helminthiasis

Helminthiasis (worm infection): causes, symptoms, diagnosis and treatment.

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Helminthiasis is a disease of humans, animals, and plants caused by parasites (worms).

Causes of helminthiasis

At present, more than 250 kinds of worms have been found to be parasitic on the human body in my country, including more than 70 kinds.The most common are roundworms (roundworms, pinworms, trichinella, whipworms), tapeworms (pork, bovine and dwarf tapeworms, broad tapeworms, echinococcus) and flukes (liver flukes and cat flukes).

Worms are characterized by developmental stages: egg → larva → sexually mature form.

Worm infections most commonly occur after their eggs and/or larvae enter the body.According to different infection mechanisms and transmission routes, helminthiasis is divided into: soil helminthiasis, biological helminthiasis and contact helminthiasis.The development of soil worms does not require an intermediate host, the development of biological worms requires successive changes in one, two or three hosts, and contact worms are transmitted by contact.

Pork tapeworm, bovine tapeworm, echinococcus and other types of worms develop by successive changes in one, two or three hosts.Intermediate hosts can be fish, molluscs, crustaceans, and insects.A person becomes infected with these worms by eating food that has not been adequately heat treated:

• beef infected with bovine tapeworm larvae;
• Pork infected with Finnish pork tapeworm;
• Lightly salted fish with Opisthorchis or larval tapeworm larvae;
• Raw water or vegetables and fruits treated with this water.

Whipworms, roundworms, hookworms, and hookworms develop in the absence of an intermediate host.Egg and larval forms of these parasites are passed into the soil in feces.If personal hygiene rules are not followed, they can penetrate the body of a new host.

Enterobiasis (the causative agent - pinworm) and hymenoderma (the causative agent - the dwarf tapeworm) are transmitted through contact, that is, through personal contact between a healthy person and an infected person, through the use of shared utensils, toiletries, bed linens and by inhaling the dust in the room where the infected person lives.In the case of pinworms, autoinfection often occurs.

Certain types of worms inhabit certain organs, causing various helminthiasis:

• In the large intestine - pork, cattle, dwarf tapeworms, nematodes (hookworms, roundworms, Strongyloides), pinworms, whipworms.Pork tapeworm larvae can enter the bloodstream from the intestinal lumen and spread throughout the body, settling in adipose tissue, muscle blood vessels, eye chambers and brain;
• In the liver and biliary tract - flukes (Opisthorchis, Clonorchis sinensis, Fasciolopsis).Echinococcus tapeworm cysts are mainly located in the liver. After rupture, cysts can be found in the mesentery, peritoneal layer, spleen and other organs;
• In the respiratory organs - Echinococcus, paragonimiasis, paragonimiasis, causing paragonimiasis;
• In the nervous system - schistosomiasis, paragonimiasis, hydatid disease and alveolar coccosis;
• In the visual organ - oncocercariasis, loaciasis, complex forms of taeniasis;
• In the circulatory system - nematodessis, schistosomiasis, diphyllobothriasis;
• In the lymphatic system - filariasis, trichinellosis;
• In the skin and subcutaneous tissue - hookworm, carcinocercerasis, loaciasis, larval stage of schistosomiasis;
• In the skeletal system - hydatid disease;
• Skeletal muscle - trichinellosis, musculoskeletal cysticercosis.

The lifespan of a helminth in the definitive host can vary, depending on the type of parasite, ranging from weeks (pinworms) to years (tapeworms) and decades (fasciolia).

Disease classification

There are two types of worms that parasitize humans:

• Nemathelminthes – roundworm, class Nematoda;
• Plathelminthes are flatworms, which include the classes Cestoidea (tapeworms), Trematoda (trematodes).

According to the transmission route of parasites and their biological characteristics, they can be divided into:

• Biological helminthiasis;
• soil worm disease;
• Exposure to parasitic infection.

Symptoms of helminthiasis

Worms have different effects on the human body:

• Antigenic effects occur when local and systemic allergic reactions occur;
• Toxic effects (helminth waste causing discomfort, weakness, dyspeptic symptoms);
• Traumatic effects (when the parasite becomes anchored to the intestinal wall, the blood supply is disrupted, leading to mucosal necrosis and subsequent atrophy; absorptive processes may be disturbed; the worms exert mechanical compression of the tissue);
• Bacterial invasion after migration of helminth larvae leads to secondary inflammation;
• disrupt metabolic processes;
• Anemia occurs due to the absorption of blood by certain worms;
• Nerve reflex effect - worms stimulate nerve endings, causing bronchospasm, intestinal dysfunction, etc.;
• Psychogenic effects, manifested by neurotic conditions and sleep disorders;
• Immunosuppressive effects.

