Worm infestations

Worm infestationsorhelminthiasis– parasitic diseases with primary damage to the digestive organs. Helminths, parasitic worms, can live in many parts of the gastrointestinal tract (gastrointestinal tract), incl. in the large intestine, in the rectum. The diagnosis and treatment of colonic manifestations of helminth infections is carried out jointly by doctorsparasitologistandcoloproctologist.

Infection with helminthiasis is characterized by the following properties:

• a chronic course in which nutrients and defenses are gradually depleted;
• more often the body is attacked by hookworm, roundworms, toxocariasis, trichocephalosis;
• pathology is studied and treated not only in pediatrics and therapy, but also in gastrology, surgery, dermatology, allergology and other fields.

The disease affects a small percentage of the country's population, but tends to spread in areas with poor infrastructure and medical development.

Causes and mechanism

Helminths parasitizing the colon are represented by three classes:

1. Roundworms (nematodes): roundworms, pinworms (enterobiosis), whipworms (trichocephalosis), eels (strongyloidiasis), hookworms, toxocara.
2. Tapeworms (cestodes): broad tapeworm, beef tapeworm and pig tapeworm.
3. Flukes (trematodes): schistosomes.

Most of themhelminthscomplex development cycle. Between eggs and adults there are intermediate stages: larvae, cystic forms (cysts or fins). Worm eggs are resistant to adverse conditions and can survive in soil and water for a long time. With raw water, unwashed hands, fruits and vegetables contaminated with soil, they enter the human body.

Young children are more susceptiblehelminthiasisdue to the habit of putting hands and foreign objects in the mouth. Animals are often carriers of helminths. Meat, fish, crustaceans contain eggs, larvae or fins. Such food, raw or insufficiently thermally processed, also serves as a source of infection.  

Parasites cannot exist in the aggressive acidic environment of the stomach. But their shell is resistant to the action of gastric juice. In addition, the presence of helminths in food in the stomach is short-lived. And then, together with the food bolus, they pass into the intestine, where the life cycle continues with the formation of adult individuals.  

More favorable conditions for the life of helminths are created in the small and large intestines. There is a slightly alkaline environment, there are many food residues, the mucous membrane is abundantly supplied with blood. A number of adaptive mechanisms (hooks, suckers, developed muscles) help worms stay in the lumenGastrointestinal tract, attach to the intestinal mucosa and do not come out with the feces.

Their presence in the large intestine leads to local inflammatory processes - typhlitis, colitis, sigmoiditis, proctitis. In the process of life they are releasedtoxins. Many of them are strong allergens.  

Some of the parasites penetrate the ductal system of the pancreas, bile ducts and liver, causing damage to these organs. In addition, the larvae of a number of helminths are capable of piercing the intestinal wall. With the flow of blood and lymph, they enter the muscles, lungs, eyes and brain and cause damage to these organs.

Classification of helminthiasis

Depending on the group affiliation, the following types of parasitic infections are distinguished:

• cystodoses – echinococcosis, taenia, taeniarhynchiasis;
• nematodes – trichocephalosis, ascariasis, nekatoriasis;
• Trimatodes – opisthorchosis, fascioliasis.

Division of parasites depending on the way of survival in the environment:

• helminths;
• biohelminths;
• contact helminths.

Classification according to the method of propagation in the host:

• water;
• food;
• percutaneous.

There are 2 types of parasites depending on the area of distribution.

1. Intestinal form. They enter the host's body through the oral cavity, gradually spreading down the gastrointestinal tract. The permanent habitat is the intestines. These parasites include strongyloidiasis, hookworm and taenia.
2. Extraintestinal forms. Penetration can also develop through the gastrointestinal tract, but then the parasites migrate through the intestinal walls to other organs. For example, blood vessels, subcutaneous fat, liver, brain. Opisthorchosis, fascioliasis and trichinellosis have this property.

Extraintestinal forms are considered the most dangerous, causing severe complications.

Symptoms

Helminthiasis can be asymptomatic for a long time. Subsequently, non-specific symptoms of intestinal disorders appear:

• nausea;
• decreased appetite;
• aching or cramping pain in the abdomen;
• bloating;
• flatulence;
• diarrhea, constipation, their alternation.

A distinctive symptomenterobiosis: itching, burning in the anus, in the perianal region. This symptom is due to the fact that a sexually mature femalesedgescomes out and lays eggs. This happens mainly at night.

If the course is unfavorable, the intestinal lumen can become clogged with clusters of worms. In these cases, there is a typical clinical picture of mechanical intestinal obstruction with severe abdominal pain, bloating, repeated vomiting, stool retention and flatulence. Obstruction is complicated by inflammation of the peritoneum with an extremely severe general condition of the patient.  

