Helmintiasis FK Unila oleh dr. P.U Saragih

Helminthiasis 1

HELMINTIASISpengelolaan investasi cacing pada dewasa

Bachti Alisjahbana

Sub Bagian InfeksiBagian Penyakit Dalam FKUP / RSHS

Helminthiasis 2

Type of helminthiasis

Intestinalascariasis Ascaris lumbricoidesankilostomiasis N. americanus, A duodenaletaeniasis T. solium, T saginatatrichuriasis Trichuris trichiuraOxyuriasis Oxyuris vermicularis

blood/ tissuefilariasis W. bancrofti, B. malayi, dst.schistosomiasis Schistosoma mansoni,hepatic worm F. hepatica

Helminthiasis 3

Soil transmitted nematodes

Helminthiasis 4

Epidemiologi (burdens and trends)

• Puplation at risk: 2 billion

• Population infected: > 1 billion

• Mostly children

• Mortality Ankilostomiasis 65.000

• Mortality Ascaris Lumbricoides 60.000

• An. Mort trichuris 10.000

• Pregnant woman : 44 million infected with hookworm

chronic blood loss --> Fe defisiensi

Helminthiasis 5

Epidemiology

Infection are related to:

• Poverty and poor living conditions

• Inadequate sanitation and water supplies

• Soil Quality and climate

• poor personal and environmental hygiene

• poor health awareness

Helminthiasis 6

According to route of infection

• direct

– Trichuris trichiura

– Enterobius vermicularis

• modified direct

– Ascaris lumbricoides

– Toxocara canis

• penetrating the skin

– Ancylostoma duodenale

– Strongiloides stercoralis (also direct)

Helminthiasis 7

Oxiuriasis & Trichuriasis ~ etiologi, epidemiologi

• Oxyuris vermicularis, enterobius vermicularis

• Trichuris trichiura / thread worm / wip worm

• penyebaran geografis /epidemiologi: seluruh dunia

predisposisi

– hygiene, sanitasi buruk

– anak

Helminthiasis 8

O. vermicularis & T. trichiura ~ siklus hidup

usus halus

paru

telur

Helminthiasis 9

Oxiuriasis ~ gambaran klinik, diagnosis

• Pruritus ani– dd/ jamur, alergi, piskosomatik

• Anoreksia• gizi kurang• irritable (anak)• vaginitis• iritasi --> mual, muntah, mencret • komplikasi: appendisitis, penyebaran intra famili

diagnosis• telur cacing (tinja, swab)• sedikit eosinofilia

Helminthiasis 10

Oxiuriasis ~ pengobatan

Umum

• terapi keluarga

• kebersihan kuku dan pribadi

• hygiene & sanitasi

Spesifik

• Allbendazole, adult 400 mg, single dose

• Mebendazole, 100 mg, single dose

• Pyrantel palmoate 10mg/kgbw, single dose)

Helminthiasis 11

Trichuriasis ~ gejala klinik dan diagnosis

• Ringan, tidak spesifik• tanda iritasi;

perut kembung, sukar BAB, mencret kembung, flatus• Korelasi dengan infeksi ascariasis,• Korelasi dengan E. Hystolitica

– Dysentri berat – Anemia– Hipoproteinemia

• Komplikasi pada investasi berat– ileus– perforasi– prolaps rekti

• Diagnosis– telur di tinja

Helminthiasis 12

Trichuriasis ~ terapi

• Deferensial diagnosis:

– Cacing lain,

– Disentri

• Antihelmintik

– Mebendazole 600mg, single oral dose

– Albendazole 400 mg, single oral dose

Suportive

• Nutrisi

• hygiene

• suplementasi besi

Helminthiasis 13

Askariasis

Helminthiasis 14

Askariasis ~ etiologi, epidemiologi

• Askaris lumbricoides

• cacing terbanyak pada manusia (25 % infected)

• penyebaran geografis /epidemiologi: seluruh

dunia

predisposisi

– sanitasi buruk

– iklim panas

Helminthiasis 15

Askariasis ~ life cycle

usus halus

paru

telur

Helminthiasis 16

Ascariasis ~ Clinical symptoms

• Larval ascariasis (migrating larva)– Pneumonitis (Loefler syndrome): fever, cough, sputum,

dyspnoe, asthma, radiological pulmonary infiltration.– Other organs: brain, renal, retina, bone marrow.– Eosinophilia

• Adult worm– minimum symptoms, nutritional problem– Colic, obstruction– regurgitasi

• Wandering Ascariasis– In patient with fever, anestethic agent, liver abcess– Peritoneal lession– Billiary ascariasis

Helminthiasis 17

Ascaris ~ other effects & complication

Immunopathological effects– Sensitivity, anal pruritus, vomiting, glottis edema– High IgE

Indirect effects– relation of ascariasis to poiomyelitis

Nutritional relationships– Protein energy malnutrition– Vitamin A deficiency --> night blindness– Low vitamin C.

