Parasitic diseases in children (enterobiosis, ascariasis). Parasitic diseases in children Diagnosis of parasitic diseases in children

Worm eggs and protozoan cysts are stages of development that are stable in the external environment and are perfectly preserved in a standing stool.

What to do if a child has a helminthic invasion? First, don't panic. We still do not live in wild Africa, and severe infections that are life-threatening, we practically do not occur. You need to contact a pediatrician, get recommendations for treatment; at the same time, carefully read the instructions for the drug - unfortunately, our doctors do not know the necessary dosages of these drugs, and treatment with a low dosage will not lead to deworming. Another problem is the differences between the recommendations of the domestic Pharmaceutical Committee and the internationally accepted approach to the treatment of invasions. Just recently, instructions for pyrantel appeared on the instructions that this drug is not recommended for children under 2 years old, and the WHO has been talking about this for 10 years.

Some mothers are afraid to treat children with antihelminthic drugs, considering them to be very toxic. This is also a myth. Modern anthelmintic drugs are so cleverly designed that they are deadly for worms, but have little effect on the human body. Nevertheless, it is impossible to give them to children for “prevention”, as some parents do and even recommended by not very competent doctors. Medicines are not sweets and should be given strictly according to indications. This is why analysis is so important.

But in some cases, a person is able to fight worms and remove them from the body, in others - no. And the point here is the potential of his immune system.

What you need to know about worms

A person can be for a helminth:

• The main host (an adult worm capable of producing offspring lives in the body) in the case of ascariasis, enterobiasis, teniidosis, strongyloidiasis, hookworm, etc.
• Intermediate host (helminth larvae live and develop in the body) in case of trichinosis, cystercercosis, echinococcosis, etc.

• Infection with some worms (roundworm, whipworm, etc.) occurs when vegetables, fruits, and herbs contaminated with soil are eaten; through dirty hands. The eggs or larvae of these helminths mature in the soil.
• You can become infected with pinworms through dirty hands, swallowing the eggs that the patient excretes with feces.
• Infection with pork tapeworm, bovine tapeworm, cat fluke, trichinella, etc. occurs when eating raw or thermally insufficiently processed meat and fish. The formation of larvae in these worms occurs in the body of an intermediate host, which a person can eat.
• Larvae of some helminths (for example, filaria, elephantiasis) enter the body through the bites of blood-sucking insects.
• Hookworm and schistosis larvae are able to actively penetrate the skin while bathing, working in the garden or walking barefoot on the grass.

Pathological action of worms:

• Cause allergic diseases, any: from urticaria and atopic dermatitis to bronchial asthma.
• toxic action. They poison the body with the products of their vital activity.
• Mechanical damage to the tissues of the organ where they live.
• Stealing the body of nutrients and/or blood.
• Decreased body defenses.

The course of the disease depends on:

Diagnostics:

Treatment of helminthiasis depends on the type of helminth that caused it. The effectiveness of anthelmintic therapy is higher if the whole family is examined for worms and appropriate treatment is carried out. After treatment, a follow-up examination is necessary (repeated stool tests, etc.).

Types of helminthiases:

Trematodoses (caused by fluke worms).

• Opisthorchiasis.
• Fascioliasis.

Nematodes (caused by roundworms).

• Ascariasis.
• Enterobiasis.
• Hookworm.
• Trichinosis.
• Dracunculosis.
• Strongyloidiasis.
• Trichuriasis.

Cestodosis (caused by tapeworms).

• Diphyllobothriasis.
• Hymenolepiasis.
• Tenidosis.
• Echinococcosis.

Opisthorchiasis. The disease is caused by opisthorchia (feline fluke). You can become infected by eating raw, poorly fried, lightly salted or dried fish. Recently, Japanese cuisine has become very popular. Keep in mind that sushi, rolls and other delicacies are made from raw fish, and not always tested for opisthorchia.

Fascioliasis. The disease is caused by a liver fluke. Liver fluke larvae are waiting for their future host in the grass. You can get infected through dirty hands, water, unwashed vegetables and herbs. A bad habit of chewing a blade of grass plays a role in liver fluke infection.

Enterobiasis. Called pinworms.

Ascariasis. Called ascaris.

