Helminths (worms) in children: symptoms, signs, treatment

Ways of infection with worms:

• contact with soil and water that contain parasite eggs (sandbox and puddle are no exception);
• consumption of foods that have not been properly processed - plant foods, meat, fish may contain worm eggs;
• neglect of hygiene;
• transmission of worms from mother to child during childbirth;
• regular contact with animals, especially street animals or those that go outside;
• visiting a room with insects;
• contacts with already infected children;
• low immunity;
• moving to another country, associated with stress on the body and incomplete acclimatization.

Based on the causes of the disease, it is not difficult to develop a system of minimal prevention - teach the child to wash his hands regularly, feed him only properly processed foods, and ensure sanitary control in the house. However, no one has canceled contacts with street animals and licking swings; the result is intestinal damage by parasites. Not all helminths immediately manifest themselves actively - they can remain dormant in the body for years, so regular checks, especially for children, are extremely important.

Description of the disease

Helminthic infestation or helminthiasis (damage to the body by worms) is a widespread phenomenon in childhood. Few children have not suffered from helminthiasis at least once in their life. Manifestations of the disease, as a rule, are known to everyone: the child suffers from itching in the anus (intensified at night), stomach upset, loss of appetite, and a feeling of fatigue.

While in the intestines, the worms feed at the expense of the host’s body, affecting internal organs and systems. Currently, more than 300 varieties of worms are known. The most common in childhood are pinworms and roundworms.

Helminthic infestation requires immediate treatment by a qualified gastroenterologist. While in the child’s body, worms disrupt the process of absorption of nutrients, their waste products have a negative effect on the gastrointestinal tract, and, if left untreated, can affect other vital organs - the lungs, brain, etc.

How do children become infected and why?

The vast majority of cases of helminthic infestation are due to nematodes (ascariasis, enterobiasis, trichocephalosis). Infection with cestodes and trematodes accounts for 2 to 5% of all cases of helminthiasis. The cause of infection with tapeworms and flukes is travel to the tropics and subtropics, consumption of poorly fried or boiled meat, game, fish (infection with the broad tapeworm), as well as contact with animals that carry the infection.

Roundworms and pinworms enter a child's body when eating food with dirty hands, eating poorly washed berries, fruits and vegetables, and through contact with animals or carriers of ascariasis and enterobiasis.

When children are infected with pinworms, self-infection often occurs when the hands that the child used to scratch the skin around the anus transfer thousands of eggs onto toys, linen, household items, dishes, and door handles. He becomes infected again and infects his family members.

Children of primary preschool age taste everything that comes into their field of vision. Therefore, places where children have frequent contact with each other (playgrounds and kindergartens, playrooms in educational and shopping centers) become breeding grounds for helminth eggs. The defense system of a small child’s body is not yet perfect, and the need to observe hygiene rules has not yet developed.

The situation is aggravated by an imperfect system for detecting helminth infections. Erased symptoms, or their complete absence, may accompany the development of worms in children. This is why parents find it difficult to determine the causes of illness when complications of helminthiasis develop.

For example, the development cycle of pinworms makes it possible to detect symptoms of its presence only during a certain period of the development cycle. A scraping taken from a child at the wrong time may be false negative. That is why it is recommended to scrape the worm eggs three times: with a break of 2-3 days between them, and again, after 2 weeks.

Reasons for the increased risk of infection of children with ascariasis and enterobiasis:

• Irregular hand washing before eating, after a walk, or after contact with animals;
• Rare change of underwear, less than 2 times a day, or once in the morning.
• Persistent habit of putting toys in the mouth, sucking a finger, biting nails;
• Lack of nail care for children;
• Unsanitary conditions in the child’s home, the presence of flies and cockroaches;
• Contact with domestic animals that carry helminths on their fur and paws after a walk;
• Careless washing of vegetables, berries, herbs and fruits before eating.

Types of worms in children

The most common classification of helminthic infestations is depending on the type of pathogen. The following groups of parasites are distinguished:

• nematodes (roundworms): these include roundworms (actually, worms), pinworms, whipworms;
• cestodes (tapeworms): broad tapeworm, pork tapeworm;
• trematodes (flukes): cat fluke, pulmonary and liver flukes and others.

Depending on the characteristics of the life cycle of worms, there are three main types of helminthiasis:

• contact (damage from pinworms, dwarf tapeworm): parasite eggs are transmitted from child to child through dirty hands, household items, etc.;
• geohelminthiasis (infection with roundworms, hookworms, etc.): worm eggs are found in the ground and enter the body when eating unwashed vegetables and fruits, or not following hygiene rules;
• biohelminthiasis (infection with bovine, pork tapeworm, echinococcus): intermediate forms of development of the parasite are found in the body of carriers (fish, shellfish, dogs, etc.), enter the body by eating contaminated meat or by contact.

