{"id":9228,"date":"2020-04-23T04:32:00","date_gmt":"2020-04-23T01:32:00","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/examen-coproparazitologic\/"},"modified":"2026-02-18T23:16:30","modified_gmt":"2026-02-18T21:16:30","slug":"examen-coproparazitologic","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/examen-coproparazitologic\/","title":{"rendered":"\u041a\u043e\u043f\u0440\u043e\u043f\u0430\u0440\u0430\u0437\u0438\u0442\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u043e\u0435 \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435"},"content":{"rendered":"<p style=\"text-align: left;\"><em><strong>Informa\u0163ii generale \u015fi recomand\u0103ri pentru efectuarea examenului coproparazitologic<\/strong><\/em><\/p>\n<p style=\"text-align: justify;\">Prin acest examen este detectat\u0103 prezen\u0163a unor parazi\u0163i cu localizare intestinal\u0103, \u00een limitele impuse de ciclul biologic al fiec\u0103rui parazit:<em>\u00a0<\/em><\/p>\n<p style=\"text-align: justify;\"><strong>Protozoare<\/strong><em>: Giardia lamblia, Trichomonas intestinalis, Entamoeba spp<\/em>.,\u00a0<em>Blastocystis hominis<\/em><\/p>\n<p style=\"text-align: justify;\"><strong>Helmin\u0163i<\/strong><\/p>\n<ul style=\"text-align: justify;\">\n<li><u>Nematode<\/u>:<em>Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis, Strongyloides stercoralis<\/em><\/li>\n<li><em><u>Trematode<\/u><\/em><em>: Fasciola hepatica<\/em><\/li>\n<li><u>Cestode<\/u>:<em>Taenia spp., Hymenolepis nana<\/em>,\u00a0<em>Diphyllobotrium latum<\/em><sup>1;3;6<\/sup>.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Parazi\u0163ii intestinali sunt r\u0103sp\u00e2ndi\u0163ti ubicuitar, infest\u0103rile fiind mai frecvente \u00een zonele cu instala\u0163ii de ap\u0103 deficitare.<\/p>\n<p style=\"text-align: justify;\">Diareea, malnutri\u0163ia, anemia \u015fi obstruc\u0163ia intestinal\u0103 reprezint\u0103 c\u00e2teva din consecin\u0163ele infest\u0103rii cu parazi\u0163i intestinali. Protozoarele pot determina diaree \u015fi\/sau malabsorb\u0163ie at\u00e2t prin secre\u0163ia de toxine, c\u00e2t \u015fi prin invadarea sau doar aderarea la mucoasa intestinal\u0103 prin mecanisme necunoscute.<\/p>\n<p style=\"text-align: justify;\">Helmin\u0163ii (viermii intestinali) pot obstrua intestinul, determina s\u00e2nger\u0103ri sau interfera cu absorb\u0163ia intestinal\u0103 a substan\u0163elor nutritive. Larvele sau ou\u0103le pot disemina \u00een zone extraintestinale \u015fi induce inflamatie sau distructii tisulare.<\/p>\n<p style=\"text-align: justify;\">Unii parazi\u0163i din categor\u00eda protozoarelor sau helmintilor pot habita tractul intestinal al omului \u015fi animalelor f\u0103r\u0103 a provoca manifest\u0103ri clinice<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Pentru a cre\u015fte sensibilitatea clinic\u0103 a testului (mai ales c\u0103 unele elemente parazitare sunt eliminate intermitent), se recomand\u0103 3 examene succesive, la interval de 7 zile.<\/p>\n<p style=\"text-align: justify;\">Dup\u0103 tratarea unei parazitoze examenul coprologic de control se va efectua dup\u0103 un interval de timp variabil \u00een func\u0163ie de diagnostic. Astfel, dup\u0103 tratamentul unei infec\u0163ii cu protozoare, controlul se va efectua dup\u0103 3-4 s\u0103pt\u0103m\u00e2ni iar in infec\u0163iile cu helmin\u0163i dup\u0103 1-2 s\u0103pt\u0103m\u00e2ni<sup>1;3;5;6<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em><u>Giardia lamblia<\/u><\/em><\/strong>, cunoscut \u015fi ca\u00a0<em>Giardia intestinalis<\/em>\u00a0\u0438\u043b\u0438\u00a0<em>Giardia duodenalis<\/em>, este parazitul cel mai frecvent depistat la examenul coproparazitologic. Reprezint\u0103 un organism unicelular (protozoar) prev\u0103zut cu flageli care \u00eei asigur\u0103 mobilitatea. Este localizat \u00een intestinul sub\u0163ire (duoden \u015fi jejun) unde se ata\u015feaz\u0103 de microvilii enterocitelor prin intermediul unui disc adeziv. Datorit\u0103 multiplic\u0103rii sale extrem de rapide num\u0103rul elementelor parazitare poate dep\u0103\u015fi 1 milion\/cm. Consecin\u0163ele infest\u0103rii sunt astfel tulbur\u0103ri de digestie \u015fi absorb\u0163ie intestinal\u0103, cu spolierea treptat\u0103 a organismului-gazd\u0103 de substan\u0163ele nutritive necesare. De asemenea, parazitul poate acoperi mucoasa duodeno-jejunala pe suprafe\u0163e \u00eentinse constituind adev\u0103rate bariere mecanice care reduc \u015fi mai mult capacitatea de absorb\u0163ie a principiilor nutritive \u015fi a vitaminelor<sup>7<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Parazitul prezint\u0103 dou\u0103 forme de via\u0163\u0103:\u00a0<em>trofozoit<\/em>\u00a0sau stadiul vegetativ \u015fi\u00a0<em>chist<\/em>\u00a0sau stadiu de rezistenta. Are o \u00eenmul\u0163ire simpl\u0103 prin diviziune binar\u0103. Parazitul posed\u0103 un rezervor animal, format \u00een special din roz\u0103toare (castor, hamster, etc), dar \u015fi caine<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Boala se transmite pe cale digestiva (fecal-oral\u0103) prin m\u00e2ini murdare, consum de fructe \u015fi\/sau legume nesp\u0103late, precum \u015fi de apa contaminat\u0103 cu forma chistic\u0103 a parazitului. Cel mai frecvent sunt afecta\u0163i copiii mici din cre\u015fe \u015fi gr\u0103dini\u0163e, precum \u015fi rudele acestora. Infec\u0163ia se transmite cu u\u015furin\u0163\u0103 deoarece doza infectant\u0103 a chisturilor este redus\u0103 (~ 10 chisturi), chisturile sunt rezistente la clorinarea apei \u015fi pot supravie\u0163ui c\u00e2teva s\u0103pt\u0103m\u00e2ni \u00een apa rece, precum \u015fi din cauza existen\u0163ei rezervoarelor animale<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Dup\u0103 ingestie, procesul de dechistare are loc la nivelul duodenului \u015fi \u00een treimea proximal\u0103 a duodenului \u015fi jejunului sub ac\u0163iunea sucurilor digestive. Dechistarea este un proces rapid, termin\u00e2ndu-se \u00een 10 minute \u015fi este semnalat\u0103 de emergen\u0163a flagelilor ventrali, ie\u015firea acestora fiind urmat\u0103 de \u00eentreg trofozoitul. Trofozoitul se fixeaz\u0103 de enterocit, se hr\u0103ne\u015fte cu con\u0163inutul intestinal \u015fi, \u00een decurs de 15-30 minute de la dechistare, \u00eencepe s\u0103 se divid\u0103 prin fisiune binar\u0103. Pe m\u0103sura ce parazitul antrenat de fluxul intestinal este \u00eempins \u00een aval c\u0103tre colon, trofozoitul se autoprotejeaz\u0103 de microambientul local prin conversie \u00een forma chistic\u0103. Acesta va fi eliminat odat\u0103 cu materiile fecale \u00een exterior, constituind o nou\u0103 surs\u0103 de infec\u0163ie<sup>4;7<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Tabloul clinic include:<\/p>\n<ul style=\"text-align: justify;\">\n<li><em>infec\u0163ii silen\u0163ioase<\/em>(mai ales la adul\u0163i);<\/li>\n<li><em>giardioza acut\u0103<\/em>: boal\u0103 diareic\u0103 acut\u0103 combinat\u0103 cu un sindrom gazos \u015fi dispeptic biliar;<\/li>\n<li><em>giardioza cronic\u0103<\/em>: disconfort digestiv persistent, episoade diareice altern\u00e2nd cu tranzit intestinal normal sau chiar \u00eencetinit.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Malabsorb\u0163ia de diverse grade este o complica\u0163ie dezvoltat\u0103 \u00een aproximativ 10-15% dintre cazuri, at\u00e2t \u00een formele acute, c\u00e2t \u015fi cronice de boal\u0103. Al\u0103turi de aceasta pot ap\u0103rea alergodermii polimorfe complexe<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul giardiozei se stabile\u015fte cel mai frecvent prin examenul microscopic al materiilor fecale (depistarea chisturilor), precum \u015fi prin testul imunoenzimatic (identicarea antigenul Giardia \u00een scaun). Determinarea anticorpilor specifici nu prezint\u0103 utilitate datorit\u0103 persisten\u0163ei \u00eendelungate a acestora chiar \u015fi \u00een urma tratamentului eficace.<\/p>\n<p style=\"text-align: justify;\">\u00cen absen\u0163a instituirii tratamentului, chisturile continu\u0103 s\u0103 fie eliminate \u00een mediul inconjurator timp de s\u0103pt\u0103m\u00e2ni sau luni<sup>4;7<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Pentru depistarea purt\u0103torilor se recomand\u0103 controlul periodic al copiilor din colectivit\u0103\u0163i precum \u015fi al persoanelor care lucreaz\u0103 \u00een sectorul alimentar<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Entamoeba histolytic\u0103<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este o amoeb\u0103 intestinal\u0103 obligatoriu patogen\u0103, hematofag\u0103, capabil\u0103 s\u0103 invadeze \u0163esuturile intestinale \u015fi extraintestinale<sup>4<\/sup>. Reprezint\u0103 agentul etiologic al amibiazei, boal\u0103 cu evolu\u0163ie cronic\u0103 ce este endemic\u0103 \u00een regiunile tropicale \u015fi subtropicale umede, \u00een special \u00een India, Sri Lanka, Vietnam, Cambodgia, Indonezia, Malaezia.