PENGANTAR

HELMINTHOLOGI

dr. Wiwien S Utami, M.Sc

 Taxonomic classification of helminths
Sub Phylum Class Genus examples
kingdom
Metazoa Nematodes Ascaris (roundworm)
Trichuris (whipworm)
Round worms;
appear round in Ancylostoma (hookworm)
cross section, they Necator (hookworm)
have body cavities, Enterobius (pinworm or
a straight alimentary threadworm)
canal and an anus Strongyloides

Platyhelminthes Cestodes Taenia (tapeworm)

Flat worms; Adult tapeworms are found in the intestine
dorsoventrally of their host
flattened, no body They have a head (scolex) with sucking
cavity and, if organs, a segmented body but no
present, the alimentary canal
alimentary canal is Each body segment is hermaphrodite
blind ending

Trematodes Fasciolopsis (liver fluke)

Non-segmented, usually leaf-shaped, with Schistosoma (not leaf
two suckers but no distinct head shaped!)
They have an alimentary canal and are
usually hermaphrodite and leaf shaped
Schistosomes are the exception. They are
thread-like, and have separate sexes
Classification of helminths

Nematodes (roundworms)
Platyhelminthes (flatworms)
Trematodes (flukes)
Cestodes (tapeworms)
 CLASSIFICATION
HELMINTHS
a. Nematoda (roundworms)
Elongated , round and un-
segmented
Complete digestive system ,
highly developed separate-
sexes
Eggs & larva- suited for
external environment.
Most human infections-
ingestion of egg or larva
Examples Ascaris lumbricoides,
Ankylostoma duodenale,
Enterobius vermiculoaris etc
 CLASSIFICATION

b. Platyhelminthes
Flatworms are flattened,
hermaphroditic, with a
few exceptions
Two classes, Fascioloa hepatica
Trematoda (flukes) &
Cestoda (tapeworms).
I. Trematoda (flukes)
Fasciola hepatica, Clonorchis
sinensis, Schistosoma spp
II. Cestodes, or tapeworms
Taenia saginata
Taenia solium, Echinococcus
granulosus,
 Helminthic diseases
Intestinal
Soil Transmitted Helminthes
Enterobiasis (pinworm)(autoinfection cycle)
Round
worms Invasive
Trichinosis (muscle pain, uncooked carnivores)
Filaria (worms in lymphatics or under skin)
flukes Schistosomiasis (liver or urinary tract
granulomas and fibrosis)

Tape Cysticercosis (cysts in brain, seizures)

worms
Echinococcus (massive cysts in liver or lung)
 Intestinal nematodes
Adult worms in the
the intestine
Larvae pass
through lungs
trichiuris
enterobius

Larvae enter Eggs

bloodstream Eggs ingested
ascaris

strongyloides
hookworm Larvae hatch
Larvae penetrate
from eggs
through intact skin
 Examples of important metazoa intestinal
nematodes
Trichuris (whipworm)
A soil transmitted helminth
prevalent in warm, humid conditions
Can cause diarrhoea, rectal prolapse
and anaemia in heavily-infected
people
Ancylostoma and Necator (hookworms)
A major cause of anaemia in the
tropics
Strongyloides
inhabits the small bowel
infection more severe in
immunospressed people (e.g.
HIV/AIDS, malnutrition, intercurrent
disease)
Enterobius (pinworm or
threadworm)
prevalent in cold and
temperate climates but
rare in the tropics
found mainly in children
Ascaris (roundworm)
Found world-wide in
conditions of poor
hygiene, transmitted by
the faecal- oral route
Adult worms lives in the
small intestine
Causes eosinophilia
 Examples of important metazoa systemic
nematodes

Filaria including: Toxocara

Onchocerca volvulus Transmitted by A world-wide infection of
the simulium black fly, this dogs and cats
microfilarial parasite can cause visual
Human infection occurs
impairment, blindness and severe
when embryonated eggs
itching of the skin in those infected
are ingested from dog or
Wuchereria bancrofti The major cat faeces
causative agent of lymphatic filariasis
It is common in children
Brugia malayi Another microfilarial and can cause visceral
parasite that causes lymphatic larva migrans (VLM)
filariasis
 Examples of important flatworms - cestodes
1. Intestinal - (tapeworms) 2. Systemic
Taenia saginata Echinococcus granulosus (dog
worldwide tapeworm) and Echinicoccus
acquired by ingestion of multilocularis (rodent tapeworm)
contaminated, uncooked beef
a common infection but causes
minimal symptoms Hydatid disease occurs when
the larval stages of these
Taenia solium organisms are ingested
worldwide
acquired by ingestion of The larvae may develop in the
contaminated, uncooked pork that human host and cause space-
contains cystercercus occupying lesions in several
Less common, but causes organs, e.g. liver, brain
cystecercosis a systemic disease
where cysticerci encyst in muscles
and in the brain may lead to
epilepsy
Examples of important metazoa trematodes (flukes)
Intestinal
Fasciolopsis buski
A common parasite of humans and
pigs in South- east Asia. This
parasite is one of the largest
trematodes to infect man (8cm in
length) and lives in the upper
intestine. Chronic infection leads to
inflammation, ulceration and
haemorrhage of the small intestine Paragonimus westermani
Extraintestinal
Fasciola hepatica (liver fluke)-
Primarily, a parasite of sheep,
humans become infected when
they ingest metacercariae that
have encysted on watercress. The
adult trematode lives in the intra-
hepatic bile ducts of the liver.
Fascioliasis can lead to severe
anaemia in humans
Clonorchis sinensis (liver
fluke)- Widespread in China,
Japan, Korea and Taiwan,
this parasite is acquired by
ingestion of infective
metacercariae in raw or
pickled fish
( lung fluke)- Widespread in
the Far East and South east
Asia, the parasite is acquired
by ingestion of infective
metacercariae in raw or
pickled crustaceans
Schistosoma haematobium,
S. mansoni and S. japonicum
Soil Transmitted Helminthes

