6/14/2022

Infeksi Soil-transmitted Helminth

pada Latar Belakang
Anak Perawakan Pendek
• Angka kejadian perawakan pendek masih cukup tinggi di seluruh dunia

– Indonesia: 30,8% (2018) → 27,7% (2019) (RISKESDAS)

– Jawa Barat peringkat ke-18 (31.1%)

• SDG’s merupakan salah satu target indikator capaian menurunkan jumlah anak
Stunting usia <5 tahun sebesar 40% pada tahun 2020
dr. RIYADI SpA(K) M.Kes
DIVISI INFEKSI DAN PENYAKIT TROPIS
RSUP DR. HASAN SADIKIN
BANDUNG

Perawakan pendek atau short stature:

panjang/tinggi badan menurut usia (PB/U atau TB/U) dan jenis kelamin
dibawah -2 SD atau persentil 3 kurva yang berlaku.
(UKK endokrinologi IDAI)

• Di Indonesia, 30,7% anak usia sekolah dinyatakan pendek

– 12,3% sangat pendek
– 18,4% pendek

• Stunting merupakan bagian dari perawakan pendek yang terbanyak akibat

nutrisi yang tidak adekuat (malnutrisi) dan infeksi.

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Infeksi STH
Prevalensi kecacingan di dunia

Prevalensi kecacingan di Indonesia 28,12%

• Ascaris lumbricoides 39%, Trichuris trichiura 24%, dan cacing tambang (Ancylostoma
duodenale dan Necator americanus) 5%
• Anak usia Sekolah 60-80%, usia pra-sekolah (24-59 bulan) 20-30%
(Laporan Kementerian Kesehatan, 2003 dan 2006)

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KECACINGAN Ascaris lumbricoides

• soil-transmitted helminthiasis (STH) adalah infeksi cacing nematode
usus yang dalam penularannya atau siklus hidupnya memerlukan tanah • 1/8th the world’s population infected
yang sesuai untuk berkembang menjadi bentuk infektif
• Prevelansi kecacingan di Indonesia pada anak umumnya masih cukup • Geographic prevalence highest in warm and wet
tinggi dengan rata-rata prevalensi tahun 2002-2009 sebesar 31,8%, climates
sementara prevalensi kecacingan di Jawa barat khususnya didaerah
pedesaan antara 24,6% sampai 26,9%. Pada penelitian yang dilakukan • Intensity of infection greatest in children:
diindonesia tahun 2010 pada anak usia dibawah lima tahun 5 – 10 years
menunjukkan adanya hubungan antara kejadian cacingan dengan
kondisi sarana penyediaan air bersih, kondisi sarana pembuangan tinja,
kondisi sarana pembuangan air limbah dan jenis lantai rumah

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Ascaris lumbricoides
• Largest of nematodes infecting humans

• Adult habitat: small intestine (jejunum)

• Obligatory extra-intestinal migration (eosinophilia)

• Lifespan: 1 – 2 years

• 1 adult female = 200,000 eggs/day

Löeffler Syndrome (Pneumonitis)

Ascaris lumbricoides
Clinical Features:

• Larval phase: eosinophilia, pneumonitis

• Adult phase:
• Malnutrition, Impaired Physical Growth
• Mild abdominal discomfort → Small bowel obstruction (in
children, few as 60 worms) Transverse sections of Ascaris
• Wandering ascaris: biliary tract obstruction, cholangitis, larvae in pulmonary alveoli
pancreatitis, liver abscess

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Whipworm: Trichuris trichiuria

• Adult habitat: caecum, colorectum

• No extra-intestinal phase

• Lifespan: 1 - 3 years

• Symptom :
- 90% infections are asymptomatic
- Symptoms with heavy infections

• Intensity of infection peaks by age 10

Whipworm:Trichuris trichiuria Human Hookworm

Epidemiology
Clinical Features:
• Asymptomatic • > 1200 million infections /year: 100 million are symptomatic
• Physical Weakness, Anemia • Significant cause of anemia & protein malnutrition

• Stunted Growth, Cognitive Deficits

• It is due to 2 parasites both of which occur worldwide:
• Stool frequency (12+/day), nocturnal stooling
• Necator americanus - predominant species in sub-Saharan
• Trichuris dysentery syndrome Africa, south Asia and the Pacific
• Trichuris colitis • Ancylostoma duodenale –predominant in S. Europe, N.
• Rectal prolapse Africa, western Asia, northern China, Japan and the west
coast of America

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Human Hookworm
Human Hookworm

• Necator americanus is the predominant hookworm species

• Adult habitat: small intestine

• Lifespan:
~ 1 year (A. duodenale)
~ 3 - 5 years (N. americanus)

• Adult size: 0.5 ─ 1 cm

• Daily eggs per worm: 5 ─ 20,000

Human Hookworm Human Hookworm

Symptoms and signs
• Minor Clinical Features:
- Often itchy papules are found at the site where the larva
• Ground-itch –> Dry cough, wheezing
penetrated the skin (1-2 wks later) in primary infection
- may be cough and wheezing as the larva migrates through
• Abdominal discomfort
the lungs
• Progressive iron-deficiency anemia
40 – 160 worms associated with Hgb < 11 g/dL
• Major
• Failure to thrive, extreme fatigue
Hookworm anaemia
– Tiredness, aches and pains, Pallor • IQ loss
– Breathlessness, Oedema

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At-Risk Populations for Hookworm Disease Human Hookworm: Prevention and control
• Women and Children: Low Iron Stores
1. Health education and improve sanitation facilities
• Children: – install pit latrines
• Physical growth stunting
• Cognitive deficits and intellectual retardation
2. Encourage use of protective footwear
• Women of Child-bearing age
• Puberty 3. Discourage soil eating (pica)
• Menstruation
• Pregnancy
• Increased Maternal Mortality (anemia) 4. Mass drug treatment of communities
• Low Birthweight
• Infant Mortality 5. Iron supplementation in areas of low iron intake

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