Extraintestinal disorders include:

• headache;
• weakness, reduced productivity;
• changes in the emotional background: depression, irritability, insomnia;
• weight loss;
• pale skin, skin rash, pallor and dryness of visible mucous membranes;
• dry cough;
• frequent colds;
• the occurrence and frequency of bronchial asthma attacks;
• bruxism - teeth grinding during sleep;
• muscle and joint pain.

These symptoms are caused by organ and tissue damage, intoxication, immune deficiency, allergies and vitamin deficiency. If helminthiasis is not diagnosed, they are associated with other causes.

Diagnosis

Diagnosisdiagnosed based on laboratory tests of blood and stool. The general blood test shows a decrease in the level of hemoglobin and red blood cells. The level of eosinophilic leukocytes increases. It should be borne in mind thatanemiaand eosinophilia are characteristic of other diseases and therefore only indirectly indicate helminthiases.

Blood immunodiagnosis is aimed at detecting specific antibodies to parasitic tissues. Be sure to examine the stool for hidden blood and worm eggs. To diagnose enterobiosis, a scraping from the perianal area is performed. For scraping, use a cotton swab or plaster. Damage to the intestinal mucosa is diagnosed using endoscopic methods - sigmoidoscopy, colonoscopy.

There are additional diagnostic tests that help determine the type of pathogen, the area of its spread and the degree of damage:

• allergy skin test with the addition of helminth antigens;
• Ultrasound of abdominal organs with assessment of the state of the intestines, liver, spleen, pancreas;
• fibrogastroduodenoscopy - visual examination of the upper parts of the digestive tract using the introduction of a specific device through the oral cavity;
• colonoscopy - visual examination of the walls of the large intestine by introducing a probe with a camera;
• endoscopic biopsy - removal of tissue sections during endoscopic examination, followed by microscopy and histological analysis;
• radiography or CT of internal organs with the addition of contrast to evaluate the morphological properties of tissues, detect foreign elements and identify the integrity of the walls;
• liver scintigraphy - the introduction of a radioactive tracer that accumulates in the liver and emits radiation shown on the monitor (the morphology, size, location of the organ, the presence or absence of defects can be assessed).

Research methods are prescribed depending on the symptoms that appear and the doctor's suspicion of the extent of the spread of helminthiasis.

Treatment

Helminthiasisare treated with medication. Depending on the type of parasite, a course of treatment is developed using specificdewormermedicines. Many of them additionally strengthen the immune system. Along with specific treatment, patients take vitamin-mineral complexes and digestive enzymes. Maximum attention is paid to personal hygiene. In case of intestinal obstruction, emergency surgery is required.

In severe cases, it is not enough to use drugs to treat helminths. It is better to use products specifically targeted against a certain type of parasite:

• anticystaden;
• antinematodes;
• anti-trematodes;
• broad spectrum of action against various groups of parasites.

In addition to specific treatment, it is necessary to prescribe symptomatic drugs to eliminate manifestations caused by helminths:

• antibacterial drugs with additional complication of the condition by activated pathogenic microflora of the digestive tract;
• sorbents that envelop and remove the products of intoxication by helminths before they are absorbed into the systemic bloodstream;
• enzymes that improve the digestive process, especially if helminthiasis is complicated by diarrhea;
• probiotics - use is mandatory when using anthelmintic and antibacterial drugs to restore the normal state of the intestinal microflora;
• cardiac glycosides for complications of helminthiasis with cardiovascular pathologies;
• non-steroidal anti-inflammatory drugs to suppress an active inflammatory process due to the action of parasites;
• glucocorticosteroids prescribed to activate the immune system and develop acute allergic reactions.

Surgery is considered a last resort. Prescribed for complications. For example, when parasites move from the intestines to other organs.

Prevention

In order to prevent the penetration of helminths into the human body, it is recommended to perform the following actions:

• frequent washing of hands and food before consumption;
• maintaining basic personal hygiene;
• use of antiglycemic drugs for animals;
• heat treatment of meat and fish;
• preventive use of drugs against helminths, especially if characteristic symptoms appear or the patient is at risk.

Prevention methods reduce the risk of helminth infection, but cannot completely eliminate it. That is why doctors recommend periodically donating stool for analysis.

Forecast

The prognosis depends on the following factors:

• a type of parasite;
• area of distribution of helminths;
• degree of intoxication;
• complications for internal organs and systems.

Timely identified and treated parasitic infection guarantees a positive prognosis. If the therapy is carried out in the early stages, complications will not develop. If it is missing or prescribed incorrectly, pathologies begin to develop that worsen well-being. In severe cases, the abdominal and thoracic organs are damaged and the infection can spread all the way to the brain. Such pathologies worsen the quality of life and can cause incapacity. Possible death due to the development of anaphylactic shock and helminthiasis of the central nervous system. Therefore, in this case, timely diagnosis is important.