How to identify and cure parasitic diseases in children. Features of therapy for parasitic invasions in children Helminthiasis in children

1. Helminthiasis

Classification of helminthiasis. According to the biological principle: nematodes (roundworms), cestodoses (tape), trematodes (flukes).

Epidemiological: geohelminthiasis, biohelminthiasis, contact.

Ascariasis

Clinic. The migration phase often proceeds under the guise of acute respiratory infections, bronchitis (including malaise, dry cough or scanty sputum, low-grade fever, dry and moist wheezing in the lungs).

Possible urticaria, vesicular rash on the hands and feet, 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 upset stool and gastric secretion); hypotonic (decreased blood pressure, weakness) and neurological (dizziness, headache, fatigue, sleep disturbances, vegetative-vascular disorders) forms.

Complications. Ascariasis obstruction of the intestine, 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 the 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, with the late intestinal phase - ascaris eggs in feces.

Treatment. Piperazine, levamisole, and combantrine are used to expel young individuals and adults of ascaris. 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). Effectiveness is enhanced by taking piperazine after dinner, before bedtime. Levamisole (decaris) is prescribed after meals at a dose of 150 mg once, pyrantel is recommended once after meals at the rate of 10 mg / kg. Oxygen treatment is carried out on an empty stomach or 3 to 4 hours after breakfast for 2 to 3 consecutive days.

Forecast. In the absence of complications requiring surgical intervention, favorable.

Prevention. Mass survey of the population and treatment of all infested with ascariasis. Protection of the soil of vegetable gardens, orchards, 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 the alveococcus. Infection occurs after the ingestion of oncospheres in the mouth after contact with contaminated skins of foxes, arctic foxes, dogs, with the water of stagnant reservoirs and when eating forest berries collected in an endemic area. Accumulations 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, dull aching pain.

After a few years, the liver becomes bumpy and very dense. Jaundice may develop, and the spleen sometimes enlarges. With the collapse of the nodes, the body temperature rises, sweating is observed.

Diagnosis. Based on laboratory data - leukocytosis, eosinophilia, increased ESR, hyperproteinemia, hypergammaglobulinemia. Serological tests are performed with the alveococcal antigen. To clarify the localization, X-ray and ultrasound examination, liver scan, computed tomography are used. Trial puncture is prohibited due to the danger of contamination of other organs.

Differential diagnosis. Differentiate with tumors, echinococcosis and liver cirrhosis.

Treatment. Surgical and symptomatic.

3. Ankylostomiasis (hookworm and non-kotorosis)

Adult helminths are hematophages. When fixed to the intestinal mucosa, they injure tissues, lead to the formation of hemorrhages, cause bleeding, anemization, maintain the state of allergies, dyskinesia of the gastrointestinal tract and dyspepsia.

Clinic. Itching and burning, asthmoid symptoms, fever, eosinophilia. In the late stage, nausea, drooling, vomiting, abdominal pain, bowel dysfunction (constipation or diarrhea), and bloating appear.

Diagnosis. Confirmed by the detection of eggs in the feces and occasionally in the duodenal contents.

Treatment. Deworming is carried out with combantrin or levamisole. With severe anemia (hemoglobin below 67 g / l), iron preparations, transfusion of erythrocyte mass are used.

Forecast. In most cases, favorable.

Prevention. In foci of ankylostomiasis, one should not walk barefoot and lie on the ground without bedding. It is necessary to thoroughly wash and scald fruits, vegetables, berries with boiling water before eating them, you cannot drink unboiled water.

4. Diphyllobothriasis

Clinic. Characterized by nausea, weakness, dizziness, abdominal pain, unstable stools, discharge of strobila scraps during defecation.

Diagnosis. Confirmed by the detection of tapeworm eggs and scraps of strobila in feces.

Treatment. In case of severe anemia, before helminthization, vitamin B is prescribed at 300 - 500 μg i / m 2 - 3 times a week for a month, iron preparations, hemostimulin, hematogen. For deworming, fenasal, male fern extract, pumpkin seed decoction are used.