Helminthiasis is characterized by stages of development.Each stage has its own clinical symptoms.

During the initial acute phase, the worms have usually not yet released their eggs, the body undergoes sensitization (production of antibodies, release of inflammatory mediators, increased permeability of blood vessel walls) and trauma to the organs through which the larvae migrate.There may be no clinical symptoms, but in some cases, the disease may have overt clinical manifestations.The acute phase lasts from 1 to 4 months, sometimes 8 to 10 months or longer.

Complaints of patients in the acute phase:

• Elevated body temperature for several days to two months (low-grade fever or above 38°C, accompanied by chills, severe weakness, and sweating);
• recurring itchy rash;
• Local or general edema;
• Regional lymphadenopathy;
• muscle and joint pain;
• Cough, asthma attack, chest pain, long-term catarrhal symptoms, bronchitis, tracheitis, pneumonia symptoms, asthma syndrome, hemoptysis;
• Abdominal pain, nausea, vomiting, and bowel disturbances.

At the end of this phase of helminth infection, acute allergic phenomena gradually subside, without the clinical development of the chronic phase.

As "young" worms mature, the acute phase changes to the subacute phase.Then comes the chronic phase, which corresponds to the development of the parasite into a sexually mature individual.Clinical manifestations develop against the background of toxic effects of worm waste, traumatic effects of helminths on organs (hookworms, typhoid, etc.), mechanical effects (echinococcal cyst growth in the liver, compression of adjacent organs; cysticerci - in the brain), secondary inflammatory processes (duodenitis is observed in strongyloidiasis), metabolic disorders (vitaminosis or hypovitaminosis), gastric and functional disorders.Duodenum, secondary immunodeficiency, etc.

Symptoms depend on the organ, size and number of worms infesting them.

forIntestinal helminthiasisThe following syndromes are characterized by:

• Dyspepsia (stomach upset, feeling full after eating, early satiety, bloating, nausea);
• pain;
• Neurasthenia (feelings of extreme fatigue, increased nervous excitability and irritability).

Pinworm disease is characterized by perianal itching at night.When a large number of roundworms are infested, intestinal obstruction, pancreatitis, obstructive jaundice, etc. may occur.

Intestinal tapeworm(taeniasis, taeniasis, hymenoderma, taeniasis, etc.) asymptomatic or with a few symptoms (symptoms such as indigestion, pain, anemia, etc.).

liver fluke(Fascioliasis, opiodriasis, clonorchiasis) Causes:

• chronic pancreatitis;
• hepatitis;
• gallbladder cholangitis;
• Neurological disorders.

hookworm diseaseManifested as vegetative asthenia syndrome (weakness, fatigue, pale skin) due to iron deficiency anemia.

Filariasis is characterized by an allergic syndrome of varying severity and regional lymphadenitis.

Urogenital schistosomiasisSymptoms include blood at the end of urine, frequent urination, painful urination, etc.

Asymptococcosis, cysticercosis, hydatid diseaseMay remain asymptomatic for long periods of time.In the later stages, cysts containing parasites may suppurate or rupture, leading to serious consequences such as anaphylactic shock, peritonitis, and pleurisy.

For diseases caused by parasitic migratory larvaeanimal wormWhen a person is not a natural host, distinguishing between cutaneous and visceral forms.The cutaneous form is caused by the invasion of human skin by certain animal worms: schistosomiasis (flukes) in waterfowl, hookworms, and strongyles (nematodes) in dogs and cats.Worm larvae penetrate the skin when a person comes into contact with soil or water.There may be a burning, stinging or itching sensation at the site where the worms have invaded.Symptoms of short-term fever and general malaise may occur.Recovery occurs in 1-2 weeks (less commonly 5-6 weeks).

The visceral form is formed by ingesting worm eggs with water and food.Uncomfortable, allergic rash (rash) may occur during an illness attack.In the human intestine, larvae hatch from worm eggs, penetrate the intestinal wall into the bloodstream, and reach internal organs, where they grow and reach a diameter of 5-10 cm, compressing tissues and disrupting the function of the organs.When tapeworm larvae (cysticerci, tsenura) are located in the meninges and brain parenchyma, headaches, symptoms of cerebral hypertension, paresis and paralysis, and epileptiform convulsions are observed.Larvae can also be located in the spinal cord, eyeball, serosa, myenteric connective tissue, etc.

The outcome of helminthiasis can be complete recovery with elimination of the worms or irreversible changes in the host body.

Diagnosis of helminthiasis

The diagnosis of helminthiasis is based on the combined results of the chief complaint, information provided by the patient regarding the course of the disease, laboratory data, and instrumental methods.