Helminthiasis 18

Ascaris ~ diagnosis, and dd/

Diagnosis

– Eggs in faeces / stool

– Serological diagnosis less value

• Lack of correlation with infection burden

• Cross reaction to other helminths

Deferential diagnosis

– Pulmonary symptoms resemble other pulmonary infections

– Larva ascariasis must be distinguished with toxocara, hookworm, stongyloides, schistosomiasis

Helminthiasis 19

Ascarias ~ Therapy

• Allbendazole 200 mg, adult 400 mg, single dose

• Mebendazole 100 mg twice daily for one day

• Levamisole 5 mg/kg bw, single dose

• Pyrantel palmoate 10mg/kgbw, single dose

Helminthiasis 20

Ankilostomiasis

Helminthiasis 21

Ancylostomiasis ~ etiologi, epidemiologi

• Ancylostoma duodenale, stongyloides, Necator americanus,

trychostrongilus.

• Infeksi melalui penetrasi kulit

• anemia pada dewasa

• penyebaran geografis /epidemiologi: seluruh dunia

predisposisi

– hygiene, sanitasi buruk

– kekebalan tubuh menurun

Helminthiasis 22

Ancylostomiasis ~ pathology

• Vesiculation, pustulation .. Ground itch

• Asthma or bronchiolitis

• Established infection --> anemia

Helminthiasis 23

Ankilostomiasis – siklus hidup

Helminthiasis 24

Ankilostomiasis ~ siklus hidup

usus halus

paru

telur

InfectionPenetrasi (N. americanus & ancylostoma), Ingestion (N. americanus)

Migrating larvaegrow & develop in the lung (N. americanus)

Helminthiasis 25

Ankilostomiasis ~ gambaran klinik

• gatal di kaki

• dermatitis, mkulopapula, vesikel

• batuk, batuk darah

• perut kembung, flatus, mencret (awal 2 minggu)

• anemia ( 10-20 minggu)

• tergantung jumlah cacing ~ 500 cacing

Helminthiasis 26

Ankilostomiasis- Anemia & hypoproteinemia

• Chronic blood loss

• Hypochromic microcytic anemia

• Cacing membutuhkan

– Serum & darah

– 0.03 ml / hari / cacing

• Hemoglobin sebanding dengan jumlah cacing

• Plasma feritin berbanding terbalik dgn jumlah cacing

Hypoproteinemia

• Protein losing enteropathy

• Keterbatasan sintesa albumin

• Oedema

Helminthiasis 27

Ankilostomiasis ~ diagnosis

• Telur di dalam tinja

• telur dalam sputum

• sedikit darah dalam tinja

• hitung jumlah telur ~ anemia

• eosinofilia pd fase awal

Komplikasi

• dermatitis berat

• anemia berat

– gangguan pertumbuhan

– payah jantung

Helminthiasis 28

Ankilostomiasis ~ terapi

umum

• Perbaikan gizi

• Pengelolaan anemia

spesifik

• Albendazole, single dose, 400 mg

• Mebendazole, 100 mg, twice day for 3 days

• Pirantel pamoat, single dose 10mg/kg BW,

• Bephenium hydroxynapthoate

• Tetrachlorethylene

Helminthiasis 29

Tissue & blood nematodes

Helminthiasis 30

Taeniasis ~ etiologi, epidemiologi

• Taenia solium, (babi)

• Taenia saginata (sapi

• cysticercosis ~ karena larva

• penyebaran geografis /epidemiologi: seluruh dunia Afrika, India, Filipina,

• Indonesia--> Bali, Irian, Sumatera utara

• predisposisi

– hygiene, sanitasi buruk

– peternakan babi, sapi, binatang tidak terawasi

– kebiasaan defekasi ditempat sembarangan

– makan daging mentah

Helminthiasis 31

Taeniasis ~ siklus hidup

Helminthiasis 32

Taeniasis ~ gejala klinis

• Kebanyakan asimtomatik• keluar proglotid melalui tinja• nausea, nyeri perut• berat badan menurun• nafsu makan meningkat• diare• pruritus ani\

Komplikasi Cysticercosis• kejang / epilepsi• tidak sadar

Helminthiasis 33

Taeniasis ~ diagnosis, terapi

• Proglotid dalam tinja

• proglotid keluar aktif

• telur taenia dalam tinja

• penentuan spesies dengan identifikasi proglotid

• produksi telur berfluktuasi --> harus berulang-ulang

Obat

• praziquantel (single dose)

• niclosamide (single dose)

• paromomisin

• atabrin, bithionol (sudah tidak dipakai)