From Big Medical Encyclopedia

ShISTOSOMATOZY (scb istosom a tosis, singular; synonym: shistosomoza, bilgar-tsioza) — group of the tropical helminthoses which are relating to tremato-doses and characterized by defeat of preferential urinogenital bodies, digestive organs and tendency to a chronic current.

The following shistosomatoza are most widespread: urinogenital

(synonym: bilharziasis urogenitalis, haemat-uria endemica), intestinal (synonym: Munson disease, bilharziasis intesti-nalis Mansoni), Japanese (synonym: bilharziasis japonica, Katayama disease) and interkalatny.

History. The chronic local disease which is characterized by release of bloody urine was known in Egypt and Mesopotamia more than 3000 years ago. In many ancient papyruses there is a description not only symptoms, but also some remedies for this disease. In 1843 Mr. of J. Fujii in Japan described the disease which is often found in Katayama's province followed by increase in a liver and spleen and called it Katayama's disease (in a crust, time the Japanese schistosomatosis). In 1851 Mr. Bilgarts (T. Bilharz) opened a bisexual trematode, to-ruyu called Distoma haematobium. At the same time he established that at infection with this helminth at the patient diarrhea and a hamaturia is observed. Further the activator was carried to the sort Schistosoma, and the disease received the name a schistosomatosis (schistosomiasis). In 1898

P. Munson found in Calais the sick person of egg with a side thorn and assumed existence of one more form of an invasion — an intestinal schistosomatosis. In 1904 Mr.

of F. Katsurada 1907 Mr. Sambon described the Japanese Sh. V activator (L® W. Sambon) gave the name to the parasites producing eggs With a side THORN — Schistosoma mansoni. Intermediate owners of S. japonicum were established in 1913 — 1914 to Miyairi and Suzuki (To - Miyairi, M. Suzuki), S. mansoni and S. haematobium — in 1915 by R. Th. Lei per. Drugs of antimony for Sh.'s treatment were offered by Kristofersen (J. Century of Christhophersen) in 1918. Interkalatny Sh.'s activator opened in 1934 for A. Fisher.

Geographical distribution and statistics. Shistosomatoza are registered in 73 countries. Sh.'s area stretches between 38 °C. highway and 35 ° SL. The countries, among the population to-rykh Sh. is most widespread, are: in Africa — Angola, Ghana, Egypt, Zambia, Madagascar, Malawi, Mozambique, Nigeria, the United Republic of Tanzania, Senegal, Sudan, the Central African Republic, Chad; in South America — Brazil; in Southeast Asia — Philippines; in Southwest Asia — the Yemen Arab Republic. Sh.'s area tends to continuous expansion as a result of intensive population shift, and also creation

of the irrigational systems and artificial water reservoirs which are biotopes of mollusks — intermediate owners shistosy. By estimates of WHO (1980), more than 500 million people are subject to risk of infection and apprx. 200 million have these helminthoses. Areas of various forms Sh. are not identical. Urinogenital III. it is widespread in the majority of the countries of Africa, and also Syria, Iran, Iraq, Saudi Arabia; intestinal — in the countries of Africa, the Arabian peninsula, South America and on nek-ry islands of the Caribbean Sea; Japanese — on Philippines, in Japan, China. The area interkalatny is most limited by III., its small centers are registered in Gabon, Zaire, the United Republic of Cameroon and Chad. In the tropical and subtropical countries of Sh. take on social and economic value the second place after malaria. In our country cases of Sh. of the persons which caught abroad are registered.

