of antihistaminic medicines, intravenous infusions, vitamins, warm glycosides, NPVS, glucocorticoids. At echinococcosis as the main method of treatment of patients serves surgical intervention (liver cyst/abscess operations, an ekhinokokkektomiya).
Prevention of geohelminthoses is performed by hygienic education of the population, environmental protection from fecal pollution, instilling in children of rules of personal hygiene. In respect of the prevention of spread of biohelminthoses an important role is played by expulsion of helminths of pets, veterinary and health control of sale of meat production, careful heat treatment of meat and fish. In prevention of contact helminthoses major importance has a rupture of the mechanism of transfer of activators in organized, mainly nurseries, collectives. Performing seasonal medicamentous prevention of helminthoses in families (for example, albendazoly), regular parasitological inspection of children and risk groups is expedient.