trematoda new
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TREMATODA
dr. Lieza Dwianasari S, M.kes
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TrematodaMenurut tempat hidupnya cacing dewasa dibagi :
1. Trematoda Hati(liver flukes)Clonorchis sinensis, Opisthorchis felineus, Opisthorchis viverrini & fasciola hepatica
2. Trematoda Usus(Intestinal flukes)Fasciolopsis buski, Echinostomatidae, Heterophyidae
3. Trematod Paru(lung flukes)Paragonimus westermani
4. Trematoda Darah(blood flukes)Schistosoma japonicum, s. mansoni, s. haematobium
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MORFOLOGI
- Bentuk pipih dorso ventral & simetris bilateral
- 2 buah batil isap (mulut & perut)
- Hidup secara anaerob
- Hermafrodit kecuali Schistosoma sp.
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Trematoda Hati
Clonorchis sinensis
Hospes : manusia, kucing, anjing, beruang kutub & babi
Penyakit : Klonorkiasis
Distribusi geografikCina, Jepang, Korea & Vietnam
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Daur Hidup
Cacing dewasa di saluran empedu terjadi peradangan
Luas kelainan patologis berhubungan dengan intensitas (juml. Cacing) & lama infeksi ada 3 stadium.
Pada infeksi berat penebalan & pelebaran setempat sumbatan saluran empedu fibrosis & kerusakan sel-sel hati
Anemi, pembesaran hati, edema, asites, dan diare
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Telur + tinja
menetas, HP I (bila di makan keong air)
Mirasidium
Sporokista
Redia
Serkaria
HP II (ikan)
kista di bawah kulit ikan (metaserkaria)
Tx. Prazikuantel
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Opistorchis felineus
Hospes : manusia, kucing & anjing
Penyakit : opistorkiasis
Distribusi geografik:Eropa tengah, selatan & timur, Asia, Vietnam &
india
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Daur Hidup
Cacing dewasa di sal. Empedu & sal Pankreas
- Berukuran 7 – 12 mm- Mempunyai batil isap dimulut & perut- Bentuk seperti lanset, pipih dorsoventral
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Opistorchis viverriniGeografik : Muangthai
Fasciola hepaticaHospes : Kambing & Sapi
Penyakit : fasioliasis/river root
Penyebaran geografikAmerika latin, Perancis & negara-negara sekitar laut tengah
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Morfologi & Daur Hidup
- Cacing dewasa bentuk pipih seperti daun- Besarnya 30 x 13mm- Telur 140 x 90 mikron,oval warna kuning
kecoklatan
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Telur belum matang dari sal.empedu ke tinja
di air telur matang (9 – 15 hr) berisi mirasidium
Menetas
Mirasidium
HP I
Serkaria
HP II (rumput/tmbh air)
Metaserkaria
Tertelan
Sal empedu
CD
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Patologi & Gejala Klinis
Kerusakan parenkim hatiSaluran empedu mengalami peradanganPenebalan & sumbatan sirosis periportal
Dx. Telur dalam tinja, cairan duodenum & empedu
rx. serologis
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Trematoda ParuParagonimus westermani
Hospes : manusia, kucing, luak anjing, harimau, serigala
Penyakit : Paragonimiasis
Penyebaran Geografik RRC, Taiwan, Korea, Jepang, Filipina, Vietnam, Thailand, India, Malaysia, Afrika dan Amerika Latin.
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Morfologi & Daur Hidup
- CD hidup dalam kista di paru- Bentuk spt biji kopi- 8 – 12 mm x 4-6 mm, berwarna coklat tua
Telur keluar bersama tinja/sputum (blm matang) 16 matang (berisi mirasidium) menetas mirasidium HP I(keong) serkaria HP II(ketam) metaserkaria manusia/mamalia CD duodenummenembus dinding usus rongga perut diafragma Paru
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Jaringan hospes mengadakan reaksi sehingga cacing dewasa berada dalam kista
Gejala KlinisBatuk kering batuk darah(endemic hemoptysis)
Dx. Telur dlm sputum / cairan pleuraTx : Prazikuantel & bitionol
Epidemiologi- Kebiasaan makan ketam mentah- Penyuluhan kesehatan
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Trematoda Usus
Fasciola buski
HD : anjing, kelinci, manusia, babi
Distribusi geografik Taiwan, Vietnam, Thailand, India & Indonesia
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Morfologi & Daur Hidup
- CD. P 2 – 7,5 cm L 0,8 – 2,0 cm
- Bentuk lonjong tebal- Kutikulum ditutupi duri-duri
CD melekat pd usus muda spt duodenum & yeyunum. Mkn isis & mukosa usus terdapat peradangan / tukak & abses erosi pendarahan
Infeksi berat terjadi intoksikasi & sensitisasi
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Gejala Klinis
- Diare- Nyeri epigastrium- Kad. Konstipasi- Tinja kuning berbau busuk & berisi sisa-sisa makanan- Napsu makan baik / berlebihan
Dx: Telur dalam tinjaTx: Diklorofen, niklosamid, prazikuantel
Prognosis: Inf. Berat kematian reinfeksi
Epidemiologi : - Kebiasaan makan tumbuhan air yang mentah- Defekasi di air
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Echinostomatidae
