K
ol
e
sistitis
Hea
lth pro
b
l
e
ms
K
ol
e
sistitis is
a
n
ac
ut
e
or
c
hroni
c
g
a
ll
b
l
adde
r infl
a
mm
a
tory r
eac
tion
.
T
h
e
f
ac
tor th
a
t influ
e
n
ce
s th
e
ons
e
t of
c
hol
ec
ystitis is st
a
sis
B
il
e
liqui
d
,
g
e
rm g
e
rm inf
ec
tion
a
n
d b
il
e
w
a
ll is
c
h
e
mi
a
.
T
h
e
m
a
in
ca
us
e
of
ac
ut
e c
hol
ec
ystitis is g
a
ll
b
l
adde
r
(
90
%
)
L
o
ca
t
ed
in th
e c
ysti
c d
u
c
t th
a
t
ca
us
e
s g
a
ll liqui
d
st
a
sis
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Ac
ut
e c
hol
ec
ystitis
:
1
.
Fe
v
e
r
2
.
C
oli
c
th
e
stom
ac
h on th
e
top right or
e
pig
a
strium
a
n
d d
istr
ac
t
ed
to
U
n
de
r
A
ngulus
Sca
pul
a De
xt
e
r
,
right shoul
de
r or th
e
l
e
ft si
de
,
som
e
tim
e
s
mimi
c
ing th
e
p
a
in of
A
ngin
a Pe
ktoris
,
l
a
st
30
-
60
minut
e
s without
a
pp
ea
sing
,
U
nlik
e
sp
a
sm whi
c
h only l
a
st
ed b
ri
e
fly in
b
ili
a
ry
c
oli
c
.
3
.
A
tt
ac
ks
a
pp
ea
r
a
ft
e
r
c
onsumption of l
a
rg
e
foo
d
or foo
d
f
a
tty
a
t night
.
4
.
F
l
a
tul
e
ns
a
n
d
n
a
us
ea
C
hroni
c
l
e c
holositis
1
.
Me
n
'
s
d
ig
e
stiv
e d
isor
de
r
2
.
Re
p
ea
t
ed a
tt
ac
k
b
ut not striking
.
3
.
Na
us
ea
,
vomiting
a
n
d
not
bea
ring f
a
tty foo
d
4
.
S
tom
ac
h p
a
in is not
c
l
ea
rly
acc
omp
a
ni
ed b
y
be
ing n
a
k
ed
.
R
isk f
ac
tor
1
.
W
om
e
n
2
.
A
g
e
>
40
y
ea
rs
3
.
O
ft
e
n
c
onsuming f
a
tty foo
d
s
4
.
T
h
e
r
e
is
a
history of
ac
ut
e c
hol
ec
ystitis
be
for
e
.
S
impl
e
insp
ec
tion
a
n
d
support r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
I
kt
e
rik if th
e ca
us
e
of th
e
ston
e
in th
e e
xtr
a
h
e
p
a
ti
c b
il
e d
u
c
t
2
.
T
hi
c
k g
a
ll
b
l
adde
r m
a
ss
3
.
P
r
e
ssur
e
p
a
in
acc
omp
a
ni
ed b
y lo
ca
l p
e
ritonitis signs
,
a
positiv
e
murphy sign
S
upport
B
loo
d
l
ab
or
a
tori
e
s show l
e
uko
c
ytosis
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
T
h
e d
i
a
gnosis is
e
nfor
ced b
y
a
n
a
mn
e
sis
,
physi
ca
l
e
x
a
min
a
tion
,
a
n
d
Lab
or
a
tory
e
x
a
min
a
tion
.
D
i
a
gnosis of
A
pp
ea
l
A
ngin
a
p
ec
toris
,
ac
ut
e a
pp
e
n
d
i
c
itis
,
p
e
rfor
a
tion p
e
pti
c
ul
ce
r
,
ac
ut
e
p
a
n
c
r
ea
titis
C
ompli
ca
tions
Ga
mp
e
r or g
a
ll
b
l
adde
r
e
mpi
e
m
a
,
g
a
ll
b
l
adde
r p
e
rfor
a
tion
,
Ge
n
e
r
a
l
Pe
ritonitis
,
L
iv
e
r
Ab
s
e
s
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
L
ooks on
bed
2
.
Fa
sting
3
.
I
nst
a
ll
a
tion of infusion
4
.
P
rovision of
a
nti
-
p
a
in
a
n
d a
nti
-
n
a
us
ea
5
.
G
iving
a
nti
b
ioti
c
s
:
a
.
Pe
ni
c
illin group
:
a
mpi
c
illin inj
ec
tion
500
mg
/
6
hours
a
n
d a
moxylin
500
mg
/
8
hours
IV
,
or
b
r
ea
kf
a
st
.
Se
f
a
losporin
:
Se
phtri
a
kson
1
gr
a
m
/
12
hours
,
Se
fot
a
ksim
1
gr
a
m
/
8
hours
,
or
C
..
Me
troni
da
zol
e
500
mg
/
8
hours
C
ouns
e
ling
a
n
d ed
u
ca
tion
Fa
mili
e
s
a
r
e a
sk
ed
to support p
a
ti
e
nts to un
de
rgo
a
low
-
f
a
t
d
i
e
t
a
n
d
los
e
w
e
ight
.
F
ollow up pl
a
n
1
.
I
n p
a
ti
e
nts who h
a
v
e e
xp
e
ri
e
n
ced ac
ut
e c
hol
ec
ystitis
a
n
d
T
h
e
g
a
ll
d
om h
a
s not
bee
n
a
ppoint
ed
th
e
n r
ed
u
ce
s f
a
t int
a
k
e
a
n
d
los
e
w
e
ight must
be
s
ee
n wh
e
th
e
r
c
hol
ec
ystitis o
cc
urr
ed
Ac
ut
e
r
ec
urring
.
2
.
I
t shoul
d be
s
ee
n th
e
r
e
is no in
d
i
ca
tion for surg
e
ry
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
Pa
ti
e
nts who h
a
v
e d
i
a
gnos
ed c
hol
ec
ystitis
a
r
e
r
e
f
e
rr
ed
to th
e
s
e
rvi
ce
(
I
nn
e
r
d
is
ea
s
e
sp
ec
i
a
list
)
W
h
e
r
ea
s if th
e
r
e a
r
e
in
d
i
ca
tions for surg
e
ry
Pa
ti
e
nts
a
r
e a
lso r
e
f
e
rr
ed
to surg
e
ons
.
E
quipm
e
nt
Lab
or
a
tory for r
e
gul
a
r
b
loo
d c
h
ec
ks
Ac
ut
e a
pp
e
n
d
i
c
itis
Hea
lth pro
b
l
e
ms
Ac
ut
e a
pp
e
n
d
i
c
itis is infl
a
mm
a
tion th
a
t
a
ris
e
s su
dde
nly in
a
pp
e
n
d
ik
,
is on
e
of th
e ac
ut
e abd
omin
a
l
ca
s
e
s th
a
t
a
r
e
most oft
e
n
e
n
c
ount
e
r
ed
,
a
n
d
if
N
ot
add
r
e
ss
ed ca
n imm
ed
i
a
t
e
ly
ca
us
e
p
e
rfor
a
tions
.
Ca
us
e
:
1
.
L
um
e
n o
b
stru
c
tion is
a
f
ac
tor of th
e d
omin
a
nt
ca
us
e
s of
ac
ut
e a
pp
e
n
d
i
c
itis
2
.
