blok 14-protozoa dan helminth penyebab inf sist digestif.ppt

8/10/2019 Blok 14-Protozoa dan helminth penyebab inf sist digestif.ppt

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Nemathelminthes Platyhelminthes

Class Nematoda Class Cestoda dan Class Trematoda

Silindris, panjang Pipih seperti pita atau daun

Tidak bersegmen Bersegmen

Sex terpisah antara jantan dan betina Pada umumnya hermaphrodyte

Saluran pencernaan lengkap Saluran pencernaan tidak lengkap

Mempunyai rongga tubuh Tidak memiliki rongga tubuh


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Morphologic features :

- Nonsegmented

- Generally cylindrical, mostly tapered at bothends

- Covered by cuticle

- Generally a light cream-white colour

- Well formed digestive tracts, with anal andoral openings

- Separated sexes (in which the males aregenerally smaller than the females)

- Certain modifications of apparatus in the oralopening and esophagus are important in the

identification of the species

The Nematodes (roundworms)


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Epidemiology :

- Affects more than other parasitic

diseases

- More prevalent in areas with poor

sanitation, areas where human feces

are used as fertilizer

Ascaris lumbricoides


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Telur infektif tertelan

Larva menetas disal.cerna, penetrasi ke

mukosa intestinal

Terbawa aliran darah

portal, terbawa alirandarah sistemik ke

paru

Larva matur di paru(10-14 hari),

menembus alveolus

naik ke bronchial tree,tertelan kembali ke

sal.cerna

Larva menjadi cacingdewasa di usus halus

deposisi 200.000 telur perhari

Telur keluar bersama tinja

Telur fertil menjadiinfektif setelah 18 hari

sampai beberapaminggu


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Morphologic features of adult worms :

- Resembles earth worm

- Length : females 20-35 cm,males seldom excedeed 30 cm

long

- Creamy white in colour


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Clinical manifestations :

- Asymptomatic in mild infection

- Heavy infection can cause bowel

obstructionfever, malaise, abdominal

distention, abdominal pain, vomitting

- Pneumonitis during larval migration

through the lungs


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Diagnosis :

- Examination of the stoolfertile or infertile

eggs

Ascaris lumbricoideseggs in fresh stool

examination

Fertile

Corticated

Decorticated

Infertile


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Fertile corticated eggs :

- Broadly oval, 45-75 m X 35-50 m

- Consists of 3 layers, outer covering(albuminoid coat) stained golden brown by

the bile, coarse surface


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Fertile decorticated eggs :

- Broadly oval, 45-75 m X 35-50 m

- Consists of 2 layers, already lost its outer

covering (albuminoid coat)thick

yellowish inner shell is obvious


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Infertile eggs :- Longer and narrower than the fertile

eggs, 90 m X 40 m

- The wall might consists of 2 or 3 layers,coarse surface


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Treatment of infections :

Albendazole single dose 400 mg

Mebendazole 2x100 mg selama 3 hari Pyrantel pamoate single dose 11 mg/KgBB

H A t


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Epidemiology :

- High prevalence in population which defecate

directly onto the soil and do not costumarily

wear shoes

- Climate : sufficient rainfall, sandy loam soil

Hoo worm Ancy ostomaduodenale and Necator

americanus)


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the infective larvaepenetrate the skin

carried through theblood vessels to the

heart and then to thelungs

penetrate into the

pulmonary alveoli,ascend the bronchialtree to the pharynx,and are swallowed

larvae reach the smallintestine, where they

reside and matureinto adults

Adult worms attach tothe lumen of small

intestine, with

resultant blood loss

Eggs are passed in thestool

under favorable

conditions (moisture,warmth) larvae hatchin 1-2 days

rhabditiform larvae

after 5 to 10 daysrhabditiform becomefilariform (third-stage)

larvae that are infective


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Morphologic features of adult worms : N. americanus adult worms similar to

Ancylostoma duodenale but slighly smallerclinically it is considered unimportant to

differ these two Difference : the buccal capsule of N.

americanus armed with a pair of cuttingplates, while the buccal capsule ofAncylostoma duodenale had 2 pair of teeth

Grayish white or pinkish

Male 1 x 0.5 cm, female somewhat larger


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AB


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- In penetrating the skin may cause ground itch(less common with Ancylostoma than with N.americanus)

- Pneumonitis less severe than in Ascariasis

- Heavy infection : gastrointestinal discomfort,diarrhea

- Acute intestinal hemorrhage is rare

- Chronic infection : iron deficiency anemia

Diagnosis :

- eggs in fresh stool examination

- larvae might be seen in the eggs of hours long

specimens



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Eggs in stool examination :

- Oval, 56-60 m X 36-40 m

- Thin and colourless shell


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- Hatched larvae in the stools must be differentiated fromlarvae of Strongyloides stercoralis- Rhabditiform larvae of hookworms have a long & narrow

buccal capsule (between oral opening and esophagus)

