Diphyllobotrioses

Diphyllobothriosis (Latin diphyllobothriosis: English diphyllobothriasis, fish tapeworm infection) - intestinal helminthiasis caused by tapeworms.

Characterized by a chronic course with a predominant violation of the activity of the gastrointestinal tract and the development of megaloblastic anemia.

[1], [2], [3], [4], [5], [6]

Epidemiology diffulobotriosis

The main source of contamination of the environment is man, a certain role can be played by domestic and wild animals that feed on fish. The mechanism of human infection is oral. Transmission factors - infested raw, under-salted or poorly heat-treated fish, as well as caviar. The incidence of diphyllobothriasis has a focal character. Often affects the adult population, especially engaged in fishing and fish processing. Diphyllobotrioses are prevalent mainly in the northern hemisphere: in the countries of northern Europe, the USA, and Canada.

[7], [8]

What causes diphyllobothriasis?

Human diphyllobothriasis is caused by a wide tapeworm (Diphyllobothrium latum) and a number of so-called small tapeworms (more than 10 types of difillobotriid).

D. Latite is referred to as Plathelminthes, class Cestoda, family Diphyllobothriidae. Lentz wide reaches a length of 10 m and more, on the scolex has two slit-shaped suckers, with which it is attached to the wall of the small intestine of the man . The body of the helminth consists of 3-4 thousand segments, the transverse size of which is larger than the longitudinal. In mature hermaphroditic segments, oval-shaped eggs are formed, covered with a yellowish-brown shell with a lid on one end.

The development of D. Latum occurs with the change of three hosts. The final owners are man, less often animals that feed on fish (cat, dog, bear, fox, etc.). Unlike the chains, the mature segments of the tapeworm do not detach from the strobila. Eggs are excreted in faeces and remain viable for 3–30 days, but continue to develop only when released into the water. In the water after 2-3 weeks coracidia leaves the egg, which is swallowed by the intermediate host. The development of the second larval stage, the procercoid, occurs in his body. The crustaceans containing invasive larvae swallows an additional host — a predatory (pike, perch, ruff, burbot) or a passive salmon fish (chum salmon, pink salmon) —in the intestines of which the crustaceans are digested, and the procercoids migrate to the muscles, spawn, liver and other organs, where they turn into plerocercoids (invasive stage for humans).

Pathogenesis of diphyllobotriosis

Lentetsy, attaching to the mucous membrane of the small intestine, infringe upon it with Bothria, ulcerating, necrotizing and atrophying the traumatized areas. With multiple invasions, helminths can cause intestinal obstruction. Eosinophilia and catarrhal phenomena in the mucous membrane in the early period of the disease are caused by sensitization of the organism to the helminth antigens. Endogenous hypo-and avitaminosis B ₁₂, and folic acid underlies the pathogenesis of diphyllobothriasis megaloblastic anemia. The helminth secretes a specific protein component (releasing factor). Violating the relationship of vitamin B ₁₂ and gastromucoprotein. As a result of long-term parasitization of the pathogen (up to 20 years), even one individual of the helminth, anemia acquires the features of pernicious and is accompanied by damage to the peripheral nerves and spinal cord.

[9], [10], [11]

Symptoms of diphyllobotriosis

Symptoms of diphyllobotriosis are often absent, or manifest as mild sensations of abdominal discomfort. However, in any clinical course, the discharge of large fragments of the helminth with feces is observed. When the manifest during the invasion there are such Symptoms diphyllobothriasis as abdominal pain, cramping in nature from time to time acquire, nausea, hypersalivation. Appetite is sometimes increased, but there is a loss of weight and decreased performance. With the development of anemia, fatigue, dizziness, palpitations are more pronounced. An early manifestation of anemia is glossitis, accompanied by burning of the tongue. In the future, there may be pain when eating due to the spread of inflammatory and dystrophic changes in the gums, mucous membrane of the cheeks, palate, pharynx and esophagus. In severe cases, an increase in the liver and spleen is observed. Neurological disorders in diphyllobothriasis: paresthesias, disturbance of the feeling of vibration, numbness, ataxia - occur more often than with true pernicious anemia, and may not be accompanied by signs of anemia. Later, the conduction along the side pillars is disturbed, spasticity, hyperreflexia appear; patients become irritable, depression may develop.

[12], [13], [14]

Complications of diphyllobotriosis

Diphyllobotriasis may be complicated by B ₁₂ - deficiency anemia, sometimes intestinal obstruction may develop.

[15]

Diagnosis of diphyllobotriosis

Diagnosis of diphyllobothriasis is based on clinical and epidemiological data (fish consumption, a combination of dyspeptic syndrome with signs of anemia), the detection of helminth eggs during coprooscopic examination or as a result of a study of fragments of strobila of helminth isolated during defecation.

In peripheral blood smears, aniso- and poikilocytosis, erythrocyte basophilic granularity (Jolly's corpuscles are often seen), reticulocytopenia, thrombocytopenia, and neutropenia are determined. Diphylobothriasis In ₁₂ -deficient anemia develops in about 2% of invasive D. Latum, in about 40% of patients the content of vitamin in serum is lowered. More often, hematological changes are recorded in elderly people.

[16], [17]

Differential diagnosis of diphyllobothriasis

Differential Diagnosis of diphyllobothriasis is carried out with other diseases accompanied by anemia (ankilostomidosis, trichocephalosis), hyperchromic and hemolytic anemias.

Indications for consulting other specialists

In severe anemia, hematologist consultation is indicated.

Treatment of diphyllobothriasis

Indications for hospitalization

Hospitalization is indicated for severe anemia.

[18], [19], [20], [21], [22], [23]

Drug treatment of diphyllobothriasis

Specific treatment of diphyllobotriasis is carried out with praziquantel or niclosamide (see Teniarhinz).

With severe anemia and serum cyanocobalamin level less than 100 pg / ml before deworming, treatment with cyanocobalamin at a dose of 200-400 mg / kg for 2-4 weeks is indicated.

[24], [25], [26],

Approximate periods of disability

Terms of disability set individually.

[27], [28],

Clinical examination

Diphyllobotriosis does not require medical examination. Control analyzes of feces for the presence of tapeworm eggs wide through a 1 and 3 months after anthelmintic treatment. If the passage of fragments of a tapeworm is resumed or helminth eggs are found in the feces, a repeated course of antiparasitic treatment is carried out.

[29], [30], [31], [32], [33], [34]

How to prevent diphyllobothriasis?

To prevent diphyllobothriasis, fish should be eaten after a thorough heat treatment or long-term salting (the latter also applies to caviar consumption). It is necessary to protect water bodies from contamination by human and animal feces, to carry out sanitary and educational work among the population of foci.

[35], [36]

Prognosis for diphyllobothriasis

Diphyllobotriasis with uncomplicated course has a favorable prognosis.

[37], [38], [39]