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Lecture notes, cheat sheets
Infectious diseases. Parasitic diseases. Epidemiology, clinic, treatment (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 17. Parasitic diseases. Epidemiology, clinic, treatment 1. Helminthiases Helminthiases are diseases caused by parasitic worms (helminths) and their larvae that have settled in the body. Classification of helminthiases According to the biological principle: nematodoses (roundworms), cestodoses (tapeworms), trematodoses (flukes). According to the epidemiological: geohelminthiases, biohelminthiases, contact. 2. Ascariasis The causative agent is the roundworm, which parasitizes in the adult stage in the small intestines. The lifespan of roundworms is about a year. In the migratory stage (the first 6-8 weeks after infection), roundworm larvae have a mechanical and sensitizing effect, causing hemorrhages and eosinophilic infiltrates in the tissues of various organs. In the intestinal phase (8 weeks after infection), adult roundworms cause general toxic-allergic and neuro-reflex reactions of the body and a variety of local mechanical effects. Clinic. The migratory phase often proceeds under the guise of acute respiratory infections, bronchitis (with malaise, dry cough or scanty sputum, subfebrile temperature, dry and moist rales in the lungs). Urticaria, vesicular rash on the hands and feet may occur, volatile eosinophilic infiltrates in the lungs are possible. In the intestinal phase, the gastrointestinal form is distinguished (the main symptoms are salivation, nausea, loss of appetite, cramping pains around the navel, sometimes disorders of the stool and gastric secretion), hypotonic (decrease in blood pressure, weakness) and neurological (the main symptoms are dizziness, headache, fatigue, sleep disturbance, vegetative-vascular disorders) forms. Complications. Ascariasis intestinal obstruction, ascariasis appendicitis, perforative peritonitis, liver ascariasis with the development of jaundice, subdiaphragmatic abscess, pancreatic ascariasis with symptoms of acute pancreatitis, creeping of ascaris into the respiratory tract with the development of asphyxia. The diagnosis is made on the basis of laboratory data, based on the detection of nematode larvae in sputum and antibodies in the blood, in the late intestinal phase - roundworm eggs in feces. Treatment. For the expulsion of young individuals and adult roundworms, piperazine, levamisole, and combantrin are used. Piperazine is taken after meals 2 times a day with an interval between doses of 2-3 hours for 2 days in the amount of 1,5-2 g per dose (3-4 g / day). The effectiveness of therapy increases when taking piperazine after dinner at night. Levamisole (Decaris) is prescribed after meals at a dose of 150 mg once, it is also recommended to take combantrin once after meals at a rate of 10 mg/kg. Oxygen treatment is carried out on an empty stomach or 3-4 hours after a meal for 2-3 days in a row. The prognosis in the absence of complications is favorable. Prevention. It is necessary to conduct a mass examination of the population, identify and treat all those infected with ascariasis, as well as protect the soil of vegetable gardens and orchards from contamination with feces. Thorough washing under running water and scalding vegetables and fruits with boiling water. Compliance with personal hygiene measures. 3. Alveococcosis Etiology, pathogenesis. The causative agent is the larval stage of alveococcus. Infection occurs when oncospheres enter the mouth after contact with contaminated skins of foxes, arctic foxes, dogs, with water from stagnant bodies of water and by eating wild berries collected in endemic areas. The larvae (usually in the liver) infiltrate tissues and grow into them, thereby disrupting the blood supply to organs and causing degenerative and atrophic changes in them. Clinic. The disease 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, sometimes the spleen is enlarged. With the disintegration of the nodes, the body temperature rises, sweating is observed. The diagnosis is made on the basis of laboratory data (leukocytosis, eosinophilia, increased ESR, hyperproteinemia, hypergammaglobulinemia). Put serological reactions with alveococcal antigen. To clarify the localization, X-ray and ultrasound examinations, as well as liver scans, and computed tomography are used. Trial puncture is not performed due to the risk of infection of other organs. Differential diagnosis is carried out with tumor processes, echinococcosis and cirrhosis of the liver. Methods of treatment: surgical and symptomatic. 