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    39 views35 pages

    Helmintiazele Catedra PDF

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    Надежда Герман

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    © All Rights Reserved
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    = ay \ MINISTERUL SANATATI AL REPUBLICII MOLDOVA ih UNIVERSITATEA DE STAT DE MEDICINA $I FARMACIE | NICOLAE TESTEMITANU Catedra boli infectioase Catedra boli infectioase de perfectionare a medicilor 1 | 3 PATOGENIA, TABLOUL CLINIC, . DIAGNOSTICUL SI TRATAMENTUL - | ., HELMINTIAZELOR = Ly age, eR i Ghid practic pentru studenti si rezidenti 23 per aia a | < e , v " * Chisindu + ; 2001 E ee ‘ * Pe Bl A (caU: 616. 34-008.895.1 de Cont metic etal al USMF “Bente Testemiany ou 1 in 20102000 ‘Autori: C Andriuta, V.PAntea, T.Holban, Rodica Galed, AAndrijd, Gh Placintd, A.Panasiue Recenzent Galina Rusu ~ sof al eatedrei boli infectioase la copii « USMF Nicolae Testemijanu, doctor in medicin’, confe- ‘enfiar universitar; Petra Tarovoi ~ gf al lboratorului Epidemiologia hepatitelor vi- fale Ia Central National Stintfico-Practic de Medicina Preventivi, doctor habilitat in me ind, cercetitorstinjfic superior, Om Emerita Republicii Moldova, Redactor stiinjifie: Constantin Andriust— doctor babilitat in me- dicing, profesor universitar Redactor: Lidia Cassa Corector: Aurelia Siratan Machetare computerizath: Tatiana Pendus (© CEP Medicina a USMF, 2001 ISBN 9975-945-91-0 © C.Andriuts, V Pantea, 2001 Se INTRODUCERE, __ in programele de studi pent prepiira stdenior resident indomeaiul patolopa infecpease sunt nluse de asemenca boil parazi- tare, dine eate un compartment aparts, poate 1 mai veluminos, i e- vine helmintiazelor.Acestea sunt rapandite pe tot pobul pamantese, 0 ‘arte dn ele Inlnindu-se destul de frecvent si in Republica Moldova CConcomitent patologia in cauzi nu este chueidat in manualele de boli Infectioase editate mn ultimi ania Rominia (MVoiculescu, 1990, M.Chiotan, 1998; Rebedea, 2000), arin manuael pubicte in Rusia este deserisi fragmenta gi suecint (E Suvaloy, 1990, 1995), In legatura cu cele menponate a fost aletuit acest gid practic me- nit 8 acopere acest gol informational-didactic gs contribute lao pre- ‘tire mal buns a vitorilor medi la fnsareafacula gla stuicrea ‘ai ampla a patologie infectioase in rezidenfiat cu difert profil ‘Ghidal practic clade deseneres mai detaliat a patogenia, blow linc, diagnosticului gi watamentul diferitelorhelmintaze,inelusv a ‘eor care se intlnes in Republica Moldova. La elaborare aia tnut cont de dificult diagnostcului si tatamentlu dfentclor belmintaze, find insuficient elucidate tn literatura didactica, precum gi de dele bibligrafice recente, de expeienaautonlor acumlata in acest dome Pe parcursul a mai multor ani ‘Actualul ghd practic este adresat studenfilor din ani V-VI del di- verse facut de medicind,rezdenpilor de diverse specalti,tinelor ‘medic nfecioniga, de familie, internist, laboran,paraitlog,epde- miologi et. | CARACTERISTICA GENERALA A HELMINTIAZELOR 51 1M. PACTUL LOR ASUPRA SANATATH ORGANISMULUT UMAN, Helmintiazele epezint un grap de maladi provocate deni Delhi (re. helms, helmuntos~verms para). ~~ Actalmente sunt destise este 250 speci de elmingi care pot ataca pssnana mand prvocind diver incomodiiin side. To blag ‘in functie