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Helminthiasis

worms in the human body

Helminthiasis- helminthic diseases caused by helminths - round and flat, less often ring-shaped and spike-headed parasitic worms.Helminthiasis is characterized by a chronic course and systemic effects on the body with the development of abdominal, allergic, anemic syndromes and chronic toxicosis;damage to the lungs, liver, bile ducts, brain and organ of vision.In the diagnosis of helminth infections, laboratory (helminto-ovoscopic, helminto-larvoscopic, serological) and instrumental (x-ray, endoscopic, ultrasound, etc.) methods are used.Treatment of helminth infections depends on the type of parasite and includes specific (anthelmintic) and pathogenetic therapy.

General information

Helminth infections are helminthic invasions caused by various types of lower parasitic worms - helminths.Helminthiasis has a chronic course, accompanied by exhaustion of the body and reduction of its natural defenses.Enterobiosis, ascariasis, hookworm, trichuriasis and toxocarosis occupy leading positions in the structure of helminthiasis.

According to official statistics, the rate of infection of the population of our country with helminthiasis is 1-2%, but in some regions it reaches 10% or more.The problem of the increasing incidence of helminthiasis is relevant not only for infectious diseases, but also for pediatrics, therapy, surgery, gastroenterology, dermatology, allergology, urology and other areas of practical medicine.

Causes of helminthiasis

To date, more than 250 pathogens of helminthiasis in humans are known;The most common of them are about 50 species.Helminths parasitizing the human body are represented mainly by roundworms (class Nematoda) and flatworms (class flukes - Trematoda and tapeworms - Cestoidea);Less commonly, people are infected with ringworms (Annelida) and acanthocephala (Acanthocephala).Representatives of roundworms include pinworms, roundworms, trichinella, whipworms;tapeworms - bovine, porcine and dwarf, echinococci, broad tapeworm;flukes - cat and liver flukes.

The life cycle of helminths includes egg, larval and adult stages.Depending on the characteristics of the development of parasitic worms and ways of infection, helminth diseases are divided into biohelminthoses, geohelminthoses and infectious (contact) helminthoses.

  1. Geohelminthsare the majority of roundworms (nematodes).Egg and larval stages of development of geohelminths occur in the soil under certain conditions of temperature and humidity.Contagion with geohelminthiasis occurs when personal hygiene is not observed, consumption of water, fruits, vegetables contaminated with parasites, or contact with soil contaminated with feces.Geohelminthiasis includes helminth diseases such as ascariasis, hookworm, trichuriasis, strongyloidosis.
  2. To the numberbiohelminthsbelong to flukes (trematodes) and tapeworms (cestodes), as well as some types of nematodes.To reach an invasive stage, they need a change in one or two intermediate hosts, which can be fish, crustaceans, molluscs and insects.The causative agents of biohelminthiasis enter the human body by eating meat or fish that have not undergone sufficient heat treatment, or by drinking raw water.Representatives of biohelminthosis are diphyllobothriasis, clonorchiasis, opisthorchiasis, teniosis, teniarynchiasis, trichinellosis, fascioliasis, echinococcosis.
  3. Kinfectious helminthiasesbelong to infestations that are transmitted from person to person through personal contact, through shared toiletries, dishes, underwear, or through self-infection.These are enterobiosis, hymenolepiasis, strongyloidosis, cysticercosis.

Classification

Helminth infections are classified depending on the biological characteristics of helminths, their way of existence in the external environment, routes of infection and habitat in the human body.Taking into account the biological characteristics of pathogens, the following are distinguished:

  • nematodes(ascariasis, enterobiosis, trichuriasis, hookworm, nekatoriasis, etc.)
  • cestodiiasis(taeniasis, cysticercosis, hymenolepiasis, taeniarhynchiasis, echinococcosis)
  • trematodes(opisthorchosis, clonorchiasis, schistosomiasis, fascioliasis).

Based on the mode of existence of parasitic worms in the environment, geohelminthiasis, biohelminthiasis and contact helminthiasis are distinguished.Helminthiasis infection can occur through food, water or the percutaneous route.Depending on the localization of pathogens in the human body, helminth infections are divided into:

  • Intestinal.Human intestines are parasitized by pathogens of ascariasis, enterobiosis, hookworm, trichuriasis, strongyloidosis, trichostrongyloidosis, diphyllobothriosis, taeniosis, taeniarhynchosis, hymenolepiasis, etc.
  • Extraintestinal.Extraintestinal helminths can live in the liver, gall bladder, blood vessels and subcutaneous tissue.Extraintestinal parasitoses include filariasis, dracunculosis, opisthorchosis, schistosomiasis, fascioliasis, clonorchiasis, paragonimosis, trichinellosis, cystocercosis, etc.

In addition, in accordance with the principle of localization, luminal (including intestinal) and tissue (skin and visceral) helminthiases are distinguished.

