PARASITOLOGY IN THE CLINIC DEPARTMENT OF PARASITOLOGY FACULTY

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

INTRODUCTION PARASITIC DISEASE IN ASIA (A VERY COMMON DISEASE) w w Asia is in the tropic area Low grade of Social Economic Low grade of education The bad habit of the people

PARASITIC PROTOZOA w w w BALANTIDIASIS CRYPTOSPORIDIASIS GIARDIASIS PNEUMOCYSTOSIS SARCOSPORIDIOSIS TOXOPLASMOSIS

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

Cases found in Surgical clinic a. b. c. d. e. f. g. h. i. j. 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 a. Cysticercosis cellulosae in the brain b. Hydatidosis in the brain c. Coenuriasis in the brain d. Sparganosis in the brain e. Amoebic abces in the brain

INTERNAL MEDICINE MAY BE FOUND a. b. c. Ascariasis Trichuriasis d. Strongyloidiasis e. Enterobiasis (rare in adult age) f. Trichostrongyliasis g. Capillariasis (find in Philippines and Thailand, never yet find in Indonesia) Hookworm infektion

INTERNAL MEDICINE MAY BE FOUND h. Visceral Larva Migrans (VLM) i. Diphyllobothriasis j. Taeniasis saginata k. Taeniasis solium l. Hymenolepsiasis Nana m. Diphylidiasis caninum n. Echinococcosis

CASES COMMONLY FOUND IN PEDIATRIC WARD a. b. c. d. e. f. g. 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 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 LIKELY FOUND DURING SKIN EXAMINATION 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

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

PARASITES MAY BE FOUND IN OBSTETRIC WARD a. Toxoplasmosis b. Trichomoniasis vaginalis

PARASITES MAY BE FOUND IN NEUROLOGICAL CLINIC a. b. c. d. e. f. g. h. Trichinosis Angiostrongyliasis Gnathostomiasis Schistosomiasis Paragonimiasis Cysticercosis Hydatidosis Draconcoliasis

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

CHARACTERISTIC OF DISEASES CAUSED BY PARASITE w Example : w Parasites living inside the tissue or blood circulation of sensitive/ hypersensitive person, may induce allergic reaction or even anaphylactic reactions – 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 w 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 w ABDOMINAL PAIN w – 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 w COUGH AND WHEEZE – – MIGRATION OF Ascaris lumbricoides THROUGH THE LUNGS PNEUMOCYSTIS INFECTION PARAGONIMIASIS WESTERMANI HOUSE DUST MITES NEUROLOGICAL SYMPTOMS w w w CYSTICERCOSIS CELLULOSAE TOXOPLASMOSIS MALARIA TROPICA EOSINOPHILIC MENINGITIS P. A. M. (Naegleria fowleri)

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

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

SIGN AND SYMPTOMS OF PARASITIC DISEASE w KERANDEL’S SIGN – AFRICAN SLEEPING SICKNESS w ROMANA’S SIGN – INFECTION WITH Trypanosoma cruzi w WINTER BOTTOM’S SIGN – AFRICAN TRYPANOSOMIASIS w KERATITIS – Acanthamoeba sp. – Onchocerca volvulus w RETINOCHOROIDITIS – Toxoplasma gondii

DIAGNOSIS w Clinical manifestations caused by parasitic infection are commonly very unspecific, therefore laboratory examination is necessary for definite diagnosis w The aim of laboratory examination is to look for any stages of parasite life cycle in the examination materials w To do accurate laboratory examination, requires decision on: – Correct selection of type of sample material (according to parasite life cycle) – Accurate laboratory technique

TREATMENT w Individual w Type of treatment w 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 w Humoral immunity produces antibodies w Cellular immunity (Cell Mediated Immunity/CMI) is the response produced by specific immune cells (T cells)

Beneficial Parasites Medicinal leeches are being used to decrease swelling and improve blood flow in surgery sites including skin grafts and reattachments. Medicinal maggots are being used to clean wounds that contain dead tissue. This photo shows the healthy pink tissue after maggots have been used

Thank you …………………. April 2005