Etiology. Activators III. treat type of flat worms (R1a-thelminthes), to the class Trematoda, the Schistosomatidae family, the sort Schis-

of Fig. 1. Diagrammatic representation of a structure of S. haematobium:

a male (i) on whose ventral surface, in a fillet, the female is located (2).

tosoma. The greatest medical value have four appearance of this sort: S. haematobium (Bilharz,

1852) Weinland,

1858 — the activator of an urinogenital schistosomatosis; S. mansoni Sambon,

1907 — the activator of 1 intestinal schistosomatosis; S. japonicum Katsurada, 1904 — the activator of the Japanese schistosomatosis and S. intercalatum Fisher, 1934 — the activator of an interkalatny schistosomatosis. Shi-stosomy — the only diclinous trematodes causing a disease of the person. Length of males is from 4 to 20 mm, width is 0,5 — 1,2 mm; females have length from 7 to 26 mm, width of 0.17 — 0,3 mm. On veins

of a trawl surface of a male there is a fillet (the ginekoformny channel), inside to-rogo the threadlike female (fig. 1) is located. Shistosoma of different types differ among themselves on morphology of adult individuals (to a structure of a cuticle, number of seed plants at a male, to an arrangement of ovaries and amount of eggs in a uterus at a female), and also in a form of eggs and the larvae leaving them. Eggs shistosy; large (reach the size 0,16 — 0,18 X 0,07 — 0,08 mm), colourless, are supplied with a thorn: at S. haematobium and S. intercalatum — terminal, S. mansoni — side, S. japonicum — side rudimentary (fig. 2, and, in, d). Activators III. have a difficult development cycle with change of owners (fig. 3). Final owners shistosy are the person, many wild and domestic mammals. At the person they parasitize in veins: S. haematobium lives in veins of a bladder, a shistosoma of other types — in veins of intestines, and S. mansoni and S. intercalatum affect preferential lower mesenteric vein, a S. japonicum — as well upper. Average life expectancy of adults of shistosy 3 — 10 years, separate individuals can live 20 — 30 years. Each couple of helminths produces depending on a type of 300 — 3000 eggs in days, S. japonicum has the greatest reproductive ability. Eggs pass through walls of blood vessels, tissues of a bladder or intestines and are allocated to the environment with urine or a stake of final owners. Advance on fabrics is facilitated thanks to action tsitol the itichesky enzyme emitted by the germ located in egg.

Development of eggs is possible only in water. Eggs leave miratsidiya, to-rye get into an organism of intermediate owners — mollusks (see): the sorts Bulinus for S. haematobium and S. intercalatum; the sorts Biomphalaria in Africa and Australorbis or Tropi-corbis in America for S. mansoni; the sorts Oncomelania for S. japonicum. Standing or slaboprotochny reservoirs with a pure bottom, well developed water vegetation and

Fig. 2 moderated zatene-are optimum for life of mollusks. Microdrugs of eggs shistosy (the arrow specified thorns): and — S. haematobium;

— S * intercalatum; in — S. mansoni; — S. japonicum; X 720 *

niy: the rivers with drift, creeks, ponds, lakes, water reservoirs, irrigation canals, rice zero, etc. In a body of mollusks there is a development and reproduction of two generations of larvae — maternal sporocysts and the daughter of stubs sporocysts, in a cut cercariae form. Duration of development of S. mansoni in a body of a mollusk makes 4 — 5 weeks, S. haematobium and S. intercalatum — 5 — 6 weeks, S. japo-nicum — 7 weeks and more.

Fig. 3. Scheme of a life cycle of the activator of an intestinal schistosomatosis (S. mansoni): I \an adult parasite in venous system of intestines of the person; 2 — the egg shisto-catfishes allocated with excrements and which got to water; z — miratsidiya, left egg in water; 4 — a mollusk — the intermediate owner of S. mansoni; 5 — cercariae (an invasive stage), left in water a mollusk and getting through skin into a human body. In a circle the diagrammatic representation of a male is given (with?), on which ventral surface, in a fillet, the female (Q) is located.