I
nt
e
stin
a
l mu
c
os
a e
rosion
beca
us
e
of th
e
p
a
r
a
sit
e e
nt
a
mo
eba
hystoliti
ca a
n
d
for
e
ign o
b
j
ec
ts
oth
e
r
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
L
ow
e
r right
abd
omin
a
l p
a
in
,
a
t first th
e e
pig
a
stri
c a
r
ea
th
e
n spr
ead
to
MC B
urn
e
y
.
W
h
a
t if th
e
r
e
h
a
s
bee
n infl
a
mm
a
tion
(>
6
hours
)
suff
e
r
e
rs
ca
n
shows th
e
lo
ca
tion of th
e a
rt of
be
ing som
a
ti
c
.
C
lini
ca
l symptoms
1
.
V
omiting
(
visu
a
l stimuli
)
d
u
e
to th
e ac
tiv
a
tion of th
e
v
a
gus n
e
rv
e
.
2
.
A
nor
e
xi
a
,
n
a
us
ea a
n
d
vomitus
a
rising
a
f
e
w hours l
a
t
e
r
,
I
t is
a c
ontinu
a
tion of p
a
in th
a
t
a
ris
e
s
a
t th
e be
ginning
.
3
.
D
isuri
a a
lso
a
ris
e
s if th
e a
pp
e
n
d
ix infl
a
mm
a
tion is
c
los
e
to
Ve
sik
a
urin
a
ri
a
.
4
.
Ob
stip
a
tion
be
for
e
th
e c
oming of p
a
in
a
n
d
som
e
suff
e
r
e
rs
e
xp
e
ri
e
n
c
ing
d
i
a
rrh
ea
,
a
ris
e
s usu
a
lly on th
e
lo
ca
tion of th
e
p
e
lvi
ca
l
a
pp
e
n
d
ix
S
timul
a
t
e
th
e
r
ec
tum
a
r
ea
.
5
.
O
th
e
r symptoms
a
r
e
f
e
v
e
r th
a
t is not too high
,
n
a
m
e
ly th
e
t
e
mp
e
r
a
tur
e be
tw
ee
n
37
.
50
c
-
38
.
50
c b
ut if th
e
t
e
mp
e
r
a
tur
e
is high
e
r
,
it is thought to h
a
v
e bee
n
p
e
rfor
a
t
ed
.
6
.
Va
ri
a
tions in th
e
lo
ca
tion of th
e A
pp
e
n
d
ix
a
n
a
tomy will
e
xpl
a
in
c
ompl
a
ints of
som
a
ti
c
p
a
in
Va
rious
.
F
or
e
x
a
mpl
e a
long
a
pp
e
n
d
ix with th
e
tip
e
xp
e
ri
e
n
c
ing infl
a
mm
a
tion in th
e
low
e
r l
e
ft qu
ad
r
a
nt will
ca
us
e
p
a
in in
th
e a
r
ea
,
th
e
r
e
trro
ce
k
a
l
a
pp
e
n
d
ix will
ca
us
e
fl
a
nk p
a
in or
bac
k
,
p
e
lvi
ca
l
a
pp
e
n
d
ix will
ca
us
e
p
a
in in supr
a
pu
b
i
c
a
n
d
r
e
troil
ea
l
a
pp
e
n
d
ix
ca
n
ca
us
e
t
e
sti
c
ul
a
r p
a
in
,
m
a
y
be beca
us
e
irrit
a
tion to sp
e
rm
a
ti
ca
l
a
rt
e
ri
e
s
a
n
d
ur
e
t
e
rs
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
I
nsp
ec
tion
1
.
T
h
e
suff
e
r
e
r w
a
lks
b
ow whil
e
hol
d
ing his p
a
inful stom
ac
h
2
.
B
lo
a
t
ed
if p
e
rfor
a
t
ed
3
.
T
h
e
protrusion of th
e
low
e
r right stom
ac
h is s
ee
n in
A
pp
e
n
d
i
c
ul
a
r
ab
s
ce
ss
.
Pa
lp
a
tion
1
.
T
h
e
r
e
is
McB
urn
e
y
P
r
e
ss
Pa
in
2
.
T
h
e e
xist
e
n
ce
of
a
r
eb
oun
d
t
e
n
de
rn
e
ss
(
P
r
e
ss r
e
l
ea
s
e
p
a
in
)
3
.
T
h
e
pr
e
s
e
n
ce
of
de
f
a
ns mus
c
ul
a
r
4
.
R
ovsing positiv
e
sign
5
.
PSOAS
signpositiv
e
6
.
Ob
tur
a
tor signpositiv
e
Pe
r
c
ussion
Ke
tok p
a
in
(+)
A
us
c
ult
a
tion
N
orm
a
l p
e
rist
a
lsis
,
p
e
rist
a
lti
c d
o
e
s not
e
xist in p
a
r
a
lyti
c
ill
e
us
beca
us
e
of p
e
ritonitis
g
e
n
e
r
a
lis
a
t
a d
u
e
to p
e
rfor
a
t
ed a
pp
e
n
d
i
c
itis
.
Rec
t
a
l plug
Te
n
de
r p
a
in
a
t
9
-
12
Ge
n
e
r
a
l p
e
ritonitis
(
p
e
rfor
a
tion
):
1
.
Pa
in
a
ll
abd
omin
a
l
2
.
D
ou
b
l
e
loss is lost
3
.
noisy int
e
stin
e
s
d
is
a
pp
ea
r
A
pp
e
n
d
ix th
a
t h
a
s g
a
ngr
e
n
e
or p
e
rfor
a
tion mor
e
oft
e
n o
cc
urs with
S
ymptoms
a
s follows
:
1
.
P
rogr
e
ssiv
e
symptoms with mor
e
th
a
n
36
hours
d
ur
a
tion
2
.
H
igh f
e
v
e
r mor
e
th
a
n
38
.
5
o
C
3
.
Le
ko
c
ytosis
(
A
l mor
e
th
a
n
14
,
000
)
4
.
De
hy
d
r
a
tion
a
n
d ac
i
d
osis
5
.
DISTENCE
6
.
D
is
a
pp
ea
rn
e
ss of th
e b
ow
e
l nois
e
7
.
Pa
in
P
r
e
ss
e
s for th
e
low
e
r right qu
ad
r
a
nt
8
.
Reb
oun
d
t
e
n
de
rin
e
sssign
9
.
R
ovsingsign
10
.
P
r
e
ssing th
e e
ntir
e abd
omin
a
l fi
e
l
d
S
upport
1
.
C
ompl
e
t
e Pe
riph
e
r
a
l
B
loo
d Lab
or
a
tory
a
.
O
n
ac
ut
e a
pp
e
n
d
i
c
itis
,
70
-
90
%
of th
e
l
e
uko
c
yt
e
v
a
lu
e
l
ab
or
a
tory r
e
sults
a
n
d
Ne
utrophils will in
c
r
ea
s
e
.
b
r
ea
kf
a
st
.
I
n
c
hil
d
r
e
n
a
r
e acc
omp
a
ni
ed b
y
Le
ko
c
ytosis
11
,
000
-
14
,
000
/
MM
3
,
with
Ca
l
c
ul
a
t
e c
h
ec
ks
T
yp
e
shows th
e
l
e
ft shift n
ea
r
a
lmost
75
%
.
C
..
I
f th
e
num
be
r of l
e
ko
c
yt
e
s is mor
e
th
a
n
18
,
000
/
mm
3
th
e
n it is g
e
n
e
r
a
lly
a
lr
ead
y
Pe
ritonitis p
e
rfor
a
tion o
cc
urs
.
d
.
U
rin
a
ry
e
x
a
min
a
tion
ca
n
be
us
ed a
s
a c
onfirm
a
tion
a
n
d
Ge
t ri
d
of urologi
ca
l
ab
norm
a
liti
e
s th
a
t
ca
us
e abd
omin
a
l p
a
in
.