<\/p>\n<p style=\"text-align: justify;\">\u00cen Rom\u00e2nia se \u00eent\u00e2lnesc cazuri sporadice, de obicei \u00een mediu rural, \u00een focar, sau la persoane care au c\u0103l\u0103torit \u00een \u0163\u0103ri tropicale \u015fi nu au respectat regulile de igien\u0103<sup>7<\/sup>.<\/p>\n<p style=\"text-align: justify;\">E.\u00a0histolytica prezint\u0103 dou\u0103 forme morfologice:<em>trofozoit<\/em>sau stadiul vegetativ \u015fi\u00a0<em>chist<\/em>\u00a0sau stadiul de rezisten\u0163\u0103. Rezervorul de infec\u0163ie este reprezentat de omul purt\u0103tor de forme chistice. Transmiterea se face pe cale digestiv\u0103 prin intermediul m\u00e2inilor murdare sau prin consumul de alimente contaminate cu ajutorul unor artropode (mu\u015fte, g\u00e2ndaci de buc\u0103t\u0103rie). Transmiterea hidric\u0103 este rar\u0103, dar are un poten\u0163ial epidemic<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Parazitul se localizeaz\u0103 la nivelul colonului, \u00een special \u00een colonul descendent \u015fi sigmoid unde, datorit\u0103 efectului s\u0103u citolitic \u015fi proteolitic asupra \u0163esuturilor, determin\u0103 leziuni grave \u2013 abcese cu aspect de \u201ebuton de c\u0103ma\u015f\u0103\u201d; \u00een acest stadiu parazitul este hematofag. Tabloul clinic clasic este similar celui din dizenterie, cu scaune numeroase (15-20\/zi), s\u0103race cantitativ, \u00eenso\u0163ite de dureri abdominale \u015fi tenesme rectale care sunt refractare la tratamentul cu antibiotice uzuale.<\/p>\n<p style=\"text-align: justify;\">\u00cen absen\u0163a tratamentului, trofozoi\u0163ii de E. histolytica se pot r\u0103sp\u00e2ndi pe cale hematogen\u0103 la ficat, pl\u0103m\u00e2n sau creier, unde provoac\u0103 abcese amoebiene asociate cu un prognostic rezervat<sup>7<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul se bazeaz\u0103 pe examenul morfologic, coprocultur\u0103 pe medii difazice, metode imunologice de detectare a anticorpilor specifici pentru formele extraintestinale de boal\u0103.<\/p>\n<p style=\"text-align: justify;\">Examenul morfologic consta \u00een eviden\u0163ierea parazitului sub form\u0103 de trofozoit \u00een cursul stadiului acut, diareic de boal\u0103, sau sub forma de chist \u00een stadiile de acalmie sau de purtator de parazit. Diagnosticul morfologic poate fi practicat coproparazitologic (direct, pe probe concentrate sau pe frotiuri colorate) ori pe fragmente bioptice intestinale recoltate prin colonoscopie<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Entamoeba coli<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este o amib\u0103 comensal\u0103 care intr\u0103 \u00een alc\u0103tuirea florei intestinale normale, av\u00e2nd rolul de a men\u0163ine un echilibru \u00eentre diversele popula\u0163ii microbiene locale.<\/p>\n<p style=\"text-align: justify;\">Nu are capacitate invaziv\u0103 \u015fi nici nu este hematofag\u0103; prezint\u0103 ambele forme biologice de via\u0163\u0103 \u2013 trofozoit \u015fi chist \u2013 cu o \u00eenmul\u0163ire prin diviziune binar\u0103. Devine patogen\u0103 numai \u00een condi\u0163iile alter\u0103rii imunit\u0103\u0163ii locale, cel mai adesea dup\u0103 tratamente antibiotice prelungite. \u00cen aceste situa\u0163ii, se dezvolt\u0103 manifest\u0103ri de colit\u0103 cu tranzit intestinal accelerat \u015fi scaune mucoase, f\u0103r\u0103 s\u00e2nge sau puroi. Deseori apar \u015fi manifest\u0103ri cutanate de hipersenasibilizare.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul se bazeaz\u0103 pe examenul coproparazitologic, cu identificarea trofozoi\u0163ilor sau a mai mult de 5 forma\u0163iuni chistice parazitare pe c\u00e2mpul microscopic<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Blastocystis hominis<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este un protozoar cu taxonomie controversat\u0103, cu caractere biologice apropiate de fungi \u015fi cu multe neclarit\u0103\u0163i \u00een ceea ce prive\u015fte morfobiologia sa (\u00eenmul\u0163ire prin sciziparitate, sporulare sau \u00eenmugurire).<\/p>\n<p style=\"text-align: justify;\">Prezint\u0103 4 forme morfologice majore:<\/p>\n<ul style=\"text-align: justify;\">\n<li>forma vacuolar\u0103 \u2013 comensal\u0103, cel mai frecvent identificat\u0103, cu aspect de \u201crulment\u201d;<\/li>\n<li>forma amoeboidal\u0103 \u2013 identic\u0103 cu cea vacuolar\u0103, cu excep\u0163ia formei neregulate datorat\u0103 pseudopodelor; nucleii sunt pozi\u0163iona\u0163i central iar vacuolele sunt absente;<\/li>\n<li>forma granular\u0103 \u2013 considerat\u0103 forma oportunist\u0103; prezint\u0103 1-6 nuclei periferici iar citoplasma este ocupat\u0103 de numeroase granule de dimensiuni variabile;<\/li>\n<li>forma chistic\u0103 \u2013 controversata mult timp; existen\u0163a sa este \u00een prezent bine documentata, \u00eens\u0103 pentru a o identifica sunt necesare tehnici speciale de laborator.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Blastocystis hominis este un parazit cosmopolit, fiind \u00eent\u00e2lnit mai frecvent \u00een regiuni cu deficien\u0163e igienice; este comensal \u015fi cu poten\u0163ial oportunist fiind implicat \u00een infec\u0163ii severe la pacien\u0163ii imunodeprima\u0163i.<\/p>\n<p style=\"text-align: justify;\">Transmiterea parazitului se face pe cale digestiv\u0103 (m\u00e2ini murdare), interuman\u0103 (cu risc nosocomial accentuat \u00een special \u00een armat\u0103), hidric\u0103 (diareea turi\u015ftilor) \u015fi sexual-veneric\u0103 (homosexuali). Rezevorul animal de parazit a fost p\u00e2n\u0103 nu demult controversat, dar se accept\u0103 riscul zoonotic, cu prec\u0103dere de la porc, cal \u015fi rozatoare.<\/p>\n<p style=\"text-align: justify;\">Tabloul clinic al blastocystozei include tulbur\u0103ri de tranzit intestinal (alternarea constipa\u0163iei cu diareea) \u015fi alergodermiile.<\/p>\n<p style=\"text-align: justify;\">Examenul coproparazitologic reprezint\u0103 principala metoda de identificare a parazitului. Conform opiniei majorit\u0103\u0163ii speciali\u015ftilor, decelarea unui num\u0103r minim de 5 elemente parazitare pe c\u00e2mpul microscopic reprezint\u0103 criteriul de diferen\u0163iere \u00eentre comensalism \u015fi patogenicitate<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Ascaris lumbricoides<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este un vierme cilindric (nematod) specific omului, cu dezvoltare obligatorie pe sol (geohelmint) \u015fi r\u0103sp\u00e2ndire ubicuitar\u0103. Prezint\u0103 dimorfism sexual, femela av\u00e2nd dimensiuni de 25-31 cm \u015fi masculul de 15-25 cm.<\/p>\n<p style=\"text-align: justify;\">Ascaridioza constituie una din bolilele parazitare frecvent \u00eent\u00e2lnite \u00een mediu rural \u015fi mai pu\u0163in \u00een cel urban.<\/p>\n<p style=\"text-align: justify;\">Rezervorul de infec\u0163ie este reprezentat de omul parazitat cu Ascaris lumbricoides, femela fiind capabil\u0103 s\u0103 depun\u0103 zilnic \u00een intestinul uman cca 200 000 ou\u0103. Ajunse pe sol odat\u0103 cu fecalele, ou\u0103le neembrionate \u00een momentul depunerii vor deveni embrionate dup\u0103 5-7 zile de stagiu pe sol, la temperaturi de 20-24 \u00baC \u015fi umidiate peste 10%. Omul se poate contamina cu ou\u0103 embrionate prin intermediul m\u0103inilor murdare \u015fi prin ingerarea de legume\/fructe nesp\u0103late. Insectele (mu\u015fte, g\u00e2ndaci) au un rol important \u00een poluarea alimentelor cu ou\u0103 de Ascaris. Dup\u0103 ce p\u0103trund \u00een intestinul omului s\u0103n\u0103tos (\u00een special copii) ou\u0103le \u00ee\u015fi pierd inveli\u015ful protector \u015fi pun \u00een libertate embrionul (larva); acesta traverseaz\u0103 activ peretele intestinal \u015fi, prin intermediul circulatiei sangvine \u015fi limfatice, ajunge \u00een parenchimul hepatic, unde sta\u0163ioneaz\u0103 o perioad\u0103 de 4-5 zile. Ulterior, larva urmeaz\u0103 calea venelor suprahepatice, traverseaz\u0103 atriul \u015fi ventriculul drept \u015fi prin artera pulmonar\u0103 ajunge la pl\u0103m\u00e2n. \u00cen sta\u0163ia pulmonar\u0103 larva sufer\u0103 dou\u0103 n\u0103p\u00e2rliri, rezult\u00e2nd \u00een final un element ciliat care prin mi\u015fc\u0103ri de autopropulsie rupe septurile interalveolare \u015fi ascensioneaza prin bronhiole c\u0103tre faringe. \u00cen cavitatea orofaringian\u0103 larva poate urma dou\u0103 c\u0103i: fie va fi eliminat\u0103 \u00een exterior prin expectora\u0163ie, fie va ajunge \u00een intestin prin degluti\u0163ie; \u00een ultima situatie, larva are nevoie de 60-75 zile pentru a atinge stadiul de adult. Astfel, parazitul sufer\u0103 un\u00a0<em>circuit perienteric<\/em>\u00a0\u00eenainte de a ajunge \u00een intestin \u015fi a deveni un vierme adult<sup>4;7<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Tabloul clinic reflect\u0103 etapele ciclului parazitar, exist\u00e2nd manifest\u0103ri provocate de larvele pulmonare \u015fi de adul\u0163ii de la nivelul intestinului sub\u0163ire:<\/p>\n<p style=\"text-align: justify;\">\u2013 pneumonia intersti\u0163ial\u0103 tranzitorie hipereozinofilic\u0103 Loeffler: tuse spastic\u0103, wheezing, expectora\u0163ie seroas\u0103 ce con\u0163ine eozinofile \u015fi cristale Charcot-Leyden;<\/p>\n<p style=\"text-align: justify;\">\u2013 alergii polimorfe;<\/p>\n<p style=\"text-align: justify;\">\u2013 enterita ascaridiozic\u0103: dureri periombilicale, v\u0103rs\u0103turi, tulbur\u0103ri de tranzit intestinal; num\u0103rul parazi\u0163ilor din intestin poate dep\u0103\u015fi cifra de 40; la acest nivel exercit\u0103 o ac\u0163iune mecanic\u0103, spoliatoare \u015fi toxic\u0103 put\u00e2nd genera obstruc\u0163ii intestinale \u015fi malnutri\u0163ie protein-caloric\u0103.