Helminthiasis of the hepatobiliary system and the intestine.

Helminths (worms) or parasites very often infect a person, penetrating various organs and tissues of the body. Helminthiasis is a disease caused by parasitic worms. Among helminthiases, there are: 
 

• trematodoses (flukes), 
• cestodoses (tapeworms), 
• nematodoses (roundworms).  

Of trematodiasis in humans, opisthorchiasis (opisthorchiasis, clonorchiasis, fascioliasis) is more often parasitic . Of cestedoses – a wide ribbon (diphyllobothriasis), bovine (teniarchosis), pork (teniosis, cysticercosis) and dwarf tapeworms, single-chamber echinococci and alveococci, Of nematodoses – roundworms, whipworms (trichocephallosis), pinworms, trichyloids, and anchylostomils.

Helminthiases are ubiquitous, cause significant harm to human health and cause diseases of animals, fur animals, fish and plants.
 

Ways of infection.

A person is infected with helminthiases more often through the mouth, where eggs or larvae get from contaminated hands, as well as vegetables, berries, fruits and even dust, for example, with ascariasis, trichocephalosis, etc.
Larvae of the causative agents of hookworm infections, stronkoloidosis actively penetrate the skin of a person in contact with contaminated soil.
A person becomes infected when eating insufficiently thermally processed beef with larvae of pork tapeworm (teniosis), freshwater fish with larvae of broad tapeworm (diphyllobothriasis), cat fluke (opisthorchiasis), clonorchis (clonorchiosis), through hands contaminated with dog feces containing eggs or larvae echinococcus (echinococcosis), etc.

Pathogenesis.
In the pathogenesis of helminthiases, the sensitization of the body and the subsequent development of allergic reactions, the toxic effects of parasites, mechanical damage to tissues, the absorption of blood and nutrients (vitamins, etc.) by parasites play a role in the acute phase. In a number of helminths, larvae migrate to the patient’s tissues. In this case, conditions are created that facilitate the attachment of a secondary bacterial infection, for example, with opisthorchiasis, purulent cholangitis sometimes joins . 
 

Clinical symptoms.
The clinical manifestations of helminthiases depend on the type of pathogen, the intensity of the invasion, the patient’s body condition and a number of other factors. The disease is sometimes asymptomatic, but more often, as a result of invasion, general and sometimes specific symptoms appear.

Signs of asthenisation are weakness, fatigue, irritability, etc. Symptoms associated with a lesion of the gastrointestinal tract are nausea, salivation, flatulence, rumbling and transfusion in the abdomen, diarrhea, etc. These symptoms are common, but they are not specific. Weight loss with helminthiasis can also take place, but it happens with a severe course of invasion or with a complication.

Specific symptoms.

• Iron deficiency anemia occurs with hookworm infection, strongyloidosis, as a result of the migration of their larvae into the pulmonary circulation and into the airways. 
• Attacks of bronchial asthma can occur with ascariasis and strongyloidosis as a result of the migration of their larvae into the pulmonary circulation and into the airways.  
• Muscle damage in trichinosis, clinically manifested by muscle pain. 
• Transient fever often occurs with trichinosis and cestodoses (teniosis, teniarchosis, cysticercosis, diphyllobothriasis, hymenolepidosis, echinococcosis). 
• Portal hypertension is sometimes found in clonarchosis. 
• Obstructive jaundice and intestinal obstruction with ascariasis and echinococcosis. 
• Steatorrhea is characteristic of strongyloidosis. 
   

Description of helminths.

Some diagnostic value is visual recognition of helminths in the feces.
The length of helminths from 1-2 mm to 45-55 mm with a thickening at one end is characteristic of pinworms and whipworm. With a length of 10-30 cm, resembling earthworms – roundworms. The length of the tapeworm is from 2 to 20 cm, consisting of segments secreted outward with feces – pork or bovine, or wide ribbon, tapeworm. In the study of the head with an increase: with the presence of two rows of hooks – pork tapeworm, in the absence of hooks – bull tapeworm. If there are two deep slots on the head end, a wide ribbon. All other parasites excreted with feces can be detected only by microscopic examination.

Diagnostics.

• Eosinophilia (more than 0.44 109 l) – must be expressed in numbers, not percent. But eosinophilia also occurs in other diseases – with hypersensitivity to drugs, atopic diseases, bronchopulmonary aspergillosis, pulmonary eosinophilic infiltrates, vasculitis, periarteritis, lymphomas, rarely autoimmune hepatitis, etc. 
• Specific diagnosis – the study of feces on worm eggs or on cysts. Feces should be delivered to the laboratory within 24 hours, as the eggs of some helminths contained in them quickly deform. With a microscopic examination of sputum, nasal mucus, vaginal discharge, it is also possible to detect some helminths (pinworms, roundworm larvae, etc.). In the duodenal contents, eggs of trematodes parasitizing in the liver (fascioli, hookworms, etc.) can be found. Microscopic examination of pieces of muscle of the patient can reveal trichonella and cystocerci.
   

