Worm infestationsOrhelminthiasis– parasitic diseases with primary damage to the digestive organs. Helminths, parasitic worms, are capable of living in many parts of the gastrointestinal tract (GI tract), incl. in the large intestine, in the rectum. Diagnosis and treatment of colonic manifestations of helminthic infections are carried out jointly by doctorsparasitologistAndcoloproctologist.
Helminthiasis infection is characterized by the following properties:
- chronic course, in which nutrients and protective forces are gradually depleted;
- most often the body is invaded by hookworm, roundworm, toxocara, whipworm;
- pathology is studied and treated not only in pediatrics and therapy, but also in gastrology, surgery, dermatology, allergology and other areas.
The disease affects a small percentage of the country's population, but it tends to spread in areas with poor infrastructure and medical development.
Causes and mechanism
Helminths parasitizing the large intestine are represented by three classes:
- Roundworms (nematodes): roundworms, pinworms (enterobiasis), whipworms (trichocephalosis), eels (strongyloidiasis), hookworms, toxocaras.
- Tapeworms (cestodes): large tapeworm, bovine and porcine tapeworm.
- Flukes (trematodes): schistosomes.
Mosthelminthscomplex development cycle. Between eggs and adults, there are intermediate stages: larvae, cystic forms (cysts or finns). Worm eggs are resistant to adverse conditions and can survive for a long time in soil and water. With raw water, unwashed hands, soil-contaminated fruits and vegetables, they enter the human body.
Young children are more sensitivehelminthiasisdue to the habit of putting hands and foreign objects in the mouth. Animals often carry helminths. Meat, fish, shellfish contain eggs, larvae or fins. These foods, raw or insufficiently heat-treated, also constitute a source of infection.
Parasites cannot exist in the harsh acidic environment of the stomach. But their shell resists the action of gastric juice. In addition, the presence of helminths in food in the stomach is short-lived. And then, together with the food bolus, they pass into the intestine, where the life cycle continues with the formation of adult individuals.
More favorable conditions for the life of helminths are created in the small and large intestines. There is a weakly alkaline environment, there are a lot of food residues, and the mucous membrane is abundantly supplied with blood. A number of adaptive mechanisms (hooks, suction cups, developed muscles) help worms stay in the light.Gastrointestinal tract, attach to the intestinal mucosa and do not come out with stools.
Their presence in the large intestine leads to local inflammatory processes - typhlitis, colitis, sigmoiditis, proctitis. During their life they are releasedtoxins. Many of them are strong allergens.
Some parasites enter the pancreatic ductal system, bile ducts and liver, causing damage to these organs. In addition, the larvae of a number of helminths are capable of piercing the intestinal wall. Along with blood and lymph flow, they enter the muscles, lungs, eyes and brain and cause damage to these organs.
Classification of helminthiasis
Depending on group membership, the following types of parasitic infection are distinguished:
- cystodoses – echinococosis, taeniasis, taeniarinchiasis;
- nematodes – trichocephalosis, ascariasis, necatoriasis;
- Trimatodes – opisthorchiasis, fascioliasis.
Distribution of parasites according to the mode of survival in the environment:
- helminths;
- biohelminths;
- contact helminths.
Classification according to the mode of propagation in the host:
- water;
- food;
- percutaneous.
There are 2 types of parasites depending on the distribution area.
- Intestinal form. They enter the host's body through the oral cavity and gradually spread through the gastrointestinal tract. The permanent habitat is the intestine. These parasites include strongeloidiasis, hookworm, and tenniosis.
- Extraintestinal forms. Penetration can also develop through the gastrointestinal tract, but the parasites then migrate through the intestinal walls to other organs. For example, blood vessels, subcutaneous fat, liver, brain. Opisthorchiasis, fascioliasis and trichinosis have this property.
Extraintestinal forms are considered the most dangerous; they lead to serious complications.
Symptoms
Helminthiases can remain asymptomatic for a long time. Subsequently, non-specific symptoms of intestinal disorders appear:
- nausea;
- decreased appetite;
- aching pain or cramping in the abdomen;
- bloating;
- flatulence;
- diarrhea, constipation, their alternation.
Distinctive symptomenterobiosis: itching, burning in the anus, in the perianal area. This symptom is due to the fact that a sexually mature femalepinwormscomes out and lays eggs. This mainly happens at night.
If the outcome is unfavorable, the intestinal lumen may be blocked by masses of worms. In these cases, there is a typical clinical picture of mechanical intestinal obstruction with severe abdominal pain, bloating, repeated vomiting, retention of stools and gas. The obstruction is complicated by inflammation of the peritoneum with an extremely serious general condition of the patient.