Forecast. In the absence of complications, it is favorable.

Prevention. Do 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 the early period, there may be fever, pain in muscles and joints, vomiting, diarrhea, soreness and enlargement of the liver, less often the spleen, leukocytosis and high eosinophilia, allergic skin rashes. 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 biliary colic.

Dizziness, various dyspeptic symptoms are frequent. They reveal muscle resistance in the right hypochondrium, enlarged liver, occasionally icterus of the sclera, enlarged gallbladder, symptoms of pancreatitis. Most often, with opisthorchiasis, the phenomena of cholecystitis, biliary dyskinesia, chronic hepatitis and pancreatitis develop, less often - symptoms of gastroduodenitis, enterocolitis. Opisthorchiasis may be asymptomatic.

Diagnosis. Based on the detection of helminths in the feces and duodenal contents of eggs.

Treatment. Deworming is carried out with mebendazole (vermox).

Prevention. Explaining to the population the dangers of eating raw, thawed and frozen (stroganin), slightly salted and insufficiently fried fish.

6. Teniosis

Diagnosis set on the basis of repeated examination of feces for the presence of segments of helminths and mucus from the perianal folds (by scraping) for the presence of tapeworm eggs.

Treatment. Vermox treatment. Sometimes essential extract of male fern and pumpkin seeds are used.

Prevention. Do not eat uncooked or uncooked pork.

7. Trichocephalosis

Clinic. Disturbed by salivation, decreased (less often increased) appetite, pain in the right half of the abdomen and epigastrium, nausea, constipation or diarrhea, sometimes headache, dizziness, restless sleep, irritability are noted; moderate hypochromic anemia and slight leukocytosis are possible. At low intensity, the invasion of whipworms is asymptomatic.

Diagnosis. Set when whipworm eggs are found in feces.

Treatment. Mebendazole and other anthelmintic drugs are prescribed. Previously, the patient is given a cleansing enema.

Forecast. Favorable.

8. Fascioliasis

Etiology, pathogenesis. The causative agents are hepatic and giant flukes. The main source of human infestation is various farm animals. Human infection usually occurs in the warm season when the fasciola larvae are swallowed with water, sorrel, lettuce and other herbs. The lifespan of helminths in the body is about 10 years. Traumatization and toxic-allergic damage to the hepatobiliary system are important. It is possible that fasciolus can enter other tissues and organs.

Clinic. The disease is characterized by eosinophilia, allergic phenomena, disorders of the liver and gallbladder function, reminiscent of the symptoms of opisthorchiasis (jaundice and attacks of biliary colic are more common).

Diagnosis. The 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 a later stage, the diagnosis is based on the detection of eggs of fascioli in the duodenal contents and feces.

Treatment. Anthelmintic drugs are prescribed, and after deworming, choleretic drugs are prescribed for 1 to 2 months. A long-term (at least a year) clinical examination of patients is required.

Forecast during treatment is favorable.

Prevention. Prohibition of the use of 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-chambered bladder, the wall of which consists of two layers (outer and inner), of cells that form small parietal protrusions. The bubble cavity is filled with liquid. Echinococcus eggs are highly resistant in the external environment, withstand drying and exposure to low temperatures.

Epidemiology. It is widespread throughout the world, the infection of the population is very wide, shepherds, hunters and persons who have constant contact with the final owners of echinococcus are more often sick.

The transmission mechanism of the invasion. Fecal-oral (as a result of ingestion of invasive eggs of echinococcus upon contact with dogs, sheep, on whose wool there may be helminth eggs), the route of transmission is food, water, household.

Clinic. Pain in the chest of a different nature, dry cough, then with purulent sputum, hemoptysis, shortness of breath. If the bladder breaks into the bronchus, a severe cough, cyanosis, suffocation appears, the contents of the bladder can be found in the sputum. With suppuration of echinococcal blisters, a lung abscess develops.

