Upload
deagratia
View
44
Download
11
Embed Size (px)
DESCRIPTION
FK Unila
Citation preview
Helminthiasis 1
HELMINTIASISpengelolaan investasi cacing pada dewasa
Bachti Alisjahbana
Sub Bagian InfeksiBagian Penyakit Dalam FKUP / RSHS
Helminthiasis 2
Type of helminthiasis
Intestinalascariasis Ascaris lumbricoidesankilostomiasis N. americanus, A duodenaletaeniasis T. solium, T saginatatrichuriasis Trichuris trichiuraOxyuriasis Oxyuris vermicularis
blood/ tissuefilariasis W. bancrofti, B. malayi, dst.schistosomiasis Schistosoma mansoni,hepatic worm F. hepatica
Helminthiasis 3
Soil transmitted nematodes
Helminthiasis 4
Epidemiologi (burdens and trends)
• Puplation at risk: 2 billion
• Population infected: > 1 billion
• Mostly children
• Mortality Ankilostomiasis 65.000
• Mortality Ascaris Lumbricoides 60.000
• An. Mort trichuris 10.000
• Pregnant woman : 44 million infected with hookworm
chronic blood loss --> Fe defisiensi
Helminthiasis 5
Epidemiology
Infection are related to:
• Poverty and poor living conditions
• Inadequate sanitation and water supplies
• Soil Quality and climate
• poor personal and environmental hygiene
• poor health awareness
Helminthiasis 6
According to route of infection
• direct
– Trichuris trichiura
– Enterobius vermicularis
• modified direct
– Ascaris lumbricoides
– Toxocara canis
• penetrating the skin
– Ancylostoma duodenale
– Strongiloides stercoralis (also direct)
Helminthiasis 7
Oxiuriasis & Trichuriasis ~ etiologi, epidemiologi
• Oxyuris vermicularis, enterobius vermicularis
• Trichuris trichiura / thread worm / wip worm
• penyebaran geografis /epidemiologi: seluruh dunia
predisposisi
– hygiene, sanitasi buruk
– anak
Helminthiasis 8
O. vermicularis & T. trichiura ~ siklus hidup
usus halus
paru
telur
Helminthiasis 9
Oxiuriasis ~ gambaran klinik, diagnosis
• Pruritus ani– dd/ jamur, alergi, piskosomatik
• Anoreksia• gizi kurang• irritable (anak)• vaginitis• iritasi --> mual, muntah, mencret • komplikasi: appendisitis, penyebaran intra famili
diagnosis• telur cacing (tinja, swab)• sedikit eosinofilia
Helminthiasis 10
Oxiuriasis ~ pengobatan
Umum
• terapi keluarga
• kebersihan kuku dan pribadi
• hygiene & sanitasi
Spesifik
• Allbendazole, adult 400 mg, single dose
• Mebendazole, 100 mg, single dose
• Pyrantel palmoate 10mg/kgbw, single dose)
Helminthiasis 11
Trichuriasis ~ gejala klinik dan diagnosis
• Ringan, tidak spesifik• tanda iritasi;
perut kembung, sukar BAB, mencret kembung, flatus• Korelasi dengan infeksi ascariasis,• Korelasi dengan E. Hystolitica
– Dysentri berat – Anemia– Hipoproteinemia
• Komplikasi pada investasi berat– ileus– perforasi– prolaps rekti
• Diagnosis– telur di tinja
Helminthiasis 12
Trichuriasis ~ terapi
• Deferensial diagnosis:
– Cacing lain,
– Disentri
• Antihelmintik
– Mebendazole 600mg, single oral dose
– Albendazole 400 mg, single oral dose
Suportive
• Nutrisi
• hygiene
• suplementasi besi
Helminthiasis 13
Askariasis
Helminthiasis 14
Askariasis ~ etiologi, epidemiologi
• Askaris lumbricoides
• cacing terbanyak pada manusia (25 % infected)
• penyebaran geografis /epidemiologi: seluruh
dunia
predisposisi
– sanitasi buruk
– iklim panas
Helminthiasis 15
Askariasis ~ life cycle
usus halus
paru
telur
Helminthiasis 16
Ascariasis ~ Clinical symptoms
• Larval ascariasis (migrating larva)– Pneumonitis (Loefler syndrome): fever, cough, sputum,
dyspnoe, asthma, radiological pulmonary infiltration.– Other organs: brain, renal, retina, bone marrow.– Eosinophilia
• Adult worm– minimum symptoms, nutritional problem– Colic, obstruction– regurgitasi
• Wandering Ascariasis– In patient with fever, anestethic agent, liver abcess– Peritoneal lession– Billiary ascariasis
Helminthiasis 17
Ascaris ~ other effects & complication
Immunopathological effects– Sensitivity, anal pruritus, vomiting, glottis edema– High IgE
Indirect effects– relation of ascariasis to poiomyelitis
Nutritional relationships– Protein energy malnutrition– Vitamin A deficiency --> night blindness– Low vitamin C.
