Diphyllobothriasis: symptoms in humans and treatment regimen

Diphyllobothriasis is a parasitic disease, accompanied by a primary lesion of the digestive tract, as well as megaloblastic anemia. Its causative agent is a large tapeworm - a wide ribbon (D.latum), whose length can reach up to 10 m, as well as more than 10 species of less studied lentets from the genus Diphyllobothrium.

Causes of the disease

Human infection with diphyllobothriasis occurs when ingested, inadequately processed or poorly salted fish products are eaten, as well as when cutting fish and not enough processing dishes after it. And the ingress of helminths into the human body occurs according to a long chain.

Method of distribution of diphyllobothriasis

Eggs of tapeworms ripen in fresh water with a temperature of 10-20 ° C for about a month. Then, embryos-coradiations are separated from them, which, in turn, are eaten by small crustaceans, for example, copepods. This is the first intermediate stage of infection, in which helminth larvae are formed - the plerocercoids. Then comes the second stage, when freshwater fish such as pike, ruff, perch, burbot, trout, etc., eat the crustaceans, and in its body the larvae complete their development to the stage of the matured individual. And only after that, the helminth finds its final host and, accordingly, the source of the invasion - a person, or, more rarely, a representative of fish-eating animals, for example, a pig, a fox, a bear, a seal, etc. It is in their organisms that the mature helminth already parasitizes, the eggs of which go out during defecation and come down with sewerage into fresh water bodies, starting a new chain of infections.

Parasitizing in the intestine a wide ribbon consists of several thousand segments (proglottids) containing eggs, and firmly attached to the walls of the donor's small intestine by means of two slots (botryas) located at the head end. And although the length of the parasite sometimes reaches 10 meters, it is not uncommon for several worms to coexist in one human body.

Geography of the spread of the disease

Human diphyllobothriosis is most common among residents of regions with a moderate cold climate, where the main food of the population is fish and its caviar. The disease occurs in European countries, especially in Scandinavia, Japan, South America, Africa, USA, Canada, and Russia.

Pathogenesis and pathoanatomical picture of diphyllobothriasis

Getting into the human body, a wide ribbon has a pathogenic effect on it, mechanical, toxic-allergic and neuro-reflex. Firstly, this is an infringement of the intestinal mucosa by the botryas when the helminth is attached to the walls. As a result, atrophy and necrosis of the mucosa occurs. The products of the parasite exchange provoke autosensitization processes. There is a significant endogenous hypoavitaminosis of folic acid and vitamin B12, which, together with intoxication of the body with the products of the vital activity of the parasite, provokes the development of megaloblastic anemia in 2% of cases. The duration of invasion is up to ten years.

Symptoms of diphyllobothriasis

From 20 to 60 days - this is the incubation period has diphyllobothriasis, the symptoms in a person begin to manifest only after the expiration of this period. It is during this period that helminths acquire sexually mature forms, attach themselves to the walls of the intestine and begin to function. Diphyllobothriasis begins to show itself gradually. Attacks of nausea, eructation and vomiting, bloating , epigastric pain, deterioration of appetite, stool disorder - all accompanying early diphyllobothriasis symptoms. A photo of a person with a diphyllobothriasis of a later stage will invariably depict him with a noticeable pallor of the skin and mucous membranes, and the patient himself will suffer fatigue, dizziness, weakness, abdominal pain, paresthesia, hepatosplenomegaly, achillia, cracks in the tongue (later the surface of the tongue becomes smooth).

Observed tachycardia, hypotension, drowsiness, systolic noises at the top, the noise of the top. Laboratory blood tests of a presumably infected patient show the following pattern: decreased hemoglobin, a low amount of erythrocytes, a buildup of direct bilirubin, a high color index, neutropenia, leukocytosis, increased ESR. The severity of anemia, as well as the severity of the disease, is affected by the intensity of helminthic invasion, the presence of concomitant diseases, the general resistance of the organism, the quality and quantity of food consumed.

For a severe form of diphyllobothriosis, funicular myelosis is characteristic, which is expressed by a violation of deep sensitivity, weakness of the legs, and unsharpened paresthesia. In some patients, allergic rashes appear on the skin (urticaria), the size of the liver and spleen increases. In isolated cases epileptiform (convulsive) seizures, numbness of extremities, instability in walking are recorded. Like these ones Serious has diphyllobothriasis symptoms, and the treatment of this disease needs to start immediately after it is diagnosed. A prolonged course of diphyllobothriasis causes intestinal obstruction.

But, it is worth noting that diphyllobothriasis, whose symptoms consist of an impressive list of ailments, sometimes has an absolutely latent (asymptomatic) course of the disease, in which infection is detected only with the detection of parasite fragments in the feces.