General events.

It is necessary to observe hygiene measures, especially with enterobiosis. Helminthiasis screening of all family members is recommended.

Before prescribing antiparasitic therapy, it is necessary to prepare the body for better drug tolerance and greater treatment effectiveness.
Within 7-10 days, you must follow a soft, sparing diet (you can rice diet), exclude milk and dairy products, chocolate, cocoa, sweets, baked, limit coffee, foods that irritate the gastrointestinal tract.
It is necessary to regulate the work of the intestines (for constipation, take soft laxatives), take enzymes (festal, mezym forte, etc.), make dubazhes to cleanse the biliary tract and liver, every other day. Drug therapy.

Ascaridosis . 

Apply Vermoxum ( mebendazole and other synonyms) 100 mg 2 times a day, the course of treatment is 5 days or Combantrine ( pyrangel, nemocide and other syn.) At 10 mg / kg MT in one dose for 3 days or piperazine adipate 1, 0 3 times a day 30 minutes after eating for 2 days, or medamine (carbendazine) in a daily dose of 10 mg / kg in 3 divided doses for 2 days or Albendazole is prescribed at a dose of 400 mg per day once or 200 mg 2 times a day day. 

Enterobiosis (pinworms).

Assign Albendazole – at a dose of 5 mg / kg of body weight once. Neither preparation nor diet is required. After 14 days, the course of treatment should be repeated in the same dose and in the same mode. Efficiency is 100%.  

Trichinosis.

Apply inside Vermoxum ( mebendazole and other blue.) 100 mg 3 times a day for 7-12 days or Albendazole – at a dose of 10 mg / kg body weight per day (average dosage of 800 mg per day) in 2 doses after meals within 7 to 10 days. In severe invasion and organ damage (myocarditis, pneumonitis, meningoencephalitis) are also prescribed: Glucocorticosteroids and Symptomatic agents (Analgesics and Antihistamines)

Trichocephalosis (whipworm). 

Inside take Vermoxum ( mebendazole , etc. syn.) At 100 mg per day for 3 days; in the absence of effect, a repeated course is carried out lasting up to 5 days at a dose of 100 mg per day or Albendazole – 400 mg per day once after a meal.

Diphyllobothriasis.

In severe anemia, pathogenetic therapy should be started before deworming, including folic acid (inside of 0.002 g 3 times a day) and IM Cyanobalamin (200 μg daily until the blood picture normalizes). Specific oral therapy Praziquantel ( azinox and other syn.) 600 mg in the morning or Phenasal (niclosamide) 3.0 g once in the morning on an empty stomach once.    
   
 

Teniosis

In the treatment using Praziquantel ( azinox and other syn.) 600 mg in the morning or Phenasal (niclosamide) 3.0 g in the morning on an empty stomach once.

Tenarinhoz

Apply Praziquantel ( asinox and other syn.) 600 mg in the morning or Phenasal (niclosamide) 3.0 g in the morning on an empty stomach once.

Trematodoses (fascioliasis, opisthorchiasis, clonorchiasis). 

Inside Praziquantel (azinox) at the rate of 75 mg / kg MT per day in 3 divided doses after meals for 2 days. Before a specific treatment, for its better tolerance and effectiveness, detoxification therapy is necessary . Reefings are possible.

Hydatidosis echinococcosis. 

The causative agent is the larval stage of the cestode Echinococcus granulosus. Larvae with blood flow migrate to the liver, where most of the larvae remain, grow, turning into a cyst. Part of the larvae can enter the lungs, less often to other organs and also turn into a cyst. Treatment of echinococcosis is usually surgical. Chemotherapy is performed in cases of rupture of cysts and contamination of the body. Albendazole is the most effective drug for the treatment of hydatid echinococcosis. Before the appointment of the drug, a clinical blood test, a biochemical blood test is necessary to determine the condition of the liver and kidneys. Treatment is carried out with normal laboratory parameters. Albendazole is prescribed at a dose of 10 mg / kg body weight in 2 to 3 doses after meals. The duration of treatment is 4 weeks. In the process of treatment, every 5-7 days, a blood test and aminotransferases are necessary. Treatment of echinococcosis is multi-course. Albendazole is prescribed in courses with an interval of 2 weeks to 1 month. The duration of treatment in the presence of cysts is 12-18 months.

Against the background of infections, other diseases often develop – duodenitis, cholecystitis, cholangitis, pancreatitis , etc. Therefore, patients who are free from infection also need to carry out further non-specific treatment of these diseases.