Diphyllobothriasis is a parasitic disease, accompanied by a predominant lesion of the digestive tract, as well as megaloblastic anemia. Its causative agent is a large tapeworm - wide tapeworm (D.latum), the length of which can reach up to 10 m, as well as more than 10 species of less studied tapeworms from the genus Diphyllobothrium.
Causes of disease
Infection of a person with diphyllobothriasis occurs when eating infested, insufficiently thermally processed or poorly s alted fish products, as well as when cutting fish and insufficiently processing dishes after it. Moreover, the entry of helminths into the human body occurs according to a long chain.
Method of spreading diphyllobothriasis
Tapeworm eggs mature in fresh water at a temperature of 10-20°C for about a month. Then embryos-coraditions are separated from them, which, in turn, are eaten by small crustaceans, for example, copepods. This is the first intermediate stage of infection, during which helminth larvae are formed - plerocercoids. Then the second stage occurs, when the freshwaterfish, such as pike, ruff, perch, burbot, trout, etc., eat crustaceans, and in its body the larvae complete their development to the stage of a sexually mature individual. And only after that, the helminth finds its final host and, accordingly, the source of invasion - a person, or, less often, a representative of fish-eating animals, for example, a pig, a fox, a bear, a seal, etc. It is in their bodies that the mature helminth already parasitizes, whose eggs are released during defecation and enter fresh water bodies with sewage, starting a new chain of infections.
A wide tapeworm parasitic in the intestine consists of several thousand segments (proglottids) containing eggs, and is firmly attached to the walls of the donor's small intestine with the help of two slits (bothria) located at its head end. And although the length of the parasite sometimes reaches 10 meters, it is not uncommon for several worms to coexist in one human body at once.
Geography of the spread of the disease
Human diphyllobothriasis is most common among residents of regions with a temperate cold climate, where the main food of the population is fish and its caviar. The disease occurs in European countries, especially Scandinavian, Japan, South America, Africa, USA, Canada, and Russia.
Pathogenesis and pathoanatomical picture diphyllobothriasis
Getting into the human body, a wide tapeworm has a pathogenic effect on it of a mechanical, toxic-allergic and neuro-reflex nature. First, thisinfringement of the intestinal mucosa by bothria when the helminth is attached to the walls. As a result, atrophy and necrosis of the mucosa occurs. Metabolic products of the parasite provoke autosensitization processes. Significant endogenous hypoavitaminosis of folic acid and vitamin B12 is observed, which, together with intoxication of the body with the parasite's waste products, provokes the development of megaloblastic anemia in 2% of cases. The duration of the invasion is up to ten years.
Symptoms of diphyllobothriasis
From 20 to 60 days - this is the incubation period that diphyllobothriasis has, the symptoms in a person begin to appear only after this period. It is during this period that helminths acquire sexually mature forms, attach to the walls of the intestine and begin to function. Diphyllobothriasis begins to manifest itself gradually. Attacks of nausea, belching and vomiting, bloating, epigastric pain, loss of appetite, impaired stools are all symptoms accompanying early diphyllobothriasis. A photo of a person with advanced diphyllobothriasis will invariably show him with marked pallor of the skin and mucous membranes, and the patient himself will suffer from fatigue, dizziness, weakness, abdominal pain, paresthesia, hepatosplenomegaly, achylia, tongue fissures (later the surface of the tongue becomes smooth).
There are tachycardia, hypotension, drowsiness, systolic murmurs at the apex, murmur of the top. Laboratory tests of the blood of a suspected infected patient show the following picture:reduced hemoglobin, low red blood cell count, increased direct bilirubin, high color index, neutropenia, leukocytosis, elevated ESR. The severity of anemia, as well as the severity of the course of the disease, is affected by the intensity of helminthic invasion, the presence of concomitant diseases, the general resistance of the body, the quality and quantity of food consumed.
For a severe form of diphyllobothriasis, funicular myelosis is characteristic, which is expressed by a violation of deep sensitivity, weakness of the legs, and unsharp paresthesias. In some patients, allergic rashes (urticaria) appear on the skin, the liver and spleen increase in size. In isolated cases, epileptoform (convulsive) seizures, numbness of the extremities, instability when walking were recorded. These are the serious symptoms of diphyllobothriasis, and the treatment of this disease should be started immediately after its diagnosis. Prolonged course of diphyllobothriasis causes intestinal obstruction.
But, it is worth noting that diphyllobothriasis, the symptoms of which consist of an impressive list of ailments, sometimes has an absolutely latent (asymptomatic) course of the disease, in which infection is detected only with the detection of fragments of the parasite in the feces.
