Soil Transmitted Helminthiasis (Parasitology)

Soil Transmitted
Helminthiasis
AHS/Parasitologi/FKUSU
Refference
References
1.
2.
3.
4.
5.
Roberts L, Janovy Jr J. Gerald D. Schmidt & Larry S. Roberts

Foundations of Parasitology. 7th ed. McGraw Hill. New York. 2005 :
397-99, 417-24, 431-5
Brooker S, Bundy DAP, Soil Transmitted Helminths
(Geohelminths). In : Cook GC, Zumla AI (ed). Mansons Tropical
Disease. 22nd ed. Saunders Elsevier. 2009 : 1517-40
World Health Organization. Preventive Chemotherapy in Human
Helminthiasis : Coordinated Use of Anthelminthic Drugs in Control
Intervensions : A Manual for Health Professionals and Programme
Managers. Geneva, Switzerland : World Health Organization; 2006
World Health Organization. Weekly Epidemiological Record : SoilTransmitted Helminthiasis : Estimates of The Number of Children
Needing Preventive Chemotherapy and Number Treated . Geneva,
Switzerland : World Health Organization; 2011
Hotez PJ, Brooker S, Bethony JM, et al. Hookworm Infection. The
New England Journal of Medicine. 2004; 351 : 799-807
Soil Transmitted
Helminthiasis
Learning
Objective
Agents of
the disease
Pathology
Diagnosis
Prevention
Soil Transmitted
Helminthiasis
General
o Nematode infections
o Transmitted via soil medium either :

1. Ingestion of embryonated eggs
2. Skin penetration by infective larvae
Soil Transmitted
Helminthiasis
General
o Etiology :
Ascaris lumbricoides
Trichuris trichiura
Common STH
agents
Hookworms
Strongyloides stercoralis
Toxocara spp.
Soil Transmitted
Helminthiasis
o Infections STH associated
General
with:
Poverty and poor condition
Crowded living conditions,
combined with lack of
access to health care and
low levels of education
(poor personal and health
awareness)
Soil quality and climate
Inadequate water supply
and poor environmental
Soil Transmitted
Helminthiasis
Global Estimation
Ascariasis
General
o Etiology
: Ascaris lumbricoides
(roundworm)
o Habitat
: small intestine, especially
jejunum and upper ileum
o One of the most common &
widespread human infection, about 1
billion people worldwide
Morfology
Adult Ascaris lumbricoides

Morfology
Egg of A.
lumbricoides
corticated
Fertilized
Unfertilized
decorticate
d
10
Morfology
Egg of A.
lumbricoides
Infectious
corticated
11
Ascariasis
Life Cycle
Infective stage:
fertilized egg
Diagnostic
stage:
egg & adult in
feces
Route of
infection:
ingestion
12
Ascariasis
Pathology
o Majority symptomless
o May be caused by migrating larvae
or adult worms
13
Ascariasis
Pathology
Migrating Larvae
When juveniles break out of lung

cappilaries into the respiratoric system
small hemorrhage
Segments of 4th stage larvae can be
seen in the bronchioles associated with
infiltration with PMN and eosinophil
with scattered Charcot-Leyden crystals
and radiological pulmonary infiltration
Ascaris pneumonitis (Lfflers
14
Ascariasis
Pathology
Ascaris pneumonitis (Lfflers

pneumonia): fever, cough, sputum,
wheeze, skin rash, eosinophilia, and
radiological pulmonary infiltration.
Larvae may wander into the brain,
eye, causing granulomas.
15
Ascariasis
Pathology
Adult
worms
Adult
can cause physiological
abnormalities in the small intestine
malabsorbtion of nutrients and
micronutrients, malnutrition, growth failure
and cognitive impairments
Intestinal ascariasis GI discomfort, colic
and vomiting are quite common
16
Ascariasis
Pathology
The commonest
complication of
ascariasis among
children below 10
years is small-bowel
obstruction
Heavy infection can
cause intestinal colic,
fatal intestinal
blockage
17
Ascariasis
Pathology
Wandering worms:
may reach liver, billiary tract,
appendix and oesophagus
acute and chronic
inflammation with infiltrations
by eosinophils, histiocytes
and mononuclear cells at
sites of ectopic ascariasis
granuloma formation around
ova in tissues
18
Ascariasis
We assume 6 adult worm in human body for
example.
Indonesian people: 220 million; prevalence 60%
792 million adult worms.
One adult worm absorbs 0.14g carbohydrate daily
and 0.035g protein daily
One gram of rice contains 0.8g carbohydrate
We will lose carbohydrate: 110.880 Kg/ daily
110 tons of rice/day
One gram of meat contains 0.19g protein
We will lose protein: 145.895 kg/day 729 cows
( 200 Kg)
Ascariasis
Diagnostic
o Adult worm out of body openings

o Larvae std 4th in sputum
o Eggs in feces fertilized/unfertilized
o Eosinophilia
o Serology (?)
20
Trichiuriasis
General
o Etiology: Trichiuris trichiura

