37
Severe infestations (1000
‐20000) cause intrahepatic and extrahepatic biliary
obstruction. May have repetitive cholangitis. Sometimes worms migrate into the
liver. Cholecystitis may occur. Secondary biliary cirrhosis may develop. Patient
may have jaundice and hepatosplenomegaly. Patients have higher risk
development of cholangiocarcinoma, proportional to the parasite burden. Patients
may develop cholangiohepatitis with formation of intraductal strictures and stones,
and with recurrent cholangitis.
Complications: abscessis of the live, cholangitis, rupture of parazitive cyst,
peritonitis, primary cancer of the liver.
Diagnosis. Specific diagnosis: Holding of ovoscopy of feces or duodenal
aspirate. Need to use concentration techniques. Serum Immunoblot has 92%
sensitivity for active infection. Monoclonal ELISA test sensitive and specific to
100%. Non-specific diagnostics: eosinophilia, leukocytosis, biochemical methods,
USD, cholecystography.
Treatment. Praziquantel 75 mg/kg divided in 3 doses x 1 day. In very heavy
clonorchiasis, 2 days of therapy may be needed. Pathogenetic therapy.
Prophylaxis. The guarding of the water reservoirs. Sanitary control of the
processing of the fish products.
38
Appendix№1
Professional algorithm for formation practical skills of the diagnostics of the
nematodoses (ascariasis, trichuriasis, trichinosis, enterobiasis (pinworm), filariases,
ancylostomiases (hookworms), strongyloidiases, dracunculiasis).
Professional algorithm for formation practical skills of the diagnostics of the
nematodoses (ascariasis, trichuriasis, trichinosis, enterobiasis (pinworm), filariases,
ancylostomiases (hookworms), strongyloidiases, dracunculiasis).
№ Task
1. Possess of the
methods of
clinical
examination
of the patient
with
nematodoses
1. To elucidate
complaint of the
patient.
To determine complaints of the patient,
which are typical for syndromes:
- general intoxication
- allergic manifestations
- disorders of gastrointestinal tract .
To pay attention on appearance and
dynamics of:
- fever;
- irritation;
- headache;
- disorder of the sleep;
- disorder of the stool;
- rash;
- pain in the epigastrium area
2. To take the
history
2.To take the history
(anamnesis)
I. Anamnesis
of the disease
II. Life history
III. Epidemiological
anamnesis
3. Objectively
examination
To establish the diseases in the last,
anamnesis of vaccination.
Use into food dirty fruits and vegetables,
insufficiency thermal processing pork,
beef or fresh water fish, water plants;
presence in the endemic areas
(opisthorchiasis)
Remember: presence, dynamics of the
symptoms depend from the period of the
disease, severity of the course, age of the
patient, concomitant pathology
Pay attention on:
- temperature;
39
- edema of the face;
- itching;
- skin rash;
Pay attention on:
- abdominal pain;
- decreased of appetite, heartburn;
- hepatomegaly;
- meteorism;
- jaundice;
- symptoms of peritonitis;
Pay attention on:
- tachycardia;
3. Prescribe
laboratory
and
instrumental
investigations
, interpret the
results of
investigations
1. 1. blood count.
2. urinanalyses.
3.investigation of feci
4. biochemical
methods
5. ultrasound
investigation
6. cholecystography
7. fibro-esphago-
gastro-duodenoscopy
I. General examination:
- skin, mucous
membranes;
II. Gastrointestinal
tract: - tongue;-
percussion and
palpation of abdomen;
III. Cardiovascular
system:
IV. Nervous system
Pay attention on anemia, leukocytosis,
eosinophylia.
Finding of the eggs or proglottids in feci
Dysproteinemia, changes of the
biochemical tests (increase of total
bilirubin and it’s fractions, ALT, AST
and other)
- decrease of arterial pressure;
- muffed heart sound.
- disorder of heart rhythm;
- sleeplesness
- irritation
- fatigue
- dizziness
- headache
40
ASCARIDOSIS
Etiology
Ascaris lumbricoides
Epidemiology
Anthroponosis. Peroral helmints.
The mechanism of the transmission is fecal-oral
Pathogenesis
Early (migratory) phase
Late (intestinal) phase
Clinics ↓
↓ ↓
↓
General toxic
syndrome
increase
the
temperatur
e
arthralgia
- mialgia
Allergic
syndrome
itch
- skin rash
damage of the
respiratory tract
bronchitis
pneumonia
rhinopharingitis
- Leffler’s
syndrome
damage of the gastrointestinal
tract
decrease of appetite
nauseas
meteorism
disorder of the function of
intestine
abdominal pain
fatigue, bad sleep
headache
Complications
acute appendicitis
mechanic jaundice
purulent cholecystitis
abscess of liver
pancreatitis
obstruction of the intestine (till
perforation)
perforation of the intestine, peritonitis
asphyxia
Diagnostics
leukocytosis
eosinophilia (30-40%)
Specific
diagnostics
-
larvae in the sputum
-
ovoskopy
-
serological methods (RIHA,
immunofermentive method)
Treatment
Albendasolum
Mebendazole
Antihistaminic remedies
Prophylaxis the personal hygiene; sanitary-hygienic measures