Table of contents:
- Ways of infection of diphyllobothriasis, methods of treatment and prevention
- Briefly about helminth
- Etiology of the disease
- Pathogenesis of diphyllobothriasis
- Diphyllobothriasis symptoms
- Diagnostic methods
Video: Diphyllobothriasis Treatment And Prevention Methods
Ways of infection of diphyllobothriasis, methods of treatment and prevention
- 1 Briefly about helminth
- 2 Etiology of the disease
- 3 Pathogenesis of diphyllobothriasis
- 4 Symptoms of diphyllobothriasis
- 5 Complications
- 6 Diagnostic methods
- 7 Therapy
- 8 Prevention
Diphyllobothriasis is a chronic parasitic infection caused by a zooanthroponous parasite of the cestodose class. People living in freshwater areas with many reservoirs and rivers are prone to infection of the helminth. Fish is the main source of infection.
As the epidemiological picture shows, botryacephalosis is most often recorded in Canada, Germany, Italy, France, Finland, Holland, North America and Russia. All segments of the population and age groups are susceptible to this disease. Unfortunately, there is no immunity to helminthiasis, so treatment of diphyllobothriasis is mandatory. With timely medical care, the disease has a positive prognosis.
Briefly about helminth
The causative agent of the invasion is the tapeworm of the species Diphyllobothrium latum (diphyllobothrium latum, broad tapeworm), Diphyllobothrium pacificum (diphyllobothrium pacificum) and Diphyllobothrium nihonkaiense (diphyllobothrium nihonkaiense). The helminth is rather large and can reach 12 m in length. The tapeworm consists of a flattened head (scolex), a body and 2 suction slits (bothria). The structure of the worm is formed from many (300-4000) proglottids (segments).
Helminth eggs are oval in shape and are reliably protected by a two-layer coating. In size, the larvae are small and invisible to the eye. Their average values are from 50 to 60 microns. Helminth eggs are visible only under a microscope. The broad tapeworm lives up to 25 years. Located in the body of an intermediate or main host, the worm lays eggs, provoking severe intoxication and gastrointestinal dysfunction.
Helminth has a complex ontogeny. For its full maturation, a fresh water environment is needed. At the same time, the temperature favorable for the development of the worm is from +10 to +20 degrees. The helminth migrates with the help of 3 intermediate carriers. After the larva reaches the embryonic state, the worm leaves the egg outside and is immediately swallowed by the first host, a freshwater crustacean (daphnia or cyclops).
Further, the infected crustaceans along the food chain enter the stomach of the fish, and from there they move to muscle tissue and eggs. In them, the helminth goes through several stages of development, completing its growth and reproduction already in the body of the final host - a person, a cat, a dog, a pig or wild animals that feed on fish.
The eggs are released into the environment through the excrement of the host.
Etiology of the disease
A person becomes infected with a parasite through eating fish, which has larvae inside. Most often this applies to pike, ruff, perch and burbot. Penetrating orally into the stomach, the helminth moves throughout the gastrointestinal tract, settling on the walls of the mucous membrane, internal organs and in the subcutaneous tissue.
At the end of their ontogenesis, the eggs of the tapeworm enter the environment with human waste products, after which they are absorbed into the soil or end up in a reservoir.
The incubation period of the broad tapeworm lasts from 1.5 months to several years. In this regard, finding a “settler” is not easy
The helminth appears only at the last stage of development. Its symptom complex is non-specific and mimics various types of disease, which significantly complicates the diagnosis of the disease and timely provision of medical care to the patient. The number of eggs released by a sexually mature female tapeworm can reach 2 million.
Pathogenesis of diphyllobothriasis
Helminths can be found not only in raw fish products. You can also find the larvae of the parasite in smoked and madder fish. Marine species that go to spawn in fresh waters - chum salmon, pink salmon, Pacific salmon, etc. - are not insured against the parasite.
It is quite difficult to visually recognize an infected fish. Outwardly, as a rule, it looks normal, and the larvae of the parasite are so small that it is simply impossible to make out them without special laboratory equipment.
The action of the tapeworm on the host organism is pathogenic, due to its mechanical effect on the affected tissues, a strong deficiency of vitamins B12 and B9 (folic acid), a neuro-reflex, toxic and allergic reaction. This means that by attaching itself to the intestinal mucosa, the parasite pinches it, contributing to microtrauma and atrophy.
