PARAZITOZE INTESTINALE

1.Importana
- incidena foarte crescut la copil
- nu confer imunitate
- efect nefavorabil asupra nutriiei, imunitii
- frecvena formelor asimptomatice

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2.Manifestri clinice
- fr manifestri
- digestive: greuri, vrsturi, dureri abdomen,
prurit anal, diaree (uneori cronic), afectare
hepatic
- neuropsihice: cefalee, iritabilitate, insomnie,
ameeli, convulsii; meningit cu eozinofile
(ascarizi, toxocara)
- cutanate/mucoase: erupii, prurit
- alte: respiratorii (ascarizi, toxocara) tulb.ritm
(tenia), tulb.oculare (toxocara), febr, eliminarea
paraziilor. 2
3.Ex.paraclinice
- hemoleucograme:hipereozinofile, anemie
carenial, anemie macrocitar n botriocefaloz
- biologie: probe hepatice, imunograma
- explorri diagnostice: ex.coproparazitologic,
scotch test, ex.bilei, IDR toxocara, serologie
fascioloz, toxocara, lamblii, hidatidoza,
trichinelloza; biopsie int., biopsie muscular,
Rx.pulmonar

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4.Entiti
4.1.Oxiuraza
- parazit:Enterobius vermicularis (mic, alb,
M:2-5 mm, F:8-15 mm)
- ciclul: f.adult n intestin g depunere ou
perianal autoinfestare
- simptom dominant: prurit anal vesperal, vulvo-
vaginit, observarea parazitului
- dg.:scotch test

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4.2.Ascaridioza
- parazit: Ascaris lumbricoides; alb-roz 15-35 cm
- ciclul: f.adult n intestin subire eliminare ou
neembrionate prin scaun pe sol devine
embrionat (infestant) tub digestiv - larvele
traverseaz mucoasa intestinal circulatia
- plmn/arbore respirator tub digestiv.

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- simptome dominante
faza larvar: tuse, infiltrat pulm, hipereozinofilie
30-60% (s.Lffler)
faza adult: tulb.digestive, alergice, eliminarea
parazirului, ocluzie intestinal, scade eozinofilia
dg.:ex.parazitologic (adult), hipereozinofilie
mare, Rx.pulmonar, echo abdominal

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4.3.Tricocefaloza
- parazit: Trichuris trichiura: 25-30 mm
- ciclul: adult n int.gros eliminare ou
neembrionat larve ingerate
- simptom dominant: tulb.dig.nespecifice
- dg.: ex.coprologic

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4.4.Infestaia cu cestode
Clasificare: cestode mari (viermi plai tenii,
botriocefal)
cestode mici (Hymenolepis nana)
4.4.1.Infestaia cu Tenia solium
4.4.1.1.Mecanisme: a) ingerare de carne de
porc infestat (cisticerci) n intestin subire
scolexul evagineaz din cisticerc, fixare pe
perete intestinal, se dezvolt vierme adult (1-3
m) eliminare proglote cu ou porc intestin
muchi (cisticerci)

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b) Ingerare de ou de tenie (ap, alimente
contaminate, autoinfestaie) intestin, eliberare de
embrioni hexacani traverseaz peretele
circulaie localizare n esuturi (muchi, creier,
ochi, etc.)
4.4.1.2.Simptome:
- digestive: vrsturi, diaree, dureri, uneori ocluzii
- manifestri alergice cutanate
- neurologice (neurocisticercoz): convulsii,
hidrocefalie, encefalit, etc.
- oculare: uveit, corioretinit, etc.
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4.4.1.3.Diagnostic
- ex.coprologic: ou, proglote, coproantigene
(ELISA)
- IDR la antigenele T.S.
- examen baritat tub digestiv
- CT, histologie a esutului afectat
- eozinofilie

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4.4.2.Infestaia cu Tenia saginata
- gazda intermediar: bovinele
- mecanism i simptome: ca la T.solium (rareori
realizeaz cisticercoza uman)
4.4.3.Infestaia cu Botriocefal
- gazda intermediar: petele
- simptome digestive i anemie megaloblastic
- diagnostic: examen coprologic

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4.4.4.Echinococoza (boala hidatic)
- parazit: Echinococcus granulosus
- ciclul: animale infestate (cine, pisic ) ou
embrionate ingestie - se elibereaz
embrionul, strbate mucoasa intestinal
- circulaie esuturi (ficat 60%, plmn, creier,
cord etc.)