He
y
.
Mea
sur
e
m
e
nt of
HCG
l
e
v
e
ls wh
e
n susp
ec
t
ed ec
topi
c
pr
e
gn
a
n
c
y in wom
e
n
f
e
rtil
e a
g
e
.
2
.
P
l
a
in photo
abd
om
e
n
a
.
O
n
ac
ut
e a
pp
e
n
d
i
c
itis
,
pl
a
in
abd
omin
a
l photo
e
x
a
min
a
tion not mu
c
h
h
e
lp
.
b
r
ea
kf
a
st
.
T
h
e
f
ac
tory is wi
de
r
a
n
d
forming infiltr
a
t
e
s th
e
n th
e
int
e
stin
e
on
T
h
e b
ottom right will
c
oll
a
ps
e
.
C
..
Ede
m
a
tous int
e
stin
a
l w
a
lls
,
this situ
a
tion will
a
pp
ea
r on
T
h
e
low
e
r right
a
r
ea
is
e
mpty
abd
om
e
n from th
e a
ir
.
d
.
T
h
e a
ir
de
s
c
ription s
ee
ms to
be
push
ed
to
a
noth
e
r p
a
rty
.
He
y
.
T
h
e
pro
ce
ss of infl
a
mm
a
tion in th
e
right ili
ac
foss
a
will
ca
us
e
mus
c
l
e c
ontr
ac
tions so th
a
t s
c
oliosis
a
ris
e
s to th
e
right
.
f
.
I
f th
e
r
e
h
a
s
bee
n
a
p
e
rfor
a
tion
,
th
e
n on th
e abd
om
e
n photo it will
e
r
ec
t
L
ooks fr
ee a
ir un
de
r th
e d
i
a
phr
a
gm
. \
g
.
P
l
a
in photo of supin
e abd
om
e
n on
a
pp
e
n
d
i
c ab
s
ce
ss
e
s som
e
tim
e
s
G
iv
e a
p
a
tt
e
rn of
a
ir spots
a
n
d
flui
d
w
a
t
e
r l
e
v
e
ls in th
e
st
a
n
d
/
LLD
position
(
De
ku
b
itus
),
ca
l
c
ifi
ca
tion of rim
-
lik
e
(
c
ir
c
ul
a
r
)
spots
a
roun
d
p
e
riph
e
r
a
l
M
uko
ce
ll
a
whi
c
h origin
a
t
e
s from
A
pp
e
n
d
i
c
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
H
istory of
d
is
ea
s
e a
n
d
physi
ca
l
e
x
a
min
a
tion is still
a d
i
a
gnosis
ba
sis
Ac
ut
e a
pp
e
n
d
i
c
itis
.
D
i
a
gnosis of
A
pp
ea
l
1
.
Ac
ut
e c
hol
ec
ystitis
2
.
D
iv
e
rtik
e
lm
ac
k
e
lli
3
.
Re
gion
a
l
E
nt
e
ritis
4
.
Pa
n
c
r
ea
titis
5
.
U
r
e
t
e
r ston
e
6
.
C
ystitis
7
.
Ec
topi
c
pr
e
gn
a
n
c
y is
d
istur
bed
(
k
e
t
)
8
.
Ac
ut
e
s
a
lpingitis
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Pa
ti
e
nts who h
a
v
e bee
n
d
i
a
gnosis
A
kuth
a
rus
A
pp
e
n
d
i
c
itis
a
r
e
imm
ed
i
a
t
e
ly r
e
f
e
rr
ed
to s
e
rvi
ce
Sec
on
da
ry to
C
ito op
e
r
a
tions
.
Ma
n
a
g
e
m
e
nt in prim
a
ry h
ea
lth s
e
rvi
ce
s
be
for
e be
ing r
e
f
e
rr
ed
to
:
1
.
Bed
r
e
st
T
ot
a
l
F
owl
e
r
P
osition
(
A
nti
T
r
a
n
de
l
e
n
b
urg
)
2
.
Pa
ti
e
nts with
a
ll
e
g
ed a
pp
e
n
d
i
c
itis shoul
d
not
be
giv
e
n
a
nything
b
y mouth
.
3
.
T
h
e
p
a
ti
e
nt n
eed
s intr
a
v
e
nous liqui
d
to
c
orr
ec
t if th
e
r
e
is
de
hy
d
r
a
tion
.
4
.
Na
sog
a
stri
c
pip
e
s
a
r
e
inst
a
ll
ed
to
e
mpty th
e
stom
ac
h so th
a
t
Red
u
ce
s
abd
omin
a
l
d
ist
e
nsion
a
n
d
pr
e
v
e
nts vomiting
.
C
ompli
ca
tions
1
.
A
pp
ea
r
a
n
ce
of
A
pp
e
n
d
ix
2
.
Ge
n
e
r
a
l
Pe
ritonitis
3
.
Se
psis
Re
f
e
r
e
n
ce c
rit
e
ri
a
D
i
a
gnos
ed
p
a
ti
e
nts must
be
r
e
f
e
rr
ed
to s
ec
on
da
ry s
e
rvi
ce
s for
C
ito op
e
r
a
tion is
ca
rri
ed
out
.
E
quipm
e
nt
Lab
otorium for
c
ompl
e
t
e
p
e
riph
e
r
a
l
b
loo
d c
h
ec
ks
Pe
ritonitis
Hea
lth pro
b
l
e
ms
Pe
ritonitis is infl
a
mm
a
tion of p
e
riton
e
um
.
Pe
ritonitis
ca
n
be ca
us
ed b
y
ab
norm
a
liti
e
s in th
e abd
om
e
n in th
e
form of infl
a
mm
a
tion
a
n
d c
ompli
ca
tions for
e
x
a
mpl
e
Pe
rfor
a
tion of
a
pp
e
n
d
i
c
itis
,
g
a
stri
c
ul
ce
r p
e
rfor
a
tion
,
typhus p
e
rfor
a
tion
abd
omin
a
lis
.
I
l
e
us
o
b
stru
c
tiv
e a
n
d b
l
eed
ing
beca
us
e
of hollow org
a
l p
e
rfor
a
tions
beca
us
e
Abd
omin
a
l tr
a
um
a
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
G
r
ea
t p
a
in in th
e abd
om
e
n th
a
t is f
e
lt
c
ontinuously
d
uring
a
f
e
w hours
,
ca
n only
be
in on
e
pl
ace
or spr
ead
throughout
th
e abd
om
e
n
.
T
h
e
int
e
nsity of p
a
in is strong
e
r wh
e
n th
e
p
a
ti
e
nt mov
e
s lik
e
R
o
ad
,
b
r
ea
th
e
,
c
ough
,
or str
a
t
e
ingly
.
2
.
I
f th
e
r
e
h
a
s
bee
n
bac
t
e
ri
a
l p
e
ritonitis
,
th
e
p
a
ti
e
nt
'
s
b
o
d
y t
e
mp
e
r
a
tur
e
will ris
e a
n
d
Ta
kik
d
i
a
o
cc
urr
ed
,
hypot
e
nsion
a
n
d
suff
e
r
e
rs look
ed
l
e
tigik
a
n
d
sho
c
k
ed
.
3
.
Na
us
ea a
n
d
vomiting
a
ris
e d
u
e
to th
e
p
a
thologi
ca
l
d
isor
de
r of th
e V
isor
'
s org
a
ns
or
d
u
e
to irrit
a
tion of th
e
on
e
um
.
4
.