Daily exit tserkariyev in water from the struck mollusk can fluctuate from 1 — 2 to several thousand. The cercariae supplied with the extended doubled tail actively move in water. Duration of their life 24 — 48 hour. By means of muscular contractions and proteolytic substances, vyra-batyvayekhmy special glands, cercariae actively are implemented through skin into an organism of the final owner at stay it in water. In the course of penetration through leather of cercariae loses a tail appendage, turning into a shistosomu-la. Young parasites migrate on limf, and to circulatory ways through

heart and lungs to a liver where there is a formation of a mature parasite and pairing of helminths. Further puberal helminths depending on specific accessory migrate against a blood flow in veins of a bladder or mesenteric veins where there is a postponement of eggs. From the moment of implementation tserkariyev in skin and before emergence of eggs shistosy in urine or excrements there pass 30 — 40 days, quite often this period happens longer.

Epidemiology. A source of an invasion at urinogenital and Sh.'s interkalat-number is the person. At an intestinal schistosomatosis, in addition to the person — rodents of nek-ry types (e.g., sandworts, the Nile rats, etc.). Sources of the activator of the Japanese Sh. along with the person are many house and wildings (pigs, sheep, horses, buffalo s, dogs, cats, foxes, rodents); at this invasion the zoophilous strain (on the lake of Taiwan) infesting only animals is known.

The person who caught Sh. becomes a source of an invasion in 4 — 6 weeks. A susceptibility of people to infection of a shistosomama general, more struck there are groups of the population, to-rye often contact to biotopes of mollusks. As the greatest value children and teenagers have sources of an invasion. Their more intensive invasion is noted and according to excrements and urine more eggs are allocated, than at an invasion at adults. It is explained by weak tension of immunity of children to a schistosomatosis. Besides, children considerably more often than adults, bathe in reservoirs. Distribution and intensity of transfer of Sh. are defined by species of mollusks, density of their population, speed of reproduction and extinction, age structure of population and contact of people with biotopes of mollusks. Water temperature of reservoirs 18 — 28 ° is optimum for development of the majority of species of mollusks. Optimum water temperature for implementation miratsidiyev in mollusks 20 — 30 °; for penetration tserkariyev through skin of the final owner 30 — 35 °.

In distribution of mollusks vegetation and a relief of a bottom of reservoirs, quantity of the dropping-out rainfall, flow rate of water and its chemical structure is of great importance. High infectiousness of mollusks is promoted by a continuity of fecal pollution of reservoirs that is characteristic of not channeled rural settlements. People usually catch in operating time on the irrigated fields, during the bathing, washing of linen, the use of the neobez-infected water, the containing cercaria. Infection of S. japonicum can come at contact with a grass, on a cut the infested mollusks crept. Agricultural workers and the personnel servicing irrigation systems are subject to the increased risk of infection.

Pathogeny. In different stages of the development the activator has various pathogenic effect on a human body. Shistosomula possess the sensibilizing and injuring action in the course of their migration on tissues of the owner. Parasitizing of adult individuals in veins of an abdominal cavity is not followed by the expressed disturbances in a wall of vessels. Patol. changes develop at migration of eggs of the activator from a gleam of vessels in a bladder or intestines through their walls. Further in a wall of a bladder or a gut fibrous fabric develops and there is calcification. It is followed by reduction or even the termination of allocation of eggs of the activator with urine or excrements that is connected with difficulty of passing of eggs through fibrous fabric. The eggs of the activator which did not pass through fibrous fabric can be brought in a liver, lungs, in a head or spinal cord where around them granulematozny process develops.

Pathological anatomy. In an acute stage of Sh. in the place of penetration into skin tserkariyev are observed the dermatitis with infiltration of skin, hypodermic cellulose neutrophils, eosinophils which is followed by allergic hypostasis and an erythema of skin; eosinophilic infiltrates in lungs are noted (see). The main fabric change at all forms Sh. are the granulomas developing around eggs shistosy. In the beginning necrotic and exudative processes prevail, infiltrates consist of granulocytes and histiocytes. Mature granulomas consist of epithelial and colossal cells like cells of foreign bodys (see. Colossal cells). This stage is replaced by fibrosis.

