Opisthorchiasis - Treatment and Prevention

Treatment of opisthorchiasis should be comprehensive, individual and take into account concomitant diseases. Hospitalization of patients is carried out according to clinical indications. A gentle regimen is prescribed, diet No. 5 for 6 months.

The drug of choice is praziquantel or its domestic analogue azinox. Treatment of opisthorchiasis is usually outpatient (except for patients with pronounced symptoms of the acute phase, severe organ damage, toxic-allergic manifestations). In the acute phase, therapy begins after the fever has been relieved, intoxication and allergic symptoms have been eliminated. The drug is prescribed in a daily dose of 75 mg / kg of body weight after meals in three doses at intervals of 4-6 hours. The maximum single dose is 2 g, daily - 6 g. The drug is not recommended for children under two years of age and pregnant women (in the first trimester). Nursing women should not breastfeed on the day of administration and the next day. Alcohol consumption is contraindicated. Short-term side effects are possible: headache, dizziness, feeling of intoxication, dyspeptic disorders. The effectiveness of one course of treatment is 90-94%.

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

In the acute stage of the disease, etiotropic treatment of opisthorchiasis is carried out after stopping the fever, eliminating intoxication and allergic manifestations. Given the polymorphism of the clinical manifestations of opisthorchiasis and its frequent combination with other diseases, in the chronic stage of the disease, complex therapy should be carried out aimed at stopping acute conditions and achieving remission of concomitant diseases, and then specific treatment should be carried out. 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 of age, women in the 1st trimester of pregnancy. Given the partial elimination of the drug from the body with breast milk, nursing women are not recommended to breastfeed on the day of treatment and the next day.

When taking praziquantel, side effects may occur: dizziness, headache, feeling of intoxication, dyspeptic disorders. These effects occur 30-40 minutes after taking, last 1-2 hours, are mild and do not require discontinuation of the drug or drug correction. Given the possibility of these effects, specific treatment of opisthorchiasis should be prescribed on weekends, and not to perform work that requires increased attention and quick reactions. Alcohol intake on the day of specific therapy is strictly contraindicated.

In the late stage of the disease, with the development of cholangitis and biliary dyskinesia, duodenal intubation with the introduction of magnesium sulfate or sorbitol is prescribed, which is carried out 1-2 times a week for 1-2 months. Choleretic agents are indicated, preferably from the group of cholekinetics. Antispasmodics and analgesics are used for pain. In the case of secondary infection of the bile ducts, 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 complete protein-vitamin diet and iron preparations.

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

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Forecast

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

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Clinical examination

A medical examination is carried out in cases of severe and complicated course of the invasion.

Opisthorchiasis requires medical examination for 1-2 years. The frequency of gastroenterologist examinations and the volume of rehabilitation measures are determined individually. In case of allergy, an allergist consultation is necessary.

A control examination for egg secretion is carried out 3, 6, 12 months after the end of anthelmintic treatment for opisthorchiasis. A three-fold study of feces and duodenal intubation are carried out.

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How to prevent opisthorchiasis?

Opisthorchiasis can be prevented by following these guidelines:

• detection of foci and treatment of patients with opisthorchiasis;
• conducting extensive health education work among the population in the following areas:
• deworming of domestic carnivores;
• protection of the environment from faecal pollution;
• high-quality heat treatment of carp fish before eating it;
• control of intermediate hosts of opisthorchiasis and free-swimming stages of the parasite.

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

• fry small pieces for at least 20 minutes;
• cook for 20 minutes from the moment of boiling;
• bake fish pies for 40-60 minutes;
• use strong salting (20% salt to the weight of the fish) with a 10-day curing period;
• dry small carp species (roach, dace) for 3 weeks with 2-3 days of preliminary salting;
• Cold smoking of fish should be carried out after strong salting or freezing for 3-4 weeks.