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Helminthiasis

worms in the human body

Helminthiasis– helminthic diseases caused by helminths – parasitic round and flat worms, less often ringed and with spiny heads.Helminthiases are 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 (helminth-ovoscopic, helminth-larvoscopic, serological) and instrumental (X-ray, endoscopy, ultrasound, etc.) methods are used.Treatment of helminthic infections depends on the type of parasite and includes specific (anthelmintic) and pathogenetic treatment.

General information

Helminthic infections are helminthic infestations caused by various types of lower parasitic worms - helminths.Helminthiases have a chronic course, accompanied by exhaustion of the body and a reduction in its natural defenses.In the structure of helminthiasis, the main places belong to enterobiasis, ascariasis, hookworm, trichuriasis and toxocariasis.

According to official statistics, the rate of infestation 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 concerns not only infectious diseases, but also pediatrics, therapy, surgery, gastroenterology, dermatology, allergology, urology and other practical medical areas.

Causes of helminthiasis

To date, more than 250 pathogens of helminthiasis in humans are known;The most common of these number around 50 species.Helminths parasitizing the human body are mainly represented by roundworms (Nematode class) and flatworms (fluke class - Trematoda and tapeworms - Cestoidea);Less commonly, human infections occur by annelids (Annelida) and acanthocephala (Acanthocephala).Representatives of roundworms include pinworms, roundworms, trichinellae and whipworms;tapeworms - bovine, porcine and dwarf tapeworms, echinococci, broad tapeworm;flukes - cat and liver flukes.

The life cycle of helminths includes egg, larva and mature stages.Depending on the features of the development of parasitic worms and the routes of infection, helminthic diseases are divided into biohelminthiasis, geohelminthiasis and contagious (contact) helminthiasis.

  1. Geohelminthsconstitute the majority of roundworms (nematodes).The developmental stages of soil-transmitted helminth eggs and larvae take place in the soil under certain temperature and humidity conditions.Infection with soil-transmitted helminthiasis occurs through non-compliance with personal hygiene, consumption of water, fruits, vegetables contaminated with parasites or contact with soil contaminated with feces.Soil-transmitted helminthiasis includes helminthic diseases such as ascariasis, hookworm, trichuriasis and strongyloidiasis.
  2. By numberbiohelminthsbelong to flukes (trematodes) and tapeworms (cestodes), as well as certain types of nematodes.To reach the invasive stage, they need to change 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 has not undergone sufficient heat treatment or by drinking raw water.Representatives of biohelminthiasis are diphyllobothriasis, clonorchiasis, opisthorchiasis, taeniasis, taeniarinchiasis, trichinosis, fascioliasis, echinococcosis.
  3. Kcontagious helminthiasesbelong to invasions that are transmitted from person to person by personal contact, by sharing toiletries, dishes, underwear or by self-infection.These are enterobiasis, hymenolepiasis, anguillulosis, cysticercosis.

Ranking

Helminth infections are classified based on the biological characteristics of helminths, their mode of existence in the external environment, routes of infection and their habitat in the human body.Taking into account the biological characteristics of pathogens, we distinguish:

  • nematodes(ascariasis, enterobiasis, trichuriasis, hookworm, necatoriasis, etc.)
  • cestodiasis(teniasis, cysticercosis, hymenolepiasis, teniarinchiasis, echinococcosis)
  • trematodes(opisthorchiasis, 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 percutaneously.Depending on the localization of pathogens in the human body, helminthic infections are divided into:

  • Intestinal.Human intestines are parasitized by pathogens of ascariasis, enterobiasis, hookworm, trichuriasis, strongyloidiasis, trichostrongyloidiasis, diphyllobothriasis, taeniasis, taeniarynchosis, hymenolepiasis, etc.
  • Extraintestinal.Extraintestinal helminths can live in the liver, gallbladder, blood vessels and subcutaneous tissues.Extraintestinal parasitoses include filariasis, dracunculiasis, opisthorchiasis, schistosomiasis, fascioliasis, clonorchiasis, paragonimiasis, trichinosis, cystocercosis, etc.

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

Symptoms of helminthiasis

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

Acute phase

In the acute period of helminthiasis, the main manifestations are caused by the toxic-allergic effect of parasitic worms on the body.Patients present with fever, rash, muscle pain, and lymphadenopathy.Abdominal syndrome (dyspepsia, abdominal pain), pulmonary syndrome (dry cough, bronchospasm, shortness of breath), hepatitis syndrome (enlargement of the liver and spleen), asthenovegetative syndrome (apathy, fatigue, sleep disturbances, irritability) often develop.

Chronic phase

In the chronic phase of helminthiasis, organ-specific lesions predominate, caused mainly by mechanical trauma to the site of helminthic parasitism.Thus, the determining factors in the course of intestinal helminthiasis are dyspeptic disorders and abdominal pain.Violation of absorption processes in the intestine is accompanied by polyhypovitaminosis and a gradual loss of body weight.Iron deficiency anemia frequently accompanies intestinal helminthiasis.In case of massive helminthic infestation, rectal prolapse, development of hemorrhagic colitis and intestinal obstruction are possible.

In the chronic phase of helminthiasis, which occurs with primary lesions of the hepatobiliary system, obstructive jaundice, hepatitis, cholecystitis, cholangitis and pancreatitis may occur.In case of migration of pinworms during enterobiasis, the development of persistent vaginitis, endometritis and salpingitis is possible.

The chronic stage of strongyloidiasis occurs with the formation of ulcers of the stomach and duodenum.With trichinosis, the cardiovascular system (myocarditis, heart failure), respiratory organs (bronchitis, bronchopneumonia) and the central nervous system (meningoencephalitis, encephalomyelitis) can be affected.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 of the liver and lungs occur, 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, so the necessary level of protective immunity is not achieved.In the presence of concomitant diseases, helminthiases modify and worsen their course.The outcome of helminthiasis can be a cure (with natural death or expulsion of the helminth) or residual phenomena, often with disabling consequences.

Diagnosis

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

For intestinal helminthiasis, skin allergy testing to helminthic antigens may be informative.In order 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 computed tomography of internal organs, liver scintigraphy.

worms in the intestines

Treatment of helminthiasis

A holistic approach to the treatment of helminthic infections consists of etiotropic and syndromic therapy.Specific treatment involves the prescription of anthelmintic drugs, taking into account the type of helminths and the stage of invasion.The effectiveness of deworming is assessed based on the results of a repeated parasitological examination.For etiotropic treatment of helminthiasis, the following groups of drugs are used:

  • antinematode
  • antiestodosis
  • anti-trematode
  • broad-spectrum medications.

For intestinal helminthiasis, antibacterial drugs, enterosorbents, enzymes, probiotics, etc. are used.are added to the main treatment.Symptomatic treatment of helminthiasis may include the prescription of antihistamines, intravenous infusions, vitamins, cardiac glycosides, NSAIDs and glucocorticoids.For echinococcosis, the main treatment method for patients is surgery (liver cyst/abscess surgery, echinococcectomy).

Prevention

Prevention of geohelminthiasis involves hygiene education of the population, protection of the environment from fecal pollution and instilling in children the rules of personal hygiene.In terms of preventing the spread of biohelminthiasis, deworming of pets, veterinary and sanitary control of the sale of meat products and careful heat treatment of meat and fish play an important role.In the prevention of contact helminthiasis, the main importance is to break the mechanism of transmission of pathogens in organized groups, mainly of children.It is advisable to carry out seasonal drug prevention of helminthiasis in families (for example, albendazole), regular parasitological examination of children and risk groups.