What Are Dangerous Parasites And How To Deal With Them?

Intestinal parasitosis, according to WHO, is the most common after tuberculosis. Such a helminth as opisthorch is considered the number one carcinogen worldwide. An allergist, a pediatrician tells about the treatment of helminthiasis in children and adults, about proven drugs against worm infestation.

Some say they are monsters, others ignore them, so who are they? Parasites (Greek: parasitos — a breadwinner, a worm) are creatures that feed on other organisms of the plant or animal world (called hosts) and temporarily or permanently reside on or in them. For the parasite, the host's body is a source of nutrition, a place of residence, and protection from enemies.

What to do if you are faced with this problem and how to protect your body from the destructive effects of parasites?

Now, when medicine is fighting swine flu, HIV infection, hepatitis, resistant bacterial infections, do we have time and opportunities to pay attention to the problem of parasites? How dangerous are they to our civilized society, armed with hygiene products and refined products? Any practicing specialist is forced to be a helminthologist or parasitologist, because in everyday practice he constantly has to face this problem.

Helminths are one of the oldest creatures in the world that have adapted to life in the human body and cause enormous damage to human health. Unfortunately, both doctors and the general public pay undeservedly little attention to helminthiasis in Ukraine. Accounting and registration of helminthiasis in our country is far from perfect, so the number of deaths caused by helminthiasis is unknown.

For example, according to the US Department of Health and Human Services, the number of deaths caused by parasitic diseases during the year is comparable to those from cancer and stroke. The situation in our country is, of course, much worse. A person is exposed to helminth infestation even more often than to acute respiratory diseases.

Intestinal parasitosis, according to WHO, is the most common after tuberculosis. Such a helminth as opisthorch is considered the number one carcinogen worldwide. According to Professor E. I. Bodna, in some regions of Ukraine (Poltava, Sumy, Chernihiv), more than 60% of the population is affected by helminths. Every year, the number of registered so-called imported cases of parasitic diseases, including helminthiasis, increases.

First of all, this trend is connected with increased population migration. Having entered the human body, parasites must overcome three protective barriers. Worms can die in the mouth under the action of special enzymes. If the helminths break through this obstacle, they will be met by the aggressive acidic environment of the stomach, and then by the local immunity of the intestine, which produces antibodies against foreign influences. In a weakened body, especially after drug therapy, all these obstacles may not work. Then the worms still get into the intestines and develop into sexually mature individuals.

How can parasites enter the human body?

• With vegetables, fruits, berries, in the cultivation of which fertilizers are used - animal and human feces. Meat and fish are often the source of infection.
• With the air, inhaling dust with eggs or parasite cysts.
• Because of dirty hands, not only their own, but also those of sellers, workers in the food industry and public catering. Eggs of several types of worms were found on one loaf of bread from a street stall.
• When swimming in freshwater reservoirs. For example, schistosome eggs are excreted in the urine, and the larvae that hatch through the skin enter the human body. It is not necessary to swallow them, it is enough to walk barefoot in the water.
• Infection can occur from domestic animals (cats, dogs, guinea pigs and others).

1 gram of cat feces can contain up to 20 million toxoplasma cysts. Usually, infection with worm eggs is possible from the age when the child is out of the crib, i.e. from 6-7 months. Children who have direct contact with earth and sand are especially likely to be infected. Babies have poorly developed defense mechanisms against invasion — the stomach is not acidic enough, and the immune system is not fully formed.

The possibility of infection of preschool children with worms is almost 100%. Children of this age group do not yet have sufficiently developed hygienic skills, and knowledge of the environment is largely through the mouth.

Clinical manifestations

The course of the disease is different - from asymptomatic to severe forms with a fatal outcome, depending on the type of parasites, their number, the host's sensitivity to their waste products and a number of other factors.

In the pathogenesis and clinic of helminthiasis, two main phases are distinguished: acute — the first 2-3 weeks after the infestation (with a severe course of up to 2 months or more) and chronic, lasting from several months to many years.

The most common clinical syndrome with helminthic infestation is gastrointestinal tract (GI) dysfunction. Children may have: unstable stool (constipation is more common, but there may also be loose stool); painful abdominal syndrome (from "flying" pains in the abdomen without specific localization, which pass in a few minutes, to persistent severe pains that imitate the symptoms of "acute abdomen"); flatulence; phenomena of dyspepsia of the upper gastrointestinal tract (belching, nausea, rapid satiety). Often noted: decreased appetite or hunger pangs, disturbed night sleep, teeth grinding (bruxism); irritability, moodiness, aggressiveness. The toxic effect of parasites on the central nervous system can cause seizures, mental retardation, depression, and hyperactivity.

