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Opisthorchiasis: symptoms
Last reviewed: 23.04.2024
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The incubation period for opisthorchiasis is 2-6 weeks after eating the affected fish. Symptoms of opisthorchiasis are characterized by polymorphism.
There is no unified classification of opisthorchiasis. Isolate an acute phase of invasion, which can be asymptomatic or erased in the native inhabitants of endemic regions during reinfusion or superinfection. The clinically pronounced form of the acute phase is observed in individuals arriving in an endemic region. Chronic phase of the disease in the absence of symptoms of the acute phase is regarded as primary chronic: if it is preceded by an acute phase - as a secondary chronic. Organ damage (biliary tract, pancreas, stomach and duodenum) can persist even after the release of the body from opisthorchia, so some authors identify the residual phase of the disease.
The acute phase with asymptomatic infestation is diagnosed in parasite eggs found in duodenal contents and feces, for minor eosinophilia and elevated IgM content.
A grated form, in addition to these criteria, characterizes short-term subfebrile condition.
Clinically pronounced form manifests a sudden fever, pain in the right hypochondrium, myalgia, arthralgia, rashes on the skin. An increase in the spleen and liver, leukocytosis and hypereosinophilia of the blood.
With a mild form of fever (about 38 ° C) lasts up to 2 weeks, abdominal pain is undefined localization, diarrhea, mild leukocytosis and eosinophilia.
The medium-heavy form of opisthorchiasis is characterized by fever (38-39.5 ° C) of remitting, permanent or irregular type lasting up to 3 weeks, urticaria on the skin, myalgia and arthralgia, pain in the right hypochondrium, in some cases - moderate diarrhea and vomiting. The liver and spleen are enlarged; possible asthmatic bronchitis.
The severe course of opisthorchiasis is characterized by high fever, marked intoxication (headache, insomnia, inhibition or agitation, tachycardia), polymorphous skin rashes. The picture of hepatitis is expressed: pain in the right hypochondrium, enlargement of the liver, jaundice, increased bilirubin level, increased activity of aminotransferases and alkaline phosphatase. A part of patients develop erosive-ulcerative gastroduodenitis with severe pain in the epigastric region, nausea, vomiting, flatulence, diarrhea. Possible pain in the chest, shortness of breath, cough, flying infiltrates in the lungs. There are cases of myocarditis. Characterized by hyperleukocytosis (20-60x10 9 / l). Eosinophilia in the range of 10 to 80-90%, an increase in ESR.
Symptoms of opisthorchiasis in the acute phase last from 2-3 weeks to 2 months, after which the clinical signs subsided and the disease passes into the chronic phase, the signs of which appear after several months and even years and are characterized by significant polymorphism.
The defeat of the hepatobiliary system is most often observed. Patients note severity in the right hypochondrium and epigastric region, deterioration of appetite, nausea, vomiting, diarrhea. The liver is slightly enlarged, sensitive at palpation, dense. Functional indicators are usually unchanged. The gallbladder is enlarged, the point of the gallbladder is painful; possible attacks of colic pain. With duodenal probing, the amount of bile is increased, the content of leukocytes in it is increased.
When the pancreas is damaged, shingles are noted. Possible development of chronic gastritis, gastroduodenitis, ulcerative lesions of the mucous membrane of the stomach and duodenum.
Patients often suffer from headache, dizziness, insomnia; there is depression.
The acute stage of the disease lasts up to two months, after which the clinical symptoms of opisthorchiasis gradually disappear, and the disease passes into a chronic stage, characterized by a variety of clinical manifestations, which often develop only after a few years. In some patients, opisthorchiasis can be manifested only by the symptoms of cholangitis and cholecystitis, in others by signs of a deficiency of digestive enzymes, in others by general toxic and allergic lesions.
Most often, the chronic stage of the disease manifests itself as symptoms of damage to the hepatobiliary system. Patients complain of a feeling of heaviness, raspiraniya in the epigastric region and right hypochondrium, sometimes with irradiation in the back and left hypochondrium. Appetite is reduced, nausea, vomiting, diarrheal disorders are not uncommon. In most patients, the liver is slightly enlarged and compacted, moderately painful on palpation. However, biochemical indicators of liver function are often within normal limits. The gallbladder is enlarged, with painful pain. In patients with hypertensive and hyperkinetic types of biliary dyskinesia, bile duct syndrome is often expressed, the size of the gallbladder is not increased. Body temperature, as a rule, does not increase. During duodenal sounding, it is difficult to obtain a reflex from the gallbladder. The amount of bile, especially portion "B", is increased. With a microscopic examination of bile, leukocytes and epithelial cells are found. Methods of cholecystography and ultrasound often determine dyskinesia of the biliary tract and gallbladder.
When the pancreas is affected, shingles develop pain with irradiation to the left half of the thorax, back, left shoulder. Periodically on an empty stomach appears hyperglycemia and decreases the content of digestive enzymes.
In patients with chronic opisthorchiasis, the functions of the stomach and duodenum of the secretory and enzymatic character are often violated; develop chronic gastritis, duodenitis, gastroduodenitis, up to the formation of ulcers. Due to damage to the central nervous system, headache, dizziness, sleep disturbances, emotional imbalance, depression, irritability, frequent mood changes, paresthesia, increased sweating.
In chronic opisthorchiasis, in a number of cases, cardiovascular damage can occur, manifested by pains or unpleasant sensations behind the sternum, palpitations. The boundaries of the heart can be expanded, the tones are muffled, tachycardia arises, arterial hypotension. On the ECG, diffuse dystrophic changes in the myocardium are detected.
Often, the course of opisthorchiasis is complicated by the attachment of a secondary infection of bile ducts. In patients, the body temperature rises, liver function is impaired, it significantly increases in size. Sometimes there is short-term jaundice. When bile is sown, a pathogenic microflora is found. In the blood, leukocytosis, a stab-shift in the leukocyte formula, increased ESR, increased hyperproteinemia, gamma globulinemia, increased bilirubin content, and the activity of transaminases increased.
A prolonged course of invasion can lead to the formation of chronic hepatitis syndrome, and subsequently to the development of liver cirrhosis and even hepatocellular carcinoma and liver cancer. That is why the International Agency for the Study of Cancer O. Viverrini is referred to the first group of human carcinogens.
[Complications of opisthorchiasis
In the chronic phase of the disease, purulent cholangitis and cholecystitis, acute and chronic pancreatitis, peptic ulcer and duodenal ulcer, peritonitis, cholangiocarcinoma are often found.
The course of the invasion is long (up to 20 years and more), but benign. Lethal outcomes are rare and associated with complications (peritonitis, cholangiocarcinoma).