The symptoms and treatment of opisthorchiasis in children

Opisthorchiasis refers to the feral infestation that affects fish-eating mammals, however, in endemic regions, the main source of pathogens is considered. Parasites enter the body of the carrier when eating fish of the carp family, which has not been fully heat treatment, was not sufficiently well frozen, was poorly salted and poorly dry. Among indigenous people North infection of the population reaches 80-100% that is connected with traditions of local people who fish without heat treatment. Children living in the Northern regions of Western Siberia, 8 years opisthorchiasis affected in 80-100 % of cases. In the Kama river basin among indigenous children aged one year to three years, when examination revealed isolated cases of lesions helminthic infestation, and to 14-15 years the incidence is 30-40 %.Among the local Russian-speaking population infection a little lower.

The symptoms of opisthorchiasis in children

In children with acute opisthorchiasis, the disease can occur without obvious symptoms, the disease can have different clinical manifestations. In Pediatrics to meet all known variants of acute pathology: cholangitis, hepatocholecystitis, lipopathy and respiratory. Chronic opisthorchiasis may take a latent form and be accompanied by severe symptoms with symptoms of chalapathi and gastroduodenopathies, and the cause of in children of cirrhosis of the liver is deservedly considered a viral infection.

In regions that are considered highly endemic for opisthorchiasis, a disease in children accepts primary chronic course. Clinic may develop later in the middle and even in old age, the cause of recurrence can be a comorbidity or intoxication. In areas with medium endemicity opisthorchiasis is acute, in children aged from one year to three years, he manifested in the form of subfebrility, pathology is accompanied by complaints of pain in the right hypochondrium and epigastric region, in some cases, patients appear skin rashes or exudative polymorphous character. Among the symptoms of opisthorchiasis in children may be catarrh of the upper respiratory tract, an upset chair. When inspecting and carrying out of laboratory researches it is stated lymphadenopathy, enlarged liver, low concentration of albumin in the blood eosinophilia, the value of which reaches 12-15 %. Over time, the primary manifestations of the diseasejoined by other changes in the blood picture, such as increased erythrocyte sedimentation rate up to 20-25 mm/h, elevated concentrations of ALPHA2-globulins, there is a tendency to decrease in hemoglobin, there are signs of underdevelopment. In children aged four to seven years of allergic reaction more pronounced eosinophilia is 20-25 %, leukocytosis up to 10 12h109/l. Have their own characteristics symptoms of opisthorchiasis in children of secondary school age, subject to a massive invasion. After 2-3 weeks after contact with pathogens in the body of a child in this age group, he noted fever, rash on the skin develops pulmonary syndrome in the form of volatile infiltrates or pneumonia develops pronounced degenerative changes in the myocardium. In extremely severe form of opisthorchiasis develops allergic hepatitis, which is manifested as jaundice and Eosinophilia hepatosplenomegaly is 30-40 %, erythrocyte sedimentation rate is kept at 25-40 mm/h, increasing the concentration of ALPHA2 - and gamma-globulins in the blood serum, increased activity of transaminases, especially alkaline phosphatase, bilirubin concentration in blood reaches 25-35 µmol/l due to the conjugated fraction. The severity of symptoms in acute opisthorchiasis may increase gradually, the most striking manifestations of the disease be after 1-2 weeks after infection.

During the chronic process in children marked cholepathia, in rare cases, gastroenteropathy, in 1/3 of cases, there is fatigue, for young children are characterized by delayed physical growth, decreased appetite, constipation or diarrhea. During the inspection and laboratory examination, the doctor may reveal mild enlargement of the liver, in rare cases, tenderness, a characteristic symptom of pathology is considered eosinophilia, reaching 5-12 %, the downward trend of hemoglobin. Subject to constant re-infection the symptoms of opisthorchiasis is growing over time, reaching its peak for 10-12 years of a child's life. Among the most common complaints – the feeling of heaviness and pain in the right hypochondrium, nausea, unstable stool, loss of appetite, the cause of these manifestations is considered to be the transition of hypertensive dyskinesia of the gallbladder in a hypotonic form. Eosinophilia remains constant, its value corresponds to 5-12 %, there is a tendency to anemia and hypoalbuminemia. To 14-15 years, symptoms of opisthorchiasis may be indicators of a blood test in some cases come to normal, dyskinetic disorders of biliary system may not appear as often, which is likely caused by the formation of immunity to antigens of the parasite.

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Treatment of opisthorchiasis in children

Treatment of opisthorchiasis in children in the acute stage, when the disease is accompanied by high fever and malfunction of the internal organs, beginning with measures aimed at reducing intoxication. Of the drugs in this case, the prescribed antihistamines, and calcium salts, if the patient shows the glucocorticoids in the form of injections or tablets as well as medications that improve the activity of the cardiovascular system. After lowering the body temperature to normal values, the emergence of positive dynamics on the ECG or when the full normalization of the heart (preferably) and after the elimination of focal changes in lung tissue during one day treatment with praziquantel. It must be taken after meals, dividing the daily dose into three doses. Patients at the time of treatment assigned table number 5, they are encouraged to limit the use of products containing coarse fiber, and fats. Patients assigned to laxatives. Therapy is conducted in patients receiving anti-allergic drugs, calcium salts and ascorbic acid. After 3-6 months after the end of treatment, assessed its effectiveness by using laboratory tests of feces according to the method of Kato and examining under a microscope the gut contents recovered by duodenal intubation. If necessary, the treatment repeated. After the last course of therapy, the child is under medical supervision for three years, according to the testimony of this period may be of pathogenetic therapy.