Worm infestationsorhelminthiasis– parasitic diseases with primary damage to the digestive organs. Helminths, parasitic worms, are able to live in many parts of the gastrointestinal tract (gastrointestinal tract), incl. in the large intestine, in the rectum. Diagnosis and treatment of colonic manifestations of helminthic infections are carried out jointly by physiciansparasitologistANDcoloproctologist.
Helminthiasis infection is characterized by the following properties:
- chronic course, in which nutrients and protective forces are gradually depleted;
- more often the body is invaded by hookworm, roundworm, toxocara, trichocephaly;
- 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 tends to spread in areas with poor medical infrastructure and development.
Causes and mechanism
Helminths that parasitize the large intestine are represented by three classes:
- Roundworms (nematodes): roundworms, pinworms (enterobiasis), whipworms (trichocephalosis), tapeworms (strongyloidiasis), hookworms, toxocaras.
- Tapeworms (cestodes): broad tapeworm, bovine and porcine tapeworm.
- Worms (trematodes): schistosomes.
Majorityhelminthscomplex 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 susceptiblehelminthiasisdue to the habit of putting hands and foreign objects in the mouth. Animals are often carriers of helminths. Meat, fish and shellfish contain eggs, larvae or fins. These foods, raw or insufficiently heat-treated, also serve as a source of infection.
Parasites cannot exist in the aggressive acidic environment of the stomach. But its shell is resistant to the action of gastric juice. Furthermore, the presence of helminths in food in the stomach is short-lived. And then, together with the food bolus, they pass to 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 weak alkaline environment, there are many food residues, and the mucous membrane is abundantly supplied with blood. Various adaptive mechanisms (hooks, suction cups, developed muscles) help the worms to remain in the lumengastrointestinal tract, they attach to the intestinal mucosa and do not come out with feces.
Its presence in the large intestine leads to local inflammatory processes - typhlitis, colitis, sigmoiditis, proctitis. In the process of life, they are releasedtoxins. Many of them are strong allergens.
Some of the parasites penetrate the pancreatic ductal system, biliary tract, and liver, causing damage to these organs. Furthermore, the larvae of various helminths are capable of piercing the intestinal wall. With the flow of blood and lymph, they enter the muscles, lungs, eyes and brain and cause damage to these organs.
Classification of helminthiasis
Depending on group affiliation, the following types of parasitic infection are distinguished:
- cystodeses – echinococcosis, taeniasis, teniarinchiasis;
- nematodes – trichocephalosis, ascariasis, necatoriasis;
- Trimatodes – opisthorchiasis, fascioliasis.
Division of parasites depending on the method of survival in the environment:
- helminths;
- biohelminths;
- come into contact with helminths.
Classification depending on the propagation method on 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, gradually spreading through the gastrointestinal tract. The permanent habitat is the intestines. These parasites include strongeloidiasis, hookworm, and taeniosis.
- Extraintestinal forms. Penetration can also occur through the gastrointestinal tract, but the parasites 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, as they cause serious complications.
Symptoms
Helminthiasis can be asymptomatic for a long time. Subsequently, nonspecific symptoms of intestinal disorders appear:
- nausea;
- decreased appetite;
- aching or cramping pain in the abdomen;
- swelling;
- flatulence;
- diarrhea, constipation, their alternation.
Distinctive symptomenterobiasis: itching, burning in the anus, in the perianal region. This symptom is due to the fact that a sexually mature womanwormscomes out and lays eggs. This happens mainly at night.
If the course is unfavorable, the intestinal lumen may become obstructed by clusters of worms. In these cases, a typical clinical picture of mechanical intestinal obstruction is presented with severe abdominal pain, abdominal distension, repeated vomiting, retention of feces 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;
- weight loss;
- 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 helminthiases are not diagnosed, they are associated with other causes.
Diagnosis
Diagnosisdiagnosed based on laboratory tests of blood and feces. A general blood test reveals a decrease in the level of hemoglobin 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 immunodiagnosis aims to detect tissue-specific antibodies to the parasite. Be sure to examine feces for occult blood and worm eggs. To diagnose enterobiasis, scraping is performed from the perianal region. To scrape, use a cotton swab or tape. Damage to the intestinal mucosa is diagnosed by endoscopic methods - sigmoidoscopy, colonoscopy.
There are additional diagnostic tests that help determine the type of pathogen, the area of its spread and the extent of damage:
- allergy skin test with the addition of helminth antigens;
- Ultrasound of abdominal organs with assessment of the state of the intestines, liver, spleen, pancreas;
- fibrogastroduodenoscopy - visual examination of the upper parts of the digestive tract by introducing 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 – removal of tissue sections during endoscopic examination followed by microscopy and histological analysis;
- radiography 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, presence or absence of defects can be assessed).
Research methods are prescribed depending on the symptoms that appear and the doctor's suspicion of the degree of spread of helminthiasis.
Treatment
Helminthiasisare treated with medication. Depending on the type of parasite, a course of treatment with specific use is developedanthelminticdrugs. 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 with a specific focus against a specific type of parasite:
- anticystadic;
- antinematodes;
- anti-trematodes;
- broad spectrum of action against different groups of parasites.
In addition to specific treatment, it is necessary to prescribe symptomatic medications to eliminate manifestations caused by helminths:
- antibacterial drugs with additional complication of the disease by activated pathogenic microflora of the digestive tract;
- sorbents 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 development of acute allergic reactions.
Surgery is considered the treatment method of last resort. It is prescribed for complications. For example, when parasites pass from the intestines to other organs.
Prevention
To prevent the penetration of helminths into the human body, it is recommended to carry out the following actions:
- frequent washing of hands and food before consumption;
- maintain basic personal hygiene;
- use of antiglycemic medications for animals;
- heat treatment of meat and fish;
- preventive use of medicines against helminths, especially if characteristic symptoms appear or if the patient is at risk.
Prevention methods reduce the risk of helminth infection, but cannot completely eliminate it. Therefore, doctors recommend periodically donating feces 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.
Parasitic infection identified and treated in a timely manner guarantees a positive prognosis. If therapy is carried out in the early stages, no complications will occur. 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 worsen the quality of life and can cause inability to work. Possible death due to the development of anaphylactic shock and helminthiasis of the central nervous system. Therefore, in this case, timely diagnosis is important.