OPISTHORCHOSIS

From Big Medical Encyclopedia

OPISTHORCHOSIS (opisthorchosis) — helminthosis of a liver, gall bladder and pancreas, the activator to-rogo are two types of trematodes — Opisthorchis felineus and O. viverrini.

History

O. caused by O. felineus (Vinogradov's disease) at the person is for the first time described by K. N. Vinogradov in 1891 Askanazi (M. of As-kanazy) in 1904 proved that O.'s infection the person and mammals occurs through fish. Vogel (N. of Vogel) in 1932 revealed a mollusk — the intermediate owner O. of felineus. The first description of clinic of O. belongs to E. A. Pastor (1898). Helminthagogue properties at O. were found in a fuadin by Sidat and Erkhardt (L. Szidat, A. Erhardt, 1931), in potassium antimonyl tartrat and perchloromethane H. N. Plotnikov and L. K. Zerchaninov (1932), at hexachloroethane H. N. Plotnikov.

Geographical distribution

O.'s Centers meet preferential in Western Siberia, Kazakhstan, the Perm region and in Ukraine in the basin of Dnieper, the Southern Bug and the Northern Collum. In Western Europe O. is described in Holland, France and Italy. The island called by O. viverrini is widespread in Thailand and some other countries.

Etiology

Scheme of a structure Opisthorchis felineus: 1 — an oral sucker; 2 — a throat; 3 — a gullet; 4 — two intestinal branches; 5 — a belly sucker; 6 — a uterus; 7 — zheltochnik; 8 — ovaries; 9 — a seminal receptacle; 10 — seed plants; 11 — a trunk of an excretory bubble.
Mikropreparat of a liver: opistorkhisa in a bilious channel (one of them is specified by an arrow).

Activators O. — two types of trematodes — O. felineus (Rivolta, 1884, Blanchard, 1895) and O. viverrini (Poirier, 1886; Stiles et Hassal, 1896). In the USSR only O. is registered by felineus (a synonym: Distomum felineum, D. sibiricum — a fluke cat's, a fluke Siberian). O.'s body of felineus flat, 4 — 13 mm long, (fig.) 1 — 3,5 mm wide. Eggs pale yellow with a gentle double-circuit cover, a lid on one pole and a small thickening of a cover on an opposite pole; size of their 0,011 — 0,019 X 0,023 — 0,034 mm. Puberal O. of felineus parasitize in inside - and extrahepatic bilious channels (tsvetn. fig. 3), gall bladder and pancreat ducts of the person and number of carnivorous mammals (final owners). Intermediate owners of O. of felineus — mollusks of Bithynia leachi, V. inflata; additional owners — fishes this. cyprinid (Cyprinidae): the ide, Yelets, small fry Siberian, or chebak, small fry European, small fry Caspian, or a vobla, a tench, a rudd, a sazan, the man with a big mustache, a bream, a guster, sublips, zherekh, a bleak, etc.

to O. to viverrini on a structure and biology is close to O. to felineus. Length of its 5,4 — 10,2 mm, width is 0,8 — 1,9 mm; eggs of 0,019 in size — 0,029 X 0,012 — 0,017 mm. In a stage of puberty parasitizes in bilious channels, a gall bladder and pancreat ducts of the person, a cat, dog, civet (a predatory mammal this. Viverridae). Intermediate owners — mollusks (Bithynia goniophalus, V. funicula-ta), additional owners — fresh-water cyprinid fishes.

Epidemiology

the Person and carnivores infected with O. are sources of an invasion. Molluscs (see) swallow with food of egg of a parasite, got to water with excrements of sick people and animals. In mollusks there is a development and reproduction of larval generations of helminth, a cut comes to an end with an exit in water of larvae — tserkariyev. Having got through leather of fishes into their hypodermic cellulose and muscles, cercariae turn in intsistirovanny larvae here — metatserkariyev. O.'s infection the person, cats, dogs, fur-bearing animals happens at consumption of the crude or insufficiently thermally processed fish to larvae of helminth.

The lake — a natural and focal disease since occurs also at wild carnivores. However value of wildings as sources of an invasion minor. The island is most widespread among the population in basins of the rivers where there are favorable conditions for existence and reproduction of mollusks and cyprinid fishes, waters are exposed to considerable fecal pollution, and the population eats the crude and insufficiently thermally processed fish.

A pathogeny

Adult parasites damage walls of channels suckers, and young people — spinules; accumulations of parasites complicate current of bile and a secret of a pancreas. Metabolic products of helminths sensibilize an organism. In bilious channels conditions for accession of a consecutive bacterial infection are created. The irritation helminths of interoretseptor involves in the reflex way disturbance of functions of a stomach, duodenum, cardiovascular system, as a result of long irritation of walls of bilious channels and a sensitization there comes the ferruterous hyperplasia of their epithelium and a perikana-likulyarny sclerosis.

The pathological anatomy

At an intensive invasion a liver is increased and condensed; under its capsule expanded bilious channels act in the form of cords and cysts. Deep cicatricial retractions are sometimes visible. Walls of channels are thickened due to development of connecting fabric; their epithelium in a condition of a ferruterous hyperplasia, infiltrates from lymphoid elements are observed; in places there are accumulations of polymorphonuclear leukocytes, among to-rykh many eosinophilic granulocytes. In a gleam of channels — helminths, a desquamated epithelium, leukocytes, including the eosinophilic granulocytes, slime, dark grains which are thrown out from intestines of parasites. In a circle of channels — tyazh of connecting fabric with lymphoid infiltrates and neogenic bilious tubules. In a parenchyma of a liver sometimes micronecroses. At a large number of parasites and long existence of an invasion cirrhosis of which the ochagovost of changes connected with localization of helminths is characteristic develops. Gall bladder often atonichen. In a pancreas — expansion of channels, a thickening of walls, a ferruterous hyperplasia of an epithelium; in a parenchyma of body sometimes necroses and a sclerosis.

