Methodical instruction for students
of the V course medical faculty
Lesson N 3 (practical – 6 hours)
Theme 1. Nematodosis. Cestodosis. Trematodosis.
Aim: to study clinical and laboratory manifestation, diagnostics, treatment and prophylaxis of nematodosis, cestodosis, trematodosis, botulism.
Theme 1. Nematodosis. Cestodosis. Trematodosis.
Professional orientation of students: Class roundworms (Nematodoses) includes the agents of ascariasis, trichuriasis, trichinosis, enterobiasis (pinworm), filariases, ancylostomiases (hookworms), strongyloidiases, dracunculiasis.
Ancylostoma duodenale and Necator americanus, is estimated to affect approximately one-fourth of the world’s population. The present geographic distribution of hookworm infections lies in the tropical and subtropical zones. Iron deficiency anemia due to hookworms and other nutritional factors looms across most of the developing world.
Infection with the nematode Strongyloides stercoralis is potentially lethal because of its capacity to cause an overwhelming autoinfection, particularly in the immunosuppressed host. Strongloidiasis, although uncommon in comparison with the other major intestinal nematodes, is widely distributed in the tropics.
Ascariasis, or roundworm, infection is the most common helminthic infection of humans with an estimated worldwide prevalence of 1 billion. The causative organism Ascaris lumbricoides, is cosmopolitan in distribution, being most abundant in the tropical countries. Ascaris infection occurs at all stages but is most common in preschool- and young school-age children.
Infection with the nematode Trichuris trichiura is among the most prevalent helminthiasis; approximately 800 million cases occur worldwide, most abundantly in warm, moist regions. Trichuriasis has a worldwide prevalence; it is most common, however, in poor rural communities and areas in which sanitary facilities are lacking. The intensity of infection is usually light; children in the 5- to 15-years age group have the highest prevalence and probably have heavier worm loads than adults.
Trichinella spiralis is distributed throughout the world apart from Australia and many of the Pacific islands. It is widely spread in nature among a large number of carnivorous animals, humans being an incidental host. Humans usually become infected by eating inadequately processed pork.
Enterobiasis is peroral contagious helminthiasis, anthroponosis. The prevalence of pinworm infection is lowest in nurslings and reaches its maximum in schoolchildren 5-14 years old. Eggs are infective within 6hr of ovideposition and may remain so for 20 days.
Class segmented worms or tapeworms (Cestodoses) includes the agents of taenia solium (pork tapeworm), taenia saginata (beef tapeworm), echinococcusis (hydatid disease), alveococcosis, hymenolepiasis (dwarf tapeworm), diphyllobothriases.
Taenia saginate (the beef worm) occurs throughout the world. Its prevalence is determined by the eating (rare meats) and sanitation habits (human fecally contaminated grazing lands) of people. It has been particularly common in Moslem countries, Ethiopia, and Kenya. It is common, but less frequent, in Central and South America.
T. solium occurs most commonly in Eastern Europe, Central and South America, Spain, Portugal, and parts of Africa, China, and India. Cysticercosis is most common in Mexico and in certain parts of Africa and South America.
Diphyllobothriasis occurs in areas where ingestion of raw fish is common, such as Finland, Sweden, Japan, the Baltic countries, and among Canadian and Alaskan Eskimos.
Hymenolepis nana (the dwarf tapeworm) is the only tapeworm in which the life cycle can be maintained iature by humans acting as both the definitive and intermediate host. In this situation, humans spread the disease to other humans by fecal contamination of the environment. This infection is found in all parts of the world, particularly in Africa, South America, and Eastern Europe. It is a particularly common problem among children in institutions.
Echinococcosis is seen in most sheep- and cattle-raising areas of the world, including Australia, New Zealand, Argentina, Uruguay, Chile, parts of Africa, Eastern Europe, and the Middle East. It is particularly common in Lebanon and Greece.
Class flukes (Trematodoses) includes the agent of fascioliasis, fascipsidosis, clonorchiasis, paragonimiasis, schistosomiases, opisthorchiasis.
Opisthorchiasis. Human infections with O.felineus and O.viverrini are clinically similar to clonorchiasis. These two parasites are common liver flukes of cats and dogs that can occasionally be transmitted to humans. Infection with 0. felineus is endemic in Southeast Asia and eastern Europe, whereas 0. viverrini infection is commonly found in Thailand.
Fascioliasis is peroral biohelminthiasis. Infection with the liver fluke F. hepatica is a cosmopolitan zoonosis throughout the sheep-raising areas of the world. Human infections have been reported, particularly from South America, Europe, Africa, China, and Australia.
Method of implementation of practical work
Using the algorithm of communicative skills during practical work:
1. To prepare to communication with a patient and examination (mask, clean warm hands, cutoff nails, if necessary ‑ gloves, spatula, needed instruments).
