Disease of opisthorchiasis in a vesicular man, as the opisthorch looks on the photo, species, forms, stages of helminthiasis, classification according to ICD-10

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For the first time about such a serious helminthic invasion as opisthorchiasis, it became known in 1891 when a parasitic worm was found in the liver of a deceased person, which was called Siberian, and later, by other scientists, cat's fluke. At the same time, it was suggested that the first intermediate host is the freshwater mollusk, and the second is the carp fish.

The disease is common in Southeast Asia, on the territory of many countries in Europe, as well as in Russia, Ukraine, and Kazakhstan. Its habitats are the basins of large rivers. Infection occurs when shellfish eggs eggs opisthorchov, falling into a pond with human feces. For 60 days, eggs develop in cercariae, which are then introduced into the body of freshwater fish. Further development of the larva occurs in the muscles and subcutaneous tissue transforming them into megacercariae, lying in a small cyst of gray color.

Invasive larvae become 6 weeks after infection of the fish. Eating contaminated fish, a person has every chance to become infected with a parasitic opisthorchiasis. Megacercaria digestion of the cat, getting into the digestive tract, is released from the membrane and begins to move into the gallbladder and the bile ducts of the liver through the bile ducts. The deposition of eggs by opisthorchms occurs after reaching puberty( 10-12 days), and the helminths-opisthores themselves can exist in the human body up to 20 years, and sometimes much longer. The danger of opisthorchiasis can be found in the video below:

How do opisthorchias look?

The opisthorchist glistens are hermaphrodites and are a flat worm up to 20 mm long with the abdominal sucker and mouth sucker at the anterior end, lance-shaped. The causative agent of the disease is one of the types of hepatic trematodes, as the parasite-opistorch is called:

• Opisthorchis felineus;
• O. viverrini.

It is clear from the photo of opisthorchia( liver trematodes) that both these species practically do not differ in their structure and properties. The difference between them lies in the distribution area. For the vivertra fluker, the countries of Southeast Asia are the site of distribution, and the opisthorchiasis felinus is common in European countries, Russia, and Kazakhstan. Male organs are represented by lobar testes and the seminal receptacle in the posterior part of the liver fluke, and in the middle part of the body are female( uterus and vitellaria).Eggs that the worm produces in a day to 900 pieces are secreted through the genital pore located in front of the abdominal sucker.

Description of opisthorchiasis

Pathological changes caused by worms are based on the mechanical and toxic effects of worms on the human body. When moving along the bile ducts and fixing in them, the opistors violate blood circulation and disrupt the integrity of the walls of the bile passages, and young individuals additionally damage the walls with their cuticular spines. The accumulation of parasites, their eggs and exfoliating epithelium provoke stagnation of bile and cystic dilatation of the bile ducts. By isolating the metabolic products directly into the body, the opisthores in the adult cause various frustration and allergic reactions. Depending on the pathogenetic regularity, the following stages are distinguished:

• acute;
• is latent;
• is chronic.

In acute form, the disease manifests itself as a general intoxication of the body, damage to the organs of the digestive tract and signs of lung damage. After a few days or weeks it goes into a chronic stage. Classification of opisthorchiasis in adults is carried out according to different criteria, but more often this classification is carried out, based on the primary lesion of organs. The types of the disease are as follows:

1. Typhoid-like with fever, high fever and skin rash.
2. Gastroenterological, characterized by the development of ulcers in the stomach and duodenum, gastroenterocolitis, erosive gastritis.
3. Hepatocholangetic.
4. Bronchopulmonary, causing disease with bronchial asthma, bronchitis and pneumonia.

The forms of opisthorchiasis are so diverse and nonspecific that they do not fit into any definite syndrome, but cholangitis is an essential link in the pathogenesis of opisthorchiasis( pictured).According to the IBC, opisthorchiasis refers to diseases that are considered to be transmissible or transmissible. Code for ICD 10 helminthiosis is designated B66.0.

Symptoms of opisthorchiasis in adults

The first signs of what opisthorchiasis looks like, the photos and videos of which are located here, appear after the end of the incubation period and in mild form are accompanied by: a slight increase in temperature;

general malaise, weakness;

increased sweating.

