PARASITOLOGY IN PARASITOLOGY IN THE CLINICTHE CLINIC

DEPARTMENT OF PARASITOLOGYDEPARTMENT OF PARASITOLOGY

FACULTY OF MEDICINEFACULTY OF MEDICINE

PADJADJARAN UNIVERSITYPADJADJARAN UNIVERSITY

DEPARTMENT OF PARASITOLOGYDEPARTMENT OF PARASITOLOGY

FACULTY OF MEDICINEFACULTY OF MEDICINE

PADJADJARAN UNIVERSITYPADJADJARAN UNIVERSITY

INTRODUCTION

PARASITIC DISEASE IN ASIA(A VERY COMMON DISEASE)

Asia is in the tropic area Low grade of Social Economic Low grade of education The bad habit of the people

PARASITIC DISEASE IN ASIA(A VERY COMMON DISEASE)

Asia is in the tropic area Low grade of Social Economic Low grade of education The bad habit of the people

PARASITIC PROTOZOA

BALANTIDIASIS CRYPTOSPORIDIASIS GIARDIASIS PNEUMOCYSTOSIS SARCOSPORIDIOSIS TOXOPLASMOSIS

PARASITIC HELMINTHES

ANGYOSTRONGYLIASIS ASCARIASIS

DIPYLIDIASIS DIROFILARIASIS FASCIOLIASIS HYDATIDOSIS HYMENOLEPIASIS LARVA MIGRANS

LINGUATULIASIS PHYSALOPTERIASIS SCHISTOSOMIASIS SPARGANOSIS STRONGYLOIDIASIS TAENIASIS SAGINATA TRICHINOSIS TRICHSTRONGYLIDIASIS

Cases found in Surgical clinic

a. Ascariasis – as emergency cases : intestinal obstruction, intestinal perforation

b. Severe Trichuriasis – prolapsus ani

c. Trichinelliasis

d. Filariasis – elephantiasis

e. Cysticercosis cellulosae

f. Hydatid cyst

g. Coenuriasis

h. Sparganosis

i. Amoebic abscess, amoeboma

j. Parasitic Pneumonia caused Pneumocystis carinii

a. Ascariasis – as emergency cases : intestinal obstruction, intestinal perforation

b. Severe Trichuriasis – prolapsus ani

c. Trichinelliasis

d. Filariasis – elephantiasis

e. Cysticercosis cellulosae

f. Hydatid cyst

g. Coenuriasis

h. Sparganosis

i. Amoebic abscess, amoeboma

j. Parasitic Pneumonia caused Pneumocystis carinii

Cases likely found in Neurosurgery examination

a. Cysticercosis cellulosae in the brain

b. Hydatidosis in the brainc. Coenuriasis in the braind. Sparganosis in the braine. Amoebic abces in the brain

a. Cysticercosis cellulosae in the brain

b. Hydatidosis in the brainc. Coenuriasis in the braind. Sparganosis in the braine. Amoebic abces in the brain

INTERNAL MEDICINE

MAY BE FOUNDMAY BE FOUND

a. Ascariasis

b. Trichuriasis

c. Hookworm infektion

d. Strongyloidiasis

e. Enterobiasis (rare in adult age)

f. Trichostrongyliasis

g. Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

a. Ascariasis

b. Trichuriasis

c. Hookworm infektion

d. Strongyloidiasis

e. Enterobiasis (rare in adult age)

f. Trichostrongyliasis

g. Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

h. Visceral Larva Migrans (VLM)

i. Diphyllobothriasis

j. Taeniasis saginata

k. Taeniasis solium

l. Hymenolepsiasis Nana

m. Diphylidiasis caninum

n. Echinococcosis

h. Visceral Larva Migrans (VLM)

i. Diphyllobothriasis

j. Taeniasis saginata

k. Taeniasis solium

l. Hymenolepsiasis Nana

m. Diphylidiasis caninum

n. Echinococcosis

INTERNAL MEDICINE

MAY BE FOUNDMAY BE FOUND

CASES COMMONLY FOUND IN PEDIATRIC WARD

a. Ascariasis

b. Trichuriasis

c. Hookworm infection (rare ini the children)

d. Strongyloidiasis

e. Enterobiasis

f. Trichostrongyliasis

g. Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

a. Ascariasis

b. Trichuriasis

c. Hookworm infection (rare ini the children)

d. Strongyloidiasis

e. Enterobiasis

f. Trichostrongyliasis

g. Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

Ascariasis - Ascaris lumbricoides

Adult worm exit after treatment

h. Visceral Larva Migrans (VLM)