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul ascaridiozei este morfologic prin identificarea macroscopic\u0103 a viermilor adul\u0163i sau eviden\u0163ierea la examenul microscopic a ou\u0103lor neembrionate sau embrionate<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Trichuris trichiura (tricochocefal)<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este un nematod geohelmint, hematofag \u015fi specific omului. Adul\u0163ii tr\u0103iesc \u00een cec \u015fi colon prezent\u00e2nd dimensiuni medii: femela 3.5-5 cm lungime iar masculul 2-3.2 cm. Corpul este dispropor\u0163ionat, primele 3\/5 anterioare fiind sub\u0163iri \u015fi efilate (cu rol \u00een fixarea de mucoasa intestinal\u0103), iar cele 2- posterioare groase, plonj\u00e2nd \u00een lumenul intestinal.<\/p>\n<p style=\"text-align: justify;\">Femela elimin\u0103 ou\u0103le prin materiile fecale, ajung\u00e2nd \u00een contact cu solul. Geombrionarea dureaz\u0103 aproximativ 5-8 s\u0103pt\u0103m\u00e2ni. Omul se\u00a0infecteaz\u0103 pe cale digestiv\u0103 prin intermediul m\u00e2inilor murdare sau a vegetalelor ce con\u0163in urme de p\u0103m\u00e2nt contaminat cu ou\u0103 embrionate de trichocefal. Ajunse \u00een intestinul omului, ou\u0103le sunt digerate \u015fi pun \u00een libertate larvele care se vor matura \u00een decurs de o s\u0103pt\u0103m\u00e2n\u0103 la nivelul vilozit\u0103\u0163ilor intestinale. Dup\u0103 aceast\u0103 perioad\u0103 larvele se \u00eentorc \u00een lumenul intestinal \u015fi migreaz\u0103 spre cec, unde se stabilizeaz\u0103 ca forme adulte, mature sexual.<\/p>\n<p style=\"text-align: justify;\">Printre caracteristicile trichocefalului se numar\u0103 capacitatea de a se insinua sub mucoasa intestinal\u0103 prin intermediul cap\u0103tului proximal, crearea unor denivelari cu zone microulcerate la locul de p\u0103trundere \u015fi hematofagia. Rezult\u0103 astfel o reac\u0163ie inflamatorie intestinal\u0103 difuz\u0103, uneori cu aspect granulamatos, similar celui descris \u00een boala Crohn.<\/p>\n<p style=\"text-align: justify;\">Tabloul clinic este influen\u0163at de \u00eenc\u0103rc\u0103tura parazitar\u0103 \u015fi reactivitatea gazdei; se pot \u00eenregistra at\u00e2t forme a\u015fimptomatice asociate cu o \u00eenc\u0103rc\u0103tur\u0103 parazitar\u0103 redus\u0103, c\u00e2t \u015fi forme severe, asem\u0103n\u0103toare bolilor inflamatorii intestinale (diaree sanguinolenta \u00eensoti\u0163\u0103 de tenesme rectale \u015fi dureri colicative, mai ales \u00een fosa iliac\u0103 dreapt\u0103). O complica\u0163ie sever\u0103 la copil o reprezint\u0103 prolapsul rectal. Hemoleucograma indic\u0103 constant eozinofilie 10-15%.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul se stabile\u015fte prin identificarea ou\u0103lor de trichocefal la examenul coproparazitologic \u015fi, \u00een cazurile grave, prin vizualizarea viermilor adul\u0163i la rectocolonoscopie<sup>1;4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Strongyloides stercoralis<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Reprezint\u0103 unul din din cei mai evolua\u0163i parazi\u0163i. Este un nematod geohelmint, specific omului, ce prezint\u0103 dou\u0103 cicluri biologice independente (intern \u015fi extern) cu variantele de autoinfec\u0163ie (endogen\u0103 \u015fi exogen\u0103) \u015fi heteroinfec\u0163ie (direct\u0103, indirect\u0103, malign\u0103).<\/p>\n<p style=\"text-align: justify;\">\u00cen mod surprinz\u0103tor, femela este vivipar\u0103 elimin\u00e2nd direct prin orificiul uterin larve rabditoide, neinfec\u0163ioase, care ajung odat\u0103 cu materiile fecale \u00een exterior.<\/p>\n<p style=\"text-align: justify;\"><em>Ciclul direct de heteroinfec\u0163ie<\/em><\/p>\n<p style=\"text-align: justify;\">\u00cen contact cu solul, larva rabditoid\u0103 se transform\u0103 prin n\u0103p\u00e2rlire \u00een larv\u0103 strongyloida infec\u0163ioas\u0103 care poate supravie\u0163ui \u00een condi\u0163ii prielnice 2-3 s\u0103pt\u0103m\u00e2ni. Omul se infecteaz\u0103 pe cale cutanat\u0103: larva penetreaz\u0103 tegumentul intact \u015fi ajunge prin circula\u0163ia sangvin\u0103 \u015fi limfatic\u0103 la pl\u0103m\u00e2ni, unde sta\u0163ioneaz\u0103 cca 2 s\u0103pt\u0103m\u00e2ni. Dup\u0103 ce sufer\u0103 o nou\u0103 naparlire, larva rupe septurile interalveolare \u015fi ascensioneaz\u0103 prin bronhiole c\u0103tre faringe; din cavitatea orofaringian\u0103 ajunge prin degluti\u0163ie \u00een intestin unde va atinge stadiul de adult.<\/p>\n<p style=\"text-align: justify;\"><em>Ciclul indirect de heteroinfec\u0163ie<\/em><\/p>\n<p style=\"text-align: justify;\">\u00cen condi\u0163ii neprielnice de mediu, larva rabditoid\u0103 ajuns\u0103 la sol se poate transforma direct \u00een stadiul de adult liber. Ace\u015fti parazi\u0163i adul\u0163i sunt capabili s\u0103 se reproduc\u0103 \u00een sol, \u00eentre\u0163in\u00e2nd astfel un rezervor teluric \u00een a\u015fteptarea condi\u0163iilor favorabile dezvolt\u0103rii larvelor infec\u0163ioase.<\/p>\n<p style=\"text-align: justify;\"><em>Autoinfec\u0163ia<\/em><\/p>\n<p style=\"text-align: justify;\">Este posibil ca \u00een organismul parazitat larvele rabditoide s\u0103 se transforme \u00een larve infec\u0163ioase, \u00een urma unor modificari metabolice. Condi\u0163iile care favorizeaz\u0103 acest fenomen sunt constipa\u0163ia \u015fi igiena precar\u0103. Autoinfectarea se poate produce \u00een lumenul duodeno-jejunal, regiunea perianal\u0103 \u015fi epiteliul bron\u015fic; st\u0103 la baza croniciz\u0103rii bolii.<\/p>\n<p style=\"text-align: justify;\"><em>Hiperinfec\u0163ia sau ciclul malign<\/em><\/p>\n<p style=\"text-align: justify;\">\u00cen condi\u0163ii de imunodepresie sistemic\u0103 larva strongyloid\u0103 apare\u00a0<em>in situ<\/em>\u00a0la nivelul intestinului sub\u0163ire. Acesta va traversa peretele intestinal \u015fi va disemina pe calea circula\u0163iei limfatice \u015fi sangvine \u00een numeroase organe: ficat, pl\u0103m\u00e2ni, rinichi \u015fi mai ales creier. Rata de mortalitate este ridicat\u0103.<\/p>\n<p style=\"text-align: justify;\">Tabloul clinic include:<\/p>\n<ul style=\"text-align: justify;\">\n<li>manifest\u0103ri cutanate: alergodermii;<\/li>\n<li>tulbur\u0103ri intestinale (enteropatia strongyloidozic\u0103): sindrom diareic cronic, grata persistenta, dureri colicative episodice;<\/li>\n<li>manifest\u0103ri respiratorii: tuse cu expectora\u0163ie seroas\u0103, dispnee cu wheezing, dureri toracice;<\/li>\n<li>tulbur\u0103ri neuropsihice: anxietate, depresie;<\/li>\n<li>manifest\u0103ri sistemice nespecifice: stare subfrebil\u0103.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Hemograma indic\u0103 eozinofilie 10-15%.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul strongyloidozei se bazeaz\u0103 pe depistarea larvelor rabditoide \u00een fecale, lichid duodenal, sputa sau lavaj bronholaveolar. \u00cen cazurile severe sunt necesare biopsii duodeno-jejunale<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Fasciola hepatic\u0103<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este un trematod hermafodit cu localizare la nivelul c\u0103ilor biliare. Este r\u0103sp\u00e2ndit \u00een zonele temperate, inclusiv Rom\u00e2nia, rezervorul animal fiind reprezentat de ovine.<\/p>\n<p style=\"text-align: justify;\">Adultul de Fasciola hepatic\u0103 elimin\u0103 oul neembrionat, neinfec\u0163ios prin bil\u0103; oul traverseaz\u0103 nemodificat tubul digestiv \u015fi se excret\u0103 prin materiile fecale.