PARASIT

PARASIT PENYEBAB
PENYEBAB
GANGGUAN
GANGGUAN TUMBUH
TUMBUH
KEMBANG
KEMBANG
dr. ISTIANA, M.Kes
FAKULTAS KEDOKTERAN UNLAM
 Parasit penyebab
gangguan tum bang

• Cacing (Helminth) Usus

• Protozoa Usus
 CACING USUS
‘Soil Transmitted Helminths’ :
1. Ascaris lumbricoides
2. Trichuris trichiura
3. Necator americanus
4. Ancylostoma duodenale
5. Strongyloides stercoralis
ASCARIS LUMBRICOIDES
 Ascaris lumbricoides
• Sinonim : cacing gelang
The common round worm
• Hospes : Manusia
• Distribusi geografis :
– Kosmopolit, t.u daerah tropis
– Indonesia : ± 70 - 80%
• Habitat :
– Lumen usus halus
 Telur
Ascaris lumbricoides
3 Jenis telur, yaitu telur fertil, infertil
dan decorticated
Perbedaan berdasarkan : bentuk,
ukuran, warna, dinding dan isi
TELUR FERTIL INFERTIL
Bentuk Oval Lonjong dan
agak pipih
Ukuran 60× 45µm 80x45m
Warna Coklat Coklat
Dinding Tebal, 3 lapis Tipis, 2 lapis
-Lapisan albumin -Lapisan
-Lapisan albumin
glikogen -Lapisan
-Lapisan vitelin glikogen
Isi Embrio yang Granula
belum membelah
Telur Decorticated :
Telur yang kehilangan lapisan albumin,
Tidak berwarna
A B C
– Cacing dewasa :
• Nematoda terbesar
• Silindris
• Mulut : 3 bibir
• Ekor
• ♀ : lancip dan lurus
♂ : melingkar ke ventral
 Bibir
Ascaris lumbricoides
 Life Cycle
• Egg ingested – duodenum - blood
vessel – liver – lung – trachea – small
intestine – egg – soil
• Egg - Adultworm: 2 months
Patogenesis tergantung :

• Respon imun hospes

• Efek migrasi larva
• Efek mekanik cacing dewasa
• Defisiensi gizi akibat keberadaan
C.dws
 Patologi dan Gejala klinis
• Gejala disebabkan oleh stadium :
1. Stadium larva :
- Pulmo : “Loeffler’s Syndrom
 Pneumonitis Ascaris, eosinofilia, urtikaria
 RÖ : gambaran infiltrat pulmoner yg
sementara
 hilang dlm bbrp minggu

- Sirkulasi : ke berbagai organ

- otak, jantung, ginjal, mata, dll
2. Akibat cacing dewasa :
- Intestinum :
1. Asymtomatik : jika jumlah cacing <
20 ekor
2. Symtomatik :
- mual, nafsu makan berkurang,
- Obstruksi usus, perforasi usus
- inf.berat t.u anak-anak :
malabsorbsi, maldigesti, def.vit.
- kemampuan cacing dewasa untuk
bermigrasi besar
• Infeksi Ascariasis berhubungan
dengan malnutrisi pada anak-anak,
anemia defisiensi besi, serta
gangguan pertumbuhan dan
perkembangan
 Diagnosis
• Berdasarkan gejala klinis
• Laboratoris :
- ditemukan telur atau cacing dewasa
pada tinja
- ditemukan larva pada sputum
 Terapi
• Pirantel pamoat
• Mebendazole
• Albendazole
• Levamizole
 Pencegahan
• Sanitary disposal of feces.
• Hygienic habits such as cleaning of
hands before meals.
• Health education.
TRICHURIS TRICHIURA
 Trichuris trichiura
= Cacing cambuk, Human whipworm
Hospes : manusia
Distribusi geografik
– Kosmopolitan, terutama daerah tropis
 Morfologi
TELUR :
Khas btk spt tong,
penonjolan di kedua
kutub, ddg tebal,
warna coklat
CACING DEWASA
Btk spt cambuk, bag.anterior langsing
post.tebal.
♂ ekor melengkung ke ventral,
♀ ekor lurus dan runcing
 SIKLUS HIDUP
Infeksi terjadi dgn cara menelan telur infektif
yg berasal dari tanah yg terkontaminasi 
Menetas di U.Halus  melekat di U.Besar
(tidak mll siklus paru)

