Helminths

Danielle Tahitoe
Helminths
The word helminth means worm
1. Phylum Nemathelminthes
Nematoda (round worm)
2. Phylium Platyhelminthes
Cestoda (tape worm)
Trematoda (flukes)
The Nematodes
Over 500.000 species distributes in water
and soil
Range 2.0 mm to over 1 m

The life span varies from 4-5 weeks until 14

years
Most has one definitive host
Intestinal Nematodes
The important of Nematodes
1. Ascaris lumbricoides
2. Hook worms
(Necator americanus, Ancylostoma duodenale)
3. Strongyloides stercoralis
4. Trichuris trichiura
5. Toxoccara
6. Enterobius vermicularis
7. Trichinella spiralis
1-5 soil transmitted helminths
Soil Transmitted Helminths
The most common causal agent:
- A.lumbricoides, T. trichiura, hookworms

The prevalence of STH in Indonesia is still

high
2007: The prevalence of STH in primary
school students, North Jakarta was 60% (n
= 305)
Ascaris lumbricoides
Female range from 20 to 30 cm in length
Male seldom over 30 cm
Mature female produce 200.000 eggs daily
Ascaris Lumbricoides
Morphology
- the fertilised egg measure 60x30 mm with
albuminous coat.
- take 3 to 4 weeks to infective stages
- the unfertilised egg is 80 x 40 mm
- life span of adult worm about 1 year
- the egg can survive in the soil for many
years
Life cycle of
A. lumbricoides
Lungs Trachea Pharynx

Circulation Swallowed
MAN
Larva hatches in Adults in small
intestine intestine
Ingested
Embryonated egg
Eggs in faeces
with 2nd stage larva
(infective stage) (diagnostic stage)
EXTERNAL
ENVIRONMENT
Advanced 2-cell stage
cleavage
Clinical aspects of
A. lumbricoides
Small number of infection larvae will produce no
symptom
Large number give pneumonitis, Loeffleers
syndrome
Adult worm in small number cause no symptom but
can give abdominal pain, intestinal colic
Large number cause intestinal obstruction,
severe allergic
Ascaris lumbricoides
Diagnosis
- detecting eggs in the feces
- adult worm emerged from anus or nose

Treatment
- Mebendazole 500 mg sekali pemberian
- Albendazole 400 mg sekali pemberian
Dosis untuk anak diatas usia 2 tahun
Pertimbangan untuk Pemilihan
Obat
Pada dasarnya: baik benzimidazole
antihelminthic drugs (albendazole dan
mebendazole) memiliki karakteristik yang
mendukung:
Sangat efektif
Dosis tunggal sebagai preventive chemotherapy
Profil keamanan obat yang sangat baik, tingkat
toksisitas yang sangat rendah
Harga terjangkau dan tersedia melalui kerjasama
dengan swasta (public-private partnerships)
 WHO Recommended To
Control Morbidity From STH
Anthelminthic medicines to the following
populations at risk of the disease:
Pre-school-age children (aged 1-4 years)
School-age children (aged 5-14 years)

Women of reproductive age (including pregnant

women in the second and third trimesters and
lactating mothers)
Adult groups exposed to STH infections (for
example, tea-pickers and miners)
Hook worms

The common human species are:

Necator americanus
Ancylostoma duodenale
Life cycle of Hook worm
Swallowed
Pharynx
Attached to small
Trachea intestine
Lungs
Adults in small
Circulation MAN intestine
Penetrates skin

Filariform larva Eggs in faeces

(infective stage) (diagnostic stage)

EXTERNAL ENVIRONMENT
Rhabditiform larva
hatches

Rhabditiform larva in soil

(occasionally in old faeces)
Clinical stage

Larvae skin penetration as ground itch

pneumonitis
Adult macrocytic hypochromic anemia
loss 0,05 ml 0,15 ml of blood/day
Hook worm
Diagnosis:

Finding the eggs in the faeces.

