What Are the Symptoms of Liver Fluke Infection?

Its danger is mainly liver damage in patients. Metabolites and mechanisms of parasites during biliary parasitism

Liver fluke disease

Liver fluke is also called clonorchiasis, and its adult parasites in human liver and bile ducts can cause liver flukes. It is clinically characterized by anorexia, diarrhea, upper abdominal discomfort, hepatomegaly, and increased eosinophils. The disease is mainly prevalent in Southeast Asian countries abroad. The disease is prevalent in 23 provinces, municipalities and autonomous regions in China. Guangdong, Taiwan and other provinces are the main endemic areas.

Introduction to liver fluke disease

Its danger is mainly liver damage in patients. Metabolites and mechanisms of parasites during biliary parasitism

Liver fluke disease Mechanical stimulation results. The lesions are mainly in the secondary bile ducts of the liver. The initial lesions are not obvious. After a long period of severe infection, the bile ducts have localized dilatation and the walls have thickened. A large number of worms can cause obstruction and bile retention, such as bacterial infection can cause cholangitis and bile duct hepatitis. Chronic infection can have a large amount of connective fibrous tissue hyperplasia, and the nearby liver parenchyma can be significantly atrophied. The bile duct secretes an increased amount of glycoprotein, and attaches to the surface of the worm eggs as the core of the stone, acts as a scaffold and an adhesive, promotes the deposition of calcium bilirubin, and finally causes pigment stones (ie, multiple stones in the liver).

Causes of liver fluke disease

Adults of liver fluke disease parasitize mainly in the hepatobiliary ducts of humans or mammals (eg cats, dogs, pigs, mice). In endemic areas, worm eggs often enter the intestine with bile, and are mixed with feces and excreted from the body. Eggs are swallowed into the digestive tract by the first intermediate host snail or marsh snail in the water to hatch hairy maggots, which undergo a series of development and reproduction of cell maggots and thunder cockles, and finally form many cymbals. The mature cercariae escapes from the snail tail and swims in the water. When encountering the second intermediate host freshwater fish or shrimp, it invades the body to form a cystic cyst.

Liver fluke disease Infectious. In endemic areas, the first intermediate host snails, marsh snails, second intermediate host carps and small miscellaneous fish live in the same waters, and fish are raised with human and animal dung, and human and animal dung is usually poured into fish ponds or Building toilets in fish ponds can cause a large number of fish infections. Capsules are more resistant to condiments. They can be maintained in soy sauce (containing 19.3% of sodium chloride) for 5 hours, and in vinegar (containing 3.36% of acetic acid) for two hours before they die. Therefore, people who eat sashimi will eat raw sashimi with seasoning, which is very easy to contract the disease. The thickness of 1mm, sacral fish fillets, all died in 90 ° C and 60 ° C water within 1 second or 10 seconds, respectively. Therefore, if you eat "fish porridge", Thick, or a large number of fish fillets, the temperature of the porridge can be reduced after it is placed in the porridge, and it is not easy to kill the cyst. After grilled small fish, if the internal fish is not thoroughly cooked, the cysts cannot be killed. People eat this food and they are susceptible to the disease. People who eat raw fish and shrimp are more likely to be infected with the disease.

Liver fluke disease symptoms

The prevalence of liver fluke disease is mainly related to the raw and semi-raw freshwater fish and shrimp of the local residents. The residents of Guangdong like to eat "fish raw" and "fish raw porridge"; the Koreans in Liaoning often eat raw fish and drink alcohol; Shandong, Children in Henan and other provinces like grilled small fish. The eating habits described above are the main ways in which people become infected with liver flukes. The name of trematodes is that adult worms of the genus Testa sinensis parasitize in the bile ducts of humans or animals. The adult lifespan can reach 20-30 years or more. The worms take up the host's red blood cells and white blood cells, and continuously excrete metabolites and secrete them.

