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Parasitic Helminths

Tapeworms

T a e n i a s i s( Penyakit Cacing Pita )

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Taenia solium ( pada babi )

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Morphology

Adult :2-4 mlong,

700-1000

segments:Scolex

Neck

Immature

segmentMaturesegment

Gravidsegment

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Taenia saginata

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Taen ia saginata (beef tapeworm)( pada binatang sapi

4- 25 m ,

1000-2000 segments

Scolex

Neck

Immature

segment

Mature segment

Gravid segment

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TAENIASIS

Agen penyebab:

Tanea soleum - babi

T. saginata - sapi

Dalam siklus hidupnya menyebabkan infeksi pdmanusia, tdp 2 stadium:

stadium dewasa/taeniasis - intestinal infection

stadium larva/cystiserciasis; cysticercosis - infeksipada jaringan

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MorfologiT. solium T. saginata

Body length 2-4m 4-8mSegment 700-1000, thin 1000-2000, thick

Scolex rostellum with hooks no rostellum and hooks

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Morfologi

T. solium T. saginata

Mature segment

Ovary( )

Gravid segmentUterine branches

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Classification of helminths

Nematodes (roundworms)

Platyhelminthes (flatworms)

Trematodes (flukes)

Cestodes (tapeworms)

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Epidemiologi

Hospes definitif ( penjamu/ resrvoir ):manusia

Penyebaran : seluruh dunia, terutama

Amerika latin, Afrika, Asia Tenggara,Eropa bagian Timur

Penularan : menelan daging babi (T.sol.)atau sapi (T.sag.) mentah/tidak dimasakdg baik.Cysticercosis( sirtiserkosis): - langsung,dan tidak langsung dari ma-mi tercemar

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Epidemiologi

T. saginata:Widespread in cattle breeding areas of the world. Prevalence >10%in some independent states of the former Soviet Union, in NearEast, and in central and eastern Africa.Lower rates in Europe, Southeast Asia, & South America

T. solium:Prevalent in Mexico, Central and South America, Africa, SoutheastAsia,and the Philippines

Infections in USA and Canada are found in immigrantsfrom areas where taeniasis is endemic, and in travelerswho consume undercooked meats in endemicareas

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Siklus Hidup Humans are the only definitive hosts for T.

saginataand T. solium. Eggs or gravid

proglottidsare passed with feces ; the eggs cansurvive for days to months in theenvironment. Cattle(T. saginata) and pigs(T.solium) become infected by ingesting vegetation

contaminated with eggs or gravid proglottids . Inthe animal's intestine, the oncosphereshatch ,invade the intestinal wall, and migrateto thestriated muscles, where they develop intocysticerci. A cysticercus can survive for severalyearsin the animal. Humansbecome infected byingestingraw or undercooked infected meat.

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In the human intestine, the cysticercusdevelopsover 2months into an adult tapeworm, which cansurvive for years. The adult tapeworms attach to

the small intestine by their scolex and reside inthe small intestine. Length of adult worms isusually 5 mor less for T. saginata(however itmay reach up to 25 m) and 2 to 7 m for T.solium. The adults produce proglottidswhichmature, become gravid, detachfrom thetapeworm, and migrateto the anusor are passedin the stool(approximately 6 per day). T.saginataadults usually have 1,000 to 2,000

proglottids, while T. soliumadults have anaverage of 1,000 proglottids. The eggscontainedin the gravid proglottids are released after theproglottids are passedwith the feces. T. saginata

may produce up to 100,000and T. soliummayproduce 50,000 eggsper proglottid respectively.

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Taenia saginata - The Beef Tapeworm

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Taenia solium- The Pork Tapeworm

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Cysticercus in pig muscle

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Manifestasi klinis

Incubation period:

taeniasis - eggs appear in 8-14 weeks

cystercosis - days to years

Symptoms:

Taeniasis

mild abdominal symptoms

occasionally appendicitis or cholangitis frommigrating proglottids

passage of proglottids (active or passive)

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Manifestasi klinis

Cysticercosis:

migrating larvae may localize in eye,CNS, or cardiac tissue

neurocysticercosis - severe, may befatal

headache

nausea

vomiting

epileptiform seizures

hydrocephalus - either by accumulation ofCSF behind cyst or my inflammatoryresponse

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Manifestasi klinis

Taenia saginata < Taenia solium :sistiserkosis T.saginata jarang terjadi

T.saginata , terutama cacing dewasa yg

menimbulkan gangguan pada manusia Gangguan sal.cerna karena panjang

cacing dalam usus ( 25 meter ) : diare,rasa lapar.

