Opisthorchiasis in adults - symptoms, prevention and treatment

Since childhood, we know how tasty and useful fish, boiled, fried, baked in the oven. We are told about phosphorus, iodine and omega-3, but often forget to say that it is the fish that can become a serious cause of not the most pleasant disease that is called opisthorchiasis.

This disease has become quite widespread, in the world there are 21 million. people who are infected with these helminths. This "uncontrolled" parasitic disease is very difficult to diagnose, its symptoms are diverse and nonspecific, it causes a number of serious complications, and its outcome is the most unfavorable.

It happens that patients for years are unsuccessfully treated by a pulmonologist, an allergist, an oncologist and other specialists.

How can I get infected?

How is opisthorchiasis infected, and what is it? Opisthorchiasis is a disease caused by flat worms of the trematode class (opisthorchis). The most common pathogens are hepatic fluke, cat and Siberian fluke. These are very small parasites of a lanceolate shape with a length of 8 to 18 mm. They develop with the help of two intermediate hosts, after which they reach the person or any carnivorous animal, thereby infecting it and causing the disease.

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The main source of infection is a sick person or animal, the feces of which, along with the eggs of the parasite, enter the water. Later, eggs can swallow snails, in the body of which the larvae of the parasite will multiply, then they will come out into the water in the form of larvae - cercariae.

In what fish is opisthorchosis known - a cercaria is very much in the fishes of the Cyprinidae family: it is a yaz, carass, dace, roach, vobla, rudd, carp and bream. The probability of infection from the pike is extremely small. Sturgeon (sturgeon), salmon (chum, pink salmon, salmon) and sea fish are safe against infection by the opisthorch. Further development of cercariae occurs in the muscles and subcutaneous tissue of carp fish, where they become metacercariae.

Infection of humans and animals occurs with the use of invasive, poorly processed (raw, light-salted) fish. In the gastrointestinal tract of the final host, under the action of duodenal juice, the capsule and larva shell dissolve, resulting in Metacercaria migrate to the common bile duct, intrahepatic bile ducts, as well as into the ducts of the pancreas.

In the hepatopancreatobiliary system, after 3-4 weeks, the metacercaria turns into a mature opisthorchis capable of producing eggs. The complete cycle of helminth development from the egg stage to the mature specimen lasts 4-4.5 months. Invasive human opisthorchis can vary from a few units to tens of thousands. In the body of the final host, the cat's fluke can parasitize for 20-25 years.

Symptoms of opisthorchiasis

After infection with opisthorchiasis, symptoms in adults may not appear for a fairly long time, but after the onset of helminth activity, they can not be detected.

Signs of opisthorchiasis will begin to appear as a result of the multiplication of larvae in the region of the liver and pancreas, after their detection, diagnosis and treatment should be immediate. Although the symptoms of opisthorchiasis are not life-threatening, remember, treatment in the early stages of the disease is much easier.

Acute phase (or acute opisthorchiasis). Characterized by the development of a "bright" clinical picture:

Soreness in the muscles and joints.
Poor appetite, weight loss.
Soreness in the right hypochondrium, possibly the appearance of shingles in the localization (location) of the inflammatory process in the pancreas with irradiation (spread) to the left arm and / or the left half of the thorax.
Increase in body temperature (up to 38-40 ° C) with chills, increased sweating, intoxication (poisoning) of the body.
Allergic reactions - skin itching, allergic urticaria (rashes on the skin of an allergic nature, arising on contact allergen (a substance that is perceived by the immunity as being foreign and causes an allergic reaction) with the skin);
Dyspeptic (digestive disorders) disorders (nausea, vomiting, diarrhea).

The clinical picture of acute opisthorchiasis is typical for many infectious diseases. Therefore, its diagnosis is difficult.

Chronic opisthorchiasis

At this stage, you can find symptoms that are characteristic of diseases such as hepatitis, cholecystitis, pancreatitis, gastroduodenitis. In chronic opisthorchiasis symptoms may be present permanently or occur periodically with alternating periods of exacerbation and remission (absence of symptoms of the disease).

In the right subchamber there are always paroxysmal pains, similar to the biliary colic, which turn into the right half of the thorax. Dispepsic disorders are observed. Since the parasite also affects the nervous system, it manifests itself with the corresponding symptomatology. The patient complains of fast fatigue, insomnia, irritability, nervousness.

There is increased sweating, tremors of hands, eyelids and tongue. Quite often neurological symptoms come to the fore, which contributes to incorrect diagnosis. In addition to the listed, the patient may have allergic manifestations (hives, itching, Quincke edema, food allergies).

Opisthorchiasis: photo

As opisthorchiasis looks, you can see the pathogen of the disease in the photo.

