PARASITOLOGY IN THE CLINIC DEPARTMENT OF PARASITOLOGY FACULTY OF MEDICINE PADJADJARAN UNIVERSITY

PARASITIC DISEASE IN ASIA (A VERY COMMON DISEASE) 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 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 Ascariasis – as emergency cases : intestinal obstruction, intestinal perforation Severe Trichuriasis – prolapsus ani Trichinelliasis Filariasis – elephantiasis Cysticercosis cellulosae Hydatid cyst Coenuriasis Sparganosis Amoebic abscess, amoeboma Parasitic Pneumonia caused Pneumocystis carinii

Cases likely found in Neurosurgery examination Cysticercosis cellulosae in the brain Hydatidosis in the brain Coenuriasis in the brain Sparganosis in the brain Amoebic abces in the brain

INTERNAL MEDICINE MAY BE FOUND Ascariasis Trichuriasis Hookworm infektion Strongyloidiasis Enterobiasis (rare in adult age) Trichostrongyliasis Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

INTERNAL MEDICINE MAY BE FOUND Visceral Larva Migrans (VLM) Diphyllobothriasis Taeniasis saginata Taeniasis solium Hymenolepsiasis Nana Diphylidiasis caninum Echinococcosis

CASES COMMONLY FOUND IN PEDIATRIC WARD Ascariasis Trichuriasis Hookworm infection (rare ini the children) Strongyloidiasis Enterobiasis Trichostrongyliasis Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

CASES COMMONLY FOUND IN PEDIATRIC WARD Visceral Larva Migrans (VLM) Diphyllobothriasis Taeniasis saginata Taeniasis solium Hymenolepsiasis nana Hymenolepsiasis diminuta Diphylidiasis caninum Echinococcosis

CASES LIKELY FOUND DURING SKIN EXAMINATION Cutaneous Larva Migrans (Creeping Eruption) Trichinelliasis Ground Itch Swimmer's Itch Cutaneous Amoebiasis Sarcosporidiosis caused by Sarcocystis sp. Arthropod infection : Cutaneous Myiasis; Scabies; Pediculosis

OPHTHALMOLOGIST MAY FIND Toxoplasmosis Disturbance of the eye by Acanthamoeba sp. Case never reported in Indonesia : loaiasis (worm in subconjunctiva); blinding filariasis or river blindness by Onchocerca volvulus

PARASITES MAY BE FOUND IN OBSTETRIC WARD Toxoplasmosis Trichomoniasis vaginalis

PARASITES MAY BE FOUND IN NEUROLOGICAL CLINIC Trichinosis Angiostrongyliasis Gnathostomiasis Schistosomiasis Paragonimiasis Cysticercosis Hydatidosis Draconcoliasis

PARASITES WHICH MAY BE FOUND IN NEUROLOGICAL CLINIC Coenuriasis Amebic Brain Abscess Toxoplasmosis Cerebral Malaria Trypanosomiasis Primary Amebic Meningo-encephalitis (PAM) Tick paralysis

CHARACTERISTIC OF DISEASES CAUSED BY PARASITE 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 Parasites living inside the tissue or blood circulation of sensitive/ hypersensitive person, may induce allergic reaction or even anaphylactic reactions

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

SIGN AND SYMPTOMS OF PARASITIC DISEASE GASTRO INTESTINAL SYMPTOMS 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

SIGN AND SYMPTOMS OF PARASITIC DISEASE RESPIRATORY SYMPTOMS COUGH AND WHEEZE MIGRATION OF Ascaris lumbricoides THROUGH THE LUNGS PNEUMOCYSTIS INFECTION PARAGONIMIASIS WESTERMANI HOUSE DUST MITES NEUROLOGICAL SYMPTOMS CYSTICERCOSIS CELLULOSAE TOXOPLASMOSIS MALARIA TROPICA EOSINOPHILIC MENINGITIS P.A.M. (Naegleria fowleri)

SIGN AND SYMPTOMS OF PARASITIC DISEASE CUTANEUS SYMPTOMS PRURITUS ANI GROUND ITCH SWIMMER’S ITCH CREEPING ERUPTION HEPATOSPLENOMEGALI MALARIA VISCERAL LARVA MIGRAN TOXOPLASMOSIS

SIGN AND SYMPTOMS OF PARASITIC DISEASE ANEMIA MALARIA ANCYLOSTOMIASIS ASCARIASIS DIPHYLLOBOTHRIASIS STEATORRHEA GIARDIASIS

SIGN AND SYMPTOMS OF 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

DIAGNOSIS 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

TREATMENT Individual Type of treatment Mass treatment

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

PREVENTION 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)

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. The use of leeches in medical treatment is believed to date back to ancient India however the first documented uses were in 130 B.C. in ancient Greece. Blood letting was a common practice to treatment a variety of diseases and uses leeches to collect blood reached a peak in the 1830’s. For most medical conditions this is a bad practice and loss of blood only makes the disease worse. Today scientists have discovered that leech saliva contains anticoagulants, vasodialators, anesthetics, and natural antibiotics. Medicinal maggots are raised in sterile environments to prevent contamination of the wounds. They are capable of removing debris (debriding) from a wound on a microscopic level that surgical debridment cannot achieve.

Terima kasih atas perhatiannya ...... Thank you …………………. Thank you …………………. Thank you …………………. Terima kasih atas perhatiannya ...... April 2005