4. Ankylostomiasis (ankylostomiasis and necatoriasis) Etiology, pathogenesis. The causative agents are hookworm and necator, which parasitize the human small intestine, mainly in the duodenum. Invasion occurs when larvae enter through the skin or through food with contaminated vegetables, fruits, and water. The larvae migrate for 7-10 days through the systemic and pulmonary circulation. In the small intestine they turn into sexually mature individuals and after 4-6 weeks begin to lay eggs. Hookworms can live from several months to 20 years. During the migration of larvae, toxic-allergic changes occur in the body. Adult helminths are hematophagous. When fixed to the intestinal mucosa, they injure tissues, lead to the formation of hemorrhage, 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, hypersalivation, vomiting, abdominal pain, intestinal disorders (constipation or diarrhea), flatulence join. The diagnosis is confirmed as a result of the detection of eggs of the pathogen in the feces and sometimes in the intestinal contents. Treatment. For deworming use combantrin or levamisole. With symptoms of anemia (hemoglobin below 67 g / l), iron preparations, red blood cell transfusions are used. The prognosis is favorable in most cases. Prevention. In the foci of ankylostomiasis, you can not walk without shoes and lie on the ground without bedding. It is necessary to thoroughly wash and scald fruits, vegetables, berries with boiling water before use, water for drinking must be boiled. 5. Diphyllobothriasis Etiology, pathogenesis. The causative agent is the broad tapeworm. Its lifespan can be several decades. A person becomes infected by eating fresh, insufficiently salted caviar and raw fish (pike, perch, omul, etc.). The parasite attaches to the intestinal mucosa with its bothria, injuring it. Clusters of tapeworms can close the intestinal lumen. The waste products of the helminth sensitize the body. Clinic. Characterized by nausea, weakness, dizziness, abdominal pain, unstable stool, excretion of scraps of strobilus during defecation. The diagnosis is confirmed by the detection of lentelets eggs and strobila fragments in the feces. Treatment. In case of severe anemia, before treatment with antiparasitic drugs, vitamin B12, B6, 300-500 mcg intramuscularly, 2-3 times a week for a month, iron supplements, hemostimulin, etc. are prescribed. To destroy the parasite, fenasal, male fern extract, and a decoction of seeds are used. pumpkins. The prognosis in the absence of complications in most cases is favorable. Prevention. Do not eat fish and caviar that has not undergone high-quality heat treatment. 6. Opisthorchiasis Etiology, pathogenesis. The causative agent is the feline fluke, which parasitizes in the bile ducts of the liver, gallbladder and pancreatic ducts of humans, cats, dogs, etc. The parasite lives in the human body for 20-40 years. Infection occurs when eating raw and insufficiently thermally processed carp fish. Opisthorchiasis damage the mucous membranes of the pancreatic ducts and bile ducts, creating bile stasis, and contribute to the formation of cystic enlargements and neoplasms of the liver. They have a toxic and neuro-reflex effect. Clinic. The incubation period is about 2 weeks. In the early period, there may be an increase in body temperature, muscle and joint pain, nausea, vomiting, hepatomegaly, splenomegaly, loose stools, leukocytosis and severe eosinophilia, and skin allergic manifestations. 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. Most often, with opisthorchiasis, a picture of cholecystitis, biliary dyskinesia, chronic hepatitis and pancreatitis develops; symptoms of gastroduodenitis and enterocolitis are less often observed. Opisthorchiasis can be asymptomatic. The diagnosis is made upon detection of helminth eggs in the feces and duodenal contents. Treatment. Deworming with mebendazole (Vermox) Prevention. Explanation to the population of the danger of eating fish food that has not undergone sufficient heat treatment. 7. Teniasis Etiology. The causative agent is pork tapeworm, it can be in the human body not only in the sexually mature, but also in the larval stage, causing cysticercosis. The adult parasite can reside in the small intestine for many years. The reason for infecting people with taeniasis is the consumption of raw or half-baked meat containing Finns. The diagnosis is confirmed after a double examination of feces and the detection of parasite segments and mucus from the perianal folds by scraping and the detection of helminth eggs. Treatment is carried out with the drug "vermox". Sometimes male fern ethereal extract and pumpkin seeds are used. Prevention. Eating pork that has undergone sufficient heat treatment. 8. Trichuriasis Etiology, pathogenesis. The causative agent is the whipworm, which parasitizes the human large intestine. The lifespan of the parasite is about 5 years. Whipworms injure the intestinal mucosa, are hematophagous and promote inoculation of microflora, causing reflex reactions in other organs of the abdominal cavity. The products of their metabolism cause sensitization of the body. Clinic. Patients complain of salivation, decreased (rarely increased) appetite, pain in the right side of the abdomen and epigastric region, nausea, constipation or diarrhea, headache, dizziness, sleep disturbances, irritability are sometimes noted. In the blood there is a moderate hypochromic anemia, a slight leukocytosis is possible. Whipworm infestation can also be asymptomatic. The diagnosis is made when whipworm eggs are found in the feces. Treatment. Prescribe mebendazole and other drugs. Previously, the patient is given a cleansing enema. The prognosis is favorable. 