PARASITIC DISEASES

CAUSING ANAEMIA
dr. Tri Baskoro Tunggul Satoto, M.Sc, PhD
 HABITAT OF THE HUMAN
PARASITES
 Gastrointestinal  Protozoa
 Sarcodina  pseudopodia
 Urogenital  Mastigophora (Flagellata) 
flagella
 Blood  Ciliophora (Cilliata)  cilia
 Sporozoa ( do not move) 
 Lymph PLASMODIUM  MALARIA

 Respiratory system  Helminth (Worms)

 Nemathodes  HOOKWORM
 Tissue/body cavity  Cesthodes
 Tremathodes
 Arthropoda
 MALARIA
Caused 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
MALARIA LIFE CYCLE
 Acute attack of malaria
 Cold stage
 Chill, rigor
 Hot Stage
 Fever increased
 Headache
 Flashing face
 Sweating stage
 Profuse sweating
 Decrease body temperature
 Feeling of Relief (fall a sleep)
Sporogonic cycle
General
Morphol Schufner dots

ogy of
Malaria
Parasite Mature schizont
Thick Smear of Malaria falciparum
(heavy infection of young
trophozoites)

My Pictures\falciparum_thickfilm_1.jpg
 Schizont stages

P.f.

P.m.

P.v.
P.o.
Sexual - Gametocyte stages
Plasmodium vivax
Sexual - Gametocyte stages
 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:
 Periodicalrupture 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
Cerebral malaria
 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
 All species of malaria (rarer
in Pf than Pv)
 Progressive hemolytic
anemia may accur
TREATMENT TARGETS
 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
Preparation
of thin and thick
blood smears
Preparation
of thin and thick
blood smears
Thick & Thin Smear of Malaria
heavy infection of young trophozoites of P.f.

My Pictures\falciparum_thickfilm_1.jpg
Immuno-chromatographic
technology  Rapid Diagnostic
Test (RDT)

RDT for Malaria: detect malaria

antigens
Diagnosis Parasitic Infection using
Polymerase Chain Reaction (PCR)
Every single parasite DNA were
amplified thousands time using
specific Primers  easily
detected
 HOOKWORMS
soil transmitted helminth

1.Ancylostoma
duodenale
2.Necator americanus
3.Ancylostoma braziliesis
4.Ancylostoma cyelanicum
5.Ancylostoma caninum
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
 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
 Life cycle
 Definitive host : human/animal
EGGS  RHABDITIFORM LARVA  FILARIFORM LRV SOIL:
DAMP, SHADE, WARM HOST’S SKIN

VENOUS BLOOD

RIGHT HEART

PREPATENT P.
6 – 10 mo
LUNG

PENETRATES
ALVEOLI

FAECES
DEFINIT
SMALL BRONKHUS

IVE INTESTINE TRAKHEA
HOST ADULT WORM

Life cycle of
Hookworm
 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.
 FACTORS GENERATING
ANAEMIA
1. WORM LOAD (N. americanus causes blood loss of
0.05ml/day)
2. SPECIES OF WORM (A.DUODENALE CONSUMES 4-5
TIME than N.a A DAY) (0.15 vs 0.05 ml/day/worm)
3. IRON INTAKE (4-40 MG /DAY)
4. AVAILABILITY OF IRON IN DIETS (high phytic acid intake
reduces the iron intake)
5. Disturbance of IRON ABSORPTION
6. THE PRESENCE OF OTHER CONDTION INCREASING
IRON DEMANDS (pregnancy, menstruation)
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
ANEMIA
• DIAGNOSIS
Clinical :
- WEAKNESS (TIREDNESS)
- ACHING MUSCLES
- SHORT BREATH (BREATHLESSNESS)
- PALLOR (due to melanin depletion)
- OEDEMA (related to heart failure and low serum albumin)
- PALE YELLOW SKIN when iron def. is
acompanied with hypoalbuminemia
- DYSPHAGIA
- KOILONYCHIA (typical of iron deficiency)
- SMOOTH RED TOUNGUE AND ANGULAR
STOMATITIS (RARE)
- ANAEMIA
RADIOLOGY :
- HIPERMOTILITY OF INTESTINE
LABORATORY :
- FINDING THE EGGS IN FAECES
* QUALITATIVE : DIRECT &
CONCENTRATION
* QUANTITAIVE : KATO METHOD 
INTENSITY
* CULTURE HARADA MORI 

IDENTIFICATION L.Filariform larvae
MORE SENSITIVE
 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
 Ancylostoma caninum
 ADULT :
- CURVED BODY C
- 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
CREEPING ERUPTION
LARVA FIL  HUMAN SKIN

STRATUM GERMINATIVUM

TUNNEL MOVES FEW mm – cm

/ DAY  WEEKS/MONTHS

SKIN LESSION :
- ERYTEHMA
- VESICLE
- ITCHY  SECONDARY INFECTION
PUSTULE

SYMPTOM: ITCHY & HOT SKIN

DURING LARVA INVASION
DIAGNOSIS : - CEEPING SKIN
LESION