Symptoms of helminthiasis

The clinical picture of helminthiasis is very diverse and consists of the general reaction of the immune system in response to the invasion of parasites and organ-specific lesions.During helminthiasis, acute or early phases (from 2-3 weeks to 2 months) and chronic phases (up to several years) are distinguished.The main pathological effects of helminths on the human body include toxic-allergic reactions, mechanical damage to organs and tissues, nutritional and vitamin deficiency and reduced immunological competence.

Acute phase

In the acute period of helminthiasis, the main manifestations are due to the toxic-allergic effect of parasitic worms on the body.Patients develop fever, skin rash, muscle pain, and lymphadenopathy.Abdominal syndrome (dyspepsia, abdominal pain), pulmonary syndrome (dry cough, bronchospasm, shortness of breath), hepatolienal syndrome (enlarged liver and spleen), asthenovegetative syndrome (apathy, fatigue, sleep disorders, irritability) often develop.

Chronic phase

In the chronic phase of helminthosis, organ-specific lesions prevail, mainly caused by mechanical trauma at the site of helminth parasitization.Thus, the determining factors in the course of intestinal helminthiasis are dyspeptic disorders and abdominal pain.Violation of absorption processes in the intestines is accompanied by polyhypovitaminosis and progressive loss of body weight.Iron deficiency anemia is a frequent companion of intestinal helminthiasis.With a massive helminth invasion, rectal prolapse, development of hemorrhagic colitis and intestinal obstruction are possible.

In the chronic phase of helminthosis, which occurs with primary damage to the hepatobiliary system, obstructive jaundice, hepatitis, cholecystitis, cholangitis, and pancreatitis may occur.In the case of pinworm migration during enterobiosis, the development of persistent vaginitis, endometritis and salpingitis is possible.

The chronic stage of strongyloidosis occurs with the formation of stomach and duodenal ulcers.Trichinellosis can affect the cardiovascular system (myocarditis, heart failure), respiratory organs (bronchitis, bronchopneumonia) and the central nervous system (meningoencephalitis, encephalomyelitis).Due to the invasion of lymphatic vessels by filariasis, filariasis often develops lymphangitis, lymphedema of the extremities with swelling of the mammary glands and genitals.With echonococcosis, cysts appear on the liver and lungs, and when they suppurate, complications in the form of purulent peritonitis or pleurisy are possible.

Against the background of helminthiasis in children and adults, the effectiveness of preventive vaccination and revaccination decreases, as a result of which the necessary protective level of immunity is not achieved.In the presence of concomitant diseases, helminthiases change and aggravate their course.The result of helminthiasis can be recovery (with natural death or expulsion of the helminth) or residual phenomena, often with debilitating consequences.

Diagnosis

Based on clinical and epidemiological data, helminthiases are diagnosed mainly in the chronic stage.To identify the causative agent of helminthiasis, special laboratory methods are used: microhelmintoscopic (scraping for enterobiosis), helminto-ovoscopic (examination of feces for worm eggs), helminto-larvoscopic, serological (ELISA, RIF, RSK, RNGA), histological coprology.The research material for the detection of eggs, larvae or fragments of mature helminths can be feces, vomit, duodenal contents, sputum, urine, blood, skin biopsies, etc.

Skin allergy tests with helminth antigens can be informative for intestinal helminthiases.To identify and assess the severity of organ-specific lesions, instrumental diagnostics are widely used: ultrasound of the liver, pancreas, FGDS, colonoscopy, endoscopic biopsy, radiography and CT of internal organs, liver scintigraphy.

worms in the intestines

Treatment of helminthiasis

The holistic approach to the treatment of helminth infections consists of etiotropic and syndromic therapy.Specific treatment includes the prescription of anthelmintic drugs, taking into account the type of helminth and the stage of invasion.The effectiveness of deworming is evaluated based on the results of repeated parasitological examination.The following groups of drugs are used for etiotropic therapy of helminthiasis:

  • the antinematode
  • anticestodiasis
  • anti-trematode
  • broad-spectrum drugs.

In case of intestinal helminthiasis, antibacterial drugs, enterosorbents, enzymes, probiotics, etc. are added to the main treatment.Symptomatic therapy for helminthiasis may include prescribing antihistamines, intravenous infusions, vitamins, cardiac glycosides, NSAIDs, and glucocorticoids.In echinococcosis, the main method of treating patients is surgical (hepatic cyst/abscess surgery, echinococcectomy).

Prevention

The prevention of geohelminthiasis is carried out through hygiene education of the population, protection of the environment from fecal pollution and education of children in the rules of personal hygiene.In terms of preventing the spread of biohelminthosis, an important role is played by deworming of domestic animals, veterinary-sanitary control over the sale of meat products and careful heat treatment of meat and fish.In the prevention of contact helminthiasis, the main importance is the interruption of the transmission mechanism of pathogens in organized, mainly children's, collectives.It is recommended to carry out seasonal drug prophylaxis of helminthiasis in families (for example, albendazole), regular parasitological examination of children and risk groups.