Bag.ant. tubuh terbenam dalam mukosa

sedang bag. post. Bebas di lumen usus
besar
• Patologi & Gejala klinis
-Ringan : asymtomatis
– Kronis :
- kerusakan mukosa usus dan respon
alergi hospes TGT : jumlah cacing, lama
infeksi, umur, KU hospes.
- Infeksi berat :Diare +darah 
menyerupai amoebiasis, kejang perut,
prolapsus rekti
- Infeksi lama dan masif :
anemia (t.u pd anak)  krn luka ddg usus
Diagnosis
- Klinis
- Lab. : telur yg khas dlm tinja
(jarang, sedikit, sedang,banyak)

Terapi
Mebendazole, Pirantel pamoat
 Necator americanus
Ancylostoma duodenale

• Nekatoriasis, ankilostomiasis
• Perkebunan, pertambangan
• Prevalensi di Indonesia tinggi: 30-
50%
 Morfologi
• Cacing betina: 1 cm
• Cacing jantan: 0.8 cm, bursa
• Kopulatriks
• N.americanus: menyerupai huruf S
• mempunyai benda khitin
• A.duodenale: menyerupai huruf C
• mempunyai 2 pasang gigi
Necator americanus
Ancylostoma duodenale
Gigi pada cacing dewasa
Gigi Necator americanus
Gigi Ancylostoma
duodenale
 Telur
• Ukuran: 60x40 mikron,
• Jumlah telur A.duodenale
20.000/hari,
• N.americanus 10.000/hari
• Telur mati pd 45oC dlm
bbrp jam dan 0oC dlm 7
hari
 Larva
• Rhabditiform: 250 mikron
• Makan bakteri dan organic debris
• Filariform: 600 mikron, tidak makan
• Larva: tanah lembab, berpasir, humus dan
terlindung sinar matahari
• Tidak tahan kering dan basah.
• Mati dalam 1 jam pd suhu 45oC
• Mati dlm 6 minggu kecuali ada reinfeksi
Larva rhabditiform
• Esofagus: 1/3
panjang badan
• Mulut sempit
panjang
 Larva filariform
• Bentuk: halus
panjang dengan
• panjang : 600
mikron.
• Esofagus: ¼ panjang
badan.
• Mulut tertutup.
• Ekor: lancip.
 Life cycle
• Telur - larva rhabditiform - larva
filariform menembus kulit – kapiler –
jantung – paru –bronkus – trakea –
laring - usus halus
 Life cycle
• Larva menembus kulit sampai ke usus:
1 minggu, sampai dewasa 5-6 minggu
• A. duodenale dapat menetap di usus
6-8 tahun
• N. americanus: 4-5 tahun
 Cara penularan
• larva filariform menembus kulit:
folikel rambut, pori, kulit utuh
• Port d’entrée: dorsum pedis, sela
jari,tangan, sela jari, bagian tubuh
yang kontak dg tanah
• menelan larva filariform: makanan &
minuman tercemar
 Patogenesis dan gejala
klinis
Larva:
• kulit: ground itch, dew itch
• makulopapular, eritema
• gatal hebat - infeksi sekunder
• paru: batuk, bronkhitis, pneumonitis
 Cacing dewasa
• Gejala tergantung spesies cacing, jumlah
cacing, gizi penderita
• Gastroenteritis:
- 6 minggu setelah infeksi
- Mual, muntah, nyeri epigastrium,
diare, melena
- Self limiting
• Eosinofilia
 Anemia
• Gejala klinis penting pada infeksi
hookworm ini
• cacing mengisap darah (protein dan
zat besi) dan substansi mukosa
• Antikoagulan
• berat anemia sesuai dg berat infeksi
 Anemia
• akibat anemia: pusing, lemah, napsu
makan berkurang, daya tahan
menurun, produktivitas menurun,
edema, perkembangan fisik, mental
dan seksual terhambat
• gejala ringan/tidak nampak bila gizi
baik
• Necator americanus mengisap darah
30 µl darah/hari
• Ancylostoma duodenale mengisap
darah 260 µl darah/hari
 Diagnosis pasti
• menemukan telur dalam tinja segar
• menemukan larva dalam tinja lama
• membedakan spesies: biakan Harada-
Mori
 Terapi
• Pirantel pamoat 10 mg/kg bb dosis
tunggal. Khusus untuk A.duodenale
diberikan 3 hari berturut-turut
• Mebendazol 500 mg/dosis tunggal atau
2x100 mg, 3 hari berturut-turut
• Albendazol 400 mg/dosis tunggal
• Atasi anemia
 Epidemiologi
• prevalensi tinggi di perkebunan dan
pertambangan karena tidak ada WC
• prevalensi meningkat sesuai umur
• pemakaian tinja sebagai pupuk
• defekasi di kebun, pekarangan rumah
• tidak memakai alas kaki dan sarung
tangan ketika bekerja di kebun
Strongyloides stercoralis
Strongyloides stercoralis