With echinococcosis of the liver, patients lose appetite, weakness, weight loss, headaches, decreased performance, a feeling of heaviness in the epigastrium appear. Pain in the right hypochondrium, enlarged liver, induration, and tenderness on palpation, nausea, vomiting, upset stools. In rare cases, skin subectery and jaundice.

Diagnostics. Based on clinical and laboratory data using serological tests (RSK, RNGA, latex agglutination reaction with antigen from echinococcal bladder fluid), additional research methods, chest x-ray, computed tomography of the lungs, ultrasound of the lungs.

Treatment. Usually by surgery.

Prevention. Prevention of infection of animals and humans, adherence to the rules of personal hygiene, 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 pinworm, female 9-12 cm long, males 3-4 cm. Males die after fertilization, females leave the anus and lay eggs on the perianal region and in the perineum. Infection occurs as a result of ingestion of invasive eggs. Autoinvasion is possible. In the upper part of the small intestine, the invasive 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 a minor invasion, complaints may be absent. Itching around the anus, scratching, infection, frequent stools with pathological impurities appear. Symptoms of intoxication, girls have vulvovaginitis.

Diagnostics. Based on the detection of pinworm eggs in the feces or by scraping pinworm eggs. In the blood - eosinophilia.

Treatment. Mebendazole (vermox) from 2 to 10 years, 25-50 mg / kg once, pyrantel (combantrine) 10 mg / kg (once after breakfast, chewed), piperazine up to 1 year 0.2 2 times 5 days; 2 - 3 years - 0.3; 4 - 5 years old - 0.5; 6 - 8 years old - 0.5; 9 - 12 years old - 1.0; 13 - 15 years old - 1.5.

Prevention. Compliance with personal hygiene.

Rheumatism in children and adolescents

Rheumatism is a systemic inflammatory disease of the connective tissue with a primary lesion of the heart.

Etiology, pathogenesis. The main etiological factor in acute forms of the disease is ? - hemolytic streptococcus group A.

In patients with protracted and continuously recurrent forms of rheumatic heart disease, 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 at 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. Genetic predisposition plays an important role in the development of rheumatism.

Classification of rheumatism: it is necessary to highlight the previously inactive or active phase of the disease. Activity can be minimal (I degree), medium (II degree) and maximum (III degree). To judge it, both the severity of clinical manifestations and changes in laboratory parameters are used.

The 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 peer-reviewed and latent (clinically asymptomatic).

Isolation of the latent course is justified only for the retrospective characteristics of rheumatism: latent formation of heart disease, etc.

Clinic. Most often, the disease develops within 1 to 3 weeks after a sore throat or, less often, another infection. With repeated attacks, this period may be shorter. Relapses of the disease often develop after any intercurrent diseases, surgical interventions, physical overload. A manifestation of rheumatism is a combination of acute migratory and completely reversible polyarthritis of large joints with moderate carditis.

The onset of the disease is acute, violent, less often subacute. Polyarthritis develops rapidly, accompanied by remitting fever up to 38 - 40 ° C with daily fluctuations of 1 - 2 ° C and strong sweat, but usually without chills.

The first symptom of rheumatic arthritis is increasing acute pain in the joints, aggravated by the slightest passive and active movements. Swelling of the soft tissues in the joint area joins the pain, and at the same time there is an effusion in the joint cavity. The skin over the affected joints is hot, palpation is sharply painful, the range of motion is limited due to pain.

Symmetrical lesion of large joints is characteristic - usually knee, wrist, ankle, elbow. Typical is the "volatility" of inflammatory changes, manifested in the rapid and reverse development of arthritic phenomena in some joints and their equally rapid growth in others.

All articular manifestations disappear without a trace; even without treatment, they last no more than 2 to 4 weeks. Rheumatic myocarditis in the absence of a concomitant defect is mild with complaints of mild pain or vague discomfort in the region of the heart, mild dyspnea during exertion, less often of palpitations or interruptions.

