One of the dangerous parasites capable of infecting humans and transmitted through fish is the tapeworm. Its rather high prevalence among fish in the basins of many rivers of the world is of some concern and alertness, and the disease itself requires careful consideration.
Diphyllobothriasis is an intestinal helminthia of the chronic course, caused by a tape parasite - wide tapeworm, and characterized by lesions of the small intestine and the development of B12 - deficient anemia.
Source of infection with diphyllobothriasis for humans
The relationship between the prevalence of diphyllobothriosis and the basins of many rivers on the planet, the location of lakes, as well as a temperate and cold climate, is noted. The disease is spread in North America, Canada, France, Denmark, Sweden, Holland, Finland, Italy, Germany and other countries. In the Russian Federation, diphyllobothriasis is more common in the Krasnoyarsk Territory, the river basins - Ob, Lena, Yenisei, Amur. Identified foci in the reservoirs of Nizhny Novgorod, Volgograd, Samara, Tatarstan.
Causes of diphyllobotriosis
The causative agent of the disease is Diphyllobothrium latum (wide tape), a tapeworm with a length of 2 to 10 meters or more. It belongs to the class Cestoda, family Diphyllobothriidae. It consists of a head (scolex) having two slit-like bothria for attachment to the intestinal mucosa, the neck and the body, consisting of segments in which the eggs are formed. The length of the body is due to the huge number of segments - up to 4000 pieces, and the eggs are allocated only mature segments. Parasite eggs are oval-shaped, rather large by the standards of helminth eggs and up to 70 microns, surrounded by a 2-layer shell, and also equipped with a single-pole cap. Parasitizing in the intestines, the tapeworm releases only immature eggs, their further development occurs in the environment (in freshwater bodies of water).
Diphyllobothriasis, adult tapeworm wide
The development cycle of a wide Lentac occurs with the change of 3 hosts:
- the final owner - man, cat, dog, pig, bear, fox,
- intermediate host - Cyclops crustaceans,
- additional host - freshwater fish.
Infection occurs when eating insufficiently thermally treated fish.
Parasitic worms in the small intestine. With feces, the eggs of the tapeworm fall into the external environment, into the water. First, an embryo is formed inside the egg, which then, under favorable conditions (temperature + 15 ° C), enters the reservoir after 6-16 days. The fetus actively swims in water, remaining viable up to 6 months. Perniciously germs are affected by temperatures above plus 20 °, salt water. After ingestion by a freshwater crustacean after 2-3 weeks, the embryo turns into procercoids (invasive larvae). Crustaceans with procercoids are swallowed by predatory fish (ruff, perch, pike perch, pike, burbot) or salmon fish (pink salmon, chum salmon), in the body of which they, overcoming the intestinal wall, migrate to the musculature and other organs, where within 4-5 weeks they turn in the plerocercoid (about 1-3-5 cm long with Bothria).
The plerocercoid is an invasive stage for humans. Already in the organism of the final host, they turn into a sexually mature parasite (the plerocercoid is attached to the mucous membrane of the small intestine and in 15-30 days reaches the adult stage).
The whole cycle lasts on average up to 25 weeks. The life span of the parasite is 20 years or more.
Diphyllobothriasis, life cycle
Thus, the source of infection in diphyllobothriasis is the final owner (man, domestic animals - cat and dog, pig, fox, bear), in the body of which a mature individual of a broad tapeworm can parasitize and with feces the release of eggs occurs (up to 2 million eggs in day or more) into the environment. However, we must remember that for the invasion of eggs must pass a certain path of development to the invasive stage, therefore, the final owner is not directly contagious to others.
