Fascioliasis: symptoms and treatment


Fascioliasis — is an extraintestinal helminthiasis caused by the pathological influence of the parasite on the liver parenchyma and bile ducts. Such an ailment belongs to the category of the most common helminthic invasions of the human body. The source of the disease is the causative agent, which may be a hepatic hepatic fluke or a giant fluke. In addition, clinicians identify several routes of infection with such a microorganism.

The symptomatology is dominated by nonspecific clinical manifestations, which are typical for the majority of liver pathologies. This includes soreness in the zone of the right hypochondrium, nausea, jaundice and an increase in the size of the affected organ.

The correct diagnosis can be made on the basis of data obtained during laboratory-instrumental examinations of the patient. In the treatment of the disease, conservative techniques predominate, but if necessary, surgical intervention is performed.

Etiology

Two microorganisms can be the causative agent of fascioliasis of a person — a hepatic and a giant fluke. They belong to the same subspecies, since they have a large number of common morphological characters. In addition, they can mate with each other. Their main difference is the volume — the hepatic fluke in length is up to three centimeters, and in width to 1.3 cm, and the giant reaches eight centimeters in length and twelve millimeters in width.

The carriers are agricultural livestock, but only herbivorous group. It parasitizes fasciolae in the hepatobiliary system, in which helminths lay eggs, and they, in turn, enter the environment together with faeces of the animal, and further development is carried out in fresh water.

The ways of infection with fascioliasis are as follows:


  • consumption of food for seeded wild plants — here you can include sorrel and cress-salad, vegetable greens and wild onions
  • the use of raw water from dubious water bodies
  • poor sanitation of vegetable greens and vegetables
  • eating edible liver of an animal — while entering the intestine of a person transient eggs, which do not provoke the development of the disease, but are detected during laboratory studies of stools
  • accidental ingress of contaminated water into the mouth during bathing

In all cases, except for the latter, the pathogens of the pathogen are released from their membranes in the digestive tract, after which they enter the peritoneum through the intestinal wall. Then fasciola is introduced into the parenchyma of the liver and penetrates the bile ducts. Another way of migration of such a microorganism is possible-hematogenous, that is, with the flow of blood.

About four months after ingestion, the fasciolae reach puberty and can lay eggs. Terms of parasitism can vary from five to ten years or more.

Classification

Gastroenterologists distinguish several stages of the progression of fascioliasis in humans, namely:


  1. incubation phase — this is the period from the moment of ingestion of fasciolae to the appearance of the first symptomatology. This period can last from several days to three months. Duration depends on such factors — the number of swallowed microorganisms and the state of the human immune system
  2. invasive or acute — is expressed in the migration of the causative agent of the bile duct disease
  3. latent or latent — lasts from two months to several years and is characterized by an asymptomatic course. In such cases, the course of the disease can be detected only during laboratory studies of stool or blood, as well as during the passage of ultrasound. Such interventions can be used to diagnose a completely different ailment or as a preventive measure
  4. Chronic — differs in undulating course and high probability of severe complications

Localization of fascioliasis can occur not only in the liver and bile ducts, very rarely fasciolae affect:


  • the brain;
  • lungs
  • Vision organs
  • Eustachian tubes
  • Larynx.

Symptoms

Based on the phase in which the disease occurs, its clinical picture will differ.

The first symptoms of fascioliasis, manifested in the migration phase, are characterized as follows:


  1. increase in temperature to fever
  2. general weakness and malaise
  3. intense headaches;
  4. the appearance of rashes by the type of urticaria
  5. hepatomegaly
  6. severe itching.

In the invasive phase of the disease, in addition to the above signs, the following clinical manifestations are observed:


  • pain in the epigastric region and in the zone under the right ribs
  • icterus of skin and visible mucous membranes
  • increase in temperature to 40-42 degrees;
  • persistent nausea;
  • Decrease or total absence of appetite
  • violation of the act of defecation, which is expressed in severe diarrhea;
  • increased gas formation;
  • coughing and hemoptysis
  • dyspnea and a feeling of pain in the sternum;
  • Hepatosplenomegaly is a condition in which a simultaneous increase in the liver and spleen is observed
  • abdominal dropsy
  • Anemia.

For the chronic course, during the stage of exacerbation, the most typical symptoms are:


  1. blood pressure fluctuations from normal to high values ​​
  2. heart rate disorder
  3. paroxysmal pain in the right side
  4. permanent gravity in the projection of the affected organ
  5. Biliary colic
  6. aversion to fatty foods
  7. nausea;
  8. dizziness;
  9. jaundice

Very rarely, fascioliasis is localized in the eyeball — there will be monocular blindness.