de sructura lor biologics se divizear in urmatoarele cate, Next {94a iting cinch ten, Cesoide heli informa pari} Trematoda (cimin} pla). Clasa Nematoda include parazii care proved, ‘umaioarlebeiminiave: ascaridaza, enterebioa,trichocelalora, acess smazee srongibidaa, ichineaza (vichinora).Inclasa Cestoidea se tuning paraii ce provoactteniaza tenarinchova, himenolepidora,diflebotions ‘hinoccna , Din casa Tremutoda fa pare parazifi ee provoae maladie fasciolora, opistorchora,clonorchova, metagonimiaza, aragonimiaa ee, ‘Demenjonat cin Republica Moldova se inegistreaza cca 14-16 speci ‘beim ~provcator de helmitiaze. intr le mai freovent sunt spine ‘extrobina, ascaridior,trichoefatoza,himenclpidora, elle find nic ‘mult mai rr Heminfica salt para, uncle ctape din cil de dezoltare le perce {nrganisiml emul savalanimalalui, Organismal incare parsitez&heimin- ‘ul se mai numese organismal gad ‘Conform particulariijilorbiologice ale ciclului de dezvoltare helmintit ‘s¢ mai subivizzar in peohelming (cell vital al cora efncepein medinl ‘mbiant, ma froovent insole fnlizeaz intra organism pai sibioel- ‘mini (dezoltareacAroraare loc mmai in organism vi, vind ncesttea de ‘a schimba doud sau mai multe garde pentru finaliarea cil vital) ‘Uniihelmint(Oxyursgi#ymenolepis nana), pentru dezvoltareacrora ‘mu ¢ bligatorie flaea in so, transmigandu-se pe eale de contact intm sb prin autoinvazie, secasfcd in grup helmintazelor de contact, (Organismul vi, in care biohe!mintu tinge maturitatea se mai mumest© ‘gd defnitiva sam final iar in care parazitl se dezvoltd pan la stadil de larvé ~ gazdé intermediari. Larvele unor helmingi Diphylobotrium lat, Opistorchisfelineus, Clonorchis sinensis ete) ting stadulinvaciv numai 8 4 te parai —_ sina treilea = tena sete ial le onan —padsnermatir sie De rea, neracne in ‘ata Tn ane de ra de ‘Sebaivzareaermilor paar in genelmin biotin mae ile provost de ci~inpebelmitaze gt tohrnustar ee fess os lasifichi epiemiolgice, acre se mak alii gop earl de Gohelminiazleincadurmitore mala aaron, chess, ssrongicidora,anchlesomiaele ete In grpal tichcantanlx ant eoe torcom,fsciolra,cchinococe, china tna enue i ‘waza. Gropu elminiazelr de cotati tevin enbira ss oars ‘sihimenolepidora (ab. Clasitcare epidemilgt eatnor Ta | Eb Aecemact” | iments Soe ae ics ae now ee pnt ae dezveltare i MUNDAS ee moni up re Sel cl ade pra vst FF PS s are necbegnuit S20 SOP sracteris sniru indivizii maturi, aca hci aps il aie a lt tig seme ea Sines tan ana Semen te ae em ecco ea oo nage rt espn ote int ee eal oreo gL cee es mes mi Se ee ane al = - Fede ni eens vt mie inget doen re nae Dane sree ee lca sea ae ane tance eee aimee ala Tn eS pa wee a degen oa er cease pect Se andra aetna any eaten ina. eave abee tenn omoprasten aye {rsa repli neuroumorale; prin ajunea toxialergciasecretelor st excrex See re feos emp eerie eigen in UineLamaapecpacracs scam ooo Sonora pad een il evotutici helmintiazelor depinde mult de intensitatea invaziei, ahayanice mdse cca teioe tim Soe pace cabo Sneo ec noes ef eta sin nds gata peacoat 8a amas biologice. Spre exempiu, larvele unor helraingi ‘(Ancylostoma duodenale, - ; Strongyloides stercoralis Sehistosona wenn te) fn moment inf Innate mcrae anele de menolp tana, senolnds mass si apace a sin Inporan( ot in Poona tlm cum a exhnocoor. ewcocnea surat pesiea mera ane! resco apr {conocer fate cect a erga filer ar wen Sindhnciuornorveine Deoxempla ample cis deuce Soe sreweoe hil Ropatva conduc oar meas Mai tl pri intestinal In proce de sate migae tomes ere imei, codcnd la vee deep funionals parila pocsor slog Un stip brs tena saa carat organo, aceasta avin rm desl de ave, nel cava chiar orale Ase ascandle mat user aco por roca dort otra nesta, cbr clr Iie ce eel ilrs mane. Uneot asa, mein nce ‘epi prvect afin, eae pate candace la inaicmesand iain prodssorcimnae de para asupra tein serves le per ftna man pat provera devel ‘Amsoale le wai diet elmintazsle pot proves drei evident ale schinbuli de sb- ste Antes ceeded Consus mare part in abil rive mer en menpnereaorsismalu nan mate deolure cop nce tere conden adel dehirana Prin aceasta se dela ipvitaminors By inifleboae,aposaminars Ain ascanion hipaa coe al diamine in gopl Btn himenlepdot ce ‘Derelaea metabolism protein elnintaze et cazat in primal ‘nd de ulvatea spond a protenlr deere paar in creer inal dea~ de irra asstor wane prin net unan festa. Teo {ies soc orpninal un, indonh aft n creer epi {ndejans prone, vitamin, ae substan, conduc la soperea este ey te later dial de state ingrantapalcin vee hemi se made activa incl cecalizew meabolsnal potcoer alison arin ales eer ‘etubolismal hormonal Anemia ee o consi feevent ma es ant chilesoniazs,wicbalor, ilebtirs ce inertial pirundeiindlungat a antgenelr inform deserts excrete praia, precum sia produseor de descompunere or, aloe {nstrtea imuniogc a organismal unan, Sense eran aman de ancgei praia contrib Ig modiiearea cracls eahilor de ispns, a iitarea antigenic 7 ci mong ininiripra onh ay ce pa at ge lsc ose PODS In on Se ann gc i ool rk sane 1 htp ec art ee ap rset arr Smpomele ees ma cee pairing Se eon cin fay et Ce escort oe, re er preainirad roc pee es recat cons Sos pen car Cae een earn ascel Se tpl ems oene ein de a a ur ios negara eam ot a Sirs epe yoo = ants teacup a (a he cana opener i a CORE ovine el ee oe pet Seatac gota wemeecocenae Stitt coeenie pag nr as ne Po, ‘Sialbatctvonipanal carve sar Bara crete na mide cra epetiarems proicaa aesticheotefosese deere SE deenlelite sesittnntnes oee Schl inas Cars mates pn eal tne pnd er a enue si eee, Tisai ren copter vera ale prt ‘ae Lapis cope pr rove pane cd pets ir ihn pee ara ‘Dagmeicu bmi Ce cea tr msc cin opt cigar ted ere pn ‘not pin mae roo eagle mmo st cmon ite ane tianmatefepcnopes ise a iain nase de car rl pcp sabves dagen es Itimenies tors Cae dana oes txt ona nts retrace maa ‘in mcs vinta ome te ; A. Nematodozele + 1. Anearidions Din grup nenatdozlr a gentlaniazlr ne pare sazaroca opraioc desl espn pe pol pnts, inch in Repub us! Moidova. Conform disor de matiich ofa in Repuea Mabon ‘a nregisvat nal 1996 10718 ea de scariest 1997 ~ 106 sal 199810752 inal 1999 = mama UR ‘Avaiioa eto elmunins pero al event de rst As cans lunicaies eager cra dest tans nom pens net, ‘Giacerindose cline pin ou pain expiat a pore ee {area sistmclor digest pulmonar, cardovascalr, eves ‘rologia. Prantl sca bcos eran rope nemsacor ‘iment ajre. Corl scan ae form ina rou an {at cu extremitiiemaaszpie, nd de caleaeersan alb-galue Grest- se corp variaz ne 3-6 mm, lnginea re 0-45 ema feel 12-25 amas Util ied de feel ind mai cu saving part salt mal ncovoit in orm de cig Pe are aneriara sarees mpl caiatea Dal cu 3 bunigpare cele