Tissue Helminths

dr. Kresnawati Wahyu Setiono, DTM&H, MCTM

Lect. Dept. Tropical Medicine
Nusa Cendana University
 Helminths
Nematode
Trichinella spiralis
Toxocara canis (VLM)
Wucheria bancrofti, b.malayi, b.timori (filariasis)
Gnathostoma spinigerum

Cestode
Taenia solium cytisercosis
Echinococcus granulosus, E. multilocularisis
Spirometra erinaceieuropaei, Diphyllobothrium
mansonoides

Trematodes
Liver flukes
Lung flukes
Trichinellosis
Trichinellosis

Bruno Gottsein, et al. Microbiology Reviews (2009) 127-145

Epidemiology
Bruno Gottsein, et al. Microbiology Reviews (2009) 127-145
East Nusa Tenggara
Anatomy
q The male measures about 1.2 mm
in length by 60 m in diameter. Trichinella spiralis female
q The posterior end bears a pair of
conical papillae or copulatory
bursa Male

q The female is about 2.2 mm in

Female length with a vulva opening located
on the anterior one forth of body

q The females produce eggs that

develop into larvae in the uterus
 Trichinella species :2 clades

Encapsulated Nonencapsulated

T.spiralis T.pseudospiralis

T.nativa T. papuae

T.britovi T.zimbabwensis

T.murrelli

T.nelsoni
Life cycle
 Pathology
Intestine : damage at brush border, lamina propria, villi and
smooth muscle of small intestine( jejunum)

Striated muscle : nurse cell larva complex

Basophilic transformation
Encapsulation of the larvae : 18-20 days after infection or
day 4 after invade to skeletal muscle.
Development of capillary network
 Pathology (cont)

Heart: eosinophilic myocarditis and granulomatous formation

--- interstitial myocarditis

Eye: inflammation , angiomyositis

Respiratory system: inflammation--- Lofflers pneumonitis,

obstructive bronchitis

CNS: vasculitis or perivasculitis

Renal: mesangial proliferative glomerulonephritis

 Clinical Manifestation
Incubation period : 7-30 days

Enteric phase or intestinal phase :

Irritation and inflammation of duodenum and jejunum where
the larvae penetrate cause nausea, vomiting, colic pain and
diarrhea

Migratory( invasion) phase: 2nd weeks :

Remittent fever, severe myalgia with pseudohypertrophy of
muscle and pseudoparalysis, periorbial oedema and
eosinophilia

Encystment phase: 2 months after infection :

Cachexia, oedema and extreme dehydration
Symptoms Incidence

Fever 30-90%
Diffuse myalgia 30-100%
Paralysis like state 10-35%
Periorbital and/or facial edema 15-90%
Skin rash, maculopapular examthema 15-65% Periorbital edema
and subungual bleeding

Difficulties in swallowing 35%

Diarrhea 23%
Abdominal pain , nausea , vomiting 28-40%

Severe forms(5-10%) Splinter hemorrhage

Myocarditis 20%

Encephalitis /meningoencephalitis 10-20%

Pneumonia 6%

Turk M , et al., 2006, Wanda Kociecka,et al.,2000, Virginia Capo, et al., 1996)
 Diagnosis

Patients history

Symptoms

Investigator : muscle biopsy, serological test

 Management of Trichinellosis
In asymptomatic cases
1. only anthelmintics should
be administered
2. leukocyte and eosinophil
counts should be monitored
in the peripheral blood.
Treatment of pregnant
women
1. the patient should be
admitted to a hospital
independent of the clinical
course she manifests,
2. anthelmintics not
absorbable from the
intestinal lumen should be
used exclusively, i.e.
Pyrantel at 10 mg/kg BW
for 13 days
In benign or abortive In severe and
disease moderately severe
disease
1. administration of 1.Hospitalization
anthelmintics
2.administration of
2. Administration of anthelmintics
nonsteroidal anti-
inflammatory drugs if 3. application of
necessary glycocorticosteroids
(prednisolone)
4. compensation of water
and electrolyte deficits
5. administration of
analgesic drugs
(Bruno Gottstein, et al.,2009)
 Anthelmintic drugs

Adult and children age > 2yrs

Albendazole 10-15 mg/kg/day for 10 to 15days

Mebendazole 5 mg/kg/ day for 10 to 15 days

Thiabendazole 50 mg/kg in divided dose for 5 days

Pregnant women and children < 2yrs

Pyrantel pamoat 10mg/kg BW single dose, repeated for 2 to 3 days

( active only against worms in the gut and it has no effect against newborn and muscle larvae)

( Virginia Capo, et al., 2000,Bruno Gottstein, et al.,2009)

 Prevention
1. Education of the consumer

2. Farming of pigs in modern, industrialized, indoor

pigsties under strict veterinary control and use of
certified feedstuff

3. Control of all susceptible animal (both domestic

and sylvatic) by a standardized artificial digestion
method at slaughtering or after hunting
Toxocariasis
Toxocariasis
Life Cycle
 Clinical Manifestation

Febrile, cough, abdominal pain, headache

Larva Migrans
Visceral larva migrans
Ocular toxocariasis
 Ocular Toxocariasis
Ocular toxocariasis occurs when Toxocara larvae
migrate to the eye

Symptoms and signs: vision loss, eye inflammation

or damage to the retina

Unilateral
 Diagnosis

Lab

ELISA, Immunoblot
 Treatment

Albendazole 400mg and mebendazole 500mg given

twice daily for 5 days

In severe ocular toxocariasis, corticosteroids

may be needed in addition.

Ocular granulomas : laser photocoagulation,

cryoretinopexy.
FILARIASIS
Filariasis
Life cycle
Periodicity
 Clinical Manifestation

Asymptomatic >>

Acute filariasis
- Acute filarial lymphangitis
- Acute dermatolymphangitis

Chronic condition: lymphedema, chyuria, hydrocele,

elephantiasis

Tropical pulmonary eosinophilia

 Diagnosis

Patients history

Laboratory

PCR

ELISA

USG
 Management

Medication
Supportive care
Patient education and counselling
Prevention
Control
 Medication

Recommend individual treatment

DEC 6mg/kg.day for 1 or 12 days (CDC)

MDA
Albendazole 400mg and DEC 6mg/kg
Albendazole 400mg and ivermectin 150-200mcg/kg
 Supportive care

To improve function, reduce suffering, and prevent

infection

Foot-care program

Hydrocele: surgery