Opisthorchiasis: diagnosis
Last reviewed: 23.04.2024
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Diagnosis of opisthorchiasis is based on clinical epidemiological and laboratory data: the use of thermally unprocessed, slightly salted fish in endemic regions; fever, toxic-allergic syndrome; leukocytosis and eosinophilia in the blood; in the chronic phase - the symptoms of cholecystopancreatitis, gastroduodenitis.
The signs of acute allergosis and data of instrumental examination methods (ultrasound, cholecystography, CT, MRI), indicating signs of dyskinesia of the gallbladder and bile ducts, a decrease in the excretory function of the liver, expansion of the bile ducts are most typical for the acute stage of the disease. In the chronic stage there is a moderate eosinophilia (5-12%), sometimes anemia with normo- or macroblastic type of hematopoiesis. Functions of the liver (protein-synthetic, pigmented, antitoxic) with uncomplicated opisthorchias remain normal or slightly reduced. With the development of hepatitis, cholecystitis, cholangitis, high eosinophilia is noted. The appearance of jaundice symptoms is combined with an increase in alkaline phosphatase activity with a relatively small increase in the ALT level. The involvement of the pancreas in the process is indicated by an increase in the level of glucose in the fasting serum, the altered curve with sugar loading, a decrease in the values of trypsin, amylase and lipase in duodenal contents and an increase in their content in the blood, an increase in the diastase content in the urine. Half of the patients have a decrease in the acidity of gastric juice.
Clinical diagnosis of opisthorchiasis uses EGDS, cholecystography, duodenal sounding, ultrasound of the abdominal cavity organs, determine the acidity of gastric juice.
[Specific laboratory diagnostics of opisthorchiasis
Parasitological diagnosis of opisthorchiasis in the acute stage is impossible, since helminths begin to release eggs only 6 weeks after the onset of the invasion. ELISA is used to determine specific antibodies. The following test systems are used:
- for determination of IgM - "Opisthorchis-1gM-strip";
- for determination of IgG - "Tiatop-strip";
- to determine the specific CEC - "Opistorh-CEC-strip".
Parasitological examination of bile is the most reliable method of diagnosing opisthorchiasis. Conduct a microscopic examination of the sediment of three portions of bile. Duodenal sounding is a complex and not always acceptable procedure that is not suitable for mass examinations. That is why copro-scopography, based on the study of the morphological features of the eggs of opisthorchia, is most common. In the study of stool, various methods are used: high-quality formalin-ethereal, chemical sedimentation Berezantseva, quantitative Stella and semi-quantitative Kato. Flotation methods of Füllebourne and Goryachev are also applied.
With insignificant invasion, the eggs of the opisthorchus are found to be unstable, therefore, a repeated parasitological examination of the patients is necessary after the procedures that stimulate the cholerocort (Tyubazhi according to Dem'yanovich, the reception of cholekinetics).
The final diagnosis of "opisthorchiasis" is established when duodenal contents or in feces of eggs are found in the cat's fluke, which begin to be released no earlier than 4-6 weeks after infection. In case of low-intensity invasion, it is advisable to prescribe choleretic remedies or blind probing to Demianov before conducting a fecal study, as a result of which the probability of identifying helminth eggs increases.
In the study of faeces, it is necessary to use methods of enrichment (formalin-etheric, etc.). In the case of a negative result, the study of faeces is repeated several times at intervals of 5-7 days. Examination of duodenal contents should be carried out within two hours after its reception, as long-term storage of the material in it occurs the lysis of eggs.
Example of the formulation of the diagnosis
B66.0. Chronic opisthorchiasis. Chronic cholecystopancreatitis ( Opisthorhis felineus eggs in duodenal contents).
Differential diagnosis of opisthorchiasis
Differential diagnosis of opisthorchiasis is difficult, which is associated with polymorphism and nonspecific clinical symptoms.
The acute phase of opisthorchiasis must be differentiated from typhoid, ARI, inflammatory diseases of the abdominal cavity organs (cholecystitis, cholangitis, pancreatitis), helminthic invasions (trichinosis, fascioliasis, paragonimosis), blood diseases, pneumonia, acute intestinal infections, viral hepatitis.
Acute opisthorchiasis with signs of hepatitis differs from viral hepatitis with fever against jaundice, more severe pain syndrome, high eosinophilia, increased activity of alkaline phosphatase in combination with moderately expressed signs of cytolytic syndrome.
In contrast to acute respiratory disease, acute opisthorchiasis is characterized by mild catarrhal symptoms, liver enlargement and tenderness, and eosinophilia.
Differential diagnostics of opisthorchiasis in the chronic phase is carried out with fascioliasis, cholecystitis, pancreatitis, gastroduodenitis, chronic hepatitis of other etiology.