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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 a spiny head.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 organs of vision.Laboratory (helminth-ovoscopic, helminth-larvoscopic, serological) and instrumental methods (X-ray, endoscopy, ultrasound, etc.) are used in the diagnosis of helminth infections.Treatment of helminth infections depends on the type of parasite and includes specific (anthelmintic) and pathogenic therapy.

General information

Helminth infections are helminth infestations caused by several types of lower parasitic worms - helminths.Helminthiasis has a chronic course, accompanied by exhaustion of the body and a decrease in its natural defenses.In the structure of helminthiases, the main places belong to enterobiasis, ascariasis, hookworm, trichuriasis and toxocariasis.

According to official statistics, the helminthiasis infestation rate of the population of our country is 1-2%, but in some regions it reaches 10% or more.The problem of the increasing incidence of helminthiasis is relevant not only for infectious diseases, but also for pediatrics, therapy, surgery, gastroenterology, dermatology, allergology, urology and other practical medical areas.

Causes of helminthiasis

To date, more than 250 helminthiasis pathogens are known in humans;The most common are about 50 species.Helminths that parasitize the human body are mainly represented by roundworms (class Nematoda) and flatworms (fluke class - Trematoda and tapeworms - Cestoidea);Less commonly, human infections occur with annelids (Annelida) and acanthocephala (Acanthocephala).Representatives of roundworms include pinworms, roundworms, trichinella, whipworms;tapeworms: bovine, porcine and dwarf tapeworms, echinococcus, broad tapeworm;flukes: cat and liver flukes.

The life cycle of helminths includes the stages of egg, larva and mature forms.Depending on the characteristics of the development of parasitic worms and the routes of infection, helminth diseases are divided into biohelminthiases, soil-transmitted helminthiases and contagious (contact) helminthiases.

  1. GeohelminthsThey are the majority of intestinal worms (nematodes).The stages of development of soil-transmitted helminth eggs and larvae take place in the soil under certain temperature and humidity conditions.STH infection occurs due to lack of maintenance of personal hygiene, consumption of water, fruits, vegetables contaminated with parasites or contact with soil contaminated with feces.STHs include helminth diseases such as ascariasis, hookworm, trichuriasis, and strongyloidiasis.
  2. to the numberbiohelminthsThey belong to trematodes (trematodes) and tapeworms (cestodes), as well as some types of nematodes.To reach the invasive stage they need a change in one or two intermediate hosts, which can be fish, crustaceans, mollusks and insects.The causative agents of biohelminthiasis enter the human body when eating meat or fish that has not undergone sufficient heat treatment or when drinking raw water.Representatives of biohelminthiases are diphyllobothriasis, clonorchiasis, opisthorchiasis, taeniasis, taeniarynchiasis, trichinosis, fascioliasis and echinococcosis.
  3. kcontagious helminthiasisThey belong to invasions that are transmitted from person to person through personal contact, through shared toiletries, dishes, underwear or through self-infection.These are enterobiasis, hymenolepiasis, strongyloidiasis, cysticercosis.

Classification

Helminth infections are classified according to the biological characteristics of helminths, their mode of existence in the external environment, routes of infection and habitat in the human body.Taking into account the biological characteristics of pathogens, the following are distinguished:

  • nematodes(ascariasis, enterobiasis, trichuriasis, hookworm, necatoriasis, etc.)
  • cestodiasis(taeniasis, cysticercosis, hymenolepiasis, taeniarynchiasis, echinococcosis)
  • trematodes(opisthorchiasis, clonorchiasis, schistosomiasis, fascioliasis).

Depending on the mode of existence of parasitic worms in the environment, soil-transmitted helminthiases, biohelminthiases and contact helminthiases are distinguished.Helminthiasis infection can occur through food, water, or percutaneously.Depending on the localization of pathogens in the human body, helminth infections are divided into:

  • intestinal.The human intestines are parasitized by pathogens of ascariasis, enterobiasis, hookworm, trichuriasis, strongyloidiasis, trichostrongyloidiasis, diphyllobothriasis, taeniasis, taenaryngosis, hymenolepiasis, etc.
  • extraintestinal.Extraintestinal helminths can live in the liver, gallbladder, blood vessels, and subcutaneous tissue.Extraintestinal parasitosis includes filariasis, dracunculiasis, opisthorchiasis, schistosomiasis, fascioliasis, clonorchiasis, paragonimiasis, trichinosis, cystocerciasis, etc.

Also, according to the principle of localization, luminal (including intestinal) and tissue (skin 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 organ lesions.During helminthiasis, acute or early phases (from 2-3 weeks to 2 months) and chronic phases (up to several years) are distinguished.The main pathological effects of helminths on the human body include toxic allergic reactions, mechanical damage to organs and tissues, nutritional and vitamin deficiency, and decreased 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 experience fever, rash, muscle pain, and lymphadenopathy.Abdominal syndrome (dyspepsia, abdominal pain), pulmonary syndrome (dry cough, bronchospasm, shortness of breath), hepatolienal syndrome (enlargement of the liver and spleen), asthenovegetative syndrome (apathy, fatigue, sleep disturbances, irritability) often develop.

chronic phase

In the chronic phase of helminthiasis, specific organ lesions predominate, caused mainly by mechanical trauma at the site of helminth 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 progressive loss of body weight.Iron deficiency anemia is a frequent companion of intestinal helminthiases.With massive helminth infestation, rectal prolapse, development of hemorrhagic colitis and intestinal obstruction are possible.

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

The chronic stage of strongyloidiasis occurs with the formation of stomach and duodenal ulcers.With trichinosis, the cardiovascular system (myocarditis, heart failure), respiratory organs (bronchitis, bronchopneumonia) and the central nervous system (meningoencephalitis, encephalomyelitis) may 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 econococcosis, cysts occur in the liver and lungs, and when they fester, 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, as a result of which the necessary protective level of immunity is not achieved.In the presence of concomitant diseases, helminthiases modify and aggravate their course.The result of helminthiasis can be recovery (with natural death or expulsion of the helminth) or residual phenomena, often with disabling consequences.

Diagnosis

According to clinical and epidemiological data, helminthiases are diagnosed mainly in the chronic phase.To identify the causative agent of helminthiasis, special laboratory methods are used: microhelminthoscopy (scraping for enterobiasis), helminthoscopy (examination of feces for worm eggs), helminthoscopy, serological (ELISA, RIF, RSK, RNGA), histological coprology.Test material to detect eggs, larvae or fragments of mature helminths can be feces, vomit, duodenal contents, sputum, urine, blood, skin biopsies, etc.

In the case of intestinal helminthiasis, skin allergy testing with helminth antigens may be informative.To identify and assess the severity of specific organ 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

Helminthiasis treatment

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

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

For intestinal helminthiasis, antibacterial drugs, enterosorbents, enzymes, probiotics, etc. are added to the main treatment.Symptomatic therapy for 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, echinococectomy).

Prevention

Prevention of soil-transmitted helminth infections is carried out through hygienic education of the population, protection of the environment from fecal contamination and instilling personal hygiene standards in children.In terms of preventing the spread of biohelminthiases, deworming of domestic animals, 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 thing is to break the mechanism of pathogen transmission in organized groups, mainly children.It is advisable to carry out seasonal pharmacological prevention of helminthiasis in families (for example, albendazole), periodic parasitological examinations of children and risk groups.