Habitat: females live in the superficial tissues of the

small intestine (duodenum and jejunum)
 Definitive host: Human, dogs and cats
 Route of infection: Filariform larvae penetrate the skin
of human.
 Infective stage: Third stage larvae ( filariform).
 Diagnostic stage: First stage larvae(Rhabditiform) in
feces.
Geographical distribution: - cosmopolitan parasite, mainly
in moist and warm areas of low hygiene
Morphology Egg:
- Size    : 55 x 30 um.
– Shape: oval . Clear, thin shelled Similar to hookworm
but are smaller.
Eggs are laid in the mucosa, hatch into rhabditiform larvae
that penetrate the glandular epithelium and pass into the
lumen of the intestine and out the feces 
(Eggs are seldom seen in stools).
 Morphology
Adult:
Male (parasitic or free-living):
-   0.7 mm in length
-   Rhabditiform oesophagus
-   Posterior end curved ventrally with
Spicules
Parasitic female:
-   2.2  mm  in length
-   Cylindrical oesophagus (1/3 body
length)
-   Posterior end straight

Free living female:

-   1 mm in length
-   rhabditiform oesophagus
-   posterior end straight
Morphology of Strongyloides stercoralis

a) parasitic female
b) free-living male
Rhabditiform larvae
• 220 x 15 um.
• Short buccal cavity.
• Diagnostic stage 
• appear in  stools  within 4weeks  of  
infection.
Filariform larvae posterior part

Filariform larva with

notched tail.
Infective stage
Size 600 x 20 um.
 Life cycle
Free-living cycle
Parasitic cycle: In the parasitic
stage, no male form of this organism
has been reliably identified, and the
female reproduce in a parthinogenitic
manner.
• Free living S. stercoralis dwell in
moist soil in warm climates
• Copulation occurs in soil; sperm
penetration merely activates the
oocyte to develop
parthenogenetically with no
contribution to the genetic material
of the developing embryo
• Following oviposition, eggs hatch in
the soil and give rise to 1st stage
rhabditiform larvae
• These feed on organic debris, go
through several molts and become
sexually mature adults
• This free-living heterogonic life
cycle may continue indefinitely
• However, if the environment
becomes inhospitable, the
rhabditform larvae molts to
become a nonfeeding filariform
larva - the form infective to
humans
Life Cycle cont.
2. Parasitic Phase
• When filariform larvae encounter a
human or another suitable host (e.g.
cats and dogs), they penetrate the
skin and are carried by cutaneous
veins to the vena cava
• They enter the right side of the
heart and are carried to the lungs via
the pulmonary artery
• In the lungs, following a 3rd molt, the
larvae rupture from the pulmonary capillaries
and enter the alveoli
• From the alveoli, the larvae move up the
respiratory tree to the epiglottis
• Abetted by coughing and subsequent swallowing
by the host, they migrate over the epiglottis
to the esophagus and down into the small
intestine, where they undergo a final molt
and become sexually mature females
Autoinfection

• During passage through the host digestive

system, rhabditiform larvae may undergo 2
molts to filariform larvae and by
penetrating the intestinal mucosa, enter the
circulatory system and continue their
parasitic lives without leaving the host
• Autoinfection can also occur when larvae
remain on and penetrate the perianal skin.
• Autoinfection often leads to very high worm
burdens in humans
CLINICAL ASPECTS:

• Cutaneous reaction due to skin penetration “

ground itch
• Pulmonary symptoms (including Loeffler’s
syndrome) can occur during pulmonary migration
of the filariform larvae.
• Gastrointestinal symptoms include abdominal
pain, vomiting, diarrhea, weight loss,
malabsorption,.
• Dermatologic manifestations include urticarial
rashes in the buttocks and waist areas (larva
migrans).
 Clinical aspect
• Autoinfection within the human host
can lead to the (Hyperinfection
Syndrome) or disseminated
strongyloidiasis occurs in
immunosuppressed patients,
neurologic(CNS), heart, lung , liver
complications and septicemia.
This syndrome is potentially fatal.
Larva migran
Laboratory Diagnosis

 Direct stool smears (larvae)

 Cultivation of stool. (Damp charcoal or Harada-Mori
mediums).

 Histological examination of duodenal or jejunal

biopsy specimens obtained by endoscopy can
demonstrate adult worms embedded in the mucosa.