D
iffi
c
ulty
b
r
ea
thing is
ca
us
ed b
y th
e
pr
e
s
e
n
ce
of liqui
d
s in
abd
omin
a
l
,
whi
c
h
ca
n push th
e d
i
a
phr
a
gm
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
T
h
e
p
a
ti
e
nt looks l
e
tigik
a
n
d
in p
a
in
2
.
Ca
n
be
foun
d
f
e
v
e
r
3
.
Abd
om
e
n
d
ist
e
nsion
acc
omp
a
ni
ed b
y t
e
n
de
rn
e
ss
a
n
d abd
omin
a
l r
e
l
ea
s
e
p
a
in
4
.
De
f
a
ns
M
us
c
ul
a
r
5
.
H
yp
e
rtimp
a
y
a
n on th
e abd
omin
a
l p
e
r
c
ussion
6
.
T
h
e
h
ea
rt
ca
n
d
is
a
pp
ea
r
d
u
e
to fr
ee a
ir un
de
r th
e d
i
a
phr
a
gm
7
.
T
h
e b
ow
e
l noisin
e
ss
dec
r
ea
s
e
s or
d
is
a
pp
ea
rs
8
.
Abd
omin
a
l rigi
d
ity or oft
e
n
ca
ll
ed b
o
a
r
d
stom
ac
h
9
.
A
t th
e
r
ec
t
a
l plug it will f
ee
l p
a
in in
a
ll
d
ir
ec
tions
,
with ton
e
ton
e
M
us
c
ulus
S
fingt
e
r
A
ni
dec
r
ea
s
e
s
a
n
d a
mpul
a
s of r
e
gul
a
t
e
s
c
ont
a
ining
a
ir
.
S
upport
S
upporting
c
h
ec
ks
a
r
e
not
ca
rri
ed
out in prim
a
ry s
e
rvi
ce
s to
a
voi
d
De
l
a
y in
d
oing r
e
f
e
r
e
n
ce
s
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
T
h
e d
i
a
gnosis is
e
nfor
ced ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion of typi
ca
l
t
a
n
da
t
a
n
da
foun
d
in p
a
ti
e
nts
.
D
i
a
gnosis of
A
pp
ea
l
: -
C
ompli
ca
tions
1
.
Se
pti
ce
mi
a
2
.
S
ho
c
k
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
Pa
ti
e
nts
a
r
e
imm
ed
i
a
t
e
ly r
e
f
e
rr
ed
to
a
ft
e
r th
e e
nfor
ce
m
e
nt of
d
i
a
gnosis
a
n
d
initi
a
l
m
a
n
a
g
e
m
e
nt
A
s follows
:
1
.
I
mprov
e
th
e
g
e
n
e
r
a
l st
a
t
e
of th
e
p
a
ti
e
nt
2
.
Pa
ti
e
nts f
a
sting
3
.
Dec
ompr
e
ssion of th
e d
ig
e
stion with n
a
sog
a
stri
c
or int
e
stin
a
l pip
e
s
4
.
L
ost flui
d a
n
d e
l
ec
trolyt
e
r
e
pl
ace
m
e
nt m
ade
intr
a
v
e
nous
5
.
P
rovision of intr
a
v
e
nous
e
xt
e
nsiv
e
sp
ec
trum
a
nti
b
ioti
c
s
.
6
.
Ac
tions to
e
limin
a
t
e
p
a
in
a
voi
d
d
isguis
ed
Re
f
e
r
e
n
ce c
rit
e
ri
a
Re
f
e
r to s
ec
on
da
ry s
e
rvi
ce
s th
a
t h
a
v
e
surg
e
ons
.
E
quipm
e
nt
Na
sog
a
stri
c T
u
be
Pa
rotitis
Hea
lth pro
b
l
e
ms
Pa
rotitis is infl
a
mm
a
tion in th
e
p
a
roti
d
gl
a
n
d
.
Pa
rotitis
ca
n
be ca
us
ed
b
y vir
a
l inf
ec
tions
,
bac
t
e
ri
a
l inf
ec
tions
,
or
a
utoimmun
e ab
norm
a
liti
e
s
,
with
de
gr
ee
s
ab
norm
a
liti
e
s th
a
t v
a
ry from mil
d
to s
e
v
e
r
e
.
O
n
e
of th
e
virus inf
ec
tions on
p
a
roti
ca
l gl
a
n
d
,
n
a
m
e
ly p
a
rotitis mumps
(
gon
d
ong
a
n
)
oft
e
n foun
d
on
P
rim
a
ry s
e
rvi
ce a
n
d
pot
e
nti
a
lly
ca
us
e a
n
e
pi
de
mi
c
in th
e c
ommunity
.
D
o
c
tor
a
t
P
rim
a
ry h
ea
lth s
e
rvi
ce
s
ca
n pl
a
y
a
rol
e
in t
ac
kling p
a
rotitis
M
umps
b
y m
a
king
ade
qu
a
t
e d
i
a
gnosis
a
n
d
m
a
n
a
g
e
m
e
nt
a
n
d
I
n
c
r
ea
s
e
pu
b
li
c a
w
a
r
e
n
e
ss of immuniz
a
tion
,
e
sp
ec
i
a
lly
MMR
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
Pa
rotitis
M
umps
a
.
S
w
e
lling in th
e a
r
ea
in front of th
e ea
r to th
e
low
e
r j
a
w
b
r
ea
kf
a
st
.
S
woll
e
n swoll
e
n su
dde
nly
C
..
Pa
in in th
e
swoll
e
n
a
r
ea
d
.
Ac
ut
e
ons
e
t
,
usu
a
lly
<
7
da
ys
He
y
.
C
onstitution
a
l symptoms
:
m
a
l
a
is
e
,
a
nor
e
xi
a
,
f
e
v
e
r
f
.
U
su
a
lly
b
il
a
t
e
r
a
l
,
b
ut it
ca
n
a
lso
be
unil
a
t
e
r
a
l
2
.
Ac
ut
e bac
t
e
ri
a
l p
a
rotitis
a
.
S
w
e
lling in th
e a
r
ea
in front of th
e ea
r to th
e
low
e
r j
a
w
b
r
ea
kf
a
st
.
S
woll
e
n progr
e
ssiv
e
progr
e
ss
C
..
Ac
ut
e
ons
e
t
,
usu
a
lly
<
7
da
ys
d
.
Fe
v
e
r
He
y
.
Pa
in wh
e
n
c
h
e
wing
3
.
HIV
p
a
rotitis
a
.
S
w
e
lling in th
e a
r
ea
in front of th
e ea
r to th
e
low
e
r j
a
w
b
r
ea
kf
a
st
.
N
ot
acc
omp
a
ni
ed b
y p
a
in
C
..
Ca
n
a
lso
be a
symptom
a
ti
c
4
.
Pa
rotitis tu
be
r
c
ulosis
a
.
S
w
e
lling in th
e a
r
ea
in front of th
e ea
r to th
e
low
e
r j
a
w
b
r
ea
kf
a
st
.
C
hroni
c
ons
e
t
C
..
N
ot
acc
omp
a
ni
ed b
y p
a
in
d
.
Acc
omp
a
ni
ed b
y oth
e
r symptoms of tu
be
r
c
ulosis
5
.
A
utoimmun
e Pa
rotitis
(
S
jogr
e
n
S
yn
d
rom
e
)
a
.
S
w
e
lling in th
e a
r
ea
in front of th
e ea
r to th
e
low
e
r j
a
w
b
r
ea
kf
a
st
.
C
hroni
c
or r
ec
urr
e
nt ons
e
t
C
..
N
ot
acc
omp
a
ni
ed b
y p
a
in
d
.
Ca
n
be
unil
a
t
e
r
a
l or
b
il
a
t
e
r
a
l
He
y
.
