Toksokaroz - the defeat of human tissues and organs of the larvae of a parasitic worm (helminth) toxocara Toxocara canis.The disease is widespread in our country and takes in the structure of helminth infections is one of the first places.
Toksokaroz refers to geohelminthiasis ( "geo" - land), as microscopic eggs with embryos helminth ripen and long time are stored in the ground.Natural host toxocara - a carnivorous animal from canine (dogs, wolves, foxes) and feline (cat), to the person they fall in error and do not develop to the adult forms.
disease occurs with such a variety of manifestations, that even experienced doctors are not diagnosed on clinical grounds.Toxocara larva migrates into the human body with the blood flow through the vessels and can get into any body, and this is caused by the corresponding symptoms.
often toxocariasis flows by type of allergic reaction as hives, asthma, angioedema.Suspect the presence of helminth allows complete blood count, and then the doctor appoints con
Pathogen and ways of its transmission
toxocara - parasitic worms from the class of roundworms or nematodes (Nematoda).
- most often affects human toxocara dog (dog Ascaris, Toxocara canis)
- In rare cases, the pathogen becomes toksokaroza toxocara cat (cat Ascaris, Toxocara mystax).
external parasites like Ascaris lumbricoides, as they close relatives: they share the same type structure, life cycle, migration of the larvae.However, the final home of their different, so they cause different diseases at the clinic.
toxocara is white, elongated body in the form of a thin cylinder with pointed ends.females length of 6.5-10 cm, and males are smaller have an average length of 4 to 6 cm. Adults live only in the stomach and intestines of dogs or cats, they do not occur in humans.
accidentally ingested parasites, which are the owners of other animals, causing severe damage to internal organs, as they are not adapted to living in such conditions.They can not complete the development cycle and move into a safe form for the host.
parasite always strives to be invisible to the owner, so the causes minimal changes in his body, subtle symptoms.The worm is interested in the fact that its habitat is a long time supplying it with nutrients and remain viable, therefore invasion (helminth interactions with man) is usually a benign.
infected animals occurs in the following ways:
- by eating the feces of other animals, soil, contaminated eggs toxocara;
- by eating rats, mice infected with larvae toxocara;
- during pregnancy larvae penetrate through the placenta to the developing bitch puppies;
- when ingested puppies mother's milk contaminated with the larvae of the helminth.
Egg toxocara gets into the stomach of the dog / cat, where under the influence of gastric juice its dense outer shell splits and the larva emerges.It reaches the small intestine wall and drill it enters the blood vessels.With the current blood larva passes successively through:
- hepatic veins;
- inferior vena cava;
- the right atrium and ventricle;
- left side of the heart;
- systemic circulation from which accumulate in any body.
In normal animals the larvae are deposited in the lungs, before reaching the systemic circulation.They are carried with mucus in the throat and swallowed a dog, again falling into the gastrointestinal tract.In the small intestine, the larvae reach maturity and begin to multiply.The eggs are ejected from the feces of the animal.They fall into the soil, where ripen within 1-4 weeks and become contagious for the following hosts.
person infected in the following ways:
- when ingested toxocara eggs with animal fur;
- by eating vegetables contaminated land, fruits, berries;
- at ground eating (typical for children and the mentally ill).
to infection most susceptible to small children, since they are not formed personal care skills.Usually infection occurs during the warm season, since in this period of human contact with the ground occurs quite often.Often toxocariasis occurs in people employed in agriculture, the mentally ill, in unscrupulous families.
big role in the transmission of toxocariasis play cockroaches.They eat helminth eggs and secrete them in a viable state of human habitation on the food, which leads to infection of people.
In humans, the larvae toxocara always go into the systemic circulation and deposited in the organs in which they are able to penetrate the vascular wall.The larva enters the environment unsuitable for her, so she is covered with a dense capsule and goes into an inactive form.In this form it can be stored in the body for years.Its further promotion of hamper the immune system cells that form around the larva inflammatory barrier.Any decrease in immunity leads to activation of helminth and exacerbate the disease.
