1. Helminthiasis
Classification of helminthiases. According to the biological principle: nematodes (roundworms), cestodes (tapeworms), trematodes (flukes).
According to epidemiology: geohelminthiasis, biohelminthiasis, contact.
Ascariasis
Clinic. The migratory phase often occurs under the guise of acute respiratory infections, bronchitis (including malaise, dry cough or scanty sputum, low-grade fever, dry and moist rales in the lungs).
Possible urticaria, vesicular rash on the hands and feet, and volatile eosinophilic infiltrates in the lungs. In the intestinal phase, the gastrointestinal form is distinguished (salivation, nausea, loss of appetite, cramping pain around the navel, sometimes stool disorders and gastric secretion); hypotonic (low blood pressure, weakness) and neurological (dizziness, headache, fatigue, sleep disturbance, vegetative-vascular disorders) forms.
Complications. Ascariasis intestinal obstruction, ascariasis appendicitis, perforated peritonitis, ascariasis of the liver with the development of jaundice, subphrenic abscess, ascariasis of the pancreas with symptoms of acute pancreatitis, crawling of ascaris into respiratory tract with the development of asphyxia.
Diagnosis is based on laboratory data, on the detection of nematode larvae in sputum and antibodies in the blood, and in the late intestinal phase - roundworm eggs in feces.
Treatment. Piperazine, levamisole, and combantrin are used to expel young and adult roundworms. Piperazine is prescribed after meals 2 times a day with an interval between doses of 2–3 hours for 2 days in a row at a dose of 1.5–2 g per dose (3–4 g per day). Efficiency increases when taking piperazine after dinner, before bed. Levamisole (Decaris) is prescribed after meals at a dose of 150 mg once, pyrantel is recommended once after meals at a dose of 10 mg/kg. Oxygen treatment is carried out on an empty stomach or 3–4 hours after breakfast for 2–3 days in a row.
Forecast. In the absence of complications requiring surgical intervention, favorable.
Prevention. Mass examination of the population and treatment of all those infected with ascariasis. Protection of the soil of vegetable gardens, orchards, and berry fields from contamination with feces. Thorough washing and scalding of vegetables and fruits with boiling water. Personal hygiene measures.
2. Alveococcosis
Etiology, pathogenesis. The causative agent is the larval stage of alveococcus. Infection occurs after oncospheres enter the mouth after contact with contaminated skins of foxes, arctic foxes, dogs, with the water of stagnant reservoirs and by eating wild berries collected in endemic areas. Clusters of larvae (usually in the liver) infiltrate and grow into tissues, disrupt the blood supply to organs, and cause tissue degeneration and atrophy.
Clinic. It remains asymptomatic for a long time, there is a progressive enlargement of the liver, heaviness and pressure appear in the right hypochondrium, and a dull aching pain.
After a few years, the liver becomes lumpy and very dense. Jaundice may develop, and sometimes the spleen becomes enlarged. As the nodes disintegrate, body temperature rises and sweating occurs.
Diagnosis. Based on laboratory data - leukocytosis, eosinophilia, increased ESR, hyperproteinemia, hypergammaglobulinemia. They put serological reactions with alveococcal antigen. To clarify the localization, X-ray and ultrasound examination, liver scan, computed tomography. Test puncture is prohibited due to the risk of contamination of other organs.
Differential diagnosis. Differentiate with tumors, echinococcosis and cirrhosis of the liver.
Treatment. Surgical and symptomatic.
3. Hookworm disease (hookworm and necatoriasis)
Adult helminths are hematophagous. When fixed to the intestinal mucosa, they injure tissues, lead to the formation of hemorrhages, cause bleeding, anemia, support the state of allergies, gastrointestinal dyskinesia and dyspepsia.
Clinic. Skin itching and burning, asthmatic phenomena, fever, eosinophilia. In the late stage, nausea, drooling, vomiting, abdominal pain, intestinal dysfunction (constipation or diarrhea), and bloating appear.
Diagnosis. Confirmed by the detection of eggs in the stool and occasionally in the duodenal contents.
Treatment. Deworming is carried out with combantrin or levamisole. At severe anemia(hemoglobin below 67 g/l), iron supplements and red blood cell transfusions are used.
Forecast. In most cases favorable.
Prevention. In areas of hookworm infection, you should not walk barefoot or lie on the ground without bedding. It is necessary to thoroughly wash and scald fruits, vegetables, and berries with boiling water before eating them; you should not drink unboiled water.
4. Diphyllobothriasis
Clinic. Characterized by nausea, weakness, dizziness, abdominal pain, unstable stool, and discharge of strobila fragments during bowel movements.
Diagnosis. This is confirmed by the detection of tapeworm eggs and strobila fragments in feces.
