TREMATODA USUS

Fasciolopsis buski
Heterophyes heterophyes
Metagonimus yokogawai

TREMATODA 03

Fasciolopsis buski
Penyakit

: fasciolopsiasis

Hospes

: manusia, babi

Distribusi geografik : RRC,Taiwan, Thailand

Vietnam, Indonesia
Habitat

: duodenum, jejunum

Morfologi
Cacing dewasa

2-7,5 cm x 0,8 2 cm
Lonjong, tebal
Warna daging
Kutikulum berduri
o.s < v.s
Caecum tidak bercabang
2 testis bercabang,
tandem
1 ovarium bercabang

TREMATODA 04
FASCIOLOPSIS BUSKI

Morfologi
Telur

130-140 x 80 85
Lonjong
Kekuningan
Operkulum
Dinding tipis, jernih

TREMATODA 04
FASCIOLOPSIS BUSKI

S.H. Fasciolopsis buski

Cacing dewasa dalam
duodenum/jejunum

21.000-28.000/hr

TREMATODA 05
FASCIOLOPSIS BUSKI

telur keluar
bersama tinja

25-30 hr
Kista dicernakan
dalam duodenum
tertelan
t = 27-32C
3-7 mgg

miracidium
2 hr
I.H. (Tumb. air)
mjd. metacercaria
Trapa, Eichornia
Eliocharis, Zizania

I.H. (Segmentina,
Hippeutis, Gyraulus)
sporakista R R
SK
4 7 minggu

TREMATODA 06
FASCIOLOPSIS BUSKI

GX :
nyeri epigastrium
mual
diare
edema
ileus akut

diklorofen
niklosamid
praziquantel

Pencegahan

DX :

TX :

gx klinis
(bila didaerah endemi)
menemukan telur dlm
tinja

Memasak atau
merendam dalam air
mendidih tumbuhan air
yang akan dimakan

Heterophyes heterophyes
(Penyakit: Heterophyasis)
Distribusi geografis
- Cina
- Asia Tenggara
- Mesir
Habitat
Mukosa usus

Definitif host
manusia, hewan pemakan ikan
Intermediate host
I. Pironella conica
Cerithidea cingulata
II. Tilapia nilotica
Mugil japonicus
Acanthogobius
Tilapia

Morfologi
Telur
- 29 X 16 mikron
- coklat muda
- memiliki operkulum
- kulit tebal
Dewasa
- kecil; 1,3 X 0,5 mm
- ventral sucker > oral sucker
- genital sucker +

Adults of Heterophyes heterophyes are minute flukes, measuring 1-2 mm in length. The
tests are large and paired, and are situated near a small ovary. The surface of the worm
is covered with minute spines. Adults reside in the small intestine of the definitive host.
In this figure, the following structures are labeled: oral sucker (OS), pharynx (PH),
intestine (IN), ventral sucker, or acetabulum (AC), and eggs within the uterus (UT).

Life cycle

Life cycle

Adults release embryonated eggs each with a fully-developed miracidium, and eggs are
passed in the host's feces . After ingestion by a suitable snail (first intermediate host), the
eggs hatch and release miracidia which penetrate the snails intestine . Genera Cerithidia
and Pironella are important snail hosts in Asia and the Middle East respectively. The
miracidia undergo several developmental stages in the snail, i.e. sporocysts , rediae , and
cercariae . Many cercariae are produced from each redia. The cercariae are released from
the snail and encyst as metacercariae in the tissues of a suitable fresh/brackish water fish
(second intermediate host) . The definitive host becomes infected by ingesting
undercooked or salted fish containing metacercariae . After ingestion, the metacercariae
excyst, attach to the mucosa of the small intestine and mature into adults (measuring 1.0 to
1.7 mm by 0.3 to 0.4 mm) . In addition to humans, various fish-eating mammals (e.g., cats
and dogs) and birds can be infected by Heterophyes heterophyes .