 Eosinophilia, is present in uncomplicated

strongyloidiasis, but is lost in hyper infection

 For population screening in endemic areas, an ELISA

for IgG anfi-Strongyloides antibodies is effective.
 Symptoms and Signs of
Hyperinfection
 anemia (for example, pale skin)
 constipation
 cough
 diarrhea
 eosinophilic pneumonitis (during larvae
migration through the lungs)
 Nausea
 vomiting
 weight loss.
Symptoms of Immunosuppressed patients
(organ transplant) or immunocompromised
patients (HIV):

• Death
• neurological and pulmonary
complications
• shock.
 Treatment
 Strongyloidiasis is treated with:

 Ivermectin.
 Tthiabendazole.
 No public health strategies for controlling
are active at global level.
 Control
• Good sanitation with specific care of
human waste disposal.
• Mass treatment of Ivermectin drugs
shows some progress but needs
further research.
• Setting global health plan.
• Wearing permanent shoes.
• Education Program for community.
 Entamoeba histolytica
• PENYEBARAN :
Kosmopolitan, terutama : - tropis & sub tropis.
- sanitasi jelek.
• HABITAT :
Trofozoit : lapisan mukosa & sub mukosa usus besar / colon.
• PENYAKIT : - disentri amebik
- abses hepar
• MORFOLOGI :
4 stadia : - Trofozoit
- Prakista
- Kista
- Metakista
 Entamoeba histolytica
• TROFOZOIT :
UNSTAINED : - Gerakan cepat
(Progresif)
- Pseudopodium hialin
- Bakteri (-)
- Nukleus tak terlihat
- 12 – 30 m
- D/ Pasti : RBC (+)
•  
trofozoit
Gambar Trofozoit
E.histolytica
 Entamoeba histolytica
• STAINED : - Ekto & endoplasma berbatas
tegas
- Bakteri (-)
- Pseudopodium hialin
- D/ Pasti: - granul kromatin
perifer (+)
& karyosome (+) di nukleus.
- RBC (+)
- ukuran rata-rata : > 12 m.
 
 Entamoeba histolytica
KISTA :
• UNSTAINED : - Inti : 4
- Benda kromatoid : bentuk batang
(Rod – Like) / cerutu
• STAINED : - Inti 4, Karyosome sentris + kromatin
perifer
- Diameter : > 10 m.
- D/ Pasti : - Struktur inti : Khas
- Benda kromatoid : Bentuk batang
(cerutu)
- Diameter : > 10 m.
kista
Gambar Kista
E.histolytica
 Amebiasis
SIMTOMATOLOGI
• INFEKSI ASIMTOMATIK (85 – 95 %
KASUS)
• INFEKSI SIMTOMATIK (5 – 15 % KASUS)
1. AMEBIASIS INTESTINAL
Disentrik
Kolitis non – disentrik
 Amebiasis
AMEBIASIS EKSTRA – INTESTINAL ( 5% simtomatik)
a. Hepatik
- Akut non-supuratif
- Abses hati
b. Pulmoner
c. Foki ekstra intestinal lainnya (jarang)
- Ginjal
- Limpa
- Kulit
- Otak
 
DISENTRI AMEBIK AKUT
:

• Inkubasi : 4 – 5 hari ~ 2 minggu

• Gejala : - diare : darah – lendir
- demam
- tenesmus
• Lesi intestinal pada epitel usus : “ulkus menggaung”
( bentuk botol / “flask – shaped” )
• Komplikasi : - perdarahan usus
- perforasi usus
• Lab : tinja  trofozoit (+)
ULKUS MENGGAUNG
 INFEKSI ASIMTOMATIK
(amebiasis tanpa gejala)

• tinja normal
• kista (+) : “cyst carrier“ / “cyst
passer”
 
 AMEBIASIS KRONIS /
MENAHUN
• Gejala : - diare + konstipasi
- nyeri perut samar-samar
- dispepsia
- astenia
• Komplikasi : Ameboma
• Lab : tinja : trofozoit (+)
kista (+)
 AMEBIASIS HATI /
ABSES HATI AMEBIK

• Gejala : - nyeri perut kanan atas (r.hipokondrium)

- demam
- kuning/jaundice/ichterus  gejala
hepatitis
- hepatomegali + abses
• Aspirasi (pungsi) : pus  “anchovy sauce”
- kental
- merah kecoklatan
 