Treatment. In case of severe anemia, before helminthization, vitamin B is prescribed 300 - 500 mcg IM 2 - 3 times a week for a month, iron supplements, hemostimulin, hematogen. For deworming, fenasal, male fern extract, and a decoction of pumpkin seeds are used.
Forecast. In the absence of complications - favorable.
Prevention. You should not eat raw, uncooked or insufficiently salted and dried fish, as well as “live” pike caviar.
5. Opisthorchiasis
Clinic. The incubation period is about 2 weeks. IN early period there may be fever, pain in muscles and joints, vomiting, diarrhea, pain and enlargement of the liver, less often the spleen, leukocytosis and high eosinophilia, allergic rashes on the skin. In the chronic stage, complaints of pain in the epigastric region, right hypochondrium, radiating to the back and left hypochondrium, attacks of pain such as gall bladder colic.
Frequent dizziness and various dyspeptic symptoms. Muscle resistance in the right hypochondrium, liver enlargement, occasionally icteric sclera, enlarged gallbladder, and symptoms of pancreatitis are detected. The most common symptoms of opisthorchiasis are cholecystitis and dyskinesia. biliary tract, chronic hepatitis and pancreatitis, less often - symptoms of gastroduodenitis, enterocolitis. Opisthorchiasis can be asymptomatic.
Diagnosis. Based on the detection of helminth eggs in feces and duodenal contents.
Treatment. Deworming is carried out with mebendazole (Vermox).
Prevention. Explaining to the population the dangers of eating raw, thawed and frozen (stroganina), lightly salted and insufficiently fried fish.
6. Teniosis
Diagnosis diagnosed on the basis of repeated examination of feces for the presence of helminth segments and mucus from the perianal folds (by scraping) for the presence of tapeworm eggs.
Treatment. Vermox treatment. Sometimes used ether extract male fern and pumpkin seeds.
Prevention. You should not eat undercooked or undercooked pork.
7. Trichocephalosis
Clinic. Concerns include drooling, decreased (rarely increased) appetite, pain in the right half of the abdomen and epigastrium, nausea, constipation or diarrhea, sometimes headache, dizziness, restless sleep, irritability; moderate hypochromic anemia and slight leukocytosis are possible. At low intensity, whipworm infestation is asymptomatic.
Diagnosis. Installed when whipworm eggs are detected in the feces.
Treatment. Mebendazole and other anthelmintic drugs are prescribed. The patient is first given a cleansing enema.
Forecast. Favorable.
8. Fascioliasis
Etiology, pathogenesis. Pathogens: liver fluke and giant fluke. The main source of human invasion is various farm animals. Human infection usually occurs in the warm season when fasciola larvae are ingested in water, sorrel, lettuce and other greens. The lifespan of helminths in the body is about 10 years. Trauma and toxic-allergic damage to the hepatobiliary system are important. Fasciolae can be carried into other tissues and organs.
Clinic. The disease is characterized by eosinophilia, allergic phenomena, disorders of the liver and gall bladder, reminiscent of the symptoms of opisthorchiasis (jaundice and attacks of gall bladder colic are more common).
Diagnosis. Diagnosis of the early stage of fascioliasis is difficult, since helminth eggs are released only 3 to 4 months after infection. Immunological methods are used. In the late stage, the diagnosis is based on the detection of fasciola eggs in the duodenal contents and feces.
Treatment. Anthelmintic drugs are prescribed, and after deworming, choleretic drugs are prescribed for 1 to 2 months. Long-term (at least a year) medical examination of patients is necessary.
Forecast favorable during treatment.
Prevention. Prohibition of drinking water from stagnant reservoirs, thorough washing and scalding of greens with boiling water.
9. Echinococcosis
Etiology. The causative agent of hydatid echinococcosis is the larval stage of a small cestode with a scolex with 4 suckers and hooks and 3–4 proglotids filled with eggs. The larva is a single-chamber bubble, the wall of which consists of two layers (outer and inner), of cells that form small parietal protrusions. The bladder cavity is filled with liquid. Echinococcus eggs are highly resistant to external environment, withstand drying and exposure to low temperatures.
Epidemiology. It is widespread throughout the world, infection of the population is very widespread, shepherds, hunters and people who have constant contact with the definitive hosts of echinococcus are more often affected.
Mechanism of transmission of invasion. Fecal-oral (as a result of ingestion of invasive Echinococcus eggs upon contact with dogs, sheep, on whose fur there may be helminth eggs), transmission routes are food, water, household.
Clinic. Chest pain of different nature, cough is dry, then with purulent sputum, hemoptysis, shortness of breath. If a bubble breaks into the bronchus, a severe cough, cyanosis, suffocation appears, and the contents of the bubble may be detected in the sputum. When echinococcal blisters suppurate, a lung abscess develops.
