Balantidiasis treatment drugs. Ways of infection with balantidiasis, treatment and prevention of the disease. Life cycle of balantidia
Balantidiasis is a zoonotic intestinal protozoal infection, characterized by severe intoxication and ulcerative lesions of the mucous membrane of the large intestine, with a tendency to a protracted course.
The causative agent of the disease is a protozoan, the infusoria of the genus Balantidium coli. Despite the fact that the microorganism was described for the first time in 1857, its ability to cause disease in humans was proved only in 1901 by N. S. Solovyov. Among the infectious agents that provoke intestinal diseases, balantidia is the largest: the vegetative form is 50–80 microns long, 35–60 microns wide, and the diameter of the cyst (temporary form covered with a protective sheath) is about 50 microns.
The host of balantidia are pigs (usually young piglets), for which microorganisms are not dangerous. The route of infection is fecal-oral, infection is possible through direct contact. The disease is usually registered in regions with a developed pig industry, more often in the rural population or workers in pig farms.
Despite the fairly frequent infection with balantidia (4-5%), extensive clinical picture observed in isolated cases.
With timely treatment, the prognosis is favorable. In the absence of medical care, the process becomes chronic, mortality reaches 10% or more.
Infection with vegetative forms of the protozoan is virtually impossible, since they are not viable in the environment, and occurs due to cysts that can survive up to 100 days in pig farms and more than 200 days in the soil. For this reason, a sick person (as well as an asymptomatic carrier of balantidia) practically cannot serve as a source of infection, since cysts are not formed in the human body, and if they occur, then in extremely small quantities.
Causes and risk factors
The main cause of the disease is the entry of cysts (in exceptional cases, vegetative forms) into the human gastrointestinal tract through the use of contaminated water or crops contaminated with cysts.
Risk factors:
- use of non-disinfected water from open reservoirs;
- eating vegetables without pre-treatment;
- neglect of personal hygiene measures after contact with pigs (in the household, on pig farms).
Forms of the disease
According to the duration of the course, acute and chronic balantidiasis are distinguished.
Depending on the severity, there are such forms of the disease:
- light;
- moderate;
- heavy.
The latent form implies the carriage of pathogenic microorganisms in the absence of clinical manifestations.
Despite the fairly frequent infection with balantidia (4-5%), a detailed clinical picture is observed in isolated cases.
They say about the combined form of balantidiasis when the underlying disease is combined with other infections (for example, amoebiasis or shigellosis).
Symptoms
For the acute form of the disease, a stormy, detailed symptomatology is characteristic.
After infection with balantidia, symptoms of the disease are absent for 5-30 days (latent incubation period).
Once in the gastrointestinal tract, the microorganism affects the intestinal wall, causing at the initial stage edema and hyperemia of the mucous membrane, which are replaced as the process progresses by hemorrhages and foci of necrosis, accompanied by powerful intoxication, which manifests itself:
- weakness, deterioration in general well-being;
- headache, dizziness;
- decrease or complete lack of appetite;
- an increase in body temperature to 38.5-39 ° C;
- cramping pains in the abdomen;
- frequent false urge to defecate;
- liquid fetid stools with an admixture of blood, pus, mucus (10-15 times a day).
Patients with an acute form of balantidiasis are subject to mandatory hospitalization in an infectious diseases hospital.
Objective signs: the tongue is dry, covered with white coating, the liver and spleen are enlarged, the abdomen is sharply painful when pressed in the umbilical region and in the lower sections.
There is a rapid loss of body weight, exhaustion develops within a few days (up to a week).
In chronic balantidiasis, periods of exacerbation that last from several days to a month are replaced by imaginary well-being, the vivid symptoms of the disease disappear for several months (on average, from 3 months to six months). The manifestations of the disease in this case are mild: slight pain in the abdomen, diarrhea 2-5 times a day (sometimes with an admixture of mucus, less often blood), there are no manifestations of intoxication.
Diagnostics
When diagnosing balantidiasis, it is necessary to take into account the presence of an unfavorable epidemiological history.
Laboratory and instrumental diagnostic methods:
- microscopy of a smear of liquid feces (no later than 40 minutes after defecation);
- microscopy of a biopsy of the large intestine obtained during endoscopic examination;
- endoscopic examination of the affected parts of the intestine (sigmoidoscopy).
Balantidiasis is usually registered in regions with a developed pig industry, more often in the rural population or workers in pig farms.
Treatment
Patients with an acute form of the disease are subject to mandatory hospitalization in an infectious diseases hospital.
Treatment of the disease is carried out in several directions:
- etiotropic therapy aimed at the destruction of the pathogen (antimicrobial agents);
- symptomatic drugs (hemostatics, reparants, antispasmodics, enzyme preparations);
- immunostimulating therapy;
- emergency surgery (if necessary).
Possible complications and consequences
Complications of the disease are associated with perforation and ulceration of the intestinal wall or a large vessel. It:
- perforation of the intestinal wall;
- diffuse peritonitis;
- intestinal bleeding.
If left untreated, balantidiasis may develop gastrointestinal bleeding.
Forecast
With timely treatment, the prognosis is favorable. In the absence of medical care, the process becomes chronic, mortality reaches 10% or more.
