Opisthorchiasis is a helminthiasis caused by infection with a cat fluke with primary damage to the liver, biliary tract and pancreas.
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Opisthorchus (cat fluke)
This helminth has several names - feline fluke, Siberian fluke, cat fluke and opisthorchid. Refers to flatworms.
Its body is leaf-shaped, 4-13 mm long, pale yellow. The worm is a hermaphrodite.
How is it developing?
The definitive hosts of the cat fluke are humans, cats, dogs and other piscivorous animals.
There are several intermediate hosts:
- the first is a freshwater mollusk,
- the second is fish of the carp family.
Opisthorchis parasitizes its hosts in the hepatic ducts, gall bladder, and less commonly in the pancreas. There, worms secrete eggs 26-30 microns in size, pale yellow in color.
With feces, eggs are released into the external environment. When water bodies are polluted with feces, the eggs are swallowed by the mollusk. In the body of the mollusk, larvae emerge from the eggs and undergo a series of transformations in its liver. After this, they leave the body of the mollusk and actively penetrate the fish, where they settle in the subcutaneous tissue and muscles.
Opisthorchiasis
This disease affects about 17 million people in the world, and about 350 million people living in 13 countries are at risk of infection.
Geography of distribution - from the Yenisei basin to the western borders of Europe. On the territory of Russia in the Middle Ob region, opisthorchiasis is detected in 25-30% of children under 3 years of age, at the age of 12-14 years - in 50-60%, in adults - almost 100%.
More often, the disease is recorded in river basins (Volga, Kama, Don, Ural, etc.).
How can you get infected?
The main source of infection in settlements is humans, less commonly cats and pigs, and in nature wild fish-eating mammals.
With the feces of infected animals and humans, the eggs end up in water bodies, where they can live for 5-6 months.
A person becomes infected by eating raw or undercooked fish.
The effect of worms on human health
In the acidic environment of the stomach, the outer shell that protects the parasite dissolves and it enters the duodenum. There the larva comes out and through the common bile and pancreatic ducts penetrates the liver, gallbladder and pancreas within 4-6 hours.
First of all, the body reacts to antigens secreted by the parasite. This is manifested by allergic reactions on the skin, respiratory tract, and disruption of the entire digestive system.
With massive infections, gastroduodenitis, allergic hepatitis, and myocarditis develop.
Repeated infections lead to atrophy of the walls of the bile ducts. The bodies of parasites cause difficulty in the flow of bile. Changes in the liver are dystrophic in nature.
Often these changes lead to liver cancer. The leading role of opisthorchiasis in the formation of tumors of the hepatobiliary zone (liver, gall bladder, bile ducts) has been established.
Symptoms of the acute phase of opisthorchiasis
In the acute phase, the disease is similar to a severe allergy and is manifested by the following symptoms:
- increased body temperature;
- increased number of eosinophils in the blood,
- leukocytosis,
- pain in the epigastrium and right hypochondrium,
- muscle pain,
- joint pain,
- various skin rashes,
- general weakness,
- increased fatigue.
The manifestation of symptoms in acute opisthorchiasis depends on the state of the patient’s immunity and the intensity of infection.
There are three forms of the acute phase:
- erased is characterized by low-grade body temperature,
- mild is manifested by an increase in temperature to 38-38.5⁰C and constant pain in the right hypochondrium, the temperature lasts 1-2 weeks,
- moderately severe elevated body temperature is observed for 2-3 weeks, often with a skin rash, runny nose and inflammation of the mucous membranes of the throat,
- the severe form occurs in different ways, it can be typhoid-like, with symptoms of colitis or hepatitis, and is often complicated by liver abscesses and bile peritonitis.
Symptoms of chronic opisthorchiasis
When it becomes chronic, the disease can manifest itself as a symptom complex characteristic of cholecystitis, gastroduodenitis, and pancreatitis. The leading symptoms are:
- pain in the stomach and right hypochondrium,
- nausea,
- poor tolerance to spicy and fatty foods,
- bitterness in the mouth.
Opisthorchiasis in children
In infected children aged 1 to 3 years,
- loss of appetite,
- retardation in physical development,
- biliary tract dysfunction,
- anemia.
Without treatment, symptoms increase and reach a maximum by 8-12 years of age.
In older children, the disease usually occurs in an erased form.
Diagnostics
Instrumental methods (ultrasound, CT, MRI) detect changes in the liver, gallbladder and bile ducts. Serological studies show an increase in antibody titers. However, these data do not allow us to draw a conclusion about infection.
A final diagnosis can be made only if cat fluke eggs are detected in the duodenal contents or feces. They begin to be released no earlier than 4-6 weeks after infection.
If the number of helminths is small, the patient should be given choleretic drugs before examining feces.
If the result is negative, the tests are repeated several times with an interval of 5-7 days.
Treatment
Treatment is carried out on an outpatient basis. Hospitalization is necessary for children under 3 years of age or over 3 years of age with complications.
Praziquantel is used as an antiparasitic agent. The drug is taken in recommended doses 3 times a day immediately after meals with an interval of 4-6 hours. The course of treatment is 1 day.
The mechanism of action is based on the permeability of the parasite's cell membranes to calcium ions. This causes paralysis of the worm's muscles.
On the day of taking the drug and for 2-3 days after taking it, choleretic drugs are recommended.
If you are prone to allergic reactions, antihistamines are necessary.
The effectiveness of treatment is 95-98% in children, 86-90% in adults.
Prevention
After treatment, follow-up with a doctor is carried out for a year, sometimes up to 2 years.
After taking the drug, feces are examined after 1 month, a second time after 2 months and the last time after 3 months.
The main measure to prevent infection is to eat well-heat-treated or well-salted fish.
Maintaining the cleanliness of water bodies and protecting them from fecal pollution is of great importance.
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