Classification and symptoms
Toksokaroz disease occurs in various forms:
- manifest - with clear clinical signs;
- erased - with minor non-specific symptoms;
- latent - without any manifestations observed upon examination of the patient, disturbing him.
severity of the disease depends on age:
- toxocariasis in a child younger than 12 years takes place in the manifest - severe or moderate form
- in adults symptoms of toxocariasis or erased, or absent entirely
If the disease lasts less than 3 months,it is called acute if more - chronic.In chronic toxocarosis asymptomatic periods (remissions) replaced exacerbations, during which the larvae resume their migration and cause a new wave of clinical manifestations.
On clinical displays allocate following forms of toxocariasis:
- visceral (internal organs with lesions);
Regardless larvae localization in the organism, its presence activates the cells of the immune system, making them more aggressive.They are determined to fight the parasite, which often results in allergic reactions by type:
- rashes on the skin - its elements in appearance resemble mosquito bites, can be ringed, located on any parts of the body.Accompanies rash itching of varying severity, from minor discomfort to a complete loss of peace.
- angioedema - it is localized in the neck, squeezing the throat than hinders the passage of air into the lungs.In humans, there is a sudden asthma attack, he could not breathe and exhale completely, his skin turns blue.Without emergency medical angioedema often ends with the death of a person.
- bronchial asthma - manifested in the form of a long dry cough with a slight amount of light sputum, shortness of breath and choking attacks during which a person can not make a full exhalation.The breath of the patient during an attack becomes so noisy that dry wheezing audible at a distance from him.
acute form of toxocariasis, and exacerbation of chronic often accompanied by fever, the patient's body temperature rises to 37-38 degrees C. The symptoms of intoxication: weakness, headache, loss of appetite, aching muscles and joints are expressed slightly or completely absent.In the presence of the parasite in the body react to the lymph nodes - five or more of the groups increase in size, but are painless and mobile (with no signs of inflammation).
90% of cases occurs with damage to internal organs.Symptoms toxocariasis in this case is directly connected with the system, affected larvae combined with manifestations of allergies and intoxication.As mentioned above, the parasite travels through the human body through the blood, so it is often deposited in a vast network of blood vessels and organs of the relatively slow blood flow: the liver, lungs, and brain.
defeat digestive system begins with the penetration of larvae in the liver tissue.Then they get into the bile ducts, pancreatic ducts, 12-duodenum, small intestine.Thus, the larvae break the outflow of bile and pancreatic juice, injure the intestinal wall, which is manifested by the following symptoms:
- heaviness in the right upper quadrant;
- stabbing pain under the ribs on the right;
- bitter taste in the mouth;
- breakdown chair: constipation alternating with diarrhea;
- nausea after fatty foods;
- abdominal pain;
- weight loss.
toxocara can mechanically damage the intestinal wall, leading to a small permanent loss of blood, which clinically manifested anemia (decrease in hemoglobin in the blood), weakness, pale skin and mucous membranes, tinnitus.
defeat of the respiratory system is manifested:
- persistent dry cough without phlegm, or with a small amount of it;
- shortness of breath;
- difficulty exhaling;
- bouts of breathlessness.
toxocariasis subsequently leads to the development of a full-fledged asthma, sometimes it causes severe pneumonia, pulmonary edema.
In some cases, when passing through the chambers of the heart larvae settle on the heart valves that causes the development of endocarditis.The damage disrupts the normal valve hemodynamics, clinically it is manifested as cardiac failure:
- bluish tinge to the skin of fingers, nasolabial triangle;
- shortness of breath and cough in the supine position, if damaged the left half of the heart;
- symmetrical swelling in the legs, abdomen damaged if the right half of the heart.