Classification of parasites

Different types of worms affect the body differently, and have their own characteristics both in the development cycle and in appearance and damage caused. There are three most common groups of worms: nematodes, cestodes, and trematodes.

The first group is the protocavitary worms. They live in soil and water, so they can easily become infected in the sandbox and during a walk in general. It is this group that includes the most common pinworms and roundworms, and also includes hookworms, trichinella, and guinea worms. Depending on which parasite caused the infection, ascariasis, enterobiasis, trichuriasis, etc. are distinguished.

Cestodoses are tapeworms that can live both in the intestines (the most common variant is tapeworms) and in organs (usually the larvae of tapeworms, echinococci, and alveococci live there). In accordance with which of these types of worms are found in children, echinococcosis, taeniasis, hymenolepiasis, etc. are distinguished.

And the last of the three popular groups is trematoses caused by trematodes. These are several types of flatworms - schistosome, cat/liver fluke, leukochloridium. They provoke opisthorchiasis (transmitted from fish of the carp family) and fascioliasis (the liver and bile system suffer, infection through plants or water).

Symptoms of worms

There are two forms of helminthiasis with their inherent manifestations: acute and chronic.
In acute helminthiasis, worms enter the body and provoke an immediate immune response in the form of allergic reactions (in connection with this, parents often confuse the presence of parasites with ordinary allergies). Manifestations of chronic helminthiasis can be very diverse. The clinical picture depends on the location of the parasites, their number and the specificity of the body's response to the presence of helminths.

Let us highlight the most characteristic symptoms and indirect signs of the presence of worms in a child:

• general malaise, weakness, fatigue;
• increased body temperature;
• dark circles under the eyes;
• allergic reactions in the form of skin rash (urticaria);
• problems with appetite;
• nausea and vomiting;
• smell from the mouth;
• pain in the abdominal cavity;
• bowel disorders (constipation/diarrhea);
• weight loss;
• itching in the anus;
• excretion of worm fragments in feces.

In addition to these symptoms, children and adolescents may show signs of dysfunction of organs affected by worms. Thus, if the liver is damaged, pain in the right side under the ribs, nausea, and jaundice of the skin may occur. If the lungs are damaged, asphyxia of the respiratory tract, etc. may occur. Children suffering from helminthic infestations are among the most frequently ill. Such children are susceptible to the frequent occurrence of ARVI, stomatitis, gingivitis, vulvovaginitis (girls), etc.

Signs of other helminthic infestations

Worms in children trichocephalosis (caused by whipworm) - symptoms are minimal. Dyspepsia, bloody diarrhea, constipation, flatulence, anemia are possible; with prolonged intoxication, developmental delays in children of primary preschool age are diagnosed.

Another worm in children is hymenolepiasis (the causative agent is rat tapeworm) and has no specific symptoms. A disorder of the digestive tract may appear - abdominal pain, nausea and vomiting, constipation followed by diarrhea, heartburn. The child has decreased appetite, headache, increased salivation, allergic manifestations, rhinitis of unknown etiology.

Worms in children - opisthorchiasis (pathogen - Siberian fluke, cat fluke) - enlarged lymph nodes, allergic rashes, changes in blood count (ESR and the number of eosinophils are increased, hemoglobin is decreased). Additionally – low-grade fever, catarrh of the upper respiratory tract, digestive disorders. Symptoms of gastritis, hepatitis, pancreatitis, and myocardial dystrophy appear.

Diphyllobothriasis (the causative agent is the broad tapeworm, transmitted through fish that has not undergone full culinary processing) - anemia, allergies, digestive disorders, pain in the epigastric region.

Toxocariasis (caused by Toxocara) – carriers of the disease are domestic animals that transmit helminth eggs to humans. Preschoolers who come into contact with cats and dogs most often develop toxocariasis. Symptoms – allergic cough, itching, facial swelling, fever, hepatosis, enlarged lymph nodes. Eye damage is common - keratitis, chorioretinitis, ophthalmitis, which can become irreversible.

Causes of worms in children

The main reason for the incidence of helminths is the widespread prevalence of parasite larvae and eggs in the child’s environment and non-compliance with personal hygiene rules. The method of spreading parasitic infection is fecal-oral. Helminth eggs are shed in the feces of infected people and animals.

After using the toilet, worm eggs may remain on the skin of the hands, under the nails or on the underwear. Most often, children become infected in places where large numbers of people gather (in kindergartens, schools, playgrounds). Infection occurs through sharing toys, sports equipment, etc.

In addition, the following reasons for the development of helminthic infestation are identified:

• consumption of poor-quality water and food contaminated with helminth eggs;
• use of other people's personal items (towels, linen);
• poor processing of vegetables and fruits;
• close contacts of the child with domestic and street animals.

The high incidence of helminthiasis infection in early childhood is due to the exploratory instinct of a small child. Until 2 years of age, the main form of cognition of the surrounding reality is oral. The kids are trying to get their teeth into all the subjects. That is why it is important for parents to pay special attention to the cleanliness of objects and things surrounding the child.