Helminthiasis 18
Ascaris ~ diagnosis, and dd/
Diagnosis
– Eggs in faeces / stool
– Serological diagnosis less value
• Lack of correlation with infection burden
• Cross reaction to other helminths
Deferential diagnosis
– Pulmonary symptoms resemble other pulmonary infections
– Larva ascariasis must be distinguished with toxocara, hookworm, stongyloides, schistosomiasis
Helminthiasis 19
Ascarias ~ Therapy
• Allbendazole 200 mg, adult 400 mg, single dose
• Mebendazole 100 mg twice daily for one day
• Levamisole 5 mg/kg bw, single dose
• Pyrantel palmoate 10mg/kgbw, single dose
Helminthiasis 20
Ankilostomiasis
Helminthiasis 21
Ancylostomiasis ~ etiologi, epidemiologi
• Ancylostoma duodenale, stongyloides, Necator americanus,
trychostrongilus.
• Infeksi melalui penetrasi kulit
• anemia pada dewasa
• penyebaran geografis /epidemiologi: seluruh dunia
predisposisi
– hygiene, sanitasi buruk
– kekebalan tubuh menurun
Helminthiasis 22
Ancylostomiasis ~ pathology
• Vesiculation, pustulation .. Ground itch
• Asthma or bronchiolitis
• Established infection --> anemia
Helminthiasis 23
Ankilostomiasis – siklus hidup
Helminthiasis 24
Ankilostomiasis ~ siklus hidup
usus halus
paru
telur
InfectionPenetrasi (N. americanus & ancylostoma), Ingestion (N. americanus)
Migrating larvaegrow & develop in the lung (N. americanus)
Helminthiasis 25
Ankilostomiasis ~ gambaran klinik
• gatal di kaki
• dermatitis, mkulopapula, vesikel
• batuk, batuk darah
• perut kembung, flatus, mencret (awal 2 minggu)
• anemia ( 10-20 minggu)
• tergantung jumlah cacing ~ 500 cacing
Helminthiasis 26
Ankilostomiasis- Anemia & hypoproteinemia
• Chronic blood loss
• Hypochromic microcytic anemia
• Cacing membutuhkan
– Serum & darah
– 0.03 ml / hari / cacing
• Hemoglobin sebanding dengan jumlah cacing
• Plasma feritin berbanding terbalik dgn jumlah cacing
Hypoproteinemia
• Protein losing enteropathy
• Keterbatasan sintesa albumin
• Oedema
Helminthiasis 27
Ankilostomiasis ~ diagnosis
• Telur di dalam tinja
• telur dalam sputum
• sedikit darah dalam tinja
• hitung jumlah telur ~ anemia
• eosinofilia pd fase awal
Komplikasi
• dermatitis berat
• anemia berat
– gangguan pertumbuhan
– payah jantung
Helminthiasis 28
Ankilostomiasis ~ terapi
umum
• Perbaikan gizi
• Pengelolaan anemia
spesifik
• Albendazole, single dose, 400 mg
• Mebendazole, 100 mg, twice day for 3 days
• Pirantel pamoat, single dose 10mg/kg BW,
• Bephenium hydroxynapthoate
• Tetrachlorethylene
Helminthiasis 29
Tissue & blood nematodes
Helminthiasis 30
Taeniasis ~ etiologi, epidemiologi
• Taenia solium, (babi)
• Taenia saginata (sapi
• cysticercosis ~ karena larva
• penyebaran geografis /epidemiologi: seluruh dunia Afrika, India, Filipina,
• Indonesia--> Bali, Irian, Sumatera utara
• predisposisi
– hygiene, sanitasi buruk
– peternakan babi, sapi, binatang tidak terawasi
– kebiasaan defekasi ditempat sembarangan
– makan daging mentah
Helminthiasis 31
Taeniasis ~ siklus hidup
Helminthiasis 32
Taeniasis ~ gejala klinis
• Kebanyakan asimtomatik• keluar proglotid melalui tinja• nausea, nyeri perut• berat badan menurun• nafsu makan meningkat• diare• pruritus ani\
Komplikasi Cysticercosis• kejang / epilepsi• tidak sadar
Helminthiasis 33
Taeniasis ~ diagnosis, terapi
• Proglotid dalam tinja
• proglotid keluar aktif
• telur taenia dalam tinja
• penentuan spesies dengan identifikasi proglotid
• produksi telur berfluktuasi --> harus berulang-ulang
Obat
• praziquantel (single dose)
• niclosamide (single dose)
• paromomisin
• atabrin, bithionol (sudah tidak dipakai)