With echinococcosis of the liver, patients lose their appetite, develop weakness, weight loss, headaches, decreased performance, and a feeling of heaviness in the epigastrium. Pain in the right hypochondrium, liver enlargement, thickening, and pain on palpation, nausea, vomiting, upset stool. In rare cases, subecterism of the skin and the appearance of jaundice.
Diagnostics. Based on clinical and laboratory data using serological reactions (RSC, RNGA, latex agglutination reaction with antigen from the fluid of echinococcal blisters), additional methods research, x-ray examination of organs chest, computed tomography lungs, ultrasound of the lungs.
Treatment. Usually surgically.
Prevention. Prevention of infection of animals and humans, compliance with personal hygiene rules, periodic helminthological examination of dogs and timely deworming of infected animals and humans. Information from medical and veterinary institutions is of particular importance.
10. Enterobiasis
Etiology. The causative agent is a female pinworm, 9–12 cm long, males 3–4 cm. Males die after fertilization, females emerge from the anus and lay eggs on the perianal area and in the perineum. Infection occurs as a result of ingestion of infective eggs. Autoinvasion is possible. In the upper part of the small intestine, the infective larvae leave the egg membranes and reach sexual maturity in the large intestine. Pinworms stick to the intestinal mucosa and penetrate to the muscle layer, producing toxins.
Clinic. With minor infestation, there may be no complaints. Itching around the anus, scratching, infection, and frequent bowel movements with pathological impurities appear. Symptoms of intoxication, vulvovaginitis in girls.
Diagnostics. Based on the detection of pinworm eggs in feces or by scraping for pinworm eggs. In the blood - eosinophilia.
Treatment. Mebendazole (Vermox) from 2 to 10 years 25 – 50 mg/kg once, pyrantel (Combantrin) 10 mg/kg (once after breakfast, chew), piperazine up to 1 year 0.2 2 times 5 days; 2 – 3 years – 0.3; 4 – 5 years – 0.5; 6 – 8 years – 0.5; 9 – 12 years – 1.0; 13 – 15 years – 1.5.
Prevention. Maintain personal hygiene.
Rheumatism in children and adolescents
Rheumatism is a systemic inflammatory disease connective tissue with predominant damage to the heart.
Etiology, pathogenesis. The main etiological factor for acute forms diseases – ? -hemolytic streptococcus group A.
In patients with protracted and continuously relapsing forms of rheumatic carditis, it is often not possible to establish a connection between the disease and streptococcus. In the development of rheumatism, particular importance is attached to immune disorders.
It is assumed that sensitizing agents (streptococcus, virus, nonspecific antigens, etc.) can lead in the first stages to immune inflammation in the heart, and then to a change in the antigenic properties of its components with their transformation into autoantigens and the development of an autoimmune process. Important role Genetic predisposition plays a role in the development of rheumatism.
Classification of rheumatism: it is necessary to distinguish the previously inactive or active phase of the disease. Activity can be minimal (I degree), moderate (II degree) and maximum (III degree). To judge it, both the severity of clinical manifestations and changes in laboratory parameters are used.
Classification is also carried out according to the localization of the active rheumatic process (carditis, arthritis, chorea, etc.), the state of blood circulation and the course of the disease. There is an acute course of rheumatism, subacute, protracted, continuously reviewing and latent (clinically asymptomatic).
Isolation of the latent course is justified only for the retrospective characterization of rheumatism: latent formation of heart disease, etc.
Clinic. Most often, the disease develops 1 to 3 weeks after a sore throat or, less commonly, another infection. For repeated attacks, this period may be shorter. Relapses of the disease often develop after any intercurrent diseases, surgical interventions, or physical overload. A manifestation of rheumatism is a combination of acute migratory and completely reversible polyarthritis of large joints with moderately severe carditis.
The onset of the disease is acute, violent, less often subacute. Polyarthritis develops quickly, accompanied by remitting fever up to 38–40 °C with daily fluctuations of 1–2 °C and profuse sweating, but usually without chills.
The first symptom of rheumatic arthritis is increasing sharp pain in the joints, worsening with the slightest passive and active movements. The pain is accompanied by swelling of the soft tissues in the joint area, and at the same time effusion appears in the joint cavity. The skin over the affected joints is hot, their palpation is sharply painful, the range of movements is limited due to pain.
Characterized by symmetrical damage to large joints - usually the knee, wrist, ankle, and elbow. The “volatility” of inflammatory changes is typical, manifested in the rapid and reverse development of arthritic phenomena in some joints and their equally rapid increase in others.
