Angvillulosis, Cochin diarrhea or strongyloidiasis, the symptoms of which were first described by a French doctor in 1876, are mainly distributed in tropical and subtropical countries. However, it is also found in the southern regions of Russia, in the Transcaucasus, Ukraine, and Moldova. This is one of the few helminthic invasions that can exist for up to thirty years. For a long period, the disease can proceed 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 strongyloidiasis will be discussed in this article.
How is infection carried out?
The source of infection is man. He, along with faeces, also releases eggs of roundworms into the environment. The following infection mechanisms are known:
- Oral - by eating vegetables, fruits and berries contaminated with helminth eggs or drinking water.
- Autoinvasive - infection occurs directly inintestines.
- Percutaneous - the larvae enter the body of the individual through the dermis. In addition, their entry through the glands (sebaceous and sweat) is also possible. Infection in this way occurs during agricultural work, when walking barefoot on the ground or while relaxing on the grass.
Infection with the intestinal eel is quite rare in advanced economies, as they carefully control 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 research
Doctors recommend testing for strongyloidiasis in individuals who have been in contact with the patient or have been in areas with a tropical climate, and they have signs characteristic of this pathology. No special preparation is required for this analysis. The only condition is that at least four hours must pass after eating.
IgG class antibodies to strongyloids are formed several 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 persists throughout life. ELISA detects IgG class antibodies to the causative agent of the disease in venous blood. Thanks to the study, a current or past infestation with intestinal acne is diagnosed.
Diagnostic measures
Analysis for strongyloidiasis, the symptoms and treatment of which are described in the article, is carried out in specializedlaboratories, because it is necessary to count parasite larvae in faeces, 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 a biomaterial.
Complete blood count in most patients with angvillulosis 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, there is leukocytosis and an increase in ESR.
When examining chronic infection, serological tests are the most sensitive method, but they are rarely used in practice. In this case, the presence of antibodies to intestinal acne is detected. They appear when the individual's immune system comes into contact with filariform larvae. However, the use of such tests to monitor therapy is difficult, since antibodies do not disappear until six to twelve months after treatment.
The lab returns a result that says "positive", indicating the presence of the pathogen in the body, or "negative", indicating no infection and low levels of antibodies in the blood.
Pathogen
The cause of the disease is intestinal acne, or Strongyloides stercoralis (strongyloids). What are these parasites? These are the causative agents of strongyloidiasis, belonging 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 individual of the acne with an intestinal length of only 0.7 mm, and the female - 2.2 mm. Female individuals parasitize in the mucous membrane of the small intestine of the individual. In it they lay oval transparent eggs in which larvae mature. The latter penetrate into the blood and lymphatic vessels and with the blood flow enter the alveoli of the lungs, heart, bronchi, pulmonary arteries, trachea, and then into the oropharynx and again into the intestine. In the duodenum, their maturation is completed. Adult worms can survive in the gut for up to six years.
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 can lay up to fifty eggs per day. Non-invasive, or, in other words, rhabdite-like larvae are formed from them. They are excreted into the external environment through feces and, once in the ground, mature, turning into worms of both sexes. Fertilized and free-living in the ground, females lay eggs, from which rhabdite-like larvae emerge. Of these, some turn into filariform worms, while others turn back into sexually mature worms. The transformation of larvae into filariform is also possible in the intestines of the individual. This phenomenon is characteristic of low immunity and constipation.
In the body of an individual, only the female parasitizes, she breeds without the participation of the male, unlike freely moving individuals.
Clinical picture
From the penetration of the pathogen into the body and until the appearance of the firstsymptoms of strongyloidiasis lasts from three weeks to several years. In the initial stage of the disease, there are no specific signs. As the disease progresses, allergic reactions are observed, which are rather difficult. In adults and children, the main signs are the same:
- general intoxication of the body - headache, dizziness, chills, increased sweating, weakness;
- irritability;
- blood bilirubin is too high;
- increased body temperature;
- development of bronchitis, pneumonia;
- disorders of the digestive system - nausea, vomiting, diarrhea (there is mucus in the stool);
- enlarged liver.
Early phase of illness
In this phase, the symptoms of strongyloidiasis are manifested in the form of itchy rashes on the dermis, paroxysmal cough and an increase in eosinophils in the blood. A rash in the form of blisters of a pinkish-reddish hue is located on the back, thighs, buttocks, and abdomen. The area of the lesion increases with combing. After two or three days, the rash disappears, but may appear again. The development of pneumonia, acute allergic myocarditis and asthmatic bronchitis is not excluded. In addition, the individual is worried about headaches and muscle pain, increasedirritability and fatigue. Two or three weeks after the onset of allergic reactions occur:
- pain in the epigastric region;
- nausea;
- vomit;
- diarrhea.
The spleen and liver increase in size. The dermis and sclera become icteric.
