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PARASITIC DISEASES CAUSING ANAEMIA

PARASITIC DISEASES CAUSING ANAEMIA. Prof.Dr . Supargiyono , DTM&H, PhD. SpParK. Gastrointestinal Urogenital Blood Lymph Respiratory system Tissue/body cavity. Protozoa Sarcodina  pseudopodia Mastigophora (Flagellata)  flagella Ciliophora (Cilliata)  cilia

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PARASITIC DISEASES CAUSING ANAEMIA

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  1. PARASITIC DISEASES CAUSING ANAEMIA Prof.Dr. Supargiyono, DTM&H, PhD. SpParK

  2. Gastrointestinal Urogenital Blood Lymph Respiratory system Tissue/body cavity Protozoa Sarcodina  pseudopodia Mastigophora (Flagellata)  flagella Ciliophora (Cilliata)  cilia Sporozoa ( do not move) PLASMODIUM  MALARIA Helminth (Worms) NemathodesHOOKWORM Cesthodes Tremathodes Arthropoda HABITAT OF THE HUMAN PARASITES

  3. MALARIACaused by blood protozoa : Plasmodium Plasmodium sp. Infecting human : • P. falciparum falciparum malaria; tropical malaria; malignant tertian malaria • P. vivax vivax malaria; benign tertian malaria • P. ovale ovale malaria; tertian malaria • P. malariae quartan malaria • P. knowlesi  monkey malaria human

  4. MALARIA LIFE CYCLE Clinical manifestation

  5. Acute attack of malaria • Cold stage • Chill(dingin), rigor(kaku) • Hot Stage • Fever increased(demam tinggi) • Headache(sakit kepala) • Flashing face(muka merah) • Sweating stage • Profuse sweating(banyak keringat) • Decrease body temperature(demam turun) • Feeling of Relief (fall a sleep) (merasa sehat)

  6. Sporogonic cycle

  7. General Morphology of Malaria Parasite Schufner dots Mature schizont

  8. BLOOD PARASITES:Plasmodium falciparum Mauer cleft Supargiyono 13/07/2011

  9. Thick Smear of Malaria falciparum(heavy infection of young trophozoites) My Pictures\falciparum_thickfilm_1.jpg

  10. Sexual - Gametocyte stages

  11. Plasmodium vivax

  12. Schizont stages P.f. P.m. P.v. P.o.

  13. Sexual - Gametocyte stages

  14. Malaria • P.falciparum causing severe malaria • Clinical manifestation: due to eritrocytic stage • Rupture of IRBC : released Antigens & toxins • Mature trophozoite adhere to endothelial cells • Haemolytic anaemia: • Periodical rupture of mature schizonts • Immune complex INDIRECT rupture of uninfected normal erythrocytes • Marrow suppression by some toxin of malaria parasites Marrow aspirates: dyserythropoiesis, phagocytosis of uninfected red cells

  15. Fig. 3: Schematic representation of resetting and cytoadherence leading to vessel obstruction in P. falciparum infection. Parasites inside red blood cells are depicted as black circle. Arrow shows an infected red blood cell involved in both cytoadherence and resetting. Supargiyono 13/07/2011

  16. Cerebral malaria

  17. Malaria & Pregnancy Pregnancy Physiological anemia during pregnancy Microcirculatory arrest in the placenta may cause fetal death, small-for-date babies, and premature stage (mainly in 1st pregnancy) Congenital malaria May occur in all species of malaria but very rare Progressive hemolytic anemia may accur

  18. TREATMENT TARGETS

  19. ANTIMALARIALS • TISSUE schizontocides: primaquine (8-aminoquinoline derivatives) • ERYTHROCYTIC schizontocides: • Chloroquine • Sulfadoxine-pyrimethamine • Quinine • Antibiotics • GAMETOCYTOCIDES: primaquinelength species dependent • NEW POLICY (2008) ACT • Artemisinine Combination Theraphy