Causes

The baby’s curiosity is realized with his fingers; the child, exploring the world, actively touches everything that comes to his hand and immediately puts it into his mouth, tasting for strength and taste. Thus, pinworm eggs safely enter the digestive tract of their future small host. A child becomes infected with worm eggs from the surface of unwashed fruits or by drinking contaminated water. Very often, infection occurs when communicating with animals, or when playing in the ground, sandbox, where cats and dogs like to solve their physiological problems. After a walk, children often do not wash their hands, and all the dirt, along with parasitic eggs, ends up in their mouths.

Diagnosis of worms

If any symptoms indicate that your child may have worms, it is important to immediately go to the doctor.
Due to the nonspecific symptoms of helminthiasis, parents often turn to various specialists (pulmonologists, allergists, immunologists, etc.), suspecting serious illnesses in the child. However, the cause of the symptoms that arise can often lie in the body being damaged by parasites. That is why children with chronic dermatitis, gastroenterological pathologies and pulmonary diseases, frequent vulvovaginitis in girls, must be examined for the presence of helminths. Since helminths usually predominate in the intestines, in order to identify helminthic infestation, the patient is first referred for a stool examination. The analysis will help identify the presence of parasites in the child’s gastrointestinal tract, as well as determine the type of worm that has penetrated.

In addition, the following methods for diagnosing helminthiasis can be used:

• general blood analysis;
• radiography;
• Ultrasound;
• MRI;
• CT;
• endoscopy with biopsy.

The main task of diagnostic measures is to confirm the presence of helminths in the body, determine their type and exact location. In accordance with the research data obtained, doctors select the most appropriate treatment for a particular case.

Diagnostics

Diagnosis of worms in children is carried out in different ways - depending on what worms the child is infected with, the habitat, location of the eggs, and toxins found in the body will differ.

To make a diagnosis, the following may be prescribed:

• blood test - shows anemia, hemoglobin and eosinophil levels;
• analysis for parasites - in 99% of cases it helps to detect helminthiasis, and in most cases it helps to accurately determine the type (biomaterial for research - blood from a vein);
• examination of stool - there may not be eggs in the stool, even if there is an infection, to ensure the presence of worms, this diagnosis should be carried out 3 times, which takes time;
• smear - especially effective in case of pinworm infection, since their eggs are found just outside the anus;
• stool analysis for dysbacteriosis;
• if there is a suspicion of infection of internal organs, and not just the gastrointestinal tract - CT, X-ray, ultrasound.

Diagnostics allows you to accurately identify the type of parasite and prescribe specific treatment. The doctor prescribes medications, diet, additional supportive procedures, and gives recommendations for care and hygiene.

In some cases, parents pay increased attention to helminthiasis and are constantly worried about infecting their child. This leads to regular “preventive” courses of serious anthelmintic drugs, which do not bring any benefits to the baby’s body. If your child is not losing weight, feels well, eats well, has a healthy complexion, and does not have itching in the anal area, he is likely healthy. If you want to make sure of this, it is better to get tested than to take an unnecessary course.

Treatment of worms

Effective treatment of worms in children is aimed at combating parasites at all phases of development (at the egg, larvae and adult stages), eliminating the consequences of their vital activity, relieving unpleasant symptoms and restoring the child’s body. For this purpose, the patient is first selected to take antihelminthic drugs in the form of tablets, suppositories or suspensions. The products will help block the muscle and nervous system of parasites, followed by their removal from the body naturally (through feces).

In some cases, taking an anthelmintic drug alone is not enough. A comprehensive approach to the recovery process is required. For this purpose, the child is prescribed the following groups of drugs:

• Enterosorbents - for removing harmful toxic waste products of worms from the body.
• Probiotics – to restore intestinal microflora after helminthic infestation.
• Antihistamines - to prevent and eliminate allergic manifestations accompanying helminthiasis.
• Immunomodulators – to maintain the child’s body’s defenses.
• Glucocorticosteroids are indicated in severe forms of the disease to suppress the pathological immune response.

It should be noted that the condition for effective treatment of the disease is the simultaneous administration of therapy to all members of the child’s family (to prevent re-infection).

