Bagus Uda Palgunadi,drh.,M.Kes.Laboratorium ParasitologiFakultas KedokteranUniversitas Wijaya Kusuma Surabaya

CIRI CIRI CESTODA :Tubuh pipih dorsoventralPanjang seperti pitaTidak mempunyai Tractus DigestivusTidak mempunyai Saluran Pembuluh DarahHermaphroditeTubuh terdiri dari : 1.Scolex2.Leher3.Strobila :mempunyai banyak segmen ( proglottid) proglottid immature, mature & gravidTerdiri dari 2 ordo : 1.Pseudophyllidae (mempunyai lubang uterus) 2.Cyclophylidae (tidak mempunyai lubang uterus)

Klasifikasi cestoda berdasarkan habitat:Cestoda Usus :Taenia soliumTaenia saginataDiphyllobothrium latum Hymenolepis nanaHymenolepis diminutaDipylidium caninumCestoda Jaringan (dalam bentuk larva)Echinococcus granulosus

CESTODA USUS

Taenia solium(Pork Tape Worm = cacing pita babi)

Penyebab Taeniasis solium pada manusiaDistribusi geografis : KosmopolitanLifespan : sampai 25 tahunHospes / host : DH : ManusiaIH : BabiHabitat : Usus halus (jejunum bagian atas)

telur & larva :TELUR : Bulat, 30-40m,mempunyai hexacanth embrio

LARVA : berupa cysticercus cellulosae (pada jaringan organ tubuh babi), 5 x10 mm

dewasaPanjang 2 7 mScolex : segi 4, 1 mm, mempunyai4 buah sucker & 2 baris rostellum 25-30 kait

Strobila :tdd 800-1000 proglotid immature , mature & gravid ( uterus gravid memp 7-12 cabang lateral)

PATOGENESA:

Iritasi mucosa ususObstruksi ususPerforasi ususIntoksikasi

GEJALA KLINIS

Nyeri perutDiare persistenDiare bergantian dengan konstipasiPeritonitis

Taenia saginata(Beef Tape Worm = Cacing pita sapi)

Penyebab Taeniasis saginata pada manusiaDistribusi geografis: KosmopolitanLifespan: sampai 10 tahunHospes : DH : manusiaI H : sapiHabitat : Usus halus(jejunum ) bagian atas

MORFOLOGITELUR : mirip telur T.soliumLARVA : Cysticercus bovis (Pada jaringan organ tubuh sapi), 5 x 9 mmDEWASA : panjang 4 6 mScolex : segi4, 1,50 - 2 mm, memp 4 buah sucker, tidak mempunyai rostelum & kait

Strobila : tdd 1000 2000 proglotid immature, mature, gravid ( uterus gravid tdd 15-30 cabang lateral)

Gejala klinis

Tidak menunjukkan gejala yang berartiMungkin tdp gejala ringan & menahun sakit kepala, sakit perut, diare & konstipasi bergantian, nafsu makan tidak tetap, kelelahan & lemah

Siklus Hidup Taenia sp.

Life cycle

Taeniasis is the infection of humans with the adult tapeworm of Taenia saginata or Taenia solium. Humans are the only definitive hosts for T. saginata and T. solium. Eggs or gravid proglottids are passed with feces ; the eggs can survive for days to months in the environment. Cattle (T. saginata) and pigs (T. solium) become infected by ingesting vegetation contaminated with eggs or gravid proglottids . In the animal's intestine, the oncospheres hatch , invade the intestinal wall, and migrate to the striated muscles, where they develop into cysticerci. A cysticercus can survive for several years in the animal. Humans become infected by ingesting raw or undercooked infected meat . In the human intestine, the cysticercus develops over 2 months into an adult tapeworm, which can survive for years. The adult tapeworms attach to the small intestine by their scolex and reside in the small intestine . Length of adult worms is usually 5 m or less for T. saginata (however it may reach up to 25 m) and 2 to 7 m for T. solium. The adults produce proglottids which mature, become gravid, detach from the tapeworm, and migrate to the anus or are passed in the stool (approximately 6 per day). T. saginata adults usually have 1,000 to 2,000 proglottids, while T. solium adults have an average of 1,000 proglottids. The eggs contained in the gravid proglottids are released after the proglottids are passed with the feces. T. saginata may produce up to 100,000 and T. solium may produce 50,000 eggs per proglottid respectively.

