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NUGZAR UBERI, Doctor of Medicine, M.D.
TSMU, Associated Professor
Helminthiasis is the disease caused by parasites and is known to mankind from the ancient times. The term - Helminthosis is provided by Hyppocrate (Helminth – worm (lath). Nowadays helminthosis is still the most widespread disease, which affects life quality and socio-economical status of population. This is especially actual problem in children, because 80 percents of infested population belong to this age group. Data, provided by World Health Organization is perturbing – number of affected patients exceeds the sum of the numbers of incidence of acute respiratory diseases and flu. Based on the same data, 4,5 milliard people is recorded with parasite disease in 2006 year worldwide and every third inhabitant of Europe is infested with one of the parasite.
Helminthosis causes growth retardation, anaemia, exhaustion and decrease in mental and physical abilities in children. Besides this, every parasitic disease causes allergic reaction and suppression of immunity of the organism. Lambliosis and intestinal helminthosis cause initiation of chronic allergic dermatitis (neurodermitis, eczema, rhinitis, blepharitis etc.) and bronchial asthma. Helminthes and their toxins are allergens. They cause inflammation, reveal immunosuppressing activity and stimulate production of IgE. All of these lead to the development of chronic allergic diseases, such as urticaria, atopic dermatitis, bronchial asthma etc. It is also proved that alopecia and local depigmentation of the skin are also related to intestinal helminthosis. Allergic reaction is revealed in the acute phase of the disease and is aggravated with super- and reinvasion with parasites. Allergic reaction may be represented by skin rush of different localization, lymphadenopathy, hypereosinophilia, myalgia, arthralgia, lung and abdominal syndromes, hepatosplenomegaly. prognostically serious diseases caused by parasitic infections are allergic myocarditis, eosinophilic pneumonia, meningoencephalitis, hepatitis, disorders of hemostasis.
Parasitic infections in children cause suppression of nonspecific resistance of the organism, which leads to prolongation of respiratory illnesses and other infections. It should be mentioned, that there is decreased production of antibodies against diphtheria after vaccination and worsened induction of immunity after revaccination with measles and tetanus in children. Besides this there is high false positive result after tuberculosis skin test in infested children.
Immune system always responds to parasite’s antigens and prolonged and chronic infection causes its exhaustion. In the result, decrease in the number of T-lymphocytes leads to complications, such as bacterial and viral infections and allergic pathologies. That’s why parasitic infections are at the first place in the list of the possible causes of secondary immunodeficiency, in the reports, provided by the WHO. Chronic course of helminthosis is often accompanied by disturbance of metabolism, impedance of lipids acids and carbohydrates metabolism, hypoxia, decrease in vitamins, microelements and folic acid concentrations and all of these changes can cause irreversible processes in the growing organism.
Besides serious disorders of immune system, helminthosis is very dangerous for the organism because of its toxic and mechanical effects on the body. The toxic effect is represented by decreased appetite, impedance of intestinal absorption process, growth retardation, and decrease in mental and physical abilities. This effects are caused by inhibition of release of Insulin like Growth Hormone (IGH-1) and increase of production of Tumor Necrosis Factor (TNF-a) and also by decrease of synthesis of collagen. Also helminthes can cause dangerous complications, such as obstruction of pancreatic and bile ducts, liver and pancreatic abscess, intestinal perforation with peritonitis, obstruction impassability of intestine etc.
So, it is extremely important timely diagnostics and treatment helminthosis in children.
The main indications for trial of presence of parasitic infections, are :
·        Abdominal pain.
·        Frequent nausea and vomiting, changes in appetite.
·        Gastrointestinal diseases
·        Irretentiveness, fatigue, sleep disturbances, to grind teeth during sleep (Bruxism),
·        Allergic diseases
·        Perianal pruritus
·        Vulvovaginitis,
·        Urinary tract infections
·        Eosinophilia
·        Growth retardation
·        Low self hygiene.
It should be mentioned that these clinical and laboratory data are not characterized not only for Helminthosis.
The main parasitic infections in children still remain following intestinal helminthosis: ascariasis, enterobiasis, trichocephalosis, toxocariasis. Old antihelminthic preparations are often ineffective in solving such difficult problem. The main place in pediatric practice takes modern antihelmintic preparations; and derivative of carbamatbensilimidasole – Helmadole (albendazole 200 mg) among them. Effect of Helmadole is mediated by inhibition of sinthesis parasite’s protein - tubulin. Helmadole reveals high therapeutic activity against most  nematodes, such as and most common children parasites enterobius, ascaris and protozoic disease ethiologic agent – Giardia. We should especially mention echinococcosis and toxocariasis, by which children can be infected from their favorite pets.
 Helmadole have the most wide antiparasitic spectrum. Actuality of Helmadole in pediatrics is also due to its effective action on every stage of helminthe’s development, its unique larvicidal activity, its low bioavailability, which leads to high antihelminthic concentration of Helmadol in the intestinal lumens. It is effective against parasitic and protozoic causatives of bile duct infections, is well tolerated and do not demand any dietary restrictions or laxatives and enemas.
One-time dose of Helmadole for treatment of ascariasis and enterobiasis is about 10-15 mg/kg and should be repeated in 14 days. For toxocariasis treatment regimen is 10 mg/kg a day for 10 days and treatment course should be repeated in 14 days. For treatment of lambliosis 10 mg/kg daily dose should be given for 7 days. Treatment of echinococcosis is complex with surgical intervention. Helmadole treatment regime for this disease is minimal of three courses of 28 day treatment with 10 mg/kg daily dose with two weeks apart periods.
When we discuss parasitic infections it is important to point out not only the treatment specificities, but also inevitability of the preventive measures. Patients and also parents should be recommended protect self hygiene. All vegetables and fruit should be washed carefully. Use only thermally well treated meat and fish. Avoid drinking water from opened water reservoirs or use it after boiling if there is any doubt of its contamination. It is very important to dehelminthise pets (dogs, cats). In case of infection of any family member, it is recommended to treat all family on the basis of consultation with family doctor.