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Kuliah Penunjang Blok INFEKSI

PENYAKIT
INFESTASI CACING DAN
GIGITAN SERANGGA

Paramasari Dirgahayu, dr., PhD

LABORATORIUM PERASITOLOGI- MIKOLOGI


FAKULTAS KEDOKTERAN UNIVERSITAS SEBELAS MARET
SURAKARTA
2015
Sumber: Paramasari D
LEARNING OBJECTIVE
PRIOR KNOWLEDGE MANDIRI
 PEMAHAMAN BERBAGAI MACAM HUBUNGAN SIMBIOSIS
ANTAR ORGANISME
 PEMAHAMAN BERBAGAI MACAM ISTILAH HOST/INANG
 PEMAHAMAN BERBAGAI BERBAGAI CARA INFEKSI
 PEMAHAMAN PENGGOLONGAN DAN TAKSONOMI
HELMINTHOLOGI
 PEMAHAMAN MORFOLOGI CACING (PRAKTIKUM
PARASITOLOGI)
Helminthic diseases
• Intestinal
– Others
– Strongyloides (autoinfection cycle)
roundworms • Invasive
– Trichinosis (muscle pain, uncooked carnivores)
– Filaria (worms in lymphatics or under skin)
– Schistosomiasis
flukes (liver or urinary tract
granulomas and fibrosis)
– Cysticercosis
(cysts in brain, seizures)
tapeworms – Echinococcus
(massive cysts in liver or lung)
Intestinal nematodes
Soil Transmitted Helminth= Geohelminth
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
Highest Worm Burdens in School­aged Children and 
Growth Curve of Child With Soil­transmitted 
Percentiles 17
97
16
90
15
75
14
50
13
25
10 12
3 11

W eight (kg)
10
9

8
7
6
5
4
Thiabenazole for 2 days
3
2
0 3 6 9 12 15 18 21 24 27
Age (months)
PENYAKIT AKIBAT INFESTASI CACING DAN GIGITAN SERANGGA
YANG PENTING DIBIDANG KEDOKTERAN
1. ASCARIASIS

Pre-patency:
2 months
Pneumonitis:
4 – 16 days
after infection,
short duration
(~3 wks)
PATOLOGI DAN GEJALA KLINIK

• Larval phase: eosinophilia, 
pneumonitis, Leoffler syndromes

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

• Treatment: Albendazole x 1 dose 
Löeffler Syndrome (Pneumonitis)

Transverse sections
of Ascaris larvae in
pulmonary alveoli
Ascaris causing 
intestinal 
obstruction. 
Clinical Features of Ascariasis

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2. ENTEROBIASIS
Pinworms
• AKA: seatworms or threadworms
• Most common in US
– 42 million people
– Mostly children aged 5-14 years
– Commonly institutional settings such as child
care facilities, hospitals, or family members
• Only helminthic infection with approved OTC
treatment
Pinworm transmission
• Embryonated eggs are on clothes,
bedding, bathroom fixtures or dust.

• Embryonated eggs are ingested


(fingersucking is considered a
source of infection).
• Reinfection occurs by direct anus to
mouth transfer, with eggs found
under fingernails of children who
have scratched the anal area.
Pinworm lifecycle

1. inhabit ileocecum.
2. Female migrates out
of anus and deposits
eggs in perianal region
then dies.
3.Eggs hatch within a
few hours and larvae
return to large intestine
via anus
(retroinfection),
4.crawl into
genitourinary tract, or
5.eggs are reingested
by the host.
Clinical presentation and
complications
• Frequently asymptomatic
• Most frequent symptom: nighttime
perianal itching / PRURITUS
NOCTURNAL
• Also: abdominal pain, insomia,
restlessness, anorexia, diarrhea
• Less common: vaginitis, PID, dysuria,
and UTI, leading to infertility
• Bacterial infections secondary to itching
Diagnosing Pinworms
• Visual inspection
– With a flashlight, inspect the
anal area during early morning
hours while child is asleep
• Cellophane tape sample
– Using a tongue depressor,
apply the sticky side of a piece
of tape to the perianal area
and then to a glass slide,.

– microscopic examination by a
physician
3. TRICHINOSIS
Whipworm:
Trichuris trichiuria

• Adult habitat: caecum, colorectum
• No extra­intestinal phase
• Lifespan: 1 ­ 3 years
• 90% infections are asymptomatic
• Symptoms with heavy infections
– Intensity of infection peaks by age 10
LIFE CYCLE

• “cycle of carnivorism” among hogs and rats


• humans ingest encysted larvae in infected,
undercooked pork

• larvae exist in stomach and burrow into small


intestinal mucosa
• adult males and female reemerge and produce
larvae which penetrate intestine and
circulate in bloodstream

• larvae enter skeletal muscle cells and


encyst
Pre-patency:
2 months
Clinical Features

– Asymptomatic
– Physical Weakness, Anemia 
– Stunted Growth, Cognitive Deficits
– Stool frequency (12+/day), nocturnal stooling
– Trichuris dysentery syndrome
– Trichuris colitis
– Rectal prolapse