All articular manifestations disappear without a trace; even without treatment they last no more than 2 – 4 weeks. Rheumatic myocarditis in the absence of a concomitant defect is mild with complaints of mild pain or unclear discomfort in the heart area, mild shortness of breath during exertion, less often - palpitations or irregularities.
On percussion, the heart is of normal size or moderately enlarged to the left; on auscultation and FCG, satisfactory sonority of tones or slight muting of the first tone, sometimes the appearance of a third, less often a fourth tone, a soft muscular systolic murmur at the apex of the heart and projections of the mitral valve are characteristic.
Blood pressure is normal or moderately reduced. The ECG shows flattening, widening and jaggedness of the P wave and the QRS complex, and less often, an extension of the PQ interval by more than 0.2 s. In a number of patients, a slight shift of the ST interval downward from the isoelectric line and changes in the T wave are recorded (low, negative, less often biphasic, primarily in leads V1 – V3). Extrasystoles, atrioventricular block of the second or third degree, intraventricular block, and nodal rhythm are rarely observed.
Diffuse rheumatic myocarditis is manifested by violent inflammation of the myocardium with severe swelling and dysfunction. Since the onset of the disease, severe shortness of breath has been a concern, forcing one to assume a position of orthopnea, constant pain in the heart area, and rapid heartbeat. Characteristic is “pale cyanosis”, swelling of the neck veins.
The heart is significantly and diffusely dilated, the apical impulse is weak. The tones are sharply muffled, a clear III tone (protodiastolic gallop rhythm) and a distinct but soft systolic murmur are often heard. The pulse is frequent, weak filling. Blood pressure downgraded.
Venous pressure rises quickly, but with the onset of collapse it also falls. The ECG shows a decrease in the voltage of all waves, flattening of the G wave, a change in the ST interval, and atrioventricular block.
The outcome of rheumatic myocarditis in the absence of active treatment can be myocardial cardiosclerosis, the severity of which often reflects the degree of prevalence of myocarditis. Focal cardiosclerosis does not impair myocardial function.
Diffuse myocardial cardiosclerosis is characterized by signs of decreased contractile function of the myocardium: weakening of the apex impulse, muffling of tones (especially I), systolic murmur.
Rheumatic endocarditis, which is the cause rheumatic defects heart, very poor in symptoms. Its essential manifestation is a clear systolic murmur with sufficient sonority of tones and the absence of signs of severe myocardial damage.
In contrast to the murmur associated with myocarditis, endocardial murmur is rougher and sometimes has a musical tone. Its sonority increases when the patient changes position or after exercise.
A reliable sign of endocarditis is the variability of existing murmurs and especially the emergence of new ones with unchanged (especially with normal) heart boundaries. Light and fairly quickly disappearing diastolic murmurs, sometimes heard at the beginning of a rheumatic attack on the projection of the mitral valve or vessels, may also be partly associated with endocarditis.
Deep endocarditis (valvulitis) of the mitral or aortic valve leaflets in a number of patients is reflected on the echocardiogram: thickening of the leaflets, their “shaggy” appearance, multiple echo signals from them. Pericarditis is rare in the clinic of modern rheumatism.
Dry pericarditis manifested by constant pain in the heart area and a pericardial friction rub, heard more often along the left edge of the sternum. The intensity of the murmur varies; it is usually detected in both phases of the cardiac cycle. The ECG is characterized by an upward shift of the ST interval in all leads at the onset of the disease. Subsequently, these intervals gradually return to the isoelectric line, and at the same time two-phase or negative teeth T. Sometimes ECG data is not indicative. Dry pericarditis by itself does not cause heart enlargement.
Exudative pericarditis– essentially a further stage in the development of dry pericarditis. Often the first sign of effusion is the disappearance of pain due to the separation of the inflamed pericardial layers by the accumulating exudate. Shortness of breath appears, worsening when lying down. The area of the heart with a large amount of exudate bulges somewhat, the intercostal spaces are smoothed, the apex beat is not palpable.
The heart enlarges significantly and takes on the characteristic shape of a trapezoid or round decanter. The pulsation of the contours during fluoroscopy is small. Tones and noises are very muffled (due to effusion). The pulse is frequent, low filling, blood pressure is reduced. Venous pressure is almost always increased, and swelling of the cervical and even peripheral veins is noted. The electrocardiogram is essentially the same as for dry pericarditis; an additional symptom is only a noticeable decrease in the voltage of the QRS complex.
Echocardiography is of significant diagnostic importance, as it undoubtedly establishes the presence of fluid in the heart sac. When the skin is affected, ring erythema is almost pathognomonic, which is pink ring-shaped elements that never itch, located mainly on the skin of the inner surface of the arms and legs, abdomen, neck and torso. It is found in only 1–2% of patients. Rheumatic nodules, described in the old manuals, are now practically never encountered. Erythema nodosum, hemorrhages, and urticaria are completely uncharacteristic.