Diagnosis of diphyllobothriasis

The basis for the diagnosis of "human diphyllobothriosis" is the patient's complaints and the relevant data of laboratory studies. Suspicion of the disease can serve as eosinophilia in the blood (with recent invasion), as well as thrombocytopenia and leukopenia, increased erythrocyte sedimentation rate and hyperchromic anemia. Characteristic for the disease is the megaloblastic type of hematopoiesis. The analysis indicates a large number of young forms of erythrocytes (megaloblasts, normoblasts, polychromatophiles, poikilocytes, etc.). A major role in the diagnosis is played by epidemiological history: the facts of the patient's stay in the endemic zone, eating raw freshwater fish or under-salted caviar. But the final analysis is made only when the analysis of the stool of the patient shows the presence in it of eggs or segments of a wide ribbon.

There are cases when patients who have noticed parasite fragments in their own feces refer.

It is important not to confuse the Addison-Birmer anemia and diphyllobothriasis, the symptoms of which are very similar. For this purpose, the gastric contents are checked for the presence of the factor Castle, which is absent in anemia.

Diphyllobothriasis: treatment

If the patient is diagnosed with "diphyllobothriasis", the treatment is performed immediately in the hospital. With severe anemia, before the procedures for removing the helminth, a course of vitamin therapy (B12, folic acid, iron) is prescribed. Vitamin B12 is administered as an intramuscular injection of 200-500 μg 2 or 3 times a week. The duration of vitamin therapy is 30 days.

For dehelmenmentation, drugs such as Biltricide, Praziquantel, Nichlosamide, or Azinox are used. Also, the drug "Fenasal" can be used to excrete the parasite. All drugs are taken orally and have a helminth paralyzing effect. As a result, the parasite loses its ability to stay inside the intestine and comes out. It is very important to make sure that the tape comes out completely. To achieve the final result, cleansing of the intestine with an enema is possible.

The effectiveness of such medication is about 95%, only in rare cases, complicated by intestinal obstruction, degelmentization is carried out in an operative way. Patients diagnosed with "diphyllobothriasis", whose treatment has successfully passed the stage of dehelminthization, switch to a dispensary observation with taking a stool test monthly for six months.

Folk remedies

In folk medicine for the expulsion of helminths, pumpkin seeds and a decoction of them are traditionally used. Pumpkin seeds, raw or dried, ground with water and honey and take in an amount of 300 gr. On an empty stomach portionwise for an hour. This method perfectly fights with such a problem as human diphyllobothriasis. Feedback on the successful degelmentization with the help of pumpkin seeds allows us to verify the effectiveness of this method.

Diet, food

During the treatment of diphyllobothriose, the patient should adhere to a sparing diet that excludes products that have an irritating mucosa of the intestinal walls action. It is advisable to include in the diet foods with high content of vitamin B12, as well as folic acid.

Features in children

Glistovye infestations by children are much more difficult, the symptoms of anemia and hypovitaminosis in small patients are more pronounced.

Prevention of diphyllobothriasis

If you are a lover of freshwater fish and live in the northern regions near water bodies, then in order to avoid getting caught on such an unpleasant disease as a person's diphyllobothriosis, prevention should become your life rule No. 1.

In order to avoid infection with diphyllobothriasis, one should consume only freshly cooked or roasted freshwater fish, as well as only salted salmon caviar. It is necessary to strictly observe the rules of hygiene when cutting fish and preparing dishes from it.

It should be noted that when salting fish, depending on the concentration of salt, the larvae die only after 2-7 days. Eggs of helminths with salting caviar perish in half an hour with 10% of the mass fraction of table salt in relation to the weight of caviar. If the salt is 5%, then the product becomes safe for food no earlier than 6 hours, at 3% - no earlier than two days.

Also, helminth larvae die with deep freezing (2-4 days at -18 ° C, a week at -6 ° C).

When diagnosing a patient, it is absolutely necessary to examine all members of his family, as they are in this case at risk.

On a global scale, in order to minimize the likelihood of infection, the percentage of intermediate carriers in water bodies should be reduced by reducing or eliminating the discharge of faeces into lakes and rivers, ensuring sanitary control over this process, and also for the overall condition of beaches, beaches and fish products entering food enterprises Industry and store shelves. It should be carefully monitored in medical institutions the occurrence of symptoms inherent in such a disease as diphyllobothriasis. Treatment with the confirmation of the diagnosis should be started immediately and with mandatory testing of all family members for the presence of infestation.

Features of pregnant and lactating

Glistular invasion, namely - hypovitaminosis and anemia with it, pose a great danger both for the health of the future mother and for the development of the fetus. Pregnant women should be especially careful when eating fish and caviar. It is important not to miss the first signs of a disease such as diphyllobothriasis, symptoms that can easily be confused with the manifestation of toxicosis (gestosis), and urgently seek the direction of a laboratory study of feces for the presence of helminth eggs in it.

Treatment of the disease in pregnant women is carried out by a method that is safe for the future child's health. So, for dehelmmentation pregnant and breast feeding women do not prescribe such drugs as "Biltricide", but use a safe folk remedy - pumpkin seeds. In some cases, breastfeeding with a diagnosis of "diphyllobothriasis" treatment Recommend to produce by the method of taking standard drugs for diphyllobothriasis, and the baby is transferred to artificial feeding.