•Treatment: Albendazole  x 3 days. 
Trichinella spiralis – MICROSCOPIC
EXAMINATION
Clinical features of trichinosis

• Most common sxs:


– muscle pain and tenderness
– fever +/- chills
– edema (often periorbital)
• >10% eosinophilia (often ~50%)
• elevated CPK
• +/- chronic neurologic/myocardial sxs
• self-limited (2% mortality)
Treatment of trichinosis

• antihelminthic (albendazole) to
kill any intestinal adults
• steroids to relieve inflammatory
reactions
• antipyretics
4. HOOK WORM

NECATOR AMERICANUS
Life cycle of hookworm
III. Pathogenesis and Clinical
Manifestations

• 1. Larval migration
(1) Dermatitis, known as "ground itch" or "stool
poison".The larvae penetrating the skin cause allergic
reaction, petechiae Or papule with itching and burning
sensation. Scratching leads to secondary infection.
(2) pneumonitis (allergic reaction), Loeffier's
syndrome: cough, asthma, low fever, biood-tinged
sputum or hemoptysis, chest-pain, inflammation
shadows in lungs under X-ray. These manifestations go
on about 2 weeks.
2. Adults in small intestine
(1) Epigastric pain as that of a duodenal ulcer.
(2) A large worm burden results in microcytic
hypochromatic anemia (characteristic manifestation).

The symptoms are lassitude, edema, palpitation of the heart. In


severe case, death may result from cardiac failure or physical
exhaustion.
(3).Amenorrhea, sterility, abortionmay take place in women.
(4) Gastrointestinal bleeding
(5) Infantile hookworm disease
PATOLOGI
I. LarvaLARVA
5. CUTANEUS Migrans
MIGRANS

1-CutaneousLarva Migrans(CLM)

2-Visceral Larva Migrans(VLM)


(Toxocaraiasis)

Toxocariasis is caused by larvae of Toxocara canis


(dog roundworm) and less frequently of T. cati
(cat roundworm), two nematode parasites of animals.
I. Toxocara canis  TOXOCARIASIS

These eggs are passed in dog feces,


especially puppies' feces .
Laboratory Diagnosis
• The larvae do not develop into adults in humans, a
stool examination would not detect any Toxocara 
eggs.

• However, the presence of Ascaris and Trichuris eggs


in feces, indicating fecal exposure, increases the
probability of Toxocara in the tissues.

• For both VLM and OLM, a presumptive diagnosis


rests on clinical signs, history of exposure to puppies,
laboratory findings (including eosinophilia), and the
detection of antibodies to Toxocara.
6. FILARIASIS
• Filariasis/ penyakit kaki gajah adalah penyakit
menular yang disebakan oleh cacing filarial dan
ditularkan oleh berbagai jenis nyamuk

Spesies penting:
1. Wucheraria bancrofti (lymphatic)
2. Brugia malayi (lymphatic)
3. Onchocerca volvulus
(subcutaneous)
• Periodic form : mf in
small numbers in Microfilarial
circulating blood
during the day and
periodicity
peak density at
night (10 pm to 2
to 4 am)

• Subperiodic form :
mf peak between
noon and 8 pm
Diagnosis of Wucheraria

• Frequently made on clinical grounds in endemic


regions but demonstration of microfilariae
in circulating blood is key
• Where more than one species of filarial infection
occurs need well stained slides for
morphological identification of microfilariae
Symptomatology
• Clinical manifestations vary considerably

• Asymptomatic microfilaraemics show


microscopic hematuria and/or
proteinuria

• Early signs : fever, lymphangitis (limbs,


breasts, scrotum), lymphadenitis (femoral,
inguinal, axillary and epitrochlear nodes)

• Orchitis, Lymphocoel, Hydrocoel


• Elephantiasis
Penderita Filariasis
Early
lymphedema

Advanced lymphedema

Hydrocoele

Elephantiasi
s
• Inflammatory
changes in the
lymphatics Pathology
• Chronic
lymphedema :
hyperplasia of
connective tissue,
infiltration of plasma
cells, macrophages &
eosinophils
• Eventual thickening &
verrucous changes:
elephantiasis
Treatment
• Diethylcarbamazine (DEC) : an effective
microfilaricidal drug which can eliminate
adult worms more slowly.
• Combination of DEC & Albendazole
• Combination of DEC & Ivermectin
• Elephantiasis : surgery, rigorous hygiene
7. SCHISTOSOMIASIS

S.m. S.h. S.j.


