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Parasitic Helminths

Tapeworms

Taeniasis
( Penyakit Cacing Pita )

Taenia solium ( pada babi )

Morphology
Adult : 2-4 m long, 700-1000 segments: Scolex Neck Immature segment Mature segment Gravid segment

Taenia saginata

Taenia saginata (beef tapeworm)


( pada binatang sapi

4- 25 m , 1000-2000 segments Scolex Neck Immature segment Mature segment Gravid segment

TAENIASIS

Agen penyebab: Tanea soleum - babi T. saginata - sapi Dalam siklus hidupnya menyebabkan infeksi pd manusia, tdp 2 stadium: stadium dewasa/taeniasis - intestinal infection stadium larva/cystiserciasis; cysticercosis - infeksi pada jaringan

Morfologi
T. solium Body length Segment Scolex 2-4m 700-1000, thin rostellum with hooks T. saginata 4-8m 1000-2000, thick no rostellum and hooks

Morfologi
T. solium Mature segment Ovary() T. saginata

Gravid segment Uterine branches

Classification of helminths
Nematodes (roundworms) Platyhelminthes (flatworms) Trematodes (flukes) Cestodes (tapeworms)

Epidemiologi
Hospes definitif ( penjamu/ resrvoir ): manusia Penyebaran : seluruh dunia, terutama Amerika latin, Afrika, Asia Tenggara, Eropa bagian Timur Penularan : menelan daging babi (T.sol.) atau sapi (T.sag.) mentah/tidak dimasak dg baik. Cysticercosis ( sirtiserkosis): - langsung, dan tidak langsung dari ma-mi tercemar

Epidemiologi
T. saginata:
Widespread in cattle breeding areas of the world. Prevalence >10% in some independent states of the former Soviet Union, in Near East, and in central and eastern Africa. Lower rates in Europe, Southeast Asia, & South America

T. solium:

Prevalent in Mexico, Central and South America, Africa, Southeast Asia,and the Philippines

Infections in USA and Canada are found in immigrants from areas where taeniasis is endemic, and in travelers who consume undercooked meats in endemic areas

Siklus Hidup

Humans are the only definitive hosts for T. saginata and T. solium. Eggs or gravid proglottids are passed with feces ; the eggs can survive for days to months in the environment. Cattle (T. saginata) and pigs (T. solium) become infected by ingesting vegetation contaminated with eggs or gravid proglottids . In the animal's intestine, the oncospheres hatch , invade the intestinal wall, and migrate to the striated muscles, where they develop into cysticerci. A cysticercus can survive for several years in the animal. Humans become infected by ingesting raw or undercooked infected meat.

In the human intestine, the cysticercus develops over 2 months into an adult tapeworm, which can survive for years. The adult tapeworms attach to the small intestine by their scolex and reside in the small intestine. Length of adult worms is usually 5 m or less for T. saginata (however it may reach up to 25 m) and 2 to 7 m for T. solium. The adults produce proglottids which mature, become gravid, detach from the tapeworm, and migrate to the anus or are passed in the stool (approximately 6 per day). T. saginata adults usually have 1,000 to 2,000 proglottids, while T. solium adults have an average of 1,000 proglottids. The eggs contained in the gravid proglottids are released after the proglottids are passed with the feces. T. saginata may produce up to 100,000 and T. solium may produce 50,000 eggs per proglottid respectively.

Taenia saginata - The Beef Tapeworm

Taenia solium - The Pork Tapeworm

Cysticercus

in pig muscle

Manifestasi klinis

Incubation period:

taeniasis - eggs appear in 8-14 weeks cystercosis - days to years Taeniasis


Symptoms:

mild abdominal symptoms occasionally appendicitis or cholangitis from migrating proglottids passage of proglottids (active or passive)

Manifestasi klinis

Cysticercosis:

migrating larvae may localize in eye, CNS, or cardiac tissue neurocysticercosis - severe, may be fatal

headache nausea vomiting epileptiform seizures hydrocephalus - either by accumulation of CSF behind cyst or my inflammatory response

Manifestasi klinis
Taenia saginata < Taenia solium : sistiserkosis T.saginata jarang terjadi T.saginata , terutama cacing dewasa yg menimbulkan gangguan pada manusia Gangguan sal.cerna karena panjang cacing dalam usus ( 25 meter ) : diare, rasa lapar. Penurunan berat badan, nausea, muntah ssd makan, kolik usus, spt tukak lambung, gejala peny.empedu

Manifestasi klinis
Cysticercosis occurs in humans after the ingestion of T. solium eggs
Embryonic metacestode migrates from the intestine and can lodge in a number of tissue sites such as the brain, muscle, and eyes with proclivity for the brain The clinical course largely depends on the endurance of the parasite inside the tissue and on the ensuing inflammation In the brain parenchyma, the intruding cysticercus might be destroyed within a few days by host immune mechanisms or remain viable in the brain for > 10 years

