FASCIOLOPSIS DAN CLONORCHIASIS (Trematoda)

S. HERY POERWANTO

PENDAHULUAN
Cacing Daun (pipih bbtk daun, kec. Schistosoma) Monoceous (kec. Schistosoma) Ventral : 1/lebih batil isap berotot Saluran pencernaan : Faring berotot (kec. Schistosoma), anterior pendek di tengah, bercabang 2 di bagian posterior dan buntu (sekum/caeca) Sistem ekskresi : sel api Sistem saraf : 2 buah ganglion dekat faring dg urat saraf ke arah tranversal dan longitudinal sampai posterior

TREMATODA
Klasifikasi Filum : Platyhelminthes Ordo : Prosostomata
Subordo Strigeata Amphistomata Distomata Famili Schistomatidae Paramphistomatidae Fasciolidae Ophisthorchidae Heterophyidae Troglotrematidae

Kelas : Trematoda
Genus Schistosoma Gastrodiscoides Watsonius Fasciola Fasciolopsis Clonorchis Ophistorchis Heterophyes Metagonimus Paragonimus

Subkelas : Digenea
Spesies S. Haemotobium, Mansoni Japonicum, Intercalatum G. Hominis W. watsoni F. Hepatica, F. Gigantica F. busci C. Sinensis O. Felineus, O. viverrini H. Heterophyes M. yokogawai P. westermani

 Alat reproduksi betina : ovarium, reseptakulum seminalis, saluran laurer, ootip dan uterus. Kelenjar mehlis mengelilingi ootip. Kelenjar vitelin keuar mll saluran vitelin yg dilepas oleh ovarium mll oviductus ke ootip. Pembuahan tjd di ootip. Telur yg dibuahi diselubungi kulit yg diproduksi kelenjar vitelin Telur dr ootip didorong ke dlm uterus Alat reproduksi jantan : Testis, vas deferens, vas efferens, vesica seminalis, sirus, prostat dan kantong sirus Spermatozoa dibentuk dlm testis, kmd mll vas efferens dan vas dan disimpan sementara di dlm vesica seminalis kantong sirussirus porus genitalis umum. Telur Trematoda beroperkulum, kec. Schistosoma mirasidiumsporokista(keong) redia serkaria

Pathogenesis
Pada infeksi yang ringan selalu asymptomatic. Pada infeksi akut, terjadi gejala : fever, diarrhoea, epigastric pain, enlargement and tenderness of liver Chronic infections with this parasite lead to inflammation, ulceration, hemorrhage, and abscesses of the small intestine, and these can ultimately lead to the host's death. Several books and a number of web sites state that this parasite either causes directly or is associated with an increased risk of cancer, HIV, or any number of other diseases in humans.

TREMATODA INTESTINAL
1. Fasciolopsis buski Trematoda besar 20-75 mm x 8-20 mm (usus halus) Batil isap mulut lebih kecil drpd batil isap perut Testes bercabang (2/3 tubuh) Ovarium bercabang kecil dan uterus pendek. Daur hidup : mns terinfeksi metaserkaria (tumbuhan air) Gejala klinis : Infeksi ringan asymtomatis Infeksi berat : diare, muntah Diagnosis : menemukan telur dlm tinja 2. Echinostoma spp. E. ilocanum, lindoense, malayanum, revolutum, cinetorchis mpy duri di leher pd ujung anterior Manusia terinfeksi menelan metaserkaria pada jaringan siput Cacing dewasa hidup di usus halus (diare) Diagnosis : menemukan telur dlm tinja

3. Gastrodiscoides hominis Asetabulum besar pada ujung posterior Stad. Infektif : metaserkaria dr tumbuhan air Hidup dlm usus besar Hospes reservoir : babi Gejala klinis : kolik dan diare Diagnosis : telur dlm tinja 4. 5. Heterophyes heterophyes Ukuran 1 1,7 mm x 0,3-0,4 mm (usus halus) Stad. Infektif : metaserkaria dr ikan Gejala klinis : kolik dan diare Diagnosis : telur dlm tinja Metagonimus yokogawai Ukuran 1-2,5 mm x 0,4 0,75 mm (usus halus) Batil isap di tengah di lateral lobang genital Stad. Infektif : metaserkaria dr ikan Gejala klinis : kolik dan diare Diagnosis : telur dlm tinja

