taeniasis - ocw.usu.ac.idocw.usu.ac.id/.../elo173_slide_taeniasis.pdf · microsoft powerpoint -...
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Clinical CaseClinical Case
Anda adalah dokter yang bertugas di di salah
satu Puskesmas di Kabupaten Samosir. Suatu
kali seorang pasien lelaki 40 tahun mengeluhkali seorang pasien lelaki 40 tahun mengeluh
sering mendapati sepotong benda berukuran
sekitar 1x0.5cm bewarna putih susu, kenyal dan
bergerak aktif di dalam celana dalamnya.
HY 2
Learning IssuesLearning Issues
1. Agent(s) of the disease
2. Nature of the disease
3. Risk factors3. Risk factors
4. Complications
5. Management: diagnosis, treatment,
prevention
HY 3
CestodesCestodes(tapeworm)(tapeworm)
HY 4
General Morphology & General Morphology &
Classification Classification
MorphologyMorphology
•• TapeTape--likelike
•• SegmentedSegmented
•• Scolex (head)Scolex (head)11
•• Strobila, divided into proglottids Strobila, divided into proglottids (segments):(segments):
11
22
33
HY 5
(segments):(segments):–– Immature proglottidsImmature proglottids22
–– Mature proglottidsMature proglottids33
–– Gravid proglottidsGravid proglottids44
•• HermaphroditeHermaphrodite
•• Hooks and suckersHooks and suckers
•• GIT: nilGIT: nil
•• Body cavity absentBody cavity absent
44
Classification Classification
�� Intestinal cestodes:Intestinal cestodes:�� Taenia saginataTaenia saginata
�� Taenia soliumTaenia solium
�� Hymenolepis nanaHymenolepis nana
�� Hymenolepis diminutaHymenolepis diminuta
HY 6
�� Hymenolepis diminutaHymenolepis diminuta
�� DiphyllobothriidaeDiphyllobothriidae
�� Zoonotic cestodes:Zoonotic cestodes:�� Echinococcus granulosusEchinococcus granulosus
�� Dypilidium caninumDypilidium caninum
Taenia saginataTaenia saginataBeef tapewormBeef tapeworm
•• Up to 1Up to 1--2k 2k
proglottidsproglottids
•• Gravid Gravid
segments segments
HY 8
segments segments
crawl out from crawl out from
anus anus
voluntarilyvoluntarily
•• HabitatHabitat: small : small
intestineintestine
Taenia saginataTaenia saginataLife cycleLife cycle
•• Infective stageInfective stage: : cysticercuscysticercus bovisbovis in cattle meatin cattle meat
•• Route of infection: Route of infection: ingestioningestion
•• DxDx stage: stage:
HY 9
•• DxDx stage: stage:
–– eggs in feces or anal swabeggs in feces or anal swab
–– gravid segmentsgravid segments
Taenia saginataTaenia saginataMorphologyMorphology
•• ScolexScolex: 4 suckers : 4 suckers
•• Gravid segment: Gravid segment:
–– 1515--20 branches of 20 branches of uterusuterusAA
–– Genital pore: one of Genital pore: one of
HY 11
–– Genital pore: one of Genital pore: one of each segment in each segment in irregular irregular sitesiteBB
•• EggEgg (viable up to 159 days)(viable up to 159 days)::
–– EllipticalElliptical
–– EmbryophoreEmbryophore (thick (thick
shell with radial pattern)shell with radial pattern)
–– Content: Content: hexacanthhexacanthembryo (embryo (oncosphereoncosphere))
Taenia soliumTaenia soliumLife cycleLife cycle
•• Infective stage: Infective stage:
cysticercuscysticercus cellulose in pork and or eggscellulose in pork and or eggs
•• Route of infection: Route of infection: ingestioningestion
HY 12
•• Route of infection: Route of infection: ingestioningestion
•• DxDx stage: stage:
-- eggs in feces or swabeggs in feces or swab
-- cysticercuscysticercus cellulose from tissue biopsycellulose from tissue biopsy
Taenia saginataTaenia saginataLarva Larva
•• Called Called cysticercuscysticercus
bovisbovis, no hooks, no hooks
•• InvaginateInvaginate in cattle in cattle
HY 14
muscles and tissuesmuscles and tissues
•• Ingested by human, Ingested by human,
evaginateevaginate in small in small
intestine to become intestine to become
adult wormadult worm
Taenia soliumTaenia soliumScolexScolex
•• ScolexScolex: 4 suckers, : 4 suckers,
hooks, hooks, rostellumrostellum
HY 15
Taenia soliumTaenia soliumEggs Eggs
•• Resembles the Resembles the
eggs of eggs of Taenia Taenia
saginatasaginata
HY 16
TaeniaTaenia soliumsoliumStrobilaStrobila
• Strobila: – 2-3 m long
– less than 1k proglottids
– proglottid: less uterine branches (7-12 pairs)
HY 17
Taenia soliumTaenia soliumLarva Larva
•• Called Called cysticercuscysticercus
cellulosecellulose, six hooked, six hooked
•• Habitat:Habitat:–– human’s muscles and human’s muscles and
tissuestissues
HY 18
tissuestissues
–– Pig’s muscles and tissuesPig’s muscles and tissues
Clinical ManifestationsClinical Manifestations
• Taenia solium may cause cysticercosis. The
most severe cysticercosis is that which involve
CNS (neurocysticercosis). Other sites are
lungs, liver, and eyes.
• Neurocysticercosis might cause meningitis,
epilepsy, dementia, and can be fatal.
• Taenia saginata does not cause cysticercosis.
However, the voluntary excretion of the
segments might have the patients
uncomfortable and induce mental depression.
HY 20
ManagementManagement
• Diagnosis is based on QDP (questionnaire of
demonstration proglottids). Though possible,
it’s hard to get the eggs from fecal examination.it’s hard to get the eggs from fecal examination.
• Cysticercosis is found through radiologic
examination
HY 21
ManagementManagement
• The worms need to be expelled completely from the
intestine. We need to be sure that not only have the
proglottids, but also the scolex and neck been
removed.
• Laxatives to expel proglottids
• Niclosamide
• Praziquantel 40mg/kgBW (single dose)
• Surgery for the csticercosis.HY 22