The onset of the disease is accompanied by a high temperature up to 40 ° C, severe allergic reactions, and intestinal disorders. With a strong seeding with Trichinella and failure to provide assistance, the patient may die.

Note! In order for Trichinella to completely die, it is necessary to boil the pork affected by them for 3 hours or soak it in vinegar for a long time. Everyone knows what a delicious kebab is obtained from pork marinated not in vinegar, but in kefir or lemon juice, and remember how long it is fried.

Within 1-2 months after the introduction of the larvae, the child may have a fever, cough, allergic reactions, diarrhea, vomiting. The general condition worsens. In the future, the disease proceeds mainly as gastroduodenitis (abdominal pain, flatulence, stool disorders). Such patients, as a rule, are observed for quite a long time and are treated to no avail by a gastroenterologist for various diseases of the digestive system. Intestinal acne often causes biliary dyskinesia and duodenal ulcers. Allergic diseases are frequent.

Rishta lives in tropical countries. But recently, cases of dracunculiasis began to appear in our country due to the fact that people began to often go on vacation abroad.

trichuriasis. The disease causes whipworm. Whipworm eggs enter the external environment with the feces of a sick person. You can get infected through dirty hands or by eating vegetables and fruits grown on soil that has been fertilized accordingly. Vlasoglav settles in the caecum and appendix, feeds on the intestinal mucosa.

The clinic is dominated by severe spastic abdominal pain, nausea, vomiting, significant loss of appetite, diarrhea. Vlasoglav can cause acute appendicitis.

Diphyllobothriasis. A wide tapeworm settles in the human small intestine after eating poorly thermally processed or insufficiently salted fish, as well as caviar. This vile worm grows to a size of 10-20 meters. Imagine how it fits in your stomach. Not to mention the fact that a person has to feed and poison all this colossus with the products of its vital activity. The picture is heartbreaking.

A wide tapeworm is often the cause of intestinal obstruction, causes allergies, a significant deficiency of vitamins B 12, B 1, B 2, C, intestinal disorders and seriously worsens well-being.

Signs of the disease will be abdominal pain, loose stools with mucus, nausea, vomiting, fainting, physical and mental retardation.

Infection occurs when eating raw or poorly processed meat, in particular barbecue. Tenidosis is manifested by nausea, vomiting, decrease, increase or perversion of appetite, flatulence, unstable stool, abdominal pain, sometimes simulating the clinic of acute appendicitis. Characterized by headaches, fainting, dizziness, sleep disturbances.

Cysticercosis develops when a cysticercus, an intermediate form of development of the pork tapeworm, enters the body. This condition is very dangerous, because, getting into the body through dirty hands, with food or water, the eggs and cysticerci of the pork tapeworm spread throughout the body, can enter any organ, and grow there. In a person in whose body an adult tapeworm lives, self-infection can occur.

Treatment of taeniasis caused by tapeworm is carried out in a hospital under strict medical supervision due to the risk of cysticercosis.

Human infection occurs by ingestion of helminth eggs after contact with dogs and sheep. In the intestines, larvae emerge from the eggs, which penetrate the blood vessels and spread to various organs, turning into echinococcal blisters there. The liver, lungs, brain, muscles, kidneys are mainly affected.

Echinococci are often mistaken for tumors or cysts.

Attention! If children's dosages are not given in the recipes, then the adult dose is indicated. Calculation of children's doses, see Chap. "Peculiarities of taking medications in childhood".

The antihelminthic effect of the following herbs has been proven: garlic, celandine, tansy, pumpkin seed, wormwood, birch, zhoster, fern, pomegranate, St. John's wort. It is believed that the expulsion of worms is most effective during the full moon.

Kishmish. Taken orally as an antihelminthic. Eat 1-2 cups of berries on an empty stomach.

Pumpkin seeds. Seeds (seeds) of pumpkin, fresh or in the form of infusion, are a traditional anthelmintic. Seeds should be dry, raw (not fried), fresh (stored no more than 2 years). 3-4 hours after taking the last portion of the seeds, a laxative is given and a cleansing enema is given.