ictal de decvotreAscardle ature eel § ase praia, de cbie, nines abyreal ome Mai pot user gai localan excl mal dept sal ‘Dexarceaugarele de ascarid posal octal grouse conn 20 5 stat, se pstrear mai mult imp in sl pp fac, legume "amd inavve pa an in condi chimeric bene #1223 PC. ‘umiitaten mai mare de 8%) la eujarele de ascarid incepe a se deco ‘ronal La temperatura de 24, #30°C aprile pris stadia din ‘ugorl de ascarid are en 12-18 ile, ara temperatura ous acest proces dca pnt I teva lus, Larva din ogo poate transforma in 9 a ambi pin a tad spa ptr Marina spas torn rai err a pT ‘inate la ori coe em rc crac) ae et ee eave eres a STE Sat deli gos nto ree es nd i sn eae sings venos mec seated parr pnts pan pare Sat a caper er meesenane nes Fa eats amet estan vaso miei ci a prereset as, rag mea nd ing ala pnd 8 tsi Si deere ole matin, Daa Se A mc conse 15 cn gene de eae “apunerenougoarclr de ce fere= feaidei bm momentlinvaze pi " mia pri ascadelr mature in inestinol ia eg 10-1 sa ‘eer apt aml a "euler "ascaridiaza este rispAnditA mai larg in zonele tropicale, cee ra de pet oust 8 erp scat eosin mare suse de cond Gen sn fap portant prs dvi leer Setar at esac serves oma infest cae clint 2 m= a a ature deta, Meco nesta i a oo de tansmieresacandirs pt fee. eee en pete mente, male mura joie, vel for ap ae dee de uecanne inet cial atria ae popula instarea onus mile pn nme rodseoralimentare e care nial e molipssc sufers de ascarid copii, ucrtoide a sisteme de canal area ape, persoanee cate se ocup cu ingrsaca slu- Je aferene dela domietin sau vie cu materi fecale umane. [8 Inowderat ascaridioza mai recvet Se incepisteazA in hnile © 1 intestinal i refeaun apo! pate zonele cnely primavardfagh tcamnd ale amu ‘Patol. Patogenia ascardiozi in fazee migratare intestinal este de migrate lavelor paraztare se determina o sensibilizare@ ‘reanisiauieupredusele metabolie gi de descompunerealarvelor moarté ‘Aergniascaridelor se refer a gropl calor mai pueric alergeniparazta {faca menjonat se dervolts att reach generale de hipersensiilzar, cit 0 focalecn apaitiainfitratslor covtnaiicenpulmoni,paeumoniler ais hepatic granvlometase, erupircutanate,covinohit in sangcle peer I periculoast 9 aelsunes foxsedasupa ofganismulu uma alavelor = “nearde nt cuseam Tn peronds de napa or Inc de invarie mas sre itnportan( traits mecanicalpereior intestinal, vase san Sine, eatin cu sean al polmonior de che Tarelemratore de 7 nh mail intestinal aszardiore! tor alerpic contin st exert o ‘raat ane ine mai pug exprmi, Apariasemncor chinice in ascari- Giosa intestinal in mare msde Iga de acinneatosich a produseior clminate de pari maar deaserenc yd absorb proascor ut descompuneri ascaridelor moar, fn baza derepnilrfuncii ‘soins papa och intestinae spstie sea de regu. m= Ennismel reletonce.Aceste mecanisine oa un rol important de asemenca fn ocuni eturatva ntestinalh enzata de un ghem yoluminos de ascande, ‘Accanidele maturiatetroumearA mecanic pereilntstnul pind la perforate lo Compleat imprevible poate provaca pitrunderea ascariet Inala, feat pancreas, le respirations alt orzane. De ‘mentonat ch seaidele influenza egatyasupra metabolism vitamin Conduind la delta pndoxins, retinlul sa acidulutascorbic. Toca ‘Sscariigraexect8 oaetune nega asypra evolu ieitelor mala alt Infections ot si neinfectease, a ultimul tip s© depisearA 3 nfuenta ‘munosupresivta ageaidelorasupra organismal man “abloul clink. Semnele cliese ale faeiprococe de migrate aascandelor sunt condijionate de modificrilealerpce ale organismulus uman, Ele ptf esto de variate, inh mas frevent acest stadia decurge asimptomati, sbclinic ‘Sau frst in frmele manifeste mai exprimate chiar din prima stpehnind 9 ‘maladiel par asemenea simptome ca sabicuni generale, molegeal,orans- Pitoie mai sbundenta,cefale peiodica,oboseal8,Pacientul devine nerves. Se micgoreaca expactaea de munca, In unelecazur se rdic temperatora pin la 38-40°C, aparfriscane, misigi, ara. Lao parte din bolo aes {avd de bool decurge pe fundtul une temperatugsubfebrile.Inunele cazurt {aca precoce de ascardiorA poate evoTuacuoerupieabundenasemindtoare urticaria care acoperd 10 corpl pacientul, ind Tsogitd de un prait utara puternic. Sunt earacteisice de asemenca simptomele de afclare & pulmonilor La bolnav pare tusea uscatl mai fecvent cy caracterastmatic, nai rar ou spud sangvinolent. Pactenil acu dspnce si dure i piel ‘Auseafaiy in cutis foracicd se determina diferiteraluri umede. uns © pleoezie, Mat rar peureia are un caracer exsudaty, ins cao volo beni. Jnexsudat se determin eritrcite, e2inafile iar uneor slave de ascarid. 1 dologsn plea se depsez4 malpeinitatemigratare ef. ee aconliguate i dmendn scien ese, ee cre dps peste 3-5 nex apie epetat cst oar ae tee pian aperind d-an baptid natal, lee esac plonare srt inne deo coziode in single penteic ear ‘mcr post tinge 650%. avaanprevce a ascaridoesl wna: 5 simptome de rele 2 uote apart cartovsclr ca tabicarda hiptona Tn bol in inp mse areor rin leat cle iia apr” arin ord cs ge, un cont in abate eon se meen {of ate ing spot, ipeermentens Sin ry in lan daca Sarge vari dein, cu singtoms si cxpnute rv asitomate Ia majorite caren ‘acne asad mena ober o soci ine snare Poise fasteners. ‘Sno tensa sw carcterinacdprin devalue pte de min car sth vor slr, ert Inabomen, neo pence sb orm ‘Seabee apr de sine tt sa lappa Lau bela ema te ‘tuna recs conpat seme de ener sau eneocoa nsi setae insintomal asec sinnes asmenea snptome ca sbicune = seal vege soma cbse ele vertu, mire capac ‘ua plnde esenterim. Sont posi at lealc. ‘Mature cisteror area p lun, An form lips cudmerstune 10-20 5-10 mm In petra mir patie uh imo are aconea mca aso eu acta, deol rows inflating, acne oxi aegil a produsor vile ‘nesta practi aspaoganismaa bla ‘ean pods de lanl slum sunt nant desl nt sesablgidemmantacsers Deostemal mt estcre at a Fear rst selitan, Seon cata cn exh mi c= ‘esi a ibn fend setantaus special 8% rb es cel pon unl in ret a nals organ 56 Inurl stcraorsformens cap dines conjunc sede ‘Wien recived ip insamaten degenerates Insistemol neroscentalavele se potocaliza unde in masa ceebala sin kptomeninge, dar ca mai fecvenalocalzareest cca conan, split pein gianbupa vascular. Sabana cence mu rent fo tat doit cn ab, Localizaren ventocalar atl 19% on eau vind manifest clic pronuate Maduva lvl sale Sut mat at Dosate. Lozalizaren cour este aprons eal xa cerebral, Cisticent localiza in pail subrachoidan ating angen de 1S cm, vind manos plugin ind bine tolerate gard, povocand muna © ‘eactitslrs mera nshinb layele moar decane wn spas ‘amar pron expriat pin rer muscular. br, cozinothe Tabloul linc incieiceor ext ore vara dela a aca depinde olocaliarspuranif,ntensiatn saz, adil