Strongyloidosis is a disease caused by filamentous nematodes from Strongyloides stercoralis. It is characterized by the symptoms of various pathologies of the gastrointestinal tract. The invasion was first described in 1876.Normand, a French doctor, accepted a large number of soldiers who had returned from the war in Vietnam. All of them complained of persistent diarrhea. Then it was possible to reveal in the liquid feces of patients the causative agent of the disease - round worms having small dimensions. What does strongyloid look like? The length of the female does not exceed 2.2 mm, the male is almost six times shorter. Appearance of worms is small, than differs from other nematodes: the end of the body is pointed, at the front blunt end there is an opening surrounded by small lips. But a similar subspecies of roundworms has one significant difference from other nematodes: during its life cycle the worm can change the parasitic generation free-living.
Females produce egg laying, larvae hatch from them, they enter the external environment together with feces. Once in the soil, strongyloid become free living geogelminthes, capable of reproducing offspring outside the host organism. The larvae grown in the soil are invasive to humans. Infection occurs in two ways:
- Through the skin during contact with the ground. Larvae are able to easily drill the skin and penetrate into the channel of blood vessels.
- During meals, when eating poorly washed foods. In this case, the larvae enter the bloodstream through the oral mucosa.
Regardless of the manner in which the invasion occurred, the larvae of the worms migrate along the general blood flow and become sexually mature during migration( it takes 17-27 days).Become invasive larvae can and in the intestines of the host. This happens when it is deeply embedded in the intestinal mucosa and there remains. The causative agent likes to localize in the glands of the duodenum. If much strontyloid accumulates inside the intestine, they parasitize throughout the small intestine, easily move into the large intestine and penetrate even into the pyloric section of the stomach. Mechanical damage to the mucosa is the cause of inflammatory reactions.
It is at the bottom of the glands of the duodenum that strongyloids lay eggs. In a day the female reproduces up to 50 eggs, larvae emerge from them. They go out together with the excrements. The life cycle is completed. How does the disease manifest itself?
Symptoms of strongyloidiasis
The clinical picture of strongyloidosis is very diverse. Since strongiloid larvae along with the blood flow migrate throughout the body, the symptoms of helminthiasis are very different. The first stages( the first twenty days) do not betray themselves. The patient can complain of these or other symptoms only when strongyloidosis passes into a chronic stage, proceeding with alternation of forms of exacerbation and remission. But one symptom should make any of us nervous. If the skin appears itchy rashes, if the background of an allergy pain in the muscles or in the joints - this is an occasion to turn to a specialist. A blood test shows an increase in eosinophils, an increase in the rate of sedimentation of red cells in the blood( erythrocytes).
Allergic rashes have a very distinctive appearance. On the skin appear blisters, towering above the surface of the epidermis. The color of the blisters is pinkish red. Rashes cause the strongest itching, when combed, the blisters easily change their shape. The rash does not always stay on the skin, it brings troubles to a patient with strongyloidiasis for three days, and then goes away with itself. If the blisters do not scratch, there will not even be a trace of allergy on the skin.
The main symptom of strongyloidiasis is the appearance of such rashes several times a year. The causes of such manifestations are repeated invasion. In addition to allergy, strongyloidosis patients can complain of general malaise, persistent headaches, sleep and dizziness. During the exit of the strongyloid larvae into the lumen of the lungs, symptoms of pulmonary pathologies appear. Suddenly, bronchitis may occur, and the appearance of pneumonia becomes possible.
If you make an X-ray at this time, the lungs show an infectious agent in the form of foci of inflammation( darkening), they form around the settled larva of the worm. Bronchitis just as suddenly passes as it does, but the next stage of strongyloidosis does not bring relief, symptoms of pulmonary pathology are replaced by symptoms of gastrointestinal tract diseases( abdominal pains, bloody diarrhea, painful defecation).Gradually, these manifestations also take place, the next stage, characterized by a chronic course, comes to replace them.
Forms of strongyloidiasis
Numerous observations have revealed several differences during strongyloidiasis( treatment is performed taking into account the manifestations of the clinical picture).For the combination of symptoms, several forms of strongyloidiasis are distinguished:
- Duadeno-cholelithiasis.
- Gastrointestinal.
- Nervous allergic.
- Pulmonary.
- Mixed.
The first form flows slowly and monotonously, it is manifested by the symptoms of cholecystitis, when strongyloids settle in the biliary tract, the patient suffers from pain that occurs in the right hypochondrium. He has bitterness in his mouth, nausea, a strong eructation, which often ends in vomiting. Ultrasound can identify the causes of the pathology described.
The second form of strongyloidiasis shows itself as symptoms of digestive disorders. The chair is unstable, diarrhea is replaced by constipation. In the liquid stool, blood is found. The pains in the abdomen are similar to those that arise during peptic ulcer. The patient's tongue is then coated with a white coating.
