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MEDICAL MEDICAL HELMINTHOLOGYHELMINTHOLOGY

MEDICAL MEDICAL HELMINTHOLOGYHELMINTHOLOGY

Dept. of Parasitology FK Unpad

Medical helminthology Medical helminthology : the study of : the study of parasitic worms (helminthes/ parasitic worms (helminthes/ vermes/cacing) vermes/cacing) affecting man, affecting man, which :which :

– Spend part or the entire life cycle in a Spend part or the entire life cycle in a human hosthuman host oror

– Animal parasite causing disease in Animal parasite causing disease in humanhuman

Introduction to Introduction to Medical HelminthologyMedical Helminthology

Introduction to Introduction to Medical HelminthologyMedical Helminthology

HELMINTHES

NEMATODES

NEMATHELMINTHES PLATYHELMINTHES

TREMATODES CESTODES

CLASSIFICATIONCLASSIFICATION

The species parasitic in man range in length from The species parasitic in man range in length from 2 mm (2 mm (Strongyloides stercoralisStrongyloides stercoralis) to over a meter ) to over a meter ((Dracunculus medinensisDracunculus medinensis))

The adult is an elongate cylindrical worm, The adult is an elongate cylindrical worm, bilaterally symmetrical like a thread; also known bilaterally symmetrical like a thread; also known as roundworm as roundworm

UnsegmentedUnsegmented Body covered by fine and smooth cuticle, Body covered by fine and smooth cuticle,

sometimes striatedsometimes striated Has inner body cavity (pseudocoelom)Has inner body cavity (pseudocoelom)

General characteristics of Nematodes

Nematodes Nematodes Life cycle Nematodes Nematodes Life cycle

Transmission to a new host : Ingestion the mature infectious egg or larva Penetration of the skin or mucous membranes by the

larva Some species have an intermediate host – usually an

arthropod The same animal both the definitive and intermediate host

of Trichinella spiralis Nematodes, do not multiply in man

Nematodes Nematodes Pathogenicity Nematodes Nematodes Pathogenicity

The effect of parasitic nematodes upon the host The effect of parasitic nematodes upon the host depends upon : species, the intensity of the infection depends upon : species, the intensity of the infection and the location of the parasiteand the location of the parasite

Simultaneous infection with several species of intestinal Simultaneous infection with several species of intestinal nematodes is common in tropical and subtropical nematodes is common in tropical and subtropical countriescountries

Injury may be produced by adult and larval parasitesInjury may be produced by adult and larval parasites Intestinal parasites produce less local and systemic Intestinal parasites produce less local and systemic

effect than tissue parasiteseffect than tissue parasites

Nematodes Nematodes PathogenicityNematodes Nematodes Pathogenicity

The local reaction from intestinal parasites result from The local reaction from intestinal parasites result from irritation, invasion of the intestinal wall and occasionally irritation, invasion of the intestinal wall and occasionally penertation to extraneous sitepenertation to extraneous site

The local reaction in the liver, lungs (and other) – may The local reaction in the liver, lungs (and other) – may destroy or encapsulate the larvaedestroy or encapsulate the larvae

The degree of local reaction – depend upon the The degree of local reaction – depend upon the sensitivity of the host to the proteic product of the sensitivity of the host to the proteic product of the parasiteparasite

Intestinal mucosa is damaged by biting and Intestinal mucosa is damaged by biting and bloodsucking, by lytic ferment secreted by the parasite bloodsucking, by lytic ferment secreted by the parasite and by mechanical irritationand by mechanical irritation

Pathogenicity

The general reaction are produced by loss of blood, absorption of toxin, nervous reflexes and proteic sensitization

The larvae of certain species, produce local and general reaction

In unatural host the larvae may be pass through their invasive stages, never become established as adult parasite – paratenic host

Immunity is acquired through the invasion of the tissues by the parasite and its larvae or through the absorption of its products

Immunity is both humoral and cellular

HABITAT

BLOOD AND TISSUE NEMATODES

INTESTINAL

NEMATODES

SOIL TRANSMITTED HELMINTHS (STH)

OTHER (NON-STH) FILARIA and DRACUNCULUS

NEMATODESClassification based on Habitat

Soil Transmitted Helminthes Ascaris lumbricoides Trichuris trichiura Hookworm (Necator americanus,

Ancylostoma duodenale) Strongyloides stercoralis

NEMATODESNEMATODES

Non-Soil Transmitted Helminthes Enterobius vermicularis Trichinella spiralis

Filaria and Dracunculus Wuchereria bancrofti Brugia malayi Brugia timori

Important

Important

Disease caused by Soil transmitted helminthesDisease caused by Soil transmitted helminthes Disease caused by Soil transmitted helminthesDisease caused by Soil transmitted helminthes

NEMATODE WORMS WHICH REQUIRE PERIOD OF DEVELOPMENT AND MATURATION DURING ITS LIFE CYCLE ON SOIL

NEMATODE WORMS WHICH REQUIRE PERIOD OF DEVELOPMENT AND MATURATION DURING ITS LIFE CYCLE ON SOIL

IMMATUREIMMATURE INFECTIVEINFECTIVEINTO

DEFINITION Soil transmittedhelminth :

GENERAL CHARACTERISTICS OF STH INFECTION

SOIL TRANSMITTED HELMINTHSSOIL TRANSMITTED HELMINTHSSOIL TRANSMITTED HELMINTHSSOIL TRANSMITTED HELMINTHS

Non-acute and not fatalNon-acute and not fatal Occurs primarily in slum areas Occurs primarily in slum areas Children are commonly infected with :Children are commonly infected with :

Ascaris lumbricoidesAscaris lumbricoides Trichuris trichiuraTrichuris trichiura

Young adults mostly infected with Young adults mostly infected with hookworms (in the plantations and hookworms (in the plantations and mining area) :mining area) : Necator americanusNecator americanus Ancylostoma duodenaleAncylostoma duodenale

Non-acute and not fatalNon-acute and not fatal Occurs primarily in slum areas Occurs primarily in slum areas Children are commonly infected with :Children are commonly infected with :

Ascaris lumbricoidesAscaris lumbricoides Trichuris trichiuraTrichuris trichiura

Young adults mostly infected with Young adults mostly infected with hookworms (in the plantations and hookworms (in the plantations and mining area) :mining area) : Necator americanusNecator americanus Ancylostoma duodenaleAncylostoma duodenale

Ascaris lumbricoidesAscaris lumbricoidesDISTRIBUTIONDISTRIBUTION CosmopolitanCosmopolitan Prevalence 70-90 %Prevalence 70-90 % Primarily affects underfives Primarily affects underfives

and school childrenand school children

HABITATHABITAT Lumen of the intestine :Lumen of the intestine :

JejunumJejunumMedia ileumMedia ileum

Ingestion of mature eggsIngestion of mature eggs

Hatched in the gaster, Hatched in the gaster, larva penetrates the wall larva penetrates the wall of the intestine and enter of the intestine and enter into blood circulationinto blood circulation

To the right heart To the right heart chamber, into the lungschamber, into the lungs

Alveoli – bronchioles - bronchus - Alveoli – bronchioles - bronchus - trachea - swallowedtrachea - swallowed

Arrived in the intestine and Arrived in the intestine and becomes mature adultbecomes mature adult

Source : Medical Parasitology in PlatesPiekarski G.

Larva

Ingested

Adults

Infertile eggs

Mature eggs

Migration of larva inside the

circulatory system

Ascaris lumbricoidesAscaris lumbricoidesLIFE CYCLE

Complaints due to direct effect by

PATHOGENESIS AND CLINICAL SYMPTOMSDisease ; Ascariasis

(1). Larva(1). Larva

Allergic manifestation : urticaria, Allergic manifestation : urticaria, swollen lips, asthma attackswollen lips, asthma attack

Loffler Syndromes :Loffler Syndromes : Ascaris pneumonia (coughing)Ascaris pneumonia (coughing) Hyper-eosinophiliaHyper-eosinophilia Thorax X-ray : temporary white spots Thorax X-ray : temporary white spots

Larva migrationLarva migration

Allergic manifestation : urticaria, Allergic manifestation : urticaria, swollen lips, asthma attackswollen lips, asthma attack

Loffler Syndromes :Loffler Syndromes : Ascaris pneumonia (coughing)Ascaris pneumonia (coughing) Hyper-eosinophiliaHyper-eosinophilia Thorax X-ray : temporary white spots Thorax X-ray : temporary white spots

Larva migrationLarva migration

Ascaris lumbricoidesAscaris lumbricoides


DISTRIBUTIONDISTRIBUTION CosmopolitanCosmopolitan Prevalence 70-90 %Prevalence 70-90 % Primarily affects underfives Primarily affects underfives

and school childrenand school children

HABITATHABITAT Lumen of the intestine :Lumen of the intestine :

JejunumJejunum Media ileumMedia ileum

Source : Dept. of Parasitologi FKUP, 1999

Source : Color Atlas of Medicine and Parasitology. 1977Peters W. & Gillers H.M.