In addition, with nematodes, especially with enterobiosis and ascariasis, hyperemia and irritation of the anus, perineum, and external genitalia occur. Girls often have vulvovaginitis. Parasites can cause obstruction of the intestinal lumen, bile ducts, bronchi, blood vessels, and squeeze organs.

Helminths are a powerful factor of sensitization of the body. Against the background of nematodes, atopic dermatitis increases, bronchospasm, cough appear, the course of other allergic diseases (including bronchial asthma, hay fever) worsens. Worm infestations can be the cause of allergies that first appeared, especially if they appeared in the summer-autumn period.

Eosinophilia in the general blood test is both a sign of allergy and a sign of parasitic diseases, in helminthiasis it occurs in 3-5% of cases, but in a "shocked" organ, for example, in the migration of larvae through the lungs, in the cytogram of sputum and smears from the throat and an increase in the number of eosinophils will be noted in the nose. In some situations, helminths lead to a significant increase in the level of total IgE.

Helminths weaken the work of the immune system, as a result of which the child suffers from frequent respiratory diseases, he may develop pustular or fungal lesions of the skin and mucous membranes, caries, hypovitaminosis, deficiency of trace elements, suppression of normal intestinal microflora and weakening of local immunity of the gastrointestinal tract. Chronic fatigue, hypotrophy or excess weight, pain in muscles and joints, anemia - this is not a complete list of symptoms caused by parasites.

Diagnostics of parasitic infestation

Feces, urine, duodenal contents, bile, sputum, rectal and perianal mucus, blood, and muscle tissue serve as biological material for research on the presence of helminths, their fragments, larvae, and eggs. The difficulties of diagnosing helminths are related to the peculiarities of their life cycle. The migratory phase of parasites is often not determined, although it occurs in 14.9% of patients. Fecal analysis for the detection of helminth eggs should be taken immediately after the full moon (V.I. Shaposhnikova, 1996). At the same time, the probability of detecting helminths ranges from 0 to 10-20%.

It should be noted that the simultaneous presence of different stages of helminth development in the body is possible, from larvae in the lungs to mature helminths that lay eggs in the intestines. The larvae of the causative agents of trichinellosis and strongyloidosis can be detected in the blood if blood is taken with anticoagulants, centrifuged and the supernatant of the blood plasma is examined under a microscope.

Determination of antibodies in the blood to nematodes is relevant only in the first 1-2 months of their presence in the body, when the worms are in the larval stage. Then the antibodies disappear from the systemic bloodstream, concentrating in the lumen of the intestine and being produced directly in the intestinal wall. Serological immunodiagnosis increases the accuracy from 60 to 95%, but the research is expensive and is not carried out in every laboratory. Ultrasound examination of organs, computer tomography, endoscopy with endobiopsy are used for topical diagnosis.

Immunologist professor E. A. Beysembaev in his monograph "How seriously ill patients become healthy" noted not only the connection of helminth diagnosis with the lunar cycle, but also the dependence of the effectiveness of treatment: "The laboratory staff informed us that it is useless to look for helminths on the new moon, on the full moon there is an emission of helminth eggs, during the waning moon, larvae are found in feces, and during the waxing moon, the migration phase of helminthiasis begins - larvae should be looked for in blood and sputum.

Therefore, during the waxing moon, when the migratory phase of helminths is underway, you should not give helminthicidal drugs. Let them migrate into the intestines. Therefore, during the waning month, when the parasites have already entered the intestines, the quality of the therapy will be more effective. Although mass studies and correlation were not conducted, pediatric practice confirms this conclusion.

Treatment of parasitic infection

WHO recommends preventive anthelmintic courses for preschool children twice a year — in spring and autumn. This tactic is justified, but if necessary (unfavorable epidemiological situation or clear clinical signs of helminthosis in a child), unscheduled deworming is possible. In the acute period, the basis of treatment is desensitization and detoxification.

Glucocorticoids are used according to indications only in severe cases of some helminth infections (trichinellosis, schistosomiasis, liver trematodes). It should be taken into account that if they are used incorrectly, the generalization of the invasion (strongyloidosis) or the transition of the acute phase to the long-term ongoing subacute phase (opisthorchosis, trichinellosis, etc.) may occur. It is important to monitor the regularity of the stool so that the body is not poisoned by toxins and decay products of parasites. Medicinal plants with antiparasitic activity have long been used for prevention and treatment. As a rule, these plants also have choleretic, tonic effect. Based on them, various biologically active additives and collections began to be produced.

