FASCIOLIASIS (fasciolosis, fascio-liasis) — the helminthosis of the person and animals which is characterized by a long chronic current with preferential defeat of a zhelchevydelitelny sistvkhma, sometimes — anemia. Distinguish acute and chronic phases of a fascioliasis.
The first messages about F. the person Malpigi (Malpighi, 1698) and P. S. Pallasu belong (1760).
T. it is eurysynusic among many types house and wildings. Are most struck with F. sheep, goats, cattle, are more rare than a pig, a horse, a dog. At the person the invasion of Fasciola hepatica is described usually in the form of sporadic cases; however in a tropical zone of Asia, Africa, Latin America defeat of people of F. hepatica can reach a high level. In the nek-ry districts of the USSR separate cases of F. Zarazheniye of the person of other type of a disease-producing factor are registered — by F. gigantica it is described in Vietnam, on the Hawaiian islands, in a number of the countries of Africa.
Etiolog and I. Activators F. — two types of trematodes of Fasciola hepatica L., 1758 and
Fasciola gi gantica Cobbold. 1855 from the Fasciolidae Railliet family, 1895. F. hepatica — the fluke hepatic (ordinary) has a flat leaflike body 20 — 30 long
to a mm 8 — 12 mm wide. The forefront of a body is covered with spinules and extended in a proboscis, on Krom oral and belly suckers are located. In an oral sucker there is an actinostome conducting in a throat for a cut the gullet follows. Two branches of intestines with a set of the branching side shoots depart from a gullet. In the forefront of a body after a belly sucker the rozetkovidny uterus is kokhmpaktno located, loops to-royg are filled with eggs. Further branchy ovaries and seed plants are located. Eggs of a fasciola of 0,13 in size —
0,145 X 0,07 — 0,09 mm - zheltovatobury color with a lid and a thickening of a cover on poles. F. gigantica — the fluke huge has length of 33 — 76 mm and width of 5 — 12 mm. Eggs of helminth of brown color of 0,15 in size — 0,19 X 0,075 — 0,09 mm.
The final owner fastsiol are the person, small and cattle, horses, pigs, intermediate owners — fresh-water mollusks of the Lim-naeidae family (Limnaea truncatula, L. lim-nosa, L. ovata, etc.). Eggs fastsiol with excrements get to water or to the wet soil where depending on temperature and humidity development happens in terms from 4 — 6 weeks up to several months; from them ciliate larvae — mi-ratsidiya develop. At hit are implemented into water of a mi-ratsidiya in a mollusk — the intermediate owner where there is a difficult asexual reproduction to consecutive education a sporocyst, giving generations thin, and the last — larvae having a tail — tserkariyev. Floating in water, cercariae are attached to stalks of underwater plants and turn into invasive larvae — adolescarias. The cycle of asexual reproduction fastsiol takes 4 — 6 weeks. On plants and in the wet soil of an adolescaria remain viable up to two years, during the drying quickly perish.
Get to an organism of the final owner of a larva together with water or plants, are implemented into a wall of a small bowel and are brought by a blood flow in a liver. Process of maturing, otkladka and allocation of eggs in an organism of the final owner takes 67 and more days. All development cycle of helminth — not less than 4 — 5 months
E p and d e m and about l about and I. T. — zoonosis; a source of an invasion for the person are pages - x. animals: value of the person as source of an invasion is insignificant.
Major factors of transfer of activators — the water, edible herbs growing in reservoirs and on wet or irrigation lands, the greens, vegetables, fruit washed by the water contaminated by larvae of helminth. The risk of infection increases in a hot humid climate in areas with abundance of small reservoirs — biotopes of a mollusk.
Pathogeny. In a pathogeny of an acute phase of a disease the leading role is played by enzymatic and toxic influence of metabolites of larvae of helminths at their migration on fabrics and a sensitization them an organism of the owner. In hron. to a phase the sensitization of an organism has smaller value, major factors are bruises holangiol and parenchyma of a liver at periodic movements of a parasite, organic changes of walls of the bilious courses, a gall bladder, a cholestasia, a bacterial infection of bilious ways.
Pathological anatomy. Patomorfo of l. changes in a liver in an acute phase F. are characterized by proliferative processes with massive kruglokletochny and eosinophilic infiltration inter-to a lkovy stroma, walls of bilious channels, a gall bladder, hypostasis, vasculites. Further diffusion and focal granulematozny reaction forms. At intensive general reaction the expressed proliferative processes in regional and others limf, nodes are noted. Signs of diffusion dystrophic changes in a myocardium, and sometimes and the coronary disturbances revealed on an ECG can demonstrate involvement in process and a myocardium. In hron. to a phase proliferative processes in zhelchevydelitelny system are replaced by fibrosis with disturbance of functions holangiol, the general bilious channel, a gall bladder, change of composition of bile, a cholestasia, development of a consecutive bacterial infection, a thicket staphylococcal.
Clinical pictures and. The incubation interval makes 1 — 8 weeks. The disease usually begins sharply without prodromal stage sudden rise in temperature to 38 — 39 ° above, pains in the field of the right hypochondrium, quite often pristupoobrazny character. The liver is considerably increased, painful, the spleen is less often increased. Within the first days jaundice or a subikterichnost of scleras develop, mucous membranes, skin, to edge no more than one week stick; on skin — rashes of urtikarny or polymorphic character, quite often a cardialgia, tachycardia, the fluctuations of level of the ABP which are followed at a part of patients with changes on an ECG of dystrophic character. Pathognomonic sign F. the acute short-term increase in a liver, preferential left share which is followed by sharp pains and taking place independently — Kryukov's symptom is considered. Fever, usually alternating type, keeps of 2 — 5 days to 2 — 3 weeks; then T. passes in hron. phase.