i. Diphyllobothriasis

j. Taeniasis saginata

k. Taeniasis solium

l. Hymenolepsiasis nana

m. Hymenolepsiasis diminuta

n. Diphylidiasis caninum

o. Echinococcosis

h. Visceral Larva Migrans (VLM)

i. Diphyllobothriasis

j. Taeniasis saginata

k. Taeniasis solium

l. Hymenolepsiasis nana

m. Hymenolepsiasis diminuta

n. Diphylidiasis caninum

o. Echinococcosis

CASES COMMONLY FOUND IN PEDIATRIC WARD

a. Cutaneous Larva Migrans (Creeping Eruption)

b. Trichinelliasis

c. Ground Itch

d. Swimmer's Itch

e. Cutaneous Amoebiasis

f. Sarcosporidiosis caused by Sarcocystis sp.

g. Arthropod infection : Cutaneous Myiasis;

Scabies; Pediculosis

a. Cutaneous Larva Migrans (Creeping Eruption)

b. Trichinelliasis

c. Ground Itch

d. Swimmer's Itch

e. Cutaneous Amoebiasis

f. Sarcosporidiosis caused by Sarcocystis sp.

g. Arthropod infection : Cutaneous Myiasis;

Scabies; Pediculosis

CASES LIKELY FOUND DURING SKIN EXAMINATION

OPHTHALMOLOGIST MAY FIND

a. Toxoplasmosis

b. Disturbance of the eye by Acanthamoeba sp.

c. Case never reported in Indonesia : loaiasis (worm in subconjunctiva); blinding filariasis or river blindness by Onchocerca volvulus

a. Toxoplasmosis

b. Disturbance of the eye by Acanthamoeba sp.

c. Case never reported in Indonesia : loaiasis (worm in subconjunctiva); blinding filariasis or river blindness by Onchocerca volvulus

PARASITES MAY BE FOUND IN OBSTETRIC WARD

a. Toxoplasmosis

b. Trichomoniasis vaginalis

a. Toxoplasmosis

b. Trichomoniasis vaginalis

PARASITES MAY BE FOUND IN NEUROLOGICAL CLINIC

a. Trichinosis

b. Angiostrongyliasis

c. Gnathostomiasis

d. Schistosomiasis

e. Paragonimiasis

f. Cysticercosis

g. Hydatidosis

h. Draconcoliasis

a. Trichinosis

b. Angiostrongyliasis

c. Gnathostomiasis

d. Schistosomiasis

e. Paragonimiasis

f. Cysticercosis

g. Hydatidosis

h. Draconcoliasis

Coenuriasis Amebic Brain Abscess Toxoplasmosis Cerebral Malaria Trypanosomiasis Primary Amebic Meningo-

encephalitis (PAM) Tick paralysis

Coenuriasis Amebic Brain Abscess Toxoplasmosis Cerebral Malaria Trypanosomiasis Primary Amebic Meningo-

encephalitis (PAM) Tick paralysis

PARASITES WHICH MAY BE FOUND IN NEUROLOGICAL CLINIC

Parasites living inside the tissue or blood circulation of sensitive/ hypersensitive person, may induce allergic reaction or even anaphylactic reactions

Example : – Larvae of Ascaris

lumbricoides, hookworm , Strongyloides

stercoralis, Trichinella spiralis

– Bursting of hydatid cyst (larva of Echinococcus granulosus),

– Bursting of nodule of Dracunculus medinensis

– Nephritis by Plasmodium malariae

– Black Water Fever by Plasmodium falciparum

CHARACTERISTIC OF DISEASES CAUSED BY PARASITE

CHARACTERISTIC OF DISEASES CAUSED BY PARASITE

The course of disease caused by parasite is usually

chronic mixed with periods of latency without

symptoms and sometimes with acute exacerbation

– Example : quartan malaria by Plasmodium

malariae

The course of disease caused by parasite is usually

chronic mixed with periods of latency without

symptoms and sometimes with acute exacerbation

– Example : quartan malaria by Plasmodium

malariae

SIGN AND SYMPTOMSOF PARASITIC DISEASE

ABDOMINAL PAIN– CRAMPY ABDOMINAL PAIN : AMEBIC COLITIS– INTESTINAL OR BILLIARY OBSTRUCTION : A. lumbricoides– DUODENAL ULCERS : Strongyloides stercoralis

DIARRHEA: INTESTINAL PROTOZOA– BULKY AND HAS AN OFFENSIVE ODOR : AMEBIASIS– BULKY AND FATTY : GIARDIASIS– WATERY DIARRHEA : CRYPTOSPORIDIASIS– MINIMAL GASTRO INTESTINAL SYMPTOMS : INTESTINAL HELMINTH