1. Ascaris lumbricoides
2. Trichuris trichiura
3. Strongyloides stercoralis
4. Necator americanus
5. Ancylostoma duodenale
6. Enterobius vermicularis
7. Ancylostoma caninum
8. Ancylostoma ceylanicum
9. Ancylostoma braziliense
 Ascaris lumbricoides
1. Site of inhabitation: small intestine
2. Infetive stage: embryonated eggs
3. Route of infection: by mouth
4. No intermediate and reservoir hosts
5. Life span of the adult: about 1 year
This worm lives in the lumen of small intestine,
feeding on the intestinal contents, where the fertilized
female lays eggs. An adult female can produce
approximately 240,000 eggs per day, which are passed
in feces. When passed, the eggs are unsegmented and
require outside development of about three weeks until
a motile embryo is formed within the egg.
 Ancylostoma duodenale
Necator americanus
(hookworm)
Intestinal parasites
World wide distribution
Hookworms are named for the
dorsal curve in their anterior end.
However, because they feed on
blood a heavy infection can produce
severe anemia.
 habitat of adult: small intestine of man
Infective stage: filariform larvae
Mode of transmission: penetration of
filariform larvae in skin through bare
feet. In some cases from mother to her
baby.
Diagnosis: eggs in stool
Disease: Hook worm infection
MORPHOLOGY

Adults: They look like

an odd piece thread and
are about 1cm. They are
white or light pinkish
when living. is slightly
larger than .The
males posterior end is
expanded to form a
copulatory bursa.
11/1/2017
Larva

Filariform Rhabditiform
L1, the feeding non-infective
rhabditiform stage
L2, which is also in the rhabditiform
stage, will feed for approximately 7
days.
L3 is the filariform stage of the parasite,
that is, the non-feeding infective form of
11/1/2017 the larvae
 Strongyloides stercoralis
S. stercoralis can be found in areas with tropical
and subtropical climates ex. some areas of Brazil,
Africa and Central America
Disease: Strongyloidiasis
transmission: Direct contact ( enter to skin)
Habitat : (duodenum and jejunum).
2 millimeters
Male seldom in humans
Female in duodenum
Biliary and pancreatic ducts, small bowel, colon
Strongyloides

http://www.smittskyddsinstitut
et.se/upload/Analyser/Strongyl
LarvAM-a.jpg
 Whipworm:
Trichuris trichiuria
Adult habitat: caecum, colorectum
No extra-intestinal phase
Lifespan: 1 - 3 years
90% infections are asymptomatic
Symptoms with heavy infections
Intensity of infection peaks by age 10
Pre-patency:
2 months
 Enterobius vermicularis
(Oxyuria vermicularis) (pinworm)
world wide.
primarily in children.
Most common helminthes infection in US and
western Europe.
Transmission (oral/fecal) or inhaled.
Disease : Enterobiasis or Oxyuriasis
habitat: large intestine of man (cecum and
colon)
Infective stage: embryonated egg
Peri-anal region

Females of
pinworm
 CESTODA
11/1/2017
Ciri-ciri klas Cestoidea

Pipih seperti pita, bersegmen

Tubuh t.a. skolek, leher dan strobila
Reproduksi :
Ovipar
Kadang-kadang berbiak dalam bentuk
larva
Infeksi umumnya oleh larva dalam
kista
Lanjut.
Tidak mempunyai traktus digestivus
Tidak mempunyai rongga badan
Badan (strobila) terdiri atas segmen-
segmen (proglotid) yang masing-masing
dilengkapi dengan system reproduksi
yang lengkap
Hermaphrodit reproduksi self
fertilization atau cross fertilization
Hidup di lumen usus
Ordo Cyclophyllidae

Skoleks mempunyai 4 sucker yang

berbentuk seperti mangkuk, biasanya
letaknya sentral.
Puncak skoleks mempunyai rostellum.
Pada rostellum sering terdapat kait.
Lubang genital (bila ada) terletak di
sebelah lateral proglotid.
Ordo Pseudophyllidae

Skoleks seperti senduk

Alat penghisap (sucker) berupa celah
(bothria)
Lubang genital terletak di sentral
proglotid
Morfologi secara umum

Tubuh terdiri dari :