Folk remedies against worms

Admittedly, folk remedies are the most suitable for treating helminthic infestations in children; the symptoms recede quite quickly. However, before using them, you must definitely consult a doctor, because the child’s body is very vulnerable not only to the action of parasites, but also to the inept use of medicines, even folk ones. When preparing medications at home, it is difficult to maintain the correct recipe and dosage; at best, an incorrectly prepared drug can be simply useless, at worst, it can lead to poisoning or an allergic reaction. Here are the most popular folk anthelmintic remedies:

1. Garlic enema. Garlic is an antiseptic given to humans by nature; it is also applicable against worms. A glass of cow's milk is mixed with one head of chopped garlic, the mixture is boiled, then cooled and filtered through a double layer of gauze. At night, the child is given an enema from the milk received, a third of the received drug is taken for it, and the child is treated in this way for at least a week.
2. Chamomile decoction. Another natural antiseptic that is used to treat a wide variety of diseases. To prepare the decoction, take a tablespoon of dry chamomile herb and pour boiling water over it, leave until it cools, and give the child to drink throughout the day instead of water or tea. Duration of treatment is 5 days.
3. Onion remedy. Chop a small onion, add milk and boil the resulting mixture, then cool and filter. The resulting product is given to the baby for three days in a row, 100 ml.

Simple folk recipes that will help cure a child of worms, watch the video:

Complications (helminthic infestation)

It is important for parents to both understand in a timely manner that their child has symptoms of worms and to carefully follow all the doctor’s recommendations. Only in this case can unpleasant and even life-threatening complications be avoided:

• intestinal obstruction;
• jaundice caused by blockage of the bile ducts;
• pancreatitis;
• pustular skin lesions;
• appendicitis;
• acute pulmonary failure;
• eye damage, accompanied by decreased visual acuity and development of strabismus;
• damage to the intestinal wall, peritonitis;
• encephalitis, megingoencephalitis, etc.

Prevention of helminthiases

The main thing in preventing helminthiases in children is to develop their hygiene skills as early as possible. Specific prevention of helminthiasis for children is prescribed twice a year - in spring and autumn. Drugs with a wide spectrum of action are used.

Dear parents!
Remember that only a qualified pediatrician can make an accurate diagnosis, determine the causes and nature of the disease, and prescribe effective treatment. You can make an appointment with our specialists or call a doctor at home by calling 8-800-700-31-69 Grow up healthy and happy!

Prevention of worms

In order not to think about what to do if a child has worms, you must adhere to the following rules:

• Develop personal hygiene skills in your child as early as possible.
• Keep your child's hands clean.
• Drink only clean water.
• Wash fruits, vegetables and herbs thoroughly before eating them.
• Carry out the necessary heat treatment of meat and fish.
• Conduct timely vaccination and deworming of pets.

If parents suspect that their child has helminths, they should immediately consult a specialist. Doctors at the SM-Doctor clinic for children and adolescents will help quickly diagnose helminthiasis and prescribe appropriate treatment that will destroy the identified pathogens.

A modern view of the problem of helminthiasis in children and effective ways to solve it

According to the World Health Organization, of the 50 million people who die annually in the world, more than 16 million are caused by infectious and parasitic diseases. In the structure of infectious diseases, intestinal helminthiases are in third place. The World Bank estimates that the economic cost of intestinal helminthiases ranks fourth among all diseases and injuries. Given the importance of the control of parasitic diseases for many countries, the 54th World Health Assembly in 2001 approved a strategy for the control of soil helminthiasis until 2010 [5].

In the Russian Federation, more than 10 million people are examined annually for helminth infections, most of them are children. In 2002, 813 thousand infected were identified, of which 681 thousand (83.8%) were children under the age of 14 [4]. More than 15 types of helminths are found in children, of which the most common are enterobiasis, ascariasis, opisthorchiasis, diphyllobothriasis, trichocephalosis, and hymenolepiasis. In recent years, toxocariasis has been increasingly recorded, which is associated with the widespread introduction into practice of a diagnostic test system for its detection.

In the structure of helminthiasis, the leading place is occupied by enterobiasis (91%) and ascariasis (8%). Among all infected children, 92.3% of cases of enterobiasis, 71.1% of ascariasis, 61.5% of trichuriasis and 66.2% of toxocariasis occur.

The incidence of enterobiasis and ascariasis in children in rural areas is significantly higher than in cities, which is apparently due to different sanitary and hygienic conditions in child care institutions in the city and village, as well as the degree of contamination of the environment with helminth eggs (Fig. 5).

Ascariasis is one of the most common helminthiasis, in the formation of foci of which soil contamination with ascaris eggs is of primary importance. In 2002, 74,196 cases of ascariasis were identified, including 52,801 in children under 14 years of age; compared to 2001, the incidence increased by 3.5% and amounted to 217.7 per 100 thousand children.

The incidence of trichuriasis, with a clear downward trend over the last decade, in 2002 increased by 2.8% and amounted to 7.4 per 100 thousand children. Trichocephalosis is registered mainly in the Southern Federal District (Republic of Dagestan, Chechen Republic).

Enterobiasis still ranks first in terms of prevalence among other helminthiases. In 2002, 614,955 cases of the disease were registered among children, which amounted to 2535.5 per 100 thousand patients.

The maximum number of people infected with enterobiasis in 2002 was identified in the Siberian, Northwestern, Ural, Far Eastern, and Volga federal districts.

