Kuliah Helminth Blok 17_2014

7/25/2019 Kuliah Helminth Blok 17_2014

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Aschelminthes

1.

Nematoda (round worm)

Platyhelminthes (Flatworms)

2. Cestoda (tape worm)

3. Trematoda (flat worm = fluke)


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A. Nematoda (roundworm)

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Nematoda (roundworm)

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Intestinal nematodes

Larvae pass

through lungs

Larvae penetrate

through intact skin

strongyloides

hookworm

Eggs ingested

trichuris

enterobius

Larvae enter

bloodstreamascaris

Adult worms in the

the intestine

Eggs

Larvae hatch

from eggs


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Morphology

Adults -males are 15 to 30 cm long,with strongly curved tails; females are

20 to 35 cm long, with straight tails.

Eggs -one female produces 200,000per day. The egg has an outer shell

membrane which is heavily mamillated.

This layer is sometimes rubbed off in

passage down the fecal stream.

Infertile eggs often appear longer, andthinner shelled.


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Pathogenesis

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Signs and Symptoms

Major pathology and symptoms:

Pneumonia associated with

migration of larvae in the lungs.

Obstruction of the intestines,appendix, or common bile duct.

Vomiting and abdominal pain.

May cause malnutrition inchildren with heavy infections or

poor diet.

Some infections areasymptomatic.


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Diagnosis

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Prevention and Treatment

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molt molt 3 timesAdults Newly laid Infective Larvae Adults

eggs 6h eggs

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Necator americanus- The New World hookwormAncylostoma duodenale- The Old World hookworm

Hookworms are named for the dorsal curve in their anterior end.

Hookworms are quite small, Necatoramericanusis only 11mm long.

However, because they feed on blood a heavy infection can producesevere anemia.

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Morphology

Rhabditiform larvae - long buccal cavity,indistinct genital primordium. Filariform

larvae lose oral structures & have sharp

pointed tails.

Adults - males: 7 to 11 mm long with acopulatory bursa; females: 8 to 15 mm

long.

Eggs -55 to 70 x 35 to 40 microns; verythin shell; usually seen in the 8 - 32 stage

of cleavage.

Hookworm rhabditiform larva

Hookworm filariform larva

Hookworm egg


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Life cycle


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Pathology

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Major pathology and symptoms

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Diagnosis

Recovery and identification of eggs(rarely larvae) in the feces.

Cannot differentiate Hookwormspecies by egg appearance.

To determine if a significantinfection: count the number of eggson a direct smear of theunconcentrated specimen. 5 eggs per smear indicates a light

infection

20 or more eggs is clinically significant;

100 or more is indicative of a very heavyinfection.


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4 Strongyloides stercoralis (Threadworm)

Morphology:

Rhabditiform larvae - short buccal cavity; large, prominent

genital primordium.

Filariform larvae - tail has a notch in it, in contrast with the

filariform larva of hookworms.

Must be able to differentiate these from hookworm larvae.

Eggs hatch in the intestine (not usually passed in stool

specimens). Eggs resemble hookworm eggs, but are

embryonated.

Buccal cavity of rhabditiform larva Notch in tail of filariform larva


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Life cycle

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Strongyloides stercoralis rhabditiform larva

Strongyloides stercoralis filariform larva


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Diagnosis

Diagnosis:

Recovery and

identification of larvae inthe feces.

Recovery and

identification of eggs in

duodenal drainage.


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Major pathology and symptoms

Skin allergic reactions; raised, itchy, red blotches at the site oflarval penetration.

Lungs pneumonia.

Intestinal - abdominal pain, diarrhea, vomiting, weight loss,anemia, eosinophilia. Light infections usually asymptomatic;

Heavy infection - bowel becomes edematous and congested. Death occurs in immunosuppressed patients due to heavy

autoinfection.


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Direct stool smears (larvae)

Cultivation of stool. (Damp charcoal or Harada-Mori mediums).

Histological examination of duodenal or jejunal biopsyspecimens obtained by endoscopy can demonstrateadultworms embedded in the mucosa.

