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Lecture notes, cheat sheets
Hospital pediatrics. Helminthiases in children. Clinic, diagnosis, treatment, prevention (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 15. Helminthiases in children. Clinic, diagnosis, treatment, prevention Helminthiases are diseases that develop when parasitic helminth worms and their larvae are localized in the body. Classification of helminthiasis: 1) according to the biological principle: nematodes (roundworms), cestodes (tapeworms), trematodes (flukes); 2) according to epidemiological: geohelminthiases, biohelminthiases, bontactic. 1. Ascariasis The causative agent is roundworm, which parasitizes in the adult stage in the small intestine. The lifespan of roundworms is about a year. During the migration stage (the first 6-8 weeks after infection), roundworm larvae have a mechanical and sensitizing effect, causing eosinophilic infiltrates in the tissues of various organs and causing hemorrhages. In the intestinal phase (8 weeks after infection), adult roundworms cause toxic-allergic and neuroreflex reactions of the body, and various local mechanical effects. Clinic. The migration phase often occurs under the guise of acute respiratory infections, bronchitis (malaise, dry cough or scanty sputum, low-grade fever, dry and moist rales in the lungs). Urticaria, vesicular rash on the hands and feet are possible, and volatile infiltrates may occur in the lungs. In the intestinal phase, a gastrointestinal form is distinguished, manifested by salivation, nausea, loss of appetite, cramping pain around the navel, sometimes upset stool and gastric secretion; hypotonic form, manifested by decreased blood pressure and weakness; neurological form, manifested by dizziness, headache, fatigue, sleep disturbance, and vegetative-vascular disorders. Complications. Ascariasis intestinal obstruction, ascariasis appendicitis; perforated peritonitis; ascariasis of the liver with the occurrence of jaundice, subdiaphragmatic abscess; ascariasis of the pancreas with clinical manifestations of acute pancreatitis, crawling of roundworms into the respiratory tract with the development of asphyxia. Diagnosis. Based on laboratory data, it is based on the detection of nematode larvae in sputum, antibodies in the blood, and the late intestinal phase of 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, the interval between taking the drug is 2-3 hours, for 2 days, the recommended dose is 1,5-2 g per dose (3-4 g / day). Effectiveness increases when piperazine is taken after dinner before bed. Decaris (levamisole) is prescribed after meals at a dose of 150 mg once, Pyrantel is prescribed once after meals at a dose of 10 mg/kg body weight. Oxygen treatment is carried out on an empty stomach or 3-4 hours after meals, preferably in the morning, for 2-3 days in a row. Forecast and prevention. The prognosis in the absence of complications that require surgical treatment is favorable. Prevention: mass examination of the population and treatment of all persons infected with ascariasis. Protection of the soil of vegetable gardens, orchards, and berry fields from contamination with feces. Thoroughly rinsing and scalding vegetables and fruits with boiling water. Personal hygiene measures. 2. Alveococcosis Etiology and pathogenesis. The causative agent is the larval stage of alveococcus. Human infection occurs after oncospheres enter the oral cavity through contact with contaminated skins of arctic foxes, dogs, foxes, and through the water of stagnant reservoirs when eating wild berries collected in epidemic areas. The larvae usually accumulate in the liver, infiltrate and grow into tissues, disrupting the blood supply to organs and causing tissue degeneration and atrophy. Clinic. It remains asymptomatic for a long time, but there is a progressive enlargement of the liver, heaviness and pressure appear in the right hypochondrium, and a dull aching pain appears. After a few years, the lumpy and very dense liver can be palpated. 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. Serological reactions with alveococcal antigen are used. To clarify the localization of the process, X-ray and ultrasound examinations, liver scans, and computed tomography are used. Test puncture is prohibited due to the risk of contamination of other organs. Differentiate from tumors, echinococcosis and cirrhosis of the liver. Treatment. Treatment is surgical and symptomatic. 