With kidney damage, mild proteinuria and hematuria are detected (due to generalized vasculitis and damage to the renal glomeruli and tubules), changes nervous system and sense organs.
Lesser chorea, a typical “nervous form” of rheumatism, occurs predominantly in children, especially girls. It is manifested by a combination of emotional lability with muscle hypotonia and violent, pretentious movements of the torso, limbs and facial muscles.
Minor chorea can occur with relapses, but by the age of 17–18 it almost always ends. The features of this form are relatively small damage to the heart and slightly pronounced laboratory parameters activity of rheumatism.
Diagnostics will be checked based on medical history, clinical and laboratory data. The blood test revealed neutrophilic leukocytosis with a shift to the left, thrombocytosis, an increase in ESR to 40 - 60 mm/h. An increase in titers of antistreptococcal antibodies is characteristic: antistreptohiapuronidase and antistreptokinase more than 1: 300, antistreptolysin more than 1: 250. The height of titers of antistreptococcal antibodies and their dynamics do not reflect the degree of activity of rheumatism.
In a biochemical study, an increase in plasma fibrinogen levels above 4 g/l, globulins above 10%, ? -globulins above 20%, seromucoid above 0.16 g/l, appearance of C-reactive protein in the blood.
In most cases biochemical parameters activities are parallel to the ESR values.
There are major diagnostic criteria for rheumatism (carditis, polyarthritis, chorea, ring erythema, rheumatic nodules) and minor ones (fever (not lower than 38 ° C), arthralgia, previous rheumatism or the presence of rheumatic heart disease, increased ESR or positive reaction for C-reactive protein, prolonged PQ interval on ECG).
The diagnosis is considered reliable if the patient has two major criteria and one minor, or one major and two minor, but only if one of the following evidence of a previous streptococcal infection simultaneously exists: recent scarlet fever (which is an undisputed streptococcal disease) ; culture of group A streptococcus from the pharyngeal mucosa; increases in the titer of antistreptolysin O or other streptococcal antibodies.
Treatment. Maintain bed rest for 2–3 weeks or more. In the diet, it is recommended to limit table salt, carbohydrates, and sufficient intake of proteins and vitamins. Exclusion of allergenic products.
Antibacterial therapy with benzylpenicillin sodium salt for 2 weeks, then long-acting drugs (bicillin-5).
If you are intolerant to penicillins, replace them with cephalosporins and macrolides. Vitamin therapy and potassium supplements are prescribed. Pathogenetic therapy: glucocorticoids (prednisolone). Non-steroidal anti-inflammatory drugs (indomethacin, voltaren).
Aminoquinoline preparations (rezoquin, delagil) - for sluggish, prolonged and chronic course. Immunosuppressants are rarely used. Symptomatic treatment of heart failure is carried out. When indicated, diuretic therapy is prescribed. Antirheumatic drugs do not directly affect the manifestations of chorea minor.
In these cases, it is recommended to add luminal or psychotropic drugs such as aminazine or especially seduxen to the therapy. For the management of patients with chorea, a calm environment, the friendly attitude of others, and instilling in the patient confidence in a full recovery are of particular importance.
If necessary, measures must be taken to prevent the patient from self-harm as a result of violent movements.
Treatment in a hospital for 1.5 - 2 months, then treatment in a local sanatorium for 2 - 3 months, where treatment of chronic foci of infection and clinical observation by a local pediatrician and cardiorheumatologist are carried out.
Prevention: primary correct treatment streptococcal infection, sanitation of foci of chronic infection, rational nutrition.
Secondary prevention includes bicillin-drug prophylaxis for all patients, regardless of age and the presence or absence of heart disease, who have undergone a significant rheumatic process.
Forecast favorable.
The helminth is designed very cunningly and when it penetrates the human body immune system works weakly and late.
In its development, the helminth goes through strictly defined stages, none of which can simply fall out of this series. At each stage, a change in the antigenic composition occurs, which negatively affects the child’s health: more and more new immune reactions appear.
- blindness and keratitis;
- myocarditis;
- systemic immunological damage.
- antibody-dependent cell-mediated cytotoxicity (ADCC);
- allergic reaction;
- formation of a T-cell immune response with the simultaneous synthesis of interleukins, eosinophils and class E immunoglobulin.
We can conclude that most pathological reactions develop against the background of the body’s own immune response to the introduction of a foreign agent.
This question is quite debatable and ambiguous, so there are several theories that are currently in use in the world:
- helminthiasis occurs in children and adults who are initially predisposed to atopy;
- helminthiases protect against the development of atopy;
- helminthiasis provokes the development of atopic manifestations.