The nervous-allergic form of strongyloidiasis begins with allergic rashes. Their appearance was described just above. Most often, an allergic reaction occurs where the body is in close contact with clothing( with a trouser belt, for example).The rash after three days passes even when the patient does not take proper treatment. However, after the rash, there are signs of nervous disorders in the form of severe headaches, sleep disorders, severe irritability, dizziness. Strongyloidosis is always treated in strictly stationary conditions. The huge role in the recovery is played by the prevention of repeated invasions.
The fourth form is diagnosed at the first stages of strongyloidiasis, when the larvae settle in the lungs. With a mixed form, symptoms of several stages of helminthiasis appear at once. Similar lesions are often found in those patients, in whom the invasion occurs against the background of HIV infections, cancer, malnutrition.
Diagnosis of strongyloidiasis
It is difficult to diagnose strongyloidiasis and to identify an infectious agent according to manifested symptoms. The reasons are a rather diverse clinical picture, but if the patient is simultaneously disturbed by signs of disruption of several internal systems( liver, gallbladder, intestine), this is the reason for conducting a detailed diagnostic study. What tests will help confirm strongyloidiasis:
- Examination of sputum and duodenal contents.
- Stool analysis. For its collection it is better to use plastic containers, which are sold in any pharmacy. Microscopic analysis allows us to identify and eggs strongyloid, and their larvae. But their absence in feces does not mean, then there is no parasite in the human body, since eggs or larvae appear in excrements of sick people three weeks after the onset of the disease. That is why the methods of differential diagnosis and other methods of investigation are used to confirm the diagnosis.
- Berman method or Borisenko method. The essence of the research is that strontyloid larvae love heat. The gauze is collected in the gauze, it is pulled over a jar full of warm water. If there are larvae in it, they will rush to warm water to the bottom of the can. Such a diagnostic study allows to identify the causative agent of helminthiosis in 98 cases out of a hundred.
Assays for the determination of antibodies in the conduct of differential diagnostics of wide distribution have not been received. And all because they show a rather low efficiency, while very expensive. And here after treatment the analysis of a blood on antibodies is pertinent. He will help to suggest whether the chosen therapeutic tactics proved to be effective. Where it is possible to hand over analyzes on strongyloidiasis? In any laboratory that is located at an infectious diseases hospital. The direction is prescribed by a parasitologist or infectious disease specialist.
Strongyloidosis treatment
Treatment of strongyloidiasis in adults and children is carried out according to the same scheme:
- The complex is based on the use of antihelminthic drugs. Children are prescribed Thiabendazole( daily dose of 25 mg per kg of body weight).The course is three days, three times a day with meals. Adults are prescribed Albendazole( at the rate of 10 mg per kg of body) or Praziquantel is a broad-spectrum antihelminthic drug. The main substance acts instantly on the worm, it causes persistent paralysis and leads to the death of all forms of worms.
- Then funds are allocated to help cope with allergic manifestations. To relieve the patient's condition, it is necessary to relieve the itching and reduce puffiness of the affected skin.
- Parallel symptomatic therapy is performed, which allows to eliminate possible complications of strongyloidiasis. This is why strong anti-inflammatory drugs, such as Diclofenac, are sometimes used during the treatment of strongyloidiasis.
- If the clinical picture shows signs of general intoxication of the body( its signs are often found during exacerbations of the chronic stage of the disease), the patient is assigned an infusor therapy. It helps to reduce the level of toxins in the affected body, and also supports the work of organs involved in the invasion.
Similar courses of treatment for adults and children with low immunity can be re-appointed two weeks after the end of the first days of treatment. If necessary, this frequency is observed for six months. Great attention is paid to avoiding recurrent disease. Knowing how Strongyloidosis is affected, it is important to learn how to make sure that the prescribed treatment has helped. To help in this is only able to re-diagnose. It is necessary again to hand over the feces for the presence of strontiligo larvae, the analysis of blood for antibodies. Avoid repeated invasion by observing simple rules.
What will help in the prevention of strongyloidiasis:
- You can not walk barefoot where there can be feces of pets or people on the ground.
- Since strongyloidosis is transmitted from person to person, the patient is isolated in the hospital for the duration of treatment.
- After each visit to the street or toilets, you should wash your hands thoroughly with soap.
- Drink only pure, boiled water.
- Always wash with hot water before consumption vegetables and fruits.
- It is necessary to teach the toddlers to observe the above recommendations.
It is also important to protect the environment from faecal contamination of domestic animals and people, to identify other causes of invasion in a timely manner, to disinfect contaminated soil, to sanitize the places where we live, to observe the ban on fertilizing soil with manure that has not passed the compost stage. Earlier detection and treatment of patients is an important component of prophylaxis of strongyloidiasis.