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- clinic:
semne generale: astenie, anorexie etc
manifestri alergice
semne de localizare: hepatomegalie, HTP, dureri
toracice, tuse, hemoptizie, HIC etc.
- complicaii: ruptura chistului (vomica cu lichid
hidatic, oc anafilactic, pleurezii, peritonite,
suprainfecie

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- diagnostic:
imagistic (formaiuni chistice cu localizri
diverse)
evidenierea atc specifici (ELISA)
examen lichid hidatic (protoscoleci sau crlige
rupte)

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4.5.Giardiaza
- parazit Giardia lamblia (protozoar)
- ciclul: forma vegetativ (trofozoit) n duoden,
jejun; forma chistic n ileon, colon eliminare
chiste (sol, ap) infestare
- afectarea mucoasei intestinale - malabsorbie

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- simptome: diaree acut vrsturi, diaree
cronic (steotoree), scdere n greutate; deseori
bolnav cu deficit imun
- dg.:ex.coproparazitologic (chist), ex.suc
duodenal, serologie; investigaii complexe n caz
de malabsorbie

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4.6.Larva migrans visceralis (toxocaroz)
- parazit: Toxocara canis, Toxocara cati
- Ciclul: dejecte animale sol infestare intestin-
ficat, miocard, plmn, creier - nchistare, necrozare,
calcificare

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- simptome: febr, astenie, erupii, wheezing,
hepatomegalie, sindrom neurologic
- laborator:hiperleucocitoz (pseudoleucemic),
mare hipereozinofilie (75-80%), VSH, PCR+,
TGP, gamaglobuline
- Dg.:atc.anti-antigen ascaridian (RFC) +mare
hipereozinofilie, CT cerebral

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4.7.Larva migrans cutanat
- parazit Ankylostoma
- simptome cutanate: cordon liniar de lime
1-2 mm, pruriginos, care progreseaz 1-3 cm zilnic
- Dg.:izolarea larvei din leziuni

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5.Tratament
5.1.Oxiuraz:mebendazol (Vermox 2x100 mg/zi 1
zi), albendazol (Zentel) peste 2 ani 400 mg/zi 1 zi,
sub 2 ani 200 mg/zi; flubendazol (Fluvermal 120
mg 1 zi); msuri speciale: igien, tiere unghii,
fierberea lenjeriei
5.2.Ascaridiaza: mebendazol 3 zile , flubendazol,
albendazol 1 zi, levotetramisol (Decaris 3-4 mg/kg
doz unic)

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5.3.Tricocefaloza: mebendazol 3 zile, albendazol 1
zi, flubendazol
5.4.Teniazele: Niclosamid 2g n 2 prize la interval
de o or (1 g sub 7 ani); Mepacrin 15-20 mg/kg/zi
n 4 prize la interval de 5 minute, se ascoaiz
purgativ salin atenie la eliminarea scolex;
albendazol 3 zile.

n faza de cisticerc praziquantel 50 mg/kg/zi sau

albendazol 15 mg/kg/zi + corticoterapie

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5.5.Giardiaza: metronidazol (Flagyl 15-20 mg/kg/zi
7 zile); tinidazol (Fasigyn 50-75 mg/kg/zi priz
unic); furazolidon 7 mg/kg/zi 7-10 zile n 4 prize;
quinacrin (Atebrin 6 mg/kg/zi 7 zile), albendazol 5
zile
5.6.Larva migrans visceralis i cutanat:
tiabendazol (Mintezol 25 mg/kg/zi 4-6 zile),
albendazol 5-10 zile;dietilcarbamazina 6-8
mg/kg/zi 21 zile).

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5.7.Echinococoza
- chirurgical (albendazol preoperator 4 zile,
postoperator 1-3 luni)
- puncionare aspirare injectare reaspirare
(PAIR, cu NaCl 20% sau etanol 95%)
- chimioterapie (albendazol 3 x 28 zile) la bolnavi
inoperabili sau chiste n mai multe organe

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