Opisthorchiasis: treatment and prevention

Treatment of opisthorchiasis should be comprehensive, individual and take into account co-morbidities. Hospitalization of patients is carried out according to clinical indications. Assign a gentle regime, diet number 5 for 6 months.

The drug of choice - prazikvantel or its domestic analogue of azinoks. Treatment of opisthorchiasis, as a rule, is outpatient (except for patients with severe symptoms of acute phase, severe organ damage, toxic-allergic manifestations). In acute phase, therapy is started after arresting fever, eliminating intoxication and allergic symptoms. The drug is prescribed in a daily dose of 75 mg / kg body weight after eating three meals at intervals of 4-6 hours. The maximum single dose is 2 g, the daily dose is 6 g. The drug is not recommended for children under 2 years and pregnant (in the first trimester). Nursing women on the day of reception and the next day should not breast-feed the baby. Contraindicated use of alcohol. Possible short-term side effects: headache, dizziness, a sense of intoxication, dyspeptic disorders. The effectiveness of one course of treatment is 90-94%.

In most cases, treatment of opisthorchiasis can be performed on an outpatient basis. Inpatient treatment in need of patients with decompensation of the function of organs, patients with neuropsychic diseases and with severe clinical symptoms of acute stage of opisthorchiasis. The drug of choice for the treatment of opisthorchiasis is praziquantel (praziquantel, biltricid) or its domestic analog - an azinox. It is prescribed in a daily dose of 75 mg / kg immediately after a meal, in 3 divided doses with an interval of 4-6 hours for one day. The maximum single dose is 2 g, the maximum daily dose is 6 g (10 tablets).

In acute stage of the disease development, etiotropic treatment of opisthorchiasis is carried out after relief of fever, elimination of intoxication and allergic manifestations. Given the polymorphism of clinical manifestations of opisthorchiasis and its frequent combination with other diseases, in the chronic stage of the disease, complex therapy should be conducted aimed at managing acute conditions and achieving remission of co-morbidities, and then carrying out specific treatment. The effectiveness of one course of treatment is 96-98% in children and 86-90% in adults. It is not recommended to prescribe the drug to children under 2 years old, women in the 1st trimester of pregnancy. Given the partial elimination of the drug from the body with breast milk, lactating women is not recommended on the day of treatment and the next day to breast-feed the baby.

When taking prazikvantel may occur side effects: dizziness, headache, a sense of intoxication, dyspeptic disorders. These phenomena occur 30-40 minutes after admission, last 1-2 hours, mildly expressed and do not require drug withdrawal or drug correction. Given the possibility of these phenomena, specific treatment of opisthorchiasis is advisable to appoint on weekends, do not perform works that require increased attention and quick reactions. Categorically contraindicated drinking alcohol on the day of specific therapy.

In the late stage of the disease with the development of cholangitis and biliary dyskinesia, duodenal probing with the administration of magnesium sulfate or sorbitol is administered, which are carried out 1-2 times per week for 1-2 months. Cholagogue agents are shown, preferably from the group of cholekinetics. With pain, antispasmodics and analgesics are used. In the case of secondary infection of the biliary tract, antibiotics are prescribed taking into account the sensitivity of the microflora of the duodenal contents to them. With the development of anemia, especially in children, patients are prescribed a full-fledged protein-vitamin diet and iron preparations.

In order to control the effectiveness of specific treatment 3-4 months after it, a three-time (with an interval of 7 days) control study of stool and duodenal contents is carried out.

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

Forecast

In the absence of bacterial complications, the prognosis is usually favorable: serious - with the development of purulent processes in the biliary tract, bile peritonitis and acute pancreatitis: unfavorable in the development of cholangiocarcinoma or liver cancer.

[6], [7], [8]

Clinical examination

The medical examination is carried out with a severe and complicated course of infestation.

Opisthorchosis requires medical examination for 1-2 years. The frequency of examinations of the gastroenterologist and the volume of rehabilitation measures are determined individually. Allergosis requires consultation of an allergist.

Follow-up examination for egg production is carried out at 3, 6, 12 months after the end of anthelmintic treatment of opisthorchiasis. Conduct a threefold study of faeces and duodenal sounding.

[9], [10], [11], [12]

How to prevent opisthorchiasis?

Opisthorchias can be prevented if the following directions are observed:

• detection of foci and treatment of patients with opisthorchiasis;
• carrying out of wide sanitary-educational work among the population in the outbreaks:
• dehelminthization of domestic carnivores;
• environmental protection from fecal pollution;
• qualitative heat treatment of fish of carp breeds before eating it for food;
• The struggle with the intermediate hosts of the opisthorchus and the free-floating stages of the parasite.

At home, disinfect fish is recommended in the following ways:

• fry small pieces for at least 20 minutes;
• cook for 20 minutes from the moment of boiling;
• bake fish pies 40-60 minutes;
• apply a strong salting (20% salt to the weight of fish) with a 10-day exposure;
• thin carp breeds (roach, dace) for 3 weeks with a 2-3-day preliminary ambassador;
• cold smoked fish should be held after a strong salting or freezing for 3-4 weeks.