Shistosomoz - the gelmintny disease caused by blood sosalshchikami-shistosoma; proceeding with toksiko-allergic reactions, damage of a GIT or urinogenital bodies. The sharp period of a shistosomoz is characterized by fever, papular rashes and an itch of integuments; cystitis, pyelonephritis, , a colpitis, prostatitis, an epididymite or colitis, a gepatosplenomegaliya, ascites can develop in a chronic stage. It is diagnosed thanks to detection of eggs of helminths in samples of urine or a calla, to carrying out a tsistoskopiya, urography. For treatment of a shistosomoz protivogelmintny means are used; according to indications surgical treatment is carried out.
Shistosomoz () – the trematodoza caused by helminths of the sort Schistosoma and including urinogenital, intestinal and Japanese shistosomoz. Helminthosis is widespread in the countries of Asia, Africa, Latin America. According to WHO statistics, 300 million people suffer from shistosomoza; annually 500 thousand residents of the endemic countries perish from this disease and its complications. Men catch shistosomozy 5 times more often than women. The chronic current of a shistosomoz leads to an invalidization of able-bodied population, and causes anemia, delay of physical and intellectual development in children. In view of specifics of a disease, except infectious diseases, the urology and gastroenterology is engaged in studying of a shistosomoz.
Reasons of a shistosomoz
The blood sosalshchik causing shistosomoza belong to the class Trematoda, the sort Schistosoma. These are flat diclinous helminths 4-20 mm long, 0,25 mm wide. On a body of helminth there are 2 suckers - oral and belly, located closely to each other. Females shistosy are longer and thinner than males. On a body of a male there is a longitudinal fillet (the ginekoformny channel) by means of which it holds a female. Eggs shistosy have diameter of 0,1 mm, the oval form and a big thorn on one of poles. In a human body several types shistosy can parasitize: S.haematobium (activator of an urinogenital shistosomoz), S.mansoni (activator of an intestinal shistosomoz), S.japonicum (activator of the Japanese shistosomoz), etc.
A final owner polovozrely shistosy and the tank of an infection is the person and mammals. In their organism shistosoma parasitize in small veins of a large intestine, an abdominal cavity, a small pelvis, a uterus, a bladder. Helminths eat blood, and also partially adsorb nutrients through a cuticle. The postponed shistosomam of egg migrate in a bladder or intestines where ripen and from where are brought with urine and a stake out of an organism. At hit in fresh-water reservoirs egg leaves a larval form of helminth – miratsidiya which further development demands presence of the intermediate owner – fresh-water mollusks. Having taken root into a body of a mollusk, miratsidiya are in it 4-8 weeks; during this time they undergo a cycle of asexual reproduction as a result of which larvae having a tail shistosy – a tserkariya are formed.
Invasive larvae leave again in water from where can get into a human body through the intact integuments or mucous membranes. Infection of the person shistosomozy can occur during bathing, an intake of water, washing of linen, watering of the earth, religious practices and so forth. By means of the emitted lytic enzymes and the active movement of a larva take root into capillaries of skin, a venula, reach the right departments of heart and pulmonary capillaries. In 5 days from the beginning of migration of a metatserkariya reach a portal vein and its hepatic branches, and in 3 weeks finally settle in duodenal, mezenterialny venous textures, bladder vessels. 2,5-3 months of a larva later turn in polovozrely shistosy and begin to lay eggs. Feature of parasitizing of activators of a shistosomoz is ability of eggs to get through a vascular wall, to leave in surrounding fabrics and a gleam of hollow bodies (intestines and a bladder) and already from there to be allocated to the external environment.
In the period of a migratory phase of larvae of manifestation of a shistosomoz are connected with destruction of small blood vessels, hemorrhagic reactions. Adjournment of eggs in a submucous, mucous or muscular layer of a bladder and walls of a mochetochnik causes specific inflammatory process with formation of harzial granulomas and ulcers, development of fibrosis and wrinkling of a bladder, calcification of eggs. Long existence of ulcer defects can lead to development of cancer of bladder. Intestinal is followed by harzial colitis from the outcome in a gut wall sclerosis; development of harzial appendicitis is possible.
