Opisthorchiasis and pregnancy
Opisthorchiasis - a parasitic disease,the causative agent of which is from the family of worms opistorhid - cat fluke or opistorhisov. In our country this disease is prevalent in the river basin of the Dnieper, Donets, Volga, Kama, Neman. The most powerful opisthorchiasis center is located in the Ob-Irtysh basin.
The development comes with a mandatory opisthorchis3 change the hosts: a final, additional and intermediate. The final host, t. E. Body in which the parasite reaches sexual maturity for opisthorchis a man and some animals (cat, dog, fox, fox, etc.).
Mature opisthorchis - a flatworm in length from 0.2 to 1.2 cm and a width of 0.3 cm its habitat in the host organism -. Bile ducts of liver, gallbladder, pancreas ducts.
The adult parasite release eggs thatget together with the faeces of definitive hosts into the environment. Further development of the parasite performs consistently in shellfish (intermediate host) and carp fish (optional). Parasitizing in fish larval form of the helminth (metacercariae) invasive for the final host. Mature metacercaria - it is oval, sometimes round the cyst, which is located inside the larva. Metaschistosome opisthorchis may be contaminated with the following species: ide, dace (Merge), Siberian roach (rudd, roach), tench, bream, gudgeon, Galliano, chub, barbel.
The sources of infection (infection) are a sick man, animals and some species of wild mammals.
The massive introduction of parasite eggs in pondsIt occurs when the gross violations of the rules of communal sanitation: the device dumps in the floodplain of rivers or bodies of water ice, discharges wastewater without pre-treatment, etc...
Constant fecal contamination of water bodiesIt causes high contamination of shellfish and fish larval forms of helminths. Infection with human opisthorchiasis possible by eating fish containing viable helminth larvae. Live metacercariae may be insufficient to fried, cooked, and dried and salted fish carp species. For infestation is enough to use even a single small dose of uncleared product.
His suckers parasites attach themselves tothe walls of the ducts of the liver, pancreas, gall bladder; thus they damage the epithelium, thereby promoting penetration of the infection. A large accumulation of parasites and allergic swelling of the bile duct wall prevents the outflow of bile, as a result of which the liver enlarges, thickens, becomes painful.
Symptoms in pregnant opisthorchiasis
The clinical classification opisthorchiasis distinguish acute (early) and chronic phase. According to the severity of the acute phase opisthorchiasis can distinguish severe, moderate, light and erased form of the disease.
The disease usually begins after 2-3 weeksafter eating contaminated fish. In the early days of the disease are the main symptoms of general weakness, headache, fever, accompanied by chills and drenching sweat, increase in body temperature at night to 38-40 ° C.
In the 1st week of the disease occur pain in the epigastric region or around the abdomen, nausea, sometimes vomiting and stool disorders.
Approximately one third of patients in the acute period marked catarrhal phenomena (inflammation of the mucous membrane). Further align chest paincage, coughing, shortness of breath. Often revealed enlarged lymph nodes, spleen. The lungs are listened weakening or hard breathing, wheezing, dry and wet, in severe cases of myocarditis is possible.
Over this period constant for diseaseliver disease symptoms: pain in the right upper quadrant, enlarged liver, jaundice of the sclera, the soft palate or skin. liver function is disturbed in the first weeks of the disease.
One of the permanent symptoms of the acute phase opisthorchiasis - high eosinophilia, reaching the height of 20-90% of the disease. At the same time increases the total number of white blood cells, increased erythrocyte sedimentation rate.
Pregnant women in the acute phase may opisthorchiasisdevelop severe toxicity of both the first and second half of pregnancy, a phenomenon threatening miscarriage and preterm delivery, asphyxia and intrauterine fetal death.
However, the clinical picture of acute opisthorchiasisno characteristic features, which can be immediately put the final diagnosis. The disease can occur under the guise of a flu, sore throats, bronchitis, gastritis, hepatitis (Botkin's disease), mechanical, hemolytic jaundice, infectious mononucleosis and other diseases, which implies a sharp differentsiroat opistorhoz.
The definitive diagnosis is the identification of major importance in duodenal contents and feces opisthorchis eggs, which can be detected after 4-5 weeks after infection.
opisthorchiasis treatment in pregnant women
Pregnant located in the acute phaseopisthorchiasis are subject to mandatory hospitalization in a maternity hospital. The focus of the treatment should be directed to the relief of allergic symptoms and restoration of damaged liver functions. Patients prescribed bed rest (in a horizontal position improves blood flow to the liver) and protein-carbohydrate diet. Recommended dairy, meat products, vegetables, fruits, honey. The daily amount of liquid to 2-3 liters daily kalorazh 3000 kcal. It is recommended to 400 g per day of fresh cheese.
For relief of symptoms of allergicas desensitizing therapy prescribed diphenhydramine, pipolfen, acetylsalicylic acid, calcium chloride. In order to enhance detoxification and regeneration of liver cells demonstrated a glucose solution (intravenously or orally), vitamins C, E and group B (B1, AT2, AT6, AT12), Lipotropic (methionine, lipokain and so on. d.). In severe cases the use of blood plasma transfusion, albumin prescribed corticosteroids. In the early phase of the disease antibiotics are contraindicated because of the pronounced allergic symptom.
When the pain in the liver area used antispasmodics (papaverine, no-spa, etc...); of choleretic can assign allohol, holosas, hologol and so on. d.
However, due to high vulnerability to liveracute phase opisthorchiasis pregnant showing preparations having choleretic and anti-inflammatory effect, but no adverse effects on the fetus. These primarily include infusions and decoctions of herbs (immortelle, peppermint, St. John's wort, knotweed, calendula, chamomile, Agrimony, corn silk, etc.).
To prevent fetal hypoxia should appoint sigitin, galoskorbin, triad by Nikolaev.
The delivery from infested women need time to carry out prevention of fetal hypoxia, the weakness of labor and hypotonic bleeding.
Antiparasitic treatment during the acute phase hloksilomopistorhoza during pregnancy and lactation due to toxicity of the drug is contraindicated. To it is necessary to start at the end of the lactation period, calming acute period of the disease, but no earlier than 1.5 months after infection.
The preventive system aimed atindividual links of the chain at opistorhoze epidemic, major is currently the disposal of the fish. To educate the population rational methods of treating the fish should use all available forms of health education (lectures, talks, health classes in school, leaflets, film shows).