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Opisthorchiasis hepatitis
Medical expert of the article
Last reviewed: 23.04.2024
[How is opisthorchiasis hepatitis developing?
After entering the human gastrointestinal tract, metacercaria penetrate the bile ducts, the gallbladder and the pancreatic ducts. Opisthorchis are found in the intrahepatic bile ducts in 100% of the infected, in the gall bladder - in 60, in the pancreas - in 36%.
Penetrated into the hepatobiliary system of metacercaria reach puberty in 3-4 weeks and then begin to lay eggs.
There are acute opisthorchiasis (from several days to 4-8 weeks) associated with migration of parasite larvae and the development of toxicoallergic syndrome on metabolites caused by larvae and chronic opisthorchiasis (continues 15-25 years).
The leading factor of pathogenesis in the acute phase of opisthorchiasis is a set of developing allergic reactions of immediate and delayed type that arise as a result of sensitization of the human body by the products of the exchange and decay of opisthorchiasis and damaged parasites by their own tissues. In addition, opisthorchis mechanically damage the walls of the bile duct and pancreatic ducts. Accumulations of parasites, their eggs, mucus, depleted epithelium in the ducts of the hepatopancreatic system create an obstacle to the outflow of bile and pancreatic secretions. Stasis of bile promotes the emergence of a secondary infection, whose pathogens penetrate the body ascending (through the biliary tract) and descending (hematogenous) ways.
Morphology of opisthorchiasis hepatitis
The most pronounced morphological changes in opisthorchiasis occur in the liver and in the peritoneal bile ducts.
Macroscopically: the liver is enlarged in size, with a leathery anterior margin, has adhesions with a diaphragm, subcapsular cholangioectases.
Microscopically revealed various dystrophic, atrophic changes in the parenchyma, occasionally - foci of necrosis. The hepatocytes located near the bile ducts are most affected. Disturbances in the nuclear apparatus and organelles of hepatocytes are detected at the ultra-microscopic and cytogenetic level in the form of gross destructive changes in organelles, up to lysis and necrosis. Bile ducts have thickened walls and uneven width of lumen, contain opisthorchis; characterized by cylindrical or bag-shaped cholangioectasis, productive cholangitis with proliferation of duct epithelium, accompanied by the formation of alveolar-tubular structures, whose cells are rich in mucus with a high content of mucopolysaccharides. In parallel with the proliferation of cells of the bile duct epithelium, the connective tissue surrounding them grows, which leads to a significant thickening of the duct walls.
Intrahepatic cholangioectasis is most often located on the visceral surface of the left lobe of the liver subcapsularly, translucent in the form of whitish crimped bands.
Hyperplastic processes in chronic opisthorchiasis seize the entire bile duct system, including extrahepatic biliary ducts, which lead to the formation of various strictures of the choledochus, the cystic duct.
Symptoms of opisthorchiasis hepatitis
The incubation period for opisthorchiasis is from 4 to 35 days. The disease begins sharply, with the rise in body temperature to febrile values, fever is kept from several days to 2 months; there is an intoxication, expressed in malaise, weakness.
In children, in most cases, sub-conditions are started, against a background of subfebrile temperature, abdominal pain, usually in the right upper quadrant and epigastrium, and malaise.
In adults and children in the acute phase of opisthorchiasis, the liver is enlarged in size, with palpation painful, Can be palpated from the hypochondrium of the spleen. In a number of cases, jaundice appears, from mild to intense, which is often associated with stagnant phenomena: in the biliary system.
Extremely characteristic for acute opisthorchiasis allergic phenomena in the form of a variety of skin rashes, itching, edema such as Quincke.
In addition to the defeat of the hepatobiliary system, other pathological processes (from the gastrointestinal tract, kidneys, etc.) can also be observed.
The biochemical analysis of blood reveals an increase in the activity of aminotransferases in 2-7 times compared with the norm, an increase in the level of bilirubin, a bowl of conjugated.
The picture of the clinical analysis of the blood is represented by leukocytosis, eosinophilia (from 20 to 60%) and increased ESR.
The course of opisthorchiasis hepatitis
The acute stage of opisthorchiasis, as a rule, is not allowed, the process passes into a chronic form. The local population in the outbreaks of opisthorchiasis has a primary chronic form of opisthorchiasis. Duration of the disease - from 2 to 20 years or more. With the combined course of opisthorchiasis and viral hepatitis, an increase in the frequency of moderate and severe forms of the disease, a significant severity of pain syndromes from the liver and gallbladder. When hepatitis B. C and D occur in children with opisthorchias, the incidence of death is increased, while in the case of single-infusion of opisthorchiasis, lethal outcomes in children are not observed.