Prevention
There are currently no specific measures for the prevention of balantidiasis. The non-specific ones are:
- compliance with the rules of personal hygiene;
- organization of a system for the protection of water bodies from fecal pollution by sewage;
- compliance with security measures in pig farms in order to prevent soil contamination;
- timely detection of infected persons, implementation of special control over risk groups (systematic preventive examinations).
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In terms of taxonomy, morphology, and classification, Balantidium coli is a ciliary ciliate belonging to the Protozoa subkingdom, Zoa kingdom, Ciliophora subphylum.
Habitat
Balantidia cysts enter the external environment along with animal feces, where, due to their two-layered membrane, the cysts are able to remain viable for a sufficiently long time: if in feces at a temperature of 18-20 ° C this period is about 30 hours, then in water, tap or waste, in sewerage, - up to 7 days; in nature with sufficient heat and humidity - up to 2 months, and in a dry, shaded place - up to 2 weeks.
Structure and morphology
Doctor of Medical Sciences, Professor German Shayevich Gandelman
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It has the largest dimensions of all intestinal protozoa: in the vegetative form, cell sizes can reach 50-80 × 35-60 microns, and the cyst diameter is 50 microns. The body of the balantidia resembles an egg in shape and is covered with many small cilia - these are its organs of movement (see photo).
Balantidia has a macronucleus - a vegetative nucleus responsible for metabolism, and a micronucleus - a diploid nucleus containing a genetic code that is transmitted during reproduction.
An elastic pellicle (shell), containing inside a transparent alveolar ectoplasm, covers the entire body of the ciliate and allows it to maintain flexibility in the process of movement.
In the event of an extreme situation, the balantidia passes from the vegetative form into a small cyst (up to 50 microns) of a round rather than elongated shape and without cilia, unlike the ciliate itself. From the negative impact environment the cyst is protected by a double strong shell. The cyst, unlike ciliates, is not able to move.
Life cycle of development: scheme of reproduction
After the cysts, along with pig feces, are in the external environment, they are usually carried by insects and enter the water, soil and plants (vegetables, herbs) used by humans for food. As a rule, it is in this way, that is, through contaminated products that have not undergone appropriate processing, that a person becomes infected with balantidia.
Scheme of infection
A new cycle of development of balantidia begins, which takes several days and consists in attaching an invasive form to the cells of the mucous membrane of the epithelium in the rectum and sigmoid colon of its owner. Here, balantidia begins its new life cycle, actively multiplying in a favorable environment for it.
Balantidia can reproduce in two ways - asexual and sexual. The asexual form of reproduction consists in the transverse division of one ciliate into two. The sexual form of reproduction (conjugation) is quite rare and is carried out as a result of the connection formed between the nuclei of two ciliates.
The result of sexual reproduction is the formation of cysts, which, together with feces, are brought out, after which the development pattern is repeated.
What diseases does balantidia cause?
The disease caused by balantidia was named after its causative agent - balantidiasis, or infusor dysentery. However, the invasion of balantidia does not necessarily cause the development of the disease, often ciliates seem to be embedded in the intestinal microflora, and its pathogenic effect on the human body is not manifested.
In this case, we can talk about latent carriage in a person infected with balantidia.
- Fever, fever, chills, feeling weak;
- Headache, accompanied by nausea up to vomiting spasms;
- Diarrhea with blood and mucus up to 20 times a day, flatulence;
- Sharp and drawing pains in the abdomen.
Purulent-bloody diarrhea causes weight loss. The patient experiences a feeling of dryness of the tongue and mouth, the color of the facial skin changes.
Localization of balantidia in the human body
Balantidia enters the human body in the form of a cyst, where it lives mainly in the gastrointestinal tract, and more specifically, in the large intestine, but sometimes it also affects small intestine and appendix. As already mentioned, if this ciliate lives in the intestine, having integrated into its microflora and without causing disease, then there is a latent carriage of balantidia.
However, balantidia cysts are carried throughout the body by blood flow, and then they can be found in the liver, lungs, lymphatic ducts, and heart muscle; In some cases, they may be located in bladder, in the vagina and uterus.
Ways of infection and spread
A particularly threatened category is represented by workers of livestock (especially pig) farms, slaughterhouses and meat processing enterprises, as well as those who keep pigs on their plots, since it is pigs that are the main source of infection with balantidia, and in the process of caring for them, especially when cleaning feces, the likelihood infection is on the rise.
A person with a latent carriage of balantidia cannot become a source of infection, since cysts do not form in his body, and the vegetative form is not contagious.
Diagnostics
Diagnosis of balantidiasis is carried out by the following methods:
- Sigmoidoscopy, then taking a scraping from the intestinal mucosa to determine its condition; with balantidiasis, ulcers are detected on it;
- Fecal analysis (performed in the laboratory of sanitary and epidemiological stations), in which balantidia is clearly visible under a microscope due to its large (for protozoa) sizes;
- Heidenhain's scraping, which allows detecting the presence of blood traces in the feces, determining the size of the balantidia, as well as the nature of filling their vacuoles.