<\/p>\n<p style=\"text-align: justify;\">Pentru a-\u015fi continua ciclul biologic, oul trebuie s\u0103 ajung\u0103 \u00een ape st\u0103t\u0103toare calde unde embrioneaz\u0103 \u015fi, \u00een decurs de 3 s\u0103pt\u0103m\u00e2ni, formeaz\u0103 prima larv\u0103 \u2013\u00a0<em>miracidium<\/em>. Aceast\u0103 forma larvar\u0103 trebuie s\u0103 \u00eent\u00e2lneasc\u0103 o gazd\u0103 intermediar\u0103 \u2013 un melc din genul Lymnaea \u2013 \u00een interiorul c\u0103reia se va genera \u00een final larva infec\u0163ioasa denumit\u0103\u00a0<em>cercar<\/em>. Dup\u0103 ce p\u0103r\u0103se\u015fte corpul melcului, cercarul \u00eenoat\u0103 liber \u00een ap\u0103, \u00eencepe s\u0103 secrete substan\u0163e mucoide \u015fi se \u00eenconjoar\u0103 de un perete, devenind\u00a0<em>metacercar<\/em>. Metacercarii sunt \u00eent\u00e2lni\u0163i pe plantele acvatice, \u00een mod particular \u00een culturile de salat\u0103 verde Cresson.<\/p>\n<p style=\"text-align: justify;\">Omul \u015fi ierbivorele se infecteaz\u0103 prin consumul de salat\u0103 sau plante acvatice sau chiar apa contaminate cu metacercari. Ajuns \u00een intestinul uman, peretele metacercarului va fi digerat rapid iar larva rezultat\u0103 va urma un traseu invaziv prin peretele intestinal, cavitatea peritoneal\u0103, capsula hepatic\u0103 \u015fi va atinge \u00een final canaliculele biliare, \u00een interiorul c\u0103rora se matureaz\u0103 \u00een decurs de 3 luni. \u00cen traiectul s\u0103u parazitul va provoca efecte mecanice de tip iritativ \u015fi hemoragic, precum \u015fi ac\u0163iuni toxice \u015fi hipersensibilizante.<\/p>\n<p style=\"text-align: justify;\">Tabloul clinic reflect\u0103 etapele de dezvoltare a parazitului \u015fi include:<\/p>\n<ul style=\"text-align: justify;\">\n<li>faza migratorie sau acut\u0103: febr\u0103, stare general\u0103 alterat\u0103, prurit, dureri abdominale predominant \u00een hipocondrul drept, diaree muco-sanguinolent\u0103; eozinofilia este marcat\u0103 (20-40%), iar testul hemoragiilor oculte \u00een scaun este pozitiv c\u0103 urmare a hemobiliei;<\/li>\n<li>faza obstructiv\u0103 sau cronic\u0103: icter\/subicter mecanic, asociat cu episoade colicative biliare;<\/li>\n<li>faza ectopic\u0103: forma aberant\u0103 de fascioloz\u0103 ce cuprinde fascioloza cutanat\u0103 \u015fi fascioloza buco-faringian\u0103 (datorat\u0103 consumului de ficat de miel, mai ales \u00een regiunile din Orientul Mijlociu \u015fi Africa de Nord).<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Diagnosticul se bazeaz\u0103 pe detectarea antigenelor sau anticorpilor specifici prin metode imunoenzimatice \u00een faza acut\u0103 \u015fi cea obstructiv\u0103 a bolii \u015fi pe eviden\u0163ierea ou\u0103lor de Fasciola hepatic\u0103 la examenul coproparazitologic sau \u00een lichidul duodenal<sup>1;4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Genul Taenia<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Face parte din clasa cestodelor \u015fi include dou\u0103 specii: Taenia saginata \u015fi Taenia solium. Parazi\u0163ii se caracterizeaz\u0103 printr-un corp aplatizat \u015fi segmentat (\u00een jur de 800-2000 segmente denumite\u00a0<em>proglote<\/em>), de dimensiuni mari \u015fi un cap (scolex) care prezint\u0103 organisme de fixare la peretele intestinal (ventuze \u015fi\/sau carlige). Pentru a fi asigurat\u0103 dezvoltarea lor biologic\u0103, ace\u015fti parazi\u0163i au nevoie de o\u00a0gazd\u0103 intermediar\u0103.<\/p>\n<p style=\"text-align: justify;\">Rezervorul de infec\u0163ie este reprezentat de omul purt\u0103tor de tenie \u00een stadiul adult ale c\u0103rei proglote terminale, pline cu ou\u0103 (50 000-250 000\/segment), se desprind \u00een lumenul intestinal \u015fi sunt eliminate activ \u00een mediul exterior, prin fortarea sfincterului anal, independent de defeca\u0163ie. De aici, odat\u0103 cu hrana, pot ajunge \u00een intestinul unor animale care de\u0163in rolul de gazd\u0103 intermediara \u015fi care vor face forma larvar\u0103 a infec\u0163iei (cisticercoz\u0103).<\/p>\n<p style=\"text-align: justify;\">Taenia saginata este un vierme plat cu dimensiuni mari (8-12 m), av\u00e2nd un numar de 1000-2000 segmente, \u00een timp ce Taenia solium are lungimi cuprinse \u00eentre 2 \u015fi 8 m \u015fi prezint\u0103 800-1000 segmente. Gazda intermediar\u0103 este reprezentat\u0103 de bovine \u00een cazul Taeniei saginata \u015fi de porcine \u00een cazul Taeniei solium. Omul se infesteaz\u0103 prin consumul de carne de vit\u0103\/porc insuficient preparat\u0103 termic, care con\u0163ine formele larvare (<em>cysticercus bovis<\/em>\u00a0\u015fi respectiv\u00a0<em>cysticercus cellulosae<\/em>)<sup>7<\/sup>. \u00cen tubul digestiv al omului, corpul veziculos al larvei este digerat iar scolexul se evagineaz\u0103 \u015fi se fixeaz\u0103 de mucoasa intestinului cu ajutorul ventuzelor. Dup\u0103 aproximativ 60-65 zile se va atinge stadiul adult, omul constituind astfel gazda definitiv\u0103 pentru tenie<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Tabloul clinic este dominat de eliminarea de proglote terminale; simptomatologia digestiv\u0103 este similar\u0103 celei din sindromul de colon iritabil: diaree mucoid\u0103, uneori cu mulaje tubulare intestinale de mucus, \u00eenso\u0163it\u0103 de dureri abdominale cu carcater colicativ, grea\u0163\u0103, apetit modificat (bulimie sau, dimpotriv\u0103, anorexie), scadere ponderal\u0103.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul se bazeaz\u0103 fie pe examenul macroscopic al proglotelor eliminate, fie prin eviden\u0163ierea microcopic\u0103 a ou\u0103lor de tenie<sup>4;7<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Hymenolepis nana<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este un vierme plat, segmentat (prezint\u0103 circa 200 segmente) cu o lungime de 2-4 cm, specific omului. Parazitul nu are nevoie de o alt\u0103 gazd\u0103 \u00een cursul dezvolt\u0103rii sale biologice, astfel c\u0103 omul reprezint\u0103 at\u00e2t gazda definitiv\u0103, c\u00e2t \u015fi cea intermediar\u0103.<\/p>\n<p style=\"text-align: justify;\">Rezervorul de infec\u0163ie \u00eel constituie omul purt\u0103tor de parazit, simptomatic sau nu, care elimin\u0103 \u00een mediul \u00eenconjur\u0103tor odat\u0103 cu materiile fecale ou\u0103le embrionate. Omul s\u0103n\u0103tos se infecteaz\u0103 pe cale digestiv\u0103 prin intermediul m\u00e2inilor murdare sau consumul de vegetale contaminate cu ou\u0103 embrionate de Hymenolepis nana. De asemenea, exist\u0103 posibilitatea unei autoinfec\u0163ii endogene, datorit\u0103 num\u0103rului foarte mare de parazi\u0163i (zeci-sute) care populeaz\u0103 intestinul la un moment dat.<\/p>\n<p style=\"text-align: justify;\">\u00cen intestinul omului se dezvolt\u0103 at\u00e2t formele larvare (cisticercoizi), cat \u015fi formele adulte; ciclul se nume\u015fte\u00a0<em>autoxen<\/em>\u00a0\u015fi are o durat\u0103 total\u0103 de 21-30 zile<sup>7<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Infec\u0163iile mici \u015fi medii cu Hymenolepis nana pot evolua asimptomatic; \u00een cursul infec\u0163iilor masive se \u00eent\u00e2lne\u015fte\u00a0 tabloul clinic de abdomen cronic dureros: colici abdominale, tranzit intestinal alternant, tulbur\u0103ri de apetit, sc\u0103dere ponderal\u0103, tulbur\u0103ri neuropsihice nespecifice.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul se bazeaz\u0103 \u00een principal pe identificarea ou\u0103lor caracteristice la examenul coproparazitologic<sup>4;7<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><u>Dyphilobothrium latum (botriocefal)<\/u><\/strong><\/p>\n<p style=\"text-align: justify;\">Este o cestod\u0103 cu corpul plat format din 2000-4000 segmente (proglote) \u015fi cu o lungime de 10-16 m. Se fixeaz\u0103 \u00een intestinul omului cu ajutorul a dou\u0103 ventuze, situate la nivelul scolexului ce are o form\u0103 ovoidal-migdalat\u0103 caracteristic\u0103.<\/p>\n<p style=\"text-align: justify;\">Parazitul are nevoie \u00een cursul dezvoltarii sale biologice de dou\u0103 gazde intermediare (un crustaceu din genul Cyclops \u015fi pe\u015fti r\u0103pitori: \u015ftiuca, biban, crap, mihalt) \u00een organismul c\u0103rora se vor dezvolta larvele. Omul s\u0103n\u0103tos se infecteaz\u0103 pe cale digestiv\u0103 prin consumul de pe\u015fte crud \u015fi icre ce con\u0163in larve \u00eenchistate<sup>7<\/sup>. \u00cen intestinul omului scolexul evagineaz\u0103 \u015fi se fixeaz\u0103 cu ventuzele de mucoas\u0103; stadiul de adult este atins dup\u0103 70-90 zile, omul constituind astfel gazda definitiv\u0103 pentru parazit. Viermele adult elimin\u0103 un num\u0103r mare de ou\u0103 (p\u00e2n\u0103 la un milion\/zi) care vor fi excretate \u00een mediul \u00eenconjur\u0103tor odat\u0103 cu materiile fecale.<\/p>\n<p style=\"text-align: justify;\">Botriocefalul nu distruge enterocitul \u015fi, \u00een consecin\u0163\u0103, nu provoac\u0103 un sindrom de malabsorb\u0163ie. \u00cen schimb, exercit\u0103 o ac\u0163iune de spoliere selectiv\u0103 prin consumul de vitamina B12 \u015fi acid folic; de asemenea, prin pozi\u0163ionarea sa \u00een jejunul superior poate bloca receptorii pentru factorul intrinsec. Din aceste motive se \u00eent\u00e2lne\u015fte frecvent \u00een botriocefaloza anemia megaloblastic\u0103. Al\u0103turi de posibilitatea expulzarii spontane a viermelui \u00een cursul defec\u0163iei, persoanele afectate mai pot prezenta o simptomatologie digestiv\u0103 similar\u0103 teniazei.