Fresh pumpkin seeds. Seeds are cleaned, keeping the inner gray-green skin, crushed to a state of gruel. Can be mixed with honey. Take on an empty stomach, slowly, over an hour:

• children 3-4 years old - 75 g per day;
• children 5-6 years old - 100 g per day;
• children 10 years and older - 150-200 g per day;
• adults - up to 3 glasses a day.

Infusion: Grind 500 g of unpeeled seeds in a meat grinder, pour 5 cups of warm boiled water and evaporate without boiling over low heat or in the oven until half the volume of liquid is reduced. Remove the formed layer of oil from the surface, strain. Drink depending on age in the same doses as when taking fresh seeds.

"Powder from the peel of pumpkin seeds with pumpkin pulp" - a finished product, sold in pharmacies. Mix the powder with warm boiled water until the density of sour cream and take it slowly, in small portions, for 15-20 minutes 2-3 times a day before meals. Adults - 60-80 g, children - 30-40 g each. Pumpkin seeds can be replace with watermelon seeds (but pumpkin is still preferable). Watermelon seeds are used in the same way as pumpkin seeds. Garlic. A decoction of garlic. Pour 5-6 cloves of medium-sized garlic with 100 ml of water, bring to a boil, cool, strain. During the week, do enemas with this decoction, preferably on a full moon. Eat several heads of garlic on an empty stomach with boiled milk. Contains santonin. It helps well with round worms (ascaris, pinworms). Take: children 1-3 years old 0.25-0.75 g, 4-6 years old 1-1.5 g, 7-9 years old 1.75-2.25 g, 10-14 years old 2.5-3, 5 g, older than 15 years 4-5 g. Cytvar seed is quite poisonous and, if the dose is exceeded, can cause poisoning (nausea, vomiting, abdominal pain, diarrhea, urine staining in yellow-red color). In severe poisoning, convulsions are possible. So be careful and do not exceed the dose. In case of poisoning, gastric lavage, saline laxative are indicated. Pomegranate. The bark of young pomegranate branches is used to expel worms, in particular, bull tapeworm. A decoction of pomegranate bark. Pour 50 g of bark with 2 glasses of water, leave for 6 hours. Boil until liquid is reduced by half. Cool, strain. Drink 200 ml of broth in small sips for 1 hour, on an empty stomach. After 30 minutes, take a laxative: an infusion of cassia leaves or buckthorn bark, saline laxatives (Glauber or Epsom salt, 20-30 g).

Classification of helminthiases. According to the biological principle: nematodoses (roundworms), cestodoses (tapeworms), trematodoses (flukes).

According to the epidemiological: geohelminthiases, biohelminthiases, contact.

Ascariasis

Clinic. The migratory phase often proceeds under the guise of acute respiratory infections, bronchitis (including malaise, dry cough or scanty sputum, subfebrile temperature, dry and moist rales in the lungs).

Possible urticaria, vesicular rash on the hands and feet, volatile eosinophilic infiltrates in the lungs. In the intestinal phase, the gastrointestinal form is distinguished (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 (dizziness, headache, fatigue, sleep disturbance, vegetative-vascular disorders) forms.

Complications. Ascariasis intestinal obstruction, ascariasis appendicitis, perforative peritonitis, ascariasis of the liver 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.

Diagnosis based on laboratory data, on the detection of nematode larvae in sputum and antibodies in the blood, in the late intestinal phase - ascaris eggs in feces.

Treatment. For the expulsion of young individuals and adult roundworms, piperazine, levamisole, and combantrin are used. Piperazine is prescribed after meals 2 times a day with an interval between doses of 2-3 hours for 2 consecutive days at a dose of 1.5-2 g per dose (3-4 g per day). Efficiency is increased when taking piperazine after dinner, before bedtime. Levamisole (Decaris) is prescribed after meals at a dose of 150 mg once, pyrantel is recommended once after meals at a rate of 10 mg/kg. Oxygen treatment is carried out on an empty stomach or 3-4 hours after breakfast for 2-3 days in a row.

Forecast. In the absence of complications requiring surgical intervention, favorable.

Prevention. Mass examination of the population and treatment of all infested with ascariasis. Protection of the soil of kitchen gardens, orchards, berry fields from contamination with feces. Thorough washing and scalding vegetables and fruits with boiling water. Personal hygiene measures.