(whipworm)
o Habitat: large intestine, especially
caecum and vermiform appendix
o Recent estimate suggests that T
trichiura infects 795 million people
worldwide
21
Trichiuriasis
Morfology
Adult Trichuris trichiura
Egg of Trichuris trichiura
22
Trichiuriasis
Life cycle
Infective stage:
fertilized egg
Diagnostic
stage:
Eggs in feces
Route of
infection:
ingestion
23
Trichiuriasis
Pathology
o Majority symptomless
o Anterior portion of worm embedded in
intestinal mucosa of large intestine and
feed on cell contents petechial
hemorrhage
o Mucosal damage may facilitate the
invasion of other infections
24
Trichiuriasis
Pathology
o In heavy infection,
The worms spread throughout the
colon to the rectum cause
hemorrhage, mucopurulent stools and
symptoms of dysentery with rectal
prolapse (Trichuris Dysentry
Sindrome = TDS)
Anemia, hypoproteinemia, growth
retardation
25
Trichiuriasis
Pathology
26
Trichiuriasis
Diagnostic
o Eggs in feces
o High eosinophilia in peripheral blood
film
o Sigmoidoscopy adult worms
27
Ancylostomiasis
General
o Etiology
: Ancylostoma duodenale
Necator
americanus
o Habitat
: small intestine
o Recent estimate suggest that
hookworms infect 740 million people
worldwide
28
Ancylostomiasis
Morfology
Adult Ancylostoma duodenale
29
Ancylostomiasis
Morfology
Adult Necator americanus
30
Ancylostomiasis
Morfology
Hookworm larvae
Rhabditiform larvae
Filariform larvae
31
Ancylostomiasis
Morfology
Egg of
Hookworm
32
Ancylostomiasis
Life Cycle
Infective stage:
Filariform larvae
Diagnostic stage:
Eggs in feces
Route of infection:
normally aquired by
skin penetration
A.duodenale
Uncommon, A duodenale
can be transmitted through
undercooked meat including
rabbit, lamb, beef and pork
(Wakanas disease) and
lactogenic during breastfeeding (infantile hookworm)
33
Ancylostomiasis
Pathology
Hookworm disease manifests three

main phases of pathogenesis:
oThe cutaneous or invasion period
oThe migration or pulmonary phase
oIntestinal phase
34
Ancylostomiasis
Pathology
Cutaneous Phase
Begins when larva penetrates the
skin
Pruritic , erythematous, papular rash
at the site entry (ground itch)
35
Ancylostomiasis
Pathology
Pulmonary Phase
Occurs when juveniles break out of the lung capillary
into alveoli and progress up bronchi to the throat
Each sites hemorrhage slightly
Usually asimptomatic, although there may be cough
and sore throat
Pulmonary hookworm infection resembles Lfflers
syndrome because of its association with
eosinophilia in the lung.
Hookworm pneumonitis may indicate severe
infection
36
Ancylostomiasis
Pathology
Intestinal Phase
The attachment of hookworms cutting organ
to the intestinal mucosa and submucosa and
the subsequent rupture of intestinal
capillaries and arterioles blood loss
Hookworm produce active suction impulses
120-200 times per minute
The secretion of anticoagulation by parasite
help to maintain continous oozing of blood at
the attachment site
37
Ancylostomiasis
Pathology
The major clinical manifestations of

hookworm disease: chronic intestinal
blood loss.
Infection with A duodenale causes
greater blood loss than does infection
with N americanus
Estimated blood loss per worm per day:
A duodenale: 0,15 ml
N americanus: 0,03 ml
38
Ancylostomiasis
Pathology
In a very heavy infection iron

deficiency anemia, hypoproteinemia,
edema, potbelly in children, delayed
puberty, mental dullness, impair
cognitive ability, heart failure and
death
39
Ancylostomiasis
Diagnostic
o Hookworm eggs or adult worms in

feces
o Rhabditiform larva cultured from
eggs by Harada-Mori method
o Serology
40
Soil Transmitted
Helminthiasis
Treatment
and Controlthree interventions
WHO has recommended
to control morbidity due to STH infections:
1.Regular drug treatment of high-risk groups
for reduction of the worm burden over time
2.Health education
3.Sanitation supported by personal hygiene
aimed to reducing soil contamination
41
Soil Transmitted
Helminthiasis
Treatment
Control
Regular drugand
treatment
of high-risk groups
The recommended drugs :
1.Albendazole (400mg) tablets given in a
single dose,
2.Levamisole (40mg) tablets given in a
single dose by weight (2.5mg/kg)
3.Mebendazole (500mg) tablets given in a
single dose;
4.Pyrantel pamoate tablets given in a single
dose by weight (10mg/kg)
42
Soil Transmitted
Helminthiasis
Treatment and Control
43
Soil Transmitted
Helminthiasis
Treatment and Control
Health
education
44
Soil Transmitted
Helminthiasis
Treatment
and Control
Sanitation supported
by personal hygiene
aimed to reducing soil contamination
45
Thank
You
46

Soil Transmitted Helminthiasis (Parasitology)

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Soil Transmitted Helminthiasis (Parasitology)

Transféré par

Droits d'auteur :

Formats disponibles

Soil Transmitted

Roberts L, Janovy Jr J. Gerald D. Schmidt & Larry S. Roberts

o Transmitted via soil medium either :

Adult Ascaris lumbricoides

When juveniles break out of lung

Ascaris pneumonitis (Lfflers

o Adult worm out of body openings

o Etiology: Trichiuris trichiura

Adult Trichuris trichiura

Egg of Trichuris trichiura

Adult Ancylostoma duodenale

Adult Necator americanus

Hookworm disease manifests three

The major clinical manifestations of

In a very heavy infection iron

o Hookworm eggs or adult worms in

Vous aimerez peut-être aussi