A feature of most helminthiasis is the chronic course of the disease, associated with the long-term presence of the pathogen in the body and repeated repeated infections. Helminth infections in children, as a rule, are accompanied by a variety of nonspecific clinical manifestations: weakness, fatigue, irritability, sleep disturbances, dyspeptic symptoms, slower growth and weight gain, and decreased immune status. The most important component of the pathology of helminth infections is the sensitizing effect of metabolic products and excretion of helminths, leading to the development of allergic reactions in the form of atopic dermatitis, asthmatic bronchitis, rhinitis, blepharitis, etc.

A selective analysis of the results of clinical examination of 520 children, carried out in the Sverdlovsk region of Perm in 2002, showed that ascariasis was detected in 1.35%, and enterobiasis in 5.8% of those examined. At the same time, on average, the number of health problems per child in children with enterobiasis in the group of preschoolers was 2.5, and in schoolchildren - 2.9. More often than others, diseases of the genitourinary system (in girls), allergic dermatitis, anemia, vegetative dystonia syndrome, neuropathic conditions and diseases of the gastrointestinal tract were noted. Of the diseases diagnosed in children with ascariasis, the most common were vegetative dystonia syndrome, functional diseases of the gastrointestinal tract, pneumonia, and allergic dermatitis. Among children with ascariasis, the incidence rate per child averaged 2.0. In the control group, which included children without parasitic diseases (37 people), the average number of health problems was significantly lower than among those infected with ascariasis and enterobiasis, and amounted to 0.2. Thus, the presence of ascariasis and enterobiasis leads to a deterioration in the general health of children. At the same time, children with various underlying diseases that lead to weakening of the body are more often infected with them.

Let us dwell in more detail on the importance of the most common helminthiasis in the development of pathology in children - ascariasis and enterobiasis [1, 3].

Ascariasis. The development of the causative agent of ascariasis (Fig. 2, 3) in the human body occurs with the migration of larvae emerging from the eggs along the bloodstream through the lungs; the larvae are then swallowed with sputum and develop into adults in the intestine. The lifespan of roundworm in the human body is several months. Ascariasis has a significant impact on the quality of nutrition and immunological mechanisms in children. Ascaris allergen is the most powerful of allergens of parasitic origin. It can cause reactions in the lungs, skin, conjunctiva, and gastrointestinal tract. Allergic reactions can be so severe that they often pose a threat to the child’s life.

The immunosuppressive effect of roundworms is due to the lack of effect of vaccination and revaccination against measles, diphtheria, tetanus, and polioviruses in children.

The leading mechanisms of pathogenesis of the migratory stage of ascariasis are the traumatic effect of larvae and sensitization by parasitic antigens. In this case, 2 main types of lesions occur in different organs and tissues.

• The traumatic effect of migrating larvae in organs and tissues along the migration route. At the beginning of migration, the larvae are still small (no more than 0.5 mm long) and cause limited hemorrhages in the wall of the small intestine and in the liver. By the end of migration, the larvae reach 2 mm in size and, penetrating into the alveoli and bronchioles, and then into the bronchi, cause more significant hemorrhages.
• Eosinophilic inflammation of the tissues in which the larvae develop. The tissue phase of ascariasis occurs during the migration of ascaris larvae to the liver and lungs. The metabolites released in this process cause serious immunological changes and inflammatory reactions. In the migration phase, ascariasis can cause hepatomegaly and asthmatic syndrome. In this case, the clinical picture resembles respiratory allergosis.

In the intestinal phase of ascariasis, important pathogenetic factors are the ability of roundworms, reaching a length of 20–40 cm, to spiral forward movements and the desire to penetrate small openings (Vater's nipple, drainage tubes, etc.). The presence of invasion leads to hypertrophy of the muscular layers of the intestinal wall, a decrease in the depth of the crypts, changes in the chemical composition of the intestinal contents, and disruption of the motor-secretory function of the stomach and intestines. Roundworms secrete inhibitors of trypsin and chemotrypsin, as a result of which the absorption of nutrients, proteins, and fats worsens. With ascariasis, functional deficiency of pyridoxine develops, the level of retinol and ascorbic acid decreases, and lactase tolerance decreases. Ascariasis is usually accompanied by intestinal dysbiosis.

Often symptoms of the intestinal phase of ascariasis are nausea, vomiting, diarrhea, fatigue, dizziness, poor sleep, and abdominal pain. An increased level of eosinophils in the peripheral bloodstream is characteristic of the migratory phase of ascariasis.

Complications of the intestinal phase of ascariasis: intestinal obstruction caused by a ball of adult roundworms; peritonitis due to perforation of the intestinal wall or penetration of roundworms into the abdominal cavity through a surgical suture; obstructive jaundice during migration of helminths into the common bile duct; blockage of the pancreatic ducts; asphyxia due to the migration of roundworms into the upper respiratory tract.