Etiology, pathogenesis. The causative agent is the larval stage of alveococcus. Infection occurs after oncospheres enter the mouth after contact with contaminated skins of foxes, arctic foxes, dogs, with water from stagnant reservoirs and by eating wild berries collected in endemic areas. Accumulations of larvae (usually in the liver) infiltrate and grow into tissues, disrupt the blood supply to organs, and cause tissue degeneration and atrophy.

Clinic. He 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.

Diagnosis. Based on laboratory data - leukocytosis, eosinophilia, increased ESR, hyperproteinemia, hypergammaglobulinemia. Put serological reactions with alveococcal antigen. To clarify the localization, X-ray and ultrasound, liver scan, and computed tomography are used. Trial puncture is prohibited due to the risk of contamination of other organs.

differential diagnosis. Differentiate with tumors, echinococcosis and cirrhosis of the liver.

Treatment. Surgical and symptomatic.

Adult helminths are hematophagous. When fixed to the intestinal mucosa, they injure tissues, lead to the formation of hemorrhage, cause bleeding, anemia, maintain an allergic state, dyskinesia of the gastrointestinal tract and dyspepsia.

Clinic. Skin itching and burning, asthmatic phenomena, fever, eosinophilia. In the late stage, nausea, salivation, vomiting, abdominal pain, bowel dysfunction (constipation or diarrhea), and bloating appear.

Diagnosis. Confirmed by the detection of eggs in the feces and occasionally in the duodenal contents.

Treatment. Deworming is carried out with combantrin or levamisole. With severe anemia (hemoglobin below 67 g / l), iron preparations, transfusion of erythrocyte mass are used.

Forecast. Favorable in most cases.

Prevention. In the foci of ankylostomiasis, one should not walk barefoot and lie on the ground without bedding. It is necessary to thoroughly wash and scald fruits, vegetables, berries with boiling water before eating them, you can not drink unboiled water.

Clinic. Characterized by nausea, weakness, dizziness, abdominal pain, unstable stool, excretion of scraps of strobilus during defecation.

Diagnosis. Confirmed by the detection of eggs of the tapeworm and scraps of strobila in the feces.

Treatment. In case of severe anemia, before helminthization, vitamin B is prescribed at 300–500 mcg intramuscularly 2–3 times a week for a month, iron preparations, hemostimulin, hematogen. For deworming, use fenasal, male fern extract, decoction of pumpkin seeds.

Forecast. In the absence of complications - favorable.

Prevention. Do not eat raw, undercooked or insufficiently salted and dried fish, as well as "live" pike caviar.

Clinic. The incubation period is about 2 weeks. In the early period, there may be fever, pain in muscles and joints, vomiting, diarrhea, soreness and enlargement of the liver, less often spleen, leukocytosis and high eosinophilia, allergic skin rashes. 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 gallbladder colic.

Frequent dizziness, various dyspeptic phenomena. Muscle resistance in the right hypochondrium, enlargement of the liver, occasionally icterus of the sclera, enlargement of the gallbladder, symptoms of pancreatitis are revealed. Most often, with opisthorchiasis, the phenomena of cholecystitis, biliary dyskinesia, chronic hepatitis and pancreatitis develop, less often - symptoms of gastroduodenitis, enterocolitis. Opisthorchiasis may be asymptomatic.

Diagnosis. It is based on the detection of helminth eggs in the feces and duodenal contents.

Treatment. Deworming is carried out with mebendazole (Vermox).

Prevention. Explanation to the population of the danger of eating raw, thawed and frozen (stroganina), lightly salted and insufficiently fried fish.

Diagnosis put on the basis of a repeated study of feces for the presence of segments of helminths and mucus from the perianal folds (by scraping) for the presence of tapeworm eggs.

Treatment. Vermox treatment. Sometimes an essential extract of male fern and pumpkin seeds are used.

Prevention. You can not eat undercooked and undercooked pork.

Clinic. Disturbed by salivation, decrease (rarely increase) of appetite, pain in the right side of the abdomen and epigastrium, nausea, constipation or diarrhea, headache, dizziness, restless sleep, irritability are sometimes noted; moderate hypochromic anemia and slight leukocytosis are possible. With a low intensity, whipworm invasion is asymptomatic.

