BAB I

PENDAHULUAN

1.1 Latar Belakang








BAB II
TINJAUAN PUSTAKA

2.1 Fasciola Hepatica
2.1.1 Definisi
2.1.2 Siklus Hidup
2.1.3 Patofisiologi
The parasitic infection in humans begins when water plants, like watercress,
containing larva are ingested. The larva (metacercaria) excyst in the stomach
and penetrate the duodenal wall, escape into the peritoneal cavity, and then
penetrate the Glissons capsule, entering the liver parenchyma. In the liver,
the flukes slowly migrate randomly through the hepatic parenchyma making
multiple small holes and cavities, causing inflammation, abscess formations,
hemorrhage, necrosis, granulation, and fibrosis, until they reach the larger
bile duct and penetrate into the lumen, which is their permanent residence.
Young flukes within the hepatic parenchyma measure few millimeters, while
adult flukes within the bile ducts measure 20 40 mm in length and 8 13
mm in width. The hepatic stage lasts two to several months and the parasite
may persist for a decade or more in the bile ducts. Hepatic parenchymal
calcification may be observed rarely, in cases with chronic disease.[4]
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279695/)
2.2 Epidemiologi

2.3 Kriteria Diagnosis
Fascioliasis is a parasitic infection typically caused by Fasciola hepatica, which is also
known as "the common liver fluke" or "the sheep liver fluke." A related
parasite, Fasciola gigantica, also can infect people. Fascioliasis is found in all 5
continents, in over 50 countries, especially where sheep or cattle are reared. People
usually become infected by eating raw watercress or other water plants contaminated
with immature parasite larvae. The immature larval flukes migrate through the
intestinal wall, the abdominal cavity, and the liver tissue, into the bile ducts, where
they develop into mature adult flukes, which produce eggs. The pathology typically is
most pronounced in the bile ducts and liver. Fasciola infection is both treatable and
preventable. (http://www.cdc.gov/parasites/fasciola/)
2.3.1 Anamnesis
2.3.2 Pemeriksaan Fisik
2.3.3 Pemeriksaan Penunjang
Direct parasitological techniques, indirect immunological tests, and imaging
techniques are presently used for diagnosis of fascioliasis in humans.
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279695/)
2.4 Tata Laksana
Triclabendazole, the only medicine recommended by WHO against fascioliasis, is
active against both immature and adult parasites, and may therefore be employed
during the acute and chronic phases. Cure rates are high , while adverse reactions
following treatment are usually temporary and mild. The recommended regimen is 10
mg/kg body weight administered as a single dose in both clinical practice and
preventive chemotherapy interventions. In clinical practice, where treatment failure
occurs, the dosage may be increased to 20 mg/kg body weight in two divided doses
12-24 hours apart
(http://www.who.int/foodborne_trematode_infections/fascioliasis/fascioliasis_diagnosi
s/en/)
or high efficacy and safety, triclabendazole (Egaten) in dose 1012 mg/kg is the drug
of choice in human fasciolosis.
[44]
Praziquantel treatment is ineffective.
[45][46]
There are
case reports of nitazoxanide being successfully used in human fasciolosis treatment
in Mexico.
[47]
There are also reports of bithionol being used successfully.
[48]

More recently, Mirazid, an Egyptian drug made from myrrh, has been investigated as
an oral treatment of trematode-caused ailments including fascioliasis


l. Emetine HCl : 30 mg/hari selama 17-18 hari atau 40 mg sampai total dosis 5
mg/kg BB
tercapai
2. Bithionol 50 mg selama 20 hari
3. Metronidazole 1.5 gram per hari selama 13-21 hari
4. Praziquantel: dosis oral 20 mg/kg/hari selama 3 hari. Obat ini tidak seefektif
seperti bila diberikan kepada infeksi trematoda lain, karena obat tidak dapat
menembus kulit kulit cacing yang tebal.

Bithionol continues to be the drug of choice (DOC) in fascioliasis,
[19]
although it is available
in the United States only under an investigational protocol from the Centers for Disease
Control and Prevention (CDC).
A new fasciolicide, triclabendazole, cured 31 of 40 infected Egyptian children with 1 day
of therapy.
[20]
A second day of treatment cured the remaining 9 children. Further studies of
the safety and efficacy of triclabendazole are pending,
[21]
and a case of resistance has
been described.
[22]
This agent is not currently available in the United States.
Praziquantel is safe, although it may not be effective against Fasciola hepatica (Fh).
Praziquantel administration is recommended only if bithionol or triclabendazole is
unavailable.
Medications previously used but no longer recommended because of toxicity or unproven
efficacy include emetine, dehydroemetine, chloroquine, albendazole, and mebendazole.
Fascioliasis complicated by ascending cholangitis requires treatment with appropriate
antibacterial antibiotics.
Surgical
Patients with ascending cholangitis may require surgery. Although one study
promoted endoscopic flushing of the gallbladder with povidone-iodine for patients in
whom oral fasciolicides proved ineffective,
[23]
this technique has had no further
validation.
2.5 Komplikasi
Severe anemia and, less commonly, pancreatitis, occur in children more frequently
than in adults.
Rare complications include ectopic foci of infection, hemoperitoneum, subcapsular
hematoma,
[26]
hepatic mass, cholecystitis, ascending cholangitis, hemobilia from
ulceration of the biliary epithelium, gallstones, and sclerosing cholangitis.

2.6 Prognosis
Prognosis is excellent with adequate therapy. A new fasciolicide, triclabendazole,
cured 31 of 40 infected Egyptian children with 1 day of therapy.
[20]
A second day of
treatment cured the remaining 9 children.

2.7 Pencegahan
No vaccine is available to protect people against Fasciola infection.
In some areas of the world where fascioliasis is found (endemic), special
control programs are in place or are planned. The types of control measures
depend on the setting (such as epidemiologic, ecologic, and cultural factors).
Strict control of the growth and sale of watercress and other edible water
plants is important.
Individual people can protect themselves by not eating raw watercress and
other water plants, especially from endemic grazing areas. As always,
travelers to areas with poor sanitation should avoid food and water that might
be contaminated (tainted). Vegetables grown in fields that might have been
irrigated with polluted water should be thoroughly cooked, as should viscera
from potentially infected
animals.( http://www.cdc.gov/parasites/fasciola/prevent.html)
Pencegahan dapat dilakukan dengan melakukan pemberantasan penyakit pada
hewan, membasmi keong air (sulit), memasak sayur dengan sempurna (jangan
makan sayur mentah)
Memasak hati dengan sempurna (mencegah Pharyngeal Fascioliasis).
Fascioliasis can be prevented through public education about avoiding consumption of
contaminated water plants, water, and raw liver.
A vaccine candidate comprising activated dendritic cells shows promise in mouse
infection. http://emedicine.medscape.com/article/997890-followup#a2648



treatment should be complemented, where feasible, by implementing measures that aim to
reduce transmission rates, including:
information, education and communication, promoting cultivation of vegetables in water
free from faecal pollution and thorough cooking of vegetables before consumption;
veterinary public health measures, including treating domestic animals and enforcing
separation between husbandry and humans;
environmental measures such as containment of the snail intermediate hosts and drainage of
grazing lands.
(http://www.who.int/foodborne_trematode_infections/fascioliasis/fascioliasis_d
iagnosis/en/)
Education
Advise patients to avoid high-risk behaviors (ie, consumption of contaminated water
plants, water, raw liver).
For patient education resources, see the Esophagus, Stomach, and Intestine
Center and Liver, Gallbladder, and Pancreas Center, as well as Abdominal Pain in
Children and Pancreatitis.