Soil Transmitted Helminthiasis [Parasitology]
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Transcript of Soil Transmitted Helminthiasis [Parasitology]
Soil Transmitted Helminthiasis
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Refference
1. 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
2. Brooker S, Bundy DAP, Soil Transmitted Helminths (Geohelminths). In : Cook GC, Zumla AI (ed). Manson’s Tropical Disease. 22nd ed. Saunders Elsevier. 2009 : 1517-40
3. 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
4. World Health Organization. Weekly Epidemiological Record : Soil- Transmitted Helminthiasis : Estimates of The Number of Children Needing Preventive Chemotherapy and Number Treated . Geneva, Switzerland : World Health Organization; 2011
5. Hotez PJ, Brooker S, Bethony JM, et al. Hookworm Infection. The New England Journal of Medicine. 2004; 351 : 799-807
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References
• Agents of the disease• Pathology• Diagnosis • Prevention
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Soil Transmitted HelminthiasisLearning Objective
Soil Transmitted HelminthiasisGeneral
o Nematode infections
o Transmitted via soil medium either :
1. Ingestion of embryonated eggs
2. Skin penetration by infective larvae
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o Etiology :• Ascaris lumbricoides• Trichuris trichiura• Hookworms• Strongyloides stercoralis• Toxocara spp.
Soil Transmitted HelminthiasisGeneral
Common STH agents
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o Infections STH associated 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 sanitation
Soil Transmitted HelminthiasisGeneral
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Soil Transmitted HelminthiasisGlobal Estimation
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o Etiology : Ascaris lumbricoides (roundworm)o Habitat : small intestine, especially jejunum
and upper ileumo One of the most common & widespread human
infection, about 1 billion people worldwide
AscariasisGeneral
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Ascaris lumbricoidesMorfology
Adult Ascaris lumbricoides
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Ascaris lumbricoidesMorfology
corticated
decorticated
Egg of A. lumbricoides
Fertilized Unfertilized
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Ascaris lumbricoidesMorfology
Infectious corticated
Egg of A. lumbricoides
AscariasisLife Cycle
Infective stage: fertilized eggDiagnostic stage: egg & adult in fecesRoute of infection: ingestion
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o Majority symptomlesso May be caused by migrating larvae or adult
worms
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AscariasisPathology
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Migrating Larvae
AscariasisPathology
• 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 (Löffler’s pneumonia)
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• Ascaris pneumonitis (Löffler’s pneumonia): fever, cough, sputum, wheeze, skin rash, eosinophilia, and radiological pulmonary infiltration.
• Larvae may wander into the brain, eye, causing granulomas.
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AscariasisPathology
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• 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
AscariasisPathology
Adult worms
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• The commonest complication of ascariasis among children below 10 years is small-bowel obstruction
• Heavy infection can cause intestinal colic, fatal intestinal blockage
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AscariasisPathology
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• 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
AscariasisPathology
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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 dailyOne gram of rice contains ± 0.8g carbohydrateWe will lose carbohydrate: ± 110.880 Kg/ daily ≈ 110 tons of
rice/dayOne gram of meat contains 0.19g proteinWe will lose protein: ± 145.895 kg/day ≈ 729 cows (á 200 Kg)
Ascariasis
o Adult worm out of body openings
o Larvae std 4th in sputum
o Eggs in feces – fertilized/unfertilized
o Eosinophilia
o Serology (?)
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AscariasisDiagnostic
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o Etiology: Trichiuris trichiura (whipworm)o Habitat: large intestine, especially caecum and
vermiform appendixo Recent estimate suggests that T trichiura
infects 795 million people worldwide
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TrichiuriasisGeneral
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TrichiuriasisMorfology
Adult Trichuris trichiura Egg of Trichuris trichiura
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TrichiuriasisLife cycle
Infective stage: fertilized eggDiagnostic stage: Eggs in fecesRoute of infection: ingestion
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o Majority symptomlesso 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
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TrichiuriasisPathology
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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
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TrichiuriasisPathology
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TrichiuriasisPathology
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o Eggs in feces
o High eosinophilia in peripheral blood filmo Sigmoidoscopy – adult worms
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TrichiuriasisDiagnostic
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AncylostomiasisGeneral
o Etiology : Ancylostoma duodenale Necator americanus
o Habitat : small intestine o Recent estimate suggest that hookworms
infect 740 million people worldwide
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AncylostomiasisMorfology
Adult Ancylostoma duodenale
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AncylostomiasisMorfology
Adult Necator americanus
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AncylostomiasisMorfology
Hookworm larvae
Rhabditiform larvae Filariform larvae
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AncylostomiasisMorfology
Egg of Hookworm
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Infective stage: Filariform larvaeDiagnostic stage: Eggs in fecesRoute of infection: normally aquired by skin penetration A.duodenale
AncylostomiasisLife Cycle
Uncommon, A duodenale can be transmitted through undercooked meat including rabbit, lamb, beef and pork (Wakana’s disease) and lactogenic during breast-feeding (infantile hookworm)
Hookworm disease manifests three main phases of pathogenesis: oThe cutaneous or invasion periodoThe migration or pulmonary phaseoIntestinal phase
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AncylostomiasisPathology
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• Begins when larva penetrates the skin• Pruritic , erythematous, papular rash at the
site entry (ground itch)
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AncylostomiasisPathology
Cutaneous Phase
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AncylostomiasisPathology
• 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 Löffler’s
syndrome because of its association with eosinophilia in the lung.
• Hookworm pneumonitis may indicate severe infection
Pulmonary Phase
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• The attachment of hookworm’s 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
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AncylostomiasisPathology
Intestinal Phase
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• 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 mlN americanus: 0,03 ml
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AncylostomiasisPathology
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• In a very heavy infection → iron deficiency anemia, hypoproteinemia, edema, potbelly in children, delayed puberty, mental dullness, impair cognitive ability, heart failure and death
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AncylostomiasisPathology
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AncylostomiasisDiagnostic
o Hookworm eggs or adult worms in feceso Rhabditiform larva cultured from eggs by
Harada-Mori methodo Serology
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WHO has recommended three interventions to control morbidity due to STH infections: 1.Regular drug treatment of high-risk groups for reduction of the worm burden over time2.Health education 3.Sanitation supported by personal hygiene aimed to reducing soil contamination
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Soil Transmitted Helminthiasis Treatment and Control
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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)
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Regular drug treatment of high-risk groups
Soil Transmitted Helminthiasis Treatment and Control
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Soil Transmitted Helminthiasis Treatment and Control
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Soil Transmitted Helminthiasis Treatment and Control
Health education
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Soil Transmitted Helminthiasis Treatment and Control
Sanitation supported by personal hygiene aimed to reducing soil contamination
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Thank You
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