DIAGNOSA & PENGOBATAN TAENIASISPemeriksaan feces : ditemukannya telur atau proglotid gravid atau scolexPengobatan dengan preparat :Prazikuantel 20 mg/Kg BB / 3 dd / p.oMebendazole (VERMOX) 200mg/2 dd/4 hari berturut-turutKombinasi Mebendazole + Pyranthel Pamoate (TRIVEXAN)

PENCEGAHAN TAENIASISPengobatan penderitaPengawasan daging babi & sapiMemasak daging 50C minimal 30Pembekuan daging pada minimal -2CBAB pada jambanNote : Pengawetan daging dengan cara pengasinan tidak selalu berhasil dengan baik

Dipylidium caninum( Dog Tape Worm = cacing pita anjing )Penyebab dipilidiasis Hospes :- DH : anjing, kucing, serigala dan manusia- IH :Ctenocephalides canis Ctenocephalides felis Pulex iritans Trichodectes canis

Siklus hidup

IH

Telur Larva oncosphere

Dewasa cysticercoid

DH

Life cycle

Gravid proglottids are passed intact in the feces or emerge from the perianal region of the host . Subsequently they release typical egg packets . On rare occasions, proglottids rupture and egg packets are seen in stool samples. Following ingestion of an egg by the intermediate host (larval stages of the dog or cat flea Ctenocephalides spp.), an oncosphere is released into the flea's intestine. The oncosphere penetrates the intestinal wall, invades the insect's hemocoel (body cavity), and develops into a cysticercoid larva . The larva develops into an adult, and the adult flea harbours the infective cysticercoid . The vertebrate host becomes infected by ingesting the adult flea containing the cysticercoid . The dog is the principal definitive host for Dipylidium caninum. Other potential hosts include cats, foxes, and humans (mostly children) , . Humans acquire infection by ingesting the cysticercoid contaminated flea. This can be promulgated by close contact between children and their infected pets. In the small intestine of the vertebrate host the cysticercoid develops into the adult tapeworm which reaches maturity about 1 month after infection . The adult tapeworms (measuring up to 60 cm in length and 3 mm in width) reside in the small intestine of the host, where they each attach by their scolex. They produce proglottids (or segments) which have two genital pores (hence the name "double-pored" tapeworm). The proglottids mature, become gravid, detach from the tapeworm, and migrate to the anus or are passed in the stool .

Morfologi & gejala klinisTelurBulat 25-40m, mempunyai hexacanth embrio sejumlah telur terbungkus dalam kapsul ( disebut egg ball) yang terdiri dari 8-15 telurDewasascolex : jajaran genjang, 4 buah sucker, rostelum 1-7 kaitStrobila 60-175 proglotid imatur, matur, gravidGejala klinis mual,nyeri epigastrium,diare, penurunan berat badan

Egg ball & adult

Diagnosa, Pengobatan& PencegahanPemeriksaan feces ditemukan telur / proglotid gravid / scolexPengobatan Niclosamid (yomesan) dws 2 gram Anak BB 11-34 1,5 g > 2 th 1 gPencegahan : Dengan pengobatan thd hospes

CYSTICERCOSISAdalah Infeksi yang disebabkan oleh Larva TaeniaPenyebab : Cysticercus cellulosae (larva Taenia solium & Cysticercus bovis (larva Taenia saginata)Morfologi : oval (lonjong)Cysticercus cellulosae 5 x 8-10 mm ; Cysticercus bovis 4-6 x 7,5-10 mm berwarna putih susu ; mempunyai invaginasi scolex ke dalam kantung

Cara infeksi : - Hetero infeksi- Auto infeksi - Internal autoinfeksi

Predileksi : Jaringan SC, otot gerak, Mata, Otak (ventrikel ke IV)

Gejala klinistergantung lokasi larva pada SC & Otot gejala ringanpada Otak epilepsi & hydrocephaluspada Mata keradangan pada iris, retina & conjunctiva

Image: Center is an image of a Taenia egg at a high magnification of 400x. When consumed by humans Taenia eggs can lead to cysticercosis, including a serious condition known as neurocysticercosis. On the left and right are x-ray images of humans with neurocysticercosis. The darker regions are cysts in the brain of the patient. Credit (L to R): Westchester Medical Center, PHIL, The Cysticercosis Working Group in Peru.

Siklus Hidup TELUR HOSPES Larva ONCOSPHERE menembus dinding usus Pembuluh darah

PredileksiLARVA CYSTICERCUS

Diagnosa : - anamnesa- Radiologis - test serologis (intradermal test)Pengobatan : operatifPencegahan : - pengobatan Hospes - personal hygiene (mencegah autoinfeksi)