CLONORCHOSIS

From Big Medical Encyclopedia

CLONORCHOSIS (clonorchosis, clonorchiasis) — the helminthosis from group of trematodoz caused by the Clonorchis sinensis helminth parasitizing in a liver and a pancreas of the person and some carnivorous (fish-eating) vertebrate animals (Cobbold, 1875; Looss, 1907).

Activator K. Cobbold is for the first time found in the person I. McConnell in 1874 (T. Cobbold, 1875) described helminth and entered it in the evils, system. Biol, a cycle deciphered at the beginning of the century the Japanese researchers, the epidemiology of a disease was in detail studied by Faust and Kou (E. Faust, O. K. of Khaw, 1927).

To. it is eurysynusic in the People's Republic of China, Japan, the countries of the Korean and Indochina peninsulas. In the USSR the main centers of a disease are in Nizhny Novgorod Priamurye.

Etiology

Scheme of a structure Clonorchis sinensis: 1 — an oral sucker; 2 — a throat; 3 — a belly sucker; 4 — a uterus; 5 — an ovary; 6 — a seminal receptacle; 7 — seed plants; 8 — an excretory bubble (full size of 10 — 20 mm).

Clonorchis sinensis — klonorkhis Chinese (a fluke Chinese) — treats type flat worms (see), to a class of trematodes. The body of its lanceolate form (fig.), is a little extended on the front end and rounded on back. Length is 10 — 20 mm, width is 2 — 4 mm. In the depth of an oral sucker the entrance to a throat opens. The belly sucker is located at distance 1/4 lengths of a body from an oral sucker and performs only fiksatorny functions. Systems of bodies have a structure, typical for trematodes. One of the main morfol, signs — strongly branched seed plants located in a back third of a body. Eggs of light-golden color, an oval form with clearly distinguishable lid at the narrowed pole, the sizes of their 0,026 — 0,035 X 0,017 — 0,019 mm, contain the created larvae miratsidiyev.

Development of a parasite happens to change of three owners.

Allocated with excrements of definitivny (final) owners (the person and animals) of egg shall get to a reservoir and to be swallowed by intermediate owners. Their role is carried out by some species of fresh-water mollusks from this. Bithyniidae, main of which are Parafossarulus manchouricus japonicus in Japan and P. manchouricus manchouricus in other districts of an area. The larvae having a tail leaving mollusks — cercariae — infest additional owners — fishes this. cyprinid in which muscles larvae, invasive for definitivny owners — a metacercaria form.

Epidemiology

the Source of activators of an invasion are patients To. people and animals — cats, dogs, wild carnivores (definitivny owners). In the presence of natural premises (presence at fauna of intermediate and additional owners) the disease is widespread in those areas where there is a custom is crude fish and there are conditions for fecal pollution of reservoirs.

The pathogeny

the Main role in a pathogeny of a disease is played by toxic and mechanical effect of helminth, development of the phenomena of an allergy and neuroreflex reactions. The expressed immunity after the postponed disease is absent.

Pathological anatomy

Pathoanatomical changes in bodies are characterized by proliferative cholangites, a sclerosis and a hyalinosis of walls of vessels, fatty dystrophy of hepatic cells, polipozy and adenomatosis of walls of the bilious courses and pancreat ducts. Ferruterous proliferation of an epithelium at To, is considered as a precancerous state. There are numerous observations confirming noticeable increase in cases of primary cancer of liver in endemic on To. districts.

A clinical picture

the Onset of the illness usually acute with the expressed allergic reactions and fever. The liver, sometimes an ikterichnost of scleras is often increased. From blood the eosinophilia to 10 — 40% and more is noted. In 3 — 4 weeks sharpness of symptoms smoothes out and the disease passes in hron, a stage. During this period of the complaint of patients the hypochondrium, epigastriums with irradiation in a back, the right half of a neck usually come down to feeling of pains in right. Nausea, vomiting, dizziness, the increased nervous irritability is quite often noted. The liver is usually increased, dense, painful hepatocystic symptoms are positive. In duodenal contents eggs of a parasite, a desquamated epithelium are found. Researches of functions of a liver quite often reveal their disturbances. In blood an eosinophilia, moderate macrocytic anemia.

In a late phase of a disease To. proceeds with the phenomena cholangitis (see), periduodenitis (see), dyskinesia of bilious channels, quite often hepatitis (see). At long-term disease sometimes develops holangiticheskiya cirrhosis (see), retentsionny jaundice is occasionally observed. Complications — infectious, including purulent, a cholangitis.

Diagnosis it is finalized on finding of eggs of the activator (klonorkhis) in excrements or in duodenal contents of the patient. Apply also serol, reactions and allergy intracutaneous tests with antigen from a parasite.

Treatment

Effective to lay down. means at To. it appeared hloksit (hexachloroparaxylene). At a five-day cycle of treatment it is appointed by 3 times a day in a daily dose of 0,06 g to 1 kg of weight. Drug is accepted after food, washing down 100 ml of milk. It is contraindicated at the diseases of a liver which are not connected with helminthoses, damages of a myocardium, pregnancy.

Forecast in uncomplicated cases and at timely specific treatment favorable.

Prevention consists in protection of reservoirs from fecal pollution and consumption of well boiled thoroughly and fried thoroughly fish.

See also Trematodoza .



Bibliography: Kassirsky I. A., etc. Guide to tropical diseases, page 248, M., 1974; P. S. Morfologiya's Staffs of phases of development of a trematode of Glonorchis sinensi (Cobbold, 1875) Looss, 1907, Medical parazitol., t. 41, No. 5, page 548, 1972, bibliogr.; In e 1 d i n g D. L. Textbook of parasitology, N. Y., 1965; B.S.'s Faust Human helmintology, L., 1949; To

o-m i at a Y. Clonorchis and clonorchiasis, Advanc. Parasitol., v. 4, p. 53, 1966, bibliogr


P. S. Posokhov.

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