With the duration of opisthorchiasis for more than 5 years, severe complications arise in the form of a stricture of the bladder duct, stenosis of the large duodenal nipple, chronic cholestatic hepatitis, cysts and abscesses of the liver,
Clinical classification
Isolate acute and chronic opisthorchiasis. Acute opisthorchiasis is divided into larval (larval) and parasitic in the form of the following syndromes: febrile, typhoid, arthralgic, hepatopancreatic, bronchopulmonary and mixed.
Chronic opisthorchiasis occurs in the following variants: latent, subclinical. Angiocholecystitis, hepatocholecystitis, gastroangiocholecystitis, hepatocholecystopancreatitis, associated. Chronic opisthorchiasis manifests clinically mainly symptoms of chronic cholecystitis and pancreatitis. Cholecystopathic variant of the disease has a picture of chronic recurrent cholecystitis, cholangiocholecystitis, cholestatic hepatitis.
Leading clinical syndromes are pain abdominal and dyspeptic. In the vast majority of patients, localization of pain is noted in the right hypochondrium and epigastrium. The pains are constant, characterized as oppressive, aching, of varying intensity. Hepatomegaly is a constant symptom; the spleen can be simultaneously increased. Dyspeptic phenomena are expressed in the deterioration of appetite, belching, vomiting, intolerance to fatty foods, instability of the stool.
Almost all patients with chronic opisthorchiasis have an asogenic syndrome in the form of weakness, lethargy, headaches, dizziness,
The presence of inflammatory and dyskinetic phenomena from the side of the biliary system is recorded during instrumental studies: ultrasound of the liver and gallbladder, fractional chromatic duodenal sounding, hepatobiliary scintigraphy.
Biochemical blood analysis often reveals an increased level of bilirubin, mainly conjugated, an increase in the activity of alkaline phosphatase and GGTP, with normal ALT and ACT activity.
In clinical blood analysis, just as in the acute stage of opisthorchiasis, eosinophilia,
Diagnosis of opisthorchiasis hepatitis
For the diagnosis of opisthorchiasis, information about the presence in the focus of opisthorchiasis and the use of thermally unprocessed fish of the Cyprinidae family is of great importance. Of the clinical symptoms, attention is drawn to the acute onset of the disease with fever, allergic rash and abdominal pain predominantly in the right hypochondrium; from laboratory tests - changes in peripheral blood in the form of leukocytosis and severe eosinophilia.
Parasitological diagnostics of acute opisthorchiasis is impossible, since helminths begin to excrete eggs only 6 weeks after the invasion. A serological test is recommended to detect antibodies to opisthorchis using RIGA and ELISA.
The main criterion for the diagnosis of opisthorchiasis is the detection of eggs of opisthorchis in feces and in duodenal contents. Usually, helminth eggs are detected no earlier than 1 month after the onset of the disease, and only after repeated studies.
Differential diagnosis of opisthorchiasis with viral hepatitis must be carried out due to the considerable similarity of the clinical picture of diseases,
Against viral: hepatitis will be indicated by fever or prolonged subfebrile condition with severe intoxication, very moderate activity of aminotransferases, defeat of bile ducts, confirmed by ultrasound, severity of pain in the right upper quadrant.
If there is no viral hepatitis with opisthorchiasis, then serological markers for hepatitis viruses will be negative.
Treatment of opisthorchiasis hepatitis
When treating patients with opisthorchiasis, the principle of phase, pathogenetic therapy (ursosan), specific treatment (prazikvantel (biltricid, azinoks)) and rehabilitation therapy aimed at restoring the impaired functions of the hepatobiliary system, pancreas and gastrointestinal tract should be observed.
Specific therapy is performed using prazikantel (biltricide). Biltricide is used for acute and chronic stages of the disease. The drug is active against mature and immature forms of the parasite. Biltricide is administered in a dose of 60-75 mg per 1 kg of the body weight of the patient for the course of treatment.
The domestic preparation of azinoks is not inferior in effectiveness to biltricid; he is prescribed in a dose of 30-40 mg per 1 kg of body weight.
These drugs lead to complete dehelminthization in 86.2% of patients with a descriptive hydrology hospital.
The effectiveness of specific treatment is assessed after 3 months after the course and after 6-12 months. The criteria for clearing the parasite are negative results of triple coprocopy and single duodenal sounding.
Prevention of opisthorchiasis hepatitis
Prevention of opisthorchiasis includes several directions. It is necessary to identify the foci of opisthorchis and to treat patients with opisthorchiasis in the foci; conducting sanitary-educational work among the population in natural foci; dehelminthization of domestic carnivores; The struggle with the intermediate hosts of the opisthorchs. Decontamination of carp invaded by metacercariae of the parasite at home is carried out for 32 hours at -28 ° C, salting with 20% saline solution for 10 days, cooking for at least 20 minutes from the boiling point.
Specific prevention does not exist.