The acute phase of the course of helminthic invasion can be tightened and characterized by increased severity of the condition. In this case, the body temperature rises to 39.5 ° C, catarrhal manifestations in the upper respiratory tract. In 10-20% of patients, severe course of the acute phase of helminthiasis is noted, and typhoid-like, gastroenterological or hepatocholangic variants are recorded. When you go to the chronic stage, the symptoms of opisthorchiasis depend on the variant in which the disease occurs.

Gastroenterocolitis type of the disease develops in 90% of all affected by opisthorchiasis and 2/3 of the patients have symptoms of involvement in the pathological process of the pancreas. The defeat of the digestive tract is accompanied by constant paroxysmal pain in the right hypochondrium, nausea, vomiting, bloating. If the liver is mostly affected, then jaundice of varying degrees of intensity develops, an increase is seen in the lymph nodes, and severe pain occurs in the liver region.

In the clinical picture of opisthorchias, characteristic asthenovegetative( malfunctions in the transmission of nerve impulses) and allergic syndromes are noted. Finding out what opisthorchiasis looks like, one should not forget about the influence of worms on the central and autonomic nervous systems. Therefore, invasive people often complain of severe headaches, insomnia, dizziness. Violations of the autonomic nervous system are manifested in the involuntary trembling of the eyelids, tongue, fingers, delayed vascular reaction, drooling, pronounced special skin lesions( dermographism).

The development of helminthic invasion is manifested in the following diseases:

1. Purulent-destructive inflammation of the hepatic bile duct and inflammation of the gallbladder.
2. Perforation of the gallbladder.
3. Purulent inflammation of liver tissue, cirrhosis and primary liver cancer.
4. Acute pancreatitis, which can sometimes go to pancreatic cancer.

Opisthorchiasis in adults even after treatment leaves consequences in the form of hepatitis, gastritis, cholecystitis, cholangitis, low immunity. To diagnose helminthiasis in adults because of the unclear manifestations, the masking of symptoms for other diseases, is very difficult. First of all, the epidemiological analysis is taken into account, ie, the origin of the infestation is determined. Then the doctor studies the clinical picture, conducts blood tests. In laboratory diagnostics, helminthoscopy methods are used using a combination of flotation and sedimentation methods or each separately, as well as immunodiagnostics.

Treatment of opisthorchiasis( code for ICD B66.0)

The main approach in the treatment of this dangerous lesion in adults is a comprehensive approach based on a combination of etiotropic and pathogenetic therapy. After the diagnosis is established, the doctor prescribes antihistamines to stop allergic reactions, as well as to remove painful pain medications. In the presence of concomitant infections, antibiotics, probiotics are used. In addition, bile preparations are prescribed, which facilitate the passage of bile and prevent the development of stagnant phenomena. At the same time, a special diet with a low fat content in products must be observed.

The duration of this first stage of treatment does not exceed twenty days, and then a special antiparasitic drug is administered leading to a spasm of the muscles of parasites that can no longer be retained on the walls of the bile ducts and are removed from the body. However, these drugs have a number of dangerous side effects, so it is recommended that this stage of treatment take place in a hospital setting. At the final stage of therapy, a set of measures are taken to restore normal functioning of all internal organs, including the liver and pancreas.

Preparations Nosh-Pa, Baralgin, Drotaverin relieve pain and spasms, and to improve digestion take Mezim-forte or other drugs with a similar effect. In the third, the recovery stage, the tjubazh is prescribed for the liver region with xylitol, mineral water, the intestines are cleaned, and herbal infusions, hepatoprotectors, are used to facilitate the outflow of bile. The entire process of treatment of opisthorchiasis in adults is under close medical supervision, regularly examining the feces and contents of the stomach for the presence of eggs and opisthorchia.

It should be noted that the presence of opisthorchiasis need not necessarily be accompanied by deworming. For elderly and elderly people, the antiparasitic drug( Praziquantel) is administered very cautiously and not earlier than 3 weeks after the onset of infection. The terms of dispensary observation, depending on the severity of the course of the invasion and taking into account the clinical manifestations, range from two to three years and even more. Preventive maintenance consists in observance of rules of preparation of fish for the use.