9. Fascioliasis Etiology, pathogenesis. The causative agents of the disease are liver and giant flukes. The main source of infection for humans is farm animals. A person becomes infected in the warm season when the larvae enter the body with water, greens. The life span of helminths in the body lasts about 10 years. Traumatization and toxic-allergic damage to the hepatobiliary system play an important role in pathogenesis. It is possible for the parasite to enter other tissues and organs. Clinic. The disease is characterized by eosinophilia in the blood, allergic symptoms, dysfunction of the liver and gallbladder, similar to the symptoms of opisthorchiasis (jaundice and attacks of gall bladder colic are more common). Diagnosis at an early stage of the disease is difficult, since helminth eggs begin to be released only 3-4 months after infection. Immunological methods are used. In the late stage, the diagnosis is confirmed by the detection of fasciol eggs in the duodenal contents and feces. Treatment. Anthelmintic drugs are prescribed, and after deworming, cholagogues are prescribed for 1-2 months. A long-term (at least 1 year) medical examination of patients is necessary. The prognosis for treatment is favorable. Prevention. It is necessary to prohibit the use of water from stagnant reservoirs, but you need to thoroughly wash and scald the greens with boiling water. 10. Echinococcosis Etiology. The causative agent of hydatous echinococcosis is the larval stage of a small cestode that 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 (outer and inner) of cells that form small parietal protrusions. The bubble cavity is filled with liquid. Echinococcus eggs are highly stable in the external environment, withstand drying and exposure to low temperatures. Epidemiology. The disease is widespread throughout the world, infection of the population is very widespread, shepherds, hunters and persons who have constant contact with the final owners of echinococcus are more likely to get sick. Reservoir and source of invasion. The final hosts are carnivores, domestic animals (dog, fox, wolf), in which a mature worm parasitizes in the intestines. Its segments, containing eggs, are excreted with feces into the external environment. Intermediate hosts are herbivores and omnivores (sheep, goats, pigs, horses, rodents). The mechanism of transmission of invasion is fecal-oral (as a result of ingestion of invasive echinococcus eggs upon contact with dogs, sheep, on whose wool there may be helminth eggs), the route of transmission is food, water, household. Pathogenesis. When a person swallows echinococcosis eggs in the stomach and intestines, the latter are released from the oncospheres, penetrate through the intestinal wall into the blood, then into the liver, where the larval stage of echinococcosis is formed. The growing bubble causes compression of the surrounding tissues of the lung, bronchi, and 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, severe coughing, cyanosis, and suffocation appear, 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, a feeling of heaviness in the epigastrium, pain in the right hypochondrium, liver enlargement, thickening, pain on palpation, nausea, vomiting, stool upset. In rare cases, subicteric skin and jaundice may appear. Diagnostics. Based on clinical and laboratory data using serological reactions (RSC, 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, a diagnosis is made. Treatment. Usually by surgery. Prevention. Prevention of infection of animals and humans, observance of 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. 11. Enterobiasis Etiology. The causative agent is pinworm. The female has a length of 9-12 cm, males - 3-4 cm. Males die after fertilization, females come out of the anus and lay eggs on the perianal region and in the perineum. Infection occurs as a result of ingestion of invasive eggs. Possible autoinvasion. In the upper small intestine, infective larvae leave the egg shells 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 slight invasion, complaints may be absent. There is itching around the anus, scratching, infection, rapid stools with pathological impurities. Symptoms of intoxication, girls have vulvovaginitis. Diagnosis is based on the detection of pinworm eggs in the stool or by scraping on the pinworm eggs. In the blood - eosinophilia. Treatment. Mebendazole (Vermox): from 2 to 10 years, 25-50 mg/kg taken once, pyrantel (Combantrin) - 10 mg/kg once after breakfast (must be chewed), piperazine - up to 1 year 0,2 g 2 times during 5 days; 2-3 years - 0,3 g; 4-5 years - 0,5 g; 6-8 years - 0,5 g; 9-12 years - 1,0 g; 13-15 l - 1,5 g. Prevention. Compliance with personal hygiene. Author: Gavrilova N.V. << Back: Acute and chronic viral hepatitis. Etiology, pathogenesis, clinical picture, differential diagnosis, treatment (Viral hepatitis. Chronic hepatitis) >> Forward: Rabies. Etiology, epidemiology, clinic, diagnostics, treatment
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