What is hymenolepiasis

Hymenolepiasis - the disease belongs to the group of helminthiases caused by flat tapeworms( chains), called "dwarf" and "rat."Parasites are in the small intestine of a sick person, stand out with feces.

Treatment of hymenolepiasis is carried out by specific drugs after laboratory confirmation of the diagnosis of feces on eggs of worms or in the detection of sexually mature individuals. With the consequences of the disease, the body has to struggle for a long time. First, the patient is engaged in infectious disease doctor, then the therapist, gastroenterologist, pediatrician.

The prevalence of hymenolopidosis

The disease occurs in all regions, but the maximum incidence is observed in Latin America, northern Africa, Asia, the Middle East, and Transcaucasia. The percentage of infected population reaches 34 in some areas. In Russia, the territories of the Amur and Tomsk regions are considered dangerous for infestation by a dwarf chain.

Cases of hymenolepiasis are found elsewhere, but they are often associated with epidemiology with travel, business trips from the Far East. Children are prone to infection 3.5 times more often than adults. Most patients are sick between the ages of 4 and 14.Doctors explain this feature with shortcomings in hygienic skills and reduced immunity.

Characteristics of the pathogens

Both types of chain affect not only humans, but also some rodents( hamsters, mice, rats).To infect humans, the most important is dwarf tartar. It among the tapeworms is considered small, reaches a length of 10 to 50 mm, a width of 0.5-0.7 mm. A round head, neck and ribbon-shaped body are prominent in the structure.

Has 4 suckers at the head end, proboscis surrounded by a whisk of a variety of chitinous hooks. The structure of the body is divided into the smallest segments. Their number reaches several hundred. Immediately behind the neck are immature segments, then - hermaphroditic, at the end - mature forms that have a uterus with round or oval eggs.

The surface of the eggs is covered with two transparent shells. Between them pass the crimped filaments( filaments).Inside there is oncosphere with three pairs of hooks. When the segments are filled with eggs, they are separated from the helminth body, able to move independently.

Man serves both as an intermediate and ultimate host of the chain. The entire life cycle from the larval to the adult stage occurs in the human body, the parasite does not need to go outside. Scientists parasitologists do not exclude the possibility of developing dwarf chain in fleas, flour beetles as an intermediate host.

Ratscratch rarely infects people. The adult form exceeds the dimensions of the dwarf species( length from 20 to 60 cm, width 0.2-0.4 cm).There are no hooks on the proboscis. There is an intermediate host - mostly insects( fleas, cockroaches, flour worms, wasps).Autoinvasion is not typical.

Stages of development of the parasite

Eggs of the dwarf chain come to the person when swallowed. They pass through the stomach into the upper parts of the small intestine. At this point the oncosphere, with the help of its hooks, dumps the egg shell and penetrates into the villi of the mucous membrane or into solitary follicles.

The tissue implantation phase occurs more often in the lower third of the small intestine. After 6-8 days oncosphere turns into an embryo( cysticercoid).It has a characteristic appearance: an inflated front part with a head hidden inside, a caudal appendage with hooks.

Cysticercoids are able to develop not only in the mucous epithelium, but also in the submucosal layer, lymphoid follicles, in other organs( lymph nodes of the mesentery, liver).After the destruction of the villi of the mucosa, the cysticercoids fall into the intestine. The tissue phase ends and the intestinal begins.

Suckers and hooks help the parasite to attach to the mucosa in the small intestine. Formation of an adult occurs 2 weeks. It turns out that the development period of the mature dwarf chain is 3 weeks in total.

How does the infection occur?

Children and adults are infected with hymenolopidosis when they swallow the eggs of the pathogen from unwashed vegetables and fruits contaminated with feces, water in the pool, with unwashed hands, food, household items.

Sexually mature specimens of helminth mature in the small intestine of the larva after 3 weeks. From this moment the person becomes infectious, as with a feces allocates segments with eggs. They can last for a long time in the ground, in water, and be transported by dust or insects for considerable distances.

