Opisthorchiasis

Fluke Siberian
Fluke Siberian

Opisthorchiasis - helminthiasis of the liver and pancreas. The causative agent of opisthorchiasis - Opisthorchis felineus - Fluke Siberian (cat) in length 4 -13 mm (Fig.); in the stage of puberty parasitizes in the bile and pancreatic ducts, gallbladder man, cats, dogs, foxes and other mammals. Intermediate host helminth - molluscum (snail); additional hosts - cyprinid fish (IDE, Dace, chebak, and others).
Stand out with faeces sick people and animals helminth eggs when released into the water swallowed shellfish, which is the development and reproduction of parasites, ending with access to water tailed maggots - cercarial. Cercariae swallowed by a fish. People and animals infected with opisthorchiasis by eating raw, frozen, slightly salted, not fried and cooked fish larvae helminth. Opisthorchiasis mainly spoken in Western Siberia, Kazakhstan. The Perm region; found in Ukraine (the Dnipro basin), in the Volga region, Komi ASSR.
The clinical picture. In the clinical course of opisthorchiasis two phases: early - acute and late - chronic. The incubation period is 2 to 4 weeks. The disease begins abruptly, with rise of temperature up to 39-40 degrees (early phase). Febrile period lasts from several days to 2 months. and more. Pain in muscles and joints, cough, skin rashes, gastrointestinal disorders, liver enlargement, less spleen and lymph nodes, puffiness of the face. Possible jaundice. In the blood, leukocytosis, and eosinophilia. The patient is incapacitated from 3 - 4 weeks to 2 months. and more. Sometimes the disease is mild. In late chronic phase of opisthorchiasis is a pain in the epigastric region and right hypochondrium, often paroxysmal. The liver usually enlarged and sealed, often enlarged and gall bladder. Complications: bacterial, including purulent, cholecystitis, bile peritonitis. Liver cirrhosis, primary liver cancer, and pancreatic cancers are more common in troubled by opisthorchiasis foci.
The diagnosis. Absolute proof of opisthorchiasis is detected in the stool and duodenal contents of eggs opistorhisov.
Treatment of opisthorchiasis. Assign inside haksil (hexachlorparaxylol) for 2 or 5 days in a row. During the two-day course daily dose for adults - 6-10 g, children - 0,1-0,15 g on 1 kg of weight of a child. During the five-day course daily dose for adults and 3.5 - 4 g, children - 60 mg per 1 kg of body weight. In both cases, the daily dose divided into 3 doses and give the food (it is better to drink milk). When detected in the stool or the duodenal contents of the patient eggs opistorhisov in 4-6 months. repeat the treatment. Simultaneously with specific therapy is used choleretic, antispasmodic (papaverine 0.02 g 3 times a day, and others), vitamins; produce duodenal intubation 1 times a week for 1-2 months; bacterial infections of the biliary tract - antibiotics in conventional doses; in the early phase antihistamines (diphenhydramine 0.05 g 3 times a day, and others).
Prevention. Protection of water bodies from contamination by faeces, exclusion from eating undercooked and slightly salted fish. The fish is well-cooked and cooked and smoked safe. Maggots opistorhisov occurs when frozen fish in Lido-salt mixture: when temperature -18 OC 15-20 days, the temperature is 23-25 OC 3 days, temperature-30 - 40 degrees in 6 hours and 3 hours respectively. Of great importance in the fight against opisthorchiasis has health education.

Opistorhoz (opisthorchoses) is a parasitic infection of the liver, gallbladder and pancreas.
Agents of opisthorchosis - flukes of the genus Opisthorchis - O. felineus and O. viverrini. O. felineus (Fluke cat, or Siberian) has a flat body length 4-13 mm, width 1-3,5 mm, with oral and abdominal suckers. Deep oral suction Cup is the mouth, leading into the throat, followed by the esophagus; depart from the last 2 branches of the intestine. In the rear part of the body - 2 testicles between them - excretory bubble. Ahead of the testes - ovary, samadiyami, uterus with eggs. In the lateral parts of the parasite - galechniki (Fig). Eggs are yellowish, with lid, size 0,011-0,019X0,023- - 0,034 mm. In the stage of puberty parasitizes in the bile and pancreatic ducts, gallbladder person and some mammals, animals (cats, dogs, foxes and other); intermediate host - shell is made leachi; additional hosts - cyprinid fishes (IDE and others). O. viverrini in structure and biology close to O. felineus; its length 5,4-10,2 mm, width - 0,8;- 1,9 mm
People and animals, infected O., releasing eggs trematodes are the source of infestation for shellfish. In them is the development of miracidia, sporocysts, Redi and cercariae; cercariae leave shellfish and actively implemented in fish. Man and mammals get opistorchosis by eating raw, poorly salted and undercooked fish. O. prevalent in areas where there is fecal contamination of the waters, the waters abound with buitiniam and cyprinids fish, and the population eat raw fish.
In the bile and pancreatic ducts are observed expansion of the lumen, a thickening of the walls, glandular epithelial hyperplasia. In the circumference of the duct connective tissue. Sometimes cholangitis cirrhosis (printing. Fig. 1 - 6). In the basis of the pathogenesis of - toxic-allergic reactions, mechanical action of worms, creation of favorable conditions for secondary bacterial infection.


In the early phase of opisthorchiasis - fever, malaise, pain in the liver, eosinophilic leukocytosis. In late phase - pain in the epigastrium and right hypochondrium, radiating to the back, sometimes in the left hypochondrium. Often they are in the nature of attacks biliary colics. The liver usually enlarged and sealed, often enlarged and gall bladder. In duodenal juice mucus and epithelial cells, white blood cells, eggs of helminths. The amount of bile portions "" sometimes increased its concentration increased or, conversely, lowered. When Acting has always angiocholitis, often - biliary dyskinesia, at least - angiocholitis; ordinary chronic hepatitis and pancreatitis, for some patients - cholangitis cirrhosis of the liver.
Complications - bacterial, sometimes purulent angiocholitis, biliary peritonitis, primary cancer of the liver and pancreas.
The diagnosis is based on detection of helminth eggs in duodenal juice and Calais.
Treatment. Helminthicidal effect has haksil (hexachlorparaxylol) - 1,4-bis-trichlorodibenzo.
The agent shall inside 2 consecutive days in a daily dose of 0.1-0.15 g per 1 kg of body weight of the patient (adult - 6-10 g); the daily dose given in 3 divided doses after meals. Laxative not appointed. If necessary through 4-6 months. repeat the treatment. At the same time resort to symptomatic and pathogenetic therapy (drainage of the biliary tract, bile-expelling, antispasmodic, vitamins etc); when a bacterial infection - antibiotics.
Prevention includes the protection of waters from fecal contamination, elimination of food raw, poorly salted and undercooked fish. Cm. also Trematodozov.

opistorhoz
Fig. 1. Opisthorchiasis human liver; many opistorhisov in the bile ducts (magnifier). Fig. 2. Opisthorchiasis human liver. The suction Cup of opisthorchis draws the wall of the bile duct (small increase). Fig. 3. Experimental opisthorchiasis the liver of Guinea pigs; 37-th day after infection; cirrhosis (small increase). Fig. 4. Experimental opisthorchiasis the liver of Guinea pigs; 87-th day after infection; cirrhosis (magnifier). Fig. 5. Opisthorchiasis pancreas rights; three opistorchis duct cancer (small increase). Fig. 6. Opisthorchiasis pancreas person; group opistorhisov duct cancer (magnifier).