Trichocephalosis( trichyuriasis or trichurosis) is an anthroponotic disease characterized by a chronic course, mainly affecting the organs of the gastrointestinal tract, which can also lead to toxic damage to the nervous system.
The most commonly caused by a withered person( cases of humans catching cats, dogs or other animals with whiskers are extremely rare), trichocephalosis is most common in regions with a humid subtropical or temperate climate( local population invasion rate reaches 50%), although individual cases of infection are recorded everywhere.
In the Russian Federation, the outbreak of trichurosis, which has a non-permanent( sporadic) nature, is most often observed in the territory of the Central Chernozem and the North Caucasus, most often in rural areas.
In the general structure of nematodes( infections caused by roundworms), according to the total number of people infected with this parasitic infection in endemic areas, trichocephalus retains the second - after ascariasis - position. Trichyuriasis most often infects children between the ages of five and fifteen.
Pathogen and life cycle of development of
The causative agent of trichocephalosis is a withered head - a round worm with a hairy-tapered anterior part of the body and a thickened caudal end, giving it a resemblance to a whip. For this similarity in the medical literature of the last century, this helminth was called a whip.
In a female reaching a length of 35-55 mm, the ratio of the anterior part of the body to the posterior part is 2 to 1, in the male, whose length varies within 30-45 mm, the length of the threadlike part of the body is 1.5 times the length of the tail section. In females the caudal end looks like a saber-like arcuate arc, while in males it is twisted into a spiral.
Vlasoglavy can be painted in a grayish-white or brownish color. The cuticle covering their bodies has a transverse striation.
The digestive system of helminths begins with the mouthpiece - without lips - with a hole leading to a thin long esophagus. Due to the accumulation of digestive glands, grouped on its front surface in one row, the esophagus has a distinct form. In the area of the transition of the hairy part of the body to the thickened caudal region, the esophagus is connected to the intestinal tube, in the posterior end of which there is an anus.
In a female having an unpaired reproductive system, the genital pore is located at the point of transition of the capilliform head to the thickened posterior section. Unpaired male reproductive system involves the presence of a pointed bent spicule( its length is 2.5 mm), placed in the spicula vagina, dotted with a number of spines.
Photo of the parasite of trichocephalosis( whitewashed)
Eggs of whipworms, painted in golden yellow or in a tan color, are barrel-shaped. At the poles of the eggs, colorless cork-like formations are clearly visible, arising from the protrusion of the inner shell. Each egg is covered with a thick smooth shell consisting of four layers( shells).
The only purpose of the fibrous inner shell is to protect the contents of the egg from possible chemical damage, the three remaining shells protect it from mechanical damage.
After leaving the womb of the female laying them before the comminution begins, the eggs of the whip heads need development and ripening in the external environment.
The filiform front end of the withered head at the same time penetrates at once three membranes( mucous, submucosal and muscular) of the intestinal wall, and the caudal end hangs into the intestinal lumen.
As an optional hematophagus, the helminth feeds not so much on blood as on tissue juices entering its esophagus directly from the capillaries. The fertilized female harvester daily allocates more than three thousand immature eggs to the lumen of the intestine, from where, together with the excrements of the patient, they enter the soil, where they ripen to the invasive stage.
High humidity, constant access of oxygen and ambient temperature, kept at a level of 25-30 degrees - these are the optimal conditions for the successful development of nematodes. Under such conditions, the eggs of the wet-head, which are in the soil, can remain invasive for three years.
The protection of eggs is so high that, being in the climatic conditions of the middle belt, they are able to overwinter in the soil covered by a thick snow cover. Eggs of whipworms are not afraid of insolation, they are resistant to drying, and even short-term flooding can survive.
Vlasoglavy able to parasit exclusively in the body, the person infected by swallowing invasive eggs. The morphological index of the invasiveness of a matured larva( the average duration of its incubation in the soil is at least three weeks) is the presence of a spear-shaped stiletto.
When entering the small intestine, the egg shell breaks down. The larva that emerges from it through the stiletto penetrates deep into the mucosa of the intestinal wall, where it develops for several days.
After this, entering the intestinal lumen, the larva appears in the caecum, where, once again having penetrated into the mucosal tissue, after six weeks it turns into a sexually mature individual. It was found that females predominate among adult parasites.
From all of the above, it is clear that the phase of migration in the life cycle of slag is absent. The duration of its parasitization in the human intestine ranges from five to seven years.