Adult worms expelled after deworming

Complaints due to direct effect by

PATHOGENESIS AND CLINICAL SYMPTOMS

(2). Adult worm (2). Adult worm

Irritations of the mucosal foldsIrritations of the mucosal folds Blocking of the intestine - ileusBlocking of the intestine - ileus Erratic migrationErratic migration Competes in the absorption of Competes in the absorption of

food and vitaminsfood and vitamins Release of toxic metabolic Release of toxic metabolic

products products

Irritations of the mucosal foldsIrritations of the mucosal folds Blocking of the intestine - ileusBlocking of the intestine - ileus Erratic migrationErratic migration Competes in the absorption of Competes in the absorption of

food and vitaminsfood and vitamins Release of toxic metabolic Release of toxic metabolic

products products


Diagnosis

Laboratory diagnosisLaboratory diagnosis Identify the eggs found in feces Identify the eggs found in feces using following methods :using following methods : Direct smear methodDirect smear method Concentration method Concentration method

Identify larva found in sputumIdentify larva found in sputum Identify adult worm found expelled Identify adult worm found expelled

from anus, mouth, nostrilfrom anus, mouth, nostril Do quantitative lab method to Do quantitative lab method to

measure level of infectionmeasure level of infection Additional : chest X-rayAdditional : chest X-ray


TreatmentTreatment

?Drug availableDrug available

Pyrantel pamoatePyrantel pamoate

MebendazolMebendazol

Oxantel pamoateOxantel pamoate

PiperazinePiperazine

AlbendazoleAlbendazole

Drug availableDrug available

Pyrantel pamoatePyrantel pamoate

MebendazolMebendazol

Oxantel pamoateOxantel pamoate

PiperazinePiperazine

AlbendazoleAlbendazole

Based on prevalence of Based on prevalence of A. lumbricoides A. lumbricoides in one area :in one area :

Ascaris lumbricoidesAscaris lumbricoidesMass treatment

prevalence > 30 %, treatment 3x/yearprevalence > 30 %, treatment 3x/year prevalence (20-30) %, treatment prevalence (20-30) %, treatment

2x /year2x /year prevalence (10-20) %, treatment prevalence (10-20) %, treatment

1x /year1x /year prevalence < 10 %, individual prevalence < 10 %, individual

treatment in positive cases onlytreatment in positive cases only

PREVENTIONPREVENTION


treatment of individual casetreatment of individual case

Provision of sanitary public bath, wash Provision of sanitary public bath, wash and toilet facilities and toilet facilities

Media information and health educationMedia information and health education

Routine health check up of children Routine health check up of children

treatment of individual casetreatment of individual case

Provision of sanitary public bath, wash Provision of sanitary public bath, wash and toilet facilities and toilet facilities

Media information and health educationMedia information and health education

Routine health check up of children Routine health check up of children

Distribution Distribution Trichuriasis - cosmopolitanTrichuriasis - cosmopolitan Primarily in hot and humid areasPrimarily in hot and humid areas prevalence 80-90 %, especially among prevalence 80-90 %, especially among

underfives and school childrenunderfives and school children

Infection byInfection byTrichuris trichiuraTrichuris trichiura

Infection byInfection byTrichuris trichiuraTrichuris trichiura

HabitatHabitat Caecum, appendix, colon (proximal end)Caecum, appendix, colon (proximal end)

Mode of infection Mode of infection oral oral Infective eggs embedded under Infective eggs embedded under

fingernail (hand to mouth infection)fingernail (hand to mouth infection) Ingested with contaminated food/drinks Ingested with contaminated food/drinks

(carried by insect vector: cockroach, (carried by insect vector: cockroach, flies)flies)

Trichuris trichiuraTrichuris trichiuraTrichuris trichiuraTrichuris trichiuraLIFE CYCLE

C

Maturation in soil (3-5 weeks)

Adult in colon,especially in Caecum

Eggs inFeces

Eggs hatch(Proximal intestine)

In human body

In Soil

Trichuris trichiuraTrichuris trichiuraTrichuris trichiuraTrichuris trichiura

Disease : TrichuriasisDisease : Trichuriasis

Heavy infectionHeavy infection worm migrate to worm migrate to colon, rectumcolon, rectum

Prolapsus rectiProlapsus recti, worm found in , worm found in mucosal lining (due to frequent mucosal lining (due to frequent defecation) defecation)

Disease : TrichuriasisDisease : Trichuriasis

Heavy infectionHeavy infection worm migrate to worm migrate to colon, rectumcolon, rectum

Prolapsus rectiProlapsus recti, worm found in , worm found in mucosal lining (due to frequent mucosal lining (due to frequent defecation) defecation)

PATHOLOGY AND CLINICAL SYMPTOMS



Chronic and heavy infectionChronic and heavy infection Heavy anemia (Hb = 3 gr%) (1 Heavy anemia (Hb = 3 gr%) (1

worm absorb 0,005 cc worm absorb 0,005 cc blood/day)blood/day)

Abdominal pain, nausea, Abdominal pain, nausea, weight loss, vomiting weight loss, vomiting

Prolapsus rectiProlapsus recti Headache, feverHeadache, fever

Mixed infection may Mixed infection may

occur with occur with Ascaris Ascaris

lumbricoideslumbricoides, ,

hookworm and hookworm and

Entamoeba histolyticaEntamoeba histolytica

Identify egg worm found in fecal Identify egg worm found in fecal samplesample

IdentifyIdentify adult worm from adult worm from prolapsed anus and rectum (by prolapsed anus and rectum (by proctoscopy)proctoscopy)

Measure level of infection by Measure level of infection by counting :counting : Number of eggs per gram fecesNumber of eggs per gram feces Number of female worm expelled Number of female worm expelled

through deworming through deworming

Identify egg worm found in fecal Identify egg worm found in fecal samplesample

IdentifyIdentify adult worm from adult worm from prolapsed anus and rectum (by prolapsed anus and rectum (by proctoscopy)proctoscopy)

Measure level of infection by Measure level of infection by counting :counting : Number of eggs per gram fecesNumber of eggs per gram feces Number of female worm expelled Number of female worm expelled

through deworming through deworming

Diagnosis


Drugs availableDrugs available:: Oxantel pamoateOxantel pamoate Mebendazol (drug of choice)Mebendazol (drug of choice)

TreatmentTreatment

Trichuris trichiuraTrichuris trichiuraTrichuris trichiuraTrichuris trichiuraPREVENTIONPREVENTION

Elimination of source of infectionElimination of source of infection Improved personal hygiene (hand Improved personal hygiene (hand

washing, toilet training)washing, toilet training) Through washing of sold Through washing of sold

vegetables vegetables Health educationHealth education Provision of sanitary public toiletProvision of sanitary public toilet

Infection by HookwormInfection by Hookworm

PREFERENTIAL HABITAT Small intestine (jejunum) In heavy infection : duodenum, colon

GEOGRAPHIC DISTRIBUTION GEOGRAPHIC DISTRIBUTION Cosmopolitan, especially :Cosmopolitan, especially :– Tropical equator Tropical equator – Coal/tin mines, coffee/rubber Coal/tin mines, coffee/rubber

plantationsplantations Ideal soil for egg development :Ideal soil for egg development :

– Sandy soilSandy soil– Clay soil Clay soil – Muddy soil hindered from excessive Muddy soil hindered from excessive

dryness or wetness dryness or wetness

HOOKWORMHOOKWORM LIFE CYCLE

Immatureegg

Larvae enteredBlood stream

Filariform lpenetrate skin

arvae

Adult in intestine( jejunum )

Eggs infeces

Larvae exit fromCapillary and

entered Alveoli

Larvae enteredPulmonary

Infective larvae

Filariform larvae

Rhabditiform larvae Hatch in soil

Matureegg

Immatureegg

In human body

In Soil

Disease: Ancylostomiasis Disease: Ancylostomiasis Synonym: Uncinariasis, necatoriasisSynonym: Uncinariasis, necatoriasis infection by infection by A. duodenaleA. duodenale are more are more

serious than serious than N. americanusN. americanus Chronic infection rarely produce Chronic infection rarely produce

acute manifestationacute manifestation Tissue damage and symptoms are Tissue damage and symptoms are

caused by :caused by :– Larva stageLarva stage

– Adult wormAdult worm


HOOKWORMHOOKWORM

PATHOLOGY CAUSED BY LARVA STAGE

HOOKWORMHOOKWORM

Larva penetrates the skin - Larva penetrates the skin - maculopapules - erythema - heavy maculopapules - erythema - heavy itching : itching : ground itch/dew itchground itch/dew itch

In sensitive patient, larva carried in In sensitive patient, larva carried in the circulation, may cause:the circulation, may cause:– Bronchitis / PneumonitisBronchitis / Pneumonitis

PATHOLOGY CAUSED BY ADULT WORM

Hooked to the intestinal mucosal wall : Hooked to the intestinal mucosal wall : abdominal pain, nausea, diarrheaabdominal pain, nausea, diarrhea

Absorbing 0,2-0,3 ml of blood/day/worm : Absorbing 0,2-0,3 ml of blood/day/worm : progressive anemia, hypo chrome, progressive anemia, hypo chrome, microcytic type of Fe deficiency anemiamicrocytic type of Fe deficiency anemia

Heavy anemia (Hb may reach 2 gr %) :Heavy anemia (Hb may reach 2 gr %) :– Dyspnea, physical weakness, headacheDyspnea, physical weakness, headache– Rapid pulse beat, cardiac weaknessRapid pulse beat, cardiac weakness– Children : physical growth retardation, Children : physical growth retardation,

mentalmental

HOOKWORMHOOKWORM

(Anemia by HOOKWORM)

HOOKWORMHOOKWORM

Source : Color Atlas of Medicine and Parasitology. 1977 Peters W. & Gillers H.M.

Blood smear of patient with heavy infection caused by hookworm indicating Fe deficiency anemia with low MCHC and low serum Fe

concentration

PATHOLOGY CAUSED BY ADULT WORM

Atrophic glossitis found with hypo Atrophic glossitis found with hypo chromic microcytic anemia, chromic microcytic anemia, caused by heavy infection of caused by heavy infection of hookworm hookworm

Tongue surface become smooth Tongue surface become smooth and lacking of papillae and lacking of papillae

(Anemia by hookworm)

HOOKWORMHOOKWORMPATHOLOGY CAUSED BY ADULT WORM

Glositis atrofik pada Glositis atrofik pada anemi hipokrom anemi hipokrom mikrositer yang mikrositer yang disebabkan infection disebabkan infection berat HOOKWORM berat HOOKWORM

Tampak lidah halus Tampak lidah halus dan kurang papiladan kurang papila

source : Atlas Parasitologi Kedokteran, Zaman P. Alih Bahasa : Anwar C.; Mursal Y.

