Opistorkhoz – the gelmintny disease caused by flat helminths of a class of sosalshchik and proceeding with defeat of gepatopankreatobiliarny system. The current of an opistorkhoz is characterized by fever, belly-aches, appetite violation, skin rashes, jaundice, a gepatosplenomegaliya, dyspepsia, asthmatic bronchitis, an astenovegetativny syndrome. Diagnostics of an opistorkhoz is based on detection of eggs of opistorkhis in duodenal contents and in Calais, the results of serological reactions yielded biochemical blood test, tool researches (ultrasonography, holetsistokholangiografiya, KT). For therapy of an opistorkhoz bile-expelling and fermental medicines are used protivogelmintny (prazikvantet, azineconstruction Department).
Opistorkhoz – extra intestinal helminthosis from group of trematodoz which causative agents parasitize in bilious channels of a liver and a pancreas, causing polymorphic clinical manifestations. The most intense center of an opistorkhoz is located in the territory of Western Siberia, in lower reaches of the Irtysh River and the average Ob Current where the invazirovannost of local population approaches 80-90%. Besides, as areas, endemic on an opistorkhoza, serve basins of the Volga Rivers, Kama, Dnieper, Don, Yenisei, etc., mainly, connected with fishery and fish processing. The greatest incidence is registered among persons aged from 15 up to 50 years, mainly men. Danger of an opistorkhoz is that at a long current it increases risk of development of cancer of liver and a pancreatic cancer.
Reasons of an opistorkhoz
Opistorkhoz cause two types of helminths-sosalshchikov: Opisthorchis felineus and Opisthorchis viverrini. In the territory of Russia the felineus activator O. – the Siberian or cat's dvuustka is widespread. It is flat helminth 4-20 mm long, 1-4 mm wide, having the lanceolate body supplied with oral and belly suckers. Opistorkhoz called by O. viverrini meets in the countries of Southeast Asia.
Development of opistorkhis happens to triple change of owners: the first intermediate owner mollusks, as the second intermediate - fresh-water fishes of family of Karpov act (a bream, a sazan, a tench, Yelets, an ide, small fry, etc.) and to final - mammals (a cat, a dog, a fox, an otter, a polar fox, a sable, the person) eating fish. Final owners allocate eggs with larvae to the external environment together with excrements. Having got to a reservoir, eggs are swallowed by fresh-water mollusks of the sort Codiella in which organism undergo changes: at first leaves egg miratsidiya which consistently turns in a sporotsist, I thin also a tserkariya. The larva (tserkariya) having a tail leaves a body of a mollusk and in a reservoir is attached to Karpov' body of fishes, takes root into connecting and muscular tissue where it intsistirutsya, turning into metatserkary. Being in a body of fishes, in 6 weeks of a larva become invasive, i.e. gain ability to cause in final owners.
Infection of the person and animals occurs at the use invazirovanny, badly processed (crude, fresh-salted) fishes. In a GIT of the final owner under the influence of duodenal juice the capsule and covers of larvae are dissolved therefore metatserkariya migrate to the general bilious canal, intra hepatic bilious channels, and also to canals of a pancreas. In gepatopankreatobiliarny system in 3–4 weeks of metatserkariya turns into the mature opistorkhis capable to produce eggs. The full cycle of development of helminth from an egg stage to a polovozrely individual lasts 4–4,5 months. The Invazirovannost of the person of an opistorkhisama can vary from several units to tens of thousands. In an organism of the final owner the cat's dvuustka can parasitize 20-25 years.
Pathogenesis of an opistorkhoz
Character and expressiveness of the pathological processes characterizing a current of an opistorkhoz depend on massiveness and duration of an invasion, a condition of immune system. Depending on these factors the current of an opistorkhoz can be erased or manifest; easy, medium-weight and heavy. In pathogenesis of an opistorkhoz allocate early (sharp) and late (chronic) stages.
In a sharp stage of helminthosis the toksiko-allergic reactions developing in response to action of metabolites of parasites on the owner's organism dominate. They are followed by increase in permeability of a vascular wall, perivaskulyarny hypostasis and eozinofilny infiltration of a stroma of various bodies, formation of the necrotic centers in a liver parenchyma. Damage by sosalshchik of an epithelium of bilious channels causes a giperplaziya of scyphoid cages, cystous expansion of the small bilious courses. At a chronic opistorkhoz in walls of bilious channels the slow inflammation develops, growth of connecting fabric comes to light, quite often there is an obstruction helminths of small bilious channels. These processes lead to development of a secondary bacterial holangit, dyskinesia of biliary tract, formation of gallstones, in hard cases – to cirrhosis and portal hypertensia. Damages of a pancreas at an opistorkhoza are defined, mainly, by hypostasis of gland and violation of outflow of a pancreatic secret that is followed by clustery expansion of tubules, a proliferative kanalikulit and fibrosis of body.
Symptoms of an opistorkhoz
The sharp phase of an opistorkhoz demonstrates in 2-4 weeks after infection. The easy form of helminthosis begins with sudden jump of body temperature to 38 °C and the subsequent preservation of a subfebrilitet during within 1-2 weeks. At this time patients feel weakness, belly-aches, note unstable character of a chair. In peripheral blood at an easy current of an opistorkhoz comes to light moderated and an eozinofiliya to 15 - 20%.
