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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
12
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.