Pobat parasit.ppt

7/24/2019 Pobat parasit.ppt

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OBAT

PENYAKIT PARASIT

Moch Aris Widodo

PPD UNISMA


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The major parasitic diseases, including::

protozoan diseases (ae!iasis" a#aria$"

he#inthic in%ections (ascariasis" entero!iasis$"

ectoparasitic in%estations (head and !od& #ice$'


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Initial Presentation

Nonspeci%ic %eer" chi##s" ri)ors" diaphoresis" a#aise" oitin) Orthostatic

h&potension"E#ectro#&te a!nora#ities

Erythrocytic Phase

Prodroe* +eadache" anore,ia" a#aise" %ati)-e" &a#)ias Nonspeci%ic cop#aints

s-ch as a!doina# pain" diarrhea" chest pain" and arthra#)ias

Paro,&s* +i)h %eer" chi##s" and ri)or' .o#d phase* Seere pa##or" c&anosis o% the

#ips and nai# !ed" and c-tis" anserina (/)oose %#esh0$

+ot phase* 1eer !et2een 34'56. (743'861$ and 376. (745'961$'

S2eatin) phase*1o##o2s hot phase !& :;< ho-rs' 1eer reso#es

Mar=ed %ati)-e and dro2siness" 2ar" dr& s=in" tach&cardia" co-)h" seere

headache" na-sea" oitin)" a!doina# pain" diarrhea" and de#iri-

>actic acidosis and h&po)#&ceia (2ith %a#cipar- a#aria$ Aneia Sp#enoe)a#&

P. falciparum Infections

+&po)#&ceia" ac-te rena# %ai#-re" p-#onar& edea" seere aneia"

thro!oc&topenia" hi)h?o-tp-t heart %ai#-re" cere!ra# con)estion" seiz-res and coa"

and ad-#t respirator& s&ndroe


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ECTOPARASITES

A parasite that #ies on the o-tside the !od& o% the host is ca##ed an

ectoparasite. Approximately 6 to 12 million people become infested2ith pedic-#osis &ear#& in the United States'749 Pedic-#osis -s-a##& is

associated 2ith poor persona# h&)iene" and in%ections are passed %ro

person to person thro-)h socia# and se,-a# contact' The three t&pes o%

h-an #ice !e#on) to t2o )enera* Pediculus, including the head and

!od& #ice" and Phthirus, with only one species, the crab louse.9,10010!

The h-an #o-se is detecta!#e to the h-an na=ed e&e and eas-resappro,iate#& : to @ in #en)th'


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ICE

The t2o species that !e#on) to this )ro-p inc#-de Pediculus humanus

capitis "head louse# and P. humanus corporis "body louse#. $emale

#ice deposit e))s on the hair' The e))s (or nits$ reain %ir#& attached

to the hair" and in a!o-t 74 da&s" the #ice hatch to %or n&phs"2hich at-re in : 2ee=s' Usin) !oth their piercin) o-th parts and

a p-pin) deice" the #arae and ad-#ts %eed on the !#ood o% the host'

The !od& #o-se and head #o-se are essentia##& identica#" a#tho-)h the&

#ie on di%%erent parts o% the !od&' Un#i=e the head #o-se" 2hich #ies

on the hair" the !od& #o-se is ore %re-ent#& %o-nd on c#othin) o%

the in%ected host'

P-!ic or cra! #ice are %o-nd on the hairs aro-nd the )enita#s" a#tho-)h

the& can occ-r in other areas o% the !od& (e')'" e&e#ashes"

!eards" and a,i##ae$' Patients -s-a##& cop#ain o% seere pr-rit-s

%ro pap-#ar #esions prod-ced !& the !ite o% the #o-se' +&persensitiit&

to %orei)n ateria# inected !& the #ice can prod-ce ac-#ar

s2e##in)s and occasiona##& can #ead to secondar& !acteria#

In%ections'


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!E"ATO#ES

+OOKWORM DISEASE

This is an in%ection o% the sa## intestine ca-sed !& eitherAncylostoma

duodenale or %ecator americanus. %. americanus is foundin the so-theastern United States" 2here the teperat-re and h-idit&

proide the proper enironent'Ancylostoma is seen rarely in the

United States'