Manifestasi klinis
Cysticercosis can affect humans at any age Most common during the 3rd and 4th decades of life About 10% occur in children In infants initial signs of cysticecosis in infants is generalized seizure CT with contast or T2-weighted MRI isolated cystic lesion in the brain parenchyma Typically the lesion disappears spontaneously 2-3 months later, but in some granuloma cacification (permanent sequela) Isolated lesion is most common; some children have two-several cysts Cystcercotic encephalitis is a severe form of CNS cystcercosis that occasionally occurs in children, particularly adolescent girls

Manifestasi klinis
In adults neurocysticercosis is quite different: Multiple brain cysticerci, variable immune response, chronic inflammation, chronic persistence of many active cysts, vasculitis and protean clinical picture Epilepsy occurs in 50% of cases; intracranial hypertension in 30% Occular Cysticercosis: Subretinal area or vitreous chamber Muscular cystcercosis: Rare in both children and adults; usually benign course

Cysticercosis

in brain Cystcercosis in eye Cysticercosis in subcutaneous tissues and muscles

Diagnosis
Taeniasis
stool

examination anal swab gravid segment examination


Cystisercosis
biopsy

funduscopy
X-ray,

B ultrasonic, CT Serological tests

CYSTICERCOSIS

T. saginata egg

Diagnosis

Taeniasis

microscopic identification of eggs and proglottids in feces after 3 months eggs do not distinguish species Serology CT for visualization of calcified cysts MR for cysts in fourth ventricle

Cysticercosis

Pengobatan

Taeniasis

praziquantel praziquentel if active cystercosis, but only under hospitalization due to acute inflammatory reaction; steroids given to control inflammation surgical

Cystercosis

shunt - ventriculoperitoneal shunt to drain CSF cyst removal endoscopic fenestration (hole in cyst wall)

Pengobatan

Intestinal T. solium and T.saginata infection: Praziquantel - (5-10 mg/kg once) Neurocysticercosis: Albendazole - 15 mg/kg/day (maximum, 800 mg/day) divided into two doses X 8 days Two months later, if repeat imaging studies show cysts: Praziquantel in a total dose of 75mg/kg divided in three doses for 15 days. Repeat imaging studies in two months

Pencegahan
Prevention/Control Education Identification and immediate treatment of infected individuals Freezing meat at -5C (23F) for > 4 days effectively kills cysticerci Irradiation

Taeniasis
ingestion of undercooked pork

poor sanitation

poor hygiene

Tapeworm

Cysticercosis

Taenia saginata & Taenia solium


Laboratory Findings/Diagnosis

CT and MRI are the most relaible tools for the diagnosis of neurcysticercosis Serologic tests are unreliable (cross reactivity with antigens of other parasites)

Serology is highly specific for CNS inection when tests are performed on CSF

Tapeworms
Definitive hosts: harbor adult worms Intermediate hosts: harbor tissue cysts (containing worm heads) Humans acquire infection two ways:

ingestion of eggs from feces (to acquire tissue cysts) ingestion of tissue cysts in undercooked meat (to = Intermediate host acquire a tapeworm)

= Definitive host

TAENIASIS
T. saginata

TAENIASIS
Tanea soleum

TANEIASIS
Epidemiology

Reservoir:

humans definitive host for both T. saginata and T. soleum worldwide highest in Latin America, Africa, SE Asia, Eastern Europe T. soleum rare in US, Canada, UK, but increasingly recognized in immigrants

Occurrence:

TANEIASIS
Epidemiology Transmission:

T. saginata - ingestion of raw or undercooked beef or beef products containing cysticerci T. soleum - ingestion of raw or undercooked pork or pork products; measly pork Cysticercosis

direct transmission of eggs


direct contact (mouth-mouth) autoinfection - reverse peristalsis of eggs or proglottids in intestine

indirect by contaminated food or water

III. Pathogenicity
Taeniasis intestinal descomfort: vomiting, diarrhoea or constipation, loss of appetite, appendicitis and intestinal obstruction Cysticercosis The methods of infecting eggs: auto-infect oneself in body; auto-infect oneself outside body; infect from other person

5.6 The Parasitic Helminths


Tapeworms, flukes, and roundworms Adults large enough to be seen with the naked eye From 1 mm to 25 m in length Microscope is necessary to identify eggs and larvae Two major groups: Flatworms and Roundworms

Life Cycles and Reproduction


Fertilized egg (embryo), larval, and adult stages In most, adults derive nutrients and reproduce sexually in a hosts body

Nematodes- separate sexes Trematodes- separate sexes or hermaphroditic

Must complete the life cycle by transmitting an infective form to the body of another host

Larval development- intermediate (secondary) host Adulthood and mating- definitive (final) host

Flatworms
Phylum Platyhelminthes Thin Often segmented Subdivisions

Cestodes (tapeworms) Trematodes (flukes)

Among the most common tapeworms in humans are the pork tapeworm, the beef tapeworm, the fish tapeworm, and the dwarf tapeworm. Infections involving the pork and beef tapeworms are also called taeniasis. Length of adult worms

5 m or less for T. saginata (however it may reach up to 25 m) 2 to 7 m for T. solium.