Diphyllobothriasis, wide ribbon
Infection mechanism - alimentary. Invasion occurs as a result of eating insufficiently thermally treated or raw fish (ruff, perch, pike perch, pike, burbot, pink salmon, chum), in the body of which there is a plerocercoid - a parasite developmental for humans. The plerocercoid can be found both in the internal organs and in the muscle tissue of the fish. Many of the patients consumed salted fish and salted caviar, cooked at home. In rare cases, infection occurs through transmission factors (cutting board and knives, dishes contaminated with plerocercoids). Often, fans of syroedeniya (fish, caviar), cooking kebabs from fish.
Susceptibility to difillobotriozu universal. The adult population is ill more often in comparison with children's age.
Pathogenic effect of wide tapeworm on the human body
1) the mechanical effect of helminths on the intestinal wall at the point of their attachment (this causes necrosis and tissue atrophy),
2) irritation of the nerve endings of the mucous membrane with the development of neuro-trophic disorders, which leads to dysfunction of the gastrointestinal tract,
3) allergic reactions due to sensitization of the body by the parasite's vital activity products,
4) hypo-and avitaminosis of B12 and folic acid and, as a result, megaloblastic anemia (the binding of the gastromucoprotein, an internal gastric factor with vitamin B12, is disturbed, as a result of which the vitamin is not absorbed but is absorbed by tape.) The level of vitamins C, B1, B6 in the blood of patients may also decrease.
Immunity after suffering helminthiasis is unstable, repeated invasions are possible.
Symptoms of diphyllobotriosis
The incubation period (from the moment of infection until the patient's complaints appear) can last from 20 to 60 days. More often manifestations of the disease are mild. The onset of the disease is gradual.
First, there is nausea, sometimes vomiting, pain throughout the abdomen, moderately severe fever, unstable stool, changes in appetite (increased or decreased). Some patients may develop intestinal obstruction associated with the accumulation of tape in the small intestine.
Characterized by the development of B12-deficient anemia, manifested by weakness, dizziness, palpitations, fatigue, pale skin, swelling on the face or limbs, possible development of glossitis (bright red spots, cracks, and then atrophy of the papillae, the tongue becomes "lacquered"). Such changes can be on the gums, mucous membrane of the cheeks, pharynx, esophagus (pain when eating).
There may be lesions of the nervous system (numbness, paresthesias - “crawling feeling”, disturbance of superficial and deep sensitivity, unstable gait). Manifestations of the funicular myelosis are possible (as with Addisson-Birmer pernicious anemia) - in a patient with unexpressed paresthesias, disturbances of sensitivity.
Changes in blood count: decrease in the number of erythrocytes, hemoglobin, but the color index is increased. Jolly's little bodies (blood cells with remnants of nuclei) and Kebot rings (with basophilic punctuation of polychromatophils), megaloblasts, megalocytes can be found. Also marked leukopenia (decrease in leukocytes), thrombocytopenia (decrease in platelets).
The severity of anemia depends on the degree of invasion, the presence of concomitant diseases, the quality of nutrition of patients.
Sometimes the disease is latent (covertly, without clinical symptoms).
Diagnosis of diphyllobotriosis
Diagnosis is based on clinical and epidemiological data, as well as the results of laboratory studies.
1) epidemiological history (stay in an endemic area, the fact of eating 20-60 days ago, raw, lightly salted, insufficiently thermally processed fish and its products, for example, caviar),
2) clinical data (the appearance of one or several groups of symptoms of varying severity), sometimes patients complain of separation with feces of parts of the strobila (body) of the broad tapeworm,
Diphyllobothriasis, segments or segments
3) paraclinical data: complete blood count (decrease in the number of erythrocytes and hemoglobin in normal or elevated color index, the appearance of altered blood corpuscles — Jolly's calf (blood corpuscles with remnants of nuclei) and Kebot rings (with basophilic polychromatophil punctuation), the appearance of megaloblastic cells , decrease in the number of leukocytes and platelets).
4) Specific parasitological studies: coproovoscopy (detection of fragments of the body of the parasite (segments) under microscopy).
