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PARASITOLOGY IN THE CLINIC

PARASITOLOGY IN THE CLINIC. DEPARTMENT OF PARASITOLOGY FACULTY OF MEDICINE PADJADJARAN UNIVERSITY. INTRODUCTION. PARASITIC DISEASE IN ASIA (A VERY COMMON DISEASE) Asia is in the tropic area Low grade of Social Economic Low grade of education The bad habit of the people.

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PARASITOLOGY IN THE CLINIC

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  1. PARASITOLOGY IN THE CLINIC DEPARTMENT OF PARASITOLOGY FACULTY OF MEDICINE PADJADJARAN UNIVERSITY

  2. INTRODUCTION PARASITIC DISEASE IN ASIA (A VERY COMMON DISEASE) • Asia is in the tropic area • Low grade of Social Economic • Low grade of education • The bad habit of the people

  3. PARASITIC PROTOZOA • BALANTIDIASIS • CRYPTOSPORIDIASIS • GIARDIASIS • PNEUMOCYSTOSIS • SARCOSPORIDIOSIS • TOXOPLASMOSIS

  4. ANGYOSTRONGYLIASIS ASCARIASIS DIPYLIDIASIS DIROFILARIASIS FASCIOLIASIS HYDATIDOSIS HYMENOLEPIASIS LARVA MIGRANS LINGUATULIASIS PHYSALOPTERIASIS SCHISTOSOMIASIS SPARGANOSIS STRONGYLOIDIASIS TAENIASIS SAGINATA TRICHINOSIS TRICHSTRONGYLIDIASIS PARASITIC HELMINTHES

  5. Cases found in Surgical clinic • Ascariasis – as emergency cases : intestinal obstruction, intestinal perforation • Severe Trichuriasis – prolapsus ani • Trichinelliasis • Filariasis – elephantiasis • Cysticercosis cellulosae • Hydatid cyst • Coenuriasis • Sparganosis • Amoebic abscess, amoeboma • Parasitic Pneumonia caused Pneumocystis carinii

  6. Cases likely found in Neurosurgery examination • Cysticercosis cellulosae in the brain • Hydatidosis in the brain • Coenuriasis in the brain • Sparganosis in the brain • Amoebic abces in the brain

  7. INTERNAL MEDICINE MAY BE FOUND Ascariasis Trichuriasis Hookworm infektion Strongyloidiasis Enterobiasis (rare in adult age) Trichostrongyliasis Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

  8. INTERNAL MEDICINE MAY BE FOUND Visceral Larva Migrans (VLM) Diphyllobothriasis Taeniasis saginata Taeniasis solium Hymenolepsiasis Nana Diphylidiasis caninum Echinococcosis

  9. CASES COMMONLY FOUND IN PEDIATRIC WARD Ascariasis Trichuriasis Hookworm infection (rare ini the children) Strongyloidiasis Enterobiasis Trichostrongyliasis Capillariasis (find in Philippines and Thailand, never yet find in Indonesia)

  10. CASES COMMONLY FOUND IN PEDIATRIC WARD Visceral Larva Migrans (VLM) Diphyllobothriasis Taeniasis saginata Taeniasis solium Hymenolepsiasis nana Hymenolepsiasis diminuta Diphylidiasis caninum Echinococcosis

  11. CASES LIKELY FOUND DURING SKIN EXAMINATION Cutaneous Larva Migrans (Creeping Eruption) Trichinelliasis Ground Itch Swimmer's Itch Cutaneous Amoebiasis Sarcosporidiosis caused by Sarcocystis sp. Arthropod infection : Cutaneous Myiasis; Scabies; Pediculosis

  12. OPHTHALMOLOGIST MAY FIND • Toxoplasmosis • Disturbance of the eye by Acanthamoeba sp. • Case never reported in Indonesia : loaiasis (worm in subconjunctiva); blinding filariasis or river blindness by Onchocerca volvulus

  13. PARASITES MAY BE FOUND IN OBSTETRIC WARD • Toxoplasmosis • Trichomoniasis vaginalis

  14. PARASITES MAY BE FOUND IN NEUROLOGICAL CLINIC • Trichinosis • Angiostrongyliasis • Gnathostomiasis • Schistosomiasis • Paragonimiasis • Cysticercosis • Hydatidosis • Draconcoliasis

  15. PARASITES WHICH MAY BE FOUND IN NEUROLOGICAL CLINIC • Coenuriasis • Amebic Brain Abscess • Toxoplasmosis • Cerebral Malaria • Trypanosomiasis • Primary Amebic Meningo-encephalitis (PAM) • Tick paralysis