Eosinophilia, is present in uncomplicated strongyloidiasis, butis lost in hyper infection

For population screening in endemic areas, an ELISA for IgGanti-Strongyloides antibodies is effective.

iagnosis


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While hookworm infection dies out over aperiod of years after the patient has movedfrom an endemic area, strongyloidiasis maypersist for years, due to autoinfection(internal infection).

In cases with severe diarrhea, Strongyloideseggs may be present in stool specimens.Strongyloides eggs contain well-developed

larvae. Hookworm eggs do not have welldeveloped larvae until passed from the bodyand mature for one to two weeks in the soil.


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Microfilaria--177~296!m in length, encased in a

sheath with free endings. Bluntly rounded

anteriorly and tapers to a point posteriorly. A

large number of nuclei seen in the body are

arranged in a column from head to the posterior

Wuchereria bancrofti Brugia malayi


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Size Larger, 244~296 by5.3~7 !m

Smaller, 177~230 by5~6 !m

Shape Curves of body arenatural, smooth

Curves of body arerigid, the small inlarger curve

Cephalic space Shorter (length is equalto or less than width)

Longer (length is twotimes as long as

width)Body nuclei Equal sized, clearly

defined, countableUnequal sized,coalescing, uncountable

Terminal nuclei No Two


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The Platyhelminthes (Flatworms):

Cestoda dan Trematoda

General Characteristics:

Multicellular animals characterized by a flat,

bilaterally symmetric body, dorsoventrallyflattened and solid (no body cavity).

Most are hermaphroditic.

Overall size varies greatly, some members are as

small as 1mm, and others may be 20 meters orlonger.


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B. Cestodes (tapeworms)

Adult worms -Flat & ribbon-like;

Scolex (head) -Characterized by thepresence of sucking disks or lateral grooves.Some have hooks (armed) to attach to a hostorganism.

Rostellum -A small button-like structure onthe scolex of armedtapeworms from whichthe hooks protrude. It may be retractable.

Strobila - Chain of segments (proglottids =

square body segments used for reproduction)

Immature proglottids: developing

reproductive

Mature proglottids: mature reproductive

organs.

Gravid proglottids: contain eggs in the

uterus, terminal segments.


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Cestodes (tapeworms)

Dioecious - each proglottid has both male & femalereproductive organs; can fertilize itself.

Reproductive organs Male: testes are spread throughout the segment; sperm is

collected in the seminal vesical; delivered to female organ viacopulatory spicules.

Female: ovaries produce eggs, which are stored in the uterus.

Development of proglottids -

New proglottids bud from behind the scolex.

As they are pushed back, they mature & eggs are produced.

When filled with eggs, they are gravid

proglottids. Eggsare sometime released in feces, but often are retained withinthe segment. Hexacanth embryos (onchospheres) developwithin the eggs.

Proglottids - a few are usually shed every 2-3 days.


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Cestodes (tapeworms)

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Taenia sppGeneral :

Scolex - attaches to human intestine.

Larva - cysticercus, a fluid filled bladder with an

invaginated scolex.

Eggs of both species are identical.

Adult Tapeworm have no intestinal tract.

Excretory system: flame cell (the function is

similar with kidney and anus in mamalia).

Length: T. saginata > T. solium


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Taenia solium The Pork Tapeworm

General:

Man is the only definitive host.

Infection - ingestion of cysticercus in flesh ofswine.

Size - up to 7 meters in length.

Life expectancy - 25 years or more.

Autoinfection called cysticercosis, due toingestion of eggs from feces if infected with adult

worm.

Racemose form of infection may develop in thebrain. A Racemose is a larva which is branching,spreading throughout tissue.


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Taenia saginata The Beef Tapeworm

General:

Man is the only definitive host.

Infection - ingestion of cysticercus in flesh ofcow.

Size - up to 10 meters in length (although 70'

worms have been reported).

life expectancy - 25 years or more.


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Taenia saginata The Beef Tapeworm

Morphology:

Scolex - unarmed (no hooks); 4

sucking disks.