Urinogenital III. proceeds with preferential defeat of urinogenital system, hemorrhagic cystitis develops (see). In distant -

shy in all layers of a wall of a bladder, but it is more in a submucosa, eggs shistosy accumulate, to-rye in the subsequent perish and are exposed to calcification. Around them the granulomas acting over a mucous membrane in the form of yellow small knots («sandy spots») form. Being opened, they lead to formation of ulcers, hems, development of papillomas, to-rye malignancies can be exposed. The inflammation and petrification are followed by a sclerosis of walls of a bladder and reduction of its volume. In ureters a large number of eggs shistosy is found, the diffusion inflammation with a sclerosis of walls and narrowing of a gleam, especially in the lower third is noted, Krom is promoted also by a papillomatosis of a mucous membrane. These processes can be complicated by nonspecific pyelonephritis (see Kidneys, diseases). In a neck of uterus acute extensive erosive process passes into the granulomatosis, a sclerosis (see) which is followed by development of a ferruterous pseudo-erosion (see the Erosion of a neck of uterus) and a papillomatosis (see Papilloma, a papillomatosis). Are typical hron. a salpingitis (see the Adnexitis) with narrowing of a gleam of uterine tubes, a nonspecific inflammation and a granulomatosis of an ovary from the outcome in a sclerosis.

In a chronic stage of intestinal and Japanese Sh. the large intestine preferential is surprised. The ulcer and hemorrhagic colitis developing in the beginning is replaced by a granulomatosis. Granulomas are located preferential in a submucosa, development of polyps and pseudoneoplasms is possible. Polyps reach 8 cm in dia., have the extended form usually without leg, bleed, ulcerate. Pseudoneoplasms at circular coverage of separate segments of a gut can cause a stenozirovaniye, reminding dense fibroma if the sclerosis, or a lymphosarcoma prevails if nodes soft. They reach sometimes 20 cm in dia., eminate under a serous cover. The special type of fibrosis of a liver is noted, at Krom of a very techtonic dance of hepatic segments it is not broken, but the pylephlebitis and a granulomatosis on the course of branches of a portal vein lead to emergence whitish and nacreous tyazhy, corresponding to their topography (see. Portal vein; Liver, diseases). The joining portal hypertensia (see) leads to a splenomegaly (see) and to development of a porto-caval anastomosis (see). In lungs nonspecific focal pneumonia sometimes develops (see), and at an embolism of branches of pulmonary arteries granulomas arise eggs shistosy, allergic arteritis with the centers of a fibrinoid necrosis of walls of vessels and an obliteration of gleams develops, an arteriovenous anastomosis of glomal type owing to pulmonary hypertensia is formed (see Lungs, diseases). These changes promote development of a pulmonary heart (see). Eggs shistosy can be brought in the hematogenous way also to a head and spinal cord, causing in them inflammatory changes, pseudoabscesses.

Immunity at Sh. not sterile. The humoral response to implementation of parasites develops on antigens shistosomul, later on antigens of adult individuals and eggs in the beginning. Shistoso-muly are surrounded with eosinophils and are affected by the enzymes emitted by them. Against adult individuals various antibodies are developed, but they have no protective properties. Thanks to ability of adult parasites to an antigenic mimicry (inclusion in a superficial membrane of a parasite of group isoantigens, antigens like HLA, etc.) they successfully resist to defense reactions of an organism of the owner. Antibodies do not destroy adult individuals and do not interfere with adjournment of eggs, however superinvasions warn, destroying shisto-somula. Detection of the antibodies formed in the course of an invasion is the cornerstone of an immunodiagnosis of shisto-somatoz.

Clinical manifestations, diagnosis, treatment and forecast of separate shisto-somatoz. In a wedge, Sh.'s current allocate acute and hron. stages. The acute stage corresponds to the period of penetration tserkariyev in a human body and migrations shistosomul, chronic — to parasitizing of adult individuals.