Enterobiasis. The development of the enterobiasis pathogen (Fig. 1) in the human body occurs within the gastrointestinal tract. The larvae emerge from the eggs (Fig. 4) and, on average, develop into adults within 2 weeks, which parasitize the lower parts of the small intestine and the upper parts of the large intestine. The lifespan of pinworms can reach 100 days, and the state of infestation in children due to repeated infections can last much longer.

Inflammatory reactions during enterobiasis develop under the influence of larvae, which produce hyaluronidase, proteolytic enzymes, lectin-like substances that promote the activation of the complement system, the release of prostaglandins by the cells of the host tissues surrounding the helminth [1, 2, 3].

With enterobiasis, the processes of absorption and digestion of food products are disrupted. In 30–40% of infected people, the acidity of gastric juice decreases, up to anacidosis and inhibition of pepsin-forming function. In most children, the intestinal microbiocenosis changes. Impaired absorption and digestion of nutrients in the intestines lead to weight loss and delay the growth and development of the child.

An additional factor in the pathogenesis of enterobiasis is the mechanical effect of pinworms in the intestines, leading to pinpoint hemorrhages, erosions, and penetration of bacterial flora, in particular pathogens of intestinal infections.

A striking symptom of enterobiasis is perianal itching, which occurs when the female moves during oviposition (Fig. 6). Severe itching occurs, as a rule, during sleep, more often at night, from 23.00 to 1.00 am. It is at this time that helminths can, remaining unnoticed, lay eggs that will mature to the invasive, contagious stage by the morning. Despite its apparent harmlessness, perianal itching is difficult for children to tolerate and can persist for quite a long time after enterobiasis is cured as a result of the formation of a persistent focus of excitation in the cerebral cortex. Complications that arise as a result of perianal itching are skin damage when scratching, perianal pruritis, eczema, weeping dermatitis. The etiological agent of the inflammatory process is most often streptococci.

Abdominal pain is a common symptom of enterobiasis. Pain of a transient nature is observed in the majority of infected people. Sometimes acute abdominal pain may be the reason to seek surgical help. In such cases, it is often not possible to detect a specific pathology; only the accumulation of gases is detected.

In recent years, the number of cases of the formation of perianal granulomas or abscesses in children, inside which female pinworms or helminth eggs were found, has increased. In this regard, it is advisable to screen all children with these conditions for enterobiasis.

In many cases, enterobiasis occurs over a long period of time and is repeated many times. As a result, the intestinal biocenosis is disrupted and the antagonistic properties of the intestinal microflora in relation to pathogens of acute intestinal infections are reduced. In the majority of infected children, the number of E. coli decreases and the proportion of lactonegative intestinal flora increases. The activity of enterokinase and alkaline phosphatase in feces increases. Since the intestinal microflora is one of the factors that supports the activity of intestinal enzymes, disturbances in the processes of digestion and absorption of nutrients that develop as a result of enterobiasis lead to loss of body weight and retard the growth and development of the child. Pinworms have a mechanical effect on the intestinal mucosa, which leads to pinpoint hemorrhages, erosions, and penetration of bacterial flora, in particular pathogens of intestinal infections. The antagonistic properties of the flora in relation to the causative agents of typhoid fever and other intestinal infections are reduced [1, 3].

If pinworms migrate into the abdominal cavity, urinary and genital tracts, inflammatory and allergic reactions outside the intestine may develop.

One of the common complications of enterobiasis is vulvovaginitis due to the penetration of pinworms into the genital tract and the addition of bacterial infections. If vulvovaginitis develops in a girl, a parasitological examination for enterobiasis should be prescribed and, if the result is positive, this invasion should be treated with simultaneous bacteriological examination and, if necessary, antibacterial therapy.

Against the background of enterobiasis, children often develop urinary tract infections, especially girls, since enterobiasis is a factor predisposing to the development of this complication.

Parasitism by pinworms in children leads to suppression of nonspecific immunity, manifested by a decrease in the level of interferon a in the blood serum. A decrease in the nonspecific resistance of the child’s body leads to an increase in the incidence of viral and bacterial infections.

The presence of enterobiasis leads to a decrease in the effectiveness of preventive vaccinations. The immune layer against diphtheria was initially lower among children infected with pinworms. Protective immunity does not develop during primary vaccination against this dangerous infection, and during revaccination in many cases there is no immune response. It is difficult to develop immunity when vaccinated against measles and tetanus, so to increase the effectiveness of vaccinations, you first need to make sure that the child’s body is free from helminthiasis pathogens.

In children with allergic diseases, enterobiasis develops much more often. Due to the relatively high probability of detecting enterobiasis in children with allergic diseases, patients in this group should be recommended to be examined for enterobiasis and deworming if infestation is detected.

Enterobiasis negatively affects the neuropsychic development of children. This invasion leads to a lag behind the corresponding age norms. Among those infected with enterobiasis, there is a high percentage of irritable children, with a disruption in the process of falling asleep, and with negative habits (biting nails, sucking fingers, etc.).