*Echinostoma ilocatum*Echinostoma malayanum*Echinostoma lindoense*Echinostoma recurvatum*Echinostoma revolutum
Hospes : manusia, tikus, anjing, burung, ikanPenyakit : ekinostomiasis
Distribusi geografikFilipina, Cina & Indonesia
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Morfologi & Daur Hidup
- duri-duri di leher 37 – 51 buah- P : 2,5 mm – 13 – 15 mm- L : 0,4 – 0,7 mm – 2,5 – 3,5 mm- CD hidup di usus halus- Telur mempunyai operkulum
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Telur menetas
Mirasidium
HP I
Sporokista
Redia induk
Redia anak
Serkaria
HP II
Metaserkaria
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Patologi & gejala klinis
- Cd kerusakan ringan pada mukosa- Infeksi berat radang kataral pada dinding usus /
ulserasi- Pada anak diare, sakit perut, anemia & edema
Dx : menemukan telur dlm tinjaTx : - tetrakloroetilen (yg dianjurkan) - prazikuantel
EpidemiologiKeong sawah yang dikonsumsi dimasak secara matang
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Heterophyidae
Heterophyes- heterophyesMetagonimus yokogawaiHaplorchis yokogawai
Hospes : manusia, anjing, rubah & jenis burung – burung tertentu
Penyakit : heterofiliasis
Distribusi geografikMesir, Turki, Jepang, Korea, RRC, Taiwan, Filipina,
Indonesia
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Morfologi & Daur Hidup
- CD P 1-1,7 mm & L 0,3-0,75 mm
Telur
Mirasidium
HP I
Sporokista
Redia induk
Redia anak Serkaria HP IIMetaserkaria
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Patologis & gejala klinis
CD iritasi pada usus muda : mulas-mulas/kolik, diare lendir
Telur aliran getah bening menyangkut di katup-katup/otot jantung payah jantung
Dx : telur dlm tinjaTx : Pirazikuantel, tetrakloroetilen
Prognosis baik
EpidemiologiManusia, Pedagang ikan, kucing & anjing, makan ikan mentah
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TREMATODA DARAH
Schistosoma japonicumSchistosoma mansoniSchistosoma haematobium
Hospes : manusia
Penyakit : Skistosomiasis / bilharziasis
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Cacing dewasa jantan : - kelabu / putih kehitaman - 9,5 – 19,5 mm x 0,9 mm - ada canalis gynaecophorus tempat cacing betina
Cacing dewasa betina : - lebih halus & panjang - 16,0 – 26,0 mm x 0,3 mm - 50 – 300 butir telur berukuran 95 – 135 x 50-60 mikron - tidak beroperkulum, berduri - Pada kapiler darah & vena
kecil dekat permukaan selaput lendir usus / kandung kemih
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Telur menetas di dalam air
Mirasidium
Hp
Sporokista I
Sporokista II
Serkaria
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Cara infeksi :Serkaria menembus kulit kapiler darah
Jantung kiri Paru Jantung kanan
Peredaran darah besar ke cab. Vena portae
v.portae hati (jadi dewasa)
Vena usus/vena kdg kemih
CD betina bertelur setelah kopulasi
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Patologis & Gejala Klinis
Ada 3 Stadium1.Masa tunas biologik
a. Gejala Kulit & alergiPerubahan kulit eritema & papula rasa gatal & panas .Bila banyak dermatitisHilang dalam 2 – 3 hari
b. Gejala Parubatuk berdahak yang produktif, kdg disertai
darah. Pada yang rentan asma
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c. Gejala toksemiaMinggu 2 – 8 setelah infeksiTergantung banyak serkaria yang masuk Infeksi berulang toksemia dengan demam tinggi, lemah, malaise, napsu makan turun, mual, muntah, sakit kepala, dapat sampai 3 bln
2.Stadium akutSejak CD betina bertelurTergantung jumlah telurdemam, malise, BB turun, diareHepatomegali
6-8 bulanSplenomegali
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3. Stadium MenahunFibrosis sirosisHipertensi portalSplenomegaliEdema pd tungkai bawahAsites & ikterusHematemesis
Dx : telur dalam tinjaTx : emetin, fuadin stibofen, reprodal, Neo-antimosan, Astiban TW 56,
Lucanthone HCL, Miracil d Nilodin, Niridazol, Prazikuantel
Epidemiologi-Berhub.erat dg pertanian yang mendapat air dari irigasi-Pengobatan masal tiap 6 bulan-Pemberantasan HP
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Schistosoma Japonicum
Hospes : Manusia, anjing, kucing, rusa, tikus sawah, sapi, babi, rusa
Penyakit : Oriental schistosomiasis Skistosomiasis japonika Kotayama / demam keong
Distribusi geografik :RRC, Jepang, Filipina, Taiwan, muangthai, Vietnam, Malaysia, Indonesia
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Morfologi & Daur Hidup
- Cacing Dewasa jantan ± 1,5 sm betina ± 1,9 cm
- Hidup di vena mesenterika soperior- Telur pada dinding usus halus, hati, paru, otak
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CD di vena mesenterika superior
Telur di usus halus
Tinja + telur
Air
Mirasidium
HP
Sporokista I
Sporokista II
Serkaria
Infeksi manusia
Skistosomula
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Dx : telur dalam tinja / jaringan biopsi (hati/rektum)
Epidemiologidaerah endemi sulawesi tengah, danau Lindu,
dan lembah NapuPengobatan masal