Anguillulosis, Cochin's diarrhea or strongyloidosis, the symptoms of which were first described by a French doctor in 1876, are mainly common in tropical and subtropical countries. However, it is also found in the southern regions of Russia, in the Caucasus, Ukraine, and Moldova. This is one of the few helminth infections that can last up to thirty years. Over a long period, the disease can occur without any signs, but at the same time, with a decrease in immunity, it provokes conditions that threaten the life of the individual. Diagnosis, causes and symptoms of strongyloidosis will be discussed in this article.
How is infection infected?
The source of infection is a person. Together with feces, it secretes roundworm eggs into the environment. The following infection mechanisms are known:
- Oral - when eating vegetables, fruits and berries, or drinking water, seeded with helminth eggs.
- Autoinvasive - infection occurs directly in the intestine.
- Percutant - the larvae penetrate the individual through the dermis. In addition, their entry through the glands (sebaceous and sweaty) is also possible. Infection in this way occurs during agricultural work, when walking barefoot on the ground or while resting on the grass.
Acne poisoning is quite rare in advanced economies, as they carefully monitor the condition of the soil and water. There is information that from thirty to one hundred million people, living mainly in subtropical and tropical latitudes, are infected with angvillulosis.
Indications for the study
Doctors recommend testing for strongyloidosis to individuals who have been in contact with the patient or who have been in areas with a tropical climate, and they have signs characteristic of this pathology. Special preparation for this analysis is not required. The only condition is that at least four hours should pass after eating.
IgG antibodies to strongyloids are formed a few weeks after infection. In the acute period of the disease, the number of antibodies is maximum. Further, their level decreases. However, a low titer of immunoglobulin G is maintained throughout life. Using ELISA, IgG antibodies to the causative agent of the disease in venous blood are detected. Thanks to the study, current or previous invasion of intestinal acne is diagnosed.
Diagnostic measures
Strongyloidosis analysis, the symptoms and treatment of which are described in the article, is carried out in specialized laboratories, because it is necessary to count in the feces of the larvae of the parasite, and not eggs, as is done when other intestinal diseases are detected. The effectiveness of a single study of feces does not exceed fifty percent. Urine and sputum can also be used as biomaterial.
A general blood test in most patients with anguillosis is manifested by eosinophilia, that is, the level of these blood cells increases from six to fifteen percent. However, against the background of taking immunosuppressants, this phenomenon is not observed. In addition, leukocytosis and an increase in ESR are noted.
In the study of chronic infection, the most sensitive method is serological tests, but in practice they are rarely used. In this case, the presence of antibodies to intestinal acne is detected. They appear upon contact of an individual’s immune system with filar larvae. However, the use of such tests to control therapy is difficult, because antibodies disappear no earlier than six to twelve months after cure.
The laboratory produces a result that indicates “positive”, which indicates the presence of a pathogen in the body, or “negative”, which indicates the absence of infection and a low level of antibodies in the blood.
Causative agent of the disease
The cause of the disease is intestinal cinnamon, or Strongyloides stercoralis (strongyloids). What are these parasites? These are the causative agents of strongyloidosis, related to the type of roundworms. The specificity of this nematode is that it goes through the entire life cycle without leaving the host. The male species of eutrophy has an intestinal length of only 0.7 mm, and the female - 2.2 mm. Females parasitize in the mucous membrane of the individual’s small intestine. In it, they lay oval transparent eggs in which the larvae mature. The latter penetrate into the blood and lymph vessels and enter the alveoli of the lungs, heart, bronchi, pulmonary arteries, trachea, and then into the oropharynx and again into the intestine with blood flow. In the duodenum, their maturation is completed. Adult worms can survive in the intestines for up to six years.
The parasitic generation - female and male individuals, they are in the duodenum, and with massive infection - in the entire small intestine, as well as the pyloric stomach. A fertilized female per day can lay up to fifty eggs. Non-invasive, or, in another way, rhabditoid larvae are formed from them. They are secreted into the environment through feces and, once in the ground, mature, turning into worms of both sexes. Fertilized and free-living females in the earth lay eggs, from which rhabditoid larvae emerge. Of these, some turn into filariform ones, and others again into mature worms. Transformation of larvae into filariform ones is also possible in the intestines of an individual. This phenomenon is characteristic of low immunity and constipation.
In the body of an individual, only the female is parasitic; she reproduces without the participation of the male, unlike free-moving individuals.
Clinical picture
From the penetration of the pathogen into the body and until the appearance of the first symptoms of strongyloidosis, it takes from three weeks to several years. In the initial stage of the disease, specific symptoms are absent. As the disease progresses, allergic reactions are observed, proceeding quite severely. In adults and children, the main signs are the same:
- general intoxication of the body - headache, dizziness, chills, increased sweating, weakness;
- irritability;
- bilirubin in the blood is too high;
- increase in body temperature;
- the development of bronchitis, pneumonia;
- digestive system disorders - nausea, vomiting, diarrhea (there is mucus in the bowel movements);
- enlarged liver.
Depending on the severity of clinical signs, the course of angvululosis occurs: asymptomatic - observed in individuals who live in endemic areas, as well as manifest - distinguish between early or migratory, as well as chronic or late stages.
Early phase of the disease
In this phase, the symptoms of strongyloidosis are manifested in the form of itchy rashes on the dermis, paroxysmal coughing and an increase in eosinophils in the blood. A rash in the form of blisters of a pinkish-red hue is located on the back, hips, buttocks, stomach. The area of damage increases with combing. After two or three days, the rashes disappear, but may appear again. The development of pneumonia, acute allergic myocarditis and asthmatic bronchitis is not ruled out. In addition, the individual is concerned about headaches and muscle pain, increased irritability and fatigue. Two or three weeks after the onset of allergic reactions occur:
- epigastric pain;
- nausea;
- vomiting
- diarrhea.