Treatment:
Albendazol

Mebendazol
Strongyloides stercoralis
Female lives in the small intestine 2 mm
The eggs develop by parthenogenesis

The free living female 1 mm

The free living male 0.7 mm

Strongyloides stercoralis
Life cycle
the parasites show 3 differences mode of
development:
1. Direct development
2. Indirect development
3. Autoinfection
Life cycle of S. stercoralis
Clinical Aspects
skin reaction - creeping eruption
pneumonitis

intestinal syndrome

the gluteal region dermatitis

( autoinfection )
Strongyloides stercoralis
Diagnosis
Stool culture rhaditiform larvae

Treatment
Thiabendazol drug of choice
Trichuris trichiura
Male is the principal host
The common name whip worm

The thick posterior part of the body

forming and the long thin anterior
portion
The adult worms are form 3 to 5 cm
Trichuris trichiura
Trichuris trichiura egg
Trichuris trichiura
Each female worm produces from 3000
to 7000 eggs daily
Infection is acquired by ingestion of the
fully embryonated eggs
Larvae pass to the cecal area where
their attach
Life Cycle of Trichuris trichiura
Clinical aspect
Light infection are usually asymptomatic
Heavier infection may be characterized by
abdominal pain, bloody/ muccoid diarrhea,
tenesmus, weight loss, weakness
Heavy infection:

- anemia
- moderate eosinophilia
- prolaps of the rectum
Diagnosis

Detection eggs in the faeces

Recommended Frequency of Re-Treatment
with Preventive Chemotherapy for STH in
School-Age Children, by Category of Risk

Category of Risk Prevalence of any STH Re-treatment schedule

among school-age
children
High-risk areas >50% Twice a year
Moderate risk areas >20% and <50% Once a year
Low-risk areas <20% None
(case-by-case treatment)
Hal-Hal Penting dari Dokumen
WHO
Indonesia termasuk dalam kategori negara
dengan beban penyakit cacingan tertinggi
lebih dari 2/3 dari anak usia 1-14 tahun
membutuhkan pengobatan (preventive
chemotherapy)
Target grup meliputi anak usia 1-5 tahun, anak
usia sekolah, wanita usia reproduksi, dan
pekerja dengan resiko tinggi
Pengendalian STH yang efektif membutuhkan
cakupan pengobatan 75% selama 4-6 tahun
Gambaran Umum Kebutuhan Pengobatan
STH (preventive chemotherapy needs)
 Perkiraan Prevalensi STH
(model)
STH prevalence in Indonesia: Data-based
Supporting Factors in
Indonesia
A poor hygienic standard and high outdoor
activity
A tropical countries, with warm and moisture soil
Agricultural countries farming without any
shoes or sandals high risk of hookworm
infection (N. Americanus)
Improper faeces management lack of septic

tank in several areas faeces go to the sewer

used for watering plants and roads eggs
of worms as route of infection
 The Problem Faced of STHs
Infection
Affecting cognitive abilities in children
Not specific signs and symptoms
Being underestimated
High rate of reinfection
Lack of knowledge among people in endemic
Diagnosis is difficult during larval migration
Increasing susceptibility to other important
illnesses such as malaria, tuberculosis, and HIV
infection
Prevalansi STH di Indonesia
Banyak survei spesifik ditemukan di Indonesia
mencakup 157 kabupaten dan 29 propinsi
Pada seluruh provinsi terdapat survei dengan
prevalensi >50%, kecuali:
- 2 provinsi <20%: Kepulauan Riau dan Bengkulu

- STH >20% dan <50% di Jambi, Lampung, DKI

Jakarta, Jawa Barat, DI Yogyakarta, Sulawesi
Utara dan Sulawesi Tengah
STH di Indonesia - Kesimpulan

Infeksi STH tersebar luas dengan prevalensi

tinggi di Indonesia hal ini sesuai dengan
perkiraan WHO bahwa >2/3 anak-anak
membutuhkan pengobatan (preventive
chemotherapy)
Pengendalian STH dan Nutrisi
pada Anak Pesan Kunci
Masa penting utk pertumbuhan anak dan
penentu tinggi badan pada usia dewasa adalah
masa-masa di bawah usia 2 tahun;
Tingkat prevalensi STH mencapai puncaknya
pada sekitar usia 18 bulan;
Sehingga, pencegahan seawal mungkin menjadi
prioritas utama terlebih dari segi nutrisi;
Dan anak-anak akan terus bertumbuh
pengendalian STH telah terbukti dapat
meningkatkan pertumbuhan anak usia sekolah.
HELMINTOLOGI
 Telur Ascaris Lumbricoides
stadium dibuahi corticated

Telur Ascaris Lumbricoides

stadium tidak dibuahi
Telur Ascaris Lumbricoides
stadium infektif berisi larva
Ascaris lumbricoides

Mulut Ascaris
Tabungan kami ........
Ascaris lumbricoides
Larva Cacing tambang
 Cacing tambang

Mulut Necator
americanus
Mulut Ancylostoma
duodenale
Cacing tambang
Strongyloides stercoralis

Stadium parasiter

Stadium bebas