DIAGNOSIS AMEBIASIS

INTESTINAL
- SPESIMEN TINJA :
~ Cara langsung
~ Tak langsung ( ritchie )  trof / kista 
~ Pewarnaan ( trichom )
~ Kultur : trofozoit 
TAMBAHAN :
~ Radiologi
~ Sigmoidoskopi
DIAGNOSIS AMEBIASIS

EKSTRA – INTESTINAL
* AMEBIASIS HATI ( ABSES )
Spesimen aspirasi abses :
- Nanah : kental merah coklat : langsung 
trofozoit (-)
Spesimen serum darah :
- Tes difusi gel
- Hemaglutinasi tidak langsung
- Tes aglutinasi lateks
- Elisa
- Tes antibodi fluoresen
 PENGOBATAN
AMEBIASIS

DISENTRI AKUT
• METRONIDAZOL 750 mg 3 dd I 5 –
10 hari
• TINIDAZOL 500 mg (50 mg / kg)
• ORNIDAZOL
• KLEFAMIDA 250 mg 3 dd II 10 hari
• SEKNIDAZOL 500 mg
AMEBIASIS KRONIS / PEMBAWA KISTA
• DILOKSANID FUROAT 500 mg, 3 dd I 10
hari
• DI – IODOHIDROKSIKUINOLIN 650 mg
3 dd I 21 hari
 
AMEBIASIS EKSTRAINTESTINAL
• METRONIDAZOL 750 mg, 3 dd I 5 – 10
hari
• KLOROKUIN 250 mg, 2 dd I 14 hari
 
 Check for understanding
M.C.Q.
1- Entamoeba histolytica trophozoites are found
in:
a- Duodenum of infected human.
b- Jejunum of infected human.
c- Caecum of infected human.
d- All of the above.
2- Infection with Entamoeba histolytica occurs
through eating green salad contaminated with:
a- Trophozoites of Entamoeba histolytica.
b- Cysts of Entamoeba histolytica.
c- Both trophozoites and cysts of Entamoeba
histolytica.
Giardia lamblia
 Hospes dan Tempat
Hidup
• Hospes : Manusia
• Tempat Hidup : Usus kecil terutama
kripta duodenum dan proksimal
yeyunum, kandung empedu dan saluran
empedu
 Nama Penyakit
• Giardiasis
• Lambliasis
• Giardia Enteritis
• Diare Giardia

Cara Penularan :
Tertelan kista matang
Siklus Hidup
 Morfologi Trofozoit
• Seperti jambu monyet/layang-layang
• P : 10-20 ωm, L : 5-15 ωm
• Mempunyai batil isap, 2 inti, 4 ps
flagel, 2 aksonema, 2 benda parabasal
• Pergerakan seperti daun jatuh
Bentuk Trofozoit
 Morfologi Kista
• Oval/bulat
• P : 11-14 μm, L : 7-10 μm
• Dinding tipis dan kuat
• Mempunyai 2-4 inti
 Pathogenesis and Clinical Picture
• Trophozoites feed on mucus

no symptoms.
(Asymptomatic carrier – cyst passer)

• Trophozoites cause hyperaemia and

inflammation of duodenal wall
(Duodenitis)

symptoms as:
Epigastric pain, digestive disturbances,
Steatorrhoea (fatty diarrhea- Stool is
light-coloured and greasy
and flatulence.
• In patients with impaired
Pathogenesis immunity
and Clinical Picture
as:
a- Hypogammaglobulinaemia.
b- Diminished secretory IgA in small intestine.
c- Diminished gastric acidity or achlorohydria.

Severe symptoms as
Cholangitis
Persistent diarrhea, steatorrhoea, &
Cholecystis
Malabsorption, Anemia.
Hypoproteinemia, fat-soluble vitamin deficiency.
Jaundice and biliary colic.
Patologi dan Gejala Klinis
• Dengan batil isapnya melekat pada mukosa
duodenum dan yeyunum
• Tidak selalu menimbulkan kelainan patologis
• Gejala muncul oleh karena lesi rasa tidak
enak di epigastrium, mual atau meteorismus,
diare disertai stetore, kolisistitis atau
gejala seperti kanker usus, sindroma
malabsorbsi lainnya. Kadang-kadang kolik
dan ikterik
 Diagnosis dan Terapi
Diagnosis : Menemukan trofozoit/kista
Pengobatan :-Metronidazol
Dewasa 3X250 mg 7 hr
Anak 25 mg/kg/hr 5 hr
-Tinidazol
Dewasa 1,5 gr/hr SD
Anak 1-1,5 gr/hr SD
Alogaritma Diagnostik
Giardiasis