Ascaridosis in children

Ascariasis is an invasion of the roundworm by an ascarid. It can initially take the form of an allergic disease with fever, skin eruptions, "volatile" eosinophilic infiltrates in the lungs, hypereosinophilia of the blood; in a chronic stage, ascariasis is usually accompanied by mild abdominal pain, dyspepsia, sometimes asthenia.

ICD-10 code

• В77.0 Askaridosis with intestinal complications.
• 877.8 Askaridosis with other complications.
• 877.9 Unspecified ascariasis.

Epidemiology

Ascariasis is common in all climatic zones of the globe, with the exception of permafrost regions, highlands, deserts. The most affected population is the zones of the humid tropical and subtropical climate.

Ascaridosis is referred to as geogelmintosis. The eggs that have separated from the feces fall into the soil, depending on ambient temperature, humidity and aeration, ripen within 2-3 weeks. Infection occurs with the use of vegetables, fruits, drinking water, contaminated eggs parasite. Eggs of ascarids are sensitive to high temperatures, drying out; in wet soil can remain viable up to 6 years. Transmission of ascaridosis in the middle zone occurs from April to October, in the tropical climate zone - throughout the year. The most affected by ascaridosis are children aged 5-10 years due to activity, poorly developed hygiene skills and lack of immunity to invasion.

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The cause of ascaridosis

Ascaris - a large worm spindle-shaped, pale pink. The female is 25-40 cm long, the posterior end of the body is straight, pointed, the male is 15-20 cm long, the caudal end hooks on the abdominal side. The body of the helminth is covered with a thick cross-striated cuticle. Female lays in the lumen of the intestine more than 200 thousand fertilized and unfertilized eggs per day. Eggs are excreted with feces into the environment. Life expectancy of the roundworm is about 1 year.

What causes ascariasis?

Symptoms of Ascaridosis

The incubation period with ascariasis is 2-3 weeks. With low-intensity invasion, the early stage of the disease is subclinical. In children of preschool and early school age, the acute phase of the disease is usually manifested by fever or high subfebrile condition, skin exudative rashes, sometimes pains throughout the abdomen, nausea, upset of the stool. It is often noted pulmonary syndrome in the form of dry or wet cough with the development of "flying" infiltrates, less often - pneumonic foci, eosinophilia of blood up to 20-40% against leukocytosis to 12-15 x 10 ⁹ / l. With a particularly massive invasion, in addition to pneumonia and pleuropneumonia, granulomatous hepatitis with hepatosplenomegaly, mild jaundice, increased activity of transaminases, alkaline phosphatase, bilirubin levels, all globulin fractions and shifts in sediment samples can occur in the blood serum. Do not exclude heart lesions with tachycardia, deafness of cardiac tones, signs of dystrophic changes in the myocardium.

Symptoms of Ascaridosis

Diagnosis of ascaridosis

Diagnosis in acute stage is established on the basis of epidemiological history, clinical picture of febrile illness with skin, pulmonary syndromes, hypereosinophilia, transient dyspeptic phenomena. To confirm the diagnosis, a serological study with an ascariasis diagnosticum (RNGA, ELISA) is performed, which gives positive results for 2-3 weeks after infection. It is possible to detect larvae sputum rarely, but note a regularly large number of eosinophils, sometimes the crystals of Charcot-Leiden are visible. After 2-2,5 months after infection, the diagnosis of ascariasis is confirmed by the detection of parasite eggs in the feces. Eggs of ascarids measuring 0.05-0.1 x 0.1-0.04-0.06 mm. Oval, with a two-contour shell, which in fertilized eggs is usually surrounded by a scalloped protein coat, pigmented contents of the intestine in a yellow or brownish color. Unfertilized eggs are irregular, globular or even triangular in shape, rarely surrounded by a protein coat, filled with large irregularly shaped yellow bodies. Apply the method of Kato, and for enrichment - ether-formalin method. Currently, non-invasive methods for the detection of ascarid antigens in feces, urine, and sputum are being developed.

[7], [8], [9], [10], [11]

Treatment of ascariasis

In the acute stage of ascariasis treatment is carried out with antihistamine drugs. Ingest, in case of severe illness, parenteral solutions of calcium chloride, calcium gluconate, ascorbic acid are administered. The thiazolyl-benzimidazole-minesol (thiabendazole) derivative at the dose of 25 mg / kg per day is administered to the larval stage of ascarids in 3 meals after a meal for 5 days. Treatment can cause an increase in allergic phenomena, so it must be performed in the hospital against desensitizing therapy until the appointment of glucocorticoids in moderate doses for 5-7 days.

Treatment of ascariasis

Prophylaxis of ascaridosis

It consists primarily in the development of hygienic skills in children: washing hands after using the toilet, before eating, using only carefully washed fruits and vegetables, boiled water. Protection of the environment from contamination with eggs ascaris is achieved by neutralization of sewage with the help of settling tanks and filtration, chlorination and filtration of tap water. In the countryside, correct and timely cleaning of cesspools with prevention of sewage into water sources, use of feces for fertilizing orchards and gardens only after 4 years composting is of great importance.