With percussion, the heart is normal in size or moderately enlarged to the left, with auscultation and PCG, satisfactory sonority of tones or a slight muffling of the I tone, sometimes the occurrence of a III, less often IV tone, soft muscle systolic murmur at the apex of the heart and the projection of the mitral valve.

Blood pressure is normal or moderately low. On the ECG - flattening, widening and serration of the P wave and QRS complex, less often the lengthening of the PQ interval for more than 0.2 s. In a number of patients, a slight shift in the ST interval downward from the isoelectric line and changes in the T wave (low, negative, less often biphasic, primarily in leads V1 - V3) are recorded. Rarely are extrasystoles, atrioventricular block II or III degree, intraventricular block, junctional rhythm.

Diffuse rheumatic myocarditis is manifested by violent inflammation of the myocardium with its pronounced edema and dysfunction. From the onset of the disease, severe shortness of breath is disturbing, forcing to take the position of orthopnea, constant pain in the region of the heart, palpitations. Characterized by "pale cyanosis", swelling of the neck veins.

The heart is significantly and diffusely enlarged, the apical impulse is weak. The tones are sharply muted, a clear III tone (protodiastolic gallop rhythm) and a distinct but soft systolic murmur are often heard. The pulse is fast, weak filling. Blood pressure is lowered.

Venous pressure rises rapidly, but also decreases with the addition of collapse. On the ECG, a decrease in the voltage of all teeth, a flattening of the G wave, a change in the ST interval, and atrioventricular block are noted.

The outcome of rheumatic myocarditis in the absence of active treatment can be myocarditis cardiosclerosis, the severity of which often reflects the extent of myocarditis. Focal cardiosclerosis does not impair myocardial function.

Diffuse myocarditis cardiosclerosis is characterized by signs of a decrease in the contractile function of the myocardium: weakening of the apical impulse, muffling of tones (especially I), systolic murmur.

Rheumatic endocarditis, which is the cause of rheumatic heart disease, is very poor in symptoms. Its essential manifestation is a clear systolic murmur with sufficient sonority of tones and the absence of signs of pronounced myocardial damage.

In contrast to the murmur associated with myocarditis, the endocarditis murmur is harsher and sometimes has a musical flavor. Its sonority increases with a change in the position of the patient or after a load.

A reliable sign of endocarditis is the variability of existing murmurs and especially the emergence of new ones with unchanging (even more so - with normal) borders of the heart. Light and rather quickly disappearing diastolic murmurs, sometimes heard at the onset of a rheumatic attack on the projection of the mitral valve or vessels, may also partly be associated with endocarditis.

Deep endocarditis (valvulitis) of the cusps of the mitral or aortic valves in a number of patients is reflected on the echocardiogram: thickening of the cusps, their "hairiness", multiple echoes from them. Pericarditis in the clinic of modern rheumatism is rare.

Dry pericarditis manifested by constant pain in the region of the heart and pericardial friction murmur, which is heard more often along the left edge of the sternum. The intensity of the murmur is different, usually it is determined 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. In the future, these intervals gradually return to the isoelectric line, at the same time biphasic or negative T waves are formed. Sometimes the ECG data are not indicative. Dry pericarditis by itself does not cause enlargement of the heart.

Pericardial effusion - essentially a further stage of 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 accumulating exudate. Shortness of breath appears, aggravated by lying down. With a large amount of exudate, the region of the heart swells somewhat, the intercostal spaces are smoothed, the apical impulse is not palpable.

The heart enlarges significantly and takes the characteristic shape of a trapezoid or a round decanter. The pulsation of the contours during fluoroscopy is small. Tones and noises are very muffled (due to effusion). The pulse is fast, small filling, blood pressure is lowered. Venous pressure is almost always increased, there is swelling of the cervical and even peripheral veins. The electrocardiogram is basically 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 value, indisputably establishing the presence of fluid in the heart bag. With skin lesions, annular erythema is almost pathognomonic, which is a pink ring-shaped elements, never itching, located mainly on the skin of the inner surface of the arms and legs, abdomen, neck and trunk. It is found only in 1 - 2% of patients. The rheumatic nodules described in the old manuals are practically non-existent today. Erythema nodosum, hemorrhages, urticaria are completely uncommon.

