[Cases of trichinellesis in citizens of Moscow].
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Biomedical subjects
Publications and source records attributed to A M Bronshteĭn.
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The paper describes a case of cutaneous myiasis caused by the larvae of Hypoderma bovis. Its prolonged recurrent course over 4 months was observed. It appeared as migrating mass lesions, toxicoallergic reactions, and syncope. The paper is the first to show it possible to perform chemotherapy of myiasis with the antibiotic ivermectin in combination with aversectin ointment.
Filtration method for the detection of Opisthorchis eggs in the bile is by an order more sensitive than the routine method. It is recommended for diagnostic studies for cases with a low invasion level and in assessment of the efficacy of chemotherapeutic agents. This technique may be useful in the diagnosis of other helminthiases as well.
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Sixty patients with a chronic Opisthorchis felineus infection were administered one-day therapy with praziquantel in doses 25, 40, or 60-75 mg/kg b. m. The former two doses of the drug did not much improve the levels of the examined immunologic parameters. In patients treated with the highest dose of praziquantel a significant decrease of the total and specific IgE and CIC levels, reaching that in the reference groups, was observed in 6-8 months after the treatment, this indicating a 92% efficacy of the drug in this group of patients.
A focus of metagonimiasis and nanophyetiasis is described with the average human prevalence of 66.7 and 4.2%, respectively and low intensity of invasions (less than 100 eggs per 1 g). Metagonimiasis and nanophyetiasis are clinically expressed as chronic enterocolitis. A high effect of a single dose 10 mg/kg of azinox against metagonimiasis (98%) and nanophyetiasis (100%) was shown. The treatment course was proved to be useful in the foci of the Amur basin.
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An intensive focus of intestinal nematodiases in a foothill province of Vietnam is described; the incidence of ascaridiasis there was found to be 81.8%, trichuriasis 78.1%, and ankylostomiasis 12.3%. Polyinvasions were detected in more than 80% of the examinees. Analysis of five schemes of medamin therapy, used in three provinces in 595 patients with ascaridiasis, 490 ones with trichuriasis, and 323 ones with ankylostomiasis has shown that the treatment efficacy was reducing with the invasion intensity augmentation. In ascariasis the 3- and 5-day therapeutic schemes were the most effective, their efficacies being 68.4 and 82.0%, respectively; in trichuriasis and ankylostomiasis a 3-day scheme was the best, its efficacies being 74.0 and 71.9%, respectively. Retrograde ascarid migration occurred in 1.2% of 595 ascaridiasis patients after medamin therapy.
Examinations of 1599 residents of a polyinvasion focus at a seaside province Ha Nam Nin, Vietnam, have revealed clonorchiasis in approximately 13.9% of the examinees; in subjects aged over 30 this value was 29.3%. Factors conducive to a lower incidence of clonorchiasis were detected, among them a moderate intensity of the invasion: the mean arithmetic was 1419 +/- 306 eggs/g, the mean geometric 673 egg/g, as shown by the Kato-Kats' technique. Analysis of five therapeutic schemes used in clonorchiasis, making use of chloxilin, medamin or praziquantel, has demonstrated a low efficacy of all of them. Praziquantel therapy in a daily dose of 25 mg/kg for 2 days was found the most effective (52%), being conducive to a reduction of the invasion intensity by at least 90%. Such therapy was associated with a high incidence of side effects (91.2%), this ruling out a higher dosage.
Dirofilaria repens Railliet et Henry, 1911 was for the first time studied in the Moscow Region where 11 patients (6 males and 5 females) aged 4-72 years were recorded in 2000-2002. The geographical distribution (the southern and south-eastern parts of the region) of local cases of dirofiliriasis, was observed. There was a relatively high rate of D. repens in the male genitalia of the infected patients as compared with that reported by other authors. In accordance with the current terminology, D. repens in the Moscow Region is proposed to be regarded as emerging infection. The authors show it necessary to obligatorily record all autochtonous cases of D. repens infection, to make epidemiological surveillance and analysis in order to early detect and prevent dirofilariasis-associated complications.
The paper presents two cases of infection with Strongyloides stercoralis (in a 13-year-old boy and in a 93-year-old female), occurred in the Moscow Region, which is indicative of the resurgence of stronglyoidiasis in the Moscow Region. Although the likelihood of this infection in this region is little, nevertheless, strongyloidiasis should be borne in mind in examining patients who are not leaving for well-known endemic areas if they have an allergic reaction of unclear etiology, eosinophilia, and digestive disorders. In these cases, the syndromic-and-empiric approach to justifying and performing chemotherapy is recommended due to the inadequate efficiency of parasitological methods for diagnosing strongyloidiasis at the low rate of invasion. These cases are indicative of the rather low virulence of Moscow strains, but at the same time of their capacity for autoinvasion and accordingly for the long-term infection of patients without recurrent infections.
A clinical and epidemiological study of opisthorchiasis foci in the Yamalo-Nenets Autonomous Okrug was carried out. 764 people were surveyed, including 473 aborigines of the north, 207 denizens, and 84 migrants. Opisthorchiasis infection rate in villages was 40.5-45.7%. The intensity of infection was lower than 200 eggs per g faeces. The modelling of opisthorchiasis prevalence performed after Muench showed the highest correlation with the "simple" and "reversible" models. Factors determining the infection spread and limiting its intensity and those influencing the effect of chemotherapy were defined. Theoretically determined radical suppressive low-dose praziquantel chemotherapy was carried out. The efficacy of the drug, 25, 30, 40 and 50 mg/kg, varied from 76.5 to 92.0% (mean 88.1%), and the decrease of the egg density was more than 60%. The incidence of side effects of the therapy averaged 45.3%.
49% of patients who abused alcohol were detected among 119 persons with O. felineus infection in the focus of the infection in the Komi-Permiak Autonomous Okrug by screening questionnaire test. The abuse of alcohol in the given focus was shown to be associated with consumption of low-salt fish mostly by men. Alcoholism promotes failure to keep medical recommendations on the prevention of Opisthorchis infection and reduced motivation of opisthorchiasis treatment, and due to re- and superinvasion it decreases the efficiency of chemotherapy. Comparing the results of praziquantel treatment a month or a year after, treatment efficiency among those abusing alcohol was shown to decrease from 88% to 68%.
The authors described the clonorchiasis focus in the Vietnam province at the seaside delta of the Red River where the aforementioned invasion was accompanied with multiple invasions with intestinal nematodes. Clonorchiasis infestation rate was 28.4% ascaridiasis, 50.5%, trichocephaliasis, 21.3% ancylostomiasis, 7.0%. Clonorchiasis invasion was the result of consumed uncooked carp fish in the salad. It was revealed that the fish was reared in the ponds near the settlements and was fed untreated human and animal feces. The meal was more common among the male persons in the presence of the alcohol intake. Clinical symptoms of the mixed clonorchiasis and intestinal nematodiasis invasion was featured by pains, dyspepsia and the asthenoneurotic syndrome.