Penurunan berat badan, nausea, muntahssd makan, kolik usus, spt tukak lambung,gejala peny.empedu

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Manifestasi klinis

Cysticercosisoccurs in humans after the ingestion of T. soliumeggs

Embryonic metacestode migrates from the intestine and can lodge in

a number of tissue sites such as the brain, muscle, and eyes with

proclivity for the brain

The clinical course largely depends on the endurance of the parasite

inside the tissue and on the ensuing inflammation

In the brain parenchyma, the intruding cysticercusmight bedestroyed within a few days by host immune mechanisms or remain

viable in the brain for > 10 years

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Manifestasi klinis

Cysticercosis can affect humans at any ageMost common during the 3rdand 4thdecades of life

About 10% occur in children

In infants initial signs of cysticecosis in infants is generalized seizureCT with contast or T2-weighted MRI isolated cystic lesion in the

brainparenchyma

Typically the lesion disappears spontaneously 2-3 months later, but in

some granuloma cacification (permanent sequela)Isolated lesion is most common; some children have two-several cysts

Cystcercotic encephalitis is a severe form of CNS cystcercosis

that occasionally occurs in children, particularly adolescent girls

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Manifestasi klinis

In adults neurocysticercosis is quite different:

Multiple brain cysticerci, variable immune response, chronic

inflammation, chronic persistence of many active cysts, vasculitis

and protean clinical picture

Epilepsyoccurs in 50% of cases; intracranial hypertension in 30%

Occular Cysticercosis: Subretinal area or vitreous chamber

Muscular cystcercosis: Rare in both children and adults; usually

benign course

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Cysticercosis

in brainCystcercosis

in eye

Cysticercosisinsubcutaneous

tissues andmuscles

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Diagnosis

Taeniasisstool examination

anal swab

gravid segment examination

Cystisercosis

biopsy

funduscopy

X-ray, B ultrasonic, CT

Serological tests

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CYSTICERCOSIS

T. saginata egg

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Diagnosis

Taeniasis

microscopic identification of eggs andproglottids in feces after 3 months

eggs do not distinguish species

Cysticercosis

Serology

CT for visualization of calcified cysts MR for cysts in fourth ventricle

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Pengobatan

Taeniasis

praziquantel

Cystercosis praziquentel if active cystercosis, but

only under hospitalization due to acuteinflammatory reaction; steroids givento control inflammation

surgical

shunt - ventriculoperitoneal shunt to drainCSF

cyst removal

endoscopic fenestration (hole in cyst wall)

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Pengobatan

Intestinal T. soliumand T.saginata infection:Praziquantel - (5-10 mg/kg once)

Neurocysticercosis:

Albendazole - 15 mg/kg/day (maximum, 800 mg/day)divided into two doses X 8 days

Two months later, if repeat imaging studies showcysts: Praziquantel in a total dose of 75mg/kg dividedin three doses for 15 days. Repeat imaging studiesin two months

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Pencegahan

Prevention/Control

Education

Identification and immediatetreatment of infected individuals

Freezing meat at -5C (23F) for >4 days effectively kills cysticerci

Irradiation

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Taeniasis

Tapeworm Cysticercosis

poor

hygiene

poor

sanitation

ingestion ofundercooked pork

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T i i & T i li

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Taenia saginata& Taenia soliumLaboratory Findings/Diagnosis

CT and MRI are the most relaible tools for the diagnosis ofneurcysticercosis

Serologic tests are unreliable (cross reactivity with antigens ofother parasites)

Serology is highly specific for CNS inection when tests areperformed on CSF

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Tapeworms

Definitive hosts: harbor adult worms

Intermediate hosts: harbor tissue cysts

(containing worm heads) Humans acquire infection two ways:

ingestion of eggs from feces (to acquire tissue cysts)

ingestion of tissue cysts in undercooked meat (to

acquire a tapeworm)= Intermediate host

= Definitive host

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TAENIASIS

T. sagin ata

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TAENIASIS

Tanea so leum

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TANEIASIS

Epidemiology Reservoir:

humans definitive host for both T.saginata and T. soleum

Occurrence:

worldwide

highest in Latin America, Africa, SE

Asia, Eastern Europe T. soleumrare in US, Canada, UK, but

increasingly recognized in immigrants

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TANEIASIS

Epidemiology Transmission:

T. saginata - ingestion of raw orundercooked beef or beef products

containing cysticerci

T. soleum - ingestion of raw orundercooked pork or pork products;measly pork

Cysticercosis direct transmission of eggs

direct contact (mouth-mouth)

autoinfection - reverse peristalsis of eggs orproglottids in intestine

indirect by contaminated food or water

III P h i i

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III. Pathogenicity

Taeniasis

intestinal descomfort: vomiting,diarrhoea or constipation, loss ofappetite, appendicitis and intestinal

obstruction Cysticercosis

The methods of infecting eggs:

auto-infect oneself in body;auto-infect oneself outside body;

infect from other person

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5.6 The Parasitic Helminths

Tapeworms, flukes, and roundworms

Adults large enough to be seen with thenaked eye

From 1 mm to 25 m in length Microscope is necessary to identify eggs

and larvae

Two major groups: Flatworms andRoundworms

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Life Cycles and Reproduction

Fertilized egg (embryo), larval, and adultstages

In most, adults derive nutrients and

reproduce sexually in a hosts body Nematodes- separate sexes

Trematodes- separate sexes or hermaphroditic

Must complete the life cycle by transmitting

an infective form to the body of another host Larval development- intermediate (secondary) host

Adulthood and mating- definitive (final) host

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Flatworms

Phylum Platyhelminthes

Thin

Often segmented

Subdivisions Cestodes(tapeworms)

Trematodes(flukes)

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Among the mostcommon tapeworms inhumans are the pork

tapeworm, the beeftapeworm, the fishtapeworm, and thedwarf tapeworm.