3. Ankylostomiasis (ankylostomiasis and necatoriasis) Etiology, pathogenesis. The pathogens, hookworm and necator, parasitize in the human small intestine, more often in the duodenum. Infection occurs when the larvae penetrate the skin or when the larvae are ingested with contaminated fruits, vegetables, or water. The larvae migrate through the systemic and pulmonary circulation for about 7-10 days. In the small intestine they turn into sexually mature individuals and after 4-6 weeks begin to lay eggs. The lifespan of ankylostomids ranges from several months to 20 years. During the migration period they can cause toxic-allergic reactions. Adult helminths are hematophagous. When fixed to the intestinal mucosa, they injure the mucous membrane and tissues, which leads to the formation of hemorrhages, cause bleeding, contribute to the development of anemia, maintain the state of allergies, gastrointestinal dyskinesia and dyspepsia at a certain level. Clinic. Skin itching and burning, asthmatic phenomena, fever, eosinophilia in the blood test. In the late stage, nausea, drooling, abdominal pain, vomiting, intestinal dysfunction (constipation or diarrhea), and bloating appear. The diagnosis is confirmed by the detection of eggs in the stool, and sometimes in the duodenal contents. Treatment. Deworming is carried out with combantrin or levamisole. In case of severe anemia (hemoglobin below 67 g/l), iron supplements and red blood cell transfusions are prescribed. Forecast and prevention. The prognosis is favorable in most cases. 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, berries, and vegetables with boiling water before eating them; you should not drink unboiled water. 4. Diphyllobothriasis Etiology, pathogenesis. The causative agent is the broad tapeworm. Its lifespan is tens of years. Human infection with diphyllobothriasis occurs when eating fresh or lightly salted caviar and raw fish (pike, perch, omul, etc.). The tapeworm attaches to the intestinal mucosa with its bothria and injures it. A large accumulation of parasites can clog the intestinal lumen. Metabolic products of the helminth sensitize the body. Clinic. Characterized by nausea, weakness, dizziness, abdominal pain, unstable stool, and discharge of strobila fragments during bowel movements. The diagnosis is confirmed by the detection of tapeworm eggs and strobila fragments in the feces. Treatment. In case of severe anemia, before helminthization, vitamin B is prescribed at 300-500 mcg intramuscularly 2-3 times every 7 days for a month, hemostimulin, preparations containing iron, hematogen. For deworming, fenasal, male fern extract, and a decoction of pumpkin seeds are prescribed. Forecast and prevention. The prognosis in the absence of complications is favorable. You should not eat raw, poorly cooked or insufficiently dried and salted fish, as well as “live” pike caviar. 5. Opisthorchiasis Etiology, pathogenesis. The causative agent is the cat fluke, which parasitizes the bile ducts of the liver, pancreas, and gallbladder in humans; it can also parasitize dogs and cats. The parasite can live in the human body for about 20-40 years. Human infection occurs when eating raw (frozen), lightly salted and insufficiently fried fish of carp species (ide, chebak, dace, etc.). Opisthorchises injure the mucous membranes of the pancreatic and bile ducts, which creates an obstruction to the outflow of bile and contributes to the occurrence of cystic enlargements and liver tumors. They have toxic and neuro-reflex effects. Clinic. The incubation period is about 2 weeks. In the early period, there may be fever, pain in muscles and joints, gastrointestinal disorders in the form of vomiting and diarrhea, pain and enlargement of the liver on palpation, less often - the spleen, leukocytosis and high eosinophilia in a blood test, allergic skin rashes. As the chronic stage develops, the patient begins to complain of pain in the epigastric region, right hypochondrium, and attacks of pain similar to gall bladder colic. Dizziness and the development of other dyspeptic disorders may occur. Resistance of the muscles in the right hypochondrium, enlargement of the liver, sometimes icterus of the sclera, enlargement of the gallbladder, and symptoms of damage to the pancreas are detected. The most common symptoms of opisthorchiasis are cholecystitis, biliary dyskinesia, chronic pancreatitis and hepatitis, and rarely - symptoms of gastroduodenitis and enterocolitis. Opisthorchiasis can be asymptomatic. The diagnosis is made when helminth eggs are detected in the stool and duodenal contents. Treatment. Deworming is carried out with mebendazole (ver-mox). Prevention: it is imperative to explain to the population the dangers of eating raw, thawed and frozen (stroganina), lightly salted and insufficiently fried fish. 6. Teniasis Etiology. The causative agent is pork tapeworm, which can parasitize humans in the sexually mature stage and in the larval stage, causing the disease cysticercosis. The adult helminth parasitizes the small intestine for many years. Infection with taeniasis in humans occurs when eating raw or half-raw meat containing fins. The diagnosis is made on the basis of repeated stool examination to detect helminth segments from the perianal folds by scraping for tapeworm eggs. Treatment. Vermox. Sometimes male fern ethereal extract and pumpkin seeds are used. Prevention. You should not eat undercooked or undercooked pork. 7. Trichuriasis Etiology, pathogenesis. The causative agent is the