The differential diagnosis is carried out with anemias of various genesis (hemolytic, iron deficiency, hyperchromic), as well as other parasitological diseases (trichocephalosis, ankylostomidosis).
Treatment of diphyllobothriasis
Treatment is based on the use of antiparasitic agents. For treatment are used:
- Fenasal (niclosamide) once from 1 to 3 grams, depending on the age of the patient.
- Biltricid in the average dose of 25 mg / kg once.
As auxiliary means:
- Male Fern Seed Extract: for 2 days a light diet, devoid of fat, spicy food, on the eve of therapy in the evening a light supper, salt laxative for the night (magnesia sulphate), in the morning on an empty stomach put on a cleansing enema, then taking the drug 1 capsule every 2 minutes (total dose depending on age from 4 to 7 grams). After 30 minutes they give a saline laxative again, after 1.5 hours - a light breakfast. If there is no stool for 3 hours, then do a cleansing enema.
- Pumpkin seeds in the amount of 300 grams, pour 50-60 ml of warm water, triturated and consumed on an empty stomach for 1 hour. After 3 hours, give a saline laxative, and then after 30 minutes - a cleansing enema. You can steam the seeds in a water bath (as in teniasis).
In case of severe anemia, its correction is carried out: administration of vitamin B12 or cyanocobalamin from 200 to 500 µg parenterally 3 times a week for 1-1.5 months, as well as iron preparations (ferroplex, actiferrin, ferronal, hemofer and others).
Symptomatic therapy (painkillers, probiotics, drugs that normalize intestinal motility, if necessary, laxatives and others).
The prognosis of the disease is favorable.
Monitoring treatment is carried out after 1 and 3 months after anti-parasitic therapy. With negative analyzes of coproovoscopy further follow-up is not required. If the passage of eggs and fragments of the strope of the tapeworm continues, a second course of treatment is prescribed.
When fishing and consuming river and lake fish, prevent its raw food, carefully monitor its heat treatment. Plerocercoids are fairly stable. They die at minus 15 ° during the day (24 hours), at minus 10 ° in 3 days, at minus 4-6 ° for 9-10 days. High temperatures are more destructive for the plerocercoid - they die at a temperature of plus 55-60 °, in other words: it is recommended to roast fish for at least 20 minutes, and large pieces of fish for at least 30-40 minutes. Salt products are allowed to be consumed when the salt content in the final product is at least 9%, in which case the plerocercoids die.
Diphyllobothriasis, plerocercoids in fish meat
Early detection of symptoms and treatment of diphyllobothriasis. Regular survey on helminthiasis of fishermen before and after navigation, workers of fish processing enterprises.
Wide tapeworm reaches 10-12 m in length. Oblong oblate head (scolex) has 2 suction gaps (bothria). The body consists of 300-4000 segments (proglottids). The life span of a worm in humans can reach 25 years.
With diffilobotriasis caused by D. erinacei europaei, plerocercoid larvae inhabit the subcutaneous tissue and internal organs, causing the disease sparganosis.
Epidemiology What is diphyllobothriasis
This is an official disease, provoked by penetration into the body and increased activity of tapeworms. The causative agents of the disease are representatives of the wide ribbon species, which in length can reach from 2 to 10 m, while they are distinguished by high viability (they can change a single intermediate host). A characteristic illness has a selective locality, most often prevails in people from northern latitudes, for example, there are known cases of infection in Karelia, the Krasnoyarsk Territory, in the Kola Peninsula.
Diphyllobothriosis extensively affects the organs of the gastrointestinal tract, provokes acute symptoms of intoxication. Infectious agents enter the body from stale fish or together with fish products that have undergone poor-quality heat treatment. When confronted in practice with a tapeworm, it is important to understand that during the cycle of their viability, such parasites change three hosts. Animals or humans are the last, freshwater crustaceans become the intermediate, and the riverfish are an additional host. Therefore, in order not to get infected, it is important to selectively treat fish products.
