Helminth disease (helminth infection): causes, symptoms, diagnosis and treatment methods.
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Helminths are diseases of humans, animals and plants caused by parasitic worms (helminths).
Cause of helminth disease
Currently, in our country more than 70 species out of 250 parasitic helminth species have been found in the human body.The most common are roundworms (roundworms, pinworms, trichinella, roundworms), tapeworms (pork, beef and dwarf tapeworms, broad tapeworms, echinococcus) and trematodes (liver and cat flukes).
Helminths are characterized by developmental stages: egg → larva → sexually mature form.
Helminth infections usually occur after their eggs and/or larvae enter the body.Depending on the mechanism of infection and transmission route, helminths are divided into: global helminths, biological helminths and contact helminths.Earthworms develop without an intermediate host, helminths develop by sequential changes of one, two or three hosts, helminths are transmitted by contact.
Pork tapeworms, beef tapeworms, Echinococcus tapeworms and other worms develop when there are successive changes of one, two or three hosts.Intermediate hosts can be fish, molluscs, crustaceans and insects.A person becomes infected with these types of helminths by eating food that has not been completely heat-treated:
- beef infected with beef tapeworm larvae;
- pork infected with Finnish tapeworm;
- raw and lightly salted fish with opisthorchis larvae or broad tapeworms;
- Raw water or vegetables are treated with this water.
Whipworms, roundworms, hookworms and roundworms develop without an intermediate host.Eggs and larval forms of these parasites enter the soil in feces.If personal hygiene rules are not followed, they will enter the body of a new host.
By contact - that is, through personal contact between a healthy person and an infected person, through the common use of utensils, toiletries, bed linen and through inhalation of dust in a room where an infected person is present - intestinal helminths (pathogen - pinworm) and pleurisy (pathogen - dwarf tapeworm) are transmitted.In the case of intestinal infections, autoinfection often occurs.
Helminths of a certain type parasitize certain organs, causing many different types of helminth diseases:
- in the large intestine - pork, beef, dwarf tapeworms, nematodes (hookworms, roundworms, strongyloides), pinworms, whipworms.From the intestinal lumen, pork tapeworm larvae can enter the bloodstream and spread throughout the body, depositing in fatty tissue, muscle vessels, eye chambers, and brain;
- in the liver and biliary tract - trematodes (opisthorchis, clonorchis, fasciola).Echinococcal cysts are mainly located in the liver, and after rupture, daughter vesicles can be found in the mesentery, peritoneum, spleen, and other organs;
- in the respiratory organs - echinococci, alveococci, lung flukes, causing paragonimiasis;
- in the nervous system - schistosomiasis, paragonimiasis, echinococcosis and alveolar disease;
- in the organs of vision - cancer, ulcerative diseases, complicated forms of tapeworm disease;
- in the circulatory system - necrosis, schistosomiasis, diphtheria;
- in the lymphatic system - filariasis, trichinosis;
- in the skin and subcutaneous tissue - hookworm, ascariasis, ulcerative disease, larval stage of schistosomiasis;
- in the skeletal system - echinococcosis;
- in skeletal muscles - trichinosis, myofibromatosis.
The lifespan of helminths in the body of the final host can vary, depending on the type of parasite, and ranges from weeks (pinworms) to years (tapeworms) and decades (tapeworms).
Disease classification
There are two types of parasitic worms in humans:
- Nemathelminthes – roundworm, class Nematoda;
- Plathelminthes is a species of flatworm, including class Cestoidea - tapeworms, Trematoda - class trematodes.
Depending on the route of spread of parasites and their biological characteristics, they are distinguished:
- biological helminths;
- geohelminthiase;
- contact helminth infection.
Symptoms of helminths
Helminths have different effects on the human body:
- antigenic effect, when local and general allergic reactions develop;
- toxic effects (worm waste causes discomfort, weakness, indigestion);
- traumatic effects (when parasites fixate on the intestinal wall, blood supply is interrupted, leading to necrosis and subsequent atrophy of the mucous membrane; absorption processes may be disrupted; mechanical compression of tissues by helminths);
- secondary inflammation due to bacterial invasion after migration of worm larvae;
- violation of metabolic processes;
- due to the absorption of blood by some species of helminths, anemia occurs;
- neuroreflex effect - stimulation of nerve endings by helminths causes bronchospasm, intestinal dysfunction, etc.;
- psychological effects, manifested by neurological conditions and sleep disorders;
- immunosuppressive effect.
Helminths are characterized by stages of development.Each stage is characterized by its own clinical symptoms.
