Table of contents:
Fascioliasis is a parasitic disease caused by an invasion of the hepatic fluke (or hepatica fasciola). Pathology is characterized by damage to the liver and bile ducts. Fasciola is a flat helminth belonging to the class of trematodes.
- Symptoms of pathology
- Infection routes
- Treatment methods
- Drug therapy
- Traditional methods
- Fascioliasis prognosis
Symptoms of pathology
The following symptoms come to the fore:
- an increase in temperature to febrile values (up to 38.5-39.0) with itching;
- severe general weakness and rapid fatigue;
- dyspeptic disorders (decreased appetite, feeling of heaviness in the abdomen, flatulence, nausea);
- allergic manifestations (attacks of bronchospasm, the development of urticaria with severe redness of the skin and itching);
- periodic cough (with lung damage);
- swelling of the limbs;
enlargement of the liver in size, as well as its soreness with deep palpation due to the tension of the organ capsule;
- yellowness of the skin, mucous membranes and sclera;
- in some cases - an increase in the size of the abdomen (accumulation of fluid in the abdominal cavity) and spleen;
- visual impairment (with a rare form of eye fascioliasis).
Jaundice and fever disappear completely. In this phase, the symptoms of bile duct damage dominate, which appear mainly with secondary bacterial inflammation:
- severe soreness in the right upper quadrant of the abdomen;
- yellowness of the skin and mucous membranes with obstruction of the biliary tract;
- digestive disorders.
The danger of fascioliasis for humans is carried by symptoms of the toxic effect of products on the brain (encephalopathy), varicose veins of the esophagus and hemorrhages in the digestive tract, accumulation of fluid in the celiac cavity and weight loss.
Fascioliasis is a typical anthropozoonosis. The mechanism of infection is mainly oral and alimentary. This means that a person can get sick by eating contaminated meat, watercress, or drinking contaminated water. After that, the helminth larvae enter the intestinal cavity, where they begin their development in the patient's body.
The prevalence of fascioliasis is greatest in Asia, Africa and Latin America.
The main source of infection for humans is sheep and cattle, which in natural conditions are the final hosts for the parasite in fascioliasis. However, the entire developmental cycle of the helminth is much more complicated. It starts from the moment when eggs fall into the water with feces. There, larvae are released, which penetrate the body of the intermediate host - the mollusk, where they are transformed into cercariae. After emergence, they attach to the leaves and stems of underwater plants. It is them that are eaten by cattle, or people. Additionally, some of the helminths remain on the surface of the water.
Diagnosis of fascioliasis begins with collecting complaints from the patient. First of all, the symptoms that are characteristic of liver damage, as well as the severity of allergic symptoms (rash, bronchospasm, cough), are striking. The latter arise as a result of the body's reaction to the penetration of helminths with their antigens on the surface.
And it is also necessary to take into account the epidemiological situation in the region, since mainly cases of fascioliasis occur in outbreaks. Therefore, the patient is asked about the nature of his diet, as well as the possibility of using contaminated water or food.
It is more difficult to navigate the chronic phase of the disease. Firstly, there is no symptomatology for a long time, and, secondly, it is difficult to establish when and under what circumstances infection could occur.
The general research program for fascioliasis includes the following laboratory diagnostic methods:
- a general blood test (leukocytosis and an increase in the number of eosinophils are possible, with the addition of bacterial flora - an increase in the number of neutrophils, quite often anemia develops against the background of intoxication);
- general urine analysis (sometimes its color changes due to the increased content of bilirubin);
- biochemical blood test (there is an increase in the concentration of liver enzymes, as well as bilirubin; in severe liver dysfunction, a decrease in the amount of protein);
- examination of feces for the presence of helminth eggs (they can only be detected in the chronic phase);
- serological tests for the presence of specific antibodies to the parasite (the most specific test).
Additionally, an ultrasound examination of the abdominal organs is performed. Here, attention is paid to changes in the structure of the liver parenchyma and an increase in its size. In the chronic phase, signs of chronic inflammation of the biliary tract are revealed.
To diagnose complications of fascioliasis, fibrogastroscopy is also prescribed (to assess the veins of the esophagus) and fibrotest (it can be used to assess the degree of liver fibrosis).
The main drug used for the treatment of fascioliasis is albendazole ("Albela", "Aldazol", "Nemozol", "Zentel", "Farmoks"). The drug belongs to the benzimidazole group. The mechanism of action of the drug is its ability to suppress beta-tubulin polymerization. This leads to the destruction of the structure of the intestinal tract of helminths and paralyzes the activity of smooth muscle cells.
Also, you can not prescribe the drug if the patient has hypersensitivity to it.
Albendazole should be prescribed with caution in case of liver dysfunction, since the drug has a moderate hepatotoxic effect. Therefore, if it is necessary to use a medication, it is necessary to control the concentration of AST, ALT, bilirubin and its fractions.
Tablets are taken orally after meals 1 time per day, 400 mg. The therapeutic concentration of the drug is maintained for 20 hours. The drug should be taken with plenty of water.
In patients with decompensated liver function, praziquantel (Biltricid) is often prescribed instead of albendazole. In this case, it is necessary to monitor the concentration of the drug in the blood plasma.
It is important to consider that only these drugs are effective for fascioliasis. Such popular antiparasitic agents as Pirantel, Dekaris do not act on the causative agent of this pathology.
The duration of the course of treatment with specific drugs is from one day to three, depending on the severity of the parasitic invasion.
Traditional medicine plays an auxiliary role in fascioliasis. Choleretic herbs and preparations are of the greatest importance, which improves the effectiveness of antiparasitic agents, reduces the frequency of complications and accelerates the patient's recovery.
Collection "Phytohepatol No. 2" consists of mint, coriander, immortelle and yarrow. This combination of herbs has a pronounced antispasmodic effect on the walls of the biliary tract, and also dilutes the bile itself.
Mint, calendula, chamomile, tansy and yarrow are part of "Phytohepatol No. 3". Harvesting stimulates the production of bile, which helps to clear the ducts from parasites.
Nutrition is of great importance during the period of therapy. The patient should avoid foods high in fat (especially animal origin), as well as canned food, convenience foods and alcoholic beverages.
With timely diagnosis and treatment, the disease has a benign course. Patients are quarantined for the period of treatment. Most patients recover quickly. At the same time, they need to conduct a study of the duodenal contents after 3 and 6 months. If traces of the parasite are detected in it, then the course of therapy with antiparasitic drugs is repeated.
Lethal cases are due to surgical complications of fascioliasis - acute cholangitis, pancreatitis or cholecystitis. There is no immunity after illness.