INFECTION– BLOODY DIARRHEA : AMEBIASIS, TRICHURIASIS,

SCHISTOSOMIASIS

GASTRO INTESTINAL SYMPTOMS

SIGN AND SYMPTOMSOF PARASITIC DISEASE

COUGH AND WHEEZE– MIGRATION OF Ascaris lumbricoides THROUGH THE LUNGS– PNEUMOCYSTIS INFECTION– PARAGONIMIASIS WESTERMANI– HOUSE DUST MITES

RESPIRATORY SYMPTOMS

CYSTICERCOSIS CELLULOSAE TOXOPLASMOSIS MALARIA TROPICA EOSINOPHILIC MENINGITIS P.A.M. (Naegleria fowleri)

NEUROLOGICAL SYMPTOMS

SIGN AND SYMPTOMSOF PARASITIC DISEASE

PRURITUS ANI GROUND ITCH SWIMMER’S ITCH CREEPING ERUPTION

CUTANEUS SYMPTOMS

MALARIA VISCERAL LARVA MIGRAN TOXOPLASMOSIS

HEPATOSPLENOMEGALI

SIGN AND SYMPTOMSOF PARASITIC DISEASE

MALARIA ANCYLOSTOMIASIS ASCARIASIS DIPHYLLOBOTHRIASIS

ANEMIA

GIARDIASIS

STEATORRHEA

SIGN AND SYMPTOMSOF PARASITIC DISEASE

KERANDEL’S SIGN– AFRICAN SLEEPING SICKNESS

ROMANA’S SIGN– INFECTION WITH Trypanosoma cruzi

WINTER BOTTOM’S SIGN– AFRICAN TRYPANOSOMIASIS

KERATITIS– Acanthamoeba sp.– Onchocerca volvulus

RETINOCHOROIDITIS– Toxoplasma gondii

DIAGNOSISDIAGNOSIS Clinical manifestations caused by parasitic infection

are commonly very unspecific, therefore laboratory examination is necessary for definite diagnosis

The aim of laboratory examination is to look for any stages of parasite life cycle in the examination materials

Clinical manifestations caused by parasitic infection are commonly very unspecific, therefore laboratory examination is necessary for definite diagnosis

The aim of laboratory examination is to look for any stages of parasite life cycle in the examination materials

To do accurate laboratory examination, requires decision on:– Correct selection of type of sample material (according to

parasite life cycle)– Accurate laboratory technique

To do accurate laboratory examination, requires decision on:– Correct selection of type of sample material (according to

parasite life cycle)– Accurate laboratory technique

TREATMENTTREATMENT

Mass treatment Mass treatment

Individual Individual

Type of treatment Type of treatment

Things to observe during therapy : Efficacy of drugs against parasite vs. side

effect against the host Sometimes surgery is needed to maximize

result of treatment Consider also the patient’s general condition

and immunity status Also important with treatment of parasite is

the improvement of environmental sanitation

Things to observe during therapy : Efficacy of drugs against parasite vs. side

effect against the host Sometimes surgery is needed to maximize

result of treatment Consider also the patient’s general condition

and immunity status Also important with treatment of parasite is

the improvement of environmental sanitation

TREATMENTTREATMENT

PREVENTIONPREVENTION

The prevention against parasitic disease may be done by the following steps

Source reduction: to reduce the source of infection by treating all infected patients

Health education: to prevent the distribution of parasite Eradication of host reservoir and vector control Increase of biological immunity against infection Control of hygiene and sanitation

The prevention against parasitic disease may be done by the following steps

Source reduction: to reduce the source of infection by treating all infected patients

Health education: to prevent the distribution of parasite Eradication of host reservoir and vector control Increase of biological immunity against infection Control of hygiene and sanitation

IMMUNITY

TWO MECHANISM OF IMMUNITY

Humoral immunity produces antibodies

Cellular immunity (Cell Mediated Immunity/CMI)

is the response produced by specific immune cells

(T cells)

TWO MECHANISM OF IMMUNITY

Humoral immunity produces antibodies

Cellular immunity (Cell Mediated Immunity/CMI)

is the response produced by specific immune cells

(T cells)

Beneficial Parasites

Medicinal maggots are being used to clean wounds that contain dead tissue. This photo shows the healthy pink tissue after maggots have been used

Medicinal leeches are being used to decrease swelling and improve blood flow in surgery sites including skin grafts and reattachments.

Thank you ………………….Thank you ………………….Thank you ………………….

April2005