The #i%e c&c#es o% !oth species o% hoo=2or are sii#ar' The

ad-#t 2ors #ie in the sa## intestine attached to the -cosa' The

%ea#es #i!erate e))s" 2hich are e#iinated in the %eces and dee#opinto #arae' In%ectie #ara enter the host in containated %ood or

2ater or penetrate the s=in" 2here a pap-#ar er-ption 2ith #oca#ized

edea and er&thea can res-#t'

In the sa## intestine" 2here the ad-#t 2or #ies attached

to the -cosa" in-r& is -s-a##& ca-sed !& echanica# and #&tic

destr-ction o% tiss-e' The #oss o% !#ood can #ead to aneia andh&poproteineia'98C87

Stoo# sho-#d !e e,ained %or e))s and the rha!diti%or #arae'

Eosinophi#ia (@4 to


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TREAT"E!T: $oo%&orm #isease

Me!endazo#e (ero,$" an ora# s&nthetic !enziidazo#e" is the

a)ent o% %irst choice' It is a#so e%%ectie a)ainst ascariasis" entero!iasis"

and trich-riasis'&he adult dose for treatment of hoo=2or in%estation is 744

) t2ice dai#& %or @ da&s' Pediatric patients o#der than : &ears o% a)e sho-#d

receie the sae dose as ad-#ts'

AS.ARIASIS

Ascariasis is ca-sed !& the )iant ro-nd2orAscaris lumbricoides.

1ea#e 2ors ran)e %ro :4 to @5 c in #en)th' The 2or is %o-nd

2or#d2ide !-t ore coon#& in areas 2here sanitation is poor'

Appro,iate#& 3 i##ion peop#e in the United States hae ascariasis'.#inica# Mani%estations

D-rin) i)ration o% the #arae thro-)h the #-n)s" patients can present 2ith

pne-onitis" %eer" co-)h" eosinophi#ia" and p-#onar& in%i#trates''ther

symptoms of ascariasis include abdominal discomfort a!doina# o!str-ction"

oitin)" and appendicitis'Dia)nosis is ade !& deonstratin) the characteristic

e)) in the stoo#TREAT"E!T: Ascariasis

In !oth ad-#ts and pediatric patients o#der than : &ears o% a)e" the

treatent %or ascariasis is e!endazo#e (ero,$ 744 ) t2ice dai#&

%or @ da&s' An a#ternatie dr-) %or ascariasis is p&rante# paoate

(Antiinth$''


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A"E'IASIS

EPIDEMIO>OFY AND ETIO>OFY

Beca-se o% its 2or#d2ide distri!-tion and serio-s )astrointestina#

ani%estations" ae!iasis is one o% the ost iportant parasitic diseases

o% h-ans'

The aor ca-satie or)anis in ae!iasis is (ntamoeba histolytica, 2hich

inha!its the co#on and -st !e di%%erentiated %ro the (. dispar, 2hich is

associated 2ith an as&ptoatic carrier state and is considered nonpatho)enic'

A#tho-)h (. histolytica and (. dispar are indistin)-isha!#e orpho#o)ica##&" recent

research-sin) onoc#ona# anti!odies has !een a!#e to separate the t2o

Inasie ae!iasis is a#ost e,c#-sie#& the res-#t o% (. histolytica

in%ection' Appro,iate#& 54 i##ion cases o% inasie disease res-#t

each &ear 2or#d2ide" #eadin) to an e,cess o% 744"444 deaths'

The incidence o% ae!iasis is estiated at a!o-t 3 in the )enera# pop-#ation'35The hi)hest incidence is %o-nd in instit-tiona#ized enta##& retarded patients"

se,-a##& actie hoose,-a#s" patients 2ith ac-ired i-ne de%icienc& s&ndroe

(AIDS$


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TREAT"E!T: Ame(iasis

#ESIRE# O)TCO"E

In ae!iasis" the )oa#s o% therap& are initia##& to eradicate the parasite

!& -se o% speci%ic ae!icides and then to render s-pportie therap&'

TREAT"E!T RE*I"E!S

An-!er o% di%%erent re)iens hae !een s-))ested dependin) on thecate)or& o% ae!iasis*

as&ptoatic c&st passers"

intestina# ae!iasis"

ae!ic #ier a!scess'