Treatment
Treatment of balantidiasis should be started immediately after diagnosis, otherwise it can lead to death, especially with the development of fecal peritonitis, which requires urgent surgical intervention. Statistics show that if untreated, the mortality rate from balantidiasis is 10% - a huge figure for such diseases.
The complex treatment includes the following drugs:
- Light antibiotics (Monomycin, Oxytetracycline)
- Antiprotozoal antibacterial drugs for uncomplicated form (Tetracycline, Metranidazole, Nitazoxadine);
- Enzymatic agents that normalize the work of the gastrointestinal tract (Linex);
- Immunomodulators and detoxification agents.
If balantidiasis caused the development peptic ulcer intestines or other complications, treatment is carried out in a hospital.
Prevention
- It is necessary to strictly observe the requirements of personal hygiene, especially for people in contact with pigs, engaged in their breeding and processing;
- Thoroughly wash vegetables, fruits and herbs in running water;
- Do not drink raw water;
- Subject the meat to full heat treatment, that is, boil or fry it well.
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- What is Balantidiasis
- What causes Balantidiasis
- Symptoms of Balantidiasis
- Diagnosis of Balantidiasis
- Treatment of Balantidiasis
- Prevention of Balantidiasis
What is Balantidiasis
Balantidiasis- a parasitic disease characterized by ulcerative lesions of the colon, severe course and high mortality with late therapy.What causes Balantidiasis
Epidemiology. The disease is relatively rare. However, the infection rate of the population can be quite high. So, in rural areas 4-5% of the population is infested with balantidia. Persons in contact with pigs, which are natural carriers of balantidia, are especially often infected. In the foci, infection can occur through contact with patients with balantidiasis. Diseases occur, as a rule, in the form of sporadic cases.
Pathogenesis (what happens?) during Balantidiasis
The natural carriers of balantidia are pigs. Infection of a person occurs when balantidia, more often cysts, enter digestive tract. The causative agent can exist for a long time in the human intestine without showing a pathogenic effect. It usually lives in the lower parts of the small intestines. The reasons for the introduction of balantidia into the intestinal tissue, which is observed only in a small part of the infested, remain unexplored. Lesions caused by balantidia are localized mainly in the blind, sigmoid and rectum. Initially, areas of edema and hyperemia appear on the folds of the mucous membrane, then erosions form, balantidia penetrate into the thickness of the tissues, causing foci of hemorrhages and necrosis. After rejection of necrotic masses, a cavity remains that communicates with the intestinal lumen. The ulcers have irregular outlines, the edges are indented and thickened, the bottom is uneven, covered with a bloody-purulent coating. Perforation of ulcers may occur with the development of diffuse peritonitis.
Symptoms of Balantidiasis
In cases not complicated by a bacterial infection, balantidiasis, especially its acute forms, may not cause an increase in body temperature. Complications of balantidiasis in the form of damage to organs other than the intestines are extremely rare.
Incubation period more often lasts 10-15 days (from 5 to 30). Clinically, balantidiasis can occur in acute and chronic forms. There are also latent balantidiasis (carriage) and combined forms of balantidiasis (with amoebiasis, shigellosis, etc.). The severity of the course is dominated by moderate and severe forms. Acute forms of balantidiasis resemble enterocolitis or colitis in their manifestations. Symptoms of general intoxication appear: weakness, headache, decreased appetite, half of the patients have moderate fever, sometimes with chills. At the same time, signs of intestinal damage are observed: abdominal pain, diarrhea, flatulence, with involvement of the rectum, tenesmus is possible. In the feces there may be impurities of mucus and blood. Quite often note the dry furred language, a spasm and morbidity of a large intestine, the liver is enlarged and painful. Sigmoidoscopy reveals a focal infiltrative-ulcerative process. In the study of blood - moderate anemia, eosinophilia, a decrease in the total amount of protein and albumin, ESR is moderately increased. In severe cases of acute balantidiasis, there is a high fever, symptoms of intoxication are pronounced (chills, nausea, vomiting, headache). Stool up to 20 times a day with an admixture of mucus and blood, with a putrid odor. Patients quickly lose weight, cachexia may develop in a week. There may be signs of peritoneal irritation. Sigmoidoscopy reveals extensive ulcerative changes. In the blood hypochromic anemia, neutrophilic leukocytosis.
Acute balantidiasis
Acute forms of the disease are characterized by fever, symptoms of general intoxication and signs of intestinal damage (abdominal pain, diarrhea, flatulence, tenesmus is possible - false urge to defecate). In the stool there is an admixture of mucus and blood. Spasm and soreness of the large intestine, enlargement of the liver are characteristic. Sigmoidoscopy reveals a focal infiltrative-ulcerative process. In severe cases, general intoxication, high fever, stools up to 20 times a day with an admixture of mucus and blood with a putrid odor are noted. Patients quickly lose weight, sometimes there are symptoms of irritation of the peritoneum. With sigmoidoscopy, extensive ulcerative lesions are established.
Diagnosis of Balantidiasis
Diagnosis of balantidiasis is put on the basis of the detection of balantidia in native smears from feces or scrapings from the affected areas of the intestinal mucosa, taken during sigmoidoscopy. Due to their large size, mobility, characteristic shape and the presence of a contractile vacuole, balantidia are easily recognized. Their cysts, which are extremely rare in the human intestine, can sometimes be found in preparations stained with Lugol's solution.
