NEGLECTED DISEASES
Elsa Herdiana Murhandarwati
Dept. Parasitologi
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
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
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,
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
.in Indonesia
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?
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?
INTESTINAL HELMINTHS
The 17 neglected tropical diseases (WHO)
Sleeping sickness (HAT) Leishmaniasis
Dracunculiasis (guinea worm disease)
Echinococcis
Foodborne trematodiases Lymphatic filariasis
Onchocerciasis (river blindness) Schistosomiasis
Soil transmitted helminthiasis
(Ascariasis, Hookworm Diseases, Trichuriasis, Strongyloidiasis)
Sleeping sickness (HAT) Leishmaniasis
Dracunculiasis (guinea worm disease)
Echinococcis
Foodborne trematodiases Lymphatic filariasis
Onchocerciasis (river blindness) Schistosomiasis
Soil transmitted helminthiasis
What is shown in this map?
NTDs - global distribution
- NTDs affect more than 1 billion people: the bottom-billion , the poorest of the poor .
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
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
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.
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
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.
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:
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.
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,
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.
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.
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?
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.
Helminthiasis?
Questions you might have:
•
Why you suspect a helminthiasis?
•
What is the possible species of helminth?
Other questions ?
Questions you might have:
Why you suspect a helminthiasis?
•
What is the possible species of helminth?
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 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
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, 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 .
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 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
Diagnosing Ascariasis
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
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.
Hookworms
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,
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,
How human infected by
hookworms?
Life cycle
Larvae burrow through skin– 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?
Larvae burrow through skin
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
Male worm 8- 10mm,
female 10- 13 mm.
Large buccal cavity with
cutting
teeth.
Life span 1 year,
sometimes longer
A. duodenale
Male worm 8- 10mm,
female 10- 13 mm.
Large buccal cavity with
cutting
teeth.
N. americanus
•
smaller: male 7-9 mm,
female 9-11 mm
•
Large buccale cavity
with cutting
plates
Life span 4-20 years
smaller: male 7-9 mm,
female 9-11 mm
Large buccale cavity
with cutting
plates
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.
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.
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 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 :
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
More than 500 million infected.
Worldwide, but more in tropics and subtropics
•
Poor sanitation
•
Transmitted by
food or water
contaminated
with soil containing eggs.
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 Small, 30-50mm Attach to the
mucosa of caecum
An adult worm produces eggs
6000-7000 eggs/day