With enterobiasis in children, the level of copper, zinc and magnesium in the blood decreases significantly. Since the lack of these microelements can negatively affect the physical and mental development of children, their loss should be compensated by introducing certain foods into the child’s diet, prescribing medications (or nutritional supplements) until these indicators are normalized after enterobiasis is cured.

Main indications for examination for helminth infections:

• stomach ache;
• frequent nausea, vomiting;
• diseases of the gastrointestinal tract;
• fatigue, irritability, restless sleep, grinding teeth in sleep;
• allergic conditions;
• perianal itching (enterobiasis);
• vulvovaginitis (enterobiasis);
• urinary tract infections (enterobiasis);
• increased level of eosinophils in the blood;
• retardation in height, weight;
• untidiness.

The diagnosis of enterobiasis and ascariasis is made only upon receipt of positive results from a laboratory parasitological examination of the patient. If enterobiasis is suspected, a perianal scraping (imprint) is examined, and fecal samples are examined for ascariasis. On the laboratory referral form, you should indicate what kind of helminthiasis the doctor suspects in the child. The choice of the most effective research method by laboratory specialists will depend on this.

Treatment of ascariasis and enterobiasis

The search for remedies for the treatment of helminthiases, including enterobiasis and ascariasis, began many centuries ago. To expel pinworms, Ibn Sina recommended taking elecampane and celandine with sugar, washing them down with water. The medicine for expelling worms (“killing worms”), indicated in the Ebers Papyrus, contains, among other components, date seeds and the plant disart, sweet beer. The Salerno Health Code, which dates back to the early 16th century, recommends another remedy: mint [3].

The modern arsenal of drugs used to treat intestinal helminthiases includes a significant number of drugs of various chemical classes. They are used both in clinical practice for the treatment of identified patients or parasite carriers, and for the purpose of mass prevention.

The Russian pharmaceutical market currently offers several anthelmintic drugs that act on the causative agents of ascariasis and enterobiasis (Table 1).

The most effective drugs for the treatment of enterobiasis and ascariasis are derivatives of carbamate benzimidazole (mebendazole, medamine) and tetrahydropyrimidine (pyrantel). In addition to the ability to influence mature forms of helminths, they are distinguished by high ovicidal and larvicidal activity. Drugs of these pharmacotherapeutic groups disrupt oxidative processes, inhibit glucose transport in helminths, act on the muscles of intestinal nematodes by depolarizing their neuromuscular junctions and block the action of cholinesterase.

The effectiveness of medicines used to treat enterobiasis and ascariasis is very high, the method of administration is very simple and is designed primarily for children. It is very important that as a result of their intake, the process of releasing the pathogen into the environment is not activated. Thus, during treatment the person does not become more dangerous to others. However, pinworm eggs that have already entered the environment, in particular indoors, persist for a long time - more than 2 weeks. Therefore, it is recommended to repeat the treatment of enterobiasis after 2-3 weeks at the same dose in case hygienic measures were not effective enough. For the same reason, simultaneously with the treatment of infested people, everything possible must be done to clear the premises of pathogens.

For many years, pyrantel has been used throughout the world to treat ascariasis and enterobiasis, and has gained popularity among pediatricians and patients. According to recommendations developed in the USA (Medical Letter, 2002), pyrantel is considered a first-line drug for the treatment of enterobiasis in children and adults.

The anthelmintic effect of pyrantel pamoate is associated with a stimulating effect on the H-cholinergic receptors of the ganglion synapses of helminths, leading to spastic paralysis and their subsequent expulsion from the human body. Clinical trials of the effectiveness and tolerability of pyrantel showed its high medicinal activity against enterobiasis and ascariasis - 94-100%, as well as good tolerability [1, 3].

Pyrantel for the treatment of enterobiasis is prescribed at a rate of 10 mg/kg per day once during or after meals. For the treatment of ascariasis, pyrantel is prescribed at a dose of 5 mg/kg once. The drug is well tolerated by children; in some cases, nausea, vomiting, diarrhea, abdominal pain may develop; very rarely, a transient increase in the activity of liver transaminases, headache, dizziness, and sleep disturbances may occur. Pyrantel is contraindicated in children with liver disease.

We have extensive experience in treating enterobiasis in children with the drug Pyrantel (tablets, suspension). Pyrantel is well known on the world market of anthelmintic drugs and is widely used for the treatment of enterobiasis in Russia by many generations of doctors. In our opinion, this drug has a number of advantages compared to other anthelmintic drugs. Firstly, the drug in the form of a suspension is easy to give to children, secondly, Pyrantel has a pleasant peach taste, as a result of which the child does not experience negative emotions during treatment, and, finally, thirdly, Pyrantel has a reasonable price and is widely sold in pharmacies. The bottle is equipped with a measuring spoon with a division scale of 2.5 and 5.0 ml, which makes it easy to dose the drug depending on the body weight of the infected child (or adult). Pyrantel suspension can be used in children from 6 months of age.