<\/p>\n<p style=\"text-align: justify;\">Diagnosticul se bazeaz\u0103 \u00een principal pe identificarea ou\u0103lor de botriocefal la examenul coproparazitologic<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Preg\u0103tire pacient<\/strong><\/em><\/p>\n<p style=\"text-align: justify;\">Pacientul va evita:<\/p>\n<p style=\"text-align: justify;\">\u2013 \u00eenainte de recoltare: examenul radiologic gastrointestinal baritat, administrarea de laxative;<\/p>\n<p style=\"text-align: justify;\">\u2013 in s\u0103pt\u0103m\u00e2na premerg\u0103toare recolt\u0103rii, administrarea anumitor medicamente: bismut, Metamucil, uleiuri minerale, Tetraciclina, antiamoebiene, antidiareice, antiacide<sup>2;8<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Specimen recoltat<\/strong><\/em><strong><em>\u00a0<\/em><\/strong>\u2013 materii fecale din orice moment al zilei; se recolteaz\u0103 c\u00e2te o por\u0163iune de m\u0103rimea unei alune, din 3 locuri diferite ale bolului fecal<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Cauze de respingere a probei<\/strong><\/em><\/p>\n<p style=\"text-align: justify;\">\u2013 specimen ob\u0163inut cu uleiuri minerale, bismut, compu\u015fi de magneziu;<\/p>\n<p style=\"text-align: justify;\">\u2013 recipient murdar pe exterior;<\/p>\n<p style=\"text-align: justify;\">\u2013 specimen contaminat cu urin\u0103<sup>2;8<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Recipient de recoltare<\/strong><\/em><strong><em>\u00a0<\/em><\/strong>\u2013 recipient de unic\u0103 folosin\u0163\u0103 pentru fecale bine \u00eenchis cu capac; este interzis\u0103 ad\u0103ugarea de substan\u0163e conservante<sup>2;8<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Stabilitate prob\u0103<\/strong><\/em><strong><em>\u00a0<\/em><\/strong>\u2013 examinarea prompt\u0103 a scaunului este important\u0103 pentru scaunele lichide sau moi care ar putea con\u0163ine trofozoi\u0163i de protozoare; scaunele formate, care pot con\u0163ine chi\u015fti de protozoare, ou\u0103 sau larve de helmin\u0163i pot r\u0103m\u00e2ne\u00a0<em>c\u00e2teva ore<\/em>\u00a0la temperatura camerei sau\u00a0<em>p\u00e2n\u0103 a doua zi<\/em>\u00a0la frigider<sup>6<\/sup>.<em><strong>\u00a0<\/strong><\/em><\/p>\n<p style=\"text-align: justify;\"><em><strong>Prelucrare necesar\u0103 dup\u0103 recoltare<\/strong><\/em><strong><em>\u00a0<\/em><\/strong>\u2013 analiza se execut\u0103 din materii fecale proasp\u0103t emise (de preferat); dac\u0103 acest lucru nu este posibil, proba va fi p\u0103strat\u0103 la 2-8\u00baC\u00a0<sup>2;8<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Metod\u0103<\/strong><\/em><strong><em>\u00a0<\/em><\/strong>-\u00a0<u>examen macroscopic + examen microscopic direct<\/u>\u00a0(intre lama \u015fi lamela)<sup>2;8<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Valori de referin\u0163\u0103 <\/strong><\/em>\u2013 absente elemente parazitare intestinale<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><em><strong>Interpretarea rezultatelor<\/strong><\/em><\/p>\n<p style=\"text-align: justify;\"><em><u>Examenul macroscopic<\/u><\/em><\/p>\n<p style=\"text-align: justify;\">Examinarea se face direct \u00een recipientul \u00een care s-a prelevat proba, cu ohiul liber sau cu lupa de m\u00e2n\u0103, utiliz\u00e2nd o baghet\u0103 de sticl\u0103 sau o ans\u0103. Se observ\u0103 culoarea, mirosul, consisten\u0163a scaunului, prezen\u0163a de mucus, puroi, s\u00e2nge, precum \u015fi de elemente suspecte ca fiind parazitare. Dintre elementele parazitare se pot observa:<\/p>\n<p style=\"text-align: justify;\">-\u00a0<em><u>proglote de Taenia spp<\/u><\/em>.<\/p>\n<p style=\"text-align: justify;\">Proglotele de Taenia saginat\u0103 (rar vizibile \u00een materiile fecale, deoarece se elimin\u0103 prin orificiul anal \u00eentre defeca\u0163ii) sunt dreptunghiulare de 2 cm lungime\/0,5 cm l\u0103\u0163ime, au uterul bine dezvoltat, prev\u0103zut cu 20-30 de ramifica\u0163ii \u00eenchise \u00een deget de m\u0103nu\u015f\u0103, pline cu ou\u0103 \u015fi au mi\u015fcari periodice caracteristice. Proglotele de Taenia solium au dimensiuni de 2 cm lungime\/6-8mm l\u0103\u0163ime, uterul lor prezint\u0103 7-10 ramifica\u0163ii laterale, \u00eenchise \u00een deget de m\u0103nu\u015f\u0103 pline de ou\u0103) f\u0103r\u0103 a prezenta mi\u015fc\u0103ri.<\/p>\n<p style=\"text-align: justify;\">-\u00a0<em><u>viermi adul\u0163i de Ascaris lumbricoides<\/u><\/em><u>.<\/u><\/p>\n<p style=\"text-align: justify;\">Au corpul cilindric, de culoare roz-albicioas\u0103 \u015fi prezint\u0103 striuri discrete longitudianle. Se va preciza sexul viermelui eliminat. Femelele au 20-30 cm lungime\/5-6 mm grosime. Masculii sunt mai mici, au 15-20 cm lungime \u015fi extremitatea posterioar\u0103 incurbat\u0103.<\/p>\n<p style=\"text-align: justify;\"><em><u>Examenul microscopic direct<\/u><\/em><\/p>\n<p style=\"text-align: justify;\">Se examineaz\u0103 \u00eentre lam\u0103 \u015fi lamel\u0103 o cantitate mic\u0103 de materii fecale (1.5 \u2013 2 mg), prelevat\u0103 din diferite p\u0103r\u0163i ale probei, amestecat\u0103 \u00een ser fiziologic sau solu\u0163ie Lugol.<\/p>\n<p style=\"text-align: justify;\">Pentru realizarea preparatelor se folosesc lame curate, degresate. Pe o lam\u0103 se pune o pic\u0103tura de ser sau solu\u0163ie Lugol. Cu ajutorul unei\u00a0 baghete se prelev\u0103 o mic\u0103 cantitate din proba de examinat \u015fi se amestec\u0103 pe lam\u0103 cu pic\u0103tura de ser sau solu\u0163ie Lugol. Se acoper\u0103 cu o lamel\u0103.<\/p>\n<p style=\"text-align: justify;\">Preparatul trebuie examinat c\u00e2t mai repede pentru a se evita uscarea. Se utilizeaz\u0103 lamele de 18\/18 mm dimensiuni, astfel \u00eenc\u00e2t marginile lor s\u0103 fie cuprinse \u00een interiorul marginilor lamei. Suspensia trebuie s\u0103 fie uniform\u0103, iar lamela a\u015fezat\u0103 orizontal, nu \u00eenclinat.<\/p>\n<p style=\"text-align: justify;\">Preparatul se examineaz\u0103 \u00een \u00eentregime, deplas\u00e2nd lama de la st\u00e2nga la dreapta \u015fi de sus \u00een jos.<\/p>\n<p style=\"text-align: justify;\">Examinarea se face cu obiectiv 10x sau 20x, iar identificarea fiec\u0103rui element parazitar decelat se face cu obiectivul 40x; se utilizeaz\u0103 oculare 10x.<\/p>\n<p style=\"text-align: justify;\">La examinarea microscopic\u0103\u00a0se pot depista diferite specii de parazi\u0163i.<\/p>\n<p style=\"text-align: justify;\"><em><u>Giardia lamblia.<\/u><\/em>\u00a0Poate ap\u0103rea sub dou\u0103 forme: trofozoit (forma vegetativ\u0103) \u015fi chist. Forma vegetativ\u0103 se \u00eent\u00e2lne\u015fte excep\u0163ional, doar \u00een scaunele apoase, \u00een stadiul acut al bolii, mai ales la copii (\u00een 5-10% din cazuri). Trofozoitul este piriform de 15 \u00b5m lungime\/6-10 \u00b5m l\u0103\u0163ime. Are corp cu simetrie bilateral\u0103 cu 2 nuclei, 4 perechi de blefaroplasti \u015fi 4 perechi de flageli, un disc adeziv \u015fi un axostil.<\/p>\n<p><span style=\"font-size: small;\"><a href=\"\/ru\/examen-coproparazitologic\/giardia\/\" rel=\"attachment wp-att-9239\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9239\" src=\"\/wp-content\/uploads\/2009\/08\/giardia.jpg\" alt=\"-\" width=\"101\" height=\"104\"><\/a><\/span><\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/giardia\/\" rel=\"attachment wp-att-9239 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9239\" src=\"\/wp-content\/uploads\/2009\/08\/giardia.jpg\" alt=\"-\" width=\"101\" height=\"104\"><\/a><\/p>\n<p>Fig. 21.4.8.1 Trofozoi\u0163i de Giardia lamblia (dup\u0103 MicrobeLibrary.com)<\/p>\n<p>Chistul este ovalar \u015fi are 9-13 \u00b5m lungime \/ 6\u00b5m l\u0103\u0163ime. Are o membran\u0103 extern\u0103 fin\u0103, dubl\u0103, 4 nuclei \u015fi un\u00a0 m\u0103nunchi de flageli. Nucleii au o dispozi\u0163ie variabil\u0103, frecvent sunt grupa\u0163i la o extremitate a celulei.<\/p>\n<p>\u00cen axul chistului se observ\u0103 resturi flagelare cu dispozi\u0163ie sinuoas\u0103, \u00een form\u0103 de S.<\/p>\n<p><img decoding=\"async\" class=\"alignnone wp-image-9250 size-full\" src=\"\/wp-content\/uploads\/2009\/08\/giardia2.jpg\" alt=\"Giardia chisturi\" width=\"460\" height=\"344\" \/><\/p>\n<p>Fig. 21.4.8.2 Chisturi de Giardia lamblia (preparat\u00a0\u00een solu\u0163ie salin\u0103 \u2013 imagine din colec\u0163ia proprie a laboratorului)<\/p>\n<p>\u00cen preparatul nativ efectuat \u00een solu\u0163ie Lugol chisturile sunt evidente, fiind colorate \u00een brun.