Chinese fluke

Chinese fluke is a parasite of the genus flukes, which persists in the human body mainly in the liver. This causative agent lives in the region of China's water bodies, which is why the name is similar, but it is also found in freshwater reservoirs of European countries. The peculiarity of this parasite is the replacement of intermediate hosts, which should be taken into account as a factor of helminthosis transmission.

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Features of the structure

Chinese fluke is a parasite that belongs to the genus of flukes or flatworms - Trematodes, which causes the disease of clonorchiasis. The causative agent of pathology is Clonorchis sinensis. It is a parasite, which is a same-sexed creature with a complex structure of the body. The dimensions of the parasite range from one to two and a half centimeters.

The Chinese fluke has an oval body shape, the color is dark red with transparent translucence of internal organs. The parasite has on one side a sucker, which is firmly able to fix itself to the tissues of human organs. The structure of internal organs is such that at the end of the body of the fluke there are just two branched seeds, and in the middle part of the body there is a queen with a huge number of eggs. When fertilization of eggs takes place, they are discharged into the environment along the vitelline ducts along the fluke's body. Such eggs have a brown or dark yellow color with a sharpened end on one side in the form of a lid. One fluke is able to allocate about 400 thousand eggs at a time, many of which are viable, but after the whole life cycle.

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Life cycle of the Chinese fluke

The life cycle of the Chinese fluke passes with the replacement of several intermediate hosts, and part of this cycle certainly takes place in fresh water. This must be taken into account in order to prevent infection with this parasite.

From the body of the final host, eggs are excreted with feces, and then to continue the cycle they need to get into the fresh water. There, eggs can last a long time until the moment when they are swallowed by a clam of the genus Bithinia, which is the first intermediate host. In the body of the mollusk, eggs that are already inside the already active germ of the future worm are transformed into a larva. Further, the second intermediate host is the fresh-water fish of the carp group, mainly carp, crucian carp, bream, and also less often shrimp. In their body, the larva finally ripens and migrates to the wall of the fish itself, localized under the scales in the fleshy part and encapsulated, turning into a cyst. It is this stage of the parasite that is contagious to humans. A person becomes infected by eating meat from poorly cooked fish.

After eating such contaminated meat, the cyst enters the human intestine, where it can not be acted upon by enzymes due to a thick capsule. It migrates through the portal vein system into the liver, which is the site of the final localization of this parasite. In the liver, an adult individual, thanks to its suckers, is fixed to the liver tissue, and its considerable size allows to localize in any part of the liver itself. There may be local changes in the form of mechanical obturation of the bile ducts, as well as with a large number of parasitic flukes, the general function of the liver is disrupted and, in the first place, its detoxification ability suffers. This affects the degree of clinical manifestations of the disease, depending on the violations of the liver.

At the stage of cyst, the Chinese fluke can persist in the body of the fish for a long time, which increases the chances of infection until the second master's death. Proceeding from this, it is possible to single out the main ways of infection with the Chinese fluke:

1. thermally poorly treated freshwater fish containing parasite cysts;
2. sometimes the factor of transmission of infection can be and shrimp;

The incubation period of the clonorchosis development from the moment of the defeat of the Chinese fluke is between two and four weeks. If the parasite is not diagnosed in time and not removed from the human body, then one adult can persist for about forty years. 

Symptoms of Chinese fluke

Clinical manifestations in the defeat of the Chinese duodenum can be divided into two stages - acute and chronic. The acute stage of the disease begins from the first manifestations and requires immediate treatment to prevent the transition to chronic. The degree of severity of clinical symptoms in acute lesions depends on the number of pathogenic flukes that have affected the liver. As a reaction to any foreign body, the first symptoms in the acute stage are an increase in body temperature to subfebrile digits, unmotivated abdominal pain without a clear localization. Pain syndrome can also be more localized in the liver, which is often accompanied by yellowing of the sclera and mucous membranes. There may be dyspeptic manifestations in the form of a weakening of the stool, which occurs with an acute disturbance of the outflow of bile in the intrahepatic ducts. In this case, bile does not enter the intestines in sufficient quantity and fatty acids do not split. All this is accompanied by other symptoms - nausea, a feeling of bitterness in the mouth, belching. Also, given that the Chinese fluke generates toxic products, they are strong allergens. Therefore, in the acute stage, pain in the joints is often observed against the background of a rash rash on the skin of an allergic nature. Such a rash may look like fine small dots or be a type of hives. This is a very important diagnostic tool, especially in people who have not previously been prone to allergies. Thus, the allergic rash is polymorphic and appears without a trigger factor at the height of the subfebrile temperature.

These symptoms can go on independently without treatment, if the parasite simply changes its position and the outflow of bile is resumed for some time. In the absence of etiotropic treatment clonorhoz passes into a chronic stage.

The chronic stage of the disease can last for years, which is explained by the long life of a mature individual in the liver. Over time, when the products of the vital activity of the parasite accumulate, this destroys a certain number of hepatocytes and worsens the work of the still existing hepatic cells. So the detoxification function of the liver suffers and typical clinical manifestations occur. First and foremost, symptoms from the liver are manifested - intrahepatic outflow of bile is disrupted, which causes its stagnation. Further, the pancreas can be affected, since it has joint connections with the bile duct. This will be manifested by pain and heaviness in the right hypochondrium, symptoms of intoxication, slight yellowing of the skin and mucous membranes. When involved in the pathological process of the pancreas, symptoms of a violation of its exocrine function are observed. Therefore, there are symptoms of diarrhea, impaired absorption of nutrients - this is manifested by rumbling in the abdomen, weight loss, bloating.