The acute stage proceeds the same at allx forms of an invasion, its symptoms are shown within the first hours after infection — in places of implementation tserkariyev on skin symptoms of dermatitis can appear different degree of manifestation: itch, feeling of a pricking, local erythema, papular rashes. Skin changes quite often are followed by fever, weakness. In 5 — 6 days symptoms of dermatitis pass. In 1 — 3 week after infection, during migration shistosomul through lungs, there is a cough which is followed by allocation of a dense phlegm or a pneumorrhagia. Sometimes the phenomena of bronchitis with suffocation, muscle, joints pains develop, appetite decreases. The liver, a spleen, limf, nodes increase. In blood the high leukocytosis, an eosinophilia, acceleration of ROE comes to light. Duration of this stage

is 7 — 14 days.

Beginning hron. stages matches completion of puberty of helminths and the beginning of a yaytsekladka. From now on each form Sh. proceeds differently that depends on specific localization of the activator and ways of passing of eggs from vessels to the environment. A wedge, Sh.'s manifestations are noted approximately at 4 — 14% infected with shistosoma, living in endemic areas, in other cases the invasion proceeds asymptomatically or subclinically.

Urinogenital shistoso-m and t about z. First sign hron. urinogenital Sh.'s stages, to-ry appears in 4 — 6 weeks after infection, the terminal hamaturia (emergence of blood at the end of the act of an urination) connected with strong reduction of muscles and passing through the inflamed mucous membrane of a bladder of eggs of helminths is. The dysuric phenomena are quite often noted. Sometimes patients complain of weight in a crotch at the end of an urination. At defeat of ureters the hamaturia amplifies, patients are disturbed by kolikoobrazny back pains. The palpation of ureters causes pain and a desire to an urination. If the prostate gland and seed bubbles are affected, sharp pains in the bottom of a stomach, in crotches, an urination at the same time discontinuous, sometimes drop, sharply painful develop. At defeat of female generative organs bleeding from polypiform growths of a neck of uterus, disturbance of a menstrual cycle, abortions are observed. Current urinogenital III. can become complicated prisoyedineniyekhm consecutive infection, development of a hydronephrosis (see), a nephrolithiasis (see the Nephrolithiasis), a pyonephrosis (see), an urosepsis (see Sepsis).

The diagnosis is based on epide-miol. anamnesis (stay in the area, endemic on Sh., and contact with water in an open reservoir), wedge, picture (terminal hamaturia, dysuric phenomena), data lab. researches (in blood — a moderate leukocytosis, an eosinophilia; ROE is accelerated; in urine — existence of eggs shistosy; positive immunol. reactions) and tool inspections. I wet for parazitol. diagnoses collect preferably in the afternoon between 10 and 14 hours as the most part of eggs shistosy is allocated in hours of the maximum excretion of urine. Solution of formalin or 1:2000 solution of a mertiolat apply 5% to preservation of urine. For the purpose of detection of eggs shistosy in urine widely apply methods of filtering of urine through membrane filgugra. From immunol. methods use: an intracutaneous allergy test (see. Skin tests), reactions of binding to a kompla

of the cop (see) and indirect hemagglutination (see), methods of an immunofluorescence (see), enzyme - marked antibodies (see Enzyme-it mu but a logical method). A reliable method of tool diagnosis of urinogenital Sh. is the tsistoskopiya (see). She allows to distinguish an invasion, to reveal complications, to track dynamics of recovery after chemotherapy. At a research note a pale yellow mucosal surface of a cover of a bladder, the thinned vessels. Sometimes find a focal hyperemia around mouths of ureters, various types of deformation of mouths (funneled, dot, gaping, star-shaped). In addition, shistosom-ny hillocks come to light — the educations consisting of the dead and calcific eggs shistosy to-rye appear through the thinned mucous membrane («sandy spots»), papillomatous growths. Gistol. the research of the fabrics taken at a tsistoskopiya allows to find live or calcific eggs of helminths in 80 — 90% of cases. On the roentgenogram of uric system reveal a pathognomonic sign of chronic Sh. — extraordinary accurate contours of bodies of the uric highway. This phenomenon is connected with calcification of the died eggs shistosy, laid in a wall of a bladder, and formation of fibrous fabric. Calcification can extend to ureters, and sometimes and a renal pelvis. At excretory urography (see) strictures in lower and dilatation in upper parts of ureters come to light.