whipworm, which parasitizes the human large intestine. The lifespan of the whipworm parasite is about 5 years. The whipworm injures the intestinal mucosa and is a hematophage, which promotes the inoculation of microflora; the whipworm causes reflex reactions in other organs of the abdominal cavity. The products of their metabolism sensitize the body. Clinic. The patient is disturbed by drooling, decreased (less often - increased) appetite, pain appears in the right half of the abdomen and epigastric region, nausea, constipation or diarrhea, sometimes headache, restless sleep, dizziness, irritability appear, moderate hypochromic anemia appears in the blood test and slight leukocytosis. At low intensity, whipworm infestation does not manifest itself clinically. The diagnosis is made when whipworm eggs are detected in the stool. Treatment. Antihelminthic therapy (mebendazole and other drugs) is prescribed. The patient is first given a cleansing enema. Forecast. The prognosis is favorable. 8. Fascioliasis Etiology and pathogenesis. The causative agent of fascioliasis is liver and giant flukes. The main source of human infection are various farm animals. Infection of people often occurs in the warm season when fasciola larvae are ingested with water, sorrel and any other greens. The lifespan of helminths in the human body is about 10 years. Of particular importance are traumatization and toxic-allergic damage to the hepatobiliary system. But fasciolae can also be carried into other tissues and organs. Clinic. The disease is determined by a blood test by eosinophilia, allergic manifestations, disorders of the liver and gall bladder, which resemble the symptoms of opisthorchiasis (jaundice, attacks of gall bladder colic are observed more often). Diagnosis of the early stage of fascioliasis is difficult due to the fact that helminth eggs are released only 3-4 months after infection. Immunological methods can be used. In the late stage, the diagnosis is established based on the detection of fasciolae eggs in the duodenal contents and feces. Treatment. Anthelmintic drugs are prescribed, and after deworming it is necessary to prescribe choleretic drugs for 1-2 months. Long-term clinical examination of patients is carried out. Forecast and prevention. The prognosis for treatment is favorable. Prevention consists in prohibiting the use of water from stagnant bodies of water and recommending thorough washing and scalding of greens with boiling water. 9. Echinococcosis Etiology. The causative agent of hydatous echinococcosis is the larval stage of a small cestode, which has 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 of cells, outer and inner, which form small parietal protrusions. The bladder cavity is filled with liquid. Echinococcus eggs are highly resistant in the external environment and can 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 most often affected. Reservoir and source of invasion: the final hosts are carnivores, domestic animals (dog, fox, wolf), which have a mature worm parasitizing in their intestines; its segments containing eggs are excreted with feces into the external environment. Intermediate hosts are herbivores and omnivores (sheep, goats, pigs, horses, rodents). 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 route - food, water, household. Pathogenesis. When a person swallows Echinococcus eggs in the stomach and intestines, they are released from the oncosphere, penetrate through the intestinal wall into the blood, then into the liver, where the larval stage of echinococcosis is formed. The growing bubble compresses the surrounding tissues, the lung, bronchi, vessels and involves the pleura in the pathological process with the appearance of symptoms of a space-occupying formation. The death of the parasite leads to the addition of a bacterial infection and the formation of a lung abscess. Clinic. Chest pain of various types, dry cough, then with purulent sputum, hemoptysis, shortness of breath. If a bubble breaks into the bronchus, a severe cough, cyanosis, suffocation appears, the contents of the bubble can be found 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, subectericity 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 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, 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 begin to lay eggs on the perianal area and perineum. Infection occurs as a result of ingestion of infective eggs. Auto-invasion 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, frequent stools with pathological impurities, symptoms of intoxication, and vulvovaginitis in girls appear. 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 x 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 old - 1,5. Prevention. Compliance with personal hygiene. Author: Pavlova N.V. << Back: Medical illness in children >> Forward: Rheumatism in children and adolescents. Clinic, diagnosis, treatment
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