Does the Ministry of Health recommend not to drive or operate machinery after using specific drugs to treat small intestinal fluke in Vietnam?
How can small intestinal fluke in Vietnam disease be diagnosed?
Pursuant to Section 3, Section 4 of the Guidelines issued together with Decision 1572/QD-BYT in 2022 of the Ministry of Health, there are guidelines related to the identification of small intestinal fluke disease as follows:
“3. SUBCLINICAL
3.1. Blood tests
The red blood cell count may decrease, the eosinophil count may increase.
3.2. Image analysation
Ultrasonography, upper gastrointestinal endoscopy: can see inflammatory lesions, ulcers in the small intestine mucosa and localized inflammatory lesions under the mucosa.
3.3. Test stool, duodenal fluid, specimen
- Fecal examination for small intestinal fluke eggs by Kato, Kato-Katz techniques, fresh screening, concentrating on sediment: finding small intestinal fluke eggs.
- Endoscopic duodenoscopy: identify adult small intestinal flukes.
- Make a specimen of small intestinal fluke when treated with Carmin staining method to identify adult small intestinal fluke.
3.4. Molecular biology test
Xét nghiệm PCR để xác định loài sán lá ruột nhỏ.
4. DIAGNOSIS
4.1. Suspected case
A person with an epidemiological history of eating uncooked or salted brackish or freshwater fish or a person living in an endemic area with small intestinal flukes and having one of the following symptoms:
+ Fatigue, loss of appetite;
+ Abdominal pain, nausea, abdominal distension, diarrhea infrequently;
+ Anemia;
+ Laboratory tests: eosinophils increased.
4.2. Identified case
A case of suspected disease and confirmed by one of the following laboratory tests:
- Examination of stool or duodenal fluid confirmed the presence of small intestinal fluke eggs;
- Gastrointestinal endoscopy found adult small intestinal flukes;
- PCR test identified small intestinal fluke.
4.3. Differential diagnosis
- Small liver fluke: Clinical symptoms may include obstructive jaundice; Small liver flukes cause damage to the bile ducts in and out of the liver, sclerosing cholangitis causes thickening of the biliary wall and mild dilation of the bile ducts. In particular, the eggs of the small intestinal fluke family Heterophyidae are very similar to the eggs of the small intestinal flukes in both morphology and size. Small intestinal fluke eggs of the family Echinostomatidae are easily confused with unfertilized roundworm eggs.
- Intestinal strongyloides: fecal smear test finds strongyloidiasis larvae in stool or ELISA detects strongyloidy antibodies positive."
Accordingly, the identification of small intestinal fluke disease is carried out according to the above guidance of the Ministry of Health.
Does the Ministry of Health recommend not to drive or operate machinery after using specific drugs to treat small intestinal fluke in Vietnam?
Can I drive if I use medicine to treat small intestinal fluke in Vietnam?
Pursuant to Section 5 of the Guidelines promulgated together with Decision 1572/QD-BYT in 2022 of the Ministry of Health, there are guidelines on methods of application to treat small intestinal fluke disease as follows:
“5. TREATMENT
5.1. The principles of treatment
- Early treatment, right specific drugs, right regimen;
- Supportive treatment when necessary to improve the patient's condition;
- Patients will be re-examined after 1 month of treatment to evaluate the effectiveness of treatment; if the patient is still infected with small intestinal flukes, continue treatment and repeat the course of treatment;
- Patients with underlying diseases must combine treatment with the underlying disease.
5.2. Specific treatment
a) Medicine: praziquantel 600 mg tablets.
b) Dosage
- For adults and children ≥ 4 years old: Dose 25 mg/kg/day, single dose, taken immediately after eating, do not chew the medicine.
- For children < 4 years old: Consult a doctor during treatment and closely monitor.
c) Contraindications
- Not for use by pregnant women;
- People who are allergic to the drug;
- People who are suffering from acute illness or heart failure, liver failure, kidney failure, mental illness...
d) Instruct the patient to pay attention when using the drug:
- Lactation period: The mother stops breastfeeding during the period of taking the drug and 72 hours after the last dose; during this time milk must be expressed;
- Do not use alcohol during the treatment period;
- Do not drive, operate machinery while taking the drug and also for 24 hours after taking praziquantel because the drug can cause dizziness and drowsiness;
- Be careful with the elderly, malnourished people, people with vestibular disorders.
5.3. Symptomatic treatment
Depending on the clinical symptoms to prescribe the appropriate treatment.
- Abdominal pain relief: by oral antispasmodics.
Non-anticholinergic antispasmodics.
Anticholinergic antispasmodics.
- Diarrhea and digestive disorders: digestive enzymes of bacterial origin such as antibio 1g, 6 tablets divided 3 times a day;
- Rehydration, electrolytes by oral oresol: children 4 - 5 years old drink 750 to < 1,000ml daily; over 5 years old drink 1,000ml daily.
- Edema: the test has hypoalbuminemia < 35 g/l, or albumin > 35 g/l with severe peripheral edema, albumin infusion is indicated according to the formula:
Amount of albumin to compensate = [0.25 (g/dl)- Current albumin/blood (g/dl)] x weight (kg) x 0.8.
- Anemia: Supplement with folic acid, iron tablets, vitamin B12 in case of mild anemia, take within 3-6 months.
5.4. Supportive treatment
- Improve physical condition with proper diet and rest.
- Use multivitamins.
5.5. Follow-up after treatment
5.5.1. Inpatient follow-up
Patients are monitored for inpatient treatment for about 5-7 days, are tested to diagnose, monitor treatment, assess organ function of the body; for patients with underlying medical conditions, do tests to monitor and treat associated underlying conditions.
5.5.2. Monitoring of outpatient treatment and after inpatient treatment
- Re-examination after 1 week: the patient is re-evaluated blood count, liver function; stool examination for small intestinal fluke eggs;
- Re-examination after 1 month after treatment: the patient is re-evaluated blood count, liver function; stool examination for small intestinal fluke eggs;
- After 1 week or 1 month, if the patient's stool is tested for small intestinal fluke eggs or adult flukes, the patient should be admitted to the hospital and repeated inpatient treatment."
Accordingly, people infected with small intestinal flukes can use specific drugs to treat the disease. Regarding the dosage used will be guaranteed according to the above instructions. Patients should not drive or operate machinery during and 24 hours after taking the drug.
How to prevent small intestinal fluke in Vietnam disease effectively?
Pursuant to Section 7 of the Guidelines issued together with Decision 1572/QD-BYT in 2022 of the Ministry of Health, there are guidelines on the prevention of small intestinal flukes as follows:
“7. PREVENTION
Similar to the small liver fluke. It is cutting off the transmission route from fish to humans by not eating fish salad or undercooked fish, and conducting specific treatment for the patient in combination with environmental sanitation (fecal management and not feeding fish). human excrement).”
Thus, in order to prevent small intestinal fluke disease, it is not advisable to eat raw fish or fish salad, it is necessary to conduct environmental sanitation and keep the living environment clean.
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