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Trichinosis

The diseases caused in the person of Trichinella spiralis are widespread in many countries of the world. Infection occurs at the use in food of pork or other meat contaminated by larvae of a parasite. Recently observed sporadic epidemics of a trichinosis in North America were connected with the use of bear meat.
Etiology. The person catches at the use of the meat infected with live larvae of helminth. In intestines of a larva leave the capsule surrounding them and remain in its gleam up to full maturing. Females produce a large number of new larvae which at once penetrate a wall of a gut and migrate with a blood flow, settling mainly in cross-striped muscles, is more rare in a cardiac muscle and TsNS. In muscle cells of a larva are encapsulated and keep viability for many years. In the nature a life cycle of trichinellas is supported by the pigs and other animals eating garbage and corpses of the infected rodents.
Epidemiology. Trichinellas are widespread everywhere, except for Australia and some islands of the Pacific Ocean. The infection still relatively was eurysynusic recently in the USA. So, in 1968 live larvae of helminth were found in a diaphragm in 4% of all dead. In recent years epidemics flash after the use in food of half-cooked home-made sausage and other products prepared from pork, meat of bears, wild boars and walruses. Larvae perish at boiling or storage in the frozen state for 3 weeks. In salt and smoked meat they remain.
Patomorfologiya and pathogeny. Adult individuals of trichinellas parasitize in an upper part of intestines, causing inflammatory changes in its walls. In his mucous membrane the infiltration monocytes, eosinophils and neutrophils comes to light, the ratio between a fiber mi and crypts decreases. These inflammatory changes reach a maximum within 1 week after infection, and then gradually decrease in process of maturing of helminths. The pathological reactions arising under the influence of the larvae migrating in muscle cells consist in increase in number of eosinophils and one-nuclear cells in the corresponding fabrics. In the subsequent there is a calcification of larvae.
Clinical manifestations. The symptomatology appears only at a massive invasion. Within 1 week of stay of helminths in intestines feeling of discomfort in a stomach, the phenomena of a gastroenteritis and diarrhea are noted. In the subsequent as a result of migration of larvae in muscles widespread mialgiya, face edemas and paraorbital area appear (at 80% of patients). Pain is proportional to muscular activity. The most severe pains are noted in the field of a diaphragm intercostal and masseters. As much as possible they are expressed on 10 — the 14th day after infection, during the subsequent 2 — 3 weeks are gradually leveled. Arrhythmia and heart failure develop only at the most hard proceeding disease.
Diagnosis. The assumption of a trichinosis has to arise at inspection of patients with mialgiya, fervescence, periorbital hypostasis and anamnestic data on the use of unchecked meat. It is necessary to find out whether the similar phenomena and at other persons eating this food developed. As confirmation of the diagnosis serves positive reaction flocculation bentonite (a caption 1:5 and more). The biopsy of muscles, usually deltoid, allows to find larvae already in 3 — 4 weeks after infection. Level of muscular enzymes (a kreatininfosfatkinaza and a lactate dehydrogenase) increases at 50% of patients.
Treatment. The specific treatment directed to the larvae which got into muscles does not exist. Thiabendazole influences only indestinal flora of a parasite (25 mg/kg during 1 week). Appointment makes it sense at those few persons who know about the use of the infected products during the previous 1 — 7 days. In critical situations sick trikhinellezny myocarditis or defeats of TsNS showed treatment by corticosteroids. However efficiency raises them doubts.

 
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