Symptoms of a shistosomoz
During an urinogenital shistosomoz allocate sharp, chronic stages and a stage of an outcome. The sharp period of a disease on time coincides with a phase of migration of a larva on the blood course. At an early stage of a shistosomoz of patients allergic reactions as a small tortoiseshell, local hypostasis of skin disturb. Emergence of cough, a blood spitting, gepatosplenomegaliya, limfadenopatiya is possible. All-toxic symptoms include fever, a fever, perspiration, muscle and joints pain, a headache.
Several months later after an invasion passes into a chronic form which can have an easy, medium-weight and heavy current. At an easy form of a shistosomoz the health is not broken, working capacity remains, dizurichesky frustration are insignificant. Shistosomoz of average weight proceeds with distinctly expressed dizuriya, terminal (sometimes total) a gematuriya, increase in a liver and spleen, development of anemia. The heavy current of a shistosomoz is followed by frequent exacerbations of cystitis, pyelonephritis, formation of stones in mochetochnik and a bladder. Development of a colpitis, vaginal bleeding in women, an epididymite and prostatitis in men is possible. Late complications of a shistosomoz are infertility, striktura of a mochetochnik, , cirrhosis, HPN. Severe forms of an invasion lead to loss by patients of working capacity and can end letalno.
The early phase of an intestinal shistosomoz proceeds with the same clinical signs, as its urinogenital form (fever, an indisposition, artralgiya and mialgiya etc.). Pains in a stomach of the aching or skhvatkoobrazny character, a tenezma, the diarrhea with blood impurity alternating with locks are characteristic small appetite. In a late stage increase in a liver, portal hypertensia, ascites, gastrointestinal bleedings, pulmonary hypertensia and pulmonary heart develops. The clinic of the Japanese shistosomoz reminds an intestinal form (an allergy, colitis, hepatitis, cirrhosis), however symptoms are expressed more considerably.
Diagnostics of a shistosomoz
The main diagnostic data are obtained during the collecting the epidemiological anamnesis, the analysis of clinical manifestations, carrying out laboratory and tool researches. Except infectiologists, urologists and gastroenterologists can be involved in diagnostics of a shistosomoz. The fact of stay of the patient in the endemic center, a combination of toksiko-allergic symptoms to a dizuriya, a gematuriya, colitis has to cause vigilance of experts.
The crucial role in diagnostics of a shistosomoz belongs to detection of eggs shistosy at a research of urine and a calla. Standard techniques for identification of an urinogenital shistosomoz are methods of upholding, centrifugation or filtration of urine; intestinal - Kato's methods, Ritchi, sedimentation. In the general analysis of urine the gematuriya, a proteinuria, a leykotsituriya comes to light. Informatively carrying out a tsistoskopiya during which it is possible to find harzial granulomas and ulcers, polipoidny growths, congestions of eggs shistosy and also to carry out a biopsy of pathologically changed site of a bladder. Survey and excretory urography allow to see the calcification centers in a wall of a bladder or a mochetochnik, stones in kidneys, striktura of mochetochnik, hydronephrotic transformation of a kidney and so forth. At an intestinal shistosomoz the laparoscopy, a liver biopsy in addition can be carried out.
For preliminary diagnostics of a shistosomoz immunoassays - RSK, RNGA, IFA are used. At mass inspections of the population in endemic areas intracutaneous allergoproba with a harzial anti-gene are carried out. Urinogenital demands differentiation with an urolithic disease, bladder tuberculosis; intestinal – with amebiazy, a typhoid, dysentery, a colon cancer.
Treatment and prevention of a shistosomoz
Medicamentous therapy of a shistosomoz is effective in early stages, in the absence of complications; in the last cases quite often it is necessary to resort to surgical treatment. At all forms of a shistosomoz antigelmintny means can be used: prazikvantet, , . Success of the carried-out therapy is estimated on the basis of repeated gelmintologichesky researches and serological reactions. Surgical tactics usually is required at complications of an urinogenital shistosomoz and can include operations on mochetochnik (at development of a striktura), removal of stones from a bladder and kidneys.
At timely purpose of specific therapy forecast of an uncomplicated shistosomoz favorable. The long chronic course of helminthosis can result in disability and death of the patient from the developed complications. The package of measures for prevention of a shistosomoz includes processing of reservoirs for the purpose of extermination of Gastropoda of mollusks, active sanitary and educational work, timely identification and treatment of patients. The population of the endemic centers is recommended to boil or filter drinking water and economic needs, to use protective clothes (rubber gloves and boots) at contact with water.