In hron. to a phase F. allocate two main a wedge, option: hron. uncomplicated F. and hron. T., complicated by a bacterial infection of biliary tract. Uncomplicated F. proceeds wavy, with periodic aggravations and remissions, it is characterized by preferential dispeptic frustration (a loss of appetite, nausea, seldom vomiting), a moderate pain syndrome. Fever and essential changes of composition of blood are absent. At certain patients in the period of an aggravation pains in an upper part of a stomach of the surrounding character, the diastases which are followed by increase in urine are noted. During remissions the condition of patients is not broken, working capacity is kept. Hron. T., complicated by a bacterial infection of biliary tract (mikst-invasion), proceeds persistently, practically without remissions, pains in the field of the right hypochondrium have pristupoobrazny character, are followed by fever, a leukocytosis, acceleration of ROE that quite often serves as the reason of the wrong diagnosis of cholelithiasis.
The diagnosis is difficult because of scanty amount and frequency of allocation of helminthomas of eggs. Research of duodenal contents, especially repeated. is much more effective, than a research of excrements. It must be kept in mind a possibility of emergence of so-called transit eggs at the use in an iishcha of the liver of animals infested face-tsiolami. At the instruction on the last it is necessary to repeat a research of duodenal contents in 2 weeks. In the early period of an acute phase (in the absence of an ovoproduktion) with success apply serological tests. Sensitivity and specificity of an immunoenzyme method (reaction of en-winters-marked antibodies) with use of a specific component of antigens puberal fastsiol, according to L. D. Martynenko and sotr. (1982), irrespective of a stage of a disease reaches 97,6% (see. Enzyme-immunological method). The eosinophilia of blood to 10 — 70% against the background of a leukocytosis is characteristic.
Indicators of a functional condition of a liver - are considerably changed due to increase in activity of an alkaline phosphatase of blood serum, to a lesser extent — due to increase in alanine transferase. Are characteristic a hypoproteinemia owing to a hypoalbuminemia, the maintenance of globulinovy fractions increases further; increase in content of the connected bilirubin is natural (see).
The differential diagnosis in an acute phase of a disease is carried out with a viral hepatitis (see a viral hepatitis), a hay fever (see), cholelithiasis (see), mechanical jaundice of other etiology (see Jaundice). Main differential diagnostic characters acute F. are existence of jaundice only during fever, the expressed pain syndrome not characteristic of a viral hepatitis, a leukocytosis, a hypereosinophilia, high ROE and other symptoms of an allergy, rare at a viral hepatitis and mechanical jaundice.
Treatment. Appoint hloksit per os on three - or the five-day scheme at the rate of 0,3 g/kg on a course. At detection of bacterial microflora in bilious ways apply antibiotics with preliminary definition of sensitivity of the activator to them. Abroad in recent years at F. use albendazol.
Specific treatment F. in an acute phase carry out after removal of rough allergic manifestations (high temperature of a body, a pain syndrome, disturbances of a hemodynamics) by means of the hyposensibilizing means — antihistaminic drugs (see. Antihistaminic substances), at especially heavy current — by means of glucocorticoids in moderate doses, spasmolysants, disintoxication therapy. In hron. to a phase of a disease apply spasmolysants, in the absence of the expressed pain syndrome — cholagogue means, tyubazh bilious ways, physiotherapeutic procedure (see Physical therapy) and balneoprotsedura (see Balneoterapiya); at a bacterial infection of bilious ways — antibiotics.
The forecast at treatment F. in an acute phase of a disease it is quite favorable. In hron. to a phase, especially at accession of a bacterial infection, even at release from the activator F. clinical signs of defeat of bilious ways remain.
Prevention is based on streamlining of water handling, increase a dignity. - a gigabyte. cultures of the population. Personal prevention consists in obligatory boiling of the water from standing or slowly current reservoirs used for drink or washing of vegetables, fruit, ware, etc. Fight against a fascioliasis of page is carried out - x. animals: mass deworming of animals before pasture in the spring on a pasture for its protection from pollution by eggs fastsiol, change of pastures, deworming of manure, hydromeliorative actions.
See also T of a rematodoza.
Bibliography: Helminthoses of the person,
under the editorship of F. F. Soprunov, M., 1985; And yes - t and sh in and l and M. S. O to a problem of a fascioliasis of the person in Georgia, in book: Aktualn. probl. medical parazitol. and tropical medical, under the editorship of N. I. Topuriya, page 177, Tbilisi, 1970; Kamardinov of X. K. Clinical manifestations and a current of a fascioliasis at people, Zdravookhr. Tajikistan, No. 5, page' 13, 1975; Martynenko L. D., L y with e N to about A. Ya. and In and with and l e in V. I., Reaction of enzimmecheny antibodies in immu-
to a nodiagnostika of parasitic diseases, the Message 5. Test system for diagnosis of a fascioliasis, Medical parazitol., t. 60, No. 6, page 41, 1982; Ozeretskov-
with to and I am H. H. Immunological factors in a susceptibility to parasitic diseases, their pathogeny and clinic, in the same place, t. 50, No. 6, page 12, 1981, bibliogr.; The guide to tropical diseases, under the editorship of A. Ya. Lysenko, M., 1983; Tropical diseases, under the editorship of E. P. Shuvalova, M., 1979. H. N. Ozeretskovskaya.