Along with pyrantel, mebendazole and medamine have a good anthelmintic effect against enterobiasis and ascariasis.

Mebendazole (Vermox) for the treatment of enterobiasis is prescribed to children 2–5 years old at the rate of 5 mg/kg per day, over 5 years old - 100 mg per day. For the treatment of ascariasis in children 2–5 years of age, the drug is prescribed at a dose of 5 mg/kg in 2 doses per day for 3 days; for children over 5 years of age, mebendazole is prescribed at a dose of 10 mg/kg per day in 2 doses for 3 days.

Mebendazole is not recommended for use in the first trimester of pregnancy. It must be remembered that the drug is contraindicated in children under 2 years of age. Side effects of mebendazole include abdominal pain and loose stools.

Medamine (2-medoxycarbanylamino-benzimidazole) is close in chemical structure and spectrum of anthelmintic action to mebendazole. For the treatment of enterobiasis, it is prescribed at a dose of 10 mg/kg per day in 2-3 doses (simultaneous administration is also possible) after eating a small amount of food; it is recommended to chew the tablets and wash them down with water. For the treatment of ascariasis, medamine is prescribed in the same doses for 3 days.

Side effects of medamine include nausea and weakness. In case of allergic manifestations, the drug is discontinued. Medamin is contraindicated in the first trimester of pregnancy.

To restore the microbiocenosis of the colon in patients with intestinal nematodes, including enterobiasis and ascariasis, and to increase the effectiveness of specific therapy, it is recommended to prescribe bificol, milk bifidum-bacterin. Food products and medicinal plants that can be used for the treatment and prevention of enterobiasis have long been known. Carrots and carrot juice have a good anthelmintic effect. You can also use the anthelmintic activity of walnuts, wild strawberries, pomegranate (especially pomegranate juice), garlic and lovage.

Among the medicinal plants, St. John's wort is used in the form of decoctions and infusions, tea, as well as elecampane (Inula helenicum). The effectiveness of herbal medicine for enterobiasis is low, but the introduction of foods with anthelmintic effects into the diet is a good measure for the prevention of enterobiasis and enhances the effect of medications prescribed by a doctor.

The criteria for the effectiveness of treatment of helminthiases are a negative result of a control parasitological study of fecal samples (for ascariasis) and a perianal scraping or print (for enterobiasis), as well as the disappearance of clinical symptoms of invasion.

Prevention of helminthiases

Features of the prevention of helminthiases depend on the characteristics of their epidemiology. With enterobiasis and ascariasis, the only source of infection is humans. Infection occurs when mature infective helminth eggs are ingested. However, the epidemiology of these helminthiases is otherwise very different. Pinworm eggs mature indoors and on the human body within a few hours and last on average up to 1 month on various household items. Ascaris eggs mature when dropped into the soil within several months and remain there for up to 10 years or more. Enterobiasis is transmitted indoors from one person to another mainly through dirty hands, bed and underwear, toys, dishes and other household items contaminated with pinworm eggs.

A person becomes infected with ascariasis by ingesting soil particles containing invasive roundworm eggs (with unwashed vegetables, herbs, and fruits). The risk of infection (in the case of ascariasis) increases if a child has such a bad habit as geophagy (tasting or eating earth, sand, clay), which occurs quite often (in 3-10% of children under 7 years of age).

Prevention of enterobiasis and ascariasis is the most important task of medical and educational institutions and parents. It can be solved by simultaneously implementing a set of measures, the main components of which are the identification and treatment of infected people and sanitary and hygienic measures. Prevention of ascariasis, enterobiasis and other helminth infections in the Russian Federation is regulated by new sanitary standards and rules approved by the Ministry of Health of the Russian Federation in 2003.

For questions regarding literature, please contact the editor.

T. I. Avdyukhina, Candidate of Medical Sciences, Associate Professor T. N. Konstantinova, Candidate of Medical Sciences, Associate Professor M. N. Prokosheva RMAPO, Moscow Children's Clinical Hospital named after. P. I. Pichugina, Perm

Preventive actions

Preventing worms in children is a simple matter and does not require any special knowledge. Parents just have to follow some rules:

• before each meal, the child should wash his hands thoroughly with soap and hot water;
• Nail cutting should be done regularly;
• A small child needs to change his underwear regularly, preventing it from getting too dirty;
• in rooms where children most often play, it is necessary to regularly do wet cleaning;
• It is extremely undesirable to have a pet in the house/apartment while the child is small;
• Once a year, the whole family should take prophylactic antihelminthic medications, but only after consulting a doctor.

Worms in children are a rather unpleasant fact that you can get rid of quickly and without any problems. Parents only need to pay attention in time to the deterioration of the child’s health and seek qualified medical help, and not self-medicate.

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