A clinical picture

Patients complain of pains in epigastriß and right subcostal areas; at many they irradiate in a back and sometimes to the left subcostal area. Quite often pains periodically become aggravated in the form of attacks of bilious colic. Dizzinesses, headaches, dispeptic frustration are very frequent. Temperature usually subfebrile or normal. The liver is quite often increased and condensed, at certain patients there can occur acute short-term increase in a liver. Sharply increased and intense gall bladder is quite often palpated. The palpation of a pancreas is painful: at nek-ry patients left-side zones of a skin hyperesthesia of Zakharyin — Geda come to light (see. Zakharyina — Geda of a zone ). Sometimes there are urtikarny rashes. The spleen increases extremely seldom — only at development of cirrhosis. In juice of a duodenum — the increased amount of slime, leukocytes and epithelial cells. The reflex of a gall bladder at many patients manages to be received only at repeated zondirovaniye. The amount of bile of the second portion is frequent above norm, its concentration is increased or, on the contrary, is reduced. Functions of a liver are, as a rule, not broken. Quite often there are disturbances excretory, and sometimes and incretory function of a pancreas. In blood — an eosinophilia and moderate anemia with normomakro-blastic type of a hemopoiesis. In a gastric juice at a half of patients — decrease in acidity or an akhiliya. Most often at O. the angiocholitis, an angiocholecystitis are observed (see. Cholangitis ), dyskinesia of bilious ways (see. Bilious channels ), hron, hepatitis (see) and pancreatitis (see); at certain patients develops cirrhosis (see). Quite often also the lungs erased of a form O meet.

Complications — a purulent angiocholitis, a rupture of the stretched bilious channels with the subsequent development of bilious peritonitis (see).

Diagnosis is based on detection of eggs of an opistorchis in Calais and juice of a duodenum (see. Helmintologic methods of a research ), on a wedge, a picture and data epidemiol, the anamnesis.

Treatment

is Appointed hloksit (hexaxylene chloride) of per os in the general dose of 0,3 g/kg within 2 — 3 or 5 days. The day dose (0,15 g/kg at two-day treatment, 0,1 g/kg at three-day and 0,06 g/kg at five-day treatment) is divided into three receptions. Laxative is not appointed. Efficiency of treatment hloksily makes 20 — 85% depending on intensity of an invasion and the status of the patient. Use of a hloksil should be combined with symptomatic and pathogenetic therapy (a drainage of bilious ways, vitamins). At a bacterial infection of bilious ways — the himiopreparata normalizing function went. - kish. path and liver. At an abnormal liver function hloksit do not appoint.

The forecast

Usually a disease has rather high-quality current. Separate cases of a lethal outcome are connected with a liver failure of the mixed parasitic and virus genesis. At development of purulent processes in zhelchevydelitelny ways, at bilious peritonitises and acute pancreatitis the forecast serious.

Prevention

Major importance in prevention of infection of O. has an exception of food of the crude, poorly prisolenny and insufficiently thermally processed fish. Larvae of an opistorchis perish during the cooking of the infected fish pieces in 20 min., in fish forcemeat quenelles — in 10 min. from the beginning of boiling. Hot smoking completely neutralizes fish. It is necessary to fry fish medium-sized pieces of 15 — 20 min. At salination of fish (27 — 29 kg of salt on 1 c of fish) temperature of a brine shall be 16 — 20 °, and fish shall be in it not less than 14 days; salt content in a ready-made product not less than 14%. The same salting there has to pass a fish intended for cold smoking and jerking. In the fish placed in the refrigerator, larvae perish at t ° — 23 — 25 ° in 72 hours, at t ° — 30 ° — in 6 hours and at t ° — 40 ° — in 3 hours.

In O.'s prevention protection of the rivers and fresh-water reservoirs from fecal pollution is of great importance.

Sanitary gleam. and educational work among the population in the centers shall be directed to O. to an exception of food of crude and half-baked fish.

See also Helminthoses , Trematodoza .



Bibliography: Beer S.A. Biological aspects of a problem of an opisthorchosis, Parasitology, t. 11, century 4, page 289, 1977; The Multivolume guide to microbiology, clinic and epidemiology of infectious diseases, under the editorship of H. N. Zhukova-Verezhnikov, t. 9, page 408, M., 1968; Carpenters of H. N. Opistorkhoz (Helminthosis of a liver and pancreas), M., 1953, bibliogr.; Scriabin K. I. Trematodes of animals and person, t. 4, page 89, M. — L., 1950; G i urea I. Recherches sur la source de G infection de l'homme et des animaux par les distomes de la famille des Opistorchiides, Bull. Sect. Sci. Acad, roum., t. 2, p. 201, 1913 —1914;

E r-hardt A., Germer W. D. u. Horning B. Die Opisthorchiasis, her-vorgerufen durch den Katzenleberegel Opis-thorchis felineus, Jena, 1962.


H. H. Plotnikov.

Яндекс.Метрика