E#ectro#&te rep#aceent and n-tritiona# s-pport are essentia# ad-nctie treatent

oda#ities' >ar)e hepatic a!scess or ae!ic pericarditis a& re-ire need#e

aspiration" perc-taneo-s catheter draina)e" or rare#&" s-r)er& !e%ore dr-)

therap&'

Most re)iens re-ire a co!ination o% dr-)s adinistered conc-rrent#& or

se-entia##&'A care%-# histor& sho-#d !e ta=en 2hen one o% the di%%erentia# dia)noses

is -#ceratie co#itis !eca-se corticosteroid adinistration has the potentia# to

-nas= ae!iasis and prod-ce to,ic e)aco#on' A## patients dia)nosed as

hain) in%#aator& !o2e# disease sho-#d hae their stoo#s e,ained care%-##&

and sero#o)ic testin) done %or ae!iasis to aoid the serio-s conse-ence that

res-#ts %ro the adinistration o% corticosteroids'


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P$AR"ACOO*IC T$ERAP+

Metronidazo#e (1#a)$" tetrac&c#ine" deh&droeetine" and ch#oro-ine

(Ara#en$ are tiss-e?actin) a)ents"(are a!sor!ed 2e##$

2hereas iodo-ino# (Yodo,in$" di#o,anide %-roate (1-raide$" and paroo&cin

(+-atin$ are #-ina# ae!icides (POOR ABSORBED$

In the as&ptoatic c&st passer" it is necessar& to eradicate the ca-satie a)ent

%ro the #-en to preent intestina# ae!iasis or the dee#opent o% ae!ic #ier

a!scess'

Dr-) e%%ectieness -st !e onitored !& stoo# e,aination"

i'e'" %ro one to three ne)atie speciens %ro 7 to @ onths a%ter

treatent'

As&ptoatic c&st passers and patients 2ith i#d intestina#

ae!iasis sho-#d receie one o% the %o##o2in) #-ina# a)ents*

paroo&cin:5;@4 )G=) per da& three ties dai#& %or H da&s"

iodo-ino#


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Patients 2ith seere intestina# disease or #ier a!scess

sho-#d receie etronidazo#e H54 ) three ties dai#& %or74 da&s" %o##o2ed !& a co-rse o% one o% the #-ina#

a)ents indicated ear#ier'

An a#ternatie re)ien o% etronidazo#e :'3 )Gda& %or :

da&s has !een s-))ested to treat intestina# ae!iasis'35

In the pediatric patient" the dose o% ora# etronidazo#e is

54 )G=) per da& in diided doses to !e %o##o2ed !& a

#-ina# a)ent'

Patients 2ho are too i## to ta=e ora# etronidazo#e sho-#d

receie the dr-) in e-ia#ent doses !& the intraeno-s

ro-te'


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*IAR#IASIS


)iardia lamblia (a#so =no2n as ). intestinalis or ). duodenalis$" anenteric protozoan" is the ost coon intestina# parasite responsi!#e

%or diarrhea# s&ndroes thro-)ho-t the 2or#d' The ost %re-ent#& identi%ied

intestina# parasite in the United States" 2ith a prea#ence rate o% 7


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PAT+O>OFY

Fiardiasis res-#ts %ro in)estion o% ). lamblia c&sts in %eca##& containated

2ater or %ood' The protozoan e,c&sts -nder the sti-#-s o% #o2)astric p+ to

re#ease the trophozoite' .o#onization and -#tip#ication o% the trophozoite #ead to

-cosa# inasion" #oca#ized edea" and %#attenin) o% the i##i" res-#tin) ina#a!sorption states in the host'

>actose into#erance precipitated !& )iardiasis can persist een a%ter eradication

o% the protozoan' Ach#orh&dria" h&po)aa)#o!-? Steatorrhea" itain B7: and

%at?so#-!#e itain de%iciencies aneia" or de%icienc& in secretor& -no)#o!-#in

A (I)A$ are predispositions %or )iardiasis

Clinical Presentation of *iardiasis

Acute Onset

Diarrhea" crap#i=e a!doina# pain" !#oatin)" and %#at-#ence Ma#aise" anore,ia"

na-sea" and !e#chin)