For diagnosis importance have information about the residence of patients in rural areas and their contact by occupation with pigs.
In some cases, a small amount of balantidia is excreted with feces and they can be detected in smears only with repeated multiple analyzes or when sown on nutrient media.
2. In permanent preparations stained according to Heidenhain, balantidia, as in native smears, are easily detected at low magnification of the microscope. The main features for their recognition are the characteristic oval shape of the body and a large dark-colored bean-shaped or sausage-shaped macronucleus, located inside the cytoplasm of the protozoan in the transverse, oblique or longitudinal direction. Details of the structure of balantidia are studied at high magnification of the microscope (10x40). The macronucleus is clearly visible, and sometimes the small micronucleus adjacent to it, contractile vacuoles in the form of light uncolored vesicles in the front and rear parts of the body, digestive vacuoles filled with bacteria, fungi, starch grains, erythrocytes and leukocytes at various stages of digestion. The cilia covering the body of the protozoan are poorly visible. Balantidia cysts are round, 40-65 µm in diameter, with a double-contoured membrane and a well-marked bean-shaped nucleus.
cultural methods. Rice's medium is used for cultivation of balantidia.
Immunological methods. AT practical work do not apply.
Treatment of Balantidiasis
To prevent the disease, it is necessary to observe hygiene measures when caring for pigs, as well as timely detection and treatment of people with balantidiasis. General preventive measures are the same as for dysentery.
Which doctors should you contact if you have Balantidiasis
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High mortality is due to a large number of intestinal complications, development (extreme exhaustion) and the addition of sepsis.
Outbreaks of this intestinal infection are most often recorded in the southern regions of the globe, but individual cases are observed everywhere: as a rule, in rural areas whose population is engaged in pig breeding.
Risk factors
The main factors contributing to the spread of this severe zoonotic disease are:
- The complete lack of alertness of medical personnel towards him. That is why cases of detection of balantidiasis are relatively rare.
- The low level of sanitary culture of the rural population.
- A rather high (from 5 to 28%) infection rate among rural residents. Infection is most often exposed to people caring for the natural carriers of ciliated ciliates - pigs. During an outbreak of balantidiasis, a sick person can become a source of infection.
These protozoan pathogens were first found in the intestines of pigs in the 1980s.
Subsequent studies have shown that the infestation rate of these domestic animals is at least 80%.
In 1897, the presence of balantidia in the feces of patients was established by the Swedish researcher Malmsten. He owns the honor detailed description pathology, features of its clinical course and complaints made by patients.
The ciliated ciliate balantidium coli is ovoid in shape. Its outer surface is covered with a pellicle, generously dotted with many short cilia (arranged in longitudinal rows) that help microorganisms move around. Being a highly elastic structure, the pellicle allows a moving unicellular organism to break the symmetry of its body.
The ciliate balantidium coli has two openings: the oral (cytostomy), located in the front of the body, and the anal, located in the back of it.
All absorbed food (starch grains, erythrocytes, bacteria and fungi) first ends up in a slit-like recess (peristome), at the very bottom of which there is a mouth opening that passes into the pharynx. From here, food is sent to the endoplasm, which forms digestive vacuoles that move along the body of the microorganism.
Each balantidia is the owner of two contractile (pulsating) vacuoles located on opposite parts of the body and designed to remove excess fluid and waste products.
Consisting of a rounded reservoir and several tubules suitable for them, pulsating vacuoles alternately contract, pushing waste substances out of the unicellular organism.
Each ciliate has two nuclei:
- Macronucleus, which regulates intracellular metabolism.
- The micronucleus responsible for the transfer of genetic information during cell division.
A certain cyclicity can be traced in the existence of ciliated ciliates. Life cycle balantidia consists of two stages:
- Cyst, which, in turn, is subdivided into sexual reproduction (conjugation), during which the encountered ciliates exchange their nuclei, and asexual reproduction, characterized by the transverse division of balantidia.
Balantidia, having fallen into favorable conditions for them, begin to multiply rapidly by simple division, during which both nuclei are stretched in length, accompanied by the appearance of transverse constrictions on them. The same transverse constriction is simultaneously formed on the body of the microorganism.
After the final formation of the septum, the newly emerged cells disperse and begin an independent life.
The physiological development of ciliates balantidium coli involves the obligatory passage through the conjugation phase. Two encountered microorganisms are pressed tightly, touching each other with their mouth cavities, creating conditions for the most complex restructuring of the nuclear apparatus.
During this restructuring, the large nucleus (macronucleus) is destroyed and the small nucleus is divided (into the female and male micronucleus). As a result, the female nucleus remains in the same place, and the male nucleus, through the plasma bridge formed between the ciliates, is sent to a new microorganism to merge with its female nucleus. This is how genetic information is transferred.
After the conjugation is completed, the ciliates encyst (turn into cysts). Cysts of ciliated ciliates have a rounded shape, a double dense shell and a diameter not exceeding 50 microns (there are no cilia in cysts). After leaving the body of their host along with feces and being in the external environment, cysts continue to remain viable for a long time.