2. Greeting and identification (name, level of competence), get the agreement of patient.
3. At the receiving of agreement of patient to set confidential mutual relations (a friendly face, respect and concern, soft talk during conversation).
4. To collect complaints, anamnesis of illness and epidemiologic anamnesis, to explain to the patient the reason of finding out of separate questions (contact with an infectious patient, home and wild animals, use of poor quality meal and others like that).
5. To explain the results of questioning.
6. To explain to the patient, what examination will be done and its reasonability, to get an agreement.
7. To notify about the possibility of the occurrence of unpleasant feelings during examination.
8. To conduct the examination of patient (to estimate the general state, consciousness status, position of patient in the bed, state of skin and mucus, physical examination), demonstrating practical skills.
9. To explain the results of examination understandably for patient.
10. To finish a conversation, thank for communication, wish favourable flow of illness and rapid convalescence.
The student should know:
– Etiology of nematodoses;
– Geographical widespread of nematodoses;
– Epidemiology of nematodoses;
– Life cycles of nematodoses;
– Pathogenesis of nematodoses;
– Clinical manifestations of nematodoses;
– Laboratory diagnostics of nematodoses;
– Principles of the treatment and prophylaxis;
– Etiology of cestodoses and trematodoses;
– Geographical widespread of cestodoses and trematodoses;
– Epidemiology of cestodoses and trematodoses;
– Life cycles of cestodoses and trematodoses;
– Pathogenesis of cestodoses and trematodoses;
– Clinical manifestations of cestodoses and trematodoses;
– Laboratory diagnostics of cestodoses and trematodoses;
– Principles of the treatment and prophylaxis;
Students have to be able:
– to ask history of the disease with estimation of the epidemiological data;
– to examine the patient and reveal the main symptoms and syndromes of nematodoses;
– to perform differential diagnostics;
– to compose the plan of the laboratory and additional examination of the patient;
– to interpretate the results of the laboratory investigation;
– to analyze the results of the specific methods of the diagnostics of nematodoses;
– to compose individual plan of the treatment with account of the epidemiological data, stage of the disease, presence of the complications, severity of state, allergological anamnesis;
– to compose the plan epidemic and prophylactic measures in the focus of the infection;
– to give recommendations relatively to regime, diet, examination in the period of convalescence.
– to ask history of the disease with estimation of the epidemiological data;
– to provide examination of the patient and reveal the main symptoms and syndromes of cestodoses and trematodoses;
– to perform differential diagnostics;
– to compose the plan of the laboratory and additional examination of the patient;
– to interpretate the results of the laboratory investigation;
– to analyze the results of the specific methods of the diagnostics ;
– to compose individual plan of the treatment with account of the epidemiological data, stage of the disease, presence of the complications, severity of state, allergological history;
– to compose the plan antiepidemic and prophylaxis measures in the focus of the infection;
– to give recommendations relatively to regime, diet, examination in the period of convalescence.