S
ymptoms of
S
jogr
e
n
S
yn
d
rom
e
,
for
e
x
a
mpl
e d
ry mouth
,
d
ry
e
y
e
s
f
.
T
h
e ca
us
e
of oth
e
r p
a
rotitis h
a
s
bee
n r
e
mov
ed
R
isk f
ac
tor
1
.
C
hil
d
r
e
n
a
g
ed
2
-
12
y
ea
rs is th
e
most
c
ommon group suff
e
ring
p
a
rotitis mumps
2
.
MMR
h
a
s not y
e
t
bee
n immuniz
ed
3
.
I
n th
e ca
s
e
of p
a
rotitis
M
umps
,
th
e
r
e
is
a
history of suff
e
r
e
rs
th
e
s
a
m
e be
for
e a
roun
d
th
e
p
a
ti
e
nt
4
.
I
mmuno
de
fi
c
i
e
n
c
y
c
on
d
itions
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
Ge
n
e
r
a
l
c
on
d
itions
ca
n v
a
ry from
a
pp
ea
ring mil
d
to w
e
ight
2
.
T
h
e
t
e
mp
e
r
a
tur
e
in
c
r
ea
s
e
s in th
e ca
s
e
of inf
ec
tion p
a
rotitis
3
.
I
n th
e
pr
ea
uri
c
ul
a
r
a
r
ea
(
p
a
roti
d
gl
a
n
d
lo
ca
tion
),
th
e
r
e
:
a
.
Ede
m
a
b
r
ea
kf
a
st
.
E
ryth
e
m
a
C
..
Te
n
de
r p
a
in
(
not in th
e ca
s
e
of
HIV
p
a
rotitis
,
tu
be
r
c
ulosis
,
a
n
d
a
utoimmun
e
)
4
.
I
n th
e ca
s
e
of
ac
ut
e bac
t
e
ri
a
l p
a
rotitis
,
if th
e
p
a
roti
d b
un
d
ing m
a
s
a
s
e
F
rom th
e
post
e
rior
d
ir
ec
tion to th
e a
nt
e
rior
,
th
e P
urul
e
n s
a
liv
a
ry
a
pp
ea
rs out of th
e
d
u
c
tor
p
a
rotis
.
S
upport
I
n most
ca
s
e
s p
a
rotitis
,
supporting
e
x
a
min
a
tions usu
a
lly
d
on
'
t
r
e
quir
ed
.
S
upporting
c
h
ec
ks
ca
n
be
m
ade
to
de
t
e
rmin
e
e
tiology in
ca
s
e
s of
bac
t
e
ri
a
l or p
a
rotitis p
a
rotitis
d
u
e
to syst
e
mi
c d
is
ea
s
e
s
ce
rt
a
in
,
for
e
x
a
mpl
e HIV
,
S
jogr
e
n
S
yn
d
rom
e
,
T
u
be
r
c
ulosis
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
T
h
e d
i
a
gnosis of p
a
rotitis is
e
nfor
ced ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
C
ompli
ca
tions
1
.
Pa
rotitis
M
umps
ca
n
ca
us
e c
ompli
ca
tions in th
e
form of
:
e
pi
d
i
d
imitis
,
O
rkitis
,
or
a
trophy of t
e
sti
c
l
e
s
(
in m
e
n
),
oov
a
ritis
(
in wom
e
n
),
dea
fn
e
ss
,
myo
ca
r
d
itis
,
thyroi
d
itis
,
p
a
n
c
r
ea
titis
,
e
n
ce
ph
a
litis
,
n
e
uritis
2
.
Pe
rm
a
n
e
nt
da
m
a
g
e
to th
e
p
a
roti
d
gl
a
n
d
th
a
t
ca
us
e
s int
e
rf
e
r
e
n
ce
T
h
e
fun
c
tion of th
e Sa
liv
a
s
ec
r
e
tion
a
n
d
furth
e
r in
c
r
ea
s
e
s th
e
risk of inf
ec
tion
a
n
d de
nt
a
l
ca
ri
e
s
.
3
.
A
utoimmun
e
p
a
rotitis is
a
sso
c
i
a
t
ed
with in
c
r
ea
s
ed
in
c
i
de
n
ce
of lymphom
a
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
Pa
rotitis
M
umps
a
.
N
onm
ed
ik
a
m
e
ntos
a
Pa
ti
e
nts n
eed
to r
e
st
e
nough
S
uffi
c
i
e
nt hy
d
r
a
tion
N
utritious nutrition
a
l int
a
k
e
b
r
ea
kf
a
st
.
Med
i
ca
l
T
r
ea
tm
e
nt is symptom
a
ti
c
(
a
ntipyr
e
ti
c
,
a
n
a
lg
e
si
c
)
2
.
Ac
ut
e bac
t
e
ri
a
l p
a
rotitis
a
.
N
onm
ed
ik
a
m
e
ntos
a
Pa
ti
e
nts n
eed
to r
e
st
e
nough
S
uffi
c
i
e
nt hy
d
r
a
tion
N
utritious nutrition
a
l int
a
k
e
b
r
ea
kf
a
st
.
Med
i
ca
l
A
nti
b
ioti
c
s
SIMT
om
a
ti
c
(
a
ntipyr
e
ti
c
,
a
n
a
lg
e
si
c
)
3
.
Pa
rotitis
d
u
e
to syst
e
mi
c d
is
ea
s
e
s
(
HIV
,
T
u
be
r
c
ulosis
,
S
jogr
e
n
S
yn
d
rom
e
)
N
ot
e
xpl
a
in
ed
in this s
ec
tion
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
E
xpl
a
n
a
tion of th
e d
i
a
gnosis
,
ca
us
e
s
,
a
n
d
m
a
n
a
g
e
m
e
nt pl
a
n
.
2
.
E
xpl
a
n
a
tion of th
e
import
a
n
ce
of m
a
int
a
ining th
e ade
qu
ac
y of hy
d
r
a
tion
a
n
d
hygi
e
n
e
or
a
l
.
3
.
Pe
opl
e
n
eed
to g
e
t
ade
qu
a
t
e
inform
a
tion
ab
out
T
h
e
import
a
n
ce
of
MMR
immuniz
a
tion to pr
e
v
e
nt p
a
rotitis mumps
e
pi
de
mi
c
s
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
Pa
rotitis with
c
ompli
ca
tions
2
.
Pa
rotitis
d
u
e
to syst
e
mi
c ab
norm
a
liti
e
s
,
su
c
h
a
s
HIV
,
T
u
be
r
c
ulosis
,
a
n
d S
jogr
e
n
syn
d
rom
e
.
P
rognosis
1
.
Ad V
it
a
m
:
B
on
a
m
2
.
Ad F
un
c
tion
a
m
:
B
on
a
m
3
.
Ad Sa
n
a
tion
a
m
:
B
on
a
m
E
quipm
e
nt
1
.
T
h
e
rmom
e
t
e
r
2
.
G
l
a
ss mouth
A
s
ca
rizis
(
b
r
ace
l
e
t worm inf
ec
tion
)
Hea
lth pro
b
l
e
ms
A
s
ca
ri
a
sis is
a d
is
ea
s
e ca
us
ed b
y p
a
r
a
siti
c
inf
e
st
a
tion
A
s
ca
ris lum
b
ri
c
oi
de
s
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Dec
r
ea
s
ed a
pp
e
tit
e
,
b
ulging stom
ac
h
,
w
ea
k
,
p
a
l
e
,
dec
r
ea
s
ed b
o
d
y w
e
ight
,
Na
us
ea
,
vomiting
.
