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RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
RNT lecture 2012 Worms of the large intestine
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RNT lecture 2012 Worms of the large intestine

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DISCLAIMER: No copyright infringement intended. Images are not mine and all copyrights belong to their respective owners. This pdf file is not for sale and for educational purposes only.

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  • 1. 1Worm infectionsof the large intestineRahajeng N. Tunjungputri, MD, MScDepartment of ParasitologyFaculty of Medicine Diponegoro University2012
  • 2. Outline2  Epidemiology  Trichuris trichiura  Enterobius vermicularis  Gastrodiscoides hominis
  • 3. Epidemiology – Trichuris trichiura3  800 million people infected worldwide  Children living in poverty in the tropics and subtropics  It is most common in poor rural communities and areas in which sanitary facilities are lacking and hands, food, and drink are easily contaminated  Many people harbor infections with both Trichuris and Ascaris  In up to 10% of patients in endemic areas worm burden may be high (up to 200 worms/pts) and suffering from disease  Genetic studies: 25% of the variation in susceptibility to infection with T. Trichiura is due to genetic factors
  • 4. Worldwide distribution of T. trichiura4
  • 5. Epidemiology – Enterobius vermicularis5  Enterobius vermicularis, or pinworm, is highly prevalent throughout the world  infecting about 10% of population in developed countries, the infection rate in children is even higher  US: E. vermicularis is the most common of all helminthic infections (42 million cases in 1980s); prevalence 15-50% in children  Pinworm infection is particularly common among:  Children, institutionalized groups, and households  not associated with socioeconomic level
  • 6. Major intestinal nematodes6
  • 7. Trichuris trichiura7 The development to adult worms is about 3 months  there may be no shedding of eggs in this period Worms live approx. 3 years Adult worms inhabit the caecum and colon  May extend in severe infection Transmission
  • 8. 8  Whip-like structure  Adult: the anterior 3/5 is slender and the posterior 2/5 is thick  Thin anterior portion: has capillary-like esophagus, embedded in the mucosa  The posterior end: lies free in the intestinal lumen  After mating, the female worm produces 7000 to 20,000 eggs/day  Eggs are barrel shaped, bile stained with bipolar plugs
  • 9. Adults of T. trichiura9
  • 10. 10
  • 11. Eggs of T. trichiura under the high power11
  • 12. 12
  • 13. 13
  • 14. 14
  • 15. Trichuriasis15  Most people: asymptomatic, eosinophilia  In heavy infections, the mucosa is inflamed, edematous, and friable, and increased TNF-α  growth retardation and impaired cognitive function  Children with chronic Trichuris colitis:  chronic abdominal pain and diarrhea  iron deficiency anemia  growth retardation  dysentery syndrome: tenesmus and frequent passage of stools containing large amounts of mucus and often blood  Recurrent rectal prolapse is common
  • 16. 16
  • 17. 17
  • 18. Barium enema, air contrast18
  • 19. Diagnosis19  Trichuriasis  Finding eggs in stool (level of egg output is high)  Identifying the adult worms on the mucosa of the prolapsed rectum  Findings of worms in colonoscopy  Occasionally by air contrast barium enema in massive infection
  • 20. Treatment20  Single doses of albendazole, mebendazole, and pyrantel pamoate cure less than 50% of patients  Light and moderate infection:  Three days of albendazole (400mg PO/day)  Severe infection  5-7 days of albendazole
  • 21. Enterobius vermicularis21  E. vermicularis is a small white worm measuring 1 cm in length  inhabiting the cecum, appendix, and adjacent gut  Enterobius ova are ovoid but flattened on one side and measure approximately 56 × 27 μm
  • 22. 22
  • 23. 23
  • 24. E. vermicularis life cycle24 Hatch in the duodenum 5 or 6 weeks  develop into adult worms (max. 1 mo) Gravid female worms  Contain 10,000 ova/each  Migrate at night to the perianal and perineal regions to deposit egg  itching Eggs mature in 6 hrs (due to O2) Eggs are transferred and attached to bedding, linnen etc
  • 25. Transmission of enterobiasis25  The modes of transmission are:  viathe hands of the patient (underneath the fingernails) through frequent scratching  autoinfection  Transmission through eggs viable on  Direct exposure of eggs to clothes, bed linen, fabrics  Contaminated dust on objects  Walls of school hall, classroom, toilets  Toys, furnitures  Sexual partners engaging in oral-anal sex  Larvae migrate into the sigmoid colon  retroinfection
  • 26. Enterobiasis26  Most: asymptomatic  Perianal and perineal pruritus and scratching  restlessness, secondary infection  Vulvovaginitis, vaginal discharge  Migration of the parasite may lead to ectopic disease, such as pelvic, cervical, vulvar, and peritoneal granulomas  mimicking pelvic mass/ PID  Studies: more normal than inflamed appendices removed at surgery for suspected appendicitis contained pinworms  symptoms resembling appendicitis without invasion of the mucosa
  • 27. Appendix27
  • 28. Case report28  A 13 year old girl presented to the emergency room with a five day history of vomiting, diarrhoea, fever, and abdominal pain. She was not sexually active  In her spare time she earned money as a babysitter for 6–12 year old children  Physical examination revealed signs of peritonitis; leukocytosis and eosinophilia  USG: fluid in the peritoneum  Laparoscopy  pathology
  • 29. 29  The patient was treated with two 400 mg doses of albendazole administered one week apart.  The family contacts also received a dose of mebendazole.
  • 30. Diagnosis30  Microscopic examination of an adhesive cellophane tape pressed to the perianal area early in the morning before bathing or defecation (eg. By parents)  A single examination detects 50% of infections, three examinations detect 90%, and five examinations detect 99%
  • 31. Treatment31  Single doses of one of the followings:  albendazole (400 mg)  mebendazole (100 mg)  ivermectin (200 μg/kg)  pyrantel pamoate (11 mg/kg up to 1 g) are highly effective. A second dose is given 2 weeks later because of the frequency of reinfection and autoinfection  Other infected patients should be treated
  • 32. Gastrodisciasis32  Caused by Gastrodiscoides hominis reported from Assam state in India, Bangladesh, Phillipines, SEA countries, Nigeria  Morphology:  a ventral sucker located in the posterior end  the anterior region is narrow and ends with a rounded tip.  the posterior region contains the reproductive organs including an ovary in the shape of an oval located under the 2 lobed testes  Eggs are similar to Fasciola spp. but larger
  • 33. 33 Definitive hosts:  Human, pigs, rats Intermediate hosts:  IH1: Snails  IH2: Water plants India: water caltrops thrive in ponds fertilized by “night soil” (human feces) Transmission: ingestion of metacercaria in plants
  • 34. Gastrodisciasis34  Clinical sign  Usually asymptomatic  Occasionally diarrhea, fever, abdominal pain, colic, and an increase in mucous production  Diagnostics  Stool examination  Treatment  Praziquantel
  • 35. Prevention35  Treatment of patients and infected people with frequent contacts  Other infected family members, classmates, or residents of long-term care facilities should be treated at the same time as the index case  repeated treatment courses may be needed  Maintenance of hygiene and sanitation (hand washing)  Cleaning surface area, bed sheets, clothes, towels; preventing the spread of eggs
  • 36. Research application36  Trichuris has been shown to secrete molecules that induce antiinflammatory cytokines  It appears that infection with eggs of the porcine whipworm Trichuris suis may lead to improvement of inflammatory bowel disease  characterization of the responsible immunomodulatory molecules could lead to new therapeutic approaches
  • 37. Discussion37

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