Intestinal parasitoses

Intestinal parasitoses are a group of diseases caused by parasitism of helminths and protozoa in the intestines. Intestinal parasitoses are very common in children, with the peak incidence occurring between the ages of 7 and 12.

Causes. Among the causative agents of parasitic diseases are:

1. Helminths are divided into three classes:
   • Nematoda (nematode) - roundworms;
   • Trematoda (trematode) - flukes;
   • Cestoda (cestodes) - tapeworms.
2. Protozoa.

Currently, about 200 species of helminths parasitizing humans have been described; 65 of them are found in Russia.

Pathogenesis. In the child's body, intestinal parasitosis causes:

• mechanical damage to organs and tissues with direct and neuroreflexive impairment of their functions;
• sensitization of the body to metabolic products with the development of allergic reactions;
• intoxication with decay products;
• immunopathological reactions.

Some types of helminths go through their entire life cycle - from egg to mature parasite - in one host, while others - in two or three hosts. The host in which the helminth develops only to the larval stage is called intermediate. The host in which the helminth reaches the mature stage is called definitive.

In some children, a relatively “peaceful coexistence” of the parasite and the macroorganism is possible, which is associated with individual immune characteristics.

The classification of intestinal parasitoses distinguishes the following groups of helminthiases:

• biogelyminthoses (diseases transmitted to humans with the participation of animals);
• geohelminthiasis (diseases transmitted to humans through the external environment),
• contact helminthiases (diseases transmitted directly from the patient or through objects around him).

Symptoms of intestinal parasitosis include signs of damage to the digestive tract (abdominal pain, dyspeptic symptoms), manifestations of sensitization (urticaria, dermatitis, etc.), signs of intoxication (lethargy, loss of appetite, etc.). A number of parasites have a specific damaging effect on the host organism.

Diagnosis of intestinal parasitosis in children is based on clinical, epidemiological and laboratory data, of which the detection of parasite eggs and larvae in feces and scrapings of perianal folds is of great importance. Some types of parasites require special (radiological, endoscopic, biochemical, immunological) diagnostic methods.

Differential diagnosis of intestinal parasitoses is carried out with other intestinal diseases, pathology of the hepatobiliary zone, and allergic diseases.

Treatment of intestinal parasitoses is carried out depending on the type of parasite and the disorders it causes in the body.

Drugs used to treat parasitosis in children

Parasitosis	Preparation	Daily dose	Frequency of reception	Well
Ascariasis	Piperazine	75 mg/kg, no more than 3.5 g	In 2 doses orally	5 days
	Decaris	5 mg/kg	Inside once	1 day
	Pyrantel	11 mg/kg	Inside once	1 day
	Vermox	2.5-3 mg/kg, no more than 0.2 g	In 2 doses orally	3 days
Enterobiasis	Piperazine	75 mg/kg, no more than 3.5 g	In 2 doses orally	3 days
	Vankin	5 mg/kg	Inside once	1 day
	Combantrin	10 mg/kg	Inside once	1 day
	Vermox	2.5-3 mg/kg, no more than 0.2 g	Inside once	1 day
Diphyllobothriasis, taeniasis	Praziquantel	60 mg/kg	In 3 doses orally	1 day
Trichuriasis	Mebendazole	2.5-3 mg/kg, no more than 0.2 g	In 2 doses orally	3 days
Giardiasis	Furazolidone	6 - 8 mg/kg	In 4 doses orally	10 days
	Metronidazole	15 mg/kg	In 3 doses orally	5 days
	Tinidazole	50 mg/kg, no more than 2 g	Inside once	1 day
	Paromomycin	25 - 30 mg/kg	In 3 doses orally	7 days
	Ornidazole	40 mg/kg, no more than 1.5 g	Inside once	1-2 days

Prevention of intestinal parasitosis in children includes improving the sanitary culture of the population, developing hygiene skills in children, careful processing of food products, examination and timely deworming of domestic animals.

Dispensary observation after treatment of most intestinal parasitoses is not required.

Ascariasis is a disease caused by a helminth of the roundworm class.

Children become infected through alimentary and contact routes. The larva penetrates the portal system into the lungs, where it ascends the bronchial tree to be swallowed and then return to the intestines. The larvae can cause pneumonia and eosinophilic infiltrates in the lungs. In the intestinal phase, ascariasis in children can imitate enterocolitis and appendicitis. Typical symptoms include abdominal pain, loss of appetite, nausea, irritability, and poor sleep. The diagnosis is made by detecting ascaris eggs in the stool. Piperazine, vermox, decaris, and combantrin are used for treatment.

Enterobiasis is a disease caused by pinworms. Infection occurs by contact. Pinworms parasitize in the lower part of the small intestine and in the large intestine, to lay eggs they go into the anal area, which causes itching in the anus and promotes autoreinvasion. The diagnosis is established based on the detection of pinworm eggs in a perianal scraping or by visually determining vegetative forms. Treatment primarily includes hygienic measures to prevent self-infection - hand washing, nail clipping, frequent changes of underwear and bed linen, daily washing. Deworming should cover all family members and can be done with combantrin, vermox, decaris. piperazine.

Diphyllobothriasis is a helminthiasis caused by the broad tapeworm. It is found mainly in the basins of large bodies of water. Children become infected when eating raw infected fish. The broad tapeworm parasitizes the child's intestines, attaching to the mucous membrane with its bothria and injuring it.

The disease in children manifests itself as unstable stool, abdominal pain, nausea, weakness, and sometimes B12-deficiency anemia develops. The diagnosis is based on the detection of tapeworm eggs and strobila fragments in the feces. Deworming is carried out with praziquantel (biltricid).

Trichuriasis is a helminthiasis caused by the whipworm (geohelminth, class of nematodes). Trichuriasis is widespread mainly among the population of warm and moderate climates. A person becomes infected by eating raw vegetables, strawberries, drinking contaminated water.

Trichuris live in the large intestine, mainly in the cecum, penetrating the mucous and submucous membranes with their thin anterior end. Trichuris feeds on the superficial layers of the mucous membrane and blood. One trichuris sucks out 0.005 ml of blood per day. The number of parasites in a patient can reach several hundred. The lifespan of a parasite is approximately 5 years. Mechanical irritation of the intestine caused by the invasion of the trichuris can be the cause of motility disorders of the stomach, intestines and gall bladder. Trichuris can be a trigger for allergies in the body.

The most typical symptoms of trichuriasis are loss of appetite, nausea, vomiting, abdominal pain, weight loss, pale skin, constipation, less often diarrhea, headache, dizziness, irritability, and liver enlargement. Blood tests in most patients show hypochromic anemia and leukopenia, but eosinophilia is not typical for trichuriasis. The diagnosis is based on the detection of helminth eggs in the feces. Mebendazole is used for treatment.

Giardiasis is a disease caused by flagellate protozoa. Invasion occurs through food, water and contact, family foci are possible. Parasitosis can occur with malabsorption, developing as a result of damage to the mucous membrane of the upper parts of the small intestine, where vegetative forms of lamblia parasitize and cysts are located. Neuroreflexive effects on other organs are often the cause of biliary dyskinesia, motor and secretory disorders of various parts of the gastrointestinal tract. Lamblia in children have a pronounced sensitizing effect, contributing to the development of allergic reactions (urticaria, Quincke's edema, arthralgia). The diagnosis is established when parasites and their cysts are detected in feces or in duodenal contents. One of the drugs is used to treat giardiasis. It is advisable to repeat the course of therapy after 10-14 days. In case of persistent recurrent giardiasis, it is necessary to examine and treat people around the child.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]