Diagnosis. Established when whipworm eggs are found in the feces.

Treatment. Prescribe mebendazole and other anthelmintic drugs. Previously, the patient is given a cleansing enema.

Forecast. Favorable.

Etiology, pathogenesis. The causative agents are liver fluke and giant fluke. The main source of human invasion is various farm animals. Human infection usually occurs in the warm season when fasciola larvae are swallowed with water, sorrel, lettuce and other herbs. The life span of helminths in the body is about 10 years. Traumatization and toxic-allergic damage to the hepatobiliary system matter. Fasciola can be carried into other tissues and organs.

Clinic. The disease is characterized by eosinophilia, allergic phenomena, disorders of the liver and gallbladder, resembling the symptoms of opisthorchiasis (jaundice and attacks of gallbladder colic are more common).

Diagnosis. The diagnosis of the early stage of fascioliasis is difficult, since helminth eggs are released only 3 to 4 months after infection. Immunological methods are used. In the late stage, the diagnosis is based on the detection of fasciola eggs in the duodenal contents and feces.

Treatment. Anthelmintic drugs are prescribed, and after deworming, cholagogues are prescribed for 1 to 2 months. A long-term (at least a year) medical examination of patients is necessary.

Forecast favorable in treatment.

Prevention. Prohibition of the use of water from stagnant reservoirs, thorough washing and scalding greens with boiling water.

Etiology. The causative agent of hydatid 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), from 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. It 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.

Mechanism of transmission of invasion. Fecal-oral (as a result of ingestion of invasive echinococcus eggs upon contact with dogs, sheep, on the wool of which there may be helminth eggs), the route of transmission is food, water, household.

Clinic. Pain in the chest of a different nature, dry cough, then with purulent sputum, hemoptysis, shortness of breath. If the bubble breaks into the bronchus, there is a strong cough, cyanosis, suffocation, the contents of the bubble can be found in the sputum. With suppuration of echinococcal blisters, a lung abscess develops.

With liver echinococcosis, patients lose their appetite, weakness, weight loss, headaches, decreased performance, a feeling of heaviness in the epigastrium appear. Pain in the right hypochondrium, liver enlargement, induration, and tenderness on palpation, nausea, vomiting, upset stool. In rare cases, subekterichnost skin and the appearance of jaundice.

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.

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.

Etiology. The causative agent is pinworm female 9–12 cm long, males 3–4 cm. Males die after fertilization, females exit 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 are itching around the anus, scratching, infection, rapid stools with pathological impurities. Symptoms of intoxication, girls have vulvovaginitis.

Diagnostics. Based on the detection of pinworm eggs in feces or by scraping on pinworm eggs. In the blood - eosinophilia.

Treatment. Mebendazole (vermox) from 2 to 10 years, 25-50 mg/kg once, pyrantel (combanthrin) 10 mg/kg (once after breakfast, chew), piperazine up to 1 year 0.2 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 - 1.5.

Prevention. Compliance with personal hygiene.

• Nematodes (roundworms);
• Cestodes (flat and tapeworms);
• Trematodes (flukes).

Nematodes are the most common type of worms, most often affecting children's organisms.

These include:

• pinworms (cause enterobiasis);
• trichinella (cause the disease trichinosis);
• roundworms (provoke ascariasis);
• whipworm (causes trichuriasis).

Cestodes (flatworms or tapeworms) include:

• a wide ribbon that provokes the disease diphyllobothriasis;
• echinococcus causes echinococcosis;
• bovine tapeworm causes teniarinhoz;
• pork tapeworm causes taeniasis;
• pygmy tapeworm provokes hymenolepiasis.

• opisthorchis causes opisthorchiasis;
• hepatic fluke or hepatic fasciola causes fascioliasis;
• The pulmonary fluke Paragonimus provokes the disease paragonimiasis.

Symptoms of helminthiases are pronounced when the helminth reaches puberty and large sizes. Therefore, common symptoms include the following:

• weight loss;
• signs of general intoxication;
• increased fatigue;
• weakness;
• dysfunction of the central nervous system;
• headaches and dizziness.