In feces (at room temperature), balantidia cysts can live for at least thirty hours; having got into tap or waste water - up to seven days. Under the conditions of large pig-breeding complexes, the viability of cysts increases up to one hundred days, and when it enters the soil, up to two hundred days.
The life cycle of balantidia that has entered the human body is repeated.
- Vegetative. The length of ciliates in the vegetative stage can be from 30 to 150 microns, the width is from 30 to 100 microns. The viability of vegetative forms of balantidia is significantly inferior to the resistance of cysts: being expelled from the body along with feces, they die in five to six hours.
Ways of infection
In the vast majority of cases, balantidiasis is transmitted zoonotically (from animals to humans) by:
- Pigs are the main source of protozoal infection. It has been established that approximately 80% of their population is infected with ciliated ciliates, which do not bring the slightest harm to their health.
- Mice, rats, dogs, rabbits, wild boars, monkeys can be carriers of pathogenic microorganisms that release their cysts into the environment along with feces.
- The carriers of the infection can be synanthropic flies (represented by gadflies, real flies, bloodsuckers, blue and green meat flies) that live near human settlements.
Cases of transmission of pathogenic microorganisms by humans are quite rare. Infusor dysentery is transmitted by the alimentary (fecal-oral) route.
Cysts (sometimes vegetative forms) of balantidia enter the human digestive tract:
- together with food infected by them (unwashed fruits and vegetables) and water;
- from contaminated soil;
- through dirty hands.
The most common localization of pathogenic microorganisms at this stage is the lower sections of the small intestine. What is the reason for the sudden activation of balantidia, prompting them to begin to invade the structures of the large intestine (this process occurs in the body of only a small part of infected people), remains a mystery to this day.
The process of introduction of microorganisms is facilitated by a special enzyme secreted by them - hyaluronidase, which is capable of dissolving the mucous membranes of the colon. It is the site of the damaged mucosa that is the "entrance gate" of the beginning protozoal infection.
The first reaction of the body's immune forces to the introduction of balantidiasis pathogens into the submucosal layer of the intestinal walls is the activation of lymphocytes, histiocytes (immune cells, with active reproduction of which granulomas - inflammatory nodules appear in the affected tissues) and an increase in the number of segmented neutrophils (plasma cells, one of the first to enter into control of pathogenic bacteria).
It is these processes that provoke hyperemia, edema and purulent abscess formation of tissues at the site of introduction of balantidia. After some time, pathogenic microorganisms, penetrating into the thickness of epithelial tissues, provoke the occurrence of erosions with foci of hemorrhages and necrosis. Rejected necrotic masses leave behind cavities (ulcers) that communicate with the lumen of the affected intestine.
The area of ulcerative defects that have irregular outlines, a crater-like shape, thickened corroded edges and filled with dying cells, can be several centimeters. On the uneven bottom of the ulcers, dark necrotic masses accumulate, looking like a bloody-purulent plaque.
The clinical picture of balantidiasis depends on the form in which it occurs.
Depending on the nature of the course, researchers distinguish the following forms of pathology:
- Hidden, often referred to as balantidiocarrier and having neither clinical nor morphological manifestations, since the introduction of trophozoites into the intestinal mucosa does not occur with it.
- Sharp.
- Subacute.
- Chronic constant.
- Chronic recurrent (recurrent).
- Subclinical (asymptomatic). Since there are no signs of dysfunctional bowel disorders and intoxication of the body with this form of infusor dysentery, the pathology can be recognized only with the help of endoscopic examination and laboratory test data. As a rule, the asymptomatic form of balantidiasis is detected quite by accident, during a preventive examination, a medical examination prescribed for another disease, in preparation for pregnancy or surgery. A blood test will indicate elevated level hepatic transaminases and the presence of eosinophilia (an increase in the number of eosinophils - leukocyte germ cells - in the blood).
Balantidiasis can occur in parallel with shigellosis (bacterial dysentery), amoebiasis (amebic dysentery) and a number of other diseases. infectious diseases. Such forms of pathology are called combined.
Incubation period
The duration of the incubation period, which does not have a fixed length, most often ranges from ten to fifteen days, although medical statistics indicate that in some cases from the onset of infection to the appearance of the first clinical manifestations of balantidiasis, five to thirty days can pass.
Spicy
Acute balantidiasis has three degrees of severity:
- light;
average;
heavy.
The clinical picture of the acute form of balantidiasis in many ways resembles the course of dysentery. Pathology begins with a sharp increase in body temperature to the level of febrile (above 38 degrees) values.
Patients develop a febrile fever, characterized by alternating chills and intense heat. Sharp jumps in temperature, which do not depend on the time of day, have an irregular character, which is clearly visible on the temperature graph.
Patients have pronounced signs of general intoxication of the body:
- progressive weakness;
- severe headaches;
- persistent nausea and occasional painful vomiting.
At the same time, symptoms of acute hemorrhagic colitis develop, manifested in the occurrence of:
- Cutting cramping pains in the lower abdomen.