Gejala klinis
Infeksi ringan
- tidak tampak
Infeksi berat
- diare menahun
- kolik
- rasa tidak enak dan nyeri diperut
- terdapat eosinofili

Diagnosa dan pengobatan

Diagnosa
- pemeriksaan tinja telur
Pengobatan
Prazikuantel 25 mg/Kg BB/po/dosis tunggal
Tetrakloroetilen 5 ml/po/dosis tunggal

Pencegahan

Masak ikan dengan sempurna

Buang air besar tidak disembarang tempat
Pendidikan kesehatan
Pengawasan hewan sumber penularan

Metagonimus yokogawai
(Penyakit :Metagonimiasis)
Distribusi geografis
- Jepang
- Korea
- Cina
- Taiwan
- Malaysia
- Rusia
- Spanyol
- Balkan

Habitat
- mukosa jejunum
Definitif host
- Manusia, anjing, kucing, babi,
burung pelikan
Intermediate host
I. Semisulcospira libertina
II. Salmon, Plectoglossus

Morfologi
Telur (mirip telur Heterophyes
heterophyes)
- 28 X 17 mikron
- kuning keabuan
- memiliki operkulum
- dinding tebal
Dewasa
- kecil 1,4 X 0,6 mm
- vs > os
- testis posterior
- ovarium tengah

Metagonimus yokogawai adult flukes are minute intestinal flukes (1-2.5 mm in length)
that resemble Heterophyes heterophyes. An important distinctive feature is the position
of the ventral sucker (genitoacetabulum), which is to the side of the midline and closely
associated with the genital pore. Adults reside in the small intestine of the definitive host.
Adult M. yokogawai.
In this figure, the following structures are labeled: oral sucker (OS), pharynx (PH),
intestine (IN), genitoacetabulum (GA), ovary (OV), the large, paired testes (TE), and eggs
within the uterus (EG).

Life cycle

Life cycle

Adults release fully embryonated eggs each with a fully-developed miracidium, and eggs are
passed in the hosts feces . After ingestion by a suitable snail (first intermediate host), the
eggs hatch and release miracidia which penetrate the snails intestine . Snails of the genus
Semisulcospira are the most frequent intermediate host for Metagonimus yokogawai. The
miracidia undergo several developmental stages in the snail, i.e. sporocysts , rediae , and
cercariae . Many cercariae are produced from each redia. The cercariae are released from
the snail and encyst as metacercariae in the tissues of a suitable fresh/brackish water fish
(second intermediate host) . The definitive host becomes infected by ingesting
undercooked or salted fish containing metacercariae . After ingestion, the metacercariae
excyst, attach to the mucosa of the small intestine and mature into adults (measuring 1.0
mm to 2.5 mm by 0.4 mm to 0.75 mm) . In addition to humans, fish-eating mammals (e.g.,
cats and dogs) and birds can also be infected by M. yokogawai .

Gejala klinis
Infeksi ringan tanpa gejala
Infeksi sedang diare dan sakit perut
Infeksi berat
- demam
- nyeri perut
- kolik
- eosinofili

Diagnosa dan pengobatan

Diagnosa
- menemukan telur dalam tinja
Pengobatan
- Prazikuantel 25 mg/Kg BB/po/dosis tunggal

Pencegahan

Masak ikan dengan sempurna

BAB tidak disembarang tempat
Pengawasan Hewan sumber penularan
Hygiene pribadi

TREMATODA HATI
Fasciola hepatica
Clonorchis sinensis

Fasciola hepatica
Penyakit
Hospes
Epidemiologi
Habitat

TREMATODA 07
FASCIOLA HEPATICA

: - fascioliasis
- liver rot
: - mamalia herbivora
- kadang manusia
: Amerika latin, Perancis,
sekitar Laut Tengah
: - saluran empedu
- kandung empedu

Morfologi

Cacing dewasa

20-30 cm x 8 13 mm
Pipih, daun,
cephalic cone
o.s. = 1 mm
v.s. = 1,6 mm
caecum bercabang
testis tandem, bercabang
kelenjar vitelaria
bercabang di lat. & post.
uterus pendek, berkelok

TREMATODA 08
FASCIOLA HEPATICA

Morfologi

Telur

130-150 x 63 90
Lonjong
Kuning coklat
Operkulum

TREMATODA 08
FASCIOLA HEPATICA

S.H. Fasciola hepatica

TREMATODA 09
FASCIOLA HEPATICA

hati

saluran empedu

menembus
dinding usus

dewasa

tertelan
telur dalam tinja
9 15 hari

metaserkaria

I.H. (Tumb. air)

miracidium

cercaria

redia

sporokista

I.H. : Lymnaea truncatula

Water caltrop, trapa natans

Sumber infeksi F. hepatica

TREMATODA 10
FASCIOLA HEPATICA

GX :
awal

sakit kepala
demam
nyeri di substernum /
kuadran kanan atas

DX :

lab : menemukan telur

(tinja/cairan empedu/
cairan duodenum)

TX :