- Strongyloides has a very short and somewhat stout buccal

capsule

Hookworms rhabditiform

larvae

Strongyloides stercoraliss

rhabditiform larvae


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Treatment :

Albendazole single dose 400mg

Mebendazole 2x100mg selama 3 hari Pyrantel pamoate single dose 11 mg/KgBB


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Epidemiology :

- similar as hookworm

Strongyloides stercoralis

life cycle ofStrongyloides

stercoralis

Free living cycle

Parasitic cycle


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Morphologic features of adult worms :

- Very small, about 1 mm long


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- Ground itch similar to hookworms infection

- Pneumonitis less severe than in Ascariasis

- Heavy infection : gastrointestinal

discomfort, diarrhea, duodenal ulcer,melena

Diagnosis :

- Larvae in the stools- In a case with severe diarrhea,

embryonated eggs may be present in stool



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Larvae in stool examination : similar to

hookworms larvae with a very short and stout

buccal cavity. Eggs in stool examination : similar to

hookworms eggs, buat the Strongyloides eggs

always contained well-developed larvae

Strongyloidesstercoraliss e

Hookworms eggs


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- albendazole 400 mg/hari selama 3 hari

- Ivermectin 200 g/KgBB per hari selama 2 hari

Treatment :


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Epidemiology :

- High prevalence in population which defecate

directly onto the soil and where human feces

are used for fertilizer

Trichuris trichiura (whipworm)


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- The adult worms : 2-5 cm long, maleslightly smaller than female

- Whip-like tail

Morphologic features :


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i ti f


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ingestion ofinfective eggs (soil-

contaminatedhands or food)

Larvae hatch inthe small

intestine

Larvae matured

and establishedthemselves as

adults in the colon

adult worms are fixed in

caecum, the anteriorportions threaded intomucosa

Female worms in thececum shed between

3,000 and 20,000eggs per day

unembryonatedeggs are passedwith the stool

the eggs developinto a 2-cell

stage in the soil

2-cell stage eggsembryonate and become

infective in 15 to 30 days


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- Mild infection : asymptomatic

- Heavy infection : abdominal pain,

abdominal distention, bloody ormucoid diarrhea, tenesmus, prolapse

of the rectum, weakness

- Chronic infection : anemia

Diagnosis : eggs in stool examination



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- barrel-shaped/football-shaped

- 50-54m in length with

polar plugs in eitherends

Eggs in stool examination :


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Treatment :

- Albendazole single dose 400 mg


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THE CESTODES


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Also called tapeworms Adult tapeworms found in human all have a flat, ribbon-

like body, white or yellowish in colour

The cestode body consists of an attachment organnamed scolex, followed by a chain of segments

(proglottids) named strobila Strobila growth throughout the life of tapeworms by

continous proliferation of new proglottids in the regionimmediately posterior to the scolex

The terminal portion of strobila contains gravidsegments

In some cestodes, these terminal proglottids maybecome detached in the intestine and pass out withstool

The Cestodes : review


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The cestodes

Diphyllobothrium latum,Taenia saginata, Taeniasolium, Echinococcus

granulosus, Dipylidiumcaninum, etc

The Cestodes : review


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Epidemiology : worldwide distribution

Taenia saginata (beef tapeworm) &

Taenia solium (pork tapeworm)

Morphologic features of


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- flat, ribbon-like body,

may reach several meters

- Yellowish white in colour

- T. saginata : scolex bears 4 muscular suckers

and a small rostellum without hooks

- T. solium : scolex bears 4 muscular suckers anda double crown with hooks

Morphologic features of

adult worms ::


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Differentiating the scolex

T. saginatas scolex T. soliums scolex


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Clinical manifestations : Mostlyasymptomatic

Diagnosis : eggs and or gravid

proglottids in stool examination

Eggs (undifferentiated between theT. saginata or T. solium) :

- Round shaped, dark brown incolor

- Distinguished characteristic : athick, radially striated covering,

called the embryophore

Differentiating the gravid


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- Mature segments :width > length

- Gravid segments :length > width

- Gravid segmentscontain a brancheduterus filled with eggs :

T. solium : 7-13

branches on each sideT. saginata : 15-20branches on each side

Differentiating the gravid

proglottids


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Treatment :

- Praziquantel single dose 10 mg/KgBB


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A condition where humans ingested T. solium eggsoncosphere hatch in small intestineinvade intestinal

wallenter systemic circulationlodge in any tissues(most commonly in voluntary muscles)cysts

Treatment :

- surgical removal

- albendazole 15 mg/KgBB per hari selama 8 hari

Cysticercosis

blok 14-protozoa dan helminth penyebab inf sist digestif.ppt

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