Diagnostics of diphyllobothriasis
The basis for the diagnosis of "human diphyllobothriasis" are the patient's complaints and relevant laboratory data. Eosinophilia in the blood (with a recent invasion), as well as thrombocytopenia and leukopenia, increased sedimentation rate can serve as a suspicion of the disease.erythrocytes and hyperchromic anemia. Characteristic of the disease is the megaloblastic type of hematopoiesis. The analysis indicates a large number of young forms of erythrocytes (megaloblasts, normoblasts, polychromatophiles, poikilocytes, etc.). An important role in the diagnosis is played by the epidemiological history: the facts of the patient's stay in the endemic zone, eating raw freshwater fish or unders alted caviar. But the final analysis is made only when the analysis of the patient's feces shows the presence of eggs or segments of a wide tapeworm in it.
There are times when patients come in who have noticed fragments of the parasite in their own feces.
It is important not to confuse Addison-Birmer anemia and diphyllobothriasis, the symptoms of which are very similar. For this purpose, gastric contents are checked for the presence of the Castle factor, which is absent in anemia.
Diphyllobothriasis: treatment
If a patient is diagnosed with diphyllobothriasis, treatment is carried out immediately in a hospital. With severe anemia, before the start of procedures for removing the helminth, a course of vitamin therapy (B12, folic acid, iron) is prescribed. Vitamin B12 is administered as intramuscular injections of 200-500 mcg 2 or 3 times a week. The duration of vitamin therapy is 30 days.
For deworming, drugs such as Biltricid, Praziquantel, Niclosamide or Azinox are used. Also, the drug "Fenasal" can be used to remove the parasite. All drugs are takeninside orally and have a paralyzing helminth effect. As a result, the parasite loses its ability to stay inside the intestine and comes out. It is very important at the same time to make sure that the tape comes out completely. To achieve the final result, it is possible to cleanse the intestines with an enema.
The effectiveness of such drug treatment is about 95%, only in rare cases, complicated by intestinal obstruction, deworming is performed surgically. Patients diagnosed with diphyllobothriasis, whose treatment has successfully passed the stage of deworming, are transferred to dispensary observation with taking a stool sample monthly for six months.
Folk remedies
In folk medicine, pumpkin seeds and a decoction of them are traditionally used to expel helminths. Pumpkin seeds, raw or dried, are ground with water and honey and taken in an amount of 300 gr. on an empty stomach in portions for an hour. This method perfectly fights such a problem as human diphyllobothriasis. Testimonials about successful deworming with pumpkin seeds confirm the effectiveness of this method.
Diet, nutrition
During the treatment of diphyllobothriasis, the patient must adhere to a sparing diet that excludes foods that irritate the intestinal mucosa. It is advisable to include in the diet foods high in vitamin B12, as well as folic acid.
Features in children
Worm infestations by children are much more difficult to bear,symptoms of anemia and hypovitaminosis in young patients are more pronounced.
Prevention of diphyllobothriasis
If you are a lover of freshwater fish and live in the northern regions near water bodies, then in order not to fall for such an unpleasant disease as human diphyllobothriasis, its prevention should become your life rule No. 1.
In order to avoid infection with diphyllobothriasis, freshwater fish should only be eaten well-cooked or fried, as well as its caviar only high-quality s alted. It is necessary to strictly observe the rules of hygiene when cutting fish and preparing dishes from it.
You should know that when s alting fish, depending on the concentration of s alt, the larvae die only after 2-7 days. When caviar is s alted, helminth eggs die in half an hour at 10% mass fraction of table s alt relative to the weight of caviar. If s alt is 5%, then the product becomes safe for eating no earlier than after 6 hours, at 3% - no earlier than after two days.
Helminth larvae also die when deep frozen (in 2-4 days at a temperature of -18°C, a week later at a temperature of -6°C).
When making a diagnosis to a patient, it is imperative to examine all members of his family, since in this case they are at risk.
On a global scale, in order to minimize the likelihood of infection, the percentage of intermediate carriers in water bodies should be reduced by reducing or eliminating the discharge of faeces into lakes and rivers,ensuring sanitary control over this process, as well as over the general condition of the shores, beaches and fish products entering the food industry and store shelves. The occurrence of symptoms inherent in such a disease as diphyllobothriasis should be carefully monitored in medical institutions. Treatment, when the diagnosis is confirmed, should be started immediately and with a mandatory check of all family members for the presence of invasion.
Features in pregnant and lactating women
Worm infestation, namely, hypovitaminosis and anemia with it, pose a great danger both to the he alth of the expectant mother and to the development of the fetus. Pregnant women should be especially careful when eating fish and caviar. It is important not to miss the first signs of a disease such as diphyllobothriasis, symptoms that can easily be confused with the manifestation of toxicosis (preeclampsia), and urgently apply for a referral for a laboratory study of feces for the presence of helminthic eggs in it.
Treatment of the disease in pregnant women is carried out by a method that is safe for the he alth of the unborn child. So, for deworming, pregnant and breastfeeding women are not prescribed drugs such as "Biltricid", but use a safe folk remedy - pumpkin seeds. In some cases, breastfeeding with a diagnosis of human diphyllobothriasis is recommended to be treated by taking standard medications for diphyllobothriasis, and the baby is transferred to artificial feeding.
