Zaporozhyan state medical university departement of infectious diseases

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Niclosamide. A single morning dose of 2 g niclosamide is given to adults 

and older children on an empty stomach. 

Phenasalum is given in dose of 2 g in 3 hours after a light breakfast and 1 g 

on an empty stomach next morning.  

Mebendazole (vermox) 300 mg 2 times a day during 3 days.  

In case of bad tolerance to antihelminthic drugs pumpkin seeds are used. 

Patient has to take easily digestible food and do enema every morning during two 

days before treatment starts. In the evening of the last day before treatment saline 

purgative has to be taken and next morning on an empty stomach enema has to be 

done. 500 grams of pumpkin seeds are chopped. Twice more amount of water is 

added. Put it in steam bath for two hours, filtrate through gauze then remove oily 

film. It should be taken on an empty stomach during 30 minutes. In 2 hours after 

taking decoction saline purgative has to be given.  

Treatment of evident anemia should be started before using anthelmintic 

medicine. Parenteral vitamin B12 should be given if B

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 deficiency is manifest. 

Regular medical check-up of patient with Diphyllobothriosis lasts during 

4-6 months. In three months after course of treatment control microscopic 

examination of faeces has to be done 2-3 times with one week interval. After 

negative results of laboratory examinations patient doesn’t need to do regular 

medical check-up anymore. 

 

ECHINOCOCCOSIS is biohelminthosis, which is caused in humans by the 

larval stage of the Echinococcus granulosus and characterized by formation of 

hydatids (cyst with daughter cysts, each containing several protoscolices) in 

different organs of human body.  

Etiology. The causative agent of hydatidic echinococcosis is Echinococcosis 

granulosus. Adult helminth lives for 5–20 months in the jejunum of canines. It 

reaches 5-6 mm in length with 3-4 proglottids. There are 4 spherical suckers and 

rostellum with two rows of hooks on a scolex. Last gravid segment has about 800-

1000 eggs that are morphologically similar to Taenia eggs. The eggs are stable in 

environment and can survive during 6 months in temperature +1+20 ºC.  

Epidemiology. Echinococcosis is found on all continents. It is common in 

Australia, New Zealand, China, central Asia, the Middle East, the Mediterranean 

region, eastern Africa, and parts of South America. 

Echinococcus granulosus has both intermediate and definitive hosts. The 

adult tapeworm is found in the small intestine of the definitive host, usually dogs 

or other canines (wolfs, jackal, foxes). Gravid segments are excreted with faeces or 

crawl out from the anus without act of defecation. They release eggs contained 

larvas (oncospheres) which are infectious for the intermediate hosts (sheep, cattle, 

horses, pigs, goats, camels, human and others). Human becomes infected by 

ingestion of eggs with contaminated food (vegetables, berries) or water, by contact 

with infected dogs which have eggs on their hair. Inhalation way of transmission 

can be also realized by inspiration of oncospheres in lungs with dust.  

After humans ingest the eggs, oncospheres escape from the eggs, penetrate 

the intestinal mucosa, enter the portal circulation, and are carried to various organs, 

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most commonly the liver and lungs, rarely brain. Larvae develop into fluid-filled 

unilocular hydatid cysts that consist of an external membrane and an inner 

germinal layer. Daughter cysts develop from the inner aspect of the germinal layer, 

as do germinating cystic structures called brood capsules. New larvae, called 

protoscolices, develop in large numbers (up to 100) within the brood capsule. The 

cysts expand slowly over a period of years. Size of the cyst can be different from 1 

to 40 cm in diameter and bigger. Larvae stay viable inside the cyst for many years. 

Human with Echinococcosis is not dangerous for other people.  

There are two types of focus of Echinococcosis. They are natural and 

anthropurgic foci. Natural foci of Echinococcosis (wild cycles) involve wild 

predators such as wolves and others (definitive hosts) and herbivorous animals 

(intermediate hosts). Predators get Echinococcus granulosus by ingesting infected 

with cysts organs of herbivorous animal (liver, lungs, kidney). In their intestine 

scolices release from cyst, then attach to mucous of small intestine, grow and 

become adult helminthes.  

Anthropurgic foci are formed with dogs (definitive hosts) and farming 

animals (intermediate hosts). The infection is widely distributed in most parts of 

the world where sheep are raised and dogs are used to herd livestock. Infected dogs 

contaminate pasture with eggs of Echinococcus granulosus. Sheep and goats 

become infected by eating grass with eggs. Sometimes human feed the dogs with 

internal organs of ill animals. When a dog ingests infected meat containing cysts, 

the life cycle of Echinococcus granulosus is completed. 

Human can get Echinococcosis in natural and антропургический foci. 

Susceptibility to Echinococcosis is common. 

Pathogenesis. Negative influence of helminth on human body is result of 

mechanical and toxico-allergic affect. Echinococcus cyst can press host’s tissues 

even up to their death. In case of intrahepatic localization cyst may compress big 

biliary ducts and cause cholestasis. It may also compress big hepatic vessels and 

lead to portal hypertension. Rupture of a cyst may result in anaphylactic shock due 

to sensitization of human organism by massive releasing of foreign proteins.  

Clinical Manifestations. Since a period of years elapses before cysts 

enlarge sufficiently to cause symptoms, they may be discovered incidentally on a 

routine x-ray or ultrasound study. Clinical manifestations depend on localization 

and size of the cysts. The liver and the lungs are the most common sites of these 

cysts.  

Patients with hepatic echinococcosis can have lost of appetite, belching, 

abdominal pain. Cyst can be palpable in the right upper quadrant in case of its 

superficial localization in low parts of right lobe of the liver. Compression of a bile 

duct or leakage of cyst fluid into the biliary tree may mimic recurrent 

cholelithiasis, and biliary obstruction can result in jaundice. Rupture of or episodic 

leakage from a hydatid cyst may produce fever, pruritus, urticaria, eosinophilia, or 

anaphylaxis. Hydatid cysts may become secondarily infected with bacteria 

presenting as a hepatic abscess.  

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