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

2. 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

3. PARASITIC PROTOZOA BALANTIDIASIS CRYPTOSPORIDIASIS GIARDIASIS
PNEUMOCYSTOSIS
SARCOSPORIDIOSIS
TOXOPLASMOSIS

4. PARASITIC HELMINTHES ANGYOSTRONGYLIASIS ASCARIASIS DIPYLIDIASIS
DIROFILARIASIS
FASCIOLIASIS
HYDATIDOSIS
HYMENOLEPIASIS
LARVA MIGRANS
LINGUATULIASIS
PHYSALOPTERIASIS
SCHISTOSOMIASIS
SPARGANOSIS
STRONGYLOIDIASIS
TAENIASIS SAGINATA
TRICHINOSIS
TRICHSTRONGYLIDIASIS

5. 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

7. 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

8. 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)

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

10. 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)

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

13. 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

15. 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

16. PARASITES MAY BE FOUND IN OBSTETRIC WARD
Toxoplasmosis
Trichomoniasis vaginalis

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

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

19. 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

20. 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

21. 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

22. 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)

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

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

27. 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

28. 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

29. TREATMENT
Individual
Type of treatment
Mass treatment

30. 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

31. 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

32. 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)

33. 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.

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April
2005