SCOLEX fungsi untuk melekatkan diri
LEHER infeksi akan tetap
berlangsung selama scolex+leher ini
melekat pada dinding usus halus, meski
proglotid telah kosong/lepas
PROGLOTID/SEGMENT
proglotid immature, mature, gravid
 Ada 3 jenis proglotid :
Proglotid immature di belakang leher,
mengandung organ sexual tapi imatur
Proglotid mature di tengah, berisi
organ sexual male & female/
hermaphrodite
Proglotid gravid di posterior, organ
sexual tumbuh menjadi uterus berisi telur
 Tapeworms
The body plan of adult
scolex cestodes includes a scolex
(looks like the head), a
neck neck and strobila that can
extend for only a few
proglottids or thousands
The strobila is not truly
metameric though as
several organs like the
strobila
excretory system extend
through the entire worm
Proglottid: each
individual segment
Most worms are very
long: occupying the entire
length of small intestine

Scolex of Taenia Solium.
http://www.denniskunkel.com/product_info.ph
p?products_id=813
Morphology of tapeworms:
The scolex
The scolex is the part of the
worm that anchors it to the
intestinal epithelium and
prevents that the worm is
passed with the digested food
Scolex of Diphyllobothrium latum.
The scolex structure varies
between species of tapeworms.
a. Diphyllobothrium latum has
a scolex with elongated, slit-like
attachment organs (bothria)
b. Taenia saginata has four
muscular SUCKERS.
c. Taenia solium has similar
muscular SUCKERS and a
ROSTELLUM with rows of
chitinous hooks. Scolex of Taenia Saginata
Strobila
In most cestodes the scolex is tiny when
compared to the strobila which makes up
most of the actual worm
The strobila consists of a linear series of
proglottids
Tape worms are hermaphrodites and each
proglottid carries a set of female and male
reproductive organs
These segments are released and are
eliminated with the feces of the host.

*(Magnifications are based on a 35mm

slide image of 24mm in the narrow
dimension.)
http://www.denniskunkel.com/product_in
fo.php?products_id=813
Strobila
Strobilation: asexual
process of forming
segments
New proglottids are
continuously formed in the
neck just below the scolex
(A)
Along the length of the
worm the proglottids
increase in size and maturity,
developing from premature
(B) to mature (C, carrying
fully functional and active
sexual organs), to the
gravid stage (D) in which
essentially the entire
proglottid is filled with the
uterus and eggs
Spesies
Taenia saginata
Taenia solium
Hymenolepis nana
Hymenolepis diminuta
Dipylidium caninum
Diphyllobothrium latum
Klasifikasi

1. Ordo PSEUDO PHYLLIDEA

Diphyllobothrium latum
Diphllobothrium (Spirometra) mansoni
2. Ordo CYCLOPHYLLIDEA
Taenia saginata penting di Indonesia
Taenia solium
Hymenolepis nana
Hymenolepis diminuta
Dipylidium caninum
Echinococcus granulosus & E. Multilocularis
 TREMATODA

11/1/2017
CIRI-CIRI :
BENTUKNYA PIPIH SEPERTI DAUN, TERMASUK
DALAM FILUM PLATYHELMINTHES
UMUMNYA HIDUP SEBAGAI PARASIT PADA
VERTEBRATA
PADA BEBERAPA FASE LARVA MEMPUNYAI SILIA
MEMPUNYAI SATU ALAT PENGHISAP DI MULUT
DAN SATU ATAU LEBIH PADA PERMUKAAN
VENTRAL
ALAT KELAMIN HERMAPHRODITE, ALAT
PENCERNAAN TIDAK SEMPURNA
39
DAUR HIDUP :
PEMBIAKAN SEKSUAL TERJADI DI DALAM
INANG DEFINITIF (VERTEBRATA)
PEMBIAKAN ASEKSUAL TERJADI DI DALAM
INANG INTERMEDIER (SIPUT)
PATOGENITAS :
Infeksi yang disebabkan oleh cacing Trematoda ini
tergantung dari tempatnya di dalam inang, pengaruh
rangsang dan zat toksinnya.
Efek sistematik terjadi karena absorpsi zat toksin yang
menghasilkan reaksi alergi dan karena lukanya alat
vital.
Bahaya tidak hanya tergantung dari banyaknya
cacing tetapi juga karena invasi telur, larva, dan
cacing dewasa ke dalam jaringan.
Cacing Trematoda yang ada di dalam usus tidak
begitu merusak seperti cacing yang menyerang
jaringan, kecuali jika terjadi infeksi hebat.
41
TREMATODA
Berdasar habitat :
1. Trematoda usus : Fasciolopsis buski
2. Trematoda paru :Paragonimus westermani
3. Trematoda hati : Chlonorchis sinensis,
Fasciola hepatica, Fasciola gigantica
4. Trematoda darah : Schistosoma mansoni, S.
haematobium, S. japonicum
MORFOLOGI UMUM
o Mirasidium : spt daun, bersilia
o Sporokista : spt kantung, isi redia
o Redia : ada oral sucker, isi serkaria
o Serkaria : spt daun berekor, oral &
ventral sucker
o Metaserkaria : bentuk bulat, dinding
tebal