intestinal-amoebae - hari ini

8/10/2019 Intestinal-Amoebae - Hari Ini

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GIT protozoa (EntamoebaHistolitica)


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Ameba:

Entamoeba histolytica

Entamoeba dispar

Entamoeba coli

Entamoeba hartmanniEndolimax nana

Iodamoeba btschlii

Flagellates: Giardia lamblia Dientamoeba fragilis

Chilomastix mesnili Trichomonas hominis Trichomonas vaginalis

(other body sites)

Enteromonas hominis Retortamonas intestinalis

Apicomplexa: Cryptosporidium hominis Cryptosporidium parvum

Other: Blastocystis hominis Balantidium coli

INTESTINAL PROTOZOAunicellular eukaryotic organisms


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Fecal-Oral Transmission Factorspoor personal hygiene

food handlersinstitutionschildren in day care centers

developing countrieshighly endemicpoor sanitationtravelers diarrhea

water-borne epidemicszoonosisEntamoeba= noCryptosporidium= yesGiardia= controversial

Control/Preention improve personal hygiene especially institutions

treat asymptomatic carriers eg, family members

health education hand-washing sanitation food handling

protect water supply treat water if questionable boiling iodine not chlorine


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Amoebiasis

Amoebiasis is caused by Entamoeba histolytica.

The organism formerly known as E. histolyticais nowknown to consist of two distinct species: E. histolytica,which is pathogenic, and E. dispar, which is non-

pathogenic. Cysts of the two species are identical, but can be

distinguished by molecular techniques after culture ofthe trophozoite. E. histolyticacan be distinguishedfrom all amoebae ecept E. dispar, and from other

intestinal protozoa, by microscopic appearance. Amoebiasis occurs world-wide, although much higher

incidence rates are found in the tropics andsubtropics.


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Cont.

The organism eists both as a motiletrophozoite and as a cyst that can sur!i!eoutside the body.

Cysts are transmitted by ingestion ofcontaminated food or water, or spreaddirectly by person-to-person contact.

Trophozoites emerge from the cysts in thesmall intestine and then pass on to thecolon, where they multiply.


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Clinical features

"any indi!iduals can carry the pathogenwithout ob!ious e!idence of clinical disease#asymptomatic cyst passers$.

This is may be due in some cases to themisidentification of non-pathogenic E.disparas E. histolytica, and it is not clearhow often true E. histolyticainfection issymptomless.

%n affected people E. histolyticatrophozoites in!ade the colonic epithelium,probably with the aid of their owncytotoins and proteolytic enzymes.


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Cont.

The parasites continue to multiplyand finally frank ulceration of themucosa occurs.

%f penetration continues, trophozoitesmay enter the portal !ein, !ia whichthey reach the li!er and cause

intrahepatic abscesses. This in!asi!e form of the disease isserious and may e!en be fatal.


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ulcers with raised borders little inflammation between lesions


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%ncubation period

The incubation period of intestinal amoebiasis ishighly !ariable and may be as short as a few days oras long as se!eral months.

The usual course is chronic, with mild intermittent

diarrhoea and abdominal discomfort. This mayprogress to bloody diarrhoea with mucus, and issometimes accompanied by systemic symptoms suchas headache, nauseaand anorexia.

&ess commonly, infection may present as acute

amoebic dysentery, resembling bacillary dysentery oracute ulcerati!e colitis.


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Complications

Complications are unusual, but include toxicdilatation of the colon, chronic infectionwithstricture formation, severe haemorrhage,amoeboma, and amoebic liver abscess.

Amoebomas, which de!elop most commonly in thecaecum or rectosigmoid region, are sometimesmistaken for carcinoma. They may bleed, causeobstruction or intussuscept.

Tender hepatomegaly, a high swinging fe!er and

profound malaise are characteristic,


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'iagnosis

Tes darah samar #($

)rganisme sample tin*a dg hapusan scrsigmoidoskopi, sample biopsi *aringan, kadang aspiratabses hati.

+emeriksaan tin*a harus dlm mnt se*ak keluardasn periksa trophozoid motil yg mengandungeritrosit. "inimal sample tin*a, *ika hanya adanyakista amubatidak menu*ukkan penyakit .

ahan kerokan tukak pada daerah mukosa rektum

/ample tin*a #-$, tapi indeks kecurigaan kolitis amuba00 endoskopi dan biopsi

1emaglutinasi indirect *ika amoboebiasis in!asifdan abses hati amuba

2*i serologis mungkin #-$ *ika amat akut


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"anagement

%odokuinol, diloksanid furoat efektifdalam lumen usus.

"etronidazole, klorokuin, dehidroemetin

efektif amobiasis in!asif. dosis diloksanid furoat : 3 mg4kg4hari

selama 3 hariefektif utk cyst passer

'osis metronidazole : 5mg4kg4day selama3 hari amobiasis in!asif usus, hati danorgan lain


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pre!ention

Amobiasis sulit dieradikasi karenahuman reser!oir,

"elatih cara kebersihan menghindarikontak fekal oral

6ista bisa dimatikan denganperebusan.


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intestinal-amoebae - hari ini

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