Gravid proglottids - one inch orslightly longer; uterus contains

15 to 20 primary branches. The

uterine pore is located in a

lateral position.

Eggs are identical to T. solium,

measuring about 40 microns in

diameter.


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indistinguishable;


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Infeksi oleh kista yang mengandung larva

(cysticerci) Taenia solium.

Results when humans become the

intermediate host (incidental/accidental host)

More serious than infections with the adult

stage alone. This condition only occurs with

the pork tapeworm, Taenia solium. Neurocycticercosis: infeksi parasit pada CNS.


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1. Schistosomiasis

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Distribution Map


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Life Cycle (Basic)


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Cercariae penetrate skin"rash- called schistosome or swimmers itch.

Eggs laid in target organs release antigens

"cause Katayama fever- fever- urticaria

- malaise- diarrhea

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InS. mansoni infections

Wall of colon is damaged as eggs pass through

Inflamm. response"ulcers, inflammatory

polyps

Can lead to fibrosis

Clinically: diarrhea, abdominal pain

Eggs can also accumulate in the appendix

Can lead to appendicitis (inflammation of the appendix)

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86/109

Hepatosplenic schistosomiasis

Eggs carried by portal circulation"liver

Granulomatous response

Granulomas are walled off with fibroustissue"fibrosis obstructs portal veins"portal hypertension

Esophageal varices (dilated esophageal veins, which

drain the liver"bursting can cause bleeding todeath. Caused directly by portal hypertension.)

Splenomegaly (enlarged spleen, due to fibrosis)

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88/109

In those with severe hepatosplenic schistosomiasis

Blood gets shunted directly back to the heart (doesnt passthrough liver).

Eggs accumulate in heart, sometimes lodged in pulmonary

arterioles.

Form granulomas"block pulmonary circulation"pulmonary hypertension.

Can lead to right ventricular strain, and eventually

cardiovascular collapse.

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Genitourinary complications Eggs lodge themselves in wall of bladder & can develop into polyps Polyps can erode, ulcerate & cause hematuria (blood cells in urine) Eggs lodge in ureters and urethra, cause lumps and lesions"

kidney failure

Eggs lodge into ovaries, the uterus, cervix, fallopian tubes"lumps"complications incl. infertility(For the men: eggs can also lodge into the testes and the prostate )

CNS complications S. haematobium and S. mansoni can migrate to the spine

S. japonicum found in the brain and causes encephalopathy(general brain dysfunction)

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Diagnosis

Microscopic Detection

Take stool or urinesample to detect eggs

S. haematobiumeggs areoval and have a spike atthe tip

S. japonicum eggs smalland almost spherical with

tiny spine S. mansonieggs have a

spike on the side (spine)

S. mansoni S. japonicum

S. haematobium


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Diagnosis

Antibody tests

An earlier and more sensitive form of detection

Some complications

Cross-reactivity with other helminthic infections (otherflatworm parasites)

Cant tell the difference between current and old

infections as antibodies stay long after infection is over.

Cant tell you anything about overall worm burden so wecant tell how serious the infection is


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Prevention

For travelers its easy- dont swim in fresh, stagnant water(running water is better, still not safe).

Harder in endemic areas"people are dependent onnearby freshwater.

Focused on education, eliminating snail nesting grounds Molluscicides can be used to eliminate snails. Proper irrigation systems and engineering are key There are ways to build irrigation and canalization systems

that dont allow snails to inhabit the surrounding area

However, many irrigation/canalization projects since the 50s haveignored UN instructions, may have contributed to spread of theparasite


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Treatment

Swimmers itch and Katayama Fever are usually treated

symptomatically.

Chemotherapy is treatment of choice - Praziquantel is mostwidely used drug.

Praziquantel

Extremely well tolerated, few side effects

Broad-spectrum antihelminthic drug (antihelminthic= drugs thatexpel parasitic worms)

Cures schistosomiasis in 8090% of patients, 90% reduction in

egg excretion in those not cured

Causes worm muscles contract cannot hold onto human tissues

Resistance has been reported in Egypt and Senegal


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Treatment

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Kuliah Helminth Blok 17_2014