Diagnostics

In the case of opisthorchiasis, diagnostics presents difficulties in the early period of the disease, since from the moment of appearance clinical manifestations of the disease before the eggs of the parasite with feces pass, on average, up to six weeks.

Most often, the algorithm of diagnostic activities is as follows:

An anamnesis is collected, during which it is determined whether the patient lived in a place where it is often diagnosed opisthorchiasis, and whether there were episodes of ingestion of poorly-processed thermally fish of carp breeds.
In the general blood test, leukocytosis, an increase in ESR, a high degree of eosinophilia is detected. Biochemical blood test shows a decrease in the level of total protein in the blood, albumin, a change in hepatic enzymes.
Comprehensive diagnosis is mandatory, which is carried out on 3 specific markers - IgM, IgG, CEC, and they make it possible to accurately diagnose.
Signs of the disease when performing ultrasound diagnosis of opisthorchiasis are diffuse changes in the liver, dilatation of the bile duct and hepatomegaly.

Analysis of feces for opisthorchiasis is recommended to be carried out three times, with an interval of several days. This is due to the fact that it is not always possible to immediately detect the eggs of the pathogen. A more modern diagnostic study used for the diagnosis of opisthorchiasis is the detection of worm DNA by polymerase chain reaction. The method can be used in both children and adults.

Treatment of opisthorchiasis

If an adult has found the above symptoms, then one should not panic or despair, because treatment of opisthorchiasis in adults, although problematic, but it can be found, and rid the patient of parasites. In this case, the patient is prescribed drugs that kill helminths, thereby clearing the liver and pancreas from their presence. Such treatment is complex, it has several stages, and can be quite long.

The treatment regimen for opisthorchiasis includes several stages:

Preparatory. Continues from 10 to 20 days, depending on the severity of the current. During this period, drugs are prescribed to improve the condition and remove common symptoms. These are antispasmodics, anti-inflammatory, antiallergic agents. To optimize the outflow of bile used cholagogue. Hepatoprotectors stabilize liver function.
The second stage is a direct dehelmmentation. The doctor recommends in each individual case a course of medicines aimed at eliminating helminth from the body. Self-medication in such cases can have negative consequences, therefore it is necessary to strictly adhere to the scheme and the course of the necessary preparation, which the specialist recommends.
The third stage (rehabilitation)- is designed to restore the violations that have occurred in the body due to invasion. In addition, it is taken into account that a person was treated with biltricide, which means that there are all grounds for using cholagogue therapy by means of various kinds of tjubazhes, reception of decoctions of herbs with choleretic effect and hepatoprotectors. Also during the entire rehabilitation period, the bowels should be cleaned with enemas or laxatives.

Against the backdrop of drug treatment it is undesirable to treat people's methods, since the burden on the diseased liver is so great. So it's better to wait until the course of praziquantel is over.

Diet

The use of diet No. 5 is effective in many cases of gastrointestinal diseases. And the treatment of opisthorchiasis is no exception. During the period of therapeutic treatment of opisthorchiasis, and also during half a year afterwards, therapeutic nutrition with opisthorchiasis will promote recovery.

According to this diet, patients with opisthorchiasis are recommended to eat boiled, steam and baked dishes, that is, those that have passed through a gentle heat treatment. Also it is impossible to eat sweet and baking, very salty and sharp culinary products.

Prevention of opisthorchiasis

Primary prevention means preventing the parasite from entering the human body.

Opisthorchiasis occurs solely when cysts of opisthorchis are infected with fish that have not been properly culinary. Accordingly, you can protect yourself from infection by observing certain rules for selecting and preparing fish dishes.
Cook fish in portions, at least 20 minutes from the boiling point, fish dumplings - at least 5 minutes from the time of boiling. Fish (fish cutlets) should be fried in portions in fat for 15 minutes. Large pieces of fish weighing up to 100 g should be fried in a flattened form for at least 20 minutes. Small fish can be fried in full for 15-20 minutes. Fish pies must be baked for at least 60 minutes.
Freezing; the freezing time is 7 hours at a temperature in the fish body -40 ° C; 32 hours at -28 ° С.
Pickling - an ambassador in a solution of salt with a density of brine from the first day of salting 1.20 at 2 ° C; duration of salting from 10 to 40 days, depending on the weight of the fish.
Under no circumstances should you consume raw water, be it water from streams, wells or water pipes. At the same time, to know for sure that all parasites that can be found in contaminated water have died, boil it for at least ten minutes.
Hands should be washed often. This is the simplest, but effective way, through which a person without special efforts protects himself from the vast majority of infectious diseases.

In the presence of symptoms suggestive of infection, it is necessary to undergo examination, hand over feces to reveal eggs of worms and blood for opisthorchiasis. It should be remembered that a mature opisthorchis that secretes eggs develops from cysts for almost a month, accordingly, it is possible to detect a parasite only after the expiration of this period.