- Liquid mucopurulent, and then bloody stools, the multiplicity of which can be from 18 to 22 times during the day. Abundant stools of the patient emit a sharp putrid odor. Due to loss a large number liquid along with feces, the patient has a rapid decrease in body weight. In the most severe cases, cachexia (extreme exhaustion) may develop.
- Tenesmus (painful false urge to defecate against the background of an almost complete absence of feces), observed with lesions of the sigmoid, rectum and colon.
Physical examination of the patient reveals:
- pronounced weight loss;
- pallor of the skin;
- muscle weakness (adynamia), manifested by a sharp decline in strength and a significant decrease in motor activity;
- dry and furred tongue;
- bloating;
- soreness and enlargement of the liver;
- spasm of the large intestine.
Endoscopic examination of the patient reveals the presence of focal or diffuse erosive-ulcerative colitis. A blood test indicates mild anemia, eosinophilia, and an elevated erythrocyte sedimentation rate (ESR).
The duration of the systemic form of balantidiasis is no more than eight weeks. If the manifestations of the acute form continue to be observed, this means that the disease has passed into a latent (subacute) or chronic form.
Chronic
The intoxication syndrome in chronic balantidiasis is rather weakly expressed.
The leading role in its clinical course is acquired by intestinal manifestations of pathology, represented by:
- the presence of rapid (from two to five times during the day) loose stools, sometimes with an admixture of blood or mucus;
- increased flatulence;
- moderate soreness of the ascending and caecum with.
For a chronic relapsing form of balantidiasis, which lasts for five to ten (or even more) years, an alternation of periods of exacerbation and remission is characteristic. The duration of exacerbations can be from 1-2 to 3-4 weeks, and remissions - from three months to six months.
The temperature reaction of the patient's body to the course of the pathological process may either be absent or manifest itself in a slight increase in temperature to subfebrile (from 37.1 to 38 degrees) values. Headaches, as a rule, are not too intense and are intermittent. Patients complain of general weakness.
The chronic continuous form of infusor dysentery is characterized by a monotonous course, accompanied by the presence of moderately severe intestinal and toxic symptoms observed for several years.
There are no periods of remission. Clinical manifestations of the disease (both general toxic and diarrheal syndrome) are less intense.
Characteristic signs of a continuous form of chronic balantidiasis are bloating, a significant decrease in appetite and a gradual decrease in body weight. Lack of adequate treatment can lead to the development of cachexia.
If the pathology extends to the appendix, the patient develops symptoms of acute appendicitis, suggesting the occurrence of:
- elevated body temperature;
- signs of damage to the peritoneum;
- Rovsing's symptom, which is manifested by the occurrence of pain in the right iliac region at the time of making jerky movements of the hand along the surface of the abdominal wall in the region of the left mesogastrium (lateral paraumbilical region);
- the Shchetkin-Blumberg symptom, which makes itself felt by a sharp increase in abdominal pain resulting from the rapid removal of the palpating hand from the anterior wall of the abdomen immediately after pressing;
- symptom of Sitkovsky, consisting in the occurrence or intensification pain in the right iliac region in a patient lying on his left side;
- symptom of Bartomier-Michelson, manifested by increased pain when performing palpation of the caecum in a patient who has taken a supine position on his left side.
Complications
The severity of complications of balantidiasis is determined by several factors: the duration of the disease, its form and severity.
Infusor dysentery can lead to:
- perforation () ulcerative defects of the large intestine;
- the occurrence of intestinal bleeding;
- the development of abscesses in the abdominal cavity (in particular - to liver abscesses);
- diffuse (total) peritonitis - inflammation of the peritoneum (serous membrane lining the inner surface of the walls of the abdomen and internal organs);
- the development of appendicitis;
- the occurrence of hypochromic anemia - a disease caused by a significant decrease in the level of hemoglobin in red blood cells;
- prolapse of the rectum (rectal prolapse);
- malignancy of the affected tissues.
Diagnostics
The first stage in the diagnosis of balantidiasis is the consultation of an infectious disease specialist, to whom patients are sent who have a number of characteristic clinical manifestations of the pathology (specific abdominal pain, fever of the wrong type, repeated diarrhea with a putrid odor).
After a thorough collection of an epidemiological history and a physical examination of the patient, the doctor will prescribe him a whole range of laboratory and instrumental studies, on the basis of which the final diagnosis will be established.
Laboratory diagnostics involves microscopic examination:
Since the excretion of balantidia, subject to a certain periodicity, is extremely uneven with feces, a single study of a native smear cannot always reveal the presence of pathology. That is why the study of the patient's feces is carried out from three to six times.
An additional diagnostic method that increases the efficiency of detecting balantidiasis is the sowing of feces on Rice or Pavlova nutrient media.
- (scraping from the area of the colon affected by ulcers), taken during an endoscopic examination of the intestine. Smears prepared from these scrapings make it possible to detect balantidia much more often than preparations obtained from the patient's feces.
Thus, a reliable confirmation of balantidiasis is the detection of trophozoites (vegetative forms of balantidia) in scrapings of the affected intestinal walls, in smears of the contents of ulcers, or in freshly excreted feces of the patient.
The detection of cysts is evidence of transient carriage - a short-term (usually single) isolation of pathogenic microorganisms against the background of the complete absence of clinical manifestations of the disease.