With kidney damage, mildly pronounced proteinuria and hematuria (due to generalized vasculitis and damage to the renal glomeruli and tubules), changes in the nervous system and sensory organs are found.

Chorea minor, a typical "nervous form" of rheumatism, occurs mainly in children, especially girls. It is manifested by a combination of emotional lability with muscle hypotonia and violent, artsy movements of the trunk, limbs and facial muscles.

Chorea minor can recur with relapses, but by the age of 17 - 18 it almost always ends. The peculiarities of this form are relatively small heart damage and slightly expressed laboratory indicators of the activity of rheumatism.

Diagnostics will be checked on the basis of anamnesis, clinical and laboratory data. In the analysis of blood - neutrophilic leukocytosis with a shift to the left, thrombocytosis, an increase in ESR up to 40 - 60 mm / h. An increase in the titers of anti-streptococcal antibodies is characteristic: antistreptohyapuronidase and antistreptokinase more than 1: 300, antistreptolysin more than 1: 250. The height of anti-streptococcal antibodies and their dynamics do not reflect the degree of rheumatism activity.

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, the appearance of C-reactive protein in the blood.

In most cases, biochemical activity indicators are parallel to the ESR values.

There are large diagnostic criteria for rheumatism (carditis, polyarthritis, chorea, erythema annulus, rheumatic nodules) and small (fever (not lower than 38 ° C), arthralgia, rheumatism in the past or the presence of rheumatic heart disease, increased ESR or a positive reaction to C- reactive protein, prolonged PQ interval on ECG).

The diagnosis is considered reliable if the patient has two large criteria and one small, or one large and two small, but only if one of the following evidence of a previous streptococcal infection exists simultaneously: recent scarlet fever (which is an undeniable streptococcal disease) ; sowing group A streptococcus from the pharyngeal mucosa; increases in the titer of antistreptolysin O or other streptococcal antibodies.

Treatment. Observe bed rest for 2 - 3 weeks or more. In the diet, it is recommended to limit table salt, carbohydrates, adequate intake of boluses and vitamins. Elimination of foods that cause allergies.

Antibacterial therapy with benzylpenicillin sodium salt for 2 weeks, then prolonged-release drugs (bicillin-5).

In case of intolerance to penicillins, replacement with cefolosporins, macrolides. Prescribe vitamin therapy, potassium preparations. Pathogenetic therapy: glucocorticoids (prednisolone). Non-steroidal anti-inflammatory drugs (indomethacin, voltaren).

Aminoquinoline preparations (rezohin, delagil) - for sluggish, protracted and chronic course. Immunosuppressants are rarely used. Symptomatic therapy for heart failure is carried out. When indicated, diuretic therapy is prescribed. Antirheumatic drugs do not directly affect the manifestations of chorea.

In these cases, it is recommended to add luminal or psychotropic drugs such as chlorpromazine or especially seduxen to the therapy. For the management of patients with chorea, a calm environment, a benevolent attitude of others, instilling the patient with confidence in a full recovery are of particular importance.

If necessary, it is required to take measures to prevent self-harm of the patient 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 chronic foci of infection are treated and dispensary observation by a local pediatrician and cardioreumatologist.

Prevention: primary correct treatment of streptococcal infection, sanitation of foci of chronic infection, good nutrition.

Secondary prevention includes bicillin-medication prophylaxis for all patients, regardless of age and the presence or absence of heart disease, who have undergone a reliable rheumatic process.

Forecast favorable.



Helminth is designed very cunningly and when it enters the human body, the immune system works poorly and with a delay.

In its development, the helminth goes through strictly defined stages, none of which can simply fall out of this series. At each stage, there is a change in the antigenic composition, which negatively affects the health of the child: more and more 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.