  20. Preparation of thin and thick blood smears

  21. Preparation of thin and thick blood smears

  22. Giemsa staining • Thin film were fixed in absolute methanol for 30-60 second • No fixation for thick smear • Prepare 5% Giemsa solution with buffer/destilated water • Thick and thin smear were put into 5% Giemsa for 30 minutes • Carefully washed off the stain in runing tap water • Dry the slides and examined with 100x objective

  23. Thick & Thin Smear of Malaria heavy infection of young trophozoites of P.f. My Pictures\falciparum_thickfilm_1.jpg

  24. Immuno-chromatographic technology  Rapid Diagnostic Test (RDT) RDT for Malaria: detect malaria antigens

  25. Diagnosis Parasitic Infection using Polymerase Chain Reaction (PCR) Every single parasite DNA were amplified thousands time using specific Primers easily detected

  26. Pengobatan malaria falsiparum dengan Dihydroartemisinin+Piperaquin(DHP) dan Primakuin Dihydroartemisinin = 2-4 mg;Kg BB Piperakuin = 16-32 mg/Kg BB Primakuin = 0,75 mg/Kg BB (untuk membunuh gametocyte)

  27. Pengobatan malaria vivak dengan DHP+Primakuin Dosis Primakuin = 0,25 mg/Kg BB selama 14 hari (membunuh gametosit dan hypnozoit dalam sel hati)

  28. Pengobatan Malaria falsiparum dg Artesunat-Amodiakuin Artesunat = 4 mg/Kg BB Amodiakuin = 10 mgkKg BB Primaquin 0,75 mg/Kg BB

  29. Pengobatan Malaria vivak dg Artesunat-Amodiakuin dan Primakuin Artesunat = 4 mg/Kg BB Amodiakuin = 10 mgkKg BB Primaquin 0,25 mg/Kg BB selama 14 hari

  30. HOOKWORMSsoil transmitted helminth • Ancylostoma duodenale • Necator americanus • Ancylostoma braziliesis • Ancylostoma cyelanicum • Ancylostoma caninum

  31. Ancylostoma duodenale • ADULT WORM : - CURVED BODY  LETTER C FEMALE : 10 - 13 mm  0,6 mm MALE : 8 - 11 mm  0,5 mm - MOUTH : 2 PAIRS OF TEETH SAME SIZE - COPULATRIX BURSAE : EXTERNOLATERAL MEDIOLATERAL and POSTEROLATERAL sternum are separated each other - SPICULE MALE: A PAIR, PARALLEL

  32. Necator americanus • ADULT WORM : - CURVED BODY s - MOUTH: A PAIR OF CHITINOUS CUTTING PLATES - FEMALE :  9-11 mm  0,4 mm - MALE :  7-9 mm  0,3 mm - BURSA COPULATRIX (RAYS) EKSTERNOLATERAL sternum (el) is separated from MEDIOLATERAL st (ml). which is attached to POSTERO- LATERAL st. (pl) - SPICULE IN MALE: A PAIR, POINTED TIP

  33. HOST’S SKIN  VENOUS BLOOD  RIGHT HEART  LUNG  PENETRATES ALVEOLI  BRONKHUS  TRAKHEA  PHARYNX  SWALLOWED FAECES DEFINITIVE HOST PREPATENT P. 6 – 10 mo SMALL INTESTINE ADULT WORM Life cycle • Definitive host : human/animal EGGSRHABDITIFORM LARVA  FILARIFORM LRV SOIL: DAMP, SHADE, WARM

  34. Life cycle of Hookworm

  35. PATHOLOGY & CLINICAL SIGNS • LARVA PENETRATES THE INTACT SKIN hair follicle MACULO PAPULES & ERYTHEMATOUS ITCHYGROUND ITCH / DEW ITCH LARVAE (MANY) MIGRATE TO LUNGS, SENSITIVE INDIVIDUALBRONCHITIS / PNEUMONITIS • CHRONIC INFECTION  iron-deficiency in type + folate deficiency  ANAEMIA : MICROCYITIC HYPOCHROMIC • Anaemia does not develop until iron reserves are exhausted, after a prolonged period of negative iron balance.