In weakened people with hymenolepiasis, concomitant diseases, children, intestinal infection can be re-infected( autoinvasia).In this case, the eggs of the parasite do not leave the external environment, but develop inside the intestine.

Observations of the foci show that hymenolepiasis can be combined with enterobiosis( a disease caused by pinworms), but does not occur in areas massively infected with ascariasis. This is due to the possibility of antagonism between the species of ascarid worms and a dwarf chain.

What changes occur in the body of an infected person?

The causative agents of hymenolopidosis injure the intestinal wall by mechanical action, which causes inflammation, attachment of propagation of pathogenic microflora, a violation of the synthesis of enzymes and, on the whole, adversely affects the digestive processes.

The toxic effect on the body of slag substances of vital activity of helminths, the increase of allergic mood( sensitization), irritation of the nerve endings of the small intestine shells has definite significance.

What is the danger of the worm?

The danger from the presence of the dwarf chain is related to:

• with the ability of the parasite and eggs to migrate through the body, get into different organs;
• destruction of the intestinal wall;
• marked intoxication products of helminth decay;
• loss of an infected person's energy reserves to feed the parasite;
• by the occurrence of anemia due to blood loss( if the mucous membrane is damaged, the integrity of the vascular wall is violated);
• negative impact on the balance of intestinal microflora;
• loss of vitamins and trace elements.

How is hymenolepiasis manifested?

Symptoms of helminthiosis caused by dwarf chain, in 30% of infected are weak or absent. In such cases, they speak of the subclinical course of hymenolepiasis. In 70% of cases, all clinical manifestations are divided into 4 syndromes:

• pain - in the abdomen the patient feels sharp or dull pain in the form of repeated attacks;
• dyspeptic - loss of appetite, nausea, heartburn, diarrhea with bloody liquid feces, weight loss, dysbacteriosis;
• astenoneurotic - irritability, insomnia, dizziness, headaches, weakness;
• allergic - itchy skin rash, asymmetrical face swelling, runny nose, asthmatic bronchitis.

With massive infection, the pains are markedly cramped, accompanied by dizziness with fainting, fever, functional changes in the liver, myocardial dystrophy. Usually more severe course is observed in children.

The child loses weight, seizures appear in the form of seizures, the liver, anemia( anemia) and hypovitaminosis increase significantly, exacerbate the clinical picture. Hymenolepiasis can significantly increase the current of the pathology of the digestive organs with peptic ulcer of the stomach and duodenum, pancreatitis, hepatitis, chronic cholecystitis.

microscope. How is the diagnosis carried out?

A doctor's examination of a patient with hymenolopidosis makes it possible to notice:

• pallor of the skin;
• thinness;
• arterial hypotension;
• scratching and rash on the skin.

In the analysis of blood - reduction of hemoglobin, erythrocytes, hypochromic type of anemia, accelerated ESR, eosinophilia, leukopenia. Specific and indisputable evidence is the detection in the stool of the patient of eggs and segments of a dwarf or rat chain. They can have different stages of development.

For the analysis to coincide with the egg production cycle, it is carried out three times at intervals of 5 days. The day before the feces are given, the patient is prescribed anthelmintic drugs. This leads to increased fracture of the segments and a more intensive release of eggs into the intestine.

Serological tests are not performed due to the availability of a simpler and irrefutable method. By the type of parasites, they are differentiated with other helminthiases in the intestine( diphyllobothriasis, teniosis).

Treatment with anthelmintic means

To completely get rid of parasites and autoinvasive pathways of infection, drugs that kill both adults and eggs are needed. Specific therapies( de-worming) are prescribed depending on the specific remedy from three to seven days. The dosage depends on the weight and age of the patient. Among the drugs used the following.

Praziquantel( Biltricide) - available in the form of tablets, reaches the maximum concentration in the patient's blood two hours after ingestion, 80% of the dose is excreted by the kidneys, 20% through the intestine. The drug is able to cause muscle spasms in the worms to complete paralysis and death of the parasite.