It is necessary to differentiate urinogenital Sh. with tuberculosis of a bladder (see Tuberculosis vnelegoch-ny, tuberculosis of urinogenital bodies), new growths of kidneys (see). And a nephrolithiasis (see).

For causal treatment soaked lovogo Sh. highly effective are drugs of trivalent antimony (potassium antimonyl tartrat, fuadin, antiomalin, astiban), all of them have high toxicity and demand a long course of treatment. From these drugs apply fuadin more often — surmyanonatriyevy salt

a 3,4-disa of l of a fopirokatekhin, vypus

repents of a type of 7% of solution, it is applied intramusculary. The first dose —

1,5 ml, the second — 3,5 ml, the subsequent on 5 ml; total number of injections 10 — 15. For children a single dose the fua-dyne makes 0,1 «on 1 kg of the weight {weight) of a body, at the first injection enter a half of a dose, duration of a course of treatment the same, as at adults. From other drugs use metrifonat, hikanton,-ridazol and nrazikvantet. Metrifonat appoint once in a dose 7,5 — 10 mg to 1 kg of body weight. If necessary treatment is repeated in 2 — 4 weeks Hikanton is entered once intramusculary in a dose

of 2 — 3 mg on 1 kg of body weight. Niridazol appoint inside at the rate of 25 mg to 1 kg of body weight a day in three steps within 5 — 7 days. The praziquantel is appointed inside in doses from 20 to 60 mg to 1 kg of body weight within one day, drug differs in good tolerance.

The forecast in most cases favorable, it worsens at development of complications.

Intestinal schistosomatosis. The chronic stage begins in 6 — 8 weeks from the moment of infection. Patients complain of abdominal pains, an irregular chair with impurity of blood and slime in excrements. Quite often the disease proceeds in the form of the alternating periods of diarrhea and locks. Patients are disturbed by tenesmus, a meteorism, sometimes proctorrhagias. In process of progressing of a disease the symptoms caused polipozy a large intestine begin to prevail: abdominal pains, meteorism, bleedings, partial or full obstruction, weight loss.

The drift of eggs in lungs is shown by symptoms of acute bronchial pneumonia (cough, fever during

2 — 3 weeks, short wind, stitches). In the subsequent pulmonary hypertensia and a pulmonary heart can develop. At patients defeats of cardiovascular system can prevail: dizziness, weakness, an asthma, heartbeat or faints at small exercise stresses, dull aches in heart, a pneumorrhagia. Damage of a liver and spleen causes disturbance of a blood formation, development of hypochromia anemia, a leukopenia, thrombocytopenia, portal hypertensia with development of ascites and hypostasis of the lower extremities.

At defeats of c. N of page (see the Brain, diseases) are marked out a headache, vomiting, a vision disorder and speeches, spasms and epileptiform attacks occasionally can develop. At Sh. mental disorders which are most often presented by an adynamy (see can cause damages of a brain. An asthenic syndrome) with neurosis-like (nevrastenopo-dobny, is more rare — hysteriform) disturbances and subdepressions (see. Depressive syndromes). In isolated cases perhaps gradual development of a psychoorganic syndrome with the accruing dysmnesias, depletion of thinking, the general decrease in intelligence (see. Psychoorganic syndrome). The massive invasion at children's age leads to lag in physical and intellectual development.

The wedge, a picture at damages of a spinal cord is characterized by paraplegiya, disturbances of sensitivity, feelings of constraint in spin, back pains, etc.