Materials for self-control
Questions for self-control
1. What helminthiasis are treated to the class of the round warns (Nematodoses)?
2. What is the mechanism and factors of the infection in ascaridosis?
3. What are the phases of the pathogenesis in ascaridosis?
4. What are the clinical manifestations of the migratory phase in ascaridosis?
5. What are the complications of ascaridosis?
6. What is the blood count of the early (migratory) phase in ascaridosis?
7. What are the principles of the therapy of ascaridosis?
8. What are the principle ways of the infection in ancylostomidosis?
9. What etiotropic and pathogenesis therapy should be administered in ancylostomidosis?
10. What is the mechanism of the invasion in trichinellosis?
11. What are the cardinal signs of trichinellosis?
12. What methods are used for diagnostics of trichinellosis?
13. What are the factors of the transmission of the infection in trichocephalosis?
14. What are the ways of the infection in enterobiosis?
15. What are the criterions of the diagnosis in enterobiosis?
16. What are the ways of the transmission in strongyloidosis?
17. What are the contingents of the risk for infection in strongyloidosis?
18. What are the main clinical symptoms in strongyloidosis?
19. What are the complications of strongyloidosis?
20. What laboratory methods are used for diagnostics of strongyloidosis?
21. What is the definitive and intermediate host in diphillobothriasis?
22. What is the life cycle Taenia soleum (pork worm)?
23. What are the clinical manifestations of Taenia soleum?
24. What are the clinical manifestations in cystecercosis?
25. What is the life cycle of Hymenolepis nana?
26. What is epidemiology of hymenolepiasis?
27. What are the leading clinical syndromes in hymenolepiasis?
28. What is the etiology of echinoccosis?
29. What are the leading factors of the pathogenesis of echinoccosis?
30. What is the possible localization of cyst in echinoccosis ?
31. What are the clinical manifestations in dependence on localization of cyst in echinoccosis ?
32. What methods are used for diagnostics of echinoccosis ?
33. What is the principal method of the treatment in echinoccosis ?
34. What are the features of the life cycle trematodoses?
35. What is the epidemiology of opisthorchiasis?
36. What are the clinical manifestations of the late (chronic) stage of opisthorchiasis?
37. What are the complications of opisthorchiasis?
38. What methods are used for diagnostics of opisthorchiasis?
39. What treatment should be administered in trematodoses?
40. What methods are used for prophylaxis of trematodoses?
Tests for self control
1. What are the phases of the pathogenesis in ascardosis?
А. bacteremia
B. early (migratory)
C. extraintestinal
D. late (intestinal)
E. parenchymatous diffusion
2. What is the epidemiology of enterobiosis?
А. It is anthroponosis
B. It is peroral helminthiasis
C. It is percutaneous way of the infection
D. It is contagious helminthiasis
E. It is transmissive helminthiasis
3. What is the place of the parazitation of the agent of strongyloidoses
А. in the upper sections of the small intestine
B. in the pyloric part of the stomach
C. in the large intestine (cercum)
D. in the bill ducts
E. in the liver
4. What is the duration of the life of the adult forms in echinoccosis ?
А. It is continued from 6 months till 1 year
B. It is continued till 1 month
C. It is continued from 1 year till 3 years
D. It is continued more than 3 years
E. It is continued 7 days
5. What is epidemiology of hymenolepiasis?
А. It is peroral helminthiasis
B. It is percutaneous helminthiasis
C. It is contagious helminthiasis
D. It is transmissive helminthiasis
E. It is especially dangerous disease
6. What treatment should be administered in pork tapeworm?
А. vermitin (phenasalum; Niclosamidum)
B. decaris (levamysol)
C. mebendazol
D. Filicis maris acterium
E. Chloxil
KEYS
1. B, D
2. A, B, D
3. A, B
4. A
5. A, C
6. D
Situational tasks
1. The patient of 42 years old complains on acute headache, tenderness of the muscles of the extremities. The general weakness, fever, edemas around the eyes developed a week ago. The physician diagnosed influenza and prescribed Amixin IC. An improvement didn’t come. His wife also fell ill. She complaints of muscle pain, bad condition. They had eaten fried pork, bought 12 days ago. The temperature is 38,3°C. the face is edematous. The muscles of extremities are painful. The abdomen is soft. Stool is 2 times per day grueled. In the blood count: Нв-133 g/l, L-15,0, B-1 %,E-40 %, U-1 %,B-7 %,S-3%,L-8 %, М-6%, ESR-25 mm /h.
- What is the preliminary diagnosis?
- What methods are used for diagnostics of the disease?
- What therapy would you prescribe?
2. The woman of 36 years old is a worker of the fish plant. She came to the polyclinic with complaints of heartburn, unstable stool, weakness. The itching rash periodically developed on the body. On examination: her skin is pale, single elements of urticaric rash are marked. The stomach is soft, slightly painful around the umbilicus. On examination of the blood: hyperchromatic anemia, eosinophilia to 9% are marked.
- What is the preliminary diagnosis?
- What methods are used for diagnostics of the disease?
- What therapy would you prescribe?
Materials for classroom individual work
List of practical training tasks to be done during the practical class:
– make up methods of the examination of the patients with nematodoses
– to perform examination of the patient with nematodoses
– to provida differential diagnostics nematodoses
– to compose the plan of the laboratory investigation
– to interpret the results of the specific investigation
– to determine complications nematodoses
– to compose the plan of the treatment of patient with nematodoses
– make up methods of the examination of the patients with cestodoses or trematodoses
– to perform curation of the patient with cestodoses or trematodoses
– to perform differential diagnostics cestodoses or trematodoses
– to compose the plan of the laboratory investigation
– to interpret the results of the specific investigation
– to determine complications cestodoses or trematodoses
– to compose the plan of the treatment of patient with cestodoses or trematodoses
Theme 2. Botulism.
Professional orientation of students: The botulism is often in the center of doctor’s and explorer’s attention in spite of its rare register. It is because of hard movement, of insufficient knowledge of pathogenesis, high death rate.
In Ukraine botulism has the main importance because of use the conserved products prepared at home with out the observance of peculiar technology. During last years the information about flare of illness has been caused as a results of eating the salt and smoke fish with fabric production.
Tasks of the training course.
