Zaporozhyan state medical university departement of infectious diseases

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. 

 

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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;  

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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  

 

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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 

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