During the acute phase of helminth infection, the presence of worms in the body can produce a hematological reaction, so the following studies are recommended:

• Clinical blood tests: general analysis, white blood cell analysis, ESR (microscopic examination of blood smears with pathological changes);
• Blood biochemical tests:
• Total protein, albumin, protein fraction;
• Assessment of renal function indicators (urea, creatinine, glomerular filtration);
• Assessment of liver function indicators (bilirubin, ALT, AST, alkaline phosphatase);
• Pancreatic alpha-amylase;
• Assessment of carbohydrate metabolism: glucose (in blood), glucose tolerance test, measuring glucose in venous blood fasting and 2 hours after exercise.

The following biological materials can be examined for the presence of helminths: feces, blood, urine, duodenal contents, bile, sputum, muscle tissue, rectal and perianal mucus.

Since worms are not passed in the feces at any stage of their development, it is recommended to donate feces 3 times - every 3-4 days.

• Analysis of parasite eggs in feces.
• Test for pinworms (pinworm eggs), swab.
• Microscopic examination of stool to detect eggs of pinworms (pinworms), the causative agent of enterobiasis.
• Test for pinworms (pinworm eggs), spatula.
• Analysis is necessary if pinworm infection is suspected, as well as during hospitalization and registration of medical records.
• Kindergarten and school analysis.

The Children's Examination Program is designed to be completed before entering kindergarten or school.The results of these studies are necessary to obtain a medical certificate in form 026U approved by the Ministry of Health of the Russian Federation.

Perform immunological studies - determine helminth-specific antibodies:

• Roundworm IgG antibodies;
• Anti-Echinococcus IgG;
• IgG antibodies to Toxocar antigen;
• anti-Opisthorchis felis IgG (IgG class antibody directed against a felis fluke antigen);
• Trichinella spiralis antigen IgG antibody;
• Antibodies, IgG, to the causative agent of anisakiasis (nematodes of the genus Anisakiasis);
• Clonorchiasis pathogen antibodies, IgG;
• Antibodies to Strongyloides stercoralis (the causative agent of strongyloidiasis), IgG.

Tests designed to detect IgG antibodies to the strongyloidiasis causative agent are used for early serologic diagnosis of strongyloidiasis in the setting of clinical suspicion of the disease (eosinophilia, serpentine skin lesions, pulmonary or gastrointestinal symptoms).

In difficult cases, the following studies may be recommended:

• Plain X-ray of chest organs;
• Comprehensive ultrasound examination of abdominal organs (liver, gallbladder, pancreas, spleen);
• Abdominal and retroperitoneal CT scan;
• CT scan of chest and mediastinum;
• CT scan of the brain and skull.

Which doctors should I contact?

If you suspect helminthiasis, you should consult a therapist or general practitioner and see your pediatrician with your child.

If surgical treatment is indicated, the patient is referred to a surgeon.

Treatment of helminthiasis

Most people with worm infections do not require hospitalization.Patients with histological helminthiasis, regardless of severity, as well as those with severe and complex course, are treated in hospitals.

Treat with anthelmintics.The frequency and dosage of the drug are based on the patient's age and weight and are determined by the doctor.

Desensitization, detoxification treatments, and vitamin treatments may be needed.To lower the body temperature, nonsteroidal anti-inflammatory drugs are prescribed, for allergic reactions and itching - antihistamines, for severe edema - diuretics.In severe cases, hormonal drugs are needed.

The presence of worms in organs and tissues may be an indication for surgical treatment.

complication

• Bronchial asthma.
• pneumonia.
• bowel cancer.
• Cirrhosis of the liver.
• Portal hypertension.
• Gastrointestinal bleeding.
• ascites.
• hepatitis.
• Liver abscess.
• peritonitis.
• Allergic myocarditis.
• Meningoencephalitis.
• Chronic glomerulonephritis.
• Chronic kidney disease.
• Hemostatic disorders.
• Loss of vision.

Prevent helminthiasis

Preventative measures designed to prevent worm infections include:

• Follow personal hygiene rules (use personal towels, personal hygiene products and other daily necessities);
• Use only high-quality water in your daily life;
• Keep pets vaccinated and dewormed regularly;
• Wash vegetables, fruits, and berries thoroughly before eating;
• Sufficient heat treatment of meat and fish products.

Frequent contact with pets, children in groups of children, contact with the earth, a hobby of fishing or hunting, frequent travel to exotic countries, can be prevented by the use of medications.The whole family must take drug prophylaxis twice a year (such as spring and autumn).

Important!

The information in this section is not intended for self-diagnosis or self-treatment.In the event of pain or other worsening of the condition, diagnostic tests should only be performed by the attending physician.In order to make a diagnosis and properly prescribe treatment, you should contact your doctor.