Students have to know:
– etiology, the factors of exciter’s pathogens factors
– epidemiology of botulism
– pathogenesis
– clinic of botulism
– time of rise and clinic of botulism’s complications
– laboratory methods of diagnostic
– treatment and prevention
– administration of the urgent conditions
– prognosis of botulism
– principles of discharging hospital
Students have to be able:
– to observe the main principles of work near the patient’s bed
– to ask history case with analysis of epidemiological data
– to provide the examination and to discover the main symptoms and syndromes of botulism
– to prove the clinical diagnosis
– to make the differential diagnosis of botulism
– to perceive complications of botulism, urgent conditions
– to form the medical documents
– to make the plan of laboratory and instrumental investigation of the patient
– to analyze the results of laboratory investigation
– to make the individual plan of treatment
– to administrate the urgent help on the period before hospitalization
Self-control materials
Questions to be answered
1. The peculiarity of botulism’s exciter
2. The characteristic of botulotoxin
3. The cause of infection.
4. Factors of transmission
5. The pathogenesis of botulism
6. The classification of botulism
7. Main clinical syndromes of botulism
8. Clinic according to the seriousness of condition
9. Specific complications of botulism
10. Differential diagnosis of botulism
11. Plan of inspection for patients with botulism
12. Methods of specific diagnostic of botulism
13. Analysis of results of laboratory exploration
14. Specific therapy for botulism: the doses, the ways, of putting into.
15. Specific therapy for botulism – the longing of treatment
16. Urgent help for patients with botulism
17. Principles of discharging the patients from hospital
18. Prevention of botulism.
19. Actions in the fireplace.
20. Recommendations for convalescents.
Tests for self-control
1. Botulism belongs to:
a) Food toxic infections
b) Blood infections
c) Intestinal infections
d) Virus infections
e) Food intoxication
2. The factors of transmission for botulism
a) Products with sports of exciter with anaerobe conditions
b) The unqualitative vegetables
c) The unwashed fruits
d) All answers are right
e) The milk products
3. The dose and the structure of polivalentine whey opposite botulism
a) 10 000 ME for types A and E, 5 000 ME for type B
b) 5 000 ME for types C and E, 10 000 ME for type A
c) 5 000 ME for types A and E, 10 000 ME for type C
d) 10 000 ME for types B and E, 5000 ME for type A
e) 5 000 ME for types A and E, 10 000 ME for type B
Keys:
1 С
2 A
3 A
Task for self-control
The patient G., 32 years old was delivered to the infection hospital the days after eating the conserved mushrooms. The illness was with suddenly beginning. After the disappearance of nausea and vomit complains of abdomen swelling, bolt, dryness in the mouth, «the fog before eyes», the bifurcating of objects, the transgression of swallow are appeared.
The consciousness is preserved, the temperature is normal. The artery pressure is 160/110 mm of mercury column. The heart tones are deaf a little. There is the moderate tachycardia; there are no changes in lungs. The frequency of breath is 22 in minute. There are the ptos, anizokoria, midriaz, nistagm, the snuffle voice. The abdomen is swelling; the spleen and the liver are not bigger. The evacuation is with out pathological changes. There are the moderate leucositoz with the shift of leucosit formul to the left, the acceleration of speed of settle for erythrocytes.
1. To formulate the diagnosis.
2. To prescribe the specific diagnostic of illness
3. The plan of treatment.
Materials for class self- training.
– To examinate patient with botulism
– To make the differential diagnostic of botulism
– To make the plan of laboratory’s investigation
– To analyze the results of specific investigation
– To make the plan of treatment for patients with botulism
– To administrate urgent conditions
– To from the medical documents
4. References:
1. Infectious diseases / E. Nikitin, M. Andreychyn – Ternopil, Ukrmedknyga, 2004. – P. 77-88; 88-91.
2. Understanding infectious disease / Paul D. Ellner, Harold C. Neu – Mosby Year Book, 1992. – P. 34-35; 187-192.
3. Reese R.E. A practical approach to infectious diseases. – Little, Brown & Company, Boston-Toronto, 1986. – P. 160-165; 299-307.
Additional:
1. Reese R.E. A practical approach to infectious diseases. – Little, Brown & Company, Boston-Toronto, 1986. – P. 289-291; 740.
2. Berkow R. The Merck Manual of diagnosis and therapy. – Merck Sharp, 1987. – P. 85-88; 987-994.
3. Bibhat K. Mandal, Edmund G.L. Wilkins, Edward M. Dunbar, Richard T. Mayon – White infectious diseases. – Panther Publishers Private Limited, 1999. – P. 314-327.
Methodical instruction has been worked out by: ass. Zavidnyuk N.
Methodical instruction was discussed and adopted at the Department sitting
14.06.13 Minute N 10
Methodical instruction was discussed and reviewed at the Department sitting
__________201_ Minute N ___