“pipestem” fibrosis
Schistosomiasis -
pathogenesis

• egg granuloma (type IV reaction)--> fibrosis


• morbidity ~ worm (egg) burden
• concomitant immunity to schistosomula
• adult worms: invisible to the immune system
(survive for years)
Schistosomiasis- clinical features
• Cercarial dermatitis
• Intestinal schistosomiasis (granulomas -->
polyps, protein loss, malabsorption, strictures)
• Hepatosplenic schistosomiasis (portal
hypertension --> ascites, varices, splenomegaly,
normal hepatic function)
• Urinary schistosomiasis (hematuria, chronic
infection, obstruction)
• Other (cardiopulmonary, CNS, etc.)
Drug treatment of
schistosomiasis

• Praziquantel increases permeability


of adult parasite to Ca++.
• Tetanospasm --> death
Control of Schistosomiasis
REDUCE CARRIERS mass rx program
ELIMINATE SNAILS molluscicides
destroy snail habitats
snail-eating fish
PREVENT WATER
CONTAMINATION latrines, toilets
public health education
PREVENT HUMAN
EXPOSURE water systems
8. TAENIASIS DAN SISTISERKOSIS
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) = Intermediate host
– ingestion of tissue cysts in undercooked meat
(to acquire a tapeworm) = Definitive host
Three types of tapeworms infect
humans.
• Taenia solium
• Taenia asiatica
• Taenia saginata
Taenia solium causes cysticercosis.
Tapeworms are gross!
INFEKSI
INFEKSI
• TAENISIS TAPEWORMS
– INGESTED VIA UNDERCOOKED BEEF
– LIVE IN INTESTINES
– SYMPTOMS
• USUALLY ABSENT
• MAY INCLUDE ABDOMINAL PAIN,
FATIGUE, WEIGHT LOSS, DIARRHEA
Cysticercosis (neurocysticercosis)
Cysticercosis is caused by tapeworms!

• Definitions:
• Cysticercosis – infection caused by the
entrance of Taenia solium into the body and
the formation of cysticerci (larval form).
• Neurocysticercosis – cysticerci (larval form)
form in the brain.
Pigs are intermediate hosts.
• Feces → intestine → blood vessel → muscle

Intermediate hosts – domestic/wild swine, dogs, and primates (even humans).


Wide variety of intermediate hosts.

Feces contain embryos (contaminated food).


Intestine → blood vessel → muscle
Encyst – form protective capsule.
Cysticercus – larval form of parasite – also called bladder worm.
The symptoms of cysticercosis are
harsh!
Worms migrate all over body and form cysticerci.
Worms can migrate up CNS – one of the main sites.

Cysticercosis in brain = neurocysticercosis – can lead to epilepsy.


Cysticerci in muscles = can feel lumps sometimes.
Cysticerci in eyes = rare, float in eye and cause blurry/disturbed vision – can
lead to swelling or detachment of retina.
Cysticerci Hydatid cyst OF
Echinococcosis
Isolated cysticerci Hydatid cyst
Echinococcosis ingestion of
eggs in
pastures
ingestion of
entrails

contact
with
dogs

Cystic Hydatid Disease


Treatment of cysticercosis
and echinococcosis
• Antihelminthic therapy (e.g.,
albendazole, praziquantel)
• (Echinococcus only)
– Surgical removal
– Irrigation-evacuation of cysts
Comparison of pork
tapeworm and Echinococcus
life cycles
Definitive
hosts
Dog Dead-end
(adult Human hosts
tapeworms)
Human
Human
Intermediate
hosts Sheep
(tissue cysts) Pig
Scabies is a skin problem caused by
a bug called a mite.
(Gudig)
Scabies only affects the skin, outside
the body.

Scabies causes extreme itching, which


is usually worse at night.

Rashes, blisters, or bumps may


appear.

Rashes and itching may last for 2-3


weeks, even after being treated.
PREDILEKSI

• In between the fingers

• Around the head and neck

• Wrist, nipple, elbow, waist, armpit, buttocks,


penis, shoulder

• Hands and feet (especially in children)


PREDILEKSI
CARA INFEKSI

Scabies is passed from one person to another:

• Through skin–to-skin contact,

• By touching an infected person’s items


(such as clothing),

• Through sexual contact.

• Remember! Until you are cured, you can continue to pass


scabies on to others.
Diagnosis
• Definitive diagnosis of scabies is made by direct
visualization of the mite, eggs, or feces.
• Mineral oil should be placed on the end of a burrow,
preferably where a black dot is visible.
• The area should then be scraped with a number 5
scalpel blade and the scrapings shed onto a slide.
PENGOBATAN
Permethrin 5% (Elimite, Nix)
• Permethrin is a neurotoxin that causes paralysis and
death in ectoparasites.
• particularly for infants, young children, and pregnant
or breastfeeding women.
• The lotion should be applied over the entire body,
including the face and scalp in infants. It should be left
on for 8-12 hours and then rinsed.
Precipitated sulfur 6% in
petrolatum
• It is safe and effective and the treatment of choice
in infants <2 mo and pregnant or lactating women.
• Sulfur is less acceptable to patients secondary to
its odor and messy application.
PENCEGAHAN
• Try not to touch their skin.

• Do not share clothes with an infected person.

• Wash bedding in hot water and dry at high


temperatures (130 degrees Fahrenheit) for at least 20
minutes.

• If you are not able to wash something, sealing it in a


plastic bag will kill the bugs.
10. PEDICULOSIS
Pediculus humanus capitis

• [Head louse]
Phthirus Pubis
• Pubic louse
Pruritic infestation on the Scalp
• Dermatitis

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