TRICHINOSIS

Trichinosis - helminthiasis nematosis from the group, characterized by fever, intoxication, muscle pain, swelling of the face, skin rashes, eosinophilia, and if severe - the defeat of the internal organs and central nervous system.

Pathogen - Trichinella spiralis. Sexually mature females and males are parasitic in the small intestine. female body length of 1.5 - 1.8 mm; male body length of 1.2 - 2 mm. Larvae through the mucous membrane of the intestine into the blood and lymphatic vessels and spread throughout the body, settling in striated muscle. 6 weeks, after which the parasites are killed - B 4 depending on the intensity of infestation female larvae selection continues. The larvae remain viable for many years. The meat of the larvae die only at temperatures over 80 ° C inside the piece. Salting and smoking act on larvae weak.

The source of infection of the pathogen for humans and animals are pigs, at least - wild boars, bears (brown and white), badgers, seals, walruses and OE person infected most often in the use of Trichinella larvae infested meat or bacon with layers of muscle tissue. The spread of infection caused by the ingestion of and sale of pork and meat of wild animals, not passed veterinary and sanitary control.

For trichinosis characteristic flash and group the seasonal nature of the disease. They are confined to the period of the slaughter of pigs and hunting permit - autumn and beginning of winter. Long-term storage in the home of tinned pork, sausages, and poaching may cause outbreaks in other seasons.

The clinical picture. The incubation period of 5 to 45 days. The shorter the incubation period of the disease is more severe.

Erased form of the disease manifests low grade fever, mild myalgia, sometimes pasty face or just age, eosinophilia up to 10-12%. In mild pasty face, muscle pain more pronounced body temperature rises to 38 - 39 ° C, eosinophilia reaches 10 - 20%. Acute effects continues for about 7 - 10 days, after which for several weeks may be low-grade fever, myalgias lungs, pasty face.

For trichinosis moderate severity characterized by a rapid rise in body temperature to 39-40 ° C. Fever remitting type is accompanied by pain in muscles, joints, swelling of the face, or exudative polymorphous skin rash. Children complain of a sore throat, abdominal pain, loose stools, but the appetite is usually stored. Identify lymphadenopathy. Eosinophilia reaches 25 - 40%, leukocytosis - 10-15h109 / l. At the height of the disease increases the ESR. Disease without specific treatment lasts 2.5 - 3 weeks. In severe disease the temperature rises to 40-41 ° C, characterized by myalgia, general swelling. Often, the initial period of abdominal pain, nausea , vomiting , diarrhea. Skin rash erythematous, papular, hemorrhagic, sometimes pustular, hemorrhagic. Identify lymphadenopathy, enlarged liver, spleen. Sudden muscle pain lead to contractures. Characterized by tachycardia , hypotension. May develop infectious-toxic shock . Naturally there are myocarditis , pneumonic foci of allergic nature, often - meningoencephalitis. Approximately 1/3 of patients the nausea , vomiting , diarrhea, sometimes with blood. A number of patients have sudden attacks of abdominal pain, hemorrhagic rash on the type of hemorrhagic vasculitis in the background to leukocytosis 30-40h109 / l with eosinophilia up to 80 - 90%. Observed proteinuria, cylindruria. CNS manifested excitement, insomnia, delusions, hallucinations, meningism associated with swelling of the brain membranes and substances. With the development of meningoencephalitis revealed focal symptoms, with a primary lesion of the cerebral cortex - acute psychosis, epileptiform seizures; ESR at altitude sickness reaches 50 - 60 mm / h.

When malignant course trichinosis appear nausea , vomiting , dizenteriepodobny chair against a background of severe intoxication with impaired consciousness. During the 1st week of the disease show signs of myocardial damage, lung, central nervous system. Muscle pain, swelling of the face appear only on the 2nd week of illness.

Diagnosis is based on clinical, epidemiological history, confirmed by the detection of the parasite larvae using trichinelloscope in the product, will be a source of infection. Some assistance has serological test - complement fixation, indirect hemagglutination reaction, enzyme immunoassay. If in doubt, use a muscle biopsy (calf, shoulder) patients.

Treatment of patients with all forms of trichinosis but worn, carried out in the hospital, because there may be progression of the disease and severe adverse reactions to the specific treatment. Treatment of patients with milder forms of erased and trichinosis, and patients admitted for observation in the period of convalescence after an average severity of the disease, non-steroidal anti-inflammatory agents spend. Specific treatment - mebendazole (Vermoxum) carried trichinosis patients of average weight and seriously ill. Vermoxum designate an adult to 0.3 grams per day (children at a dose of 5 mg per 1 kg body weight) in 3 doses after meals for 7-10 days depending on the severity of the disease. For the prevention of adverse allergic reactions in response to the death of the parasites specific treatment is carried out on the background of anti-inflammatory therapy brufenom or Voltaren. Corticosteroids administered together with specific drugs in severe disease with organ lesions - prednisone at a dose of 30 to 80 mg per day, or 6-10 mg dexamethasone per day for a period of chemotherapy with a rapid decrease in dose 5-7 days after its application.

Forced position of the patient and his immobility require care to change his position in bed, after removal of heavy state - massage, passive and then active exercises.

The prognosis of early diagnosis and treatment conducted rationally favorable. Convalescents should be evaluated after 2 weeks and 1-2 and 5 - 6 months after discharge from hospital. When residual effects medical examinations and rehabilitation measures continued for 1 year.

Prevention. The basis of prevention - veterinary-sanitary control of slaughter pigs, the sale of meat products, stabling pigs in areas inaccessible houses and wild rodents, cleaning the territory from the corpses of dead animals. It is important to the hygienic education of the population - an explanation of the ways of infection with trichinosis, the spread of infection when fed to pet thermally processed meat waste, waste hunting, the need for veterinary and sanitary control of meat products from individual farms, the meat of wild animals. If such control is impossible (Geological Party, road builders, loggers, etc.), You need to cook (boil) the meat is at least 2.5-3 hours, when the thickness of the piece does not exceed 2.5 cm.

In identifying infested meat is subject to combustion or industrial waste. In identifying patients with trichinosis products that caused the infection, urgently withdrawn and after their studies are destroyed. About patients with trichinosis make emergency notification. Within 24 hours, the physician-epidemiologist examines parasitologist or hearth, identifies persons exposed to the risk of infection with trichinosis. Those who ate infested meat, remain under the supervision of a weekly local doctor or medical assistant for 6 weeks with taking blood count and blood serology. Advantageously preventive treatment mebendazole (Vermoxum) at a dose of 0.3 grams per day in 3 divided doses after meals for 5 days, the children - a dose of 5 mg / kg body weight