It is necessary to prescribe with caution to patients with allergies to herbs, and also not to overdo it with the dosage. Many of these plants are used by housewives as spices in cooking. It is possible to note a regularity in the fact that spicy dishes rich in various spices are preferred by southern peoples, who are prone to a greater risk of parasitic diseases.

Otherwise, people simply would not have survived: it is impossible to take chemotherapeutic drugs for the purpose of deworming all year round, because similar means appeared relatively recently. The most famous antiparasitic plants are: wormwood, walnut skin, cloves, ginger, grapefruit, tansy, pumpkin seeds, chili pepper, turmeric, garlic, ant tree bark, aspen bark and others. Wormwood and walnut skin (black walnut) act on 100 species of developing and adult parasites, and cloves and ginger are harmful to eggs and larvae.

Specific treatment is the basis of the fight against most human helminthiasis. 4 drugs are most often used in anthelmintic therapy: zentel (albendazole, nemozole), vermox (mebendazole), biltricid (praziquantel) and dekaris (levamisole). Piperazine and pyrantel cause disturbances in purine metabolism, so they are contraindicated in dysmetabolic nephropathy, chronic pyelonephritis, gout, and urolithiasis.

Levamisole is prescribed once at bedtime in a dose of 150 mg (2.5 mg/kg) for ascariasis.

Mebendazole is a non-absorbable drug with high selectivity against helminths. In the absence of parasites in the intestines, it is excreted unchanged, without interacting with anything. For enterobiosis, 1 tablet per day is prescribed, with a repeat after 10-14 days, for ascariasis - 1 tablet 2 times a day for 3 days, for taeniosis and strongyloidosis - 2 tablets 2 times a day for 3 days, for children at the rate of 2, 5–5.0 mg per 1 kg of body weight.

Pyrantel pamoate is used for ascariasis and enterobiosis at 10 mg per 1 kg (no more than 1 g) once, and for hookworm patients in the same dose for 2-3 days.

Albendazole has been the most popular anthelmintic drug worldwide for over 20 years, which in itself is its excellent recommendation. Its advantage lies in a wide spectrum of action on various helminths, as well as giardia.

Albendazole is prescribed 200 mg 2 times or 400 mg once for the treatment of patients with hookworm, trichocephalosis, ascariasis and enterobiosis, and for clonorchosis and opisthorchosis, adults and children over 2 years old take 1 tablet or 10 ml of suspension for 3 days. Trichinellosis is treated with mebendazole 100 mg 3 times a day for 7-10 days, and albendazole 400 mg 2 times a day for 5-10 days is also used for this purpose.

Praziquantel is widely used for trematodes and cestodoses. For patients with opisthorchosis, clonorchosis, paragonimosis, it is prescribed in a daily dose of 75 mg/1 kg of body weight (in 3 doses) for 1 day, for schistosomiasis, depending on the form of the disease — 40-60 mg/1 kg once or in 2 doses; in case of fascioliasis, the effectiveness of the drug is not high; abroad, for these purposes, it is recommended to use triclabendazole.

In case of intestinal cestodoses (diphyllobothriasis and taeniidoses), deworming is achieved with a single dose of praziquantel in a dose of 20 mg/1 kg, in hymenolepidosis, the same dose is prescribed 2 times with an interval of 10 days, in case of cerebral cysticercosis abroad, the same drug is used in a daily dose of 50 mg/1 kg in 3 doses for 14 days or more.

Against the background of anthelmintic courses, there may be side effects associated with the destruction of parasites under the influence of drugs, which are often mistaken for a side effect of the drug itself. As a rule, these phenomena are of a short-term nature and are reduced by taking sorbents (lactofiltrum, enterosgel, tagansorbent, etc.). The simplest and most accessible sorbent is rice cooked without salt. A sorbent can be prescribed in advance if it is assumed that the probability of side effects is high. In the treatment of protozoa (amoeba, trichomonads, giardia), the following drugs are widely used: metronidazole (trichopol), Makmiror, furazolidone, tinidazole.

Prevention

Preventive anthelmintic courses are best carried out in the spring, 1-2 months after the snow melts (March-April) and in the fall, when frosts begin (October-November). You can reduce the probability of infection with helminths by observing elementary hygiene: washing hands with soap after using the toilet, contact with animals or the ground, before eating; treatment of toys with a soapy solution, thorough washing of vegetables and fruits before use. Try not to eat meat and fish without good heat treatment.

If the child shows symptoms of enterobiosis (anal itching and excoriation), all adult family members are prescribed mebendazole or pyrantel once, with repeated administration after 10-14 days. In the same case, it is recommended to boil (wash in a washing machine at a temperature of 90°C) bed linen and personal linen of all family members.

Pets need to be periodically dewormed, do not feed them raw meat, fish.