Fasciolopsis busci

 Geographic distribution Reservoir hosts

Fasciolopsis buski

Echinostoma species

Far East and Indian sub- South East Asia and Japan continent pigs, dogs and rabbits Intestine Variety of mammals Intestine 88 - 116 by 58 - 69

Location of adult in host Size of ova 130 - 140 by 80 -85

Morphologic structures of Fasciolopsis buski

Adult fluke of Fasciolopsis buski. The adult flukes range in size: 20 to 75 mm by 8 to 20 mm

Liver fluke, a trematode liver parasite - helminth (Fasciola spp.) Mouth and pharynx of the adult liver fluke. Humans are infected by ingestion of uncooked aquatic vegetation on which the metacercariae stage is encysted. Metacercariae excyst in the duodenum and migrate through the intestinal wall in to the peritoneal cavity. The larvae enter the liver by penetrating the capsule and wander through the liver parenchyma for up to 9 weeks. Most damage is done in the liver parenchyma by physical irritation and metabolic by products. Dennis Kunkel Microscopy, Inc. Used with permission

Immature eggs are discharged into the intestine and stool . Eggs become embryonated in water , eggs release miracidia , which invade a suitable snail intermediate host . In the snail the parasites undergo several developmental stages (sporocysts , rediae , and cercariae ). The cercariae are released from the snail and encyst as metacercariae on aquatic plants . The mammalian hosts become infected by ingesting metacercariae on the aquatic plants. After ingestion, the metacercariae excyst in the duodenum and attach to the intestinal wall. There they develop into adult flukes (20 to 75 mm by 8 to 20 mm) in approximately 3 months, attached to the intestinal wall of the mammalian hosts (humans and pigs) The adults have a life span of about one year.

Siklus Hidup
The life cycle of this parasite is similar to that of Fasciola hepatica. The worms produce eggs (up to 25,000 eggs per worm per day) that are passed in the host's feces. The first intermediate host is a snail, and the cercariae that emerge from the snail encyst on vegetation. Humans are infected with then eat vegetation contaminated with metacercariae.

 If the eggs then reach water, they hatch in 3 to 7 weeks and form miracidia, organisms that looks similar to ciliated protozoa. The miracidia penetrate the soft tissues of snails and develop into a sporocyst state. he sporocysts then produce many daughter stages called rediae that asexually reproduce to yield cercariae. The cercariae, which feature a tail-like structure that enables them to swim, exit the snail host and encyst on nearby vegetation, where they develop into metacercariae.

Telur

The eggs are ellipsoidal, with a thin shell, and a usually small, indistinct operculum. In this particular egg, the operculum is open. Eggs range in size: 130 to 159 m by 78 to 98 m.

Fasciolopsis buski egg. The egg is very similar to that of Fasciola hepatica; approximate size = 130 m in length.

Fig. 4 Miracidia hatching from egg on left

Trematode (Fasciolopsis buski) Rediae

Pathogenesis
The adult flukes of Fasciolopsis buski attach to the intestine, resulting in local inflammation and ulceration. Heavier infections may subsequently lead to abdominal pain, malabsorption and persistent diarrhoea. Marked eosinophilia may be seen. The adult flukes of Echinostoma species attach to the intestine resulting in little damage to the intestinal mucosa.. Light infections are generally asymptomatic and heavy infections may produce light ulceration, diarrhoea and abdominal pain..

Laboratory diagnosis
Definitive diagnosis is made by observing the ova in faeces. Where identification cannot be made from the size of the ova, clinical information and the source of infection may help to provide a diagnosis. Serological techniques are available for the diagnosis of Fasciola hepatica. Diagnosis of the disease is based on recovering eggs in the host's feces.