lung fluke disease
Helminthiases / / August 12, 2017
Paragonimosis (Lat.), Paragonimiasis (Eng.), Paragonimose (fr.)
Paragonimiasis - helminthiasis, mainly affecting the lungs and brain.It is found in Korea, China, Japan, Indochina and the Indian subcontinent, in the Philippine Archipelago and the Solomon Islands, registered in Africa and South America.Individual cases Paragonimiasis a person marked in the Far East of Russia.
Etiology and epidemiology
Pathogen Paragonimiasis - fluke Paragonimus ringed (synonym P. westermani).helminth length of 8-16 mm, width 4-8 mm thickness 3-5 mm.Live paragonimus pink and brown, dead - gray-brown color.body surface is covered with a variety of helminth broad spines.The eggs are golden brown, oval, with a lid, and a thickening of the shell at the poles, the size 0,08-0,118X0,048-0,06 mm.
Under puberty paragonimusy parasites in humans, cats, Siberian tiger, pigs, dogs, mongoose.They are located mainly in the small bronchi, but sometimes on the pleura, diaphragm, pancreas, liver, skin, bra
with phlegm and sometimes feces paragonimusa final hosts (human and others.) Highlighted its eggs.For further development, they have to get into the water.At optimal egg development paragonimusa water temperature (about 30 ° C) after 4 weeks of larvae produced in eggs - miracidia that eggs and then leave the float in the water due to its ciliary cover.If there is water molluscs (intermediate hosts) miracidia penetrate into their body, turning here sporocysts.In the last two generations by parthenogenesis redia develop from germ cells.In rediyah formed cercariae which leave intermediate host and introduced into the crab and crayfish - paragonimusa additional hosts.In a further host cercariae transform into metacercariae.
Infestation the definitive hosts (human and others.) Occurs by eating infected metacercariae of freshwater crayfish and crabs raw or insufficiently heat-treated form.There is a possibility of infection by swallowing Paragonimiasis adolescariae when drinking water.
clinical picture is diverse and depends on the intensity of infestation, disease duration and localization of the pathological process.During Paragonimiasis determined staging connected with the successive defeats of certain anatomical areas.In this regard, we can distinguish four clinical forms Paragonimiasis acute abdominal acute pleuropulmonary, chronic lung and complicated paragonimiasis (extrapulmonary) paragonimiasis.
acute abdominal paragonimiasis characterized by symptoms of acute abdomen.The clinical features of this form Paragonimiasis are resistant, not amenable to the usual treatment of enteritis, acute hepatitis, mild severe symptoms of diffuse peritonitis.Acute pleuropulmonary paragonimiasis proceeds with the clinical picture of small and large focal pneumonia, acute bronchitis, exudative hemorrhagic pleurisy.Chronic pulmonary paragonimiasis characterized by a prolonged course with a tendency to deteriorate.There have been periods of exacerbations and remissions, which is due to a number of factors (re-infestation, cooling, alcohol, etc..).
patients from lung celebrated the diversity of symptoms, but the physical signs are often scarce.Chest pain occurred in 100%, cough with purulent sputum particular - at 100%, hemoptysis - at 96.4%, pulmonary haemorrhage - 42%, the temperature increase - from 70.6%, dyspnea - 55.5%, night sweats - 24.6%, changes in pulmonary sound - at 41.2%.crackles - at 54.7%, dry wheezing - 16.7%, pleural rub - in 8.7% of patients.
often chronic pulmonary paragonimiasis occurs with severe neurological syndrome that depends on the specific toxicity of the central nervous system.The frequency and nature of the symptoms include: headaches of varying intensity and frequency noted in 44.4%, dizziness - in 73.8%, fatigue - in 42.9%, sleep disorders - in 23,2%, absent-mindedness - in11.1%, increased irritability - in 30.1%, decrease in memory - in 15.1%, a decrease of intelligence - in 0.8% of cases.
Changes in the cardiovascular system appear as vagotonia symptoms, sometimes pronounced, more moderate, as well as degenerative changes in the myocardium, which is confirmed by electrocardiographic examination.
Endocrine disorders occur with an increase in thyrotoxicosis thyroid I and II degrees (in 5.5% of patients).Women often observed violation of, or absence of menstruation, observed in 40% of young people.
combined lung and brain damage occurs in about 25% of cases.brain damage commonly observed in acute pulmonary process and often occurs suddenly.Acute brain paragonimiasis flows by type of meningitis or meningoencephalitis.If the patient does not die in the acute stage of the disease, then the process becomes chronic and slowly progressing.In this case, the organic focal symptoms become more severe and polymorphic, while the number of cerebral symptoms are reduced.Often develop blindness, paralysis, seizures, mental disorders and other symptoms.Patients often become totally disabled or die.Polymorphic focal symptoms associated with a combination of various morphological changes in the brain (cysts, scarring, adhesions), distribution process to adjacent anatomical regions and dislocation phenomena.
From brain symptoms should be noted intense headache in 90.5%, stagnant nipples optic nerves - at 28.5%, vomiting - in 7.2% of patients.Mental disorders are found in 71.4% of patients and are expressed in an emotional weakness, slowness of mental reactions, memory disorder and combinatorial ability, violation of perception and in some patients - decrease of intelligence.Often mental state is determined by the symptom, similar to schizophrenia (autism, stuporous state, thought disorder, inadequacy of emotional distress, negativity).Vertigo when brain Paragonimiasis observed in 54.7% of patients and are associated with stagnation in the brain or the defeat of the vestibular system.
seizures with complete loss of consciousness have been reported in 66.8% of the "small seizure" - at 7.2%, with partial loss of consciousness or without loss of consciousness - in 4.6% of patients.Before the seizure is more common motor, less visual and sensory aura.Duration of seizures ranges from 5-10 minutes to 3 hours.The frequency of attacks by 1-2 per year to several per day.Seizures end deep sleep followed by total amnesia.Changes in the organs of vision are often focal nature: visual field loss in 35.3%, decrease in visual acuity in 32.3% of patients.
For pulmonary Paragonimiasis prognosis depends onstage of the disease, the degree of infection, clinical course, localization and distribution process mortem pictures of repeated invasions, the patient's age and treatment.Without timely and efficient treatment of pulmonary Paragonimiasis prognosis in most cases questionable.Combined pulmonary brain lesions related to severe disease and without treatment ends badly for both life and for disability.
Prevention Paragonimiasis provides for the refusal of eating raw and insufficiently cooked crabs and crayfish, from drinking raw water from reservoirs, thorough cleanliness of hands, clothes and kitchen tools during cooking of crustaceans.Social prevention is carried out by means of sanitary measures to prevent fecal contamination of water.