Infectious diseases occupy an important place among all human diseases. Helminthiases, ailments caused by worms, occupy a special place among them. One of these diseases is diphyllobothriasis of fish.
What it is
Diphyllobothriasis is an infectious disease caused by a worm from the group of cestodoses. The causative agent is Difilobottrium Latum, a roundworm. This disease is widespread in the Russian Federation; diphyllobothriasis of fish is registered in Karelia and the Murmansk region, such rivers as Indigirka, Pechora, Severnaya Dvina and Volga. The disease is prevalent mainly in cold areas. In countries of northern Europe is less common; imported cases prevail.
Fish diphyllobothriasis causes a wide ribbon. The worm parasitizes in the small intestine. Parasite eggs enter the environment along with feces and feces. Under optimal conditions (temperature up to 20 degrees), the larva leaves the egg. It is swallowed by small crustaceans - cyclops living in the water. It is in these crustaceans that the second stage of the development of the parasite, coracidia, takes place. After a crustacean is eaten by a fish living in water, a plerocercoid develops from the larva - its next stage. A person is struck by it when eating infected fish.
It was mentioned above that the main product from which diphyllobotriosis can develop is fish. Which fish is most often infected with tape? Usually affected are species such as catfish, burbot, perch, ruff, pike perch. In addition to fish, the pathogen can also be found in the meat of animals such as seals and walruses.
How does infection happen?
Diphyllobothriasis is a disease that does not manifest itself in the initial period. As mentioned above, a person becomes infected by eating infected fish. Outwardly, it does not differ from normal, therefore, it is impossible to visually determine the presence of the pathogen. Mostly river fish are infected. The worm larvae are so small that they can only be seen under a microscope.
In order for infection to occur, only one larva is sufficient. In the human intestines, worms develop in about two weeks. Clinical manifestations are expressed after the same time. Most often, fishermen, sailors, land lovers are amazed.
Fish diphyllobothriasis can also occur in domestic animals, but human infection from them is extremely rare.
People who are not connected with the listed professions or hobbies can also become infected. It all depends on how well the fish is cooked. Subject to temperature conditions, the larvae die, and the fish becomes safe to eat.
Pathogenesis of the disease
How does diphyllobothriasis of fish affect the human body? Typically, one or more broad tapeworm worms can develop in the human body, but cases of parasitization in humans of 100 or more parasite individuals have been described. Worms can live in the body for a long enough time - up to 20 years or more, while parts of its body gradually come out with feces.
Ribbon has the following effects on the human body:
- mechanical;
- neuro-reflex;
- toxic and allergic.
As mentioned, the pathogen parasitizes in the intestines. It is attached to the mucous membrane, due to which a zone of atrophy and ulceration is formed at the site of development. As a result of neuro-reflex exposure, irritation of the sensory endings of the adjacent organs occurs, which damages the function of the stomach and liver. In addition, the causative agent causes the development of megaloblastic anemia, which is based on vitamin deficiency of vitamin B12 and folic acid.
Clinic of the disease
The clinical picture depends on the degree of development of the process, the massiveness of the lesion, and the characteristics of the patient's body. Quite often, diphyllobothriasis in fish is asymptomatic. In some cases, it is possible to identify in the feces part of the worm, which provokes the development of complaints from the patient, such as abdominal pain, rumbling, burping, etc. With a significant lesion, pathological changes in the digestive system play an important role.
Patients complain of decreased appetite, vomiting, impaired stool, decreased activity, weakness. Allergic phenomena, such as urticaria, blisters, may appear on the skin.
The circulatory system in this disease also suffers, which is expressed in the form of B12-deficient anemia.
Involvement in the pathological process of the nervous system leads to the appearance of numbness, burning, tingling, and a change in the sensitivity of various parts of the body.
Fish diphyllobothriasis: diagnosis
First of all, for making a diagnosis, it is necessary to collect an epidemic history, to find out if the patient has recently visited areas endemic for this disease and areas, whether he ate raw fish or caviar.