Extraintestinal disorders include:
- headaches;
- weakness, decreased performance;
- changes in the emotional context: depression, irritability, insomnia;
- emaciation;
- pale skin, rash, pallor and dryness of visible mucous membranes;
- dry cough;
- frequent colds;
- the appearance and frequency of bronchial asthma attacks;
- bruxism – cutting teeth while sleeping;
- muscle and joint pain.
These symptoms are caused by organ and tissue damage, poisoning, immunodeficiency, allergies and vitamin deficiencies. If helminthiasis is not diagnosed, it is associated with other causes.
Diagnosis
Diagnosisdiagnosed based on laboratory tests of blood and stool. A general blood test reveals a decrease in the level of hemoglobins and red blood cells. The level of eosinophilic leukocytes is increased. It must be taken into account thatanemiaand eosinophilia are characteristic of other diseases and therefore only indirectly indicate helminthiasis.
Blood immunodiagnostics aims to detect specific antibodies directed against parasitic tissues. Be sure to examine stools for hidden blood and worm eggs. To diagnose enterobiasis, a scraping is taken from the perianal area. To scrape, use a cotton swab or tape. Damage to the intestinal mucosa is diagnosed using endoscopic methods - sigmoidoscopy, colonoscopy.
There are additional diagnostic tests that help determine the type of pathogen, area of spread and extent of damage:
- allergy skin test with the addition of helminthic antigens;
- Ultrasound of the abdominal organs with assessment of the condition of the intestines, liver, spleen, pancreas;
- fibrogastroduodenoscopy - visual examination of the upper parts of the digestive tract through the introduction of a specific device through the oral cavity;
- colonoscopy - visual examination of the walls of the large intestine by inserting a probe with a camera;
- endoscopic biopsy – collection of tissue sections during an endoscopic examination followed by microscopy and histological analysis;
- x-ray or computed tomography of internal organs with the addition of contrast to assess the morphological properties of tissues, detect foreign elements and identify the integrity of the walls;
- liver scintigraphy - introduction of a radiotracer that accumulates in the liver and emits radiation displayed on the monitor (morphology, size, location of the organ, the presence or absence of defects can be assessed).
Research methods are prescribed depending on the symptoms that appear and the doctor's suspicions about the degree of spread of helminthiasis.
Treatment
Helminthiasisare treated with medication. Depending on the type of parasite, a treatment is developed usinganthelminticdrugs. Many of them further strengthen the immune system. Along with specific treatment, patients take vitamin and mineral complexes and digestive enzymes. Maximum attention is paid to personal hygiene. In case of intestinal obstruction, emergency surgery is necessary.
In severe cases, it is not enough to use medications to treat helminths. It is best to use products specifically targeted against a specific type of parasite:
- anticystadic;
- antinematodes;
- anti-trematodes;
- wide spectrum of action against different groups of parasites.
In addition to specific treatment, the prescription of symptomatic drugs is necessary to eliminate the manifestations caused by helminths:
- antibacterial drugs with additional complication of the disease by activated pathogenic microflora of the digestive tract;
- absorbents that envelop and remove products of helminth poisoning before they are absorbed into the systemic bloodstream;
- enzymes that improve the digestive process, especially if helminthiasis is complicated by diarrhea;
- probiotics – their use is mandatory when using anthelmintic and antibacterial drugs to restore the normal state of the intestinal microflora;
- cardiac glycosides for complications of helminthiasis with cardiovascular pathologies;
- non-steroidal anti-inflammatory drugs to suppress the active inflammatory process due to the action of parasites;
- glucocorticosteroids prescribed for activation of the immune system and the development of acute allergic reactions.
Surgery is considered the treatment method of last resort. It is prescribed in case of complications. For example, when parasites move from the intestines to other organs.
Prevention
To prevent the penetration of helminths into the human body, it is recommended to perform the following actions:
- frequent washing of hands and food before consumption;
- maintain basic personal hygiene;
- use of antiglycemic drugs for animals;
- heat treatment of meat and fish;
- preventive use of drugs against helminths, especially if characteristic symptoms appear or the patient is at risk.
Prevention methods reduce the risk of helminth infection, but cannot completely eliminate it. Therefore, doctors recommend periodically giving stools for analysis.
Forecast
The forecast depends on the following factors:
- type of parasite;
- helminth distribution area;
- degree of intoxication;
- complications for internal organs and systems.
A parasitic infection identified and treated in time guarantees a positive prognosis. If treatment is carried out at an early stage, no complications will develop. If it is absent or incorrectly prescribed, pathologies begin to develop that worsen well-being. In severe cases, the abdominal and thoracic organs are damaged and the infection can spread to the brain. Such pathologies degrade the quality of life and can lead to work incapacity. Possible death due to the development of anaphylactic shock and helminthiasis of the central nervous system. Therefore, in this case, timely diagnosis is important.