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8/10/2019 Blok 14-Protozoa dan helminth penyebab inf sist digestif.ppt
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Nemathelminthes Platyhelminthes
Class Nematoda Class Cestoda dan Class Trematoda
Silindris, panjang Pipih seperti pita atau daun
Tidak bersegmen Bersegmen
Sex terpisah antara jantan dan betina Pada umumnya hermaphrodyte
Saluran pencernaan lengkap Saluran pencernaan tidak lengkap
Mempunyai rongga tubuh Tidak memiliki rongga tubuh
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Morphologic features :
- Nonsegmented
- Generally cylindrical, mostly tapered at bothends
- Covered by cuticle
- Generally a light cream-white colour
- Well formed digestive tracts, with anal andoral openings
- Separated sexes (in which the males aregenerally smaller than the females)
- Certain modifications of apparatus in the oralopening and esophagus are important in the
identification of the species
The Nematodes (roundworms)
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Epidemiology :
- Affects more than other parasitic
diseases
- More prevalent in areas with poor
sanitation, areas where human feces
are used as fertilizer
Ascaris lumbricoides
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Telur infektif tertelan
Larva menetas disal.cerna, penetrasi ke
mukosa intestinal
Terbawa aliran darah
portal, terbawa alirandarah sistemik ke
paru
Larva matur di paru(10-14 hari),
menembus alveolus
naik ke bronchial tree,tertelan kembali ke
sal.cerna
Larva menjadi cacingdewasa di usus halus
deposisi 200.000 telur perhari
Telur keluar bersama tinja
Telur fertil menjadiinfektif setelah 18 hari
sampai beberapaminggu
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Morphologic features of adult worms :
- Resembles earth worm
- Length : females 20-35 cm,males seldom excedeed 30 cm
long
- Creamy white in colour
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Clinical manifestations :
- Asymptomatic in mild infection
- Heavy infection can cause bowel
obstructionfever, malaise, abdominal
distention, abdominal pain, vomitting
- Pneumonitis during larval migration
through the lungs
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Diagnosis :
- Examination of the stoolfertile or infertile
eggs
Ascaris lumbricoideseggs in fresh stool
examination
Fertile
Corticated
Decorticated
Infertile
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Fertile corticated eggs :
- Broadly oval, 45-75 m X 35-50 m
- Consists of 3 layers, outer covering(albuminoid coat) stained golden brown by
the bile, coarse surface
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Fertile decorticated eggs :
- Broadly oval, 45-75 m X 35-50 m
- Consists of 2 layers, already lost its outer
covering (albuminoid coat)thick
yellowish inner shell is obvious
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Infertile eggs :- Longer and narrower than the fertile
eggs, 90 m X 40 m
- The wall might consists of 2 or 3 layers,coarse surface
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Treatment of infections :
Albendazole single dose 400 mg
Mebendazole 2x100 mg selama 3 hari Pyrantel pamoate single dose 11 mg/KgBB
H A t
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Epidemiology :
- High prevalence in population which defecate
directly onto the soil and do not costumarily
wear shoes
- Climate : sufficient rainfall, sandy loam soil
Hoo worm Ancy ostomaduodenale and Necator
americanus)
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the infective larvaepenetrate the skin
carried through theblood vessels to the
heart and then to thelungs
penetrate into the
pulmonary alveoli,ascend the bronchialtree to the pharynx,and are swallowed
larvae reach the smallintestine, where they
reside and matureinto adults
Adult worms attach tothe lumen of small
intestine, with
resultant blood loss
Eggs are passed in thestool
under favorable
conditions (moisture,warmth) larvae hatchin 1-2 days
rhabditiform larvae
after 5 to 10 daysrhabditiform becomefilariform (third-stage)
larvae that are infective
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Morphologic features of adult worms : N. americanus adult worms similar to
Ancylostoma duodenale but slighly smallerclinically it is considered unimportant to
differ these two Difference : the buccal capsule of N.