The medium-weight form of an opistorkhoz proceeds with fever (to 39 °C and above) which lasts about 3 weeks. Mialgiya and artralgiya, urtikarny skin rashes, Qatar of the top airways, increase in a liver and spleen, vomiting, diarrhea, asthmatic bronchitis are characteristic. Accrue , the eozinofiliya to 25 - 60%, raises SOE.
Severe forms of a sharp opistorkhoz develop at 10 - 20% of patients and can proceed by tifopodobny, gastroenterokolitichesky, gepatokholangitichesky and respiratory options. The symptomatology of tifopodobny option of an opistorkhoz includes high fever, a fever, lymphadenitis, polymorphic skin rash, dyspepsia. In clinic the phenomena of intoxication and an allergization prevail; perhaps toksiko-allergic defeat of TsNS or myocardium. At a gastroenterokolitichesky form of an opistorkhoz the clinical and patomorfologichesky picture of gastritis (catarrhal, erosive), a gastroduodenita, stomach ulcer and a duodenum, an enterokolit develops. These states are followed by a loss of appetite, nausea, pains in an epigastriya and the right podreberye, diarrhea. During gepatokholangitichesky option of a sharp opistorkhoz jaundice, a gepatosplenomegaliya, an abdominal syndrome as hepatic colic or the surrounding character prevail. Pathological syndromes can include hepatitis, holangit, cholecystitis, pancreatitis. When involving respiratory organs (respiratory option of an opistorkhoz) tracheitis, astmoidny bronchitis, pneumonia, pleurisy, fever develops.
Chronic as dyskinesia of bilious ways, the holangiogepatita, a holangiokholetsistita, cholelithiasis, chronic pancreatitis, gastritis, a duodenit most often proceeds. Signs of an astenovegetativny syndrome take place: weakness, fatigue, irritability, emotional instability, a headache, a sleep disorder, the increased sweating. The dystrophic changes of a myocardium which are shown pains behind a breast, tachycardia, arterial hypotonia can develop. The long current of a chronic opistorkhoz can be complicated by cirrhosis, a purulent holangit, phlegmon of a gall bladder, bilious peritonitis, primary cancer of a liver and pancreas.
Diagnostics of an opistorkhoz
When performing diagnostics of an opistorkhoz the epidemiological data indicating stay of the patient in the endemic centers, consumption of the freshly frozen, light-salted, insufficiently thermally processed fish are considered. Change of biochemical tests of a liver and enzymes of a pancreas - increase in bilirubin, , amylases and lipases is characteristic. Data of tool researches (FGDS, ultrasonography of a gepatoduodenalny zone and a pancreas, the cholecystography, KT, MPT of a liver and biliary tract) find signs of a gastroduodenit, dyskinesia of biliary tract, cholecystitis, a holangit, hepatitis, pancreatitis.
For parasitological confirmation of an opistorkhoz the microscopic research of duodenal contents and a calla in which eggs of a cat's dvuustka are found is conducted. For increase in probability of detection of eggs of helminth before carrying out duodenal sounding and a koproovoskopiya it is expedient to appoint to the patient of a tyubazha across Demyanov and bile-expelling medicines. The immunofermental analysis allows to reveal protivoopistorkhozny antibodies in blood serum. In view of polymorphism of clinical symptoms the current of a sharp opistorkhoz can remind viral hepatitis, a food toksikoinfektion, diseases of tifoparatifozny group, a migratory phase of an askaridoz and an ankilostomidoz.
Treatment of an opistorkhoz
Treatment of an opistorkhoz is performed step by step. At the first stage the preparatory therapy including bile-expelling and spazmolitichesky medicines, blockers of H1-histamine receptors is appointed; according to indications – short courses of antibiotics. Except medicamentous therapy, physiotherapeutic treatment (an electrophoresis of sulfate magnesia, magnetotherapy, microwave therapy) is carried out. As the purpose of a preparatory stage serves normalization of a zhelchevydeleniye and outflow of bile, knocking over of inflammatory process in a GIT and biliary tract.
Within the main stage of treatment of an opistorkhoz the protivogelmintny chemotherapy is appointed. The greatest efficiency in extermination of parasites was proved prazikvantet also its analogs. After carrying out expulsion of helminths for evacuation of opistorkhis with bile blind sounding, pulse magnetotherapy, electrostimulation of a diafragmalny nerve is carried out. In case of the expressed toksiko-allergic syndrome purpose of antihistaminic medicines, glucocorticoids is required, to infusional therapy. Control of efficiency of antiparasitic treatment assumes carrying out a triple research of excrements and duodenal contents.
The final stage of a course of treatment of an opistorkhoz is directed to removal of products of disintegration of parasites and restoration of a biocenosis of intestines. Tyubazh with xylitol, sorbite, mineral water are for this purpose carried out; bile-expelling and fermental medicines, gepatoprotektor, sorbents, pre-and a probiotics are appointed.
Forecast and prevention of an opistorkhoz
At easy and medium-weight forms of an opistorkhoz forecast usually favorable, though chances of a repeated gelmintny invasion. When developing purulent cholecystitis and peritonitis the outcome depends on completeness and the speed of rendering the surgical help. Predictively development of an acute liver failure, cancer of a liver, pancreas or holangiokartsinoma is adverse.
Actions for prevention of infection opistorkhozy include treatment-and-prophylactic work (identification and expulsion of helminths of invazirovanny), epidemiological actions (protection of reservoirs against pollution by excrements of the person and animals, respect for technology of processing and preparation of fish, destruction of mollusks), sanitary and educational work (informing the population).