NEGLECTED DISEASES. Elsa Herdiana Murhandarwati Dept. Parasitologi 2017

Transcription

1 NEGLECTED DISEASES Elsa Herdiana Murhandarwati Dept. Parasitologi 2017

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4 Taeniasis 4

5 Survives for years Take 2 months to become adult survives for years days to months in environment Life cycle image and information courtesy of DPDx. 5

6 Taeniasis Taenia saginata (beef tapeworm), Taenia solium (pork tapeworm), and Taenia asiatica (Asian tapeworm). by eating raw or undercooked beef (T. saginata) or pork (T. solium and T. asiatica). Symptoms are usually mild or nonexistent. Cysticercosis Neurocysticercosis 6

7 Geographical distribution Taenia saginata and T. solium : worldwide. Infections with T. saginata : Eastern Europe, Russia, eastern Africa and Latin America, rare in the United States. Taeniasis due to T. solium: Latin America, Eastern Europe, sub-saharan Africa, India, and Asia. Taenia solium taeniasis is seen in the United States..How come? Taenia asiatica is limited to Asia and is seen mostly in the Republic of Korea, China, Taiwan, Indonesia, and Thailand. 7

8 .in Indonesia (Map is adopted from Wandra et al, 2016) Three major endemic areas of the taeniasis/cysticercosis in Indonesia are North Sumatra, Bali and Papua (former Irian Jaya). Endemic areas are also found in other islands, such as Timor, Flores, North Sulawesi, West Kalimantan and South Sumatra. T. solium taeniasis: in Jayawijaya District, Papua. Samosir Island in Lake Toba: T. asiatica in Lake Toba. T. solium and T. saginata are well known from Bali 8

9 Prevention How to prevent taeniasis? How to cut taeniasis prevention? Can it be transmitted to the rest of your household? How to control taeniasis? How to prevent cysticercosis? Can it be transmitted to the rest of your household?

10 INTESTINAL HELMINTHS (Soil Transmitted Helminths & Taeniasis) Elsa Herdiana Murhandarwati Dept. of Parasitology 10

11 The 17 neglected tropical diseases (WHO) Virus Dengue Rabies Protozoa Chaga disease Sleeping sickness (HAT) Leishmaniasis Bacteria Buruli ulcer Leprosy Trachoma Yaws Helminth Cysticercosis/taeniasis Dracunculiasis (guinea worm disease) Echinococcis Foodborne trematodiases Lymphatic filariasis Onchocerciasis (river blindness) Schistosomiasis Soil transmitted helminthiasis (Ascariasis, Hookworm Diseases, Trichuriasis, Strongyloidiasis) 11

12 What is shown in this map? NTDs - global distribution - NTDs affect more than 1 billion people: the bottom-billion, the poorest of the poor. - NTDs are often clustered together geographically and individuals are often afflicted with more than one parasite or infection 12

13 Why is STH neglected? Affect almost exclusively poor, powerless and marginalised people living in remote rural areas and urban slums in low income countries Non-specific signs and symptoms, chronic disease, slow killers, social stigmatization Limited engagement of the governments No economic benefits for the pharmaceutical industry 13

14 Intestinal Helminths Group of helminths Nematoda, cestoda or trematoda. Nematoda: A. lumbricoides, hookworm, S. stercoralis T. trichiura E. vermicularis. Habitat of helminths Adult worms of A.lumbricoides, hokworms, S. stercoralis reside at small intestine Adult worms of T. trichiura E. vermicularis reside at colon, cecum or appendix. 14

15 STH as common enemy Intestinal worms, or soil-transmitted helminths (STH), are the most common NTDs worldwide. STHs are caused by a group of parasitic worms, most commonly: - roundworm (ascariasis), - hookworm, and - whipworm (trichuriasis) Transmission: through contaminated soil or by ingesting parasite eggs. 15

16 Why does STH infection matter? Once inside the body, adult worms live in the intestines and produce thousands of eggs a day. Though symptoms vary, they include: anemia, malnutrition, vitamin A deficiency, swelling of the abdomen, weight loss, diarrhea, and inflammation of the intestines. 16

17 Geographic distribution The World Health Organization (WHO) estimates that over 1.4 billion people are infected with one or more STHs. Globally, there are 700 million people infected with hookworm (including 44 million pregnant women), 807 million people infected with ascariasis, and 604 million people infected with trichuriasis. Transmission mainly occurs in tropical climates and where sanitation and hygiene are poor. 17

18 Case study #1 A mother took her 6 -year- old son to your clinic after she found something she thought as a rubberband. She became worried when he saw the objects moving in the toilet. The child is a physically active child. He did not had fever or having any abdominal pain. The family lived in a village with poor sanitation. Question: what do you think about this case? 18