In the initial acute stage, helminths often do not release eggs, sensitization of the body occurs (production of antibodies, release of inflammatory mediators, increased permeability of blood vessel walls) and damage to the organs through which the larvae migrate.Clinical symptoms may be absent, but in some cases the disease may have clear clinical manifestations.The acute phase lasts from 1 to 4 months, sometimes 8-10 months or more.
Complaints of patients in the acute period:
- temperature increase from several days to two months (mild fever or above 38°С, accompanied by chills, severe weakness and sweating);
- recurring skin itching;
- local or systemic edema;
- enlargement of regional lymph nodes;
- muscle and joint pain;
- cough, asthma attack, chest pain, persistent catarrhal symptoms, bronchitis, tracheitis, pneumonia-like symptoms, asthmatic syndrome, hemoptysis;
- abdominal pain, nausea, vomiting, stool disorders.
At the end of this period of helminth infection, the acute allergic phenomenon gradually subsides and the pathology in the chronic stage has not yet had time to develop.
The acute phase becomes subacute as the "young" worms gradually mature.Then comes the chronic stage, which corresponds to the development of the parasite into a sexually mature individual.The clinical picture develops based on the toxic effects of helminthic waste, traumatic effects of helminths on organs (hookworm, bristleworm disease, etc.), mechanical effects (Echinococcal cysts in the liver grow, compressing neighboring organs; adult worms - in the brain), secondary inflammatory processes (duodenitis is observed in strongyloidiasis), metabolic disorders (reduction or deficiency of vitamins), functional disordersof the stomach and duodenum, secondary immunodeficiency, etc.
Symptoms depend on the organ the worms infect, their size and number.
giveintestinal helminthsThe following syndromes are characteristic:
- indigestion (stomach discomfort, feeling of fullness after eating, early satiety, bloating, nausea);
- painful;
- neurasthenia (feeling of extreme fatigue, increased nervous excitement and irritability).
Enterobosis is characterized by nocturnal perianal itching.When infected with large roundworms, intestinal obstruction, pancreatitis, and obstructive jaundice may occur.
Intestinal Cestodoses(taeniarinhoz, diphyllobothriasis, hymenoptera, tapeworm disease and others) are asymptomatic or have few symptoms (with dyspepsia, pain, anemia).
liver flukes(fascioliasis, opisthorchiasis, clonorchiasis) causes:
- chronic pancreatitis;
- hepatitis;
- cholecystitis;
- neurological disorders.
Hookworm diseasemanifested by vegetative asthenic syndrome (weakness, fatigue, pale skin) due to the development of iron deficiency anemia.
Filariasis is characterized by an allergic syndrome of varying severity and regional lymphadenitis.
Urinary schistosomiasisSymptoms include the appearance of blood when urinating, frequent urination, and pain when urinating.
Alveococcosis, hydatid disease, echinococcosismay remain asymptomatic for a long time.In later stages, suppuration or rupture of cysts containing parasites will lead to anaphylactic shock, peritonitis, pleurisy and other serious consequences.
For diseases caused by parasitic migratory larvaewormswhen a person is not a natural host, distinguish between cutaneous and visceral forms.The cutaneous form is due to the penetration of certain types of animal helminths under human skin: schistosomiasis in waterfowl (trematodes), hookworms in dogs and cats, strongyloides (nematodes).When a person comes into contact with soil or water, helminth larvae penetrate the skin.There is a burning, tingling or itching feeling where the worms enter.There may be a short-term fever and signs of general malaise.After 1-2 weeks (less often 5-6 weeks) recovery will occur.
The visceral form develops due to ingestion of worm eggs with water and food.At the beginning of the disease there may be malaise, allergic rash (skin rash).In the human intestine, larvae hatch from helminth eggs, penetrate the intestinal wall into the blood, reach the internal organs, where they grow and reach a diameter of 5-10 cm, compressing tissues and disrupting the function of organs.When tapeworm larvae (Cysticerci, tsenura) penetrate the membrane and substance of the brain, they will cause headaches, signs of cerebral hypertension, paralysis and paralysis, and epileptic seizures.Larvae can also be located in the spinal cord, eyeball, serous membrane, intermuscular connective tissue, etc.
The outcome of helminthiasis can be complete recovery with elimination of the helminth or the development of irreversible changes in the host's body.
Diagnosis of helminths
Diagnosis of helminthiasis is established on the basis of a combination of complaints, information received from the patient about the course of the disease, data from laboratory and instrumental examination methods.