(Anemia by hookworm)

HOOKWORMHOOKWORMPATHOLOGY CAUSED BY ADULT WORM

Patient with atrophic glossitis Patient with atrophic glossitis also show fingernail also show fingernail deformity (koilonichia) deformity (koilonichia)

Fingernail becomes thin and Fingernail becomes thin and concave with elevated ridgeconcave with elevated ridge

DiagnosisDiagnosis Identify eggs from feces sample Identify eggs from feces sample Identify larva from :Identify larva from :

– Fecal cultureFecal culture

– Old feces sample Old feces sample

DiagnosisDiagnosis Identify eggs from feces sample Identify eggs from feces sample Identify larva from :Identify larva from :

– Fecal cultureFecal culture

– Old feces sample Old feces sample

HOOKWORMHOOKWORM

ANTIHELMINTHICS Tetrachlorethylen Mebendazole Albendazole Pyrantel pamoate Bitoskanate Bephenium hidroxynaphtoate

ANTIHELMINTHICS Tetrachlorethylen Mebendazole Albendazole Pyrantel pamoate Bitoskanate Bephenium hidroxynaphtoate

PREVENTIONPREVENTION Same as with Ascariasis but Same as with Ascariasis but

with the addition of : with the addition of : wearing shoes during work wearing shoes during work in plantation or mine areain plantation or mine area

PREVENTIONPREVENTION Same as with Ascariasis but Same as with Ascariasis but

with the addition of : with the addition of : wearing shoes during work wearing shoes during work in plantation or mine areain plantation or mine area

HOOKWORMHOOKWORM

Infection byInfection byStrongyloides stercoralisStrongyloides stercoralis

HOST, HABITAT AND DISTRIBUTIONHOST, HABITAT AND DISTRIBUTION

Man is the definitive HostMan is the definitive Host Habitat of female worm, Habitat of female worm,

mucosal lining of :mucosal lining of : DuodenumDuodenum Jejunum (proximal end)Jejunum (proximal end)

Found very cosmopolitan, Found very cosmopolitan, especially in the tropical and especially in the tropical and subtropical regionsubtropical region

Strongyloides stercoralisStrongyloides stercoralisLIFE CYCLE

A

B

Larvae enteredBlood stream

Filariform lpenetrate skin

arvae

Adult in duodenum, especiallyProximal duodenum

Rhabditiform lin Feces

arvae

Rhabditiform lin soilarvaeFilariform l

Infective stagearvae

Rhabditiformlarvae

EggDevelopment

Free livingadult in soil

FREE LIVINGCYCLE

Larvae exit fromCapillary, entered

Alveoli

Larvae enterLung

Life cycle in human body

Life cycle in soil

Strongyloides stercoralisStrongyloides stercoralis

CLINICAL FEATURES DiseaseDisease : : Strongyloidiasis, Strongyloidiasis,

Strongyloidosis, Cochin China Strongyloidosis, Cochin China diarrhea diarrhea

Level of infection Level of infection :: Mild - asymptomaticMild - asymptomatic ModerateModerate Heavy and chronicHeavy and chronic

In moderate infection In moderate infection Female worm embedded in the Female worm embedded in the

mucosal wall of duodenummucosal wall of duodenum Burning sensation and stinging Burning sensation and stinging

pain in the epigastriumpain in the epigastrium Nausea, vomiting, diarrhea and Nausea, vomiting, diarrhea and

constipation constipation

In heavy and chronic infection In heavy and chronic infection Loss of body weight; Anemia Loss of body weight; Anemia Dysentery (chronic); Slight feverDysentery (chronic); Slight fever May be accompanied by secondary May be accompanied by secondary

bacterial infection where worm inhabits bacterial infection where worm inhabits the entire intestinal epithelium up to the the entire intestinal epithelium up to the distal colon)distal colon)


Diagnosis

Find and identify Find and identify Rhabditiform larva :Rhabditiform larva :

– From fresh fecesFrom fresh feces– Gastric (duodenal) juiceGastric (duodenal) juice*Eggs :*Eggs :– In heavy diarrheaIn heavy diarrhea– After administration of After administration of

laxativelaxative

TREATMENT AND PREVENTION


Drugs given Drugs given ThiabendazoleThiabendazole MebendazoleMebendazole Pyrvinium pamoatePyrvinium pamoate

PREVENTIONPREVENTION Similar to the prevention of hookwormSimilar to the prevention of hookworm Autoinfection is prevented by means of :Autoinfection is prevented by means of :

– Avoid constipationAvoid constipation

– Anal hygiene Anal hygiene

NON-SOIL TRANSMITTED HELMINTHSNON-SOIL TRANSMITTED HELMINTHS

= Members of intestinal nematode that have = Members of intestinal nematode that have transmissions are not via soil.transmissions are not via soil.

= It happens because egg or larva of non-soil = It happens because egg or larva of non-soil transmitted helminths don’t do maturation transmitted helminths don’t do maturation process (to become infectious) in the soil. process (to become infectious) in the soil.

NON-SOIL TRANSMITTED NON-SOIL TRANSMITTED HELMINTHSHELMINTHS

1. 1. Enterobius vermicularisEnterobius vermicularis

2. 2. Trichinella spiralisTrichinella spiralis

Enterobius vermicularisEnterobius vermicularis

A. A. MORPHOLOGY MORPHOLOGY > > Enterobius vermicularisEnterobius vermicularis = = Oxyuris vermicularisOxyuris vermicularis = = pinworm.pinworm.> In its life, this worm (ovipar) develops from: > In its life, this worm (ovipar) develops from:

egg larva worm.egg larva worm.> Its egg is oval, assymetry, that contains embrio.> Its egg is oval, assymetry, that contains embrio.> This worm has lateral ala cephalic in anterior tip.> This worm has lateral ala cephalic in anterior tip.> One female worm can produce 11.000 eggs in one > One female worm can produce 11.000 eggs in one day.day.> The female worm will die after producing eggs.> The female worm will die after producing eggs.> The male worm will die after copulation.> The male worm will die after copulation.

B.B. LIFE CYCLE of LIFE CYCLE of Enterobius vermicularisEnterobius vermicularis

Female & male worms do copulation in cecum & around Female & male worms do copulation in cecum & around (appendix, ascending colon & ileum)(appendix, ascending colon & ileum)

Pregnant female worms migrate at night & produce eggs in anus Pregnant female worms migrate at night & produce eggs in anus & around (anal area)& around (anal area)

After several hours, eggs become mature & infectious, then come to After several hours, eggs become mature & infectious, then come to host, via:host, via:

air (person inhalates)air (person inhalates) food (person eats food food (person eats food with with infectious hand after infectious hand after scartching anal area) scartching anal area)

Eggs crack in duodenum & larvas appearEggs crack in duodenum & larvas appear

Larvas become mature (be worm) in ileumLarvas become mature (be worm) in ileum


C.C. SPREADINGSPREADING> Cosmopolite (spread around the world), especially in > Cosmopolite (spread around the world), especially in

children.children.

D.D. PATHOLOGY & CLINICPATHOLOGY & CLINIC> The worm causes disease, called enterobiasis.> The worm causes disease, called enterobiasis.> This disease has clinical symptoms:> This disease has clinical symptoms:

- Ithcing in anal area (pruritus ani) at night.- Ithcing in anal area (pruritus ani) at night.- In girl, this disease can make inflammation in - In girl, this disease can make inflammation in

fallopian fallopian tube (salpingitis). tube (salpingitis).- Intestine is seldom disturbed, etc.- Intestine is seldom disturbed, etc.


E.E. DIAGNOSISDIAGNOSIS

> Scotch adhesive tape swab method, is done before > Scotch adhesive tape swab method, is done before taking a taking a bath or defecating.bath or defecating.

F.F. TREATMENTTREATMENT

> Mebendazole, thiabendazole, etc.> Mebendazole, thiabendazole, etc.

G.G. PREVENTIONPREVENTION

> Washing hand before eating> Washing hand before eating

> Cutting long fingernail, etc.> Cutting long fingernail, etc.

Trichinella spiralisTrichinella spiralis

A.A. MORPHOLOGYMORPHOLOGY

> > Trichinella spiralisTrichinella spiralis = porkworm. = porkworm.

> In its life, this worn (vivipar) develops from larva > In its life, this worn (vivipar) develops from larva worm.worm.

> Its larva can become cyst (circular larva which is > Its larva can become cyst (circular larva which is covered by covered by hyaline capsule).hyaline capsule).

> This worm has stylet mouth to invade intestine or > This worm has stylet mouth to invade intestine or muscle muscle tissue.tissue.

> One female worm can produce about 1.350-2.000 > One female worm can produce about 1.350-2.000 larvas.larvas.

> The male worm will die after copulation. > The male worm will die after copulation.

B. LIFE CYCLE of B. LIFE CYCLE of Trichinella spiralisTrichinella spiralis Female & male worms do copulation in Female & male worms do copulation in mouse/pig/personmouse/pig/person duodenum to duodenum to

cecumcecum

Pregnant female worms enter to intestinal villi and then lymphatic sinusPregnant female worms enter to intestinal villi and then lymphatic sinus

Pregnant female worms bear larvas in lymphatic sinusPregnant female worms bear larvas in lymphatic sinus

Larva is brought by lymphatic flow, to thorachic duct, right heart, lung, left Larva is brought by lymphatic flow, to thorachic duct, right heart, lung, left heart, and then to around bodyheart, and then to around body

Host (Host (person/pig/etcperson/pig/etc) can die) can dieLarva enter to Larva enter to mouse/pig/personmouse/pig/person muscle tissue & make cysts (larva can live muscle tissue & make cysts (larva can live

until 30 years in muscle)until 30 years in muscle)

Health personHealth person eats meat ( eats meat (pigpig muscle) before cooked perfectly muscle) before cooked perfectly

Cyst wall rupture & larva release & larva become mature (be worm) in Cyst wall rupture & larva release & larva become mature (be worm) in health personhealth person duodenum duodenum

The worm can also pass placenta The worm can also pass placenta && mammary mammary

Trichinella spiralisTrichinella spiralis

C.C. SPREADINGSPREADING> Cosmopolite (spread around the world).> Cosmopolite (spread around the world).