Liver fluke disease Damaged by toxic substances, host adults continuously excrete ovum eggs and eggs with the bile into the digestive tract and excrete with feces. Liver fluke eggs are one of the smallest worm eggs in human intestinal parasites, and their shape is similar to an electric bulb. The eggs constantly develop and hatch larvae in a suitable external environment. After encountering freshwater snails and being swallowed, the larvae develop into the second stage larvae, cercariae, which escape from the snails and continuously on the water. Swimming, if encountering freshwater fish and shrimp tadpoles, it will attach the fish body and invade the fish and shrimp tissues to form infectious larvae, cysts. At this time, if you eat liver trematode cysts, small fish or shrimp or sashimi Uncooked fish and shrimp and those contaminated by liver fluke cysts, other foods can cause infections. The harm is mainly the liver damage of patients, which is the result of metabolites and mechanical stimulation of parasites during biliary parasitism. The lesions are mainly in the secondary bile ducts of the liver. The initial lesions are not obvious, and the bile ducts appear after severe infection for a long time. Localized expansion of the thickening of the tube wall, a large number of worms can cause obstructive bile stagnation, leaving a chronic infection of cholangitis and cholangiohepatitis if combined with bacterial infection, there can be a large number of connective fibrous tissue hyperplasia, and the parenchyma of the liver can be clearly atrophic The secreted glycoprotein increases and attaches to the surface of the worm egg as a calculus core that functions as a scaffold and an adhesive. Promoting the deposition of calcium bilirubin eventually leads to the appearance of pigmentary stones (multiple stones in the liver), and the detection of worm eggs is the main basis for the diagnosis. Immunological diagnosis: intradermal test, indirect hemagglutination test, convection immunoelectrophoresis test, enzyme-linked immunosorbent assay, adsorption test, indirect fluorescent antibody test, etc. have been tested for clonorchiasis sinensis, assisting diagnosis but detecting the results of patients, the difference is large and other digestive Infection with parasitic worms (especially fluke infections) is obvious, and cross-reactivity cannot be used to confirm the diagnosis. It is only used for preliminary screening of epidemiological investigations.

Clinical manifestations of liver fluke disease

Liver fluke disease The incubation period for liver fluke disease is about 1 month. Mild infections often have no obvious symptoms. Only worm eggs are found in the patient's stool, and a few have mild upper abdominal discomfort and diarrhea. Heavier infections start slowly, in addition to anorexia, diarrhea, bloating and other gastrointestinal symptoms, and often have palpitations, insomnia, dizziness and other neurasthenia symptoms. Hepatomegaly is dominated by the left lobe, and a few people with repeated infections can eventually develop cirrhosis and portal hypertension. Severely infected children can develop malnutrition and growth disorders. Lack of immunity to the disease

Liver fluke disease , Or a large number of consecutive multiple infections, before the stool can be seen in the eggs, sudden chills, high fever and diarrhea, hepatomegaly and tenderness, a few have splenomegaly and jaundice, eosinophils significantly increased. The disease is generally classified into the following clinical types: Hepatitis type: the most common type, with weakness, epigastric discomfort, bloating, loss of appetite, discomfort or pain in the liver area. Physical examination showed mild and moderate swelling of the liver, often without tenderness, and some patients had slightly elevated serum transaminase. If you do not pay attention to the epidemiological history, it is easy to misdiagnose the disease as viral hepatitis. Cholangitis type: Patients have chills, chills, fever, accompanied by epigastric colic, sometimes jaundice, and increased total white blood cells. This type of patients often have cholangitis or gallbladder stones. (3) Gastroenteritis type: manifested as bloating, diarrhea, stools about 3 to 4 times a day, no pus and blood, and no abnormalities are often found on microscopic examination. (4) Cirrhotic type: hepatomegaly, stiff, with ascites, splenomegaly, decreased plasma albumin, anemia, and lower limb edema. This type is more common in children during epidemic periods, and is often accompanied by malnutrition. (5) Dwarf type: This type is often accompanied by cirrhosis, and it occurs in children with severe liver infection. (6) Concealed type: This type is the most common and is generally asymptomatic. It is only found during physical examination, epidemiological investigation, or consultation for other diseases. (7) mixed type: accompanied by each of the above types during the illness.

Diagnosis of liver fluke disease

Those who live or travel in endemic areas and have a history of eating raw fish or shrimp and undercooked fish (including dried fish and salted fish) will experience bloating, diarrhea and other indigestion symptoms, accompanied by hepatomegaly or other hepatobiliary systems When you are sick, you should

Liver fluke disease Consider the possibility of this disease. The diagnosis depends on direct smearing or concentration of feces to find eggs. If the feces are negative many times, duodenal drainage can be used to collect bile to find worm eggs. Immunological examinations, such as intradermal tests and convection immunoelectrophoresis, can assist diagnosis.