In severe cases, with a large accumulation of helminths, intestinal obstruction, a serious pathology with a fatal outcome can be observed.
The sensitivity of the infected organism is manifested in blood eosinophilia and functional disorders of the digestive system. Without treatment, the parasite continues to exist, periodically rejecting the dead ribbon-like parts of the body (strobila) that left the host's body through feces during bowel movements.
The factors provoking the development of diphyllobothriasis include:
- Eating poorly thermally processed fish;
- Raw or semi-raw seafood dishes;
- Pets infected with helminth;
- Lightly salted fish and caviar;
- Poorly treated waste water;
- Disregard of the rules of hygiene when cutting infected fish and its further processing;
Failure to comply with sanitary and hygienic standards for the care of dishes and cutlery that have been in contact with sick fish.
The presence of fresh water bodies with an O2 content of at least 12 mg / l, shallow water well heated by the sun and a high percentage of crustacean population per 1 m2 increases the risk of infection by the broad tapeworm.
Diphyllobothriasis can occur in 2 forms - manifest and latent. The first is characterized by pronounced signs of invasion and an acute course, while the second proceeds latently, without pathological manifestations in the patient's well-being, gradually developing into a chronic disease.
Helminthiasis does not appear immediately. It can take 2 months from the moment of infection to the appearance of significant signs. The broad tapeworm does not have its own special symptoms, so it uses the manifestations of other diseases, successfully masking its presence in the body.
The intensity of the same signs directly depends on the duration of the invasion and the number of parasites. When infected with a single individual, the course of the disease is mild. The patient does not reveal any special complaints about well-being, except for slight fatigue, decreased performance, general weakness and minor skin rashes.
In the same cases, when the symptoms are pronounced, in the clinical picture of diphyllobothriasis it is noted:
Cramping pain in the abdomen of various localization;
- Nausea followed by vomiting;
- Stool disorder - diarrhea alternating with constipation;
- Violation of taste sensations;
- Fluctuations in body temperature - from subfebrile (37.5 Cє) to 39 C °;
- Anemicity with characteristic pallor of the skin and mucous membranes;
- Lowered blood pressure (blood pressure);
- Numbness and swelling of the upper and lower extremities;
- Chills like "goose bumps";
- Itching in the sphincter area;
- Frequent headaches;
- Irritability and nervousness;
- Skin rashes like urticaria;
- Gunter's glossitis in the form of bright red painful spots and cracks in the tongue, followed by mucosal atrophy;
- An increase in the size of the spleen and liver;
- Strong heartbeat or heart rhythm problems;
- Hypersalivation - increased salivation;
- Weight loss;
- Signs of vitamin deficiency;
- Violation of laboratory blood parameters - a decrease in the number of erythrocytes, leukocytes, platelets, hemoglobin, fixation of megalocytes, etc.;
- CNS damage - unsteadiness of gait, lack of tactile sensitivity, etc.;
- Low secretion of gastric juice.
With a latent course, the symptoms are subtle. The patient's diet, the presence of concomitant pathologies and the degree of damage to the body, affects the severity of the manifestations of helminthiasis. Lack of treatment leads to anemia and death.
Helminthiasis cannot be ignored. Its constant toxic activity not only provokes discomfort and changes in the patient's well-being, but also leads to the development of serious negative health consequences in him:
- Tissue necrosis and atrophic processes of the gastrointestinal mucosa, in the places of attachment of the scolex of a wide tapeworm;
- Disorders of the gastrointestinal tract due to damage to the nerve endings by the parasite;
- Disorders of the quantitative and qualitative composition of the microflora (trophism) of the intestine;
- Allergies of varying intensity, as a result of sensitization of the body to the waste products of the helminth;
- Development of megaloblastic anemia due to the absorption of vitamins B1, B12 and B6 by the tapeworm;
- Funicular myelosis - chronic, dystrophic lesions of the spinal cord;
- Bowel obstruction leading to intestinal obstruction;
- Strengthening segmental reflexes (hyperreflexia);
- Damage to the walls of the large intestine (perforation), provoking the development of abdominal inflammation (peritonitis);
As a rule, diphyllobothriasis does not pose a danger to the patient's life. But in some cases, with multiple accumulations of parasites or its long stay in the body, a severe form of anemia and pathological changes in the work of the nervous system develop.