It can be concluded that the majority of pathological reactions develop against the background of the body's own immune response to the introduction of a foreign agent.

This question is quite controversial and controversial, therefore there are several theories that are currently in use in the world:

• helminthiases occur in children and adults who are initially predisposed to atopy;
• helminthiases protect against the development of atopy;
• helminthiases provoke the development of atopic manifestations.

The most important point is that helminths in childrenaggravate the allergic situation.

Who is at risk?

• workers of meat processing plants;
• people working in laboratories.

In such people, allergization of the body gradually develops and the sensitivity to pork and human roundworms increases. In such cases, they either develop bronchospasm.

Schistosomatous cercariasis

After the penetration of schistosomes, the skin begins to itch, a nodular or papular rash appears.

Scabies

The above symptoms are a common symptom when the itch mite causes incredible itching in the skin. Often, the diagnosis of the disease is made late, which is why a person suffers from itching himself and at the same time infects with scabies and other persons in contact with him.

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 is added.

Itching is most often caused by the discharge of an itch mite, which has 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.

Infection methods

The child comprehensively studies the world around him, including trying to taste. He is still poorly versed in the rules of hygiene, is open to communication with any animals, including street animals.

Contact with contaminated surface

This happens on the street - from the ground, sand, benches and toys. Playing with an infected peer, using common objects causes helminthiasis.

Many children like to bite their hands, bite their nails, and already in adulthood, school age, do not follow the requirements of hygiene. Coming from the street, they forget to wash their hands or do not wash them thoroughly enough, without soap and if only faster.

Public places, large shops and playgrounds pose a serious danger to children. In such places where there are many people, you need to prevent the child from grabbing at everything.

Drinking water from ponds while swimming, and even low-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 the larvae emerge, migrating through the body. They get into any organs and destroy them.

The main provocateurs of helminthiasis in childhood are:

Important: Almost 85% of the total number of helminthiases is recorded in children under 14 years of age.

Symptoms

• proteins;
• glucose;
• hormones;
• carbohydrates;
• vitamins.

Usually the first signs of helminthiasis appear in 2-6 weeks. The acute phase is observed up to 4 months, then the chronic one occurs.

Help: the most common invasion is enterobiasis. Most children at different ages suffered from it.

When infected with pinworms

The main signs of pinworm infestation are:

Ascaris

When the larvae move through the body, multiple lesions of various organs appear. Observed:

• temperature rise;
• enlarged lymph nodes;
• dry cough interspersed with blood;
• enlargement of the spleen and liver;
• a characteristic feature - rashes on the hands and feet, allergic dermatitis;
• appendicitis with the accumulation of larvae in the blind process.

Children also have various disorders of the nervous system - drowsiness, lethargy, nervousness, and sometimes convulsions and seizures.

Recall 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:

1. Burning and itching in the anus. At the site of scratching, there are mucosal damage.
2. Signs of allergies - dermatitis, conjunctivitis.
3. Weight loss and growth retardation.
4. Unstable stools, other signs of dyspepsia.
5. Babies often get sick with different types of infectious diseases.

There is a decrease in cognitive abilities, mental instability.

Typical symptoms of various types of invasions in children:

1. Opisthorchiasis. Pathogens infect when eating fish that is not thermally processed enough. Digestive disorders are present, liver and pancreas are affected.
2. Toxocariasis. It is accompanied by a febrile condition, eosonophilia, and enlarged lymph nodes. Liver, spleen, eyes, heart suffer.
3. Trichocephalosis. Causes whipworm infestation. Often has no symptoms, is not diagnosed for a long time. In severe cases, bloody diarrhea is observed.

With a long course, children begin to noticeably lag behind in development, they often get sick and weaken.

What is the danger of helminthiasis

Enterobiasis is often accompanied by urticaria, lesions of the mucous membranes of the genital organs, urinary incontinence.

With opisthorchiasis, the main blow falls on the liver and pancreas, as a result of which pancreatitis and cholecystitis are possible.