D.D. PATHOLOGY & CLINICPATHOLOGY & CLINIC> The worm causes disease, called trichinosis.> The worm causes disease, called trichinosis.> There are 3 clinical stadium:> There are 3 clinical stadium:

- Intestinal invasion that is done by worm (1-2 - Intestinal invasion that is done by worm (1-2 days after days after eating infectious muscle). eating infectious muscle).

- Larva migration (7-28 days after eating infectious - Larva migration (7-28 days after eating infectious muscle). muscle). It results cerebral disturbing, cardiac It results cerebral disturbing, cardiac distrubing, fever, even distrubing, fever, even diedie..

-Forming cyst & healing process (90 days after -Forming cyst & healing process (90 days after eating eating infectious muscle). infectious muscle).

THERE ARE THREE GROUPSTHERE ARE THREE GROUPS : :— Filaria dan DracunculusFilaria dan Dracunculus— Larva Migrans Larva Migrans (TROPICAL MEDICINE)(TROPICAL MEDICINE)— Rarely found nematode Rarely found nematode (LESS (LESS

IMPORTANT !)IMPORTANT !)

THERE ARE THREE GROUPSTHERE ARE THREE GROUPS : :— Filaria dan DracunculusFilaria dan Dracunculus— Larva Migrans Larva Migrans (TROPICAL MEDICINE)(TROPICAL MEDICINE)— Rarely found nematode Rarely found nematode (LESS (LESS

IMPORTANT !)IMPORTANT !)

BLOOD AND TISSUE BLOOD AND TISSUE NEMATODENEMATODE

FILARIAFILARIALIFE CYCLELIFE CYCLELIFE CYCLELIFE CYCLE

Insect as a vector : Insect as a vector : Anopheles, Aedes, Anopheles, Aedes, Mansoni, Culex Mansoni, Culex juga juga Simulium, Chrysops Simulium, Chrysops atau atau CulicoidesCulicoides

Habitat : blood, lymph, muscle, conective Habitat : blood, lymph, muscle, conective tissue, serous cavity tissue, serous cavity

Insect as a vector : Insect as a vector : Anopheles, Aedes, Anopheles, Aedes, Mansoni, Culex Mansoni, Culex juga juga Simulium, Chrysops Simulium, Chrysops atau atau CulicoidesCulicoides

Habitat : blood, lymph, muscle, conective Habitat : blood, lymph, muscle, conective tissue, serous cavity tissue, serous cavity

Wuchereria bancrofti

Brugia malayi

Brugia timori

BLOOD AND TISSUES NEMATODEBLOOD AND TISSUES NEMATODEFilaria – caused FilariasisFilaria – caused Filariasis

TOPICS(As problem of Public Health in Indonesia)

All species above – nocturnal periodicity

In the human body, found stages :In the human body, found stages :– Adult filaria – lymph node and vessel, difficult to find – Adult filaria – lymph node and vessel, difficult to find – not importantnot important– Microfilariae – pralarvae stage – in the peripheral blood – Microfilariae – pralarvae stage – in the peripheral blood – important for diagnostic important for diagnostic

Microfilariae, must be attention about :Microfilariae, must be attention about :– Morphology for identified species of filariaMorphology for identified species of filaria– Periodicity for chose right time for take bloodPeriodicity for chose right time for take blood

Periodicity – when microfilariae found in most number :Periodicity – when microfilariae found in most number :

– Nocturnal Periodicity – only in the nightNocturnal Periodicity – only in the night

– Subperiodic nocturnal – in the night more number than in the daytimeSubperiodic nocturnal – in the night more number than in the daytime

– Diurnal Periodicity – only in the daytimeDiurnal Periodicity – only in the daytime

– Subperiodic diurnal – in the daytime more number than in the nightSubperiodic diurnal – in the daytime more number than in the night

– Nonperiodic – same number in the daytime and in the nightNonperiodic – same number in the daytime and in the night

LIFE CYCLE OF FILARIALIFE CYCLE OF FILARIA

MORPHOLOGY OF MICROFILARIAEMORPHOLOGY OF MICROFILARIAE

Appearance graceful or stiff Appearance graceful or stiff Sheathed, its clear in part of the head or the tail (the three of Sheathed, its clear in part of the head or the tail (the three of

them are sheathed)them are sheathed) ““Nuclei” in the body : spread in average or in groups, show in Nuclei” in the body : spread in average or in groups, show in

the part of :the part of : Head – without nuclei, named cephalic space, compare its length Head – without nuclei, named cephalic space, compare its length

with its widewith its wide Tail, contain the nuclei or notTail, contain the nuclei or not

PRIMARY CAUSEPRIMARY CAUSE

Wuchereria bancroftiWuchereria bancrofti Brugia malayiBrugia malayi Brugia timoriBrugia timori

Life Cycle of Life Cycle of B. malayiB. malayi

Microfilariae

Infective larva (L3)

HUMAN BODY

MOSQUITO BODY

Adult worm

Larva L2

Larva L1

LYMPHATIC FILARIASIS LIFE CYCLE

Mansonia, Anopheles, Culex, Aedes

MAIN MOSQUITO VECTORSMAIN MOSQUITO VECTORS W. bancroftiW. bancrofti AnophelesAnopheles sp sp

B. malayiB. malayi MansoniaMansonia sp sp

B. timoriB. timori An. barbirostrisAn. barbirostris

Wuchereria bancroftiWuchereria bancrofti

HABITATHABITATVessel and lymph node Vessel and lymph node

(bellow the diaphragm) (bellow the diaphragm) Can live 10-18 yearsCan live 10-18 yearsMicrofilaria in blood, Microfilaria in blood,

penetrate placentapenetrate placenta3 times metamorfosa3 times metamorfosa

HABITATHABITATVessel and lymph node Vessel and lymph node

(bellow the diaphragm) (bellow the diaphragm) Can live 10-18 yearsCan live 10-18 yearsMicrofilaria in blood, Microfilaria in blood,

penetrate placentapenetrate placenta3 times metamorfosa3 times metamorfosa

Habitat and DistributionHabitat and DistributionHabitat and DistributionHabitat and Distribution

DISTRIBUTION :DISTRIBUTION : Urban bancroftian filariasis, vektor Urban bancroftian filariasis, vektor

Culex fatigansCulex fatigans Rural bancroftian filariasis, vektor Rural bancroftian filariasis, vektor

Aedes, AnophelesAedes, Anopheles dan dan MansoniMansoni

DISTRIBUTION :DISTRIBUTION : Urban bancroftian filariasis, vektor Urban bancroftian filariasis, vektor

Culex fatigansCulex fatigans Rural bancroftian filariasis, vektor Rural bancroftian filariasis, vektor

Aedes, AnophelesAedes, Anopheles dan dan MansoniMansoni

PeriodicityPeriodicityPeriodicityPeriodicity

PERIODICITY (WHO, 1967)PERIODICITY (WHO, 1967) Commonly nocturna, also in IndonesiaCommonly nocturna, also in Indonesia In Polynesia, subperiodic diurna, vector In Polynesia, subperiodic diurna, vector

Aedes polynisiensisAedes polynisiensis

PERIODICITY (WHO, 1967)PERIODICITY (WHO, 1967) Commonly nocturna, also in IndonesiaCommonly nocturna, also in Indonesia In Polynesia, subperiodic diurna, vector In Polynesia, subperiodic diurna, vector

Aedes polynisiensisAedes polynisiensis

Wuchereria bancroftiWuchereria bancrofti

ClinicalClinicalClinicalClinicalWuchereria bancroftiWuchereria bancrofti

DIVIDED IN :DIVIDED IN : Biologic incubation Biologic incubation

periodeperiode Asymptomatic periode Asymptomatic periode Acute stageAcute stage Chronic stageChronic stage

DIVIDED IN :DIVIDED IN : Biologic incubation Biologic incubation

periodeperiode Asymptomatic periode Asymptomatic periode Acute stageAcute stage Chronic stageChronic stage

Biologic incubation periode - Biologic incubation periode - asymptomatic, amicrofilaremiasymptomatic, amicrofilaremilarva - microfilaremi (± 1 yearlarva - microfilaremi (± 1 year))

Biologic incubation periode - Biologic incubation periode - asymptomatic, amicrofilaremiasymptomatic, amicrofilaremilarva - microfilaremi (± 1 yearlarva - microfilaremi (± 1 year))

Asymptomatic Periode - Asymptomatic Periode - asymptomatic, microfilaremiasymptomatic, microfilaremi

symptom (-), microfilaria (+), symptom (-), microfilaria (+), especially in endemic areaespecially in endemic area

Asymptomatic Periode - Asymptomatic Periode - asymptomatic, microfilaremiasymptomatic, microfilaremi

symptom (-), microfilaria (+), symptom (-), microfilaria (+), especially in endemic areaespecially in endemic area

Acute stage - symptomatic, microfilaremi Acute stage - symptomatic, microfilaremi Acute alergic filarial lymphangitisAcute alergic filarial lymphangitis

– Lymphangitis, limphadenitis (±)Lymphangitis, limphadenitis (±)– Filaria fever, alergic symptom (±)Filaria fever, alergic symptom (±)

Acute stage - symptomatic, microfilaremi Acute stage - symptomatic, microfilaremi Acute alergic filarial lymphangitisAcute alergic filarial lymphangitis

– Lymphangitis, limphadenitis (±)Lymphangitis, limphadenitis (±)– Filaria fever, alergic symptom (±)Filaria fever, alergic symptom (±)

