ELEKTIF INFEKSI

DEPARTMENT PARASITOLOGY

MEDICAL FACULTY OF USU

A 16 year old female student came to CommunityHealth Centre with complaints of swelling of rightleg from thigh to toes. The swelling occurred onceevery 5-6 months. It started 4 years ago along withhardness and swelling of inguinal lymph nodes. Shealso developed chills and fever. About 4-5 days laterthe fever stopped, but the swelling of the legthe fever stopped, but the swelling of the legincreased. At this stage she had chills with severepain in the right leg. This lasted for 10-12 days, afterwhich the pain subsided. During this time she hadulcers on the swollen leg with bleeding and a yellowdischarge. This remained for 2 days. Later theswelling decreased and the ulcers started healing.

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HOW IS THE MECHANISME OF DISEASE?

HOW IS THE TREATMENT?

HOW IS THE PROGNOSIS?

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Pathogenesis

Inflammation occurs when worms die, either drug-induced or spontaneously.

Granulomas arise around those worms, characterized by macrophages which develop into giant cells: as plasma cells, eosinophils and neutrophils.

Clinical symptom is filarial fever starting when the worm death and leads to Clinical symptom is filarial fever starting when the worm death and leads to retrograde lymphangitis (painful with swelling), and lymphadenitis, which lasts for ± 1 week .

Lymph vessels dilation, not obliteration, is probably the early event

following antigenic stimulation, which spring larvae are being released. These larvae are degenerate and will be taken up by phagocytic cells.

These accompanied by triggering of the innate immune system, release pro-inflammatory cytokines and molecules that promote lymphangiogenesis

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The enlarge lymph vessels become less efficient at transporting lymph from the periphery, which in the legs is always oriented against gravity, more vulnerable to exogenous microorganisms.

Insufficient fluid transport will lead to fluid extravasations, particularly in the lower limbs, and eventually to lymphedema.

L3 preferentially stimulate IL-4 and IK-13 release from basophils as well as histamine release (King 2001). In addition, basophils comprise approximately 1% of cells in PBMC and their contribution to the observed cytokine production can be substantial. Therefore mast cells and basophils may plan an important role in regulating the host response to filarial infection by affecting T cell differentiation, local blood flow, lymphocyte proliferation or by release of histamine or other prostanoids

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PENGOBATAN

• Dietyl Carbamazyn Citrat (DEC): 6 mg/Kg BB/ hari selama12 hari.Pemberian dapat diberikan dibagi 3 dosis/hari: sesudah makan.

• Obat ini dapat membunuh mikrofilaria, cacing dewasa pada pengobatan jangka panjang.

• Untuk membunuh mikrofilaria dapat menggunakan dosis di atas; tetapi untuk membunuh cacing dewasa harus diulang beberapa kali siklusnya.kali siklusnya.

• Untuk program eliminasi filariasis melalui pengobatan masal di daerah endemis (prevalensi 1%), menggunakan kombinasi DEC 6 mg/kgBB dan albendazole400mg yang diberikan setiap tahun selama 5-10 tahun pada penduduk di atas 2 tahun

• Ivermectin : dosis tunggal 400µg/kgBB (setiap 6 bulan sekali) atau kombinasi dengan DEC (1 thn sekali).

• Antibiotik dan antimikotik jika dijumpai infeksi sekunder

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Lymphedema care treatment

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• Pengobatan akan memberikan kesembuhan pada penderita mikrofilaremia, stadium akut, lymphedema std 1-2, chyluria dan std dini elephantiasis.

• Bila sudah sampai stadium hydrochele dan elephantiasis lanjut maka diperlukan pembedahan.

• Pengobatan DEC pada filariasis akan PROGNOSIS4

• Pengobatan DEC pada filariasis akan membunuh parasit sehingga keluar Wolbachia (bakteri) menyebabkan efek samping pengobatan.

• Sehingga menambahkan antibiotik tetrasiklin dan doksisiklin dapat membunuh Wolbachia.

PROGNOSIS4

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• Bersifat respons terhadap kematian parasit; terdapat dua reaksi:

• Reaksi sistemik: demam, berupa sakit kepala, sakit pada berbagai tubuh, sendi-sendi, pusing, anoreksisa, lemah, hematuria

transien, reaksi alergi, muntah, serangan asma; Hal ini terjadi beberapa jam setelah pemberian DEC (< 3 hari).EFEK SAMPING

PENGOBATAN4pemberian DEC (< 3 hari).

• Reaksi Lokal: limfadenitis, abses, ulserasi, transien, lymphedema, hidrokel, funikulitis dan epididimitis.

• Efek samping bancroftian filariasis lebih ringan daripada brugian filariasis; hal ini disebabkan kemampuan DEC membunuh filaria lbh lambat pada W.bancrofti

PENGOBATAN4

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