ChronicDiarrhea* 1o-#?se##in)" copio-s" #i)ht?co#ored" %att& stoo#s 2ei)ht

>oss Periods o% diarrhea a#ternatin) 2ith constipation Steatorrhea" itain B7:

and %at?so#-!#e itain de%iciencies


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A## s&ptoatic ad-#ts and chi#dren o#der than 9 &ears o% a)e sho-#d !e

treated 2ith etronidazo#e :54 ) three ties dai#& %or H da&s' Thea#ternatie dr-)s inc#-de %-razo#idone 744 ) %o-r ties or paroo&cin

:5;@4 )G=) per da& in diided doses dai#& %or 7 2ee='

Paroo&cin :5;@4 )G=) per da& in three doses%or H da&s or !acitracin or

!acitracin zinc a& !e sa%e a)ents in pre)nanc&'

The pediatric dose %or etronidazo#e is 75 )G=) per da& three ties dai#& %or5 to H da&s'

1-razo#idone s-spension < )G=) per da& in %o-r doses %or H to 74 da&s and

nitazo,anide (A#inia$ s-spension (a recent#& approed a)ent$ 744;:44 )

eer& 7: ho-rs %or @ da&s are a#ternatie dr-)s %or chi#dren'

A#!endazo#e 344 ) dai#& %or 5 da&s has !een cited to prod-ce c-re rates o%8H and as !ein) e-ia#ent to etronidazo#e in chi#dren'


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EIS$"A!IASIS


This disease is ca-sed !& a protozoan !e#on)in) to the )en-s *eishmania.

The three ariations o% the disease are iscera# #eishaniasis(+ala?azar" /!#ac= %eer"0 or Assa %eer$" c-taneo-s #eishaniasis"

and -coc-taneo-s #eishaniasis' The iscera# %or is ca-sed

predoinant#& !& *. donoani, 2hereas the other t2o %ors are ca-sed

!& other species'

*eishmania e,ist in t2o %ors* as a %#a)e##ated e,trace##-#ar parasite

in the sand%#& ector (Phlebotomus in the Indian s-!continent and*ut-omyia and Psychodopygus in North and So-th Aerica" A%rica"

or the Midd#e East$ and an a%#a)e##ar aasti)ote (intrace##-#ar %or$

in the host'

The aor reseroirs %or *eishmania, dependin) on )eo)raphic #ocation" are

do)s" %o,es" s-irre#s" and rodents' The sand%#ies in)est the parasite 2hen the&

%eed on the reseroir ania#s' A%ter etaorphosis in the )-t o% the sand%#&" theparasite is trans%erred to the h-an host 2hen the in%ected sand%#& ta=es a

!#ood ea#' .-taneo-s #eishaniasis seen ost %re-ent#& in the United States

is ca-sed !& either *. bra-iliensis or *. mexicana, 2hich are endeic to

so-th Me,ico and .entra# Aerica'


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Clinical "anifestation of eishmaniasis

isceral: Early

Pap-#e that a& -#cerate" As&ptoatic period (disseination o% the aasti)ote

to or)ans* sp#een" #ier" !one arro2" and #&phatic tiss-e$

isceral: ate -./0 "onths1

1eer" chi##s" a#aise" 2ei)ht #oss" a!doina# distension" and+epatosp#enoe)a#& Persistin) raised -#cer

Cutaneous and "ucocutaneous

M-ti#ation o% nose" so%t pa#ate" and trachea (*. bra-iliensis$ -ired %ro

trans%-sion o% containated !#ood and accidenta# need#e stic= in-ries' Patients

2ith adanced?sta)e ac-ired i-node%icienc& s&ndroe (AIDS$ are reported

to !e hi)h#& s-scepti!#e to #eishaniasis'

TREAT"E!T: eishmaniasis

#ESIRE# O)TCO"E

The aor )oa# is to eradicate the aasti)ote in the tiss-e and to

iniize the ens-in) cop#ications o% #eishaniasis'