How to diagnose an infection in a child

Diagnostic measures:

• studies 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;
• biopsy of tissues of damaged organs with severe damage;
• allergic skin tests.

Ultrasound, X-ray, CT or MRI, endoscopic examinations help to check the condition of the organs.

In addition to specific drugs, a whole group of other drugs are used that help restore the body.

Antihelminthic drugs

All drugs are prescribed in a short course, often in one dose. The dose is selected according to the child's body weight.

For your information: treatment with antihelminthic drugs is usually prescribed to the entire environment of the sick child.

Taking probiotics

Immunostimulating drugs

Enterosorbents

An enema with soda helps with pinworms. For 250 milliliters of water, take ½ teaspoon of baking soda. Do 2-3 times a day.

Pediatrician advice is required before using all products.

Preventive measures

The child must be taught from an early age to cleanliness and hygiene. Hands should be washed more often: after returning from the street, playing with animals, using the toilet, before eating.

Parents need to closely monitor the child and his health. Trim your nails regularly, change your underwear, eliminate food outside, 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 recorded 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 average incidence rate for many years was noted in St. Petersburg, and the prevalence of children attending children's institutions is 35%.

The significance of certain risk factors varies with the age of the child. It has been proven that for young children, sanitary and hygienic living conditions are more important, and for adolescents, when taking anamnesis, it is necessary to pay attention to socio-economic and geographical factors (stay in a camp, a tourist trip, the presence of a younger brother or sister) (Fig. 3).

The immune protection of the gastrointestinal tract (GIT) of a child can be conditionally divided into specific and non-specific. Nonspecific protection includes a set of conditions for normal digestion: the maturity of enzymatic systems, the provision of an acid-base gradient in various parts of the gastrointestinal tract, the activity of normal microflora, and adequate motility.

Separately, it should be noted that for a disease such as giardiasis, a predisposing factor for invasion is an irregular and insufficient separation of bile into the intestine with anomalies in the development of the gallbladder (constrictions, kinks). Giardiasis, detected in patients of the pediatric department of MONIKI, was accompanied by dysfunction of the biliary tract in 100% of cases.

The specific protection of the mucous membrane of the digestive system 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 mankind 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 (from 20% and more eosinophils in the blood count), accompanying a bright and persistent allergic syndrome in the form of atopic dermatitis with severe itching and resistance to traditional therapy, or severe bronchial asthma with frequent attacks.

At the same time, the expended efforts may be useless if the study is carried out during a pause in the production of cysts or eggs. For example, the uninformative value of perianal scraping with a 1-2-fold examination method is due to the frequency of egg-laying by female pinworms. The peculiarity of the release of cysts by lamblia is called the "phenomenon of intermittent cyst secretion", in which the phases of massive cysts 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 lamblia in the feces.

Treatment of helminthiasis

For the treatment of ascariasis in older children or with a recurrence of the disease, a combined intake of anthelmintic drugs (for example, albendazole for three days, then Vermox for three days) can be used under the supervision of a doctor. An indispensable condition for the successful deworming of patients with enterobiasis is the simultaneous treatment of all members of the family (team) and strict adherence to the hygienic regime to exclude reinvasion. It should be noted that daily wet cleaning is important, since casuistic cases of the spread of the reproductive material of pinworms on dust particles to a height of up to 1.5 meters have been described.

Treatment of giardiasis involves a mandatory diet with restriction of the consumption of easily digestible carbohydrates, an increase in the proportion of protein in food, the use of "acidifying" products (decoctions of lingonberries, cranberries), the use of choleretic decoctions and preparations.

Drugs used in the treatment of ascariasis:

• Vermox (mebendazole) (for children from 2 years old) - 100 mg 2 times a day for 3 days;

Drugs used in the treatment of enterobiasis:

• Vermox (mebendazole) (for children from 2 years old) - 100 mg once;
• Pirantel - 10 mg / kg once;
• Nemozole (albendazole) (for children from 2 years old) - 400 mg once.