Chronic stage Chronic stage - symptomatic, microfilaremi- symptomatic, microfilaremi — Elephantoid tissue formation at lower extremity Elephantoid tissue formation at lower extremity

and scrotum and scrotum — Adult worm die : microfilaria reduceAdult worm die : microfilaria reduce

Chronic stage Chronic stage - symptomatic, microfilaremi- symptomatic, microfilaremi — Elephantoid tissue formation at lower extremity Elephantoid tissue formation at lower extremity

and scrotum and scrotum — Adult worm die : microfilaria reduceAdult worm die : microfilaria reduce

ClinicalClinicalClinicalClinicalWuchereria bancroftiWuchereria bancrofti

PERIODICITYPERIODICITY

Nocturnal PeriodicityNocturnal Periodicity Sub periodic nocturnalSub periodic nocturnal Diurnal PeriodicityDiurnal Periodicity Sub periodic diurnalSub periodic diurnal Non periodicNon periodic

All 3 species have nocturnal periodicity

Clinical manifestationClinical manifestation

Acute filariasisAcute filariasis Chronic filariasisChronic filariasis Atypical presentationAtypical presentation Asymptomatic carrierAsymptomatic carrier

Chronic manifestations: Chronic manifestations: PathologyPathology

Reticular cells hyperplasia

Thrombosis & inflammatory reaction

Granulomatous reaction with giant cells, histocytes, epitheloid cells

Healing with re-canalization

Adult worm

Dying worms

Intense inflammatory reaction with granuloma formation

Healing with fibrosis

Loss of architecture & complete obliteration

Transient oedema

Elephantiasis & other chronic manifestations

Secondary bacterial infection

Dilatation of lymph vessel

Dysfunctional valve

Retrograde lymph flow

Worm factors?

Host response

Lymphatic vessel dilatation, valve Lymphatic vessel dilatation, valve incompetency, lymphatic back flow, incompetency, lymphatic back flow,

pooling & oedemapooling & oedema

� Definitive host : human, monkey, dog, Definitive host : human, monkey, dog, catcat

� In vector 6-8,5 days, 2 times metamorfIn vector 6-8,5 days, 2 times metamorf

� Definitive host : human, monkey, dog, Definitive host : human, monkey, dog, catcat

� In vector 6-8,5 days, 2 times metamorfIn vector 6-8,5 days, 2 times metamorf

LIFE CYCLE AND PERIODICITYLIFE CYCLE AND PERIODICITYLIFE CYCLE AND PERIODICITYLIFE CYCLE AND PERIODICITY

Brugia malayiBrugia malayi

Nocturna, vector Nocturna, vector Anopheles barbirostrisAnopheles barbirostris (farm)(farm)

Subperiodic nocturna, vector Subperiodic nocturna, vector Mansonia Mansonia uniformis, M. indianauniformis, M. indiana (swamp) (swamp)

Nocturna, vector Nocturna, vector Anopheles barbirostrisAnopheles barbirostris (farm)(farm)

Subperiodic nocturna, vector Subperiodic nocturna, vector Mansonia Mansonia uniformis, M. indianauniformis, M. indiana (swamp) (swamp)

CLINICAL, THERAPY AND PREVENTIONCLINICAL, THERAPY AND PREVENTIONCLINICAL, THERAPY AND PREVENTIONCLINICAL, THERAPY AND PREVENTION

CLINICAL:CLINICAL: Main symptom : fever, limphangytis, Main symptom : fever, limphangytis,

limphadenitislimphadenitis Elephantiasis : lower extremity bellow knee, Elephantiasis : lower extremity bellow knee,

elbow,inguinal, rarely scrotumelbow,inguinal, rarely scrotum

CLINICAL:CLINICAL: Main symptom : fever, limphangytis, Main symptom : fever, limphangytis,

limphadenitislimphadenitis Elephantiasis : lower extremity bellow knee, Elephantiasis : lower extremity bellow knee,

elbow,inguinal, rarely scrotumelbow,inguinal, rarely scrotum

Brugia malayiBrugia malayi

THERAPY :THERAPY : Hetrazan, po 0,1 gr, 3-4 x/day, as long as 10 daysHetrazan, po 0,1 gr, 3-4 x/day, as long as 10 days

PREVENTION :PREVENTION : Pentachlorophenol (dowicide G), kill water plant Pentachlorophenol (dowicide G), kill water plant

Pistia stratioides, Eichornia, SalviniaPistia stratioides, Eichornia, Salvinia

THERAPY :THERAPY : Hetrazan, po 0,1 gr, 3-4 x/day, as long as 10 daysHetrazan, po 0,1 gr, 3-4 x/day, as long as 10 days

PREVENTION :PREVENTION : Pentachlorophenol (dowicide G), kill water plant Pentachlorophenol (dowicide G), kill water plant

Pistia stratioides, Eichornia, SalviniaPistia stratioides, Eichornia, Salvinia

ELEPHANTIASIS by ELEPHANTIASIS by B. malayiB. malayiELEPHANTIASIS by ELEPHANTIASIS by B. malayiB. malayi

Not involving external genitaliaNot involving external genitaliaCourtesy Prof. Radomyos P. Mahidol U.

Example from ThailandExample from Thailand

Example of filariasis from Malaysia

Filariasis Case at Pusat Pencegah Filariasis Case at Pusat Pencegah

Penyakit UntutPenyakit Untut – – Kepala BatasKepala Batas

Filariasis research - IMRFilariasis research - IMR

Blood TrematodaBlood Trematoda((Schistosoma sp.)Schistosoma sp.)

There are four species of schistosome There are four species of schistosome which are infective to humans:which are infective to humans:

Schistosoma mansoni, found in, found in Africa,, Brazil, , Venezuela, , Suriname ,, Puerto Rico, , and theand the Dominican Republic..

Freshwater snails of theFreshwater snails of the Biomphalaria genus are an important host for this genus are an important host for this trematode.trematode.

http://en.wikipedia.org/wiki/Schistosoma_mansoni

http://en.wikipedia.org/wiki/Africa

http://en.wikipedia.org/wiki/Brazil

http://en.wikipedia.org/wiki/Venezuela

http://en.wikipedia.org/wiki/Suriname

http://en.wikipedia.org/wiki/Puerto_Rico

http://en.wikipedia.org/wiki/Dominican_Republic

http://en.wikipedia.org/wiki/Biomphalaria

S. japonicum whose common name is whose common name is simply simply blood flukeblood fluke is found widely is found widely spread in spread in Eastern Asia and the and the southwestern southwestern Pacific region. In region. In Taiwan this species only affects animals, not this species only affects animals, not humans. Freshwater snails of the humans. Freshwater snails of the Oncomelania genus are an important host genus are an important host for for S. japonicumS. japonicum. .

http://en.wikipedia.org/wiki/S._japonicum

http://en.wikipedia.org/wiki/Eastern_Asia

http://en.wikipedia.org/wiki/Pacific

http://en.wikipedia.org/wiki/Taiwan

http://en.wikipedia.org/wiki/Oncomelania

S. mekongiS. mekongi is related to is related to S. japonicumS. japonicum and and affects both superior and inferior mesenteric affects both superior and inferior mesenteric veins. veins. S. mekongiS. mekongi differs in that it has differs in that it has smaller eggs, a different intermediate host, smaller eggs, a different intermediate host, and longer prepatent period in the and longer prepatent period in the mammalian host. mammalian host.

S. haematobiumS. haematobium, commonly referred to , commonly referred to as the as the bladder flukebladder fluke, originally found in , originally found in Africa, the Near East, and the Africa, the Near East, and the Mediterranean basin, was introduced into Mediterranean basin, was introduced into India during World War II. Freshwater India during World War II. Freshwater snails of the snails of the BulinusBulinus genus are an genus are an important host for this parasiteimportant host for this parasite

Schistosoma mansoniSchistosoma mansoni causes intestinal causes intestinal schistosomiasis schistosomiasis

Schistosoma haematobiumSchistosoma haematobium causes causes urinary schistosomiasis urinary schistosomiasis

Schistosoma japonicumSchistosoma japonicum and and Schistosoma mekongiSchistosoma mekongi cause Asian cause Asian intestinal schistosomiasis intestinal schistosomiasis

HABITATHABITAT

S. Haematobium S. Haematobium Venous vessel (Vv) Venous vessel (Vv) of urinary bladder, colon; Heparof urinary bladder, colon; Hepar

S. Japonicum S. Japonicum Vv. of intestine; Hepar Vv. of intestine; Hepar S. Mekongi S. Mekongi Vv. of intestine; Hepar Vv. of intestine; Hepar S. Mansoni S. Mansoni Vv. of Colon, Rectum; Vv. of Colon, Rectum;

HeparHepar

EPIDEMIOLOGYEPIDEMIOLOGY

Disease of schistomiasis or bilharzasis in Disease of schistomiasis or bilharzasis in Indonesia only schistomiasis japonica found Indonesia only schistomiasis japonica found

in middle sulawesi, relate to agriculture in middle sulawesi, relate to agriculture getting water from irrigation.getting water from irrigation.

Group of age hit by between 5-50 year.Group of age hit by between 5-50 year.

Mass treatment every 6 month.Mass treatment every 6 month.

The The S. japonicumS. japonicum worms are yellow or worms are yellow or yellow-brown. The males of this species yellow-brown. The males of this species are slightly larger than the other are slightly larger than the other Schistosomes and they measure ~ 1.2cm Schistosomes and they measure ~ 1.2cm by 0.5 mm. The females measure 2cm by by 0.5 mm. The females measure 2cm by 0.4 mm. The adult worms are longer and 0.4 mm. The adult worms are longer and narrower than the related narrower than the related S. mansoniS. mansoni worms.worms.