A## three %ors o% #eishaniasis are treated 2ith sti!o)#-conate

sodi- (antion& sodi- )#-conate?pentaa#ent antion&"Pentosta$" 2hich


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Fiardiasis

Naa * A#!endazo#e :44 ) ta!#et (zente#$

Indi=asi *Fiardiasis Ascariasis Ne-roc&sticercosis

E%e= sapin) FI* A!doina# pain" na-sea" diarrhea" increase in #ier %-nction

enz&es

+ati hati * Not recoended in chi#dren : &ears o#d

J-inacrine 744 )

FI* Na-sea" anore,ia" oitin) +eadache" to,ic ps&chosis" hepatitis" and ap#astic

aneiaAoid in pre)nanc&" ps&chosis and psoriasis

Nitazo,anide (A#inia$744 )G5 > s-spension

A!doina# pain" diarrhea" oitin)" and headache

Rare#& a& prod-ce &e##o2 sc#erae

Metronidazo#e (1#a)$ Ora#* :54?)" 544?) ta!#ets

FI* Na-sea" anore,ia" oitin)" diarrhea" a!doina# crapin)" )#ossitis" eta##ic

taste .NS* Dizziness" erti)o" headache" paresthesias

Aoid a#coho# a#coho# in)estion 2i## ca-se the dis-#%ira reaction* a!doina#

distress" oitin)" h&potension

/ontraindication 1irst triester o% pre)nanc&


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MA>ARIAAto2a3uone 456 mgplus Proguanil 766 mg Proguanil 766 mg -"alarone1 Pre2ention and

treatment of P. falciparum malaria

A(dominal pain, nausea, 2omiting and headache

Chloro3uine phosphate -Aralen, !i2a3uine1 4568 and 5668mg ta(lets9 56 mgm -as$Cl19 58m ampule

"alaria

*I: !ausea, 2omiting, diarrhea C!S: #i;;iness, headache, (lurring of 2ision, confusion,

fatigue #ermime 566 mg -?ansidar1 P. falciparium/resistant

"alaria ES *I: !ausea, a(dominal pain, stomatitis< $emat


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"alaria

J-inidine )#-conate 544 ) !aseG> 74 >

Ac-te a#aria

FI* Na-sea" oitin)" diarrhea

.ard'* +&potension" 2idenin) o% JRS and JT on E.F" heart !#oc=

Adinistration o% I -inidine re-ires c#ose onitorin) sho-#d nora##& onitor

E.F and a## ita# si)ns

J-inine s-#%ate @:5?) and $

.ard'* +&potension" 2idenin) o% JRS cop#e,

+eat'* +eo#&sis" #e-=openia" thro!oc&topenia

When dr-) is adinistered I" it sho-#d !e adinistered !& s#o2 in%-sion (


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Ae!iasis

Di#o,anide %-roateb (1-raide$ 544?) ta!#et

FI* Na-sea" %#at-#ence ES* Der'* Pr-rit-s

Iodo-ino# (Yodo,in$ :74?) ta!#et

FI* A!doina# pain" diarrheaDer'* Rash Ma& inter%ere 2ith th&roid %-nction test

/ontraindication Patients 2ith iodine into#erance

Metronidazo#e (1#a)$ Ora#* :54?)" 544?) ta!#ets

FI* Na-sea" anore,ia" oitin)" diarrhea" a!doina# crapin)" )#ossitis" eta##ic

taste .NS* Dizziness" erti)o" headache" paresthesias

Aoid a#coho# a#coho# in)estion 2i## ca-se the dis-#%ira reaction* a!doina#

distress" oitin)" h&potension

/ontraindication 1irst triester o% pre)nanc&


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O!at cacin)

Ierectin (Stroecta#$


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Sodi- sti!o)#-conate(Pentosta$f

>eishaniasis

FI* Na-sea" oitin)" a!doina# pain" pancreatitis" increase >1Ts

M-sc-#os=e#* M&a#)ia" %ati)-e .ard'* T?2ae inersion" !rad&cardia

+eat'* >e-=openia" thro!oc&topeniapancreatitis

+i)h#& to,ic" re-ires care%-# onitorin) o% ita#s and E.F ca-tion in patients 2ith

#ier or cardiac pro!#es

Ni%-rtio,d (>apit" Ba&er :54:$

So-th Aerican tr&panosoiasisFI* Anore,ia" na-sea

.NS* Periphera# ne-ritis" ps&chosis

+eat* +eo#&sis in F


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