Liver fluke disease treatment

Patients with severely infected liver fluke disease and malnourished should rest in bed and be given a nutritious, easy-to-digest diet. After systemic symptoms have improved, deworming treatment should be applied. Commonly used drugs are: praziquantel: the commonly used dose is 25mg / kg each time, 3 times a day for 2 months (the total amount is 150mg / kg), and it is the first choice for treating this disease. Side effects are mild and rare, with occasional headaches, dizziness, nausea, and fatigue. Albendazole (prothioimidazole): It is a high-efficiency, broad-spectrum insect repellent discovered in recent years. The dose is 5 to 10 mg / kg each time, twice daily for 7 days. There are few side effects, and a few may have dizziness, fatigue, diarrhea, etc., which can be relieved by themselves. Pregnant women and children under 2 years old are contraindicated. Patients with concurrent biliary tract infections should be given antibiotics, and those who do not respond can be considered for surgery.

Symptomatic treatment of liver fluke disease

In severe cases with malnutrition or cirrhosis, nutrition should be strengthened, the liver should be protected, and special treatment should be considered later. When there are acute surgical complications such as cholecystitis and common bile duct obstruction, they should be treated immediately.

Etiology of liver fluke disease

(1) Praziquantel has high curative effect, short course of treatment, and mild side effects. It is the first choice for treating this disease. The total dose depends on the severity of the infection, and the lighter can be treated with 75 mg / kg or 210 mg / kg for 5 days. (2) Micropowder capsules of nitrothiocyanate 3-6um

Liver fluke disease , The total dose is 6-8mg./kg aliquots 3-5 parts, 1 part per day, the drug has more side effects, and a few can appear jaundice. Jaundice and acute and chronic hepatitis for various reasons have not recovered for less than one year, and women with a history of mental illness, pregnant and lactating women, aerial work and driving are prohibited. (3) Hexachloro-p-xylene (Schizophrenia 846) dry powder type 50-70mg / kg per day, taken in two or two servings, even for 5-7 days as a course of treatment, the total adult dose is generally 17.5g. The drug has slow metabolism and excretion, and has certain side effects and delayed reactions. Individual patients may have liver damage, toxic psychosis and hemolytic reactions. Therefore, those who have the above medical history and severe neurosis and hemoglobin disease should not take it. Nitrothiocyanine and six Chloroparaxylene is now used sparingly.

Liver fluke disease diet

Strengthen manure management, ban eating immature fish, and actively treat patients.

Liver fluke disease prevention

Liver fluke disease is mainly transmitted through food. Therefore, do good publicity work in endemic areas, make the people understand the transmission of the disease, change bad eating habits, do not eat raw or semi-raw fish and shrimp; after cutting raw fish with a kitchen knife, you must wash the meat before cutting it to avoid sacral Infection; strengthen manure management, do not use manure of cats, dogs, pigs, etc. that have not been harmlessly treated to fertilize or feed fish and shrimp, and prevent manure from contaminating water sources and fish ponds; the sale of fish raw and "fish porridge" diets is prohibited And use raw fish scales, fish viscera, etc. to feed dogs, cats and other animals; census and treat patients, identify the host to protect the insects, and adopt killing, treatment or management according to the different economic value of the host. As long as the above measures can be taken effectively, it will not be difficult to achieve the goal of eliminating liver fluke disease. Vigorously do a good job in health promotion and education to improve the public's understanding of the transmission of the disease. Consciously do not eat raw or unfamiliar fish and shrimp. Improve cooking methods and change dietary habits. Note that separate use of kitchen knives, cutting boards and utensils that cut raw and cooked foods does not require raw fish Cats and dogs. Active treatment of patients and infected people is an active measure to protect people's health and reduce the source of infection. Therapeutic drugs At present Praziquantel is the first choice. Reasonable treatment of feces and changes in fish culture habits are important measures to prevent the spread of clonorchiasis In addition, combined with production, the need to clean pond mud to disinfect fish ponds has a certain effect on killing snails.