Late phase disease
Depending on the predominant syndrome, the disease is conventionally divided into the following forms:
- Pulmonary - symptoms of strongyloidiasis are manifested by severe burning in the chest, shortness of breath, fever, dry cough, difficulty breathing, eosinophilia in the blood test.
- Skin - rashes around the waist, buttocks. In some cases, traces of migration (in the form of stripes) of larvae are visible.
- Cholecystic - pain in the abdomen and in the right hypochondrium, bitterness in the mouth, lack of appetite, belching, nausea.
- Digestive - the individual has symptoms characteristic of enterocolitis, ulcerative lesions of the duodenum and stomach, enteritis, gastritis. You may experience nausea, abdominal pain, constipation, or diarrhea.
- Nerve-allergic - persistent itching of the dermis, urticaria, irritability, joint and muscle pain, sweating.
- Mixed - with this form, the course of the disease is both severe, while the intestinal mucosa is exposed to ulcerative lesions, which can provoke peritonitis and necrotizing pancreatitis, and mild.
In individuals with immune suppression, the course of the disease is complicated by brain abscess, keratitis, hepatitis,encephalitis, pyelonephritis, conjunctivitis.
Disseminated strongyloidiasis: what is it?
This is a chronic course of the disease, occurring 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. Not only parasite larvae enter the bloodstream through the walls of the intestine, but also pathogenic bacteria (E. coli), which provokes the occurrence of sepsis. Spreading to different organs, microorganisms cause the development of a local infection (meningitis). In addition, not only the number of larvae, but also adult individuals of intestinal acne increases rather quickly in the bloodstream. The symptoms of strongyloidiasis in this case are as follows:
- bloating and pain in the abdomen;
- sepsis;
- neurological and pulmonary complications.
Possible death.
The increase in the number of parasites in the body of an individual after the initial infection can occur for several decades.
Therapy of disease
There are a large number of antiparasitic agents on the pharmaceutical market. Only a doctor can understand them and correctly prescribe the right treatment. If one of the family members has become infected, then everyone who lives with the patient must take medication, regardless of the presence or absence of characteristic symptoms.
Treatment of strongyloidiasis in humans is carried out in a hospital. One ofIvermectin is considered to be the most effective medicine used worldwide. It is taken for one to two days at a single dose of 200 mcg per kilogram of the individual's weight in acute and chronic course, and in disseminated the drug is used until the results of the study (sputum, stool) for the presence of larvae become negative. It is recommended to cancel immunosuppressants for the period of taking this medication (in agreement with the attending doctor). In addition, tools such as Albendazole and Thiabendazole have proven themselves well. The dose is 25 mg/kg, but it should not exceed 400 mg. Take morning and evening for seven days.
When treating strongyloidiasis, it should be remembered that the action of medicines is aimed at exterminating only adult parasites that have settled in the intestines. Therefore, to completely suppress the infection, a second course of therapy is prescribed, that is, after 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 were cases when pathogens did not disappear from the body even after treatment. Doctors advise regular courses of pharmacotherapy, especially for individuals with low immunity and those who, for he alth reasons, constantly take immunosuppressants, as these individuals are more susceptible to disseminated angvillulosis.
During the period of pronounced manifestation of allergy, which is observed at the stage of migration andis one of the symptoms of strongyloidiasis, treatment begins with detoxification measures - the removal of toxic substances from the body. For these purposes, infusion solutions are used. In addition, the patient is given antihistamines. When the signs of allergic manifestations decrease, they proceed to deworming using antiparasitic drugs, such as Albendazole or Thiabendazole.
Doctors warn patients that taking these drugs may, for some period of time, contribute to an increase in body temperature, a deterioration in the general condition. You should not be afraid of this, because this is a temporary phenomenon.
After two weeks after completion of therapy, diagnostic studies are done. Analyzes are taken three times with an interval of three days. An individual who has had such a disease is under dispensary observation for a year. The first six months of the survey is carried out monthly, and then quarterly. The doctor makes the decision to deregister based on the results of the tests.
Forecast and preventive measures
The main prevention of strongyloidiasis (the symptoms of the disease are described above) is reduced to the following activities:
- Identification and treatment of infected individuals.
- Sanitary improvement of settlements.
- Protection of land from fecal pollution.
And there is also a ban on:
- Drinking unboiled water from unknown sources.
- Eating unwashed fruits, vegetables and herbs.
- Use in vegetable gardens and orchards, as fertilizers,undisposed faeces.
- Working with the earth without protective gloves or mittens.
An important role is played by raising public awareness about the ways of infection, as well as about the symptoms and treatment of strongyloidiasis. What kind of ailment is this, everyone needs to know - from young to old.
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. Strongyloidiasis 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 "angvillulosis" is confirmed by laboratory tests. To do this, take feces for analysis. Treatment of strongyloidiasis, the symptoms of which are manifested by a malfunction of the biliary system and liver, diarrhea, and allergic reactions, is carried out with antiparasitic drugs.