Helminths of a certain type cause specific symptoms in a child, which are due to its localization and the specifics of life. Thus, with enterobiasis, a symptom characteristic only of this disease is observed in the form of severe itching around the anus, which is especially pronounced at night. At this time, the sphincter is relaxed in the child, which allows female pinworms to freely go outside to lay eggs in the perianal folds.

• fever;
• general weakness;
• swollen lymph nodes;
• arthralgia and swelling of the legs;
• skin rashes;
• bruxism (teeth grinding during sleep);
• dry cough;
• muscle pain;
• increased salivation;
• weight loss;
• eosinophilia;
• allergic reactions;
• the presence of volatile infiltrates in the lungs;
• bronchitis;
• pneumonia;
• dyspnea.

When the larvae become sexually mature individuals, they are localized in the small intestine, where they mate and lay eggs. In this case, the disease appears with various symptoms from the gastrointestinal tract:

• nausea;
• vomit;
• stool disorder;
• diarrhea and constipation;
• stomach ache;
• bloating;
• weight loss;
• flatulence;
• loss of appetite.

A complication of ascariasis can be:

• appendicitis, since helminths are able to penetrate into the appendix;
• mechanical jaundice;
• inflammation of the pancreas;
• intestinal obstruction.

With trichinosis, the following symptoms are observed:

• muscle pain, since trichinella is able to localize in the muscles, causing inflammation in the tissues;
• high temperature above 38°C;
• swelling of the face (a characteristic sign of trichinosis).

Helminthiases caused by trematodes (flukes) are manifested by the following symptoms:

• damage to the liver and biliary tract;
• enlargement of the spleen and liver;
• the development of pancreatitis;
• disturbances in the work of the nervous and digestive systems.

Diagnosis of helminthiases in children

To identify helminthiases in children, the following clinical studies are carried out.

1. General blood analysis. In the acute stage, an increase in eosinophils is observed, which eloquently indicates an allergic reaction in the body.
2. Blood chemistry. There is an increase in biochemical tests, such indicators as ALT and AST, bilirubin, thymol test, alkaline phosphatase.
3. The most effective are serological research methods: RIF, ELISA, RNGA, RSK.
4. Until now, the most popular diagnostic method is the analysis of feces for worm eggs and scraping for enterobiasis.
5. In case of echinococcosis, effective diagnostic methods are instrumental methods (X-ray, ultrasound, CT, MRI, endoscopy in children), which reveal cysts of the liver, lungs, and brain.
6. With trichinosis, a biopsy of the muscles and skin is performed in order to identify helminth larvae.
7. When opisthorchiasis examine the duodenal fluid and the contents of the duodenum.
8. Also, bile and sputum can serve as material for research.

Treatment of helminthiases in children

For the treatment of helminthiasis in children, anthelmintic drugs are used. The choice of drug is based on several factors:

It is also necessary to choose a drug that would have:

For the treatment of helminthic invasions in children, apply:

• albendazole and mebendazole are prescribed for the treatment of enterobiasis, ascariasis, trichinosis, trichuriasis;
• helminthox for children is used in the treatment of enterobiasis, ascariasis, trichuriasis, ankylostomiasis and trichostrongylidosis.
• pyrantel is prescribed for children with enterobiasis and ascariasis;
• Praziquantel is used to treat schistosomiasis, diphyllobothriasis, and taeniasis.

For successful treatment, deworming of children in preschool groups, all family members, and even pets is carried out. A necessary measure is the observance of a hygienic regime for the prevention of re-infection (reinfestation).

Additional treatment is carried out:

• antihistamines to relieve allergy symptoms,
• treatment with enzymes, sorbents and hepatoprotectors to restore the organs of the digestive system;
• to eliminate intoxication and maintain the immune system, immunocorrectors and immunostimulants are prescribed;
• glucocorticosteroids for the treatment of complications or chronic inflammatory processes exacerbated by helminthiasis.
• multivitamin and mineral complexes to improve appetite and restore the body.

Prevention of helminthic invasions in children

The main prevention of helminthiases in children is the observance of the rules of personal hygiene.

Therefore, we can name precautionary measures for the prevention of helminthic invasions.

The most common and studied diseases - ascariasis, enterobiasis (Fig. 1) and giardiasis - are recorded everywhere. In Russia, more than 2 million patients with nematodes are detected annually. When assessing the territorial distribution of giardiasis in Russia, it was found that the highest average incidence rate for many years was noted in St. Petersburg, and the incidence of children attending childcare facilities is 35%.