S. japonicumS. japonicum

S. japonicumS. japonicum

This Parasite at human being cause This Parasite at human being cause oriental of schistosomiasisoriental of schistosomiasis, , schistosomiasis japonica, katayama schistosomiasis japonica, katayama fever or Snail Fever diseasefever or Snail Fever disease

Katayama FeverKatayama Fever Acute schistosomiasis (Katayama's fever) may Acute schistosomiasis (Katayama's fever) may

occur weeks after the initial infection, occur weeks after the initial infection, especially by especially by S. mansoniS. mansoni and and S. japonicumS. japonicum. . Manifestations include: Manifestations include:

Abdominal pain Abdominal pain Cough Cough Diarrhea Diarrhea Eosinophilia Eosinophilia Fever Fever Fatigue Fatigue Hepatosplenomegaly Hepatosplenomegaly

Faeces with egg of s. JAponicum have contact with waterFaeces with egg of s. JAponicum have contact with water

Those egg will hatch and release free-swimming larva called MiracidiaThose egg will hatch and release free-swimming larva called Miracidia

Miracidia will infect Miracidia will infect Oncomelaria hupensisOncomelaria hupensis by penetrating their skin by penetrating their skin

Inside the snail they will undergo asexual reproduction, and will become Inside the snail they will undergo asexual reproduction, and will become sporocystssporocysts

Further reproduction will produce large number of Cercaria, which is free-Further reproduction will produce large number of Cercaria, which is free-swimming larvaswimming larva

Cercaria can infect us by penetrating our skinCercaria can infect us by penetrating our skin

After penetration, they will loose their tail and become SchistosomuleAfter penetration, they will loose their tail and become Schistosomule

Enter circulation, and end at the mesenteric veinsEnter circulation, and end at the mesenteric veins

There, they will undergo sexual reproduction and produce eggThere, they will undergo sexual reproduction and produce egg

Egg will penetrate the tissue and are passed with the faecesEgg will penetrate the tissue and are passed with the faeces

S. mansoniS. mansoni

The male The male S. mansoniS. mansoni is is approximately 1 cm long (0.6 approximately 1 cm long (0.6 to 1.4 cm) and is 0.11 cm to 1.4 cm) and is 0.11 cm wide. It is white and it has a wide. It is white and it has a funnel-shaped oral sucker at funnel-shaped oral sucker at its anterior endits anterior end

The female has a cilindric The female has a cilindric body, longer and thinner than body, longer and thinner than the male (1.2 to 1.6 cm long the male (1.2 to 1.6 cm long by 0.016 cm wide). The female by 0.016 cm wide). The female parasite is darker and it looks parasite is darker and it looks gray. The darker color is due gray. The darker color is due to the presence of a pigment to the presence of a pigment (hemozoin) in its digestive (hemozoin) in its digestive tube tube

CLINICAL SYMPTOM AND PATHOLOGYCLINICAL SYMPTOM AND PATHOLOGY

Similar with Similar with S. japonicumS. japonicum, but it , but it is lighter is lighter

MORPHOLOGY AND LIFE CYCLEMORPHOLOGY AND LIFE CYCLE

Adult Worm of fairish male about 1,3 Adult Worm of fairish male about 1,3 cm and female about 2,0 cm. its life in cm and female about 2,0 cm. its life in small vena flank. Egg found in urine, small vena flank. Egg found in urine,

and rectum genitalsand rectum genitals

PathologyPathology

It can break the wall of the urinary bladder It can break the wall of the urinary bladder The most characteristic symptom is haematuria. The most characteristic symptom is haematuria. Dysuria also can occur.Dysuria also can occur. Inflammatory reaction to eggs in the bladder wall Inflammatory reaction to eggs in the bladder wall

and later fibrosis and calcification often leads to and later fibrosis and calcification often leads to mucosal hyperplasia and papilloma formationmucosal hyperplasia and papilloma formation

In Egypt vesical schistosomiasis has been In Egypt vesical schistosomiasis has been considered a common cause of malignancy of the considered a common cause of malignancy of the bladder in male agricultural workers bladder in male agricultural workers

Lab DiagnosisLab Diagnosis

Microscopic identification of eggs in stool or urine is Microscopic identification of eggs in stool or urine is the most practical method for diagnosis the most practical method for diagnosis

Stool examination should be performed when infection Stool examination should be performed when infection with with S. mansoniS. mansoni or or S. japonicumS. japonicum is suspected, and is suspected, and urine examination should be performed if urine examination should be performed if S. S. haematobiumhaematobium is suspected. Dark urine is a significant is suspected. Dark urine is a significant clinical sign of urinary schistosomiasis clinical sign of urinary schistosomiasis

Tissue biopsy (rectal biopsy for all species and biopsy Tissue biopsy (rectal biopsy for all species and biopsy of the bladder for of the bladder for S. haematobiumS. haematobium) may demonstrate ) may demonstrate eggs when stool or urine examinations are negative. eggs when stool or urine examinations are negative.

The eggs of The eggs of S. haematobiumS. haematobium are ellipsoidal with a are ellipsoidal with a terminal spine, terminal spine, S. mansoniS. mansoni eggs are also ellipsoidal eggs are also ellipsoidal but with a lateral spine, but with a lateral spine, S. japonicumS. japonicum eggs are eggs are spheroidal with a small knob.spheroidal with a small knob.

TreatmentTreatment

Schistosomiasis is readily treated using Schistosomiasis is readily treated using a single oral dose of the drug a single oral dose of the drug Praziquantel Praziquantel

PreventionPrevention

The main focus of prevention is eliminating the The main focus of prevention is eliminating the water-borne snails which are natural reservoirs for water-borne snails which are natural reservoirs for the disease. This is usually done by identifying the disease. This is usually done by identifying bodies of water, such as lakes, ponds, etc., which bodies of water, such as lakes, ponds, etc., which are infested, forbidding or warning against are infested, forbidding or warning against swimming and adding niclosamide, acrolein, swimming and adding niclosamide, acrolein, copper sulfate, etc., to the water in order to kill the copper sulfate, etc., to the water in order to kill the snails. snails.

Individuals can guard against schistosomiasis Individuals can guard against schistosomiasis infection by avoiding bodies of water known or infection by avoiding bodies of water known or likely to harbor the carrier snails likely to harbor the carrier snails

Liver TrematodesLiver Trematodes

Clonorchis sinensisClonorchis sinensis Dicrocoelium dendriticumDicrocoelium dendriticum Opistorchis felineusOpistorchis felineus Opistorchis viveriniOpistorchis viverini Fasciola hepaticaFasciola hepatica

Clonorchis sinensisClonorchis sinensis

EpidemiologiEpidemiologiyy

- China, Japan, Korea, Taiwan, Vietnam- China, Japan, Korea, Taiwan, Vietnam

HabitatHabitat

- Biliary tract, pancreatic tract- Biliary tract, pancreatic tract

HostHost

- definitive : human, cat, dog- definitive : human, cat, dog

- vector 1 :- vector 1 :

Water snail genus of Water snail genus of Bulimus, Thiara, Bulimus, Thiara, or or species species Melanoides tuberculatusMelanoides tuberculatus

MorphologyMorphology- Elongated, flat, - Elongated, flat,

transparent, bulging transparent, bulging on posterioron posterior

- Oval egg, thickened - Oval egg, thickened on posterior, found on posterior, found within faeceswithin faeces

- Vector 2 :- Vector 2 :

Fish family of Fish family of Cyprinidae, Salmonidae, Cyprinidae, Salmonidae, Gobiidae, Gobiidae, AnabantidaeAnabantidae

LIFE CYCLELIFE CYCLE

Eggs withinEggs within

faecesfaeces

MirasidiumMirasidium

(cilliated (cilliated larvae)larvae)

Swallowed by vector1Swallowed by vector1

(water snail)(water snail)

SporocystSporocyst

RediaRedia

CercariaCercaria

MetacercariaMetacercaria

Crossing fish Crossing fish (vector2) skin (vector2) skin

forming forming metascercaria metascercaria

(cyst) in fish (cyst) in fish skin/muscleskin/muscle

Swallowed bySwallowed by

definitive hostdefinitive host

Grow mature inGrow mature in

biliary tractbiliary tract

Mating Mating Eggs Eggs

DiagnosisDiagnosis

- Eggs within faecesEggs within faeces

- Immunology diagnosisImmunology diagnosis


- - Avoid eating raw fish Avoid eating raw fish must be completely must be completely cookedcooked

Dicrocoelium dendriticumDicrocoelium dendriticumEpidemiologyEpidemiology- Cosmopolite for lamb & other herbivores in Asia, - Cosmopolite for lamb & other herbivores in Asia,

Africa, Europe & AmericaAfrica, Europe & America

MorphologyMorphology- Mature form: flat, slender- Mature form: flat, slender

- Eggs: dark brown, thick wall, contain completely-- Eggs: dark brown, thick wall, contain completely-grown mirasidiumgrown mirasidium

HostHost- Definitive: lambDefinitive: lamb- Vector 1: snail genus of Vector 1: snail genus of Abida, ZebrinaAbida, Zebrina- Vector 2: ant, species Vector 2: ant, species Formica fuscaFormica fusca

Life CycleLife Cycle : comparable to : comparable to C. sinensisC. sinensis

Fasciola hepaticaFasciola hepatica

EpidemiologyEpidemiology Is the first Is the first

trematode foundtrematode found Causes fasciolatic Causes fasciolatic

hepatichepatic Is cosmopolite Is cosmopolite

mainly in country mainly in country with large farm with large farm (mostly sheep), (mostly sheep), infection in human infection in human often happens in often happens in Cuba, France, Cuba, France, England, and England, and Aljazair.Aljazair.

Habitat and hostHabitat and host

Habitat is mainly in billiary duct, may Habitat is mainly in billiary duct, may penetrate hepatic tissue causing abses.penetrate hepatic tissue causing abses.

Definitive hosts are human, sheep and Definitive hosts are human, sheep and other cattle.other cattle.

Intermediate host I is family Lymnaeidae, Intermediate host I is family Lymnaeidae, especially genus especially genus LymnaeaLymnaea..