The complex of laboratory diagnostics includes a mandatory blood test. A blood test of a sick person will indicate the presence of:
- moderate increase in erythrocyte sedimentation rate;
- low levels of albumins and proteins;
- eosinophilia;
- moderate anemia.
A group of instrumental studies aimed at identifying balantidiasis is represented by:
- Sigmoidoscopy is a diagnostic technique designed for visual examination of the mucous membranes of the distal sigmoid and rectum, performed using a special device - a sigmoidoscope. This device is made in the form of a tube equipped with a lighting device and an air supply device. After air is injected into the rectal cavity, which allows to smooth out the mucosal folds as much as possible, the air supply system is disconnected and the eyepiece is installed.
- Colonoscopy is a modern method of endoscopic examination of the large intestine using a thin, flexible and very long tube - a fibrocolonoscope. This device, equipped with a backlight and a miniature video system, allows you to transfer the image to the monitor screen. The colonoscopy procedure is also accompanied by a gentle supply of air designed to expand the intestinal lumen and smooth out the folds of the mucous membranes.
Both of the above procedures allow in patients suffering from an acute form of balantidiasis to detect the presence of focal infiltrative-ulcerative changes in the intestinal walls; in the chronic form of protozoal infection, ulcerative or catarrhal-hemorrhagic (hemorrhages and necrotic formations) defects are detected on the walls of the intestine.
Being engaged in differential diagnostics, experts compare the clinical manifestations of balantidiasis and a number of diseases (cryptosporidiosis, ulcerative colitis, giardiasis,) that have similar symptoms.
Treatment
When balantidiasis is confirmed, a sick person is necessarily placed in an infectious diseases hospital (treatment of all carriers of pathogenic microorganisms is also strictly mandatory).
Etiotropic (designed to eliminate the causes of pathology) treatment consists of:
- In the appointment of antibacterial drugs (represented by ampicillin, monomycin, oxytetracycline).
- In taking antiprotozoal drugs (represented by metronidazole, aminarson, yatren, tinidazole).
- in detoxification treatment.
- In the implementation of vitamin therapy (the patient needs vitamins A, B and C).
- In strict adherence to a special diet that prescribes plenty of fluids and the use of high-calorie foods. The patient is absolutely contraindicated for fatty and non-cooked dishes.
- In the infusion of water-electrolyte solutions that prevent dehydration of the body.
An effective addition to the systemic drug therapy is the implementation of enemas with a solution of colloidal-dispersed salt of norsulfazol.
The main criteria for the cure of protozoal infection are presented:
- the complete absence of the syndrome of "distal colitis" (or colitis syndrome);
- negative results of multiple (at least three times a week) scatological examination of feces for the presence of cysts and vegetative forms of balantidia;
- the absence of ulcerative defects of the intestinal walls.
Forecast and prevention of balantidiasis
The prognosis of balantidiasis is considered conditionally favorable, because due to modern methods With etiotropic treatment, this protozoal infection is completely cured, and the patients' ability to work is fully restored.
With untimely diagnosis, late or inadequate treatment, the level of lethal outcomes in balantidiasis in the lesions, as a rule, is 10-12%. With episodic lesions, mortality from infusor dysentery can reach 30%.
There is still no specific prevention of balantidiasis. Personal prevention of infusor dysentery requires:
- obligatory observance of rules of personal hygiene;
- refusal to use raw unboiled water;
- thorough washing of fruits and vegetables eaten;
- prolonged heat treatment of meat.
Public prevention of balantidiasis consists of:
- Health education of the population.
- Protection of the environment from pollution by the faeces of sick people and animals. To this end, measures are being taken to protect water bodies from the ingress of polluted wastewater into them. The complex of security measures at pig breeding complexes is aimed at preventing soil pollution.
- Timely detection and hospitalization of patients. To implement this task, regular medical examinations of the population and constant strict control over people at risk are carried out.
Balantidia intestinal is known as the largest of the known representatives of the protozoa. It settles in the human intestine and causes a disease called balantidia, or the so-called infusor dysentery.
Balantidia is a unicellular microorganism that stands out in size among its own kind. This infusoria can cause a number of unpleasant symptoms. If it is present in the body, it is required to seek help from a medical clinic as soon as possible to diagnose the condition and prescribe treatment. At the very beginning, it will not be very difficult to be treated, and when seeking help in the later stages, the treatment process will take much more time and effort.
In the absence of medical care, the patient's condition will steadily worsen. If balantidium stays in the body for a long time, death is not excluded.
How does balantidiasis develop?
Forms can be as follows:
Sometimes people act as additional sources of infection. The disease is more often found in pig breeders, lovers of agriculture.
Balantidia provoke the formation of cysts in the intestines of pigs, then they are excreted outward along with feces. Then they can be swallowed - with contaminated food or drink, basically all problems of this nature begin due to unwashed hands.
Another no less dangerous disease caused by protozoa is called leishmaniasis. They can get sick due to the bite of a mosquito, this can happen in underdeveloped countries. Insects often carry cysts, sit on food and various surfaces, leave them there. Cysts are able to remain viable in the external environment for three or four weeks, in the ground they can live up to 250 days.