Pathways of infection of
The source of infection is a sick person, along with feces that emits immature eggs of wet whales in the environment.
Infection with trichurosis occurs by the fecal-oral mechanism: helminth eggs, matured in the soil and become invasive, enter the human body:
- through dirty hands;
- when consuming contaminated water;
- when eating fresh greens, berries, vegetables and fruits contaminated with feces or soil.
The picture depicts the transmission scheme of the whip head
Parasitic infestation most often strikes:
- children neglecting basic rules of personal hygiene;
- people, constantly in contact with the soil( truck farmers, excavators, builders engaged in excavation work);
- of drivers of sewage transport;
- workers of sewage treatment plants and sewer networks;
- field crops that fertilize the soil with faeces that have not been properly sanitized.
Pathogenesis of
The pathogenic effect of the causative agents of trichocephalosis on the human body is due to their mechanical and allergic-toxic effects.
- At the time of implantation in the intestinal wall, the whipworm with its filiform head end is able to penetrate into its deepest layers( up to the muscular).That is why, near the place of introduction of parasites on the affected mucosal areas, the appearance of infiltrates, numerous erosions, small hemorrhages, necrosis and edema.
- Traumatic damages of intestinal walls promote the penetration of pathogenic microflora. The Russian scientist Mechnikov in 1901 proved that the invasion of vlasoglavov plays an important role in the development of tiflitis( inflammatory process in the mucous membrane of the cecum) and appendicitis.
- Enzymes and metabolites released by parasites exacerbate the effects of bacterial microflora on the mucous membranes of the colon, resulting in patients suffering from trichocephalosis suffer from allergic reactions and neurological disorders.
- Parasitizing helminths leads to a violation of fluid absorption in the large intestine, which causes the patient to develop diarrheal syndrome.
- Vlasoglavy, living in the ileocecal region( the site of the transition of the small intestine into a thick one), have a significant effect on the course of visceral reflexes that connect it to other parts of the intestine. As a result of constant irritation of the nerve endings concentrated there, a disturbance of peristalsis and motility occurs throughout the intestine.
- Whitworms that feed on blood( each worm can absorb about 0.005 ml of blood per day) and damaging blood vessels, provoke the development of iron deficiency anemia.
Symptoms of trichocephaliasis
The severity of the clinical picture with Trichurose is determined by:
- Intensity of invasion: the more helminths dwell in the patient's body - the more noticeable their presence. With a low intensity of parasitic invasion, clinical symptoms of trichurosis may either be completely absent or be mild, and as a result, it is not always possible to detect the disease in time.
- The state of the immune system. If the immune defense of the body is weakened, the disease( in both adults and small patients) can pass into a severe acute form requiring long and intensive treatment.
- The presence of concomitant( especially chronic) diseases of , significantly complicating the course of the disease.
In the clinical course of trichocephalosis, two stages are distinguished( acute and chronic), and four forms:
- Compensated.
- Subclinical , observed with moderate infection of the body and characterized by the presence of periodically occurring stitching or spastic pain in the right side.
- Manifest , accompanied by pronounced clinical manifestations, which is a consequence of the defeat of the central nervous system and organs of the gastrointestinal tract.
- Complicated.
Signs in adults
Clinical manifestations of trichocephalosis basically coincide with the symptomatology accompanying the course of the majority of parasitic infestations.
Suspected of the presence of this ailment is possible if:
- has nausea and frequent vomiting;
- persistent decrease in appetite;
- of frequent intestinal disorders accompanied by diarrhea attacks;
- enhanced motility of the digestive tract, caused by irritation of nerve endings;
- painful sensations in the right side, often taken for manifestations of appendicitis;
- disorders arising from the nervous system.
Symptomatic lesions of the central nervous system in patients with trichurosis are:
- increased irritability;
- presence of general weakness;
- with insomnia;
- dizziness;
- headaches;
- with frequent fainting.
Patients begin to lose weight rapidly. Their mucous membranes and skin become dry, prone to pustular and inflammatory diseases.
Abdominal pain, most commonly occurring in the region of the stomach or in the right ileal region, sometimes may not have a clear localization. Pain in the epigastric region in patients with trichocephalosis often resemble manifestations of peptic ulcer and duodenal ulcer. With pain in the lower abdomen, you can erroneously suspect the presence of chronic appendicitis.