  36. FACTORS GENERATING ANAEMIA • WORM LOAD (N. americanus causes blood loss of 0.05ml/day) • SPECIES OF WORM (A.DUODENALE CONSUMES 4-5 TIME than N.a A DAY) (0.15 vs 0.05 ml/day/worm) • IRON INTAKE (4-40 MG /DAY) • AVAILABILITY OF IRON IN DIETS (high phytic acid intake reduces the iron intake) • Disturbance of IRON ABSORPTION • THE PRESENCE OF OTHER CONDTION INCREASING IRON DEMANDS (pregnancy, menstruation)

  37. ANEMIA PATHOLOGY & CLINICAL SYMPTOM ARE POSITIVELY ASSOCIATED TO WORM DENSITY & FOOD INTAKE* 50 WORMS  SUB CLINICAL* 50 –125 WORMS CLINICAL SYMPTOM MAY APPEAR* 500 WORMS  BODY WEIGHT DEPENDENT SYMPTOMS IN ACUTE INECTION:* APPETITE - / +* NAUSEA, VOMITING* DIARHOEA, CONSTIPATION* HYPERTROPHY OF HEART SOUNDS* QUICK PULSE , EOSINOPHILIA HEAVY INFECTION IN CHILDRENPHYSICAL & MENTALLY DISTURBED

  38. DIAGNOSISClinical :- WEAKNESS (TIREDNESS) - ACHING MUSCLES- SHORT BREATH (BREATHLESSNESS)- OEDEMA (related to heart failure and low serum albumin) - PALE (Pucat) - DYSPHAGIA - KOILONYCHIA (typical of iron deficiency) - SMOOTH RED TOUNGUE AND ANGULAR STOMATITIS (RARE)

  39. RADIOLOGY :- HIPERMOTILITY OF INTESTINELABORATORY :- FINDING THE EGGS IN FAECES* QUALITATIVE : DIRECT & CONCENTRATION* QUANTITAIVE : KATO METHOD  INTENSITY* CULTURE HARADA MORI  IDENTIFICATION L.Filariform larvae MORE SENSITIVE

  40. Ancylostoma ceylanicum • ADULT : - BODY: CURVED  C FEMALE :  7 mm MALE :  5 mm - MOUTH : ROUND OPENING 2 PAIRS VENTRAL TEETH, 1 PAIR INNER LITTLE TEETH 1 PAIR OUTER BIG TEETH - COPULATORY SEGMENT : EXTERNO LATERAL ST. SEPARATED FROM 2 LATERAL STERNUM SITTING SIDE BY SIDE

  41. Ancylostoma caninum • ADULT : - FEMALE: 14 mm  0,6 mm - MALE : 10 mm  0,4 mm - MOUTH : 3 PAIRS OF STRONG TEETH - COPULATORY SEGMENT : ALL THREE STERNUM ARE LONG AND SEPARATED EACH OTHER

  42. CREEPING ERUPTION LARVA FIL HUMAN SKIN  STRATUM GERMINATIVUM TUNNEL MOVES FEW mm – cm / DAY  WEEKS/MONTHS CUTANEUS LARVA MIGRAN SKIN LESSION : - ERYTEHMA - VESICLE - ITCHY  SECONDARY INFECTION PUSTULE SYMPTOM: ITCHY & HOT SKIN DURING LARVA INVASION DIAGNOSIS :- CREEPING SKIN LESION

  43. References: 1. Craig and Faust's : CLINICAL PARASITOLOGY, 8th edition 2. Markel, Voge, John: Medical Parasitology, 6th edition

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