The importance of certain risk factors varies according to the age of the child. It has been proven that sanitary and hygienic living conditions are more important for young children, and for adolescents, when collecting an anamnesis, attention should be paid to socio-economic and geographical factors (staying in a camp, a tourist trip, having a younger brother or sister) (Fig. 3).

The immune defense of the gastrointestinal tract (GIT) of a child can be divided into specific and non-specific. Non-specific protection includes a complex of conditions for normal digestion: the maturity of enzymatic systems, the provision of an acid-base gradient in various parts of the gastrointestinal tract, the activity of normal microflora, and adequate motor skills.

Separately, it should be noted that for a disease such as giardiasis, a predisposing factor for invasion is irregular and insufficient bile secretion into the intestine with anomalies in the development of the gallbladder (constrictions, kinks). Giardiasis, diagnosed in patients of the pediatric department of MONIKI, was accompanied by dysfunction of the biliary tract in 100% of cases.

The specific protection of the mucous membrane of the digestive organs depends on the age of the child and his maturity. The mechanism of specific immune defense is one of the most ancient systems of the body, since helminthiases have accompanied mankind for many millennia. This mechanism is represented primarily by blood eosinophils and immunoglobulin E.

A particularly recognizable clinical picture is formed by toxocariasis (Fig. 5). Clinical markers of this invasion are the leukemoid reaction of eosinophils (from 20% or more of eosinophils in the blood formula), which accompanies a bright and persistent allergic syndrome in the form of atopic dermatitis with severe itching and resistance to traditional therapy or severe bronchial asthma with frequent attacks.

However, the effort expended may be useless if the study is carried out during a pause in the production of cysts or eggs. For example, the non-informativeness of perianal scraping with a 1-2-fold examination method is due to the frequency of oviposition by pinworm females. The peculiarity of the release of cysts by Giardia is called the "phenomenon of intermittent cyst release", in which the phases of massive release of cysts are replaced by a negative phase, which can last from 2-3 days to 2-3 weeks. During this period, it is impossible to detect Giardia in the feces.

Treatment of helminthiases

For the treatment of ascariasis in older children or with recurrence of the disease, a combination of anthelmintic agents (for example, albendazole for three days, then Vermox for three days) can be used under the supervision of a physician. An indispensable condition for successful deworming of patients with enterobiasis is the simultaneous treatment of all family members (team) and strict adherence to the hygienic regimen to exclude reinvasion. It should be noted that daily wet cleaning is important, since casuistic cases of the spread of the reproductive material of pinworms on dust particles to a height of up to 1.5 meters have been described.

Treatment of giardiasis involves a mandatory diet with a restriction of the consumption of easily digestible carbohydrates, an increase in the proportion of protein in food, the use of "acidifying" foods (decoctions of lingonberries, cranberries), the use of choleretic decoctions and drugs.

Drugs used in the treatment of ascariasis:

• Vermox (mebendazole) (for children from 2 years old) - 100 mg 2 times a day for 3 days;

Drugs used in the treatment of enterobiasis:

• Vermox (mebendazole) (for children from 2 years old) - 100 mg once;
• Pirantel - 10 mg / kg once;
• Nemozol (albendazole) (for children from 2 years old) - 400 mg once.

Drugs used in the treatment of giardiasis:

• ornidazole 25-30 mg / kg (if body weight is more than 35 kg - 1000 mg) in two divided doses for 5 days, 1 day - 1/2 dose, repeated course after 7 days;
• Macmirror (nifuratel) - 15 mg / kg 2 times a day for 7 days;
• Nemozol (albendazole) - 15 mg / kg once for 5-7 days.

3. Mandatory use of enterosorbents and a complex of multivitamins with microelements (Tables 2 and 3).

Literature

L. I. Vasechkina 1 ,Candidate of Medical Sciences
T. K. Tyurina,Candidate of Medical Sciences
L. P. Pelepets,candidate of biological sciences
A. V. Akinfiev,Candidate of Medical Sciences

GBUZ MO MONIKI them. M. F. Vladimirsky, Moscow