Niaclomazide( Fenasal) - in addition to the tablet form, is produced in a powder that is insoluble in water. In connection with the effect on the muscular system of worms, prevents their sucking to the intestinal mucosa, parasites can not absorb nutrients. At the same time, laxatives are prescribed.

Male fern extract is a herbal preparation from the fern rhizome. It can not be combined with castor oil as a laxative. Before applying antihelminthic treatment is necessary preparation:

• for two to five days, a special diet is chosen from easily digestible foods with a minimum fat content;
• in the evening the patient should take a salt laxative;
• a cleansing enema is performed in the morning before drinking the drug.

Contraindications and side effects of

Not all patients infected with himenolepidosis are treated with any medication. Contraindications to the use of praziquantel concern pregnant women in the first trimester, individuals with individual intolerance, patients with liver pathology.

Extract of male fern with hymenolepiasis is not recommended except for the listed reasons: children under two years old, exhausted people, against tuberculosis, with cardiac decompensation. Possible side effects are manifested by different systems of the body.

Negative effect on digestion is the appearance of nausea, vomiting, diarrhea with an admixture of blood, increased pain in the abdomen. The nervous system can react with fever, sweating, headaches, drowsiness, dizziness, muscle aches, cramps.

Allergic reactions strengthen the already existing symptoms. The rash spreads over the skin in the form of urticaria, itchy itching, choking attacks, swelling of the face, tongue.

Adverse events are more common in elderly patients and with massive infection with hymenolepidosis.

Additional treatments for

Adults and children with hymenolepiasis should be provided with adequate nutrition. Between the courses the patient is prescribed antihistamines, preparations with calcium, vitamin complexes. Often children need to restore the intestinal flora with probiotics.

Fecal counts are repeated 15 days after completion of the deworming course, then once a month for six months. If the eggs of the parasite are detected again, a second course of treatment is necessary. To prevent autoinvasion and contamination of people around the home of helminthiasis, sanitation and disinfection measures are mandatory.

The patient should:

• perform daily anal scouring and necessarily after defecation;
• disinfect toilet, care products, children's toys, potty;
• more often to change bed-clothes, daily to erase and iron iron briefs;
• to cut nails and wash hands thoroughly with soap.

The home is considered closed if, within six months after the course of therapy, all the results of control stool tests are negative. Most patients manage to achieve full recovery. There are rare cases of drug-resistant forms of hymenolepidosis. Duration of the disease is due to repeated autoinvasion.

Folk remedies

Vegetable decoctions against hymenolepiasis are less effective than antihelminthic drugs, but they intensify the effect on parasites. Traditional medicine recommends tansy, cloves, wormwood. They can be mixed by a pinch and brewed in a thermos.

Who else has Hymenolepidosis?

In addition to humans, waterfowl( geese and ducks) suffer from the dwarf chainworm. They become infected by eating infected snails, slugs. Usually, hymenolepiasis is noticed 20-25 days after the beginning of the swimming season on water bodies.

Owners of poultry farmers notice that birds have liquid feces with an unpleasant odor, weight is not gaining, the diseased differ unstable gait, convulsions. For treatment, also anthelmintic drugs are used, which are mixed into food.

Prevention measures

The main way to prevent hymenolepiasis is to observe adult hygiene and teach children skills. In domestic and industrial premises should be carried out the destruction of insects( flies, cockroaches, fleas), rodents.

When buying flour, pay attention to the presence of pests, garbage. This is possible in low-grade foods. Coprologic examination of children and adults is conducted to obtain a certificate in the pool, when booking a voucher for a summer camp, a sanatorium.

Investigation of feces for helminths is mandatory for quarterly employees of preschool institutions, canteens and cafes, any food units. When detecting helminthiasis for a period of treatment, a person is removed from work.

With a planned hospitalization in a hospital, a preliminary check of feces for helminths is recommended for both adults and children. Deworming requires measures to protect the public, and therefore is included in the plan for the sanitary well-being of the territories.

Modern therapy against parasites is able to completely cure a person with hymenolepiasis and relieve health problems. Do not forget that helminthiases are considered an important cause of severe systemic allergic diseases, chronic intestinal lesions.