2017 GH Sesi 10 EH Neglected Tropical Diseases
NEGLECTED DISEASES
Elsa Herdiana Murhandarwati
Dept. Parasitologi
2017
2
3
Taeniasis
4
Survives for years
Take 2 mon
onths to become adult
sur
survives for years
days to months in environment
•Life cycle image and information courtesy
of DPDx.
5
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
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
.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
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?
INTESTINAL HELMINTHS
(Soil Transmitted Helminths & Taeniasis)
Elsa Herdiana Murhandarwati
Dept. of Parasitology
elsa.herdiana@ugm.ac.id
10
The 17 neglected tropical diseases (WHO)
http://www.who.int/neglected_diseases
• 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
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
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
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
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
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
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
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
Helminthiasis?
Questions you might have:
• Why you suspect a helminthiasis?
• What is the possible species of helminth?
• Other questions ?
19
Ascariasis
20
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
What does it look like?
Largest nematode that parasite human
Ascaris adult male ( 15-30cm) and female (20-35cm)
22
How human get ascariasis?
23
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
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
26
Diagnosing Ascariasis
Eggs are
oval with
irregular
surface
27
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
29
Hookworms
Ancylostoma duodenale
Necator americanus
30
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
How human infected by
hookworms?
32
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
What does it look like?
Round, white, cylindris, 1 cm,
34
A. duodenale
Male worm 8- 10mm,
female 10- 13 mm.
Large buccal cavity with
cutting teeth.
Life span 1 year,
sometimes longer
35
N. americanus
• smaller: male 7-9 mm,
female 9-11 mm
• Large buccale cavity
with cutting plates
• Life span 4-20 years
36
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 l/worm/day.
• N. americanus (smaller): 30- 50 l/worm/day.
37
Diagnosing hookworms
38
Fecal examination
N .a m e r i c
:1 0 .0 0 0 /d a y /w o r m
A .d u o d e n :
2 0 .0 0 0 /d a y /w o r m
39
LARVA FILARIFORM HOOKWORM
40
Trichuriasis
41
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
Infectious Diseases
Whipworm Rectal Prolapse
Small, 30-50mm
Attach to the
mucosa of caecum
An adult worm
produces eggs
6000-7000 eggs/day
Life span: 3-8 years
43
Life cycle
44
45
The characteristic of “whiplike” apperance of the adult worm.
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
Infectious Diseases
Whipworm Rectal Prolapse
47
Diagnosing whipworm
Laboratory
Diagnosis:
• Eggs visible in feces.
• The egg is barrel-shape
with a plug at each
end, in the stool.
48
Prevention & Treatment
Prevention:
Proper disposal of
human waste
• Treatment:
Mebendazole.
49
Questions ?
Elsa Herdiana Murhandarwati
Dept. Parasitologi
2017
2
3
Taeniasis
4
Survives for years
Take 2 mon
onths to become adult
sur
survives for years
days to months in environment
•Life cycle image and information courtesy
of DPDx.
5
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
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
.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
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?
INTESTINAL HELMINTHS
(Soil Transmitted Helminths & Taeniasis)
Elsa Herdiana Murhandarwati
Dept. of Parasitology
elsa.herdiana@ugm.ac.id
10
The 17 neglected tropical diseases (WHO)
http://www.who.int/neglected_diseases
• 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
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
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
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
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
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
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
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
Helminthiasis?
Questions you might have:
• Why you suspect a helminthiasis?
• What is the possible species of helminth?
• Other questions ?
19
Ascariasis
20
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
What does it look like?
Largest nematode that parasite human
Ascaris adult male ( 15-30cm) and female (20-35cm)
22
How human get ascariasis?
23
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
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
26
Diagnosing Ascariasis
Eggs are
oval with
irregular
surface
27
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
29
Hookworms
Ancylostoma duodenale
Necator americanus
30
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
How human infected by
hookworms?
32
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
What does it look like?
Round, white, cylindris, 1 cm,
34
A. duodenale
Male worm 8- 10mm,
female 10- 13 mm.
Large buccal cavity with
cutting teeth.
Life span 1 year,
sometimes longer
35
N. americanus
• smaller: male 7-9 mm,
female 9-11 mm
• Large buccale cavity
with cutting plates
• Life span 4-20 years
36
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 l/worm/day.
• N. americanus (smaller): 30- 50 l/worm/day.
37
Diagnosing hookworms
38
Fecal examination
N .a m e r i c
:1 0 .0 0 0 /d a y /w o r m
A .d u o d e n :
2 0 .0 0 0 /d a y /w o r m
39
LARVA FILARIFORM HOOKWORM
40
Trichuriasis
41
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
Infectious Diseases
Whipworm Rectal Prolapse
Small, 30-50mm
Attach to the
mucosa of caecum
An adult worm
produces eggs
6000-7000 eggs/day
Life span: 3-8 years
43
Life cycle
44
45
The characteristic of “whiplike” apperance of the adult worm.
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
Infectious Diseases
Whipworm Rectal Prolapse
47
Diagnosing whipworm
Laboratory
Diagnosis:
• Eggs visible in feces.
• The egg is barrel-shape
with a plug at each
end, in the stool.
48
Prevention & Treatment
Prevention:
Proper disposal of
human waste
• Treatment:
Mebendazole.
49
Questions ?