Clinic in children
In the case of moderate invasion( in the absence of repeated infections), trichocephalosis in children can occur in subclinical form, declaring itself a periodic occurrence of stitching pain localized in the right ileal region or throughout the large intestine.
If the invasion is massive and is accompanied by repeated infections, the children are:
- nausea;
- lack of appetite;
- severe headaches;
- increased salivation;
- severe fatigue;
- instability of stool.
In young children, trichocephalosis can provoke anemia, hypoalbumism( a condition characterized by a reduced content of albumin in the blood serum) and a lag in physical development.
The defeat of the central nervous system in children is fraught with the onset of seizures and fainting.
When trichurosis, combined with ascariasis( this phenomenon is typical for regions with a temperate climate), children complain of pain throughout the abdomen, and toddlers begin to lag not only in physical, but also in mental development.
The most severe course is invasion, combined with acute intestinal infections and amebiasis. In such cases, small patients are observed:
- bloody stools;
- painful tenesmus;
- prolapse of rectum;
- a rapid decrease in body weight.
Trichocephalosis most often affects children of active age. The cases of its development in infants of the first year of life are extremely rare, the clinical manifestations of infestation are distinguished by erosion. Congenital this disease does not happen.
Complications of
The most characteristic complications of trichocephalosis are:
- prolapse of rectum;
- development of cachexia( extreme exhaustion);
- hypochromic anemia;
- dysbacteriosis of the intestine( a pathological change in the qualitative composition of the microflora inhabiting the human digestive tract).
This helminthiasis can provoke the development of appendicitis.
Diagnosis
Patients with a whole range of characteristic manifestations of parasitic infestation should pass a complex of laboratory and clinical-instrumental studies as soon as possible.
- In trichocephalasis, a clinical blood test will indicate the presence of normochromic and hypochromic anemia, moderate eosinophilia, leukocytosis, and an increase in ESR.
- The most reliable confirmation of this ailment is the results of a coproskopy, which found eggs in the stool in the bowels of the patient. With a low intensity of invasion, laboratory technicians use the methods of enrichment according to Kalantaryan and Füleleborn.
- Given the absence of specific symptomatology, cases of trichurosis require careful conduct of differential diagnosis, which allows excluding the presence of acute intestinal pathologies, gastroenteritis of viral and bacterial etiology, appendicitis, enterocolitis, ascariasis and a number of other helminthiases.
- Procedures for endoscopic examination of the intestine( sigmoidoscopy and colonoscopy) of patients suffering from trichocephaliasis allow a good examination of its hyperemic, swollen and loose mucous membranes, on the surface of which there are numerous hemorrhagic and erosive foci. In the lumen of the sigmoid and rectum, the helminths themselves, hanging from the intestinal walls, are often noticeable.
Treatment of whipworm
As a rule, patients with trichocephalosis are not hospitalized. The exception is cases accompanied by severe complications and concomitant chronic diseases.
Antiparasitic therapy is performed with the preparations :
- Albendazole.
- "Karbendatsim".
- Vermox.
- "Oksantel".
- Diphezil.
- "Pirantel".
- Helmintox.
An individual doctor is responsible for the individual selection of the dosage, taking into account the patient's age, the state of his immune system and a number of body features.
The duration of the therapeutic course does not exceed three days. Four weeks after the completion of the treatment, a three-fold control study of stool is carried out. The interval between studies is from 15 to 20 days.
If treatment was ineffective, it is repeated after two to three weeks( with mandatory replacement of the drug).
As a concomitant treatment,
- iron preparations are used;
- vitamins related to group B;
- probiotics;
- enzymes.
Prevention of
To prevent infection with trichocephalasis, it is necessary:
- Carefully observe the rules of personal hygiene( wash hands before eating and after every visit to the toilet) and demand it from all family members, including young children.
- Eat only well-washed vegetable, fruit and green cultures.
- Refuse to consume raw water from open sources.
- To pay great attention to systematic examination of urban and rural population in order to identify and immediately treat patients.
- Prevent soil contamination by human excrement. In places of mass influx of people( during folk festivals and holidays) should be installed as much as possible toilets.
- Disinfect the contents of cesspools with effective antiseptics.
- To disinfect the soil, use preparations "Thiosone", "Carbathion", "Polycarbacin", capable of destroying the eggs of nematodes.
- Regularly conduct explanatory sanitary work with the population, increasing its sanitary culture.