Particular attention should be paid to the testimony of patients. Patients may complain about the allocation of parts of the worm along with bowel movements. Particular attention should be paid to the microscopic examination of feces. The diagnosis is established when a wide ribbon is found in it. Among additional studies, sigmoidoscopy can be performed, which will allow the naked eye to see changes in the intestinal mucosa, and in some cases the parasite itself.
Sometimes it is legitimate to conduct microscopy, which allows you to detect diphyllobothriasis (photos in the fish of the pathogen are available in the literature).
An additional method of research is a general blood test. For diphyllobothriasis, an increase in leukocytes, ESR, eosinophils will be characteristic.
To clarify the diagnosis, a serological examination is necessary .
Treatment
In order to start treatment, it is necessary to confirm the diagnosis of diphyllobothriasis. Such preparations as Fenasal, a decoction of pumpkin seeds, and extract of male fern are used directly to expel a worm from the body.
To correct disorders of the blood system, the use of vitamin B12 is shown at 200-500 micrograms intramuscularly several times a week. Iron preparations are also prescribed - Ferronal, Aktiferrin, Ferropleks. To correct hemodynamic disturbances, it is necessary to establish an intravenous infusion of saline solutions - Acesol, Trisol, Lactasol.
Enema, which helps cleanse the intestines and speedy removal of the pathogen from the body, will also be useful.
If there are significant lesions of the nervous system that diphyllobotriosis of fish has led to, treatment, in addition to the use of drug support, should include physiotherapeutic methods.
The therapy is carried out for two weeks in a hospital. After this period, a control study of feces is carried out. The absence of helminth eggs in it indicates a successful outcome of treatment.
Disease complications
With untimely treatment, diphyllobothriasis of fish can be complicated by intestinal perforation. This condition requires emergency surgery.
Peritonitis often develops as a result of intestinal perforation. The presence of a worm in the intestines interferes with normal digestion. Because of this, the human body does not receive the necessary nutrients, which leads to the development of exhaustion.
Another equally important condition is immunodeficiency. Usually in the treatment of the underlying disease, it disappears on its own. However, if the process is started, severe immunodeficiency may develop with the addition of an opportunistic infection.
Severe anemia can often lead to disturbances in the functioning of the organs of the circulatory system, interfere with normal blood circulation and tissue metabolism, which is fraught with the development of organ dysfunctions.
In children, the disease can be complicated by febrile syndrome, which can lead to the development of epilepsy.
Prevention of diphyllobothriasis
Diphyllobothriasis is a disease of the type of zoonosis, therefore, the prevention of the development of this disease should take into account the endemic characteristics and environmental features. Preventive measures should affect both the transmission of the pathogen and its natural sources. First of all, it is necessary to carefully identify all carriers of this infection, since they provoke an increase in the number of patients. Fishermen and sailors must be examined for this disease.
If there are pets in the family, they should be examined. Destruction of the natural source of infection consists in cleaning up water bodies, as well as controlling fish that enter stores.
The main role in prevention is given to the sanitary service. It is the main organ that prevents the diphyllobotriosis of fish from spreading. A sanitary assessment of fish entering stores and counters is set by representatives of this organization. In addition, the local therapists, who are required to conduct educational work among the population, also play a partial role in the prevention of this disease.
A good effect has social advertising. Sometimes, such an impact on the consciousness of people is a more powerful stimulant to action.
What should be done if you develop this disease?
Surely most people are not even aware of the existence of a disease such as diphyllobothriasis. What is it and how to treat it, only doctors know best of all.
The incubation period of the disease is quite long, so people can not always associate the development of the symptoms that they have with eating fish.
Most often, they pay attention to feces, in which particles of the worm are detected. This is what makes them seek help from a doctor.
If you suspect the development of diphyllobothriasis, in no case should not hesitate. It is best to immediately consult an infectious disease specialist. It is he who can establish what disease you have developed, prescribe appropriate research methods and draw up a competent treatment plan.
In no case should you try to cure the disease yourself. Such measures can only worsen one's own condition. If there is such a situation that for some reason the infectious disease specialist cannot help, it is best to seek the help of a therapist.