Bithionol

lanjut

hepatomegali sirosis

Pencegahan

ikterus
gg. pencernaan
anemia

Mencuci dan memasak

sayuran

Clonorchis
sinensis

Sinonim :
Oriental/Chinese liver fluke
Distoma sinense
Opistorchis sinensis

Distribusi : Cina, Jepang, Korea, Vietnam

Habitat

Penyakit :
Clonorchiasis/clonorchiosis
Opisthorchiasis sinense
Chinese liver fluke disease

: Saluran empedu

MORFOLOGI
Cacing dewasa:

11-20 mm x 3-4,5 mm
Pipih seperti lancet
Oral sucker > ventral sucker
Ada pharynx
Cecum (usus) bercabang 2 sampai ke bagian posterior
Ada 2 testis berlobus dengan lekukan, letaknya tandem
Di lateral terdapat vitellaria menempati 1/3 tengah pada
lateral tubuh
Ovarium yang kecil, agak bulat terletak di depan testis di garis
tengah
Uterus berkelok-kelok

Telur:
30 x 15 mikron
Oval
Warna kuning kecoklatan
Ada operculum
Terdapat penonjolan (knob like)
Keluar dari induk berisi telur yang
berembrio

SIKLUS HIDUP
DH
: manusia, anjing, kucing (dan
sebangsanya: panther, harimau,
leopard), babi

IH I

: siput (Alocinma, Bulimus, Hua,

IH II

: Ikan air tawar yang termasuk genus

famili Cyprinidae, Salmonidae,
Gobiidae, dan Anabantidae

Parafossarulus)

KLINIS

Ringan tanpa gejala

Sedang/berat
Malaise/kelemahan
BB

turun
Congesti hepatomegali
Icterus
Cirrhosis hepatis
Asites
Iritasi mekanis di sal. empedu Cholangitis Ca
pada sal. empedu ( karena iritasi kronis sal. empedu)

DIAGNOSIS
Anamnesis
Daerah endemis
Kebiasaan makan ikan mentah

Pemeriksaan fisik:
Hepatomegali
Ikterus
Nyeri tekan
Diagnosa ditegakkan dengan menemukan telur dalam tinja atau dari
aspirasi duodenum.

TX

Praziquantel (doc)
25 mg/kg BB/hari, 3x/hari selama 3 hari
atau
dosis tunggal 40mg/kg BB

PENCEGAHAN

Putus mata rantai Host-Agent-Environment

Terapi penderita
Memakai WC dengan benar
Masak ikan dengan sempurna
Obat-obat Molluscida (membunuh siput)
Health Education

TREMATODA PARU
Paragonimus westermani

TREMATODA 11

Paragonimus westermani
Penyakit
Hospes

Epidemiologi
Habitat

: - paragonimiasis
- distomiasis paru
: - manusia
- mamalia pemakan
ketam / udang batu
: manusia Timur jauh
mamalia kosmopolit
: - paru

Morfologi
Cacing dewasa

8-16 cm x 4 8 mm
hidup sendok,
mati biji kopi
merah coklat
o.s = v.s
caecum bercabang
testis berlobus
ovarium berlobus
kutikulum berduri
kelenjar vitelaria di lat.

TREMATODA 12
PARAGONIMUS WESTERMANI

Paragonimus westermani

Morfologi
Telur

85 x 55
Dinding tebal
Kuning coklat
Operculum agak
tertekan didalam

TREMATODA 12
PARAGONIMUS WESTERMANI

Telur Paragonimus westermani

S.H. Paragonimus westermani

cacing dewasa
dalam paru

telur keluar melalui

sputum/tinja ke dalam
air tawar

TREMATODA 13
PARAGONIMUS WESTERMANI

miracidium
t = 27C
3 minggu

sporokista

diafragma

redia
menembus dinding
duodenum
tertelan

redia
menembus crustacea air
tawar
menjadi metacercaria

I.H. :

I.H. :

Hua, Semisulcospira,
Syncera,Thiara
Timur jauh

Ketam air tawar

Pomatiopsis Am. Ut
Pomacea Am. Sel

cercaria

Eriocheir, Potamon, Sesarma, Parathelphusa Timur

jauh

Pseudothelphusa Amerika Selatan

Udang batu
Astacus Timur Jauh
Cambarus Am. Ut

IH II Paragonimus westermani

TREMATODA 14
PARAGONIMUS WESTERMANI

GX :

TX :
hemoptisis
demam
epilepsi
hemiplegia
monoplegia
paresis

bila cacing
di otak

Pencegahan

DX :

Praziquantel
Bitionol

menemukan telur
(dalam sputum/cairan
pleura/tinja)

menghindari makan
crustacea mentah
jangan minum air
sungai yang tidak
dimasak
pendidikan
masyarakat