In the acute phase of helminth infection, there is a blood reaction to the presence of helminths in the body, therefore the following studies are recommended:
- Clinical blood tests: general analysis, white blood cell formula, ESR (with blood smear microscopy in the presence of pathological changes);
- Biochemical blood test:
- total protein, albumin, protein fraction;
- Assess kidney function indicators (urea, creatinine, glomerular filtration rate);
- evaluate liver function indicators (bilirubin, ALT, AST, alkaline phosphatase);
- pancreatic alpha-amylase;
- assessment of carbohydrate metabolism: glucose (in the blood), glucose tolerance test by determining glucose in venous blood on an empty stomach and after exercise after 2 hours.
The following biological materials can be tested for the presence of helminths: stool, blood, urine, duodenal fluid, bile, sputum, muscle tissue, rectal and perianal mucus.
Since helminths are not excreted in feces at any stage of development, feces should be eliminated three times - every 3-4 days.
- Analyze stool to find helminth eggs.
- Test for roundworm (pinworm eggs), cotton swab.
- Microscopic examination of stool to detect eggs of the pathogen Enterobius vermicularis (pinworm).
- Test for intestinal worms (pinworm eggs), spoon.
- Analysis is necessary if there is a suspicion of pinworm infection, as well as during hospitalization and registration of medical records.
- Analysis for kindergartens and schools.
The child screening program is intended to be completed before entering kindergarten or school.The results of these studies are necessary to obtain a medical certificate according to form 026U approved by the Ministry of Health of the Russian Federation.
Conduct immunological research - determine specific antibodies to helminths:
- anti-nematode IgG antibody;
- anti-Echinococcus IgG antibodies;
- IgG antibodies against Toxocar antigen;
- Anti-Opisthorchis cats IgG (IgG class antibody to cat trematode antigen);
- IgG antibodies against Trichinella antigen;
- antibodies against the pathogen Anisakis (nematodes of the genus Anisakis), IgG;
- antibodies against the causative agent of clonorchiasis, IgG;
- Antibody against Strongyloides stercoralis, the causative agent of strongyloidiasis, IgG.
A test aimed at detecting IgG antibodies to the causative agent of strongyloidiasis is used for early serological diagnosis of strongyloidiasis in cases of clinical suspicion (eosinophilia, tortuous skin lesions, pulmonary or gastrointestinal symptoms) of this disease.
In difficult cases, the following studies may be recommended:
- X-ray of chest organs;
- comprehensive ultrasound examination of abdominal organs (liver, gallbladder, pancreas, spleen);
- CT scan of the abdominal cavity and retroperitoneum;
- CT scan of the chest and mediastinum;
- CT scan of the brain and skull.
Which doctor should I contact?
If you suspect helminthiasis, you should consult a therapist or general practitioner and visit a pediatrician with your child.
If surgical treatment is indicated, the patient will be referred to a surgeon.
Treatment of helminths
Most people infected with helminths do not need to be hospitalized.Patients with tissue helminthiasis, regardless of severity, and patients with severe and complicated disease progression are treated in the hospital.
Treatment is carried out with anthelmintic drugs.Frequency of use and dosage depend on the patient's age and body weight and are prescribed by the doctor.
Desensitization therapy, detoxification, and vitamin therapy may be prescribed.To reduce temperature, non-steroidal anti-inflammatory drugs are prescribed, for allergic reactions and itching - antihistamines, for severe edema - diuretics.In severe cases, hormonal medications are required.
The presence of helminths in organs and tissues may be a sign that surgical treatment is needed.
complications
- Bronchial asthma.
- Pneumonia.
- Bowel cancer.
- Cirrhosis.
- Portal hypertension.
- Gastrointestinal bleeding.
- Ascites.
- Hepatitis.
- Liver abscess.
- Peritonitis.
- Allergic myocarditis.
- Meningitis.
- Chronic glomerulonephritis.
- Chronic kidney disease.
- Hemostatic disorders.
- Loss of vision.
Preventing helminths
Preventive measures to prevent helminth infections include:
- comply with the rules of personal hygiene (use personal towels, personal hygiene items and other accessories for daily use);
- Use only high quality water in daily life;
- Regular vaccination and deworming for pets;
- Thoroughly wash vegetables, fruits, berries before consumption;
- Adequate heat treatment of meat and fish products.
IMPORTANT!The information in this section cannot be used for self-diagnosis and self-treatment.In case of pain or other exacerbations of the disease, diagnostic tests should be prescribed only by the attending physician.To properly diagnose and prescribe treatment, you should contact your doctor.