  16. Parasites living inside the tissue or blood circulation of sensitive/ hypersensitive person, may induce allergic reaction or even anaphylactic reactions Example : Larvae of Ascaris lumbricoides, hookworm, Strongyloides stercoralis, Trichinella spiralis Bursting of hydatid cyst (larva of Echinococcus granulosus), Bursting of nodule of Dracunculus medinensis Nephritis by Plasmodium malariae Black Water Fever by Plasmodium falciparum CHARACTERISTIC OF DISEASES CAUSED BY PARASITE

  17. The course of disease caused by parasite is usually chronic mixed with periods of latency without symptoms and sometimes with acute exacerbation Example : quartan malaria by Plasmodium malariae CHARACTERISTIC OF DISEASES CAUSED BY PARASITE

  18. SIGN AND SYMPTOMSOF PARASITIC DISEASE • ABDOMINAL PAIN • CRAMPY ABDOMINAL PAIN : AMEBIC COLITIS • INTESTINAL OR BILLIARY OBSTRUCTION : A. lumbricoides • DUODENAL ULCERS : Strongyloides stercoralis • DIARRHEA: INTESTINAL PROTOZOA • BULKY AND HAS AN OFFENSIVE ODOR : AMEBIASIS • BULKY AND FATTY : GIARDIASIS • WATERY DIARRHEA : CRYPTOSPORIDIASIS • MINIMAL GASTRO INTESTINAL SYMPTOMS : INTESTINAL HELMINTH INFECTION • BLOODY DIARRHEA : AMEBIASIS, TRICHURIASIS, SCHISTOSOMIASIS GASTRO INTESTINAL SYMPTOMS

  19. SIGN AND SYMPTOMSOF PARASITIC DISEASE RESPIRATORY SYMPTOMS • COUGH AND WHEEZE • MIGRATION OF Ascaris lumbricoides THROUGH THE LUNGS • PNEUMOCYSTIS INFECTION • PARAGONIMIASIS WESTERMANI • HOUSE DUST MITES NEUROLOGICAL SYMPTOMS • CYSTICERCOSIS CELLULOSAE • TOXOPLASMOSIS • MALARIA TROPICA • EOSINOPHILIC MENINGITIS • P.A.M. (Naegleria fowleri)

  20. SIGN AND SYMPTOMSOF PARASITIC DISEASE CUTANEUS SYMPTOMS • PRURITUS ANI • GROUND ITCH • SWIMMER’S ITCH • CREEPING ERUPTION HEPATOSPLENOMEGALI • MALARIA • VISCERAL LARVA MIGRAN • TOXOPLASMOSIS

  21. SIGN AND SYMPTOMSOF PARASITIC DISEASE ANEMIA • MALARIA • ANCYLOSTOMIASIS • ASCARIASIS • DIPHYLLOBOTHRIASIS STEATORRHEA • GIARDIASIS

  22. SIGN AND SYMPTOMSOF PARASITIC DISEASE • KERANDEL’S SIGN • AFRICAN SLEEPING SICKNESS • ROMANA’S SIGN • INFECTION WITH Trypanosoma cruzi • WINTER BOTTOM’S SIGN • AFRICAN TRYPANOSOMIASIS • KERATITIS • Acanthamoeba sp. • Onchocerca volvulus • RETINOCHOROIDITIS • Toxoplasma gondii

  23. Clinical manifestations caused by parasitic infection are commonly very unspecific, therefore laboratory examination is necessary for definite diagnosis The aim of laboratory examination is to look for any stages of parasite life cycle in the examination materials To do accurate laboratory examination, requires decision on: Correct selection of type of sample material (according to parasite life cycle) Accurate laboratory technique DIAGNOSIS

  24. TREATMENT • Individual • Type of treatment • Mass treatment

  25. Things to observe during therapy : Efficacy of drugs against parasite vs. side effect against the host Sometimes surgery is needed to maximize result of treatment Consider also the patient’s general condition and immunity status Also important with treatment of parasite is the improvement of environmental sanitation TREATMENT

  26. The prevention against parasitic disease may be done by the following steps Source reduction: to reduce the source of infection by treating all infected patients Health education: to prevent the distribution of parasite Eradication of host reservoir and vector control Increase of biological immunity against infection Control of hygiene and sanitation PREVENTION

  27. TWO MECHANISM OF IMMUNITY Humoral immunity produces antibodies Cellular immunity (Cell Mediated Immunity/CMI) is the response produced by specific immune cells (T cells) IMMUNITY

  28. Beneficial Parasites Medicinal maggots are being used to clean wounds that contain dead tissue. This photo shows the healthy pink tissue after maggots have been used Medicinal leeches are being used to decrease swelling and improve blood flow in surgery sites including skin grafts and reattachments.

  29. Thank you …………………. Thank you …………………. Thank you …………………. Terima kasih atas perhatiannya ...... April 2005

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