americanus armed with a pair of cuttingplates, while the buccal capsule ofAncylostoma duodenale had 2 pair of teeth
Grayish white or pinkish
Male 1 x 0.5 cm, female somewhat larger
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AB
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- In penetrating the skin may cause ground itch(less common with Ancylostoma than with N.americanus)
- Pneumonitis less severe than in Ascariasis
- Heavy infection : gastrointestinal discomfort,diarrhea
- Acute intestinal hemorrhage is rare
- Chronic infection : iron deficiency anemia
Diagnosis :
- eggs in fresh stool examination
- larvae might be seen in the eggs of hours long
specimens
Clinical manifestations :
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Eggs in stool examination :
- Oval, 56-60 m X 36-40 m
- Thin and colourless shell
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- Hatched larvae in the stools must be differentiated fromlarvae of Strongyloides stercoralis- Rhabditiform larvae of hookworms have a long & narrow
buccal capsule (between oral opening and esophagus)
- Strongyloides has a very short and somewhat stout buccal
capsule
Hookworms rhabditiform
larvae
Strongyloides stercoraliss
rhabditiform larvae
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Treatment :
Albendazole single dose 400mg
Mebendazole 2x100mg selama 3 hari Pyrantel pamoate single dose 11 mg/KgBB
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Epidemiology :
- similar as hookworm
Strongyloides stercoralis
life cycle ofStrongyloides
stercoralis
Free living cycle
Parasitic cycle
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Morphologic features of adult worms :
- Very small, about 1 mm long
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- Ground itch similar to hookworms infection
- Pneumonitis less severe than in Ascariasis
- Heavy infection : gastrointestinal
discomfort, diarrhea, duodenal ulcer,melena
Diagnosis :
- Larvae in the stools- In a case with severe diarrhea,
embryonated eggs may be present in stool
Clinical manifestations :
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Larvae in stool examination : similar to
hookworms larvae with a very short and stout
buccal cavity. Eggs in stool examination : similar to
hookworms eggs, buat the Strongyloides eggs
always contained well-developed larvae
Strongyloidesstercoraliss e
Hookworms eggs
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- albendazole 400 mg/hari selama 3 hari
- Ivermectin 200 g/KgBB per hari selama 2 hari
Treatment :
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Epidemiology :
- High prevalence in population which defecate
directly onto the soil and where human feces
are used for fertilizer
Trichuris trichiura (whipworm)
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- The adult worms : 2-5 cm long, maleslightly smaller than female
- Whip-like tail
Morphologic features :
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i ti f
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ingestion ofinfective eggs (soil-
contaminatedhands or food)
Larvae hatch inthe small
intestine
Larvae matured
and establishedthemselves as
adults in the colon
adult worms are fixed in
caecum, the anteriorportions threaded intomucosa
Female worms in thececum shed between
3,000 and 20,000eggs per day
unembryonatedeggs are passedwith the stool
the eggs developinto a 2-cell
stage in the soil
2-cell stage eggsembryonate and become
infective in 15 to 30 days
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- Mild infection : asymptomatic
- Heavy infection : abdominal pain,
abdominal distention, bloody ormucoid diarrhea, tenesmus, prolapse
of the rectum, weakness
- Chronic infection : anemia
Diagnosis : eggs in stool examination
Clinical manifestations :
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- barrel-shaped/football-shaped
- 50-54m in length with
polar plugs in eitherends
Eggs in stool examination :
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Treatment :
- Albendazole single dose 400 mg
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THE CESTODES
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Also called tapeworms Adult tapeworms found in human all have a flat, ribbon-
like body, white or yellowish in colour
The cestode body consists of an attachment organnamed scolex, followed by a chain of segments
(proglottids) named strobila Strobila growth throughout the life of tapeworms by
continous proliferation of new proglottids in the regionimmediately posterior to the scolex
The terminal portion of strobila contains gravidsegments
In some cestodes, these terminal proglottids maybecome detached in the intestine and pass out withstool
The Cestodes : review
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The cestodes
Diphyllobothrium latum,Taenia saginata, Taeniasolium, Echinococcus
granulosus, Dipylidiumcaninum, etc
The Cestodes : review
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Epidemiology : worldwide distribution
Taenia saginata (beef tapeworm) &
Taenia solium (pork tapeworm)
Morphologic features of
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- flat, ribbon-like body,
may reach several meters
- Yellowish white in colour
- T. saginata : scolex bears 4 muscular suckers
and a small rostellum without hooks
- T. solium : scolex bears 4 muscular suckers anda double crown with hooks
Morphologic features of
adult worms ::
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Differentiating the scolex
T. saginatas scolex T. soliums scolex
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Clinical manifestations : Mostlyasymptomatic
Diagnosis : eggs and or gravid
proglottids in stool examination
Eggs (undifferentiated between theT. saginata or T. solium) :
- Round shaped, dark brown incolor
- Distinguished characteristic : athick, radially striated covering,
called the embryophore
Differentiating the gravid
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- Mature segments :width > length
- Gravid segments :length > width
- Gravid segmentscontain a brancheduterus filled with eggs :
T. solium : 7-13
branches on each sideT. saginata : 15-20branches on each side
Differentiating the gravid
proglottids
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Treatment :
- Praziquantel single dose 10 mg/KgBB
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A condition where humans ingested T. solium eggsoncosphere hatch in small intestineinvade intestinal
wallenter systemic circulationlodge in any tissues(most commonly in voluntary muscles)cysts
Treatment :
- surgical removal
- albendazole 15 mg/KgBB per hari selama 8 hari
Cysticercosis