Ways of infection
Infection occurs predominantly through the alimentary route, and the organs of the gastrointestinal tract become the source of pathology. Manifestations of invasion are observed during the consumption of infected fish or caviar, which did not pass all stages of heat treatment. It is not necessary to exclude infection by difillobotriozom contact-household way - through contaminated dishes, cutting boards with the presence of tapeworm larvae.
Causative agent of diphyllobotriosis
Diphyllobothrium latum (aka, a wide ribbon) is a tapeworm that reaches a length of 2 - 10 m. It belongs to the class of cestodes, the family of Diphyllobothriidae. The harmful parasite consists of a neck with a head and two slit-like devices for attaching a helminth to the mucosa of the small intestine. Another structural feature is the presence of the neck and body, consisting of segments (up to 4000 pieces), where eggs are formed. The maturation of pathogenic flora in the organism of the last host is characterized by a long incubation period, asymptomatic.
The development cycle of a wide Lentets
If we talk about the mechanism of development of the pathological process, are as follows: the infection is transmitted with the helminth eggs in infected fish, produces directly in the small intestine. With feces enters the water and the external environment, followed by the formation of the embryo in the egg. The embryos, which fall into the freshwater reservoir, swim and maintain their viability for up to six months.
After penetration into the organism of the intermediate host, the first re-larvae larvae appear, which continue their viability and are modified into the procercoids. After come to the stage of development of plerocercoid. The whole cycle lasts up to 25 weeks, and the life expectancy of adults is 20 years or more. If a person eats contaminated food, tapeworms penetrate into the digestive tract, which in the future with the help of tentacles are attached to the walls of the small intestine and absorb nutrients (in the absence of the digestive system, they feed so).
Intermediate host broad tape
In this case we are talking about the inhabitants of freshwater bodies of water. These are separate types of fish, crustaceans, Cyclops crustaceans, other representatives of the fauna. The larvae are rapidly developing, with the parasites reach the status of young individuals. After taking food, they penetrate the small intestine of carnivorous animals and humans, where they actively feed on intestinal contents and develop.
With the penetration of the larvae of a wide tapeworm, the first symptoms of diphyllobotriosis are absent for a long time. The incubation period lasts from several hours to several days, while the parasite is rapidly increasing in size due to its nutrition with intestinal contents. It is important to recognize the disease in a timely manner, otherwise adult individuals parasitize in complicated clinical pictures, causing serious health problems - intestinal obstruction. The following are typical manifestations of the disease that are not recommended to be ignored:
- nausea, epigastric pain, vomiting, loss of appetite, signs of dyspepsia,
- fatigue, dizziness, weakness, paresthesias, cracks of the tongue,
- tachycardia, unpleasant noise of the top,
- hypotension, impaired cardiac activity,
- unsharp paresthesias, weak legs,
- development of signs of anemia (red blood cells are in short supply),
- blueness of the skin, swelling of the skin,
- intestinal obstruction.
Stool tests are not always informative, but are required as part of a comprehensive diagnosis. A single history data collection is not enough for a definitive diagnosis, patient complaints, too. Here are what clinical examinations in the hospital are required to pass if you are suspected of diphyllobotriasis:
- microscopic examination of feces for the presence of eggs and fragments of strobilus,
- hematocrit with hemoglobin,
- detailed blood test for folic acid and vitamin B12.
Allocation of parasites, along with feces, is preceded by a highly undesirable infection, the development of diphyllobotriosis. In order to destroy the worms and prevent the emergence of new individuals, it is necessary to be treated with medical methods. Antiparasitic drugs are prescribed by specialists after preliminary diagnosis and clarification of the etiology of the pathological process. Here are the effective pharmacological positions:
- Praziquantel The daily dose of the drug for oral administration should be 50 mg / kg, it should be divided into 3 doses. The course of treatment lasts up to 4 days. There is a drug interaction, contraindications, it is important to avoid cases of overdose.