Cestodes

Live tapeworm larvae are sometimes ingested by consuming undercooked food. Once inside the digestive tract, a larva can grow into a very large adult tapeworm. The adults produce proglottids which mature, become gravid, detach from the tapeworm, and migrate to the anus or are passed in the stool (approximately 6 per day). Additionally, many tapeworm larvae cause symptoms in an intermediate host.

For example, cysticercosis is a disease of humans involving larval tapeworms in the human body.

Clonorchis sinensis

Figure 5.29

Life Cycle of Human Liver Fluke


Embryonated eggs are discharged in the biliary ducts and in the stool. Eggs are ingested by a suitable snail intermediate host; the egg releases miracidia, which go through several developmental stages (sporocysts, rediae, and cercariae).

Over 100 species of snail are suitable intermediate hosts

The cercariae are released from the snail and after a short period of free-swimming time in water, they come in contact and penetrate the flesh of freshwater fish, where they encyst as metacercariae.

Life Cycle of Human Liver Fluke

Infection of humans occurs by ingestion of undercooked, salted, pickled, or smoked freshwater fish. After ingestion, the metacercariae excyst in the duodenum and ascend the biliary tract through the ampulla of Vater. Maturation takes approximately 1 month. The adult flukes (measuring 10 to 25 mm by 3 to 5 mm) reside in small and medium sized biliary ducts. In addition to humans, carnivorous animals can serve as reservoir hosts.

Roundworms

Phylum Nematoda Elongate Cylindrical Unsegmented In dogs: Roundworms, tapeworms, hookworms, whip worms and heartworms. Human: potentially all of these; also pinworms and many others.

General Worm Morphology

Most developed organs are those of the reproductive tract Some degree of reduction in digestive, excretory, nervous, and muscular systems Most have thick cuticles for protection and mouth glands for breaking down the hosts tissue

Round worms

Figure 5.30

Hookworms

Hookworm

The human hookworms include the nematode species, Ancylostoma duodenale and Necator americanus. A larger group of hookworms infecting animals can invade and parasitize humans (A. ceylanicum) or can penetrate the human skin (causing cutaneous larva migrans), but do not develop any further (A. braziliense, A. caninum, Uncinaria stenocephala). Occasionally A. caninum larvae may migrate to the human intestine, causing eosinophilic enteritis.

Ancylostoma caninum larvae have also been implicated as a cause of diffuse unilateral subacute neuroretinitis.

Hookworms

Hookworm larvae can penetrate the surface of a person's skin (usually through bare feet) and migrate through it, causing a disease called 'cutaneous larva migrans' or 'creeping eruption.' The lesions appear as red lines under the skin and sometimes break open at the skin's surface. These lesions cause severe itching. Usually, the larvae will die in several weeks and the condition will disappear. In severe cases, the larvae may make their way through the skin and enter deeper tissues. This may cause lung disease and painful muscles.

Life Cycle (intestinal hookworm infection):

Life Cycle (cutaneous larval migrans):

A Helminth Cycle: The Pinworm

Person swallows microscopic eggs


Picked up from another infected person by direct contact Or by touching articles an infected person has touched

Eggs hatch in the intestine Release larvae that mature in to adult worms (about 1 month) Male and female worms mate Female migrates out of the anus to deposit eggs

Causes intense itchiness Relieved by scratching Scratching contaminates the fingers which transfer the eggs

Eggs spread to others or the original host reinfects him or herself

Pinworms
Enterobius vermicularis

Use a flashlight to inspect the anal area At night Tape test: 1 inch strip of cellophane tape is pressed firmly over the anal area for a few seconds. Repeat three separate days. In morning before bathing Transfer to a glass slide, sticky side down

Helminth Classification and Identification


Shape Size Degree of development of various organs Presence of hooks, suckers, or other special structures Mode of reproduction Kinds of hosts Appearance of eggs and larvae

Distribution and Importance of Parasitic Worms


About 50 species parasitize humans Distributed in all areas of the world Yearly estimate of worldwide infections- in the billions

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