The patient can die without proper therapy.
To establish diphyllobothriasis, a differential diagnostic method is used. The most informative studies in this sense are:
- Collecting an epidemiological history - the patient's area of residence, his culinary preferences, frequency
- Eating lightly salted or raw fish, etc.;
- General analysis of blood and urine;
- Biochemical analysis to determine the level of bilirubin, transaminases (AST and ALT), protein and its fractions;
- Study of gastric secretions;
- Analysis of feces for eggs, worms, allowing you to isolate fragments of the parasite;
- Anal swab for bacterial microscopic analysis;
- PCR method;
- Serotological diagnostic technologies aimed at finding antibodies;
- Blood sample for ESR, eosinophilia, thrombocytopenia and anemia.
Also, given the similarity of the symptoms of helminthiasis with a number of other diseases, the patient may be assigned additional studies.
They always approach the diagnosis of diphyllobothriasis in a comprehensive manner, since no type of analysis is exhaustive for making a final diagnosis. An infectious disease doctor is engaged in the treatment of helminthiasis.
Degilmentization is not a pleasant procedure. With a mild course of the disease and no complications, therapy is carried out on an outpatient basis. But in case of poor test results and serious condition, the patient is subject to urgent hospitalization and inpatient treatment. The broad tapeworm is removed from the body in stages, with the use of anthelmintic drugs and a vitamin complex.
The most effective antiparasitic action against the broad tapeworm is possessed by the following medicines:
- Fenasal / Yomezan / Vermitin;
The second stage provides for the replenishment of the vitamin deficiency. To do this, the patient is injected intramuscularly with Cyanocobalamin (vitamin B12), Ferronate, Hemofer, Ferroplekt, Aktiferrin, Hematogen and other iron injections daily.
The third stage is the prevention of helminthiasis. The most common way to prevent diphyllobothriasis in this case is peeled pumpkin seeds, filled with a little water and mixed with a few tablespoons of honey. The tool is highly effective and is used on an empty stomach 1 hour before meals.
But the action of the drugs is aimed only at paralyzing the helminth in order to detach it from the intestinal walls. The process of final elimination of the parasite ends with the cleansing of the body with the help of laxatives and agents that enhance intestinal motility.
For the correct implementation of the procedure for removing the helminth, special preparation of the gastrointestinal tract is required. Regular enemas and weak saline solutions are used as flushing methods approved for use. The very same manipulation of removing a wide tape should be very careful.
Since the body of the helminth is long enough, it is not recommended to pull it. Otherwise, the scolex may come off, and part of the tapeworm may remain inside the organ.
In a situation with intestinal obstruction, urgent surgical intervention is indicated. At the end of the course of treatment, the patient is shown a regular preventive examination for the presence of worm eggs. In case of detection of residual helminth material, repeated treatment is recommended.
Unfortunately, humans do not have natural immunity to the causative agents of diphyllobothriasis. Therefore, the risk of re-infection remains high. Observing the same precautions, you can protect yourself from infection with diphyllobothriasis and prevent the possibility of relapse in the future.
Effective measures for the prevention of helminthiasis include:
- High-quality heat treatment of fish and seafood. Any products should be well done or baked. The cooking time for fish dishes is at least 20 minutes. In the case of marinating raw fish, the percentage of salt must be at least 9%. Always store seafood only in the freezer or at a temperature of -15 Cє, but no more than a day.
- Before consuming raw fish delicacies such as sushi or sashimi, ensure that the product is properly processed by the manufacturer.
- Eliminate the use of semi-raw fish from the diet. You should also be wary of smoked and pickled fish, especially homemade ones.
Thoroughly wash tools and cutting boards after handling raw, especially diseased fish.
In addition, local control authorities in areas with a potential danger of infection are required to conduct regular sanitary and epidemiological inspections of fishing cooperatives and specialized food enterprises, hygienic monitoring of the cleanliness of reservoirs and wastewater, control over the disinfection of fish before it is released for sale, periodic examination of persons in the risk group - fishermen, food industry workers, sailing crews of river vessels.
Not the last role in the prevention of diphyllobothriasis is assigned to sanitary and preventive work with the population.