Helminthiases / / August 12, 2017
Fasciolosis (Lat.), Fascioliasis (Eng.), Fascioliase (fr.), Fasciolosis (App.)
Fasciolosis - helminthiasis, mainly affecting the hepatobiliary system.It occurs in different countries usually in the form of individual cases, but in France and Cuba have been outbreaks of fascioliasis that engulfed hundreds of people.
Etiology and epidemiology of fascioliasis
Pathogens - trematodes Fasciola hepatica and F. gigantica.F. hepatica, sometimes referred to as liver fluke, has a flat leaf-shaped body is 20-30 mm long, 8-12 mm wide.Eggs are yellowish-brown with a lid and a tubercle at the poles.The size of their 0,130-0,145X0,07-0,09 mm.F. gigantica elongated shape, its body is almost parallel to the edge.helminth length of 33-76 mm, width of 5-12 mm.Egg size 0,150-0,190X0,075-0,090 mm.
Under puberty Fasciola parasites in humans, cattle and small cattle, horses, pigs, etc. The normal localization of worms -. The bile ducts and gall bladder, perverse - the lungs and other organs and t
with feces infested fasciolas people and animals stand out helminth eggs.After contact with the eggs into the water after 4-6 weeks forms the larvae in them - miracidia that extend outward and penetrate into the shellfish.The shellfish occur larval development and reproduction of generations that end access to the water tailed cercaria larvae.cercaria tail soon disappears.His tsistogennye glands secrete a secret that surrounds the larva and solidify, forming a closed capsule around it.The encapsulated larva is called "adolescaria".
Infection with human and mammals is the result of the ingestion of water during adolescariae drinking and eating herbs growing in standing and slowly flowing waters, such as watercress.Outbreaks of fascioliasis are formed in places with a large number of stagnant water that abound clams and serve for watering livestock.
Pathological anatomy and pathogenesis
liver biopsy in the early phase of fascioliasis finds that microabscesses and mikronekrozov parenchyma with infiltration of eosinophils and its giant cells.In the later period, there is an expansion of the lumen, wall thickening and adenomatous proliferation of the epithelium of the bile ducts;sometimes there is a purulent angiocholitis.Described obliteration of hepatic duct.
The pathogenesis of fascioliasis is poisoning the body of the patient helminth products of metabolism with subsequent development of clinical allergy, especially pronounced in the early phase of the disease.It should also take into account the mechanical action on the fabric and helminths possibility of secondary bacterial infection.
Symptoms The incubation period lasts 1-8 weeks with fascioliasis.The disease begins with malaise, increasing weakness, headache, appetite decrease.Sometimes there is a rash and often fever.Fever can be laxative, wavy and even hectic.In severe cases, the temperature rises to 39-40 ° C.On examination, the patient is often found subikterichnost sclera.Soon, there is pain in the epigastric and right hypochondrium, nausea and sometimes vomiting.The liver is increased, it becomes dense and painful on palpation.
the study of blood in the early phase of the disease, as a rule, a marked eosinophilia with an increase in the number of white blood cells to 18,000-20,000 or even 52,000, eosinophils - up to 40,500 in 1 cc.mm.blood.Gradually acute effects subside, the temperature drops to normal and subfebrile, fascioliasis passes in the chronic phase.In the foreground, dyspepsia, and abdominal pain.Recently, some patients expressed mild and have the character of crushing or stabbing sensations in the epigastric and right upper quadrant.However, the pain often become paroxysmal in nature and type of gallstone colic accompanied by an increase in the gallbladder, a rise in temperature to 38 ° C and higher, sometimes develop a mild jaundice.The duration of these attacks will vary very widely - from several hours to 7-8 days.They are separated by periods when the pains are absent or insignificant.The liver usually extends from the costal arch at 2-5 cm, but may not increase.The consistency of its dense, smooth surface.In normal blood white cell count or moderate leukocytosis;eosinophilia, usually small (7-10%).
With long-term course of the disease may occur expressed liver function disorders, diarrhea, anemia, exhaustion and even death.However, in some patients infestation occurs with mild clinical signs - small dyspeptic disorders and unclear abdominal pain.
Familiarity with symptomatology fascioliasis liver shows that in the early phase of the disease are the most prominently allergy symptoms, and in the later period - the phenomenon of cholangitis, sometimes purulent, biliary dyskinesia, sometimes hepatitis.
Detection of fascioliasis in its early stage is very difficult, because the parasites begin to excrete the eggs only after 3-4 months after the entry into the human body.To differentiate it is necessary first of all from trichinosis, opisthorchiasis, clonorchiasis that in the acute phase also occur with fever and blood eosinophilia.To eliminate trichinosis resort to biopsy to identify helminths muscles.When opistorhoze clonorchiasis and within 1 month after infection with helminth eggs appear in the duodenal contents and feces.Valuable information can give epidemiological history.Some help in the diagnosis of fascioliasis have and specific immunological reactions.
Upon reaching puberty fasciolas identify them in the body is usually no difficulty: it is possible to detect specific helminth eggs in feces and duodenal juice patient.When eating liver fascioliasis of cattle in the feces appear the so-called transit Fasciola eggs, passing intact through the gastrointestinal tract of humans.In such cases it is necessary to resort to the study of duodenal juice.Analysis of faeces must be carried out not earlier than one week after the complete exclusion from the diet of the patient's liver.
fascioliasis Complications developed mainly as a result of gross pathological changes caused by Fasciola stay in the intrahepatic ducts, extrahepatic ducts and gallbladder.Epithelial cover bile ducts, injured spines covering cuticle Fasciola.Resulting damage can be a gateway for infection.At the beginning of the XX century have reported several sightings of fascioliasis flowing with jaundice, ulcerative cholecystitis and liver abscesses.Similar observations described later.Such patients are sometimes necessary to operate urgently.However, some of them, if it is possible to establish the correct diagnosis in a timely manner, can be treated conservatively.Indications for surgery arise only in cases of suspected cholecystitis destructive form, with abscess formed in the liver and is very rare in the biliary tract blockage fasciolas.
With timely recognitionfascioliasis and vigorous treatment prognosis is usually favorable.In severe cases, especially when the secondary infection, it could be serious.
fastcioleza Warning done by refraining from drinking unboiled water (in extreme cases drinking water filtered through the canvas), and thorough washing and scalding with boiling water greens, eaten raw.To combat fascioliasis pets held system therapeutic and preventive measures: mass treatment of affected animals, the destruction of molluscs, deworming manure, grazing, etc. change