C
lini
ca
l symptoms
S
ymptoms th
a
t
a
ris
e
in suff
e
r
e
rs
ca
n
be ca
us
ed b
y
ad
ult worms
a
n
d
La
rv
a
migr
a
tion
.
D
isor
de
rs
beca
us
e
l
a
rv
ae
usu
a
lly o
cc
ur wh
e
n l
a
rv
ae a
r
e
in
de
m
a
n
d
.
O
n th
e
vuln
e
r
ab
l
e
p
e
opl
e
,
sm
a
ll
b
l
eed
ing o
cc
urs on th
e
w
a
ll of
a
lv
e
olus
a
n
d a
ris
e
D
isruption in th
e
lungs
acc
omp
a
ni
ed b
y
c
oughing
,
f
e
v
e
r
a
n
d e
osinophili
a
.
O
n photo thor
ac
s
a
pp
ea
r
ed
infiltr
a
t
e
th
a
t
d
is
a
pp
ea
r
ed
within
3
w
ee
ks
.
T
his situ
a
tion is
ca
ll
ed L
o
e
ffl
e
r
'
s syn
d
rom
e
.
D
isor
de
rs
ca
us
ed b
y
ad
ult worms
a
r
e
usu
a
lly mil
d
,
a
n
d
v
e
ry
De
p
e
n
d
ing on th
e
m
a
ny worms th
a
t inf
ec
t in th
e
int
e
stin
e
.
S
om
e
tim
e
s
suff
e
r
e
rs
e
xp
e
ri
e
n
ce
symptoms of int
e
stin
a
l
d
isor
de
rs su
c
h
a
s n
a
us
ea
,
a
pp
e
tit
e
Red
u
ced
,
d
i
a
rrh
ea
,
or
c
onstip
a
tion
.
O
n s
e
v
e
r
e
inf
ec
tions
,
e
sp
ec
i
a
lly in
c
hil
d
r
e
n
ca
n o
cc
ur in m
a
l
ab
sorption so
I
nv
e
stig
a
t
e
th
e
st
a
t
e
of m
a
lnutrition
.
T
h
e
most promin
e
nt
c
lini
ca
l symptoms
a
r
e
d
is
c
omfort in th
e
stom
ac
h
,
ac
ut
e c
oli
c
in th
e e
pig
a
stri
c a
r
ea
,
t
a
st
e d
isor
de
r
Ea
t
,
d
i
a
rrh
ea
.
T
his usu
a
lly o
cc
urs
d
uring th
e
infl
a
mm
a
tion pro
ce
ss on
int
e
stin
a
l w
a
ll
.
I
n
c
hil
d
r
e
n this in
c
i
de
nt
ca
n
be
follow
ed b
y f
e
v
e
r
.
C
ompli
ca
tions
f
ea
r
ed
(
da
ng
e
rous
)
is wh
e
n
ad
ult worms spr
ead
to
a
noth
e
r pl
ace
(
M
igr
a
tion
)
a
n
d ca
us
e
s
ac
ut
e
symptoms
.
I
n th
e
st
a
t
e
of
a
h
ea
vy inf
ec
tion
,
M
ost f
ea
r
ed
if th
e
r
e
is
a
worm vomiting
,
whi
c
h will
be ab
l
e
to
ca
us
e
C
ompli
ca
tions for
c
losing
c
los
e
s
b
y
ad
ult worms
.
I
n
a
st
a
t
e
oth
e
rs
ca
n o
cc
ur
beca
us
e
of th
e b
lo
c
k
a
g
e
in th
e
int
e
stin
e b
y th
e
m
a
ss of worms
,
or
a
pp
e
n
d
i
c
itis
a
s
a
r
e
sult of th
e e
ntry of worms into th
e
lum
e
n
A
pp
e
n
d
ix
.
Ca
n
be
foun
d b
lo
c
k
a
g
e
of v
a
t
e
ri
a
mpull
a
or
b
il
e d
u
c
t
a
n
d
som
e
tim
e
s g
e
t into th
e
liv
e
r tissu
e
.
O
th
e
r symptoms
a
r
e a
t tim
e
s of in
c
u
ba
tion
a
n
d
wh
e
n worms
bec
om
e
ad
ults in th
e
sm
a
ll int
e
stin
e
,
whi
c
h r
e
sults of worm m
e
t
ab
olism
ca
n
r
a
is
e
s s
e
nsitiz
a
tion ph
e
nom
e
n
a
su
c
h
a
s urti
ca
ri
a
,
b
ron
c
hhi
a
l
a
sthm
a
,
Ac
ut
e c
onjun
c
tivitis
,
photopho
b
i
a a
n
d
som
e
tim
e
s h
e
m
a
turi
a
.
E
osinophili
a
10
%
or
mor
e
oft
e
n on inf
ec
tions with
a
s
ca
ris lum
b
ri
c
oi
de
s
,
b
ut this is not
de
s
c
ri
be
th
e
s
e
v
e
rity of th
e d
is
ea
s
e
,
b
ut mor
e de
s
c
ri
be
T
his s
e
nsitiz
a
tion
a
n
d e
osinophili
a
pro
ce
ss is not p
a
tognomist for
a
s
ca
ris inf
ec
tion
lum
b
ri
c
oi
de
s
.
R
isk f
ac
tor
1
.
Hab
it
d
o
e
s not w
a
sh h
a
n
d
s
.
2
.
Lac
k of l
a
trin
e
us
e
.
3
.
T
h
e
h
ab
it of using f
ece
s
a
s f
e
rtiliz
e
r
.
4
.
Hab
it
d
o
e
s not
c
los
e
th
e
foo
d
so th
a
t th
e
fli
e
s
a
r
e ca
rri
ed a
w
a
y
ca
rry th
e e
gg worm
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
V
it
a
l sign insp
ec
tion
2
.
B
o
d
y g
e
n
e
r
a
list insp
ec
tion
:
a
n
e
mi
c c
onjun
c
tiv
a
,
signs
Ma
lnutrition
,
abd
omin
a
l p
a
in if o
b
stru
c
tion o
cc
urs
.
S
upport
S
upporting
e
x
a
min
a
tion for this
d
is
ea
s
e
is to
d
o
Fac
t
c
h
ec
k
d
ir
ec
tly
.
T
h
e
pr
e
s
e
n
ce
of
e
ggs in th
e
stool
e
nsur
e
s
A
s
ca
ri
a
sis
d
i
a
gnosis
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
E
nfor
ce
m
e
nt
d
i
a
gnosis is
d
on
e
with
a
n
a
mn
e
sis
,
physi
ca
l
e
x
a
min
a
tion
a
n
d
T
h
e d
is
c
ov
e
ry of l
a
rv
ae
or worms in f
ece
s
.
A
pp
ea
l
d
i
a
gnosis
:
oth
e
r typ
e
s of
b
r
eed
ing
C
ompli
ca
tions
:
iron
de
fi
c
i
e
n
c
y
a
n
e
mi
a
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
G
iv
e
knowl
ed
g
e
to th
e c
ommunity for th
e
import
a
n
ce
of
c
l
ea
nlin
e
ss
Se
lf
a
n
d e
nvironm
e
nt
,
a
mong oth
e
rs
:
a
.
Ha
n
d
w
a
shing h
ab
its with so
a
p
a
n
d
running w
a
t
e
r
b
r
ea
kf
a
st
.
Mea
l
C
..
Eac
h f
a
mily h
a
s f
a
mily l
a
trin
e
s
d
.
D
o not us
e
f
ece
s
a
s f
e
rtiliz
e
r
He
y
.
T
h
e c
on
d
ition of th
e
hous
e a
n
d
th
e e
nvironm
e
nt is m
a
int
a
in
ed
to k
ee
p it
c
l
ea
n
a
n
d
not
moist
.