Intermediate host II is water plants Intermediate host II is water plants especially especially Nasturtium officinaleNasturtium officinale..

MorphologyMorphology

Big size, 30 x 13 mmBig size, 30 x 13 mm Integuments is scalyInteguments is scaly Posterior end without thornPosterior end without thorn Unique shape, like shoulder because it Unique shape, like shoulder because it

has kerucut kepalahas kerucut kepala Batil isap kepala (1 mm) and stomach Batil isap kepala (1 mm) and stomach

are almost same in size and adjacentare almost same in size and adjacent

Caecum is hyper branching until posterior Caecum is hyper branching until posterior endend

Hyper branching testis is lied between 2/4 Hyper branching testis is lied between 2/4 – ¾ posterior body, one is behind the – ¾ posterior body, one is behind the otherother

Ovary branches, anterior to testis and Ovary branches, anterior to testis and smallersmaller

Uterus is short, curved, located between Uterus is short, curved, located between ootype and porus genital.ootype and porus genital.

Egg is 130-150 x 63-90 µ in size and has Egg is 130-150 x 63-90 µ in size and has operculum. Immature eggs are lied in operculum. Immature eggs are lied in billiary duct and exit with feces.billiary duct and exit with feces.

Life cycleLife cycle

Eggs mature in water and hatch after 9-15 days

at optimum temperature 22-250C

Miracidia enter intermediate host I and developto become sporocysts, rediae I,

rediae II in 3 weeks , and cercariae

Cercariae move towardIntermediate host II

At night, in 8 hours, become metacercariae

Metacercariae exit the cyst in duodenum

Penetrate intestinal wall,Enter peritoneal cavity

Penetrate Glisson’s capsule, hepatic tissue, then into billiary duct

in 12 weeks in adult

Metacercariae penetrate definitive hosts

Eggs are expelled within fecesHepatic tissues are infiltrated

with eggs, immature eggs are lied in billiary duct

Clinical SymptomClinical Symptom

Until metacercaria penetrate Glisson’s capsule, Until metacercaria penetrate Glisson’s capsule, these is no complain. But trauma and necrotic these is no complain. But trauma and necrotic lesion rise during migration through hepatic lesion rise during migration through hepatic tissues.tissues.

In heavy infection, epithelia is scraped and In heavy infection, epithelia is scraped and young worm will return to hepatic parenchyma, young worm will return to hepatic parenchyma, form abscess pouch, and hepatic tissues are form abscess pouch, and hepatic tissues are infiltrated with eggs.infiltrated with eggs.

When larvae migrates to peritoneal cavity, focus When larvae migrates to peritoneal cavity, focus ectopic may happen in blood vessel, lungs, ectopic may happen in blood vessel, lungs, subcutaneous tissue, brain ventricles, and eyes subcutaneous tissue, brain ventricles, and eyes where abscess will be formed.where abscess will be formed.

Symptoms : colic, ikterus obstructiva, cough and Symptoms : colic, ikterus obstructiva, cough and vomiting, abdomen rigidity, acute epigastria pain, vomiting, abdomen rigidity, acute epigastria pain, leukocytosist and eosinophily until above 60%leukocytosist and eosinophily until above 60%

DiagnosisDiagnosis

Eggs are found in feces, duodenal fluid, or Eggs are found in feces, duodenal fluid, or bile. Patient, who will be examined, do not bile. Patient, who will be examined, do not eat liver.eat liver.

Need early diagnosis to prevent fatal liver Need early diagnosis to prevent fatal liver damage.damage.

Serodiagnostic test is very helpful, although Serodiagnostic test is very helpful, although it is not an routine diagnostic tool.it is not an routine diagnostic tool.


Treating patient and cattle that act as Treating patient and cattle that act as reservoir.reservoir.

Incinerating water snails.Incinerating water snails. Cooking vegetables that will be eaten.Cooking vegetables that will be eaten.

Lung TrematodeLung Trematode

Paragonimus westermaniParagonimus westermani Disease : Paragonimiasis ,Disease : Paragonimiasis ,

Pulmonary distomiasisPulmonary distomiasis

Paragonimus westermaniParagonimus westermani

EpidemiologyEpidemiology– It is cosmopolite in It is cosmopolite in

human, mainly east human, mainly east in Japan, Philippine, in Japan, Philippine, Korea, China, Korea, China, Muangthai, Taiwan, Muangthai, Taiwan, Africa, etc.Africa, etc.

– In Indonesia, it is In Indonesia, it is autochthon infection autochthon infection in animal. In human, in animal. In human, as import case.as import case.

HostHost

Definitive hosts are human and mammalians Definitive hosts are human and mammalians such as dog and catsuch as dog and cat

Intermediate hosts I are Intermediate hosts I are Semisulcaspira Semisulcaspira libertina libertina (Japan), (Japan), Brotia asperata Brotia asperata (Philipina), (Philipina), B. costula episcpalis B. costula episcpalis (Malaysia), (Malaysia), Syncera sp.Syncera sp., , and and Melania.Melania.

Intermediate hosts II are freshwater crabs Intermediate hosts II are freshwater crabs genus genus PotamonPotamon,, Eriocheir Eriocheir, , Sesarma sp.,Sesarma sp., and and crayfish.crayfish.

Life cycleLife cycle

Sometimes, into ectopic place like mesentery, pleura or brain,

and reach adulthood here

In 3-6 hours, enter abdominal cavity and penetrate abdominal wall, stay for several days before penetrating diaphragm, to pleural cavity and enter bronchioles

In duodenum, encystations happens, penetrate intestinal wall (in 30-60 minutes)

In intermediate hosts II, cercariae become metacercariae

in 5 months

In intermediate hosts I,miracidia become Rediae I,

Rediae II, and finally cercariae

Hatch in water after maturation (2-3 weeks)

Then, they are coughed with sputum or swallowed and expelled with feces

From the pouch, eggs go out to bronchioles

Metacercariae penetrate definitive hosts

Clinical signs and pathologyClinical signs and pathology

Around parasite, leukocyte infiltration happens Around parasite, leukocyte infiltration happens and is followed by forming fibrosis capsule and and is followed by forming fibrosis capsule and form cyst containing 2 worms, purulent blood, form cyst containing 2 worms, purulent blood, and eggs.and eggs.

Lungs : (1) nonsuppurative, (2) tubercle-like, (3) Lungs : (1) nonsuppurative, (2) tubercle-like, (3) suppurative, (4) ulcerative.suppurative, (4) ulcerative.

First fever, shaking chills, dry cough, then First fever, shaking chills, dry cough, then hemaptoe with sticky and rush-colored sputum hemaptoe with sticky and rush-colored sputum mainly when wake up in the morning.mainly when wake up in the morning.

Physical examination reveals a Physical examination reveals a bronchopneumonia or bronchiectasi with bronchopneumonia or bronchiectasi with pleural effusion.pleural effusion.

DiagnosisDiagnosis

Finding eggs in sputum, aspiration Finding eggs in sputum, aspiration pleural fluid, and fecespleural fluid, and feces

Serology test with intradermal test, Serology test with intradermal test, complement fixation test.complement fixation test.

Treatment and PreventionTreatment and Prevention

TREATMENTTREATMENT

- Praziquantel- Praziquantel

PREVENTIONPREVENTION Treating patientsTreating patients Cooking crab before being eatenCooking crab before being eaten

CestodesCestodes are members of phylum are members of phylum PlatyhelminthesPlatyhelminthes, also known as tapeworms., also known as tapeworms.

General morphologyGeneral morphology Scolex : organ of attachment,usually Scolex : organ of attachment,usually

bearing suckers or hooksbearing suckers or hooks Neck : part which it growsNeck : part which it grows Strobilla : the boby, consist of proglotids Strobilla : the boby, consist of proglotids

(segments)(segments)

ProglotidsImmature :segment

that is attached to the neckMature : has a

reproductive structureGravid (pregnant):

filled with eggs. Tegument: covers adult cestode, allows materials to enter and waste to

be excreted from the body

Hermaphrodite, each proglotid has a male and female reproductive structure. Mature embryo has six hooks and also known as onchosphere.

• Is not yet found in Indonesia

• Resides in ileum of human, dogs, and cats

Morphology • Adult worm 3 – 10m, can be as long as

60m, with 3000-4000 proglotids.

• In the place of sucker or hooks, are two shallow sucking grooves called bothria.

• Operculated eggs

LIFE CYCLE

• Adult tapeworms resides in

ileum. Self fertilization will occur and eggs are produced

• Unembryonated eggs is release with feces.

• eggs will develop into onchosphere which contains a ciliated embryo.

• egg disintegrate releasing the ciliated embryo , coracidium, larva stage I.• Coracidium is eaten by copepod, and inside it will develop to larva

stage II called procercoid.

• If copepode is eaten by fish, procercoid will penetrate into fish’s muscle, and develop to larva stade III called plerocercoid/sparagnum.

• human will be infected by this larva. It will attach to mucous membrane of intestine and developes into adult tapeworms.

Pathogenesis Disease: diphyllobothriasisUsually asymptomatic, can cause abdominalpain, weight loss, diarrhea, vomiting,deficiency of vit B12.

DiagnosisEggs or proglotids found in feces.

TreatmentNiclosamide, praziquantel, bithionol, atabrin

PreventionAvoid ingestion of undercooked fish

• Also called porkworm and resides in jejenum of human.

• Larva is known as cycticercus celullosae 10 x 5 mm. usually inhabit the muscle.

Morphology• Adult worm is 2 – 4m• Has a rostellum with two rows of hooks

plus four suckers.• Genital pores located lateral to proglotids.• Eggs doesn’t have opperculum, but

contains onchosphere.

L i f e cycleL i f e cycle

Eggs are digested out in the stomach of the pig.Eggs are digested out in the stomach of the pig. Using its hook and lysis substrate, the Using its hook and lysis substrate, the

oncosphere will then penetrate intestinal wall oncosphere will then penetrate intestinal wall into blood stream and reside in muscle forming into blood stream and reside in muscle forming cysticercus celullose.cysticercus celullose.