There may also be undulating periodical rashes on the skin of an allergic nature. Such symptoms are poorly expressed and because of the long course of the pathology patients do not always notice them. Therefore, the disease is not diagnosed on time.

Diagnostics

Diagnosis should be carried out in the acute stage, then the treatment will have the greatest effectiveness. To diagnose and verify the pathogen, the most accurate method is to identify the eggs of the hepatic fluke in the stool. At the same time eggs are allocated not only by people, but also by domestic animals that eat fish. Microscopically you can see oval eggs with a lid on one side.

For the purpose of differential diagnosis and refinement of changes in the body, a general blood test is performed. Specific changes that may indicate a helminthic invasion are the eosinophilia of the blood. This indicates the activation of the allergic link of immunity. In biochemical blood analysis, there may also be changes in the acute stage in the form of increased hepatic enzymes (alkaline phosphatase), as well as hyperbilirubinemia of mixed genesis.

Also in the chronic stage, it is possible to conduct immunological studies with the detection of antigen in the indirect hemagglutination reaction.

If it is a liver injury and parasitization of a scapula in it for a long time, it is also necessary to examine the internal organs with the help of ultrasound. At the same time, one can see changes in the form of enlargement of the intrahepatic ducts, lesions of the common bile duct, the formation of stones in the bladder, and the widening of the pancreatic duct. These are indirect signs of liver pathology, which allows one to suspect parasitism of the fluke.

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Treatment of Chinese fluke

Treatment of Chinese fluke is most effective in the acute stage, when it is possible to achieve a higher eradication of the pathogen. Antiparasitic agents are used in the treatment, which are effective against the adult forms of Chinese fluke.

It is very important in the treatment period to adhere to a diet that will help relieve the liver and increase the excretion of toxic products from the intestine. The main dietary recommendations are as follows:

1. dishes are recommended to eat in boiled form without the maximum content of fats and spices;
2. It is necessary to limit the intake of simple carbohydrates in the form of sweets and white bread, and give preference to porridges;
3. it is necessary to increase the protein content in the diet and vitamins by consuming vegetables and fruits;
4. useful fat-soluble vitamins, which are in deficit due to a violation of liver function;
5. consumption of fermented milk products will help normalize the intestinal microflora and restore normal digestion.

Further it is necessary to include in treatment special anthelmintic preparations, one of which is Chloksil.

Chloksil is a drug that is especially active in the localization of parasitic worms in the liver. It is available in the form of a powder. The treatment regimen for this drug can be a three-day, five-day and ten-day treatment. The three-day scheme is most effective, since it allows you to create the maximum concentration of the drug in the shortest possible time. In this case, the drug is prescribed in a daily dose of 0.2 milligrams per kilogram of body weight of the patient. The drug is taken three times a day. The first dose should be taken after a light breakfast, dissolving the powder with a glass of warm milk. After three days of treatment it is necessary to adhere to the diet for at least a week, which will save the result and improve the body's response to the drug.

On the second place on the effectiveness of treatment of hepatic forms of helminths is the preparation Prazikvantel.

Praziquantel is an anthelmintic preparation that has efficacy against flatworms, as well as against their hepatic and pulmonary forms. The mechanism of action of the drug is to activate the cellular channels of parasitic cells, which causes their persistent reduction and death. This drug is available in the form of tablets of 600 milligrams, the dosage of the drug is 25 milligrams per kilogram of the patient's body weight per day. Treatment is carried out throughout the day - that is, the dose is given in three divided doses.

After such treatment, a control study of the effectiveness of the treatment is carried out by means of several microscopic studies of feces.

In parallel with etiotropic treatment is recommended and symptomatic with the use of antispasmodics and hepatoprotectors. This will help restore the function of hepatocytes after removal of the parasite and resume normal outflow of bile. For this, you can use drugs from different groups - Gepabene, Heptral, Energl, Essentiale. Given that the acute stage is particularly pronounced allergic component, it will be justified use of antihistamines - Loratadin, Erius, Desloratadine.

Alternative methods also have wide application in the treatment of hepatic fluke. For this, tar is used. For treatment use the scheme: on the first day of treatment, two drops of tar are prescribed, which must be dissolved in one teaspoon of warm milk and taken in the morning. Then until the fifth day, the number of drops of tar is increased by two drops every day. And thus, on the fifth day, ten drops are taken. Further, the scheme is such that the number of drops should be reduced in the same order and on the ninth day of dreams, the intake decreases to two drops per day. This is the whole course of treatment.

Another recipe for an alternative herbal remedy is the use of medicinal broth from leaves of thistle, birch buds and beets. To do this, take a tablespoon of dried leaves of thistle and birch buds, then rub one small beet and pour it all with a liter of hot boiled water. This broth should be taken one tablespoon twice a day, in the morning on an empty stomach, and in the evening before eating.

Prevention

Prevention of the defeat of the Chinese fluke may be specific and nonspecific. If there are risk factors for the disease, for example, the nature of the food of the fishermen, it is recommended that the preventive administration of Chloksil be carried out twice a year for a ten-day schedule.

Nonspecific prevention consists in sanitary and hygienic measures: disinfection of water in the foci of infection, detection and treatment of patients and infected. As for individual prophylaxis, any fish should be well thermally treated before intake, which is a preventive measure of any other infection.

Chinese fluke is a flat worm that parasitizes in the human body and can cause impaired liver function, as well as chronically persist in the liver. The transmission is contaminated fish that has undergone insufficient heat treatment. Given the complexity of treating chronic forms of pathology, it is necessary to diagnose and treat this disease in time.