The diagnosis is based on data epidemiol. anamnesis, wedge, picture, results lab. and tool researches. Crucial importance has detection in excrements of S. mansoni eggs by means of methods of sedimentation or flotation (see. Helmintologic methods of a research). Use also RSK, an intracutaneous allergy test and others immunol. reactions.

At a rektoromanoskopiya (see) note a hyperemia of distal department of intestines, small ulcers, shistosomny hillocks, sometimes papillomatous growths. Use a biopsy of a mucous membrane of a rectum, at gistol. a research find live and calcific eggs shistosy. Patients in blood have an eosinophilia, a leukopenia, thrombocytopenia. At differential diagnosis it is necessary to consider an amebiasis (see)? dysentery (see), a balanthidiasis (see).

For therapy intestinal III. use drugs of antimony, niridazol, and also oksamnikin. Oksamni-kin (Oxamniquine, Vansil) — derivative tetrahydroquinoline; drug is effective at enteral and parenteral administration at the rate of

10 mg on 1 kg of body weight two times within one day. At intramuscular introduction local reaction in the form of the expressed pains is quite often observed.

The forecast more often favorable, however at a drift of eggs of the activator in a liver, lungs and c. N of page serious.

Japanese schistosomatosis. From all shistosomatoz hron. the Japanese Sh.'s stage proceeds most hard. Its symptoms appear already in 2 — 4 weeks after infection: appetite goes down,

weight decreases, headaches, fever of remittiru-yushchy type develop. In 4 — 5 weeks the chair becomes frequent, in excrements slime and blood appear, the liver and a spleen often increase. Polyps and ulcerations of intestines, fibrosis of a liver with portal hypertensia, sharp increase in a spleen with development of anemia, a leukopenia, thrombocytopenia are characteristic. At a drift of eggs in c. N of page develop paresis and paralyzes, persistent headaches, vomiting, visual disturbances are observed, to-rye can imitate a tumor of a brain. Mental disorders at the Japanese Sh. are similar with observed at intestinal Sh. (see above), but can be more expressed. The principles of diagnosis same, as well as at intestinal III.

The Japanese Sh. difficult recovers. At use of an oksamnikhin, hikan-tone recovers apprx. 20% of patients, and drugs of antimony and a niridazol — 40 — 60%. By means of a prazikvantel cure more than 75% of patients at fractional introduction it on 20 mg on \kg of body weight 3 times a day.

The forecast adverse at development of fibrosis of a liver and defeat of c. N

of page Sh and with t about with about m and t about z the intern latny. Manifestations same diseases. as at intestinal Sh., however this form is more high-quality: colitis is expressed unsharply, complications develop seldom. The principles of diagnosis and treatment same, as at intestinal Prognoz Highway favorable.

Prevention. The main action for fight against Sh., especially urinogenital and intestinal, protection of the soil and reservoirs from pollution by excrements and sick Sh.' urine of people is. It is reached by the good organization of treatment of patients. The coverage treatment of 10 — 30% of the most intensively infested sick Sh. leads to reduction of the eggs of a parasite coming to the environment by 80 —-85%. Disinfecting of allocations of patients is important. Keeping of excrements in densely closed vessel leads to death of eggs Sh. within 9 — 10 days.

To labor-consuming and expensive, but effective measures in all Sh.' prevention, destruction of mollusks — intermediate owners shistosy belongs: the instillation and ramming of old channels and construction new, removal of a layer of the earth in

10 — 15 cm with the subsequent ramming on flat coast of reservoirs, elimination of marshiness of certain sites, cultivation of ducks, to-rye eat mollusks, etc.

Treat measures of individual prevention: prohibition of bathing, washing of linen in reservoirs where mollusks live; use for drink and the economic purposes only of a decontaminated water; obligatory wearing footwear during the work on rice fields or walking on the wet earth. Implementation of these skills in daily life of people is reached by carrying out persistent a dignity. - a gleam, works.

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