Diagnostics

When the first signs appear, you need to seek help from a therapist or gastroenterologist as soon as possible. Such specialists can perform a primary examination, prescribe laboratory and instrumental examinations, based on the results of which they will correctly diagnose and make the most effective tactic of treatment of fascioliasis in humans.

The first stage of diagnostic activities is aimed at the doctor’s work with the patient and includes:






  • studying the patient’s life history — will identify the most likely path of infection with fasciolae
  • A thorough physical examination of the patient, including palpation of the anterior wall of the abdominal cavity, particularly in the right hypochondrium, examination of the skin condition, and also measurement of pressure, pulse and temperature;
  • a detailed interview of the patient — is necessary to determine the onset of manifestation and intensity of the severity of the symptoms of the disease. This will enable the specialist to determine the phase of the disease.

Laboratory diagnosis of fascioliasis involves the exercise:


  1. a clinical and biochemical blood test — to detect anemia and signs of a pathological process
  2. general urine analysis
  3. microscopic studies of fecal matter — in the feces you can detect the eggs of the pathogen
  4. determining the level of ALT and AST, as well as alkaline phosphatase
  5. serological methods — RPHA and ELISA
  6. study of duodenal contents.

In addition, it will be necessary to perform instrumental examinations of the patient, which suggest carrying out:


  • Ultrasound of the abdominal cavity;
  • CT of the liver;
  • MRI.

Fascioliasis must be differentiated from such ailments:

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  1. opisthorchiasis
  2. viral hepatitis
  3. clonorhoz
  4. pancreatitis
  5. cholecystitis of unknown etiology
  6. cholangitis.

Treatment

To neutralize the causative agent of the disease, conservative therapies are often enough, including:


  • taking medications;
  • adherence to a gentle diet
  • physiotherapy procedures
  • the use of folk remedies — only after the approval of the attending physician.

The pharmacological treatment of fascioliasis is aimed at using:


  1. antiparasitic and antibacterial agents — the duration of therapy and the daily norm is calculated on an individual basis for each patient
  2. glucocorticosteroids;
  3. antipyretics
  4. antihistamines;
  5. Proton pump blockers — with severe pain in the stomach
  6. sorbents and enzymes;
  7. antispasmodics
  8. Cholagogue preparations
  9. Special solutions for the reduction of dehydration, which can develop against persistent vomiting or diarrhea

After three months and six months from the beginning of antiparasitic therapy, a control parasitological examination is carried out, including the study of feces for the presence of helminth eggs and duodenal sounding.

The general treatment program necessarily includes adherence to a diet. Dietotherapy involves a complete rejection of:


  • fatty and spicy dishes
  • flour and confectionery products
  • seafood and offal
  • smoked products and pickles
  • Liquor.

At the same time, the basis of the diet should be:


  1. Vegetarian First Dishes
  2. Dietary types of fish and meat
  3. porridges cooked on a water basis. Particular preference is given to buckwheat and rice;
  4. fermented milk products
  5. Vegetables, after they undergo thermal treatment
  6. baked fruit
  7. Green or herbal tea.

All recommendations concerning nutrition are provided by the gastroenterologist.

If the conservative treatment is ineffective, as well as in the development of complications, surgical intervention is indicated, which can be directed to the drainage of the bile ducts or liver abscess.

Possible complications

Fascioliasis is a rather dangerous disease that very often leads to the development of such complications:


  • blockage of the bile ducts
  • formation of concrements in the gallbladder
  • liver cirrhosis
  • mechanical jaundice as a consequence of obstruction of the bile ducts
  • dyskinesia of the gallbladder
  • Anemia
  • joining a secondary infection — significantly reduces the chances of recovery;
  • chronic form of pancreatitis
  • Purulent cholangitis or cholecystitis
  • portal hypertension
  • formation of liver abscess
  • allergic myocarditis
  • hepatitis
  • strictures of the biliary tract.

Prevention

To prevent the development of such a disease, the prevention of fascioliasis includes:


  1. exclude the use of raw water from dubious water bodies
  2. control that the vegetable greens are thoroughly washed with purified water
  3. timely screening and de-worming of cattle
  4. Regular visits to the gastroenterologist for a preventive examination

Timely diagnosis and therapy of the disease makes it possible to achieve full recovery of the patient. Ignoring symptoms and reluctance to seek qualified help can lead to complications that can lead to death.