HELMINTIASIS pengelolaan investasi cacing pada dewasa

Helminthiasis

Type of helminthiasis
Intestinal ascariasis ankilostomiasis duodenale taeniasis trichuriasis Oxyuriasis blood/ tissue filariasis dst. schistosomiasis hepatic worm

Ascaris lumbricoides N. americanus, A

T. solium, T saginata Trichuris trichiura Oxyuris vermicularis W. bancrofti, B. malayi, Schistosoma mansoni, F. hepatica
2

Helminthiasis

Soil transmitted nematodes

Helminthiasis

Epidemiologi (burdens and trends)

Puplation at risk: Population infected: Mostly children 2 billion > 1 billion

Mortality Ankilostomiasis
Mortality Ascaris Lumbricoides An. Mort trichuris

65.000
60.000 10.000

Pregnant woman : 44 million infected with hookworm chronic blood loss --> Fe defisiensi
Helminthiasis 4

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 5

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 6

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

O. vermicularis & T. trichiura ~ siklus hidup

paru

usus halus

telur

Helminthiasis

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

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

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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 11

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

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Askariasis

Helminthiasis

13

Askariasis ~ etiologi, epidemiologi

Askaris lumbricoides cacing terbanyak pada manusia (25 % infected) penyebaran geografis /epidemiologi: seluruh

dunia
predisposisi sanitasi buruk iklim panas
Helminthiasis 14

Askariasis ~ life cycle

telur

paru

usus halus

Helminthiasis

15

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 16

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 17

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

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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

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Ankilostomiasis

Helminthiasis

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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

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Ancylostomiasis ~ pathology Vesiculation, pustulation .. Ground itch Asthma or bronchiolitis Established infection --> anemia

Helminthiasis

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Ankilostomiasis siklus hidup

Helminthiasis

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Ankilostomiasis ~ siklus hidup

Infection Penetrasi (N. americanus & ancylostoma), Ingestion (N. americanus)
paru

Migrating larvae grow & develop in the lung (N. americanus)

usus halus

telur

Helminthiasis

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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

25

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

26

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

27

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 28

Tissue & blood nematodes

Helminthiasis

29

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

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Taeniasis ~ siklus hidup

Helminthiasis

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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

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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)

Helminthiasis

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