The most important point is that helminths in children aggravate the allergic situation.
Who is at risk?
- meat processing plant workers;
- people working in laboratories.
Such people gradually develop allergization of the body and increase sensitivity to pork and human roundworms. In such cases, they experience bronchospasm.
Schistosomatid cercariasis
After penetration by schistosomes, the skin begins to itch and a nodular or papular rash appears.
Scabies
The symptoms described above are characteristic feature when the scabies mite causes incredible itching in the skin. Often the diagnosis of the disease is made late, which is why the person himself suffers from itching and at the same time infects other people in contact with him with scabies.
The patient cannot sleep and live normally, his appetite is disturbed, and nervousness appears. Often scratches on the skin become infected and a secondary infection occurs.
Itching is most often caused by scabies mite secretions, which have a toxic effect on the skin, causing an allergic reaction.
Dirofilariasis
The disease is similar to conjunctivitis and angioedema Quincke. The symptoms of this parasitosis are as follows.
Methods of infection
The child studies comprehensively the world around us, including tasting. He still has little understanding of hygiene rules and is open to communicating with any animals, including street ones.
Contact with a contaminated surface
This happens outdoors - from the ground, sand, benches and toys. Playing with an infected peer and using common objects causes helminthiasis.
Many children love to chew their hands, bite their nails, and as adults, school age poorly comply with hygiene requirements. Coming from the street, they forget to wash their hands or wash them insufficiently thoroughly, without soap and just to quickly.
Public places, large stores and playgrounds pose a serious danger to children. In places where there are a lot of people, you need to prevent your child from grabbing everything with his hands.
Drinking water from reservoirs while swimming, and even poor-quality tap water, can cause helminthiasis.
Through contact with infected individuals
Through an insect bite
The presence of worms in the mother
Helminths enter the body from the outside and begin their life cycle. They lay eggs, from which larvae emerge and migrate throughout the body. They enter any organs and destroy them.
The main provocateurs of helminthiasis in childhood are:
Important: Almost 85% total number helminthiasis is recorded in children under 14 years of age.
Symptoms
- proteins;
- glucose;
- hormones;
- carbohydrates;
- vitamins.
Typically, the first signs of helminthiasis appear after 2-6 weeks. Acute phase observed for up to 4 months, then becomes chronic.
Information: the most common invasion is enterobiasis. Most children of all ages suffered from it.
When infected with pinworms
The main signs of pinworm infection are:
Ascarids
As the larvae move through the body, multiple lesions appear different organs. Observed:
- rise in temperature;
- enlarged lymph nodes;
- dry cough interspersed with blood;
- enlarged spleen and liver;
- a characteristic feature is rashes on the hands and feet, allergic dermatitis;
- appendicitis with accumulation of larvae in the caecum.
Children also experience a variety of nervous system disorders - drowsiness, lethargy, nervousness, and sometimes convulsions and seizures.
Let us remember that enterobiasis is an infection with pinworms. This is one of the types of helminthiasis, the most widespread among all ages. Enterobiasis can be recognized by the following signs:
- Burning and itching in anus. There is damage to the mucous membranes at the site of scratching.
- Signs of allergies – dermatitis, conjunctivitis.
- Weight loss and growth retardation.
- Unstable stool, other signs of dyspepsia.
- Children often suffer from various types of infectious diseases.
There is a decrease in cognitive abilities and mental instability.
Characteristic symptoms of infestations different types in children:
- Opisthorchiasis. Pathogens become infected by eating fish that has not been thermally processed sufficiently. There are digestive disorders, the liver and pancreas are affected.
- Toxocariasis. Accompanied by fever, eosonophilia, increased lymph nodes. The liver, spleen, eyes, and heart suffer.
- Trichocephalosis. Causes whipworm infestation. It often has no symptoms and goes undiagnosed for a long time. IN severe cases diarrhea with blood is observed.
With a long course, children begin to noticeably lag behind in development, often get sick and weaken.
What danger does helminthiasis pose?
Enterobiasis is often accompanied by urticaria, lesions of the genital mucosa, and urinary incontinence.
With opisthorchiasis, the main impact falls on the liver and pancreas, as a result of which pancreatitis and cholecystitis are possible.
How to diagnose infection in a child
Diagnostic measures:
- examination of secretions - feces for eggs, vomit, sputum, scraping from the anus, coprogram;
- serological – ELISA, RIF, others;
- blood for eosinophilia, bilirubin, alkaline phosphatase, immunoglobulin E;
- PCR research;
- tissue biopsy of damaged organs in case of severe damage;
- skin allergy tests.