19 Helminthiasis? Questions you might have: Why you suspect a helminthiasis? What is the possible species of helminth? Other questions? 19

20 Ascariasis 20

21 Geographic Distribution All over the world, 25% world population Most prevalent in warm, tropical climates. Why? High Concentration of Ascaris in South-East Asia with less cases in Africa and Latin America. In South-East Asia approximately 73% of the people are infected. India, Bangladesh, Burma, Indonesia, Malaysia, Philippines, Vietnam, China, Kenya, Tanzania, West Africa, Turkey, Iran, Afghanistan, Brazil, Columbia, Mexico, and Peru have all reported areas where Ascaris occurs in more than 50% of the local population living in these places. Many cases of Ascaris still occur in US 21

22 What does it look like? Largest nematode that parasite human Ascaris adult male ( 15-30cm) and female (20-35cm) 22

23 How human get ascariasis? 23

24 Life cycle Adult worms live in small intestine Embryonated eggs --active in 18 days infective eggs are swallowed larvae hatch invade the intestinal mucosa carried via the portal, then systemic circulation to the lungs. The larvae mature further in the lungs penetrate the alveolar walls ascend the bronchial tree to the throat, and are swallowed. Upon reaching the small intestine, they develop into adult worms. ingestion to oviposition:2-3 months Adult worms can live 1 to 2 years. 24

25 Clinical manifestations Most cases tend to be asymptomatic Severity depends on number of eggs ingested Pneumonitis (Loeffler s syndrome) occurs when the larvae migrate to the lungs (4 days 2 weeks after infection occurs). Others: fever, urticaria, malaise, nausea, vomiting, diarrhea, central nervous system disorders, and colic. Nutritional problems that may develop can then lead to abnormal development in children. Life threatening disease when many worms are present, become entangled and form a bolus blocks the lumen intestinal obstruction Others: migration to appendix, billiary duct 25

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27 Diagnosing Ascariasis Eggs are oval with irregular surface 27

28 Prevention & treatment Prevention: Proper sanitation and hygiene are important for prevention Proper disposal of human waste Avoid eating noncooked vegetables and fruits in places lacking proper sanitation and areas that use human fertilizer. Treatment Albendazole, Mebendazole 28

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30 Hookworms Ancylostoma duodenale Necator americanus 30

31 Geographic distribution A. duodenale: South Europe, North Africa, Asia. Used to be prevalent in regions with temperate climate in warm humid places, such as mines, tunnels. N. americanus: Central and South Africa, US, China, Indonesia, Australia. Used to be only in tropics, now also in Portugal, Turkey, Iran, Japan, 31

32 How human infected by hookworms? 32

33 Larvae burrow through skin Life cycle Travel to the heart, lungs, and eventually the small intestine Adult worms suck the blood of their hosts» Causes chronic anemia, iron and protein deficiencies Ground itch occurs at the site of larvae penetration So, what is the risk factor? 33

34 What does it look like? Round, white, cylindris, 1 cm, 34

35 A. duodenale Male worm 8-10mm, female mm. Large buccal cavity with cutting teeth. Life span 1 year, sometimes longer 35

36 N. americanus smaller: male 7-9 mm, female 9-11 mm Large buccale cavity with cutting plates Life span 4-20 years 36

37 Clinical manifestations Iron deficiency anemia (caused by blood loss at the site of intestinal attachment of the adult worms) is the most common symptom of hookworm infections. A. duodenale: 150 μl/worm/day. N. americanus (smaller): μl/worm/day. 37

38 Diagnosing hookworms 38

39 Fecal examination N.americ :10.000/day/worm A.duoden : /day/worm 39

40 LARVA FILARIFORM HOOKWORM 40

41 Trichuriasis 41

42 Geographic distribution More than 500 million infected. Worldwide, but more in tropics and subtropics Poor sanitation Transmitted by food or water contaminated with soil containing eggs. Co-infection with ascaris and hookworms 42

43 Infectious Diseases Whipworm Rectal Prolapse Small, 30-50mm Attach to the mucosa of caecum An adult worm produces eggs eggs/day Life span: 3-8 years 43

44 Life cycle 44

45 45 The characteristic of whiplike apperance of the adult worm.

46 Clinical manifestations Frequently asymptomatic. Heavy infections, especially in small children, can cause gastrointestinal problems (abdominal pain, diarrhea and possibly growth retardation. Rectal pruritis and tenesmus, often results in rectal prolapse. 46

47 Infectious Diseases Whipworm Rectal Prolapse 47

48 Diagnosing whipworm Laboratory Diagnosis: Eggs visible in feces. The egg is barrel-shape with a plug at each end, in the stool. 48

49 Prevention & Treatment Prevention: Proper disposal of human waste Treatment: Mebendazole. 49

50 Questions?