Life cycle of balantidia
The life cycle of balantidia is divided into several different stages:
- The asexual stage includes the formation of cysts separate from the body of the carrier, the transverse division of individuals.
- The sexual stage includes the introduction and reproduction in the tissues of the human body, the exchange of nuclei of worms of different sexes.
After the balantidia leave their carrier, they can live in favorable conditions for them for a couple of months. But for bacteria, everything can turn out favorably - after a short time they can get into the human body, and the invasive stage of their life will begin.
The main ulcerative lesions that balantidiasis can cause are localized in the bends of the rectum, cecum, sigmoid colon. In some cases, the heart, appendix and other parts of the body may be affected.
Gradually, the products of the vital activity of bacteria poison the body of the carrier more and more, his condition is steadily deteriorating. After the transition of the disease to the acute stage, it rarely lasts more than 8 weeks - ends lethal outcome or becomes chronic.
The infusoria has a very simple structure, and that is why early treatment is not a particular problem. You can also fight at a rather late stage - etiotropic drugs are used to destroy the pathogen. But if the condition of the intestine is already seriously neglected, it will have to be restored for a long and difficult time. Many of its areas will have abscesses and ulcers that need to be treated.
Symptoms of the disease
Sometimes a disease such as balantidia can last asymptomatically. A person does not know about his illness, while actually being a carrier of cysts. Problems in the work of the body caused by protozoa can resemble other diseases. The most common symptoms are:
When performing studies in the cytoplasm of balantidia, both food particles and some blood components, such as erythrocytes and leukocytes, were often found.
Products resulting from the metabolism of balantidium coli can enter the liver or portal vein, which causes the accumulation of adipose tissue, and granular formations occur in the cell cytoplasm. With such changes, there is a violation carbohydrate metabolism, problems with protein synthesis, minerals cease to be processed properly.
The disease often occurs in complex form- then perforation of ulcers begins, peritonitis, liver abscess, pneumonia may begin, other inflammatory diseases are not excluded. Both adults and children can suffer from the disease.
In a child, the course of the disease most often occurs in an acute form, while transitions to a state of chronic relapse are constantly noted. But this is quite rare - basically the course of the disease depends on immunity and general condition organism.
The course of the disease is divided into different forms:
- Subclinical, which is characterized by a course without special symptoms, but beriberi and ulcerative lesions are noted.
- The acute form, its severity can be different, while severe intoxication with very noticeable symptoms is not uncommon. Such a disease can last for about a couple of months, without weakening its course.
- Chronic form in a relapsing form - exacerbations occur after about 3 or 4 months and can last from a week to a month. The course of the disease can be described as mild. The disease, if left untreated, can gradually last for several years.
- Continuous flow - with this form, one can observe the gradual development of signs of the disease with noticeable manifestations of toxic effects and problems with the excretory system.
Balantidia is a disease in which the course may also depend on the general condition of the body before infection. For example, if a person with reduced immunity becomes infected, against the background of balantidiasis, anemia is often added to him, weight quickly decreases, intoxication progresses, and a violation of water-salt metabolism occurs.
The disease can be determined on the basis of a comprehensive study of the symptoms, the results of tests performed in the laboratory, as well as the patient's condition. With such an ailment, a clinical blood test shows an increased level of eosinophils, which reaches a level that makes it possible to make unambiguous assumptions about the patient's condition.
If a child is sick, problems such as an enlarged spleen and liver may be noted, at elevated temperatures, arrhythmia and tachycardia may also begin, arterial pressure increases (but not to a critical level).
Diagnostic methods
Balantidia is easy to identify when looking at it with a microscope - this is facilitated by the characteristic shape and structure, rather large size, the mobility of ciliates, and the contractile vacuole, which represents the organ of the simplest microorganisms.
Also, in order to identify the disease, methods can be used in which the cultivation of bacteria is practiced on a specially prepared nutrient medium - this can be serum.
The most effective way is the use of Rice's medium - it is made up of a certain amount of meat-peptone broth, isotonic solution, bovine or horse serum, properly prepared. With frequent human contact with pigs (for example, for pig farm workers), diagnostics using this method are carried out with repetitions - it will take two or three times.
To spend effective treatment diseases, quiniofon is used - an antiprotozoal medication. According to the standard scheme, the patient is prescribed it for use three times a day, 0.5 g, for 10 days. The course of monomycin will be the same in duration - when prescribing this drug, it is continued for five days, then a week-long break is taken.
If the course of the disease is severe, the course may be required not once, but three times. Additionally, oxytetracycline is prescribed. In the treatment regimen, it is sometimes considered appropriate to include the use of ampicillin, metronidazole.
After 10 days, the doctor may re-prescribe the course of treatment. With a mild form of the disease, there is no particular danger to the body. After the treatment is considered completed, it is recommended to take restorative measures, consult a doctor and try cleansing methods.
Reception folk remedies, even ordinary kefir can help remove toxins from body tissues, improve digestion, and help restore microflora.
After the patient has managed to get rid of balantidiasis, he should undergo dispensary observation within a year. It consists in the fact that once a quarter a person makes an appointment with an infectious disease specialist for advice.