Eye shape (oftalmotoksokaroz)
quite rare form of the disease, develops in the defeat of the larvae toxocara orbit of the eye, his muscles or internal structures of the eyeball.In this case, toxocariasis in humans manifests itself:
- sudden loss of vision, complete or partial, often in one eye;
- redness of the conjunctiva;
- bulging of the eyeball;
- edema and hyperemia of the eyelids, eye socket tissues;
- bursting pain in the orbit;
ocular form of the disease predominantly affects children, with allergic symptoms and general intoxication they are not expressed.
migration of larvae in this case takes place directly in the dermis of the skin, which is manifested:
- skin itching, burning, pain;
- wiggling sensation under the skin;
- appearance on the skin of red inflamed traces of the parasite's movement;
- inflammation of the skin in the area of infestation.
toxocara penetration of larvae through the blood-brain barrier leading to inflammation of the meninges and brain tissue.The disease is serious and manifest symptoms of neurological disorders:
- severe headache Expander nature;
- excruciating nausea, vomiting fountain;
- tension of the neck muscles and back;
- increased sensitivity to sound, light, touch;
- limb muscle weakness or complete paralysis;
- impairment of consciousness up to coma;
- unsteadiness of gait, loss of balance;
- mental disorders (aggressiveness, decreased intelligence, growth retardation in children).
toksokaroza engaged doctors of various specialties, depending on which system officials struck a man and what symptoms he went to hospital.To suspect worm infestation allows them to:
- general clinical blood test, which significantly increased the number of eosinophils - blood cells responsible for immunity antiparasitic.
- the next step in the diagnosis of toxocariasis is to determine total immunoglobulin E in venous blood serum, which will also be upgraded.
In most cases, patients with eosinophilia and the high concentration of immunoglobulin E sent for consultation to infectious diseases.The defeat of the internal organs and systems, allergic reactions, swollen lymph nodes suggest a doctor at the thought of tissue helminthiasis, one of which is toxocariasis.Diagnosis of toxocariasis in children and adults is indirectly confirmed by detection of specific immunoglobulin E to toxocara serum.Direct confirmation of diagnosis - a detection larvae themselves in the patient tissues, traumatic or impossible in most cases.
in favor of toxocariasis is the presence of a dog person, infield, farm, non-observance of rules of personal hygiene.Among the methods of research informative following:
- general analysis of blood - eosinophilia in addition there are detected increase in the total number of white blood cells (leukocytosis), accelerated erythrocyte sedimentation rate, decreased hemoglobin concentration and red blood cell count (anemia);
- biochemical analysis of blood - at toxocarosis observed increase in total protein levels of amylase, AST, ALT, GGT, alkaline phosphatase, C-reactive protein;
- microscopic examination of sputum - with the defeat of the respiratory system in it found larvae toxocara;
- chest x-ray cells - larvae in the lungs leads to the appearance of eosinophilic infiltrates - portions of the lung tissue with high density that is clearly seen in the photographs.Their feature - the migration of pulmonary infiltrates on the field for each subsequent study.
- ultrasound of the abdomen - reveals an enlarged liver, spleen, inflammation of the gall bladder and pancreas;
- echocardiogram - at toxocarosis with lesions ultrasound of the heart valves can be assessed hemodynamics and severity of injury;
- computer or magnetic resonance imaging - examine the internal organs, the central nervous system for the detection of specific inflammatory sites, within which the larvae are enclosed;
- ophthalmoscopy - eye examination by an ophthalmologist internal environment that allows you to identify the foreign particles in them;
- measurement of visual acuity - when oftalmotoksokaroze visual acuity in the affected eye drops sharply, healthy - is stagnant.
toksokaroza engaged in infectious disease physician, together with doctors of other specialties, if there is a defeat:
- eye - an ophthalmologist;
- nervous system - a neurologist;
- perforation of the intestinal wall - a surgeon.
When erased and latent for disease therapy is carried out in an outpatient setting, with the manifest toxocarosis treatment in children is carried out in a hospital environment.Adult admission is shown in the development of serious complications.
All patients assigned hypoallergenic diet to reduce the activity of the immune system and prevent allergic reactions.From diet to exclude brightly colored foods, citrus fruits, chocolate, cheese, wine, pickles, meats, spices.
for medical treatment of toxocariasis in children and adults use a group of drugs listed in the table.