edezvalarea este ‘lors prtelriendvdile e organs blue Cle mai man- {ee ma grave forme cline sunt in ard ocalizare aise inence- fg inoch Chstcetcora sistemas nervos central eve in ormee cerebral ‘iva ysis. Cel ma recent senlneeascercora cerebral, aceasta ‘Pind urnoarl forme "itceroraencflick 5 eistetora sistema venti 5 shtcereoa zt ecerls, forma mt in gtr ca complete fein, simptomatologia lnc este Sane varat Bvauiachnctesecapns ite Glan § San ovata cig coli cstcescozl cerebral nd de 2am dela debt cin. Ta majnatea carr se ezol opancringocnetaia cstiercorch, Maitcoven bala deta cu crace epee pfenomene de hipertensiune inracrantani dat rin sindromal mening, tari pice deficient ‘more, tubaran eqns, eae. Epilepsia pate consti manifesta ‘nic une sau predominant &cstcrenet cerebral, past api In tice momett al values “iertenincs nracranin se exprimd clini prin cefee, pre. vom, tacare we pot soci modifi olalmologietufburi pice, eesilib, seme dentate meningeal ‘Dereginlepahie si forms de dei alia sie sunt reat cr niegrale a reser prin preena afer prantare, Pawar ‘Seirus pate determina afcaren anaizatrtal via In tone segment aos prin alzarea cisiceror da lng ior via ” mologen afctarsseioratlomoe, Prope moti fall i crchecoreaa sansa pein parezle use a ale cipal Vid sac cicero ou mada sini. chest mg rc Se eee wean rt a a Cac Sones a i mala ora ea a ee ‘oclerea datlor clnce cu investiga paacinice: examenal radiologic si aia simpli prin cae seeder prezenapaaziflor calif r= ‘ena pue et isis gazoasi si ventriculografia pot furniza informatii ences csr rec amie prose aa ‘poten veneer recom aia ifomten Pan ooze compara pri eve ma dacs coca eae dere creda [came ich eclorbianseparosclespres ‘cd ml inl ar Ese carters de serene ghrahe ck ‘Hpeatclnaie np pri facune amagltlielor sare ‘acca ca psec sail Nivel coin ee cea Sinai Diagnostica imunologicareo donb importants. Aticorp sri pot 6 rin ea de frareacomplemeatul (RFC), hemaglutinate 8 ELISA. In het cloahidan ‘nadorscenA RIF REC ELISA, bemaghatinare indir moot ‘eer. Pree antcorporin LCR conttsiun ato de sigan in 20 sel patna csticxene cerebral det beefalo mfr diagnos ‘a Dragos defn se efetuan prin examen optical ester ‘dena olen, ile agmentele de membrana veri ‘Trtamental Recent chirureald era unica tatament pos ‘indi nc az inunle carat de cisheroch ocular sau cxrebra Di! ‘itatamenalchirupca reo conucela cura radicals abi atonal” ™ ‘oti de lesan Intervet chirurgie are dep sop lichidarea efector ocve geerale de prezenapaazituls:hipeeasunea inracraiond 9 ruse Taacest Scop se efter etipareacsterlor aunt cn ene esi In spc aslorcusediuconi mening prentimaioe sos inies ‘evsiuar Tatamenalantipratarfolost lta combats Tt ‘stoner aps itor tle snr nimi lareor din estar se eos praziquantel in doc (30 meke/, izatin3 pian inp dete Eats nnd {ncaz de cinicercora ocular acini alia: cats ‘eda, enomenedipeptic, ebr,ecinofile, nat ree penta tratamenta csiceron et alen dao in dah 6 15mpg 30d ile. Esteconrandiat inca fecha neg in sacind. Reaciadverse posible: raron taut digestive noe, ‘exceptional erp, alpeie Tecopenie fo inenie ee "Print bioelmintiazele ‘Perorale se mumari si difilobotrioza care se nun i er an Shin eanctinnycnctatpeeercee a pyran ang eel fo find eens as ee me nce oe de aga Damar “loli Age piglet Dihortan aumee

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