Drugs used in the treatment of giardiasis:

• ornidazole 25-30 mg / kg (if the body weight is more than 35 kg - 1000 mg) in two doses for 5 days, 1 day - 1/2 dose, a second 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 them. M. F. Vladimirsky,Moscow

Let's talk more about these diseases below.

The symptoms of the disease depend on the form of the disease. With a simple carriage, the patient remains completely healthy, and the clinic is absent. In a chronic course, the symptoms are as follows: acute diarrhea with bloating and fever alternate with remissions. Acute balantidiasis manifests itself as fever, intoxication, diarrhea, tenesmus, and blood in the stool.

In rare cases, the disease is accompanied by bowel perforation. Then the patients are admitted to a surgical hospital. The threat to life is quite real. Fecal peritonitis that develops as a result of this infection, even in the modern world, has a high mortality rate.

Diagnosis of the disease is simple. A swab or stool test can 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 admission lasts 5 days and is repeated 2-3 times. If left untreated, death can result from complications or wasting.

The symptoms of the disease are listed below:

• carriage has no clinical symptoms;
• with the intestinal form, there is pain in the upper abdomen, nausea, vomiting, loss of appetite, diarrhea;
• with hepatic form, pain occurs in the right hypochondrium, bile stasis, jaundice, bitterness in the mouth, indigestion;
• on the background of the disease, patients develop allergic reactions, rash, exhaustion and intoxication.

Opisthorchiasis

Infection occurs when eating fish (raw, dried, poorly cooked). The worm lives in the carp family (tench, ide, roach, rudd). Symptoms of the disease appear one month after infection. Regional lymph nodes are enlarged, the patient has an unclear fever, intoxication, rash, pain in joints and muscles. The liver may be affected, symptoms of gastritis, pancreatitis appear. The disease can cover the lungs with the development of pleurisy and pneumonia.

Treatment is not prescribed without diagnosis. The clinical signs of the disease are nonspecific. Usually helminth eggs can be isolated from feces and intestinal contents. The technique is used to detect an increased titer of antibodies. Treatment is carried out in a hospital with Praziquantel. The high toxicity of the substance requires round-the-clock medical supervision.

Treatment and diagnosis are time consuming and complex. More often, visualization (ultrasound, CT, MRI) is used to determine pathology. Serological tests can be used. The clinical picture and history of the patient is important.

There is no treatment with pills for this invasion. Cysts are removed promptly. Surgeons try to drain them thoroughly to prevent the contents from entering the surrounding tissue.

Teniosis

Infection occurs through the meat of pigs affected by tapeworm. The clinical picture is very indicative for helminthiasis:

1. Weakness;
2. Abdominal pain;
3. Vitamin deficiency anemia;
4. Mental disorders (fatigue, irritability).

The diagnosis of this disease is interesting. The segments of the helminth can stand out from the anus, be found on the skin of the genitals and buttocks. During the study, an analysis of feces and scraping from the perineum is prescribed.

Treatment is with Mebendazole. The dose is prescribed by the doctor.

Ascariasis

Ascaris affects children and adults. This is the most common pathology in the world of helminths. Eggs can be found in soil and on surrounding objects. In childcare facilities, 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 profuse salivation. Also, patients have nausea, vomiting, abdominal pain. During the migration phase, ascaris larvae pass through the lungs. In this case, hemoptysis, coughing occurs. Pneumonia often develops. Children and adults with ascariasis have a symptom of asthenia. They are thin and pale, with a bloated stomach, and often suffer from colds.

If ascariasis is suspected, feces are examined. The eggs are released after 3 months from infection. Patients can be treated with Dekaris.

Trichinosis

Infection occurs when eating meat of wild and domestic animals with this infection. Most often these are wild boars, bears, badgers. Larvae die at temperatures above 80 ⁰C. Therefore, it is better to stew game unchecked by sanitary services for a long time. Kebab, polandvica and steak do not provide adequate processing.