The spleen and liver increase in size. Dermis and sclera become icteric.
Late phase of the disease
Depending on the prevailing syndrome, the disease is conditionally divided into the following forms:
- Pulmonary - the symptoms of strongyloidosis are manifested by severe burning in the chest area, shortness of breath, fever, dry cough, difficulty breathing, eosinophilia in the blood test.
- Cutaneous - rashes in the area of the waist, buttocks. In some cases, traces of migration (in the form of stripes) of larvae are visible.
- Gallbladder - pain in the abdomen and in the right hypochondrium, bitterness in the oral cavity, lack of appetite, belching, nausea.
- Digestive - the individual has symptoms characteristic of enterocolitis, peptic ulcer of the duodenum and stomach, enteritis, gastritis. Nausea, abdominal pain, constipation, or diarrhea are possible.
- Neuro-allergic - persistent itching of the dermis, urticaria, irritability, joint and muscle pain, sweating.
- Mixed - in this form, the course of the disease can be both severe, while the intestinal mucosa undergoes a peptic ulcer, which can provoke peritonitis and necrotic pancreatitis, as well as mild.
In individuals with immune suppression, the course of the disease is complicated by a brain abscess, keratitis, hepatitis, encephalitis, pyelonephritis, conjunctivitis.
Disseminated strongyloidosis: what is it?
This is a chronic course of the disease that occurs against the background of a weakened immune system as a result of taking immunosuppressants, corticosteroids or pathology - tuberculosis, aplastic anemia, diabetes, tertiary syphilis and others. Through the intestinal walls, not only the parasite larvae enter the bloodstream, but also pathogenic bacteria (E. coli), which provokes the occurrence of sepsis. Spreading to different organs, microorganisms become the cause of the development of local infection (meningitis). In addition, not only the number of larvae, but also adults of intestinal acne cinemas increases quite rapidly in the bloodstream. Symptoms of strongyloidosis in this case are as follows:
- bloating and pain in the abdomen;
- sepsis;
- neurological and pulmonary complications.
Lethal outcome is possible.
An increase in the number of parasites in the body of an individual after primary infection can occur over several decades.
Disease therapy
There are a large number of antiparasitic agents on the pharmaceutical market. Only a doctor can understand them and correctly prescribe the correct treatment. If one of the family members becomes infected, then everyone who lives with the patient should take the medicine, regardless of the presence or absence of characteristic symptoms.
Treatment of strongyloidosis in humans is carried out in a hospital. One of the most effective medicines used around the world is Ivermectin. It is taken for one to two days in a single dose of 200 micrograms per kilogram of the individual’s weight in acute and chronic course, and in case of disseminated preparation they are used until the results of the study (sputum, stool) for larvae become negative. It is recommended for the period of taking this medication to cancel (in agreement with the treating doctor) immunosuppressants. In addition, such products as Albendazole and Tiabendazole have proven themselves well. The dose is 25 mg / kg, but it should not exceed 400 mg. Accepted in the morning and evening for seven days.
When treating a disease of strongyloidosis, it should be remembered that the effect of drugs is aimed at the extermination of only adult parasites that have settled in the intestine. Therefore, to completely suppress the infection, a second course of therapy is prescribed, i.e., in two weeks, when the larvae turn into full-fledged individuals. In some cases, several more courses of medication are required to get rid of all the larvae.
In medical practice, there have been cases when pathogens did not disappear from the body even after treatment. Doctors advise regular pharmacotherapy courses, especially for individuals with low immunity and those who are constantly taking immunosuppressants for health reasons, as these individuals are more prone to disseminated angiululosis.
During the period of severe manifestation of allergies, which is observed at the stage of migration and is one of the symptoms of strongyloidosis, treatment begins with detoxification measures - elimination of toxic substances from the body. For these purposes, use infusion solutions. In addition, the patient is given antihistamines. When the signs of allergic manifestations are reduced, they proceed to deworming using antiparasitic drugs, such as Albendazole or Tiabendazole.
Doctors warn patients that taking these medications can, for some period of time, contribute to an increase in body temperature or a deterioration in general condition. This is not worth fearing, because this is a temporary phenomenon.
Two weeks after completion of therapy, diagnostic tests are done. Analyzes are taken three times with an interval of three days. An individual who has undergone such a disease is under medical observation for a year. The first six months of the examination are carried out monthly, and then quarterly. The doctor takes the decision to deregister based on the results of the tests.
Forecast and preventive measures
The main prevention of strongyloidosis (the symptoms of the disease are described above) boils down to the following measures:
- Identification and treatment of infected individuals.
- Sanitary improvement of settlements.
- Protection of the earth from faecal pollution.
There is also a ban on:
- Drinking unboiled water from unknown sources.
- Eating unwashed fruits, vegetables and herbs.
- Use in gardens and gardens, as fertilizers, uncontaminated feces.
- Work with the ground without protective gloves or gloves.
An important role is played by raising public awareness of infection routes, as well as the symptoms and treatment of strongyloidosis. What kind of ailment is it, everyone needs to know - from small to large.
In most cases, the disease is completely curable, but rehabilitation is needed for a long time. It is primarily aimed at restoring the activity of the digestive tract. If during the disease internal organs were affected, then a fatal outcome is possible in 60-80% of cases. Strongyloidosis belongs to the group of neglected tropical ailments. In all countries of the world, efforts are aimed at eradicating this infection.
Conclusion
The diagnosis of angvululosis is confirmed by laboratory tests. For this, they pass feces for analysis. Treatment of strongyloidosis, the symptoms of which are manifested by a malfunction of the biliary system and liver, diarrhea, as well as allergic reactions, is carried out with antiparasitic medicines.