Ultrasound, X-ray, CT or MRI, and endoscopic examinations help check the condition of organs.
In addition to specific drugs, a whole group of other drugs is used that help restore the body.
Antihelminthic drugs
All drugs are prescribed in a short course, often in one dose. The dose is selected based on the child’s body weight.
Please note: treatment with antihelminthic medications is usually prescribed to everyone around the sick child.
Taking probiotics
Immunostimulating drugs
Enterosorbents
An enema with soda helps with pinworms. For 250 milliliters of water take ½ teaspoon of soda. Do it 2-3 times a day.
Before using any products, please consult a pediatrician.
Preventive measures
The child needs early age teach cleanliness and hygiene. Hands should be washed more often: after returning from the street, playing with animals, going to the toilet, before eating.
Parents need to closely monitor their child and his health. Trim your nails regularly, change your underwear, avoid eating outside, and monitor the health of your pets.
Prevention includes the formation of correct behavior skills on the street and in public places– do not put your hands in your mouth, do not eat in questionable places.
The most common and studied diseases - ascariasis, enterobiasis (Fig. 1) and giardiasis - are registered everywhere. In Russia, more than 2 million patients with nematodes are diagnosed annually. When assessing the territorial distribution of giardiasis in Russia, it was found that the highest intermediate level incidence rates for many years have been noted in St. Petersburg, and the incidence of children attending child care institutions is 35%.
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The importance of certain risk factors varies according to the age of the child. It has been proven that for children younger age sanitary and hygienic living conditions are more significant, and for adolescents, when collecting anamnesis, it is necessary to pay attention to socio-economic and geographical factors (staying in a camp, a tourist trip, the presence of a younger brother or sister) (Fig. 3).
The immune defense of the child’s gastrointestinal tract (GIT) can be divided into specific and nonspecific. Non-specific protection includes a set of conditions for normal digestion: the maturity of enzymatic systems, ensuring an acid-base gradient in various departments Gastrointestinal tract, activity of normal microflora, adequate motor skills.
Separately, it should be noted that for a disease such as giardiasis, a predisposing factor for invasion is the irregular and insufficient secretion of bile into the intestines due to abnormalities in the development of the gallbladder (constrictions, kinks). Giardiasis, identified in patients of the pediatric department of MONIKI, was accompanied by biliary tract dysfunction in 100% of cases.
Specific protection of the mucous membrane of the digestive organs depends on the child’s age and maturity. The mechanism of specific immune defense is one of the most ancient systems of the body, since helminthiases have accompanied humanity for many millennia. This mechanism is represented primarily by blood eosinophils and immunoglobulin E.
A particularly recognizable clinical picture is formed by toxocariasis (Fig. 5). Clinical markers of this invasion are the leukemoid reaction of eosinophils (20% or more eosinophils in the blood count), which accompanies a pronounced and persistent allergic syndrome in the form atopic dermatitis with severe itching and resistance to traditional therapy or severe bronchial asthma with frequent attacks.
However, the effort expended may be useless if the study is carried out during a pause in the production of cysts or eggs. For example, the uninformativeness of perianal scraping with a 1-2-fold examination method is due to the frequency of oviposition by female pinworms. The peculiarity of the excretion of cysts by Giardia is called the “phenomenon of intermittent cyst excretion,” in which the phases of massive cyst excretion are replaced by a negative phase, which can last from 2-3 days to 2-3 weeks. During this period, it is impossible to detect Giardia in feces.
Treatment of helminthiases
For the treatment of ascariasis in older children or in case of recurrence of the disease, a combination dose can currently be used under medical supervision anthelmintics(for example, albendazole for three days, then Vermox for three days). An indispensable condition for successful deworming of patients with enterobiasis is the simultaneous treatment of all family members (team) and strict adherence to hygienic regime to exclude reinvasion. It should be noted that daily wet cleaning is important, since occasional cases of pinworm reproductive material spreading on dust particles to a height of 1.5 meters have been described.
Treatment of giardiasis involves a mandatory diet with limited consumption of easily digestible carbohydrates, increasing the proportion of protein in food, consumption of “acidifying” products (decoctions of lingonberries, cranberries), and the use of choleretic decoctions and drugs.
Drugs used in the treatment of ascariasis:
- Vermox (mebendazole) (for children over 2 years old) - 100 mg 2 times a day for 3 days;
Drugs used in the treatment of enterobiasis:
- Vermox (mebendazole) (for children over 2 years old) - 100 mg once;
- Pyrantel - 10 mg/kg once;
- Nemozol (albendazole) (for children over 2 years old) - 400 mg once.