<\/p>\n<p>Cu obiectivul de 40 x se detecteaz\u0103 detalii structurale \u015fi aspecte diferite:<\/p>\n<p>a) chisturi mari, oval rotunde, colorate brun deschis; sunt chisturi tinere, recent formate, bine hidratate; dubla membran\u0103 se observ\u0103 net, dar nucleii \u015fi m\u0103nunchii de flageli sunt mai estompa\u0163i;<\/p>\n<p>b) chisturi de dimensiuni medii, ovale, colorate brun \u00eenchis; dublul contur se distinge mai greu, dar interiorul chistului este net.<\/p>\n<p>c) chisturi mici albastre sau palid cenu\u015fii; sunt rar observate (2-3%); nu au contur dublu \u015fi au interior omogen; sunt chisturi neviabile.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/giardia_cyst_wtmt3\/\" rel=\"attachment wp-att-9240 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9240\" src=\"\/wp-content\/uploads\/2009\/08\/Giardia_cyst_wtmt3.jpg\" alt=\"-\" width=\"300\" height=\"300\"><\/a><\/p>\n<p>Fig. 21.4.8.3 Chist de Giardia lamblia (preparat nativ \u00een solu\u0163ie Lugol \u2013 imagine de la\u00a0<a href=\"http:\/\/www.dpd.cdc.gov\/\" rel=\"nofollow noopener\" target=\"_blank\">www.dpd.cdc.gov<\/a>)<\/p>\n<p><em><u>Entamoeba histolytica.<\/u><\/em>\u00a0Chistul matur este rotund, cu dimensiuni de 10-20 \u00b5m \u015fi cu un num\u0103r constant de 4 nuclei; con\u0163inutul chistului este relativ compact, fiind \u00eent\u00e2lnite 1-4 baghete cu capete rotunjite, denumite corpi siderofili sau cromatoizi.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/e_histodispar_2x2_a\/\" rel=\"attachment wp-att-9241 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9241\" src=\"\/wp-content\/uploads\/2009\/08\/E_histodispar_2x2_A.jpg\" alt=\"-\" width=\"300\" height=\"300\"><\/a><\/p>\n<p>Fig. 21.4.8.4 Chist de Entamoeba histolytica (preparat nativ \u2013 imagine de la www.dpd.cdc.gov)<\/p>\n<p><em><u>Entamoeba coli.\u00a0<\/u><\/em>Chistul matur are dimensiuni variabile (10-30 \u00b5m), cu un perete gros, dublu-lamelar \u015fi un con\u0163inut granular uniform ce \u00eei confer\u0103 \u00een preparatele proaspete o colora\u0163ie gri-cenu\u015fie; num\u0103rul nucleilor este constant de 8, aseza\u0163i \u00een acela\u015fi plan sau \u00een planuri diferite.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/ecoli_cyst_wtmt2\/\" rel=\"attachment wp-att-9242 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9242\" src=\"\/wp-content\/uploads\/2009\/08\/Ecoli_cyst_wtmt2.jpg\" alt=\"-\" width=\"300\" height=\"300\"><\/a><\/p>\n<p>Fig. 21.4.8.5 Chist de Entamoeba coli (preparat nativ \u2013 imagine de la\u00a0<a href=\"http:\/\/www.dpd.cdc.gov\/\" rel=\"nofollow noopener\" target=\"_blank\">www.dpd.cdc.gov<\/a>)<\/p>\n<p><em><u>Blastocystis hominis.\u00a0<\/u><\/em>Forma vacuolar\u0103 (considerat\u0103 de unii drept chist) este sferic\u0103 sau elipsoidal\u0103 \u015fi are \u00een medie 8-10 \u00b5m. Poate prezenta o capsul\u0103 proeminent\u0103; con\u0163ine o vacuol\u0103 mare central\u0103, clar\u0103, delimitat\u0103 de o band\u0103 sub\u0163ire neregulat\u0103 din citoplasma, la nivelul c\u0103reia se g\u0103sesc nucleii \u015fi granulele dispuse periferic.<\/p>\n<p>De\u0163ine \u00een general un nucleu, dar uneori poate avea 2-4 nuclei sau chiar mai mul\u0163i. La formele binucleate, nucleii pot fi dispu\u015fi la cei doi poli, iar la formele tetranucleate la periferia celule.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/bhominis_cyst_wtmt2\/\" rel=\"attachment wp-att-9243 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9243\" src=\"\/wp-content\/uploads\/2009\/08\/Bhominis_cyst_wtmt2.jpg\" alt=\"-\" width=\"300\" height=\"300\"><\/a><\/p>\n<p>Fig.21.4.8.6 Blastocystis hominis \u2013 forma vacuolara (preparat nativ \u00een solu\u0163ie salin\u0103 \u2013 imagine de la www.dpd.cdc.gov)<\/p>\n<p><em><u>Ascaris lumbricoides<\/u><\/em>. Oul este oval, de 65-80 \u00b5m\/ 50 \u00b5m. Prezint\u0103 un \u00eenveli\u015f dublu: un \u00eenveli\u015f extern, gros, cu aspect mamelonat caracteristic \u015fi un \u00eenveli\u015f intern de natur\u0103 chitinoasa, neted, transparent, stratificat.<\/p>\n<p>Oul neembrionat prezint\u0103 \u00een interior celula-ou, \u00eenconjurat\u0103 de masa vitelin\u0103, retractat\u0103, l\u0103s\u00e2nd un spa\u0163iu liber \u00eentre ea \u015fi \u00eenveli\u015furile externe. Forma \u015fi dimensiunile oului embrionat sunt asem\u0103n\u0103toare cu ale celui neembrionat, dar in interiorul lui se dezvolt\u0103 o larv\u0103 cilindric\u0103 de 250 \u00b5m, r\u0103sucit\u0103 \u00een jurul s\u0103u, \u00een forma literei S, ocup\u00e2nd \u00een \u00eentregime interiorul oului.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/ascaris\/\" rel=\"attachment wp-att-9251 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9251\" src=\"\/wp-content\/uploads\/2009\/08\/ascaris.jpg\" alt=\"-\" width=\"383\" height=\"285\"><\/a><\/p>\n<p>Fig. 21.4.8.7 Ou de Ascaris lumbricoides (preparat nativ \u00een solu\u0163ie salin\u0103 \u2013 imagine din colec\u0163ia proprie a laboratorului)<\/p>\n<p><em><u>Trichiuris trichiura (Tricocefalul)<\/u>.<\/em>\u00a0Oul este oval, brun, de 50 \/ 22 \u00b5m. Prezint\u0103 un \u00eenveli\u015f extern\u00a0gros \u015fi, \u00een interior, celula-ou \u00eenconjurat\u0103 de masa vitelin\u0103. La cei doi poli exist\u0103 dopuri albuminoase transparente, care confer\u0103 oului un aspect caracteristic de l\u0103m\u00e2ie.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/trichiuras\/\" rel=\"attachment wp-att-9252 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9252\" src=\"\/wp-content\/uploads\/2009\/08\/trichiuras.jpg\" alt=\"-\" width=\"413\" height=\"309\"><\/a><\/p>\n<p>Fig. 21.4.8.8 Ou de Trichuris trichiura (preparat nativ \u00een solu\u0163ie salin\u0103 \u2013 imagine din colec\u0163ia proprie a laboratorului)<\/p>\n<p><em><u>Strongyloides stercoralis<\/u><\/em><em>.\u00a0<\/em>Deoarece ou\u0103le eclozeaz\u0103 imediat dup\u0103 emisie \u015fi elibereaz\u0103 larve \u00een lumenul intestinal, \u00een materiile fecale se vor eviden\u0163ia doar larve.<\/p>\n<p>Larvele rabditoide m\u0103soar\u0103 250-300 \u00b5m, au un esofag \u201cbicameral\u201d (o por\u0163iune proximal\u0103 cilindric\u0103 de calibru redus \u015fi un segment distal globulos \u201c\u00een bulb de ceap\u0103\u201d) \u015fi o extremitate posterioar\u0103 ascu\u0163it\u0103.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/strogiloides\/\" rel=\"attachment wp-att-9253 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9253\" src=\"\/wp-content\/uploads\/2009\/08\/strogiloides.jpg\" alt=\"-\" width=\"409\" height=\"306\"><\/a><\/p>\n<p>Fig. 21.4.8.9 Larva rabditoida de Strongiloides (preparat nativ\u00a0\u00een solu\u0163ie salin\u0103 \u2013 imagine din colec\u0163ia proprie a laboratorului)<\/p>\n<p><em><u>Fasciola hepatic\u0103<\/u>.<\/em>\u00a0Ou\u0103le sunt neembrionate, cu dimensiuni de 140\/ 80 \u00b5m, culoare galben brun\u0103, prezent\u00e2nd la exterior o coaj\u0103 sub\u0163ire, deformabil\u0103, cu un opercul la un pol, iar \u00een interior celula ou inconjurat\u0103 de masa vitelin\u0103.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/f_hepatica_egg_wtmt_hb1\/\" rel=\"attachment wp-att-9244 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9244\" src=\"\/wp-content\/uploads\/2009\/08\/F_hepatica_egg_wtmt_HB1.jpg\" alt=\"-\" width=\"300\" height=\"300\"><\/a><\/p>\n<p>Fig. 21.4.8.10\u00a0 Ou de Fasciola hepatica (preparat nativ \u00a0\u00een solu\u0163ie salin\u0103 \u2013 imagine de la\u00a0<a href=\"http:\/\/www.dpd.cdc.gov\/\" rel=\"nofollow noopener\" target=\"_blank\">www.dpd.cdc.gov<\/a>)<\/p>\n<p><em><u>Taenia solium \u015fi Taenia saginata<\/u><\/em><em>.<\/em>\u00a0Ou\u0103le sunt embrionate, rotund-ovalare, av\u00e2nd dimensiuni de 30-50 \u00b5m. Prezint\u0103 o coroan\u0103 periferic\u0103 striat\u0103 caracteristic\u0103, alc\u0103tuit\u0103 din trei membrane embrionare; con\u0163in \u00een interior o substan\u0163\u0103 vitelin\u0103 galben-maronie \u015fi un embrion hexacant, cu 6 carlige dispuse \u00een perechi.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/tenia\/\" rel=\"attachment wp-att-9254 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9254\" src=\"\/wp-content\/uploads\/2009\/08\/tenia.jpg\" alt=\"-\" width=\"472\" height=\"350\"><\/a><\/p>\n<p>Fig. 21.4.8.11 Ou de Taenia spp. (preparat nativ \u00een solu\u0163ie salin\u0103 \u2013 imagine din colec\u0163ia proprie a laboratorului)<\/p>\n<p><em><u>Hymenolepis nana<\/u>.<\/em>\u00a0Ou\u0103le sunt transparente, av\u00e2nd dimensiuni de 47\/37 \u00b5m. Prezint\u0103 un embrion hexacant (cu trei perechi de c\u00e2rlige) \u015fi un \u00eenveli\u015f dublu alc\u0103tuit dintr-o membran\u0103 extern\u0103 fragil\u0103 \u015fi o membran\u0103 intern\u0103 dens\u0103, cu dou\u0103 proeminente care-i confer\u0103 aspect de l\u0103m\u00e2ie \u015fi de la nivelul c\u0103rora pornesc 4-8 filamente dispuse \u00eentre cele dou\u0103 membrane ale oului.