2
.
P
h
a
rm
ac
ologi
ca
l
a
.
P
ir
a
nt
e
l
Pa
mo
a
t
10
mg
/
kg
BB
/
da
y
,
singl
e d
os
e
,
or
b
r
ea
kf
a
st
.
Mebe
n
da
zol
,
a d
os
e
of
100
mg
,
twi
ce a da
y
,
is giv
e
n for thr
ee da
ys
in
a
row
,
or
C
..
A
l
be
n
da
zol
,
in
c
hil
d
r
e
n ov
e
r
2
y
ea
rs
ca
n
be
giv
e
n
2
t
ab
l
e
ts
(
400
mg
)
or
20
ml susp
e
nsion
,
singl
e d
os
e
.
Ma
y not
be
giv
e
n to th
e
moth
e
r
pr
e
gn
a
nt
T
r
ea
tm
e
nt
ca
n
be d
on
e
in
d
ivi
d
u
a
lly or m
a
ssly on
th
e c
ommunity
.
Re
quir
e
m
e
nts for
b
ulk tr
ea
tm
e
nt in
c
lu
de
:
1
.
Med
i
ca
tion is
ea
sily
acce
pt
ed
in th
e c
ommunity
2
.
S
impl
e
us
a
g
e
rul
e
s
3
.
Ha
v
e
minim
a
l si
de e
ff
ec
ts
4
.
P
olitiv
a
l
e
nt
,
so it
ca
n
be e
ffi
cac
ious to s
e
v
e
r
a
l typ
e
s
worms
5
.
P
ri
ce
s
a
r
e ea
sy to r
eac
h
C
ouns
e
ling
a
n
d ed
u
ca
tion
P
rovi
de
inform
a
tion to p
a
ti
e
nts
a
n
d
f
a
mili
e
s
ab
out th
e
import
a
n
ce
Ma
int
a
in s
e
lf
a
n
d e
nvironm
e
nt
a
l hygi
e
n
e
,
n
a
m
e
ly
:
1
.
Eac
h f
a
mily h
a
s f
a
mily l
a
trin
e
s
.
S
hit
H
um
a
ns
d
o not
ca
us
e
pollution to l
a
n
d a
roun
d
th
e e
nvironm
e
nt
O
ur r
e
si
de
n
ce
.
2
.
D
o not us
e
f
ece
s
a
s f
e
rtiliz
e
r
.
3
.
A
voi
d c
ont
ac
t with l
a
n
d c
ont
a
min
a
t
ed b
y hum
a
n f
ece
s
.
4
.
U
sing glov
e
s if you w
a
nt to m
a
n
a
g
e
w
a
st
e
/
w
a
st
e
.
5
.
Wa
sh h
a
n
d
s
be
for
e a
n
d a
ft
e
r
d
oing
ac
tiviti
e
s with
us
e
so
a
p
a
n
d
running w
a
t
e
r
.
6
.
T
h
e c
on
d
ition of th
e
hous
e a
n
d
th
e e
nvironm
e
nt is m
a
int
a
in
ed
to k
ee
p it
c
l
ea
n
a
n
d
not moist
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
: -
E
quipm
e
nt
S
impl
e
mi
c
ros
c
opi
c
l
ab
or
a
tory
e
quipm
e
nt for sp
ec
im
e
n
c
h
ec
ks
stool
.
A
nkilostomi
a
sis
(
min
e
worm inf
ec
tion
)
Hea
lth pro
b
l
e
ms
M
in
e
worms
a
r
e a d
is
ea
s
e ca
us
ed b
y
AMERICANUS ARTASITE NECORT AND ANCYLOSTOMENS DUODENALE
inf
e
st
a
tion
.
I
n
I
n
d
on
e
si
a
inf
ec
tion
b
y
N
.
A
m
e
ri
ca
nus is mor
e
oft
e
n foun
d c
omp
a
r
ed
I
nf
ec
tion
b
y
A
.
D
uo
de
n
a
l
e
.
T
his p
a
r
a
sit
e
hosp
e
s is hum
a
n
,
this worm
Ca
us
e
s
Nec
k
a
ti
a
sis
a
n
d A
nkilostomi
a
sis
.
I
t is
e
stim
a
t
ed a
t
a
roun
d
576
-
740
million p
e
opl
e
in th
e
worl
d a
r
e
inf
ec
t
ed
with min
e
worms
.
I
n
I
n
d
on
e
si
a
in
c
i
de
nt
T
h
e
high
e
st w
a
s foun
d e
sp
ec
i
a
lly in th
e c
ountrysi
de
,
e
sp
ec
i
a
lly pl
a
nt
a
tions
.
O
ft
e
n th
e
group of pl
a
nt
a
tion work
e
rs who
a
r
e d
ir
ec
tly r
e
l
a
t
ed
to
La
n
d
,
g
e
ts
a
n inf
ec
tion of mor
e
th
a
n
70
%
.
F
rom
a
stu
d
y it w
a
s foun
d
th
a
t
Ha
lf of
c
hil
d
r
e
n who h
a
v
e bee
n inf
ec
t
ed be
for
e
th
e a
g
e
of
5
y
ea
rs
,
90
%
I
nf
ec
t
ed a
t th
e a
g
e
of
9
y
ea
rs
.
I
nf
ec
tion int
e
nsity in
c
r
ea
s
e
s until th
e a
g
e
of
6
-
7
y
ea
r
a
n
d
th
e
n st
ab
l
e
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
La
rv
a
l migr
a
tion
1
.
W
h
e
n p
e
n
e
tr
a
ting th
e
skin
,
piog
e
ni
c bac
t
e
ri
a ca
n
be
in
c
lu
ded a
t th
e
tim
e
La
rv
ae
p
e
n
e
tr
a
t
e
th
e
skin
,
ca
using it
c
hing on th
e
skin
(
G
roun
d I
t
c
h
).
CREEPING ERUPTION
(
C
ut
a
n
e
ous
M
igr
a
nt
La
rv
a
),
g
e
n
e
r
a
lly
ca
us
ed b
y l
a
rv
ae
min
e
worms from
a
nim
a
ls su
c
h
a
s
ca
ts or
d
ogs
,
b
ut som
e
tim
e
s it
ca
n
be ca
us
ed b
y
a
n
A
m
e
ri
ca
nus n
eca
tor l
a
rv
ae
or
D
uo
de
n
a
l
e a
n
c
ylostom
a
.
2
.
W
h
e
n th
e
l
a
rv
ae
p
a
ss through th
e
lungs
,
pn
e
umonitis
ca
n o
cc
ur
,
b
ut not
We
ll oft
e
n
b
y lum
b
ri
c
oi
de
s
a
s
ca
ris l
a
rv
ae
.
W
orms
Ad
ult worms g
e
n
e
r
a
lly liv
e
in on
e
thir
d
of th
e
sm
a
ll int
e
stin
e a
n
d
a
tt
ac
h
ed
to th
e
int
e
stin
a
l mu
c
os
a
.
C
lini
ca
l symptoms th
a
t oft
e
n o
cc
ur
de
p
e
n
d
s on
light w
e
ight inf
ec
tion
;
th
e
gr
ea
t
e
r th
e c
lini
ca
l m
a
nif
e
st
a
tion inf
ec
tion th
a
t o
cc
urs
in
c
r
ea
singly striking lik
e
:
1
.
Ga
stro
-
int
e
stin
a
l
d
isor
de
rs
a
r
e a
nor
e
xi
a
,
n
a
us
ea
,
vomiting
,
d
i
a
rrh
ea
,
w
e
ight loss
,
p
a
in in th
e a
r
ea a
roun
d
th
e d
uo
de
num
,
j
e
junum
a
n
d
il
e
um
.