Infections involving thepork and beeftapeworms are alsocalled taeniasis.

Length of adult worms 5 m or less for T.

saginata(however it mayreach up to 25 m)

2 to 7 m for T. solium.

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Cestodes

Live tapeworm larvae are sometimes ingested byconsuming undercooked food.

Once inside the digestive tract, a larva can growinto a very large adult tapeworm.

The adults produce proglottids which mature,become gravid, detach from the tapeworm, andmigrate to the anus or are passed in the stool(approximately 6 per day).

Additionally, many tapeworm larvae causesymptoms in an intermediate host.

For example, cysticercosis is a disease of humans

involving larval tapeworms in the human body.

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Clonorchis sinensis

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Figure 5.29

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Life Cycle of Human Liver Fluke

Embryonated eggs are discharged in the biliaryducts and in the stool.

Eggs are ingested by a suitable snail intermediatehost; the egg releases miracidia, which go through

several developmental stages (sporocysts, rediae,and cercariae).

Over 100 species of snail are suitable intermediate hosts

The cercariae are released from the snail and after

a short period of free-swimming time in water,they come in contact and penetrate the flesh offreshwater fish, where they encyst asmetacercariae.

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Life Cycle of Human Liver Fluke

Infection of humans occurs by ingestion ofundercooked, salted, pickled, or smokedfreshwater fish.

After ingestion, the metacercariae excyst in the

duodenum and ascend the biliary tract throughthe ampulla of Vater.

Maturation takes approximately 1 month. Theadult flukes (measuring 10 to 25 mm by 3 to 5

mm) reside in small and medium sized biliaryducts.

In addition to humans, carnivorous animals canserve as reservoir hosts.

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Roundworms

Phylum Nematoda

Elongate

Cylindrical

Unsegmented In dogs: Roundworms,

tapeworms,hookworms, whipworms andheartworms.

Human: potentially allof these; alsopinworms and many

others.

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General Worm Morphology

Most developed organs are those of thereproductive tract

Some degree of reduction in digestive, excretory,nervous, and muscular systems

Most have thick cuticles for protection and mouthglands for breaking down the hosts tissue

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Figure 5.30

Round worms

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Hookworms

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Hookworm

The human hookworms include the nematodespecies,Ancylostoma duodenaleand Necatoramericanus.

A larger group of hookworms infecting animals

can invade and parasitize humans (A. ceylanicum)or can penetrate the human skin (causingcutaneous larva migrans), but do not develop anyfurther (A. braziliense,A. caninum, Uncinaria

stenocephala). OccasionallyA. caninumlarvae may migrate to

the human intestine, causing eosinophilicenteritis.

Ancylostomacaninumlarvae have also been implicatedas a cause of diffuse unilateral subacute neuroretinitis.

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Hookworms

Hookworm larvae can penetrate the surface of aperson's skin (usually through bare feet) andmigrate through it, causing a disease called'cutaneous larva migrans' or 'creeping eruption.'

The lesions appear as red lines under the skinand sometimes break open at the skin'ssurface.

These lesions cause severe itching. Usually,

the larvae will die in several weeks and thecondition will disappear.

In severe cases, the larvae may make their waythrough the skin and enter deeper tissues. Thismay cause lung disease and painful muscles.

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Life Cycle (intestinal

hookworm infection):

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Life Cycle (cutaneouslarval migrans):

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A Helminth Cycle: The Pinworm

Person swallows microscopic eggs Picked up from another infected person by direct contact Or by touching articles an infected person has touched

Eggs hatch in the intestine

Release larvae that mature in to adult worms (about 1

month) Male and female worms mate

Female migrates out of the anus to deposit eggs Causes intense itchiness Relieved by scratching

Scratching contaminates the fingers which transfer theeggs

Eggs spread to others or the original host reinfects himor herself

Pinworms

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Pinworms

Enterobius vermicularis

Use a flashlight to inspectthe anal area

At night

Tape test: 1 inch strip ofcellophane tape is pressedfirmly over the anal areafor a few seconds. Repeatthree separate days.

In morning beforebathing

Transfer to a glass slide,sticky side down

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Helminth Classification and Identification

Shape Size

Degree of development of various organs

Presence of hooks, suckers, or otherspecial structures

Mode of reproduction

Kinds of hosts

Appearance of eggs and larvae

Di trib ti n nd Imp rt n f P r iti

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Distribution and Importance of Parasitic

Worms

About 50 species parasitize humans

Distributed in all areas of the world

Yearly estimate of worldwide infections- in

the billions

EEEEEEEEUUUUUUW!!!

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