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/hymenolepis-nana\/\" rel=\"attachment wp-att-9245 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9245\" src=\"\/wp-content\/uploads\/2009\/08\/Hymenolepis-nana.jpg\" alt=\"-\" width=\"300\" height=\"300\"><\/a><\/p>\n<p>Fig.21.4.8.12 Ou de Hymenolepis nana (preparat nativ \u00een solu\u0163ie salin\u0103 \u2013 imagine de la\u00a0<a href=\"http:\/\/www.dpd.cdc.gov\/\" rel=\"nofollow noopener\" target=\"_blank\">www.dpd.cdc.gov<\/a>)<\/p>\n<p><em><u>Diphylobothrium latum<\/u>.<\/em>\u00a0Ou\u0103le sunt neembrionate, au aspect oval, culoare brun\u0103 \u015fi dimensiuni de 70\/45 \u00b5m. Prezint\u0103 un \u00eenveli\u015f extern dedublat, cu un opercul la unul din poli \u015fi o mic\u0103 proeminen\u0163\u0103 (caren\u0103) la polul opus; \u00een interior se g\u0103se\u015fte celula-ou \u00eenconjurat\u0103 de masa vitelin\u0103<sup>1;2\u00a0;4\u00a0;6<\/sup>.<\/p>\n<p><a href=\"https:\/\/www.synevo.md\/examen-coproparazitologic\/diphylobothrium-latum\/\" rel=\"attachment wp-att-9246 nofollow noopener\" target=\"_blank\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9246\" src=\"\/wp-content\/uploads\/2009\/08\/Diphylobothrium-latum.jpg\" alt=\"-\" width=\"300\" height=\"300\"><\/a><\/p>\n<p>Fig.21.4.8.13 Ou\u0103 de Diphylobothrium latum (preparat nativ\u00a0\u00een solu\u0163ie Lugol \u2013 imagine de la\u00a0<a href=\"http:\/\/www.dpd.cdc.gov\/\" rel=\"nofollow noopener\" target=\"_blank\">www.dpd.cdc.gov<\/a>)<\/p>\n<p style=\"text-align: justify;\"><em><strong>Limite \u015fi interferen\u0163e<\/strong><\/em><\/p>\n<p style=\"text-align: justify;\">Un rezultat pozitiv indic\u0103 prezen\u0163a parazitului, dar aceasta nu implic\u0103 \u00eentotdeauna c\u0103 parazitul este responsabil pentru simptomele pacientului<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Un singur examen negativ nu exclude posibilitatea infest\u0103rii parazitare.<\/p>\n<p style=\"text-align: justify;\">Examenul pentru Giardia poate fi negativ \u00een stadiile precoce ale infest\u0103rii, \u00een infest\u0103ri cronice \u015fi la pacien\u0163ii care elimin\u0103 ciclic parazitul.<\/p>\n<p style=\"text-align: justify;\"><a href=\"\/ru\/spitale\/rezultate\/\">\u0420\u0415\u0417\u0423\u041b\u042c\u0422\u0410\u0422<\/a>\u00a0fals negative pot s\u0103 apar\u0103 dac\u0103 \u00een s\u0103pt\u0103m\u00e2na care precede testul s-au administrat bariu, bismut, Metamucil, uleiuri minerale, Tetraciclina, medicamente antiamoebiene, antidiareice, antiacide.<\/p>\n<p style=\"text-align: justify;\">\u00cen toate aceste cazuri se recomand\u0103 determinarea de\u00a0<a href=\"\/ru\/antigen-giardia\/\">antigen Giardia<\/a>\u00a0\u00een fecale<sup>1;3.<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Acest test nu este indicat pentru depistarea Toxoplasmei gondii, Toxocarei canis, Plasmodium spp sau Trichomonas deoarece aceste organisme nu apar \u00een materiile fecale.<\/p>\n<p style=\"text-align: justify;\">Ou\u0103le de Enterobius vermicularis sunt rar \u00eent\u00e2lnite \u00een materiile fecale (doar \u00een infest\u0103rile masive) datorit\u0103 particularit\u0103\u0163ilor ciclului evolutiv. Atunci c\u00e2nd exist\u0103 suspiciunea clinic\u0103, se indic\u0103 efectuarea amprentei anale.<\/p>\n<p style=\"text-align: justify;\">Pentru identificarea ou\u0103chistilor sporozoarelor digestive (Cryptosporidium parvum \u015fi Cyclospora cayetanensis) este necesar\u0103 efectuarea de froturi colorate cu colora\u0163ii speciale (Ziehl-Neelsen modificata Hendricksen-Pohlentz)<sup>4<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">1. Dan Steriu. Infec\u0163ii parazitare, Editura Ilex, Bucuresti 2003, 26-34, 152-155, 161-166, 221-226, 231-234, 243-246, 247-250.\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">2. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate 2006. Ref Type: Catalog.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">3. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Giardia lamblia by EIA and Ova and Para\u015fites Examination. www.labcorp.com. 2003. Ref Type: Internet Communication.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">4. Lidia Lazar. Compendiu de parazitologie medical\u0103 \u2013 Parazi\u0163ii \u00een Patologia Uman\u0103. Editura Universitar\u0103 \u201cCarol Davila\u201d, Bucure\u015fti, 2006.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">5. Mayo Clinic\/Mayo Medical LaboratoriesTest Catalogs and Guides. Para\u015fitic Examination. www.mayomedicallaboratories.com. Ref Type: Internet Communication.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">6. Simona R\u0103dulescu, Meyer Ernest. Diagnosticul bolilor parazitare. \u00cen Parazitologie medical\u0103, Editura All, Bucure\u015fti,1992, 271-275.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">7. Valeriu \u015etef\u0103noiu. Diagnosticul infec\u0163iilor parazitare. Prezentare Congres SRML 2010.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">8. World Health Organisation Geneva Basic Laboratory Methods in Medical Parasitology, 1991.<\/span><\/p>","protected":false},"excerpt":{"rendered":"<p>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/p>\n<p>\u0412\u00a0\u043d\u043e\u0440\u043c\u0435\u00a0\u044f\u0439\u0446\u0430\u00a0\u0433\u0435\u043b\u044c\u043c\u0438\u043d\u0442\u043e\u0432\u00a0\u0432\u00a0\u043a\u0430\u043b\u0435\u00a0\u043f\u0440\u0438\u00a0\u043c\u0438\u043a\u0440\u043e\u0441\u043a\u043e\u043f\u0438\u0447\u0435\u0441\u043a\u043e\u043c\u00a0\u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0438\u00a0\u043d\u0435\u00a0\u043e\u043f\u0440\u0435\u0434\u0435\u043b\u044f\u044e\u0442\u0441\u044f!<\/p>\n<p>\u0410\u043d\u0430\u043b\u0438\u0437 \u043a\u0430\u043b\u0430 \u043d\u0430 \u044f\u0439\u0446\u0430 \u0433\u0435\u043b\u044c\u043c\u0438\u043d\u0442\u043e\u0432 \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u043f\u0440\u044f\u043c\u044b\u043c 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\u0432\u044b\u044f\u0432\u043b\u0435\u043d \u0432 \u043a\u0430\u043b\u0435) \u0447\u0435\u0440\u0435\u0437 1 \u043c\u0435\u0441\u044f\u0446 \u043f\u043e\u0441\u043b\u0435 \u043b\u0435\u0447\u0435\u043d\u0438\u044f.<\/li>\n<\/ul>\n<p>\u041f\u0440\u0438\u00a0\u043f\u043e\u043c\u043e\u0449\u0438\u00a0\u044d\u0442\u043e\u0433\u043e\u00a0\u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f\u00a0\u0432\u044b\u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f\u00a0\u043d\u0430\u043b\u0438\u0447\u0438\u0435\u00a0\u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u043d\u044b\u0445\u00a0\u043f\u0430\u0440\u0430\u0437\u0438\u0442\u043e\u0432\u00a0\u0441\u00a0\u043b\u043e\u043a\u0430\u043b\u0438\u0437\u0430\u0446\u0438\u0435\u0439\u00a0\u0432\u00a0\u043a\u0438\u0448\u0435\u0447\u043d\u0438\u043a\u0435\u00a0\u0432\u00a0\u043f\u0440\u0435\u0434\u0435\u043b\u0430\u0445,\u00a0\u0443\u0441\u0442\u0430\u043d\u043e\u0432\u043b\u0435\u043d\u043d\u044b\u0445\u00a0\u0431\u0438\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u0438\u043c\u00a0\u0446\u0438\u043a\u043b\u043e\u043c:<\/p>\n<ul>\n<li>\u041f\u0440\u043e\u0441\u0442\u0435\u0439\u0448\u0438\u0435<i>:\u00a0Giardia\u00a0lamblia,\u00a0Trichomonas\u00a0intestinalis,\u00a0Entamoeba\u00a0spp.,\u00a0Blastocystis\u00a0hominis<\/i>.<\/li>\n<li>\u041d\u0435\u043c\u0430\u0442\u043e\u0434\u044b:\u00a0<i>Ascaris\u00a0lumbricoides,\u00a0Trichuris\u00a0trichiura,\u00a0Enterobius\u00a0vermicularis,\u00a0Strongyloides\u00a0stercoralis<\/i>.<\/li>\n<li>\u0426\u0435\u0441\u0442\u043e\u0434\u044b:\u00a0<i>\u0422\u0430enia\u00a0spp.<\/i><\/li>\n<\/ul>\n<p>\u0414\u043b\u044f\u00a0\u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u044f\u00a0\u0447\u0443\u0432\u0441\u0442\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0441\u0442\u0438\u00a0\u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445\u00a0\u0442\u0435\u0441\u0442\u043e\u0432\u00a0\u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u0443\u0435\u0442\u0441\u044f\u00a0\u043f\u0440\u043e\u0432\u043e\u0434\u0438\u0442\u044c\u00a03\u00a0\u043f\u043e\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0435\u00a0\u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f\u00a0\u0441\u00a0\u0438\u043d\u0442\u0435\u0440\u0432\u0430\u043b\u043e\u043c\u00a0\u0432\u00a07\u00a0\u0434\u043d\u0435\u0439.