2
.
O
n l
ab
or
a
tory
e
x
a
min
a
tions
,
g
e
n
e
r
a
lly foun
d
hypo
c
hromi
c a
n
e
mi
a
mikrositik
.
3
.
I
n
c
hil
d
r
e
n
,
th
e
r
e
is
a
positiv
e c
orr
e
l
a
tion
be
tw
ee
n m
ed
ium inf
ec
tion
a
n
d
We
ight with th
e
l
e
v
e
l of
c
hil
d
int
e
llig
e
n
ce
.
I
f th
e d
is
ea
s
e
l
a
sts
c
hroni
c
,
symptom
a
ti
c
symptoms of
a
n
e
mi
a
will o
cc
ur
,
H
ipo
a
l
b
umin
e
mi
a
n
d ede
m
a
.
He
moglo
b
in is l
e
ss th
a
n
5
g
/
dL c
onn
ec
t
ed
with h
ea
rt f
a
ilur
e a
n
d
su
dde
n
dea
th
.
Pa
thog
e
n
e
sis
a
n
e
mi
a
on
T
h
e
min
e
of th
e
min
e
inf
ec
tion
de
p
e
n
d
s on
3
f
ac
tors
,
n
a
m
e
ly
:
1
.
I
ron
c
ont
e
nt in foo
d
2
.
I
ron r
e
s
e
rv
e
st
a
tus in th
e
p
a
ti
e
nt
'
s
b
o
d
y
3
.
I
nt
e
nsity
a
n
d
l
e
ngth of inf
ec
tion
R
isk f
ac
tor
1
.
Lac
k of us
e
of f
a
mily l
a
trin
e
s
2
.
T
h
e
h
ab
it of using f
ece
s
a
s f
e
rtiliz
e
r
3
.
D
o not us
e
footw
ea
r wh
e
n
c
ont
ac
ting th
e
l
a
n
d
4
.
Le
ss
a
n
d
h
ea
lthy living
be
h
a
vior
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
S
ymptoms
a
n
d c
lini
ca
l signs of min
e
worm inf
e
st
a
tions
de
p
e
n
d
on th
e
typ
e
W
orm sp
ec
i
e
s
,
th
e
num
be
r of worms
,
a
n
d
th
e
nutrition
a
l st
a
t
e
of th
e
p
a
ti
e
nt
.
P
hysi
ca
l
e
x
a
min
a
tion
1
.
Pa
l
e c
onjun
c
tiv
a
2
.
C
h
a
ng
e
s to th
e
skin
(
sol
e
s of th
e
f
ee
t
)
if m
a
ny l
a
rv
ae
p
e
n
e
tr
a
t
e
S
kin
,
r
e
f
e
rr
ed
to
a
s
G
roun
d I
t
c
h
.
S
upport
M
i
c
ros
c
opi
c e
x
a
min
a
tion on fr
e
sh f
ece
s foun
d e
ggs or l
a
rv
ae
or
Ad
ult worms
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
T
h
e d
i
a
gnosis is
e
nfor
ced b
y
a
n
a
mn
e
sis
,
physi
ca
l
e
x
a
min
a
tion
,
a
n
d
S
upporting
e
x
a
min
a
tion
.
C
l
a
ssifi
ca
tion
:
1
.
Nec
k
a
ti
a
sis
2
.
A
nkilostomi
a
sis
D
i
a
gnosis of
A
pp
ea
l
: -
C
ompli
ca
tions
:
A
n
e
mi
a
,
if it
ca
us
e
s
b
l
eed
ing
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
G
iv
e
knowl
ed
g
e
to th
e c
ommunity for th
e
import
a
n
ce
of
c
l
ea
nlin
e
ss
Se
lf
a
n
d e
nvironm
e
nt
,
a
mong oth
e
rs
:
a
.
Eac
h f
a
mily h
a
s f
a
mily l
a
trin
e
s
.
b
r
ea
kf
a
st
.
D
o not us
e
f
ece
s
a
s f
e
rtiliz
e
r
C
..
U
s
e
footw
ea
r
,
e
sp
ec
i
a
lly wh
e
n you
c
ont
ac
t with th
e
groun
d
.
2
.
P
h
a
rm
ac
ologi
ca
l
a
.
Ad
ministr
a
tion of
a
singl
e d
os
e
of pir
a
nt
e
l
10
mg
/
kg
BB
,
or
b
r
ea
kf
a
st
.
100
mg m
e
g
e
n
da
zol
e
,
2
x
a da
y
,
for
3
c
ons
ec
utiv
e da
ys
,
or
C
..
A
l
be
n
da
zol
e
for
c
hil
d
r
e
n ov
e
r
2
y
ea
rs
400
mg
,
singl
e d
os
e
,
wh
e
r
ea
s in sm
a
ll
e
r
c
hil
d
r
e
n
a
r
e
giv
e
n
a d
os
e
h
a
lf
.
N
ot giv
e
n to pr
e
gn
a
nt wom
e
n
.
C
r
ee
ping
e
ruption
:
T
opi
ca
l
T
i
abe
n
da
zol for
1
w
ee
k
.
F
or
C
ut
a
n
e
ous
Lae
v
a M
igr
a
ns
T
r
ea
tm
e
nt with
A
l
be
n
da
zol
400
mg for
5
c
ons
ec
utiv
e da
ys
.
d
.
S
ulf
a
sf
e
rosus
C
ouns
e
ling
a
n
d ed
u
ca
tion
P
rovi
de
inform
a
tion to p
a
ti
e
nts
a
n
d
f
a
mili
e
s
ab
out th
e
import
a
n
ce
Ma
int
a
in s
e
lf
a
n
d e
nvironm
e
nt
a
l hygi
e
n
e
,
n
a
m
e
ly
:
1
.
We
r
ec
omm
e
n
d eac
h f
a
mily h
a
v
e
f
a
mily l
a
trin
e
s
.
S
o th
a
t
hum
a
n w
a
st
e d
o
e
s not
ca
us
e
pollution on l
a
n
d a
roun
d
th
e
n
e
igh
b
orhoo
d
wh
e
r
e
w
e
liv
e
.
2
.
D
o not us
e
f
ece
s
a
s f
e
rtiliz
e
r
.
3
.
A
voi
d c
ont
ac
t with l
a
n
d c
ont
a
min
a
t
ed b
y hum
a
n f
ece
s
.
4
.
U
sing glov
e
s if you w
a
nt to m
a
n
a
g
e
w
a
st
e
/
w
a
st
e
.
5
.
Wa
sh h
a
n
d
s
be
for
e a
n
d a
ft
e
r ignoring
ac
tiviti
e
s with
us
e
so
a
p
a
n
d
running w
a
t
e
r
.
6
.
U
s
e
footw
ea
r wh
e
n you
c
ont
ac
t with th
e
groun
d
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
: -
E
quipm
e
nt
1
.
S
impl
e
mi
c
ros
c
opi
c
l
ab
or
a
tory
e
quipm
e
nt for insp
ec
tion
S
tool sp
ec
im
e
ns
.
2
.
S
impl
e
l
ab
or
a
tory
e
quipm
e
nt for routin
e b
loo
d c
h
ec
ks
.
P
rognosis
T
his
d
is
ea
s
e
g
e
n
e
r
a
lly h
a
s
a b
on
a
m prognosis
,
r
a
r
e
ly r
a
is
e
s
c
on
d
itions
h
ea
vy
c
lini
ca
l
,
unl
e
ss th
e
r
e
is
b
l
eed
ing in
a
long tim
e
so
A
n
e
mi
a
o
cc
urs
.
