HELMINTIASIS

pengelolaan investasi cacing pada dewasa

Bachti Alisjahbana

Sub Bagian Infeksi

Bagian Penyakit Dalam FKUP / RSHS

Helminthiasis

Type of helminthiasis
Intestinal
ascariasis

Ascaris lumbricoides

ankilostomiasis

N. americanus, A duodenale

taeniasis

T. solium, T saginata

trichuriasis

Trichuris trichiura

Oxyuriasis

Oxyuris vermicularis

blood/ tissue
filariasis

W. bancrofti, B. malayi, dst.

schistosomiasis

Schistosoma mansoni,

hepatic worm

F. hepatica

Helminthiasis

Soil transmitted nematodes

Helminthiasis

Epidemiologi (burdens and trends)

Puplation at risk:

2 billion

Population infected: > 1 billion

Mostly children
Mortality Ankilostomiasis

65.000

Mortality Ascaris Lumbricoides

An. Mort trichuris

60.000

10.000

Pregnant woman : 44 million infected with hookworm

chronic blood loss --> Fe defisiensi

Helminthiasis

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

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

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

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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

12

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

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Askariasis ~ life cycle

telur

paru

usus
halus

Helminthiasis

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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

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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

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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

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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

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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

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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

31

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

32

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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