<\/p>\n<p>\u041e\u0441\u043d\u043e\u0432\u043d\u044b\u0435\u00a0\u043f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u044f\u00a0\u043a\u00a0\u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044e\u00a0\u0430\u043d\u0430\u043b\u0438\u0437\u0430:<\/p>\n<ul>\n<li>\u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0430\u00a0\u043f\u0430\u0440\u0430\u0437\u0438\u0442\u0430\u0440\u043d\u043e\u0433\u043e\u00a0\u0437\u0430\u0440\u0430\u0436\u0435\u043d\u0438\u044f;<\/li>\n<li>\u043e\u0444\u043e\u0440\u043c\u043b\u0435\u043d\u0438\u0435\u00a0\u043f\u0440\u0438\u00a0\u0433\u043e\u0441\u043f\u0438\u0442\u0430\u043b\u0438\u0437\u0430\u0446\u0438\u0438\u00a0\u0432\u00a0\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u0430\u0440\u043d\u043e\u0435\u00a0\u043e\u0442\u0434\u0435\u043b\u0435\u043d\u0438\u0435;<\/li>\n<li>\u043f\u0440\u043e\u0444\u0438\u043b\u0430\u043a\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u0435\u00a0\u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435.<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td width=\"262\"><b>\u041f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u044c<\/b><\/td>\n<td width=\"360\"><b>\u0425\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0438\u0441\u0442\u0438\u043a\u0430<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041c\u0430\u0442\u0435\u0440\u0438\u0430\u043b<\/b><\/td>\n<td width=\"360\">\u041a\u0430\u043b<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041f\u0440\u0430\u0432\u0438\u043b\u0430\u00a0\u043f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0438\u00a0\u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430<\/b><\/td>\n<td width=\"360\">\u0421\u0442\u0430\u043d\u0434\u0430\u0440\u0442\u043d\u044b\u0435<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u0422\u0440\u0430\u043d\u0441\u043f\u043e\u0440\u0442\u043d\u0430\u044f\u00a0\u0441\u0440\u0435\u0434\u0430,\u00a0\u043f\u0440\u043e\u0431\u0438\u0440\u043a\u0430<\/b><\/td>\n<td width=\"360\">\u0422\u0440\u0430\u043d\u0441\u043f\u043e\u0440\u0442\u043d\u044b\u0439\u00a0\u043a\u043e\u043d\u0442\u0435\u0439\u043d\u0435\u0440<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041f\u0440\u0430\u0432\u0438\u043b\u0430\u00a0\u0438\u00a0\u0443\u0441\u043b\u043e\u0432\u0438\u044f\u00a0\u0442\u0440\u0430\u043d\u0441\u043f\u043e\u0440\u0442\u0438\u0440\u043e\u0432\u043a\u0438,<\/b><\/p>\n<p><b>\u00a0\u0441\u0442\u0430\u0431\u0438\u043b\u044c\u043d\u043e\u0441\u0442\u044c\u00a0\u043f\u0440\u043e\u0431\u044b<\/b><\/td>\n<td width=\"360\">\u0421\u0442\u0430\u043d\u0434\u0430\u0440\u0442\u043d\u044b\u0435<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u041c\u0435\u0442\u043e\u0434\u00a0\u0442\u0435\u0441\u0442\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u044f<\/b><\/td>\n<td width=\"360\">\u041f\u0440\u044f\u043c\u043e\u0435\u00a0\u043c\u0438\u043a\u0440\u043e\u0441\u043a\u043e\u043f\u0438\u0447\u0435\u0441\u043a\u043e\u0435\u00a0\u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435<\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><\/td>\n<td width=\"360\"><\/td>\n<\/tr>\n<tr>\n<td width=\"262\"><b>\u0420\u0435\u0444\u0435\u0440\u0435\u043d\u0442\u043d\u044b\u0435\u00a0\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f<\/b><\/td>\n<td width=\"360\">\u041d\u0435\u00a0\u043e\u0431\u043d\u0430\u0440\u0443\u0436\u0435\u043d\u044b\u00a0\/\u00a0\u041e\u0431\u043d\u0430\u0440\u0443\u0436\u0435\u043d\u044b<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"622\"><b>\u0418\u043d\u0442\u0435\u0440\u0444\u0435\u0440\u0438\u0440\u0443\u044e\u0449\u0438\u0435\u00a0\u0444\u0430\u043a\u0442\u043e\u0440\u044b<\/b><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"622\">\u041b\u043e\u0436\u043d\u043e\u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0435 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u044b \u043c\u043e\u0433\u0443\u0442 \u0431\u044b\u0442\u044c \u043f\u043e\u043b\u0443\u0447\u0435\u043d\u044b \u043f\u0440\u0438 \u0443\u0441\u043b\u043e\u0432\u0438\u0438, \u0447\u0442\u043e \u0437\u0430 \u043d\u0435\u0434\u0435\u043b\u044e, \u043f\u0440\u0435\u0434\u0448\u0435\u0441\u0442\u0432\u0443\u044e\u0449\u0435\u0439 \u0442\u0435\u0441\u0442\u0443, \u043f\u0430\u0446\u0438\u0435\u043d\u0442 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u043b \u0431\u0430\u0440\u0438\u0439, \u0432\u0438\u0441\u043c\u0443\u0442, \u0436\u0435\u043b\u0435\u0437\u043e, \u0442\u0435\u0442\u0440\u0430\u0446\u0438\u043a\u043b\u0438\u043d, \u0430\u043d\u0442\u0438\u0430\u043c\u0435\u0431\u043d\u044b\u0435\u00a0\u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u044b,\u00a0\u0430\u043d\u0442\u0438\u0434\u0438\u0430\u0440\u0435\u0439\u043d\u044b\u0435,\u00a0\u0430\u043d\u0442\u0430\u0446\u0438\u0434\u043d\u044b\u0435\u00a0\u043c\u0435\u0434\u0438\u043a\u0430\u043c\u0435\u043d\u0442\u044b.<\/p>\n<p>\u0412\u043e\u00a0\u0432\u0441\u0435\u0445\u00a0\u044d\u0442\u0438\u0445\u00a0\u0441\u043b\u0443\u0447\u0430\u044f\u0445\u00a0\u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u0443\u0435\u0442\u0441\u044f\u00a0\u043f\u0440\u043e\u0432\u0435\u0441\u0442\u0438\u00a0\u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435\u00a0\u0430\u043d\u0442\u0438\u0433\u0435\u043d\u0430\u00a0\u043b\u044f\u043c\u0431\u043b\u0438\u0439\u00a0(<i>Giardia<\/i>)\u00a0\u0432\u00a0\u043a\u0430\u043b\u0435<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table>\n<tbody>\n<tr>\n<td width=\"622\"><b>\u041f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u044f\u00a0\u043a\u00a0\u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044e<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"622\">\u00b7\u00a0\u0414\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0430\u00a0\u043f\u0430\u0440\u0430\u0437\u0438\u0442\u0430\u0440\u043d\u043e\u0433\u043e\u00a0\u0437\u0430\u0440\u0430\u0436\u0435\u043d\u0438\u044f;<\/p>\n<p>\u00b7\u00a0\u043e\u0444\u043e\u0440\u043c\u043b\u0435\u043d\u0438\u0435\u00a0\u043f\u0440\u0438\u00a0\u0433\u043e\u0441\u043f\u0438\u0442\u0430\u043b\u0438\u0437\u0430\u0446\u0438\u0438\u00a0\u0432\u00a0\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u0430\u0440\u043d\u043e\u0435\u00a0\u043e\u0442\u0434\u0435\u043b\u0435\u043d\u0438\u0435<\/td>\n<\/tr>\n<tr>\n<td width=\"622\"><b>\u0418\u043d\u0442\u0435\u0440\u043f\u0440\u0435\u0442\u0430\u0446\u0438\u044f\u00a0\u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u043e\u0432<\/b><\/td>\n<\/tr>\n<tr>\n<td width=\"622\">\u00b7\u00a0\u0412\u00a0\u043d\u043e\u0440\u043c\u0435\u00a0\u043f\u0440\u043e\u0441\u0442\u0435\u0439\u0448\u0438\u0435\u00a0\u0432\u00a0\u043a\u0430\u043b\u0435\u00a0\u043d\u0435\u00a0\u043e\u0431\u043d\u0430\u0440\u0443\u0436\u0438\u0432\u0430\u044e\u0442\u0441\u044f;<\/p>\n<p>\u00b7\u00a0\u0435\u0434\u0438\u043d\u0438\u0447\u043d\u044b\u0439\u00a0\u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0439\u00a0\u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442,\u00a0\u043d\u0435\u00a0\u043f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0435\u043d\u043d\u044b\u0439\u00a0\u0434\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e,\u00a0\u043d\u0435\u00a0\u0438\u0441\u043a\u043b\u044e\u0447\u0430\u0435\u0442\u00a0\u0432\u043e\u0437\u043c\u043e\u0436\u043d\u043e\u0441\u0442\u0438\u00a0\u0437\u0430\u0440\u0430\u0436\u0435\u043d\u0438\u044f\u00a0\u043f\u0440\u043e\u0441\u0442\u0435\u0439\u0448\u0438\u043c\u0438.<\/p>\n<p>\u041f\u0440\u0438\u00a0\u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0438\u00a0\u043d\u0430\u00a0\u043b\u044f\u043c\u0431\u043b\u0438\u0438\u00a0(\u00a0<i>Giardia<\/i>)\u00a0\u043c\u043e\u0436\u0435\u0442\u00a0\u0431\u044b\u0442\u044c\u00a0\u043f\u043e\u043b\u0443\u0447\u0435\u043d\u00a0\u043e\u0442\u0440\u0438\u0446\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0439\u00a0\u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u00a0\u043d\u0430\u00a0\u0440\u0430\u043d\u043d\u0435\u0439\u00a0\u0441\u0442\u0430\u0434\u0438\u0438\u00a0\u0437\u0430\u0440\u0430\u0436\u0435\u043d\u0438\u044f,\u00a0\u043f\u0440\u0438\u00a0\u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0439<\/p>\n<p>\u0438\u043d\u0432\u0430\u0437\u0438\u0438\u00a0\u0438\u00a0\u0443\u00a0\u0431\u043e\u043b\u044c\u043d\u044b\u0445,\u00a0\u0432\u044b\u0434\u0435\u043b\u044f\u044e\u0449\u0438\u0445\u00a0\u043f\u0430\u0440\u0430\u0437\u0438\u0442\u0430\u00a0\u0446\u0438\u043a\u043b\u0438\u0447\u0435\u0441\u043a\u0438<\/td>\n<\/tr>\n<\/tbody>\n<\/table>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[974,978],"product_tag":[],"class_list":{"0":"post-9228","1":"product","2":"type-product","3":"status-publish","5":"product_cat-teste-de-microbiologie","6":"product_cat-tract-gastrointestinal","8":"first","9":"instock","10":"sold-individually","11":"shipping-taxable","12":"purchasable","13":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/9228","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=9228"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=9228"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=9228"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=9228"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=9228"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}