Human will be infected by digestion of Human will be infected by digestion of undercooked pork.undercooked pork.

The larva will attach inside the small intestine, The larva will attach inside the small intestine, and develop into adult tapeworms that can and develop into adult tapeworms that can produce eggs. produce eggs.

These eggs will then pass through fecesThese eggs will then pass through feces

Pathogenesis • Disease: cysticercosis• Most cases are asymptomatic. Diarrhea, abdominal pain may occur. • If cysticercus migrate to brain, can cause

neurocysticercosis. Headaches, seizures, even death can occur.

Diagnosis Gravid proglotids or egg in feces, CT scan, MRI.

Treatment Praziquantel and niclosamide, also surgical removal.

• Also known as beef worm.

• Larva is called cysticercus bovis,

Morphology

• Adult beefworm is 5m,but can grow as far as 25m

.• Has four suckers,

but no hooks.

Hymenolepsis diminutaHymenolepsis diminuta

HabitatHabitat small intestinesmall intestine Definitive hostsDefinitive hosts

rats, also common in humansrats, also common in humans Intermediate hostsIntermediate hosts

grain beetle or fleagrain beetle or flea EpidemiologyEpidemiology

cosmopolite, found in Indonesiacosmopolite, found in Indonesia

MorphologyMorphology

Adult worms 10-60 mm long, 3-5 mm Adult worms 10-60 mm long, 3-5 mm wide, have 800-1000 proglotids.wide, have 800-1000 proglotids.

Rounded scolex bears a small rostellum Rounded scolex bears a small rostellum with four suckers, proglotid 0,8 mm long with four suckers, proglotid 0,8 mm long and 2,5 mm wide.and 2,5 mm wide.

Eggs without the polar filaments, sized 60-Eggs without the polar filaments, sized 60-8080μμm.m.


Adult worms in small intestine

Ingestion of arthropod host containing cysticeroid larvae

Tapeworm matures in small intestine

Ingestion by Arthropod host

Development of cysticeroid larvae

Infective embryonated egg in feces

(diagnostic stage)

Life cycle

TransmissionTransmission

Transmission or infection occurs by Transmission or infection occurs by ingestion of infected beetles or other ingestion of infected beetles or other arthropods, usually in grains and cerealsarthropods, usually in grains and cereals

PathogenesisPathogenesis

Symptoms, if any, are mild, and usually Symptoms, if any, are mild, and usually include diarrhea, nausea, and slight include diarrhea, nausea, and slight abdominal painabdominal pain

DiagnosisDiagnosis

Recovery of characteristic eggs in fecesRecovery of characteristic eggs in feces


TreatmentTreatment

Niclosamide, PraziquantelNiclosamide, Praziquantel PreventionPrevention

Limit exposure of grains and cereals to Limit exposure of grains and cereals to rats and insects.rats and insects.

HymenolepsisHymenolepsis diminutadiminuta

Dyphilidium caninumDyphilidium caninum SynonymSynonym

Double-pore dog tapewormDouble-pore dog tapeworm Definitive hostsDefinitive hosts

Cats and dogs,,, also found in humans’ Cats and dogs,,, also found in humans’ small intestine.small intestine.

Intermediate hostsIntermediate hostsDog/cat flea; Dog/cat flea; Ctenocephalides canis Ctenocephalides canis and and C.felis.C.felis.

MorphologyMorphologyAdult tapeworm is 10 to 50 cm in length. Several rows Adult tapeworm is 10 to 50 cm in length. Several rows of tiny hooklike spines are present on the cone-of tiny hooklike spines are present on the cone-shaped rostellum.shaped rostellum.The uterus in the gravid proglottid contains numerous The uterus in the gravid proglottid contains numerous packets of eggs, each packet containing 5 to 20 eggs.packets of eggs, each packet containing 5 to 20 eggs.Colorless eggs ~ 30-60Colorless eggs ~ 30-60μμm in diameter, with a six m in diameter, with a six hooked oncosphere present in each egg.hooked oncosphere present in each egg.The eggs are enclosed in membrane-bound packets.The eggs are enclosed in membrane-bound packets.

Dyphilidium caninumDyphilidium caninum

TransmissionTransmission

Infection after ingestion of cysticeroid larvae.Infection after ingestion of cysticeroid larvae. PathogenesisPathogenesis

Most of infected individuals are asymptomatic, Most of infected individuals are asymptomatic, although some with a heavy worm burden may although some with a heavy worm burden may experience mild gastrointestinal symptoms, experience mild gastrointestinal symptoms, such as nausea, diarrhea, indigestion, and such as nausea, diarrhea, indigestion, and slight abdominal pain.slight abdominal pain.


Tapeworm matures in small intestine

Ingestion of flea containing cysticeroid larvae

Scolex attaches to intestinal wall

Gravid proglottids or packets of eggs

Ingestion by dog/cat flea

Development of cysticercoid larvae in flea

External environment

Human host

Life cycle

DiagnosisDiagnosisRecovery of characteristic gravid proglottids and Recovery of characteristic gravid proglottids and egg packets (following rupture of proglottids) in egg packets (following rupture of proglottids) in human feces.human feces.

TreatmentTreatmentNiclosamide, Praziquantel.Niclosamide, Praziquantel.

PreventionPreventionGood veterinary care of cats and dogs, keeping Good veterinary care of cats and dogs, keeping animal freely from parasites.animal freely from parasites.Good personal hygiene.Good personal hygiene.


Hymenolopsis nanaHymenolopsis nana

Morphology: Morphology: smallest tapeworm, 25-40mm, found in mice and other smallest tapeworm, 25-40mm, found in mice and other

rodents, doesn’t need intermediate hostrodents, doesn’t need intermediate host the scolex bears a short rostellum with one row of hooks, the scolex bears a short rostellum with one row of hooks,

along with four suckersalong with four suckers proglottids 2 mm wide and 1mm longproglottids 2 mm wide and 1mm long Sac-like gravid uterus is usually full of eggsSac-like gravid uterus is usually full of eggs Egg: round to oval thin-shelled, 30-45 micrometer, contains Egg: round to oval thin-shelled, 30-45 micrometer, contains

an inner envelope with two polar thickenings, each having an inner envelope with two polar thickenings, each having four to eight filaments, which extend into the space within four to eight filaments, which extend into the space within the shellthe shell


Transmission: Infection is usually Transmission: Infection is usually transmitted by ingestion of infective eggs. transmitted by ingestion of infective eggs. Although most cases are asymptomatic, Although most cases are asymptomatic, mild gastrointestinal symptoms, such as mild gastrointestinal symptoms, such as diarrhea, abdominal pain, and weight may diarrhea, abdominal pain, and weight may occuroccur


Laboratory Diagnosis: Laboratory Diagnosis: recovery of recovery of characteristic eggs in characteristic eggs in human feces. Adult human feces. Adult worms and proglottids worms and proglottids are rarely seen in the are rarely seen in the stoolstool


Treatment and Prevention: Praziquantel is Treatment and Prevention: Praziquantel is the treatment of choice for infection with H. the treatment of choice for infection with H. nana. Niclosamide is also effective. Good nana. Niclosamide is also effective. Good sanitary practices are essential in the sanitary practices are essential in the prevention of infectionprevention of infection

Echinococcus granulosusEchinococcus granulosus

Morphology: hydatid tapeworm, 4 mm in Morphology: hydatid tapeworm, 4 mm in length, scolex bearing four suckers, length, scolex bearing four suckers, numerous hooks, and three proglottidsnumerous hooks, and three proglottids

Eggs: although not found, but it is identical Eggs: although not found, but it is identical to those of Taenia speciesto those of Taenia species


Transmission and PathogenesisTransmission and PathogenesisIngestion of eggs, usually by hand-to-mouth contact with Ingestion of eggs, usually by hand-to-mouth contact with infected dog feces. Symptoms vary, depending on the infected dog feces. Symptoms vary, depending on the location of the cyst in tissue. Although cysts may form in location of the cyst in tissue. Although cysts may form in many areas of the body, the lung and the liver are most many areas of the body, the lung and the liver are most commonly affected. Pulmonary symptoms, such as commonly affected. Pulmonary symptoms, such as cough and chest pain, may develop with lung infection. cough and chest pain, may develop with lung infection. One serious complication of hydatid cyst disease is the One serious complication of hydatid cyst disease is the risk of anaphylactic shock, following rupture of the cyst.risk of anaphylactic shock, following rupture of the cyst.


Laboratory Diagnosis:Laboratory Diagnosis:

The eggs are not found in human feces. The The eggs are not found in human feces. The diagnosis of hydatid cyst disease may be made by diagnosis of hydatid cyst disease may be made by radiographic and serologic studies. A combination radiographic and serologic studies. A combination of assays, including enzyme immunoassay and of assays, including enzyme immunoassay and immunoblot techniques, has been suggested ti immunoblot techniques, has been suggested ti diagnose hydatid cyst disease. The demonstration diagnose hydatid cyst disease. The demonstration of hydatid sand is also diagnostic.of hydatid sand is also diagnostic.


Treatment and preventionTreatment and preventionAlthough surgical removal of hydatid cyst Although surgical removal of hydatid cyst has long been considered the treatment has long been considered the treatment of choice, several antihelminthic agents of choice, several antihelminthic agents are now available. These include are now available. These include praziquantel and mebendazole. Infection praziquantel and mebendazole. Infection is also prevented by good personal is also prevented by good personal hygiene to prevent hand-to-mouth hygiene to prevent hand-to-mouth transmission of eggs from dogs to transmission of eggs from dogs to humans, avoidance of ingestion of sheep humans, avoidance of ingestion of sheep viscera by dogs, and antihelminthic viscera by dogs, and antihelminthic treatment of dogs, as necessarytreatment of dogs, as necessary

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