- Fenasal. These are white tablets, which can be prescribed exclusively by the attending physician. The recommended dose for patients 12 years and older is 8 to 12 pills per day. Children up to 12 years old, the daily dosage is 6 tablets by mouth, always between meals.
- Biltricid. The medicine is intended to be taken orally. The average dose is 25 mg / kg, which is required to use once. After a few days later, retake an analysis of feces, be examined.
- Niclosamide The drug causes paralysis of the musculature of the helminth, permitted to patients aged 2 years and older. The recommended daily intake is 500 mg, which is required to be taken once. After it is necessary to drink any laxative to choose from.
De-worming with alternative methods is not very effective, but there is also some benefit from traditional medicine and its recipes. This is an auxiliary treatment of diphyllobotriosis, aimed at reducing the severity of alarming symptoms, providing reliable prophylaxis to patients at risk, for example, fishermen and food industry workers. The most effective folk remedies are presented below, but before preparing them it is important to eliminate the risk of an allergic reaction to herbal ingredients. So:
- To combat parasites, it is advisable to use on an empty stomach 25-30 g of peeled and pre-ground pumpkin seeds. 2 hours after the specified dose is required to take a laxative. It is desirable to repeat this alternative treatment after 2 days in order to consolidate the result obtained.
- Required to connect 3 tbsp. l pre-chopped carrots, add to carrot puree 25-30 g of ground pumpkin seeds and 2 tbsp. l sunflower oil. The finished composition must be consumed on an empty stomach, and after 3 hours you should drink 1 tbsp. l castor oil for a laxative effect.
- It is necessary to add 15-30 g of crushed pumpkin seeds to a glass of warm milk, mix well. For a pleasant taste, you can add 1 tsp. honey, then again to bring the composition to homogeneity. In this way, it is allowed to treat children with pronounced symptoms of helminthic invasions. After a couple of days, you can repeat this delicious medication.
Who is wide?
Diphyllobothrium latum is a tapeworm with a length of 2 to 10 meters. Some specimens exceed this length. The broad tapeworm belongs to the class of cestodes (Cestoda), a family of Diphyllobothriidae. It consists of the neck, on which is the scolex (head) with two slit-like devices for attaching the helminth to the mucous membrane of the small intestine, and the body.
The body of the tapeworm consists of a huge number of segments, their number reaches 4 thousand. In mature segments large oval-shaped eggs form. They are protected by a two-layer shell, have a lid on one of the poles. Being in the intestine of an intermediate or final host, the tapeworm releases immature eggs that reach full maturity only in freshwater bodies of water.
The effects of diphyllobothriosis on human health
Consequences of the presence of the helminth in the human gastrointestinal tract:
Necrosis of tissues and atrophic processes develop in the place of attachment of botrium scolex tapeworm to the intestinal mucosa.
There are violations of the activity of the gastrointestinal tract due to damage to the nerve endings of the mucous membrane and intestinal trophic disorders,
The waste products of the broad tapeworm sensitize the body, causing allergic reactions,
Megaloblastic anemia appears due to the fact that vitamins B1, B6, B12, are adsorbed by the parasite.
Severe form of anemia leads to neurological disorders: depression, increased irritability, hyperreflexia, paresthesia.
Prevention of invasion wide tapeworm
In order to protect oneself from wide latex infection, one should carefully monitor the complete cooking of the fish: fry it for at least 30-40 minutes, salting should be carried out for 10 days, freeze fish products to destroy the parasite larvae.
Fishermen and workers of the processing industry should undergo timely medical examination, especially during the greatest activity of the parasite larvae. When the first symptoms of the disease appear, you should immediately undergo an in-depth examination by a parasitologist.
Education: in 2008, received a diploma in “General Medicine” (Therapeutic and Prophylactic) ”in the Russian Research Medical University named after NI Pirogov. Immediately passed internship and received a diploma of therapist.
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