Drugs used in the treatment of giardiasis:
- ornidazole 25-30 mg/kg (if body weight is more than 35 kg - 1000 mg) in two doses for 5 days, 1 day - 1/2 dose, repeat course after 7 days;
- Macmiror (nifuratel) - 15 mg/kg 2 times a day for 7 days;
- Nemozole (albendazole) - 15 mg/kg once for 5-7 days.
3. Mandatory use of enterosorbents and a complex of multivitamins with microelements (Tables 2 and 3).
Literature
L. I. Vasechkina 1,Candidate of Medical Sciences
T. K. Tyurina,Candidate of Medical Sciences
L. P. Pelepets,Candidate of Biological Sciences
A. V. Akinfiev,Candidate of Medical Sciences
GBUZ MO MONIKI named after. M. F. Vladimirsky, Moscow
Let's talk more about these diseases below.
Symptoms of the disease depend on the form of the disease. With simple carriage, the patient remains completely healthy, and there is no clinic. In chronic cases, the symptoms are as follows: acute diarrhea with bloating and fever alternating with remissions. Acute balantidiasis manifests itself as fever, intoxication, diarrhea, tenesmus, and blood in the stool.
In rare cases, the disease is accompanied by intestinal perforation. Then the patients are admitted to the surgical hospital. The threat to life is very real. Fecal peritonitis that develops as a result of this infection, even in modern world have a high mortality rate.
Diagnosis of the disease is simple. A smear from the intestinal mucosa or a stool test will help detect large pathogens. The main thing is to complete this research on time. Treatment is with the antibiotic Monomycin or Metronidazole. The course of treatment lasts 5 days and is repeated 2-3 times. If left untreated, death may occur from complications or exhaustion.
The symptoms of the disease are listed below:
- carriage has no clinical symptoms;
- with the intestinal form there is pain in upper sections abdominal pain, nausea, vomiting, loss of appetite, diarrhea;
- in the hepatic form, pain occurs in the right hypochondrium, bile stagnation, jaundice, bitterness in the mouth, indigestion;
- In patients with the disease, they develop allergic reactions, rash, exhaustion and intoxication.
Opisthorchiasis
Infection occurs through consumption of fish (raw, dried, poorly cooked). The worm lives in the carp family (tench, ide, roach, rudd). Symptoms of the disease appear a month after infection. Regional lymph nodes enlarge, the patient experiences vague fever, intoxication, rash, joint and muscle pain. The liver may be affected, and symptoms of gastritis and pancreatitis may appear. The disease can affect the lungs with the development of pleurisy and pneumonia.
Treatment is not prescribed without diagnosis. Clinical signs diseases are nonspecific. Typically, helminth eggs can be isolated from feces and intestinal contents. A technique is used to detect elevated antibody titers. Treatment is carried out in a hospital with the drug Praziquantel. The high toxicity of the substance requires round-the-clock medical supervision.
Treatment and diagnosis are time-consuming and complex. More often, imaging (ultrasound, CT, MRI) is used to determine pathology. Serological tests can be used. The clinical picture and medical history of the patient are important.
There is no treatment with tablets for this invasion. Cysts are removed promptly. Surgeons try to drain them carefully to prevent the contents from getting into the surrounding tissues.
Taeniasis
Infection occurs through the meat of pigs infected with tapeworm. Clinical picture very indicative of helminth infections:
- Weakness;
- Abdominal pain;
- Anemia with vitamin deficiency;
- Mental disorders (fatigue, irritability).
Diagnosis of this disease is interesting. Segments of the helminth can be released from the anus and found on the skin of the genitals and buttocks. During the study, stool analysis and scraping from the perineum are prescribed.
Treatment is carried out with the drug Mebendazole. The dose is prescribed by the doctor.
Ascariasis
Roundworms affect children and adults. This is the most common pathology in the world of helminths. Eggs can be found in the soil and on surrounding objects. In children's institutions, the disease is transmitted through toys and furniture. Ascariasis has intestinal and migratory phases. The first is characterized by an appetite disorder. In children, this symptom is well expressed. Another feature of the disease is copious discharge saliva. Patients also experience nausea, vomiting, and abdominal pain. During the migration phase, roundworm larvae pass through the lungs. In this case, hemoptysis and cough occur. Pneumonia often develops. Children and adults with ascariasis have a symptom of asthenia. They are thin and pale, with bloated belly, often suffer from colds.
If ascariasis is suspected, a stool examination is performed. Eggs are released after 3 months from infection. Patients can be treated with Decaris.
Trichinosis
Infection occurs through consumption of meat from wild and domestic animals that have this infection. Most often these are wild boars, bears, and badgers. The larvae die at temperatures above 80 ⁰C. Therefore, it is better to extinguish game that has not been inspected by sanitary services for a long time. Kebabs, Polendvitsa and steak do not provide adequate processing.
