klh filariasis - FK UWKS 2012 C

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FILARIASIS
DEFINISI FILARIASIS
Filariasis (philariasis)
is a parasitic disease caused by thread-like nematodes
(roundworms)
belonging to the superfamily Filarioidea,[1] also known as
"filariae".[2]
These are transmitted from host to host by blood-feeding
arthropods,
mainly black flies and mosquitoes.
JENIS FILARIASIS
(menurut lokasi infeksi).
1.Lymphatic filariasis
2.Subcutaneous filariasis
3.Serous cavity filariasis
JENIS FILARIASIS
(menurut lokasi infeksi).
1.Lymphatic filariasis
is caused Wuchereria bancrofti, Brugia malayi, and Brugia timori.
In the lymphatic system,
the lymph nodes, in chronic cases lead to elephantiasis.
2.Subcutaneous filariasis
is caused by Loa loa (the eye worm), Mansonella streptocerca, and
Onchocerca volvulus.
In the subcutaneous layer of the skin, in the fat layer.
L. loa causes Loa loa filariasis
O. volvulus causes river blindness.
3.Serous cavity filariasis
is caused by Mansonella perstans and Mansonella ozzardi,
in the serous cavity of the abdomen.
VECTOR FILARIA
W. bancrofti perkotaan
culex quinquefasciatus
W. bancrofti pedesaan:
anopheles, aedes dan armigeres
B. malayi :
mansonia spp, an.barbirostris.
B. timori :
an. barbirostris
EPIDEMIOLOGY
International
1.Lymphatic filariasis
90 million people and throughout the tropics and
subtropics INFECTED.
2.O volvulus in equatorial Africa and foci in Central and
South America. At least 21 million people INFECTED.
3. L loa
Approximately 3 million people in Central Africa are
infected .
In 1997, the World Health Organization (WHO) initiated a
program to globally eliminate lymphatic filariasis as a
public health problem.
EPIDEMIOLOGY
Mortality/Morbidity
Filarial diseases are rarely fatal,
infection can cause significant personal and
socioeconomic hardship
The WHO has identified
lymphatic filariasis as the second leading cause of
permanent and long-term disability in the world after
leprosy.
The morbidity of human filariasis
mainly from the host reaction to microfilariae or
developing adult worms in different areas of the body.
EPIDEMIOLOGY
Race
Filariasis has no known racial predilection.
Sex
Both sexes are equally susceptible to filariasis.
Age
All ages are susceptible and potentially microfilaremic.
Microfilaremia rates increase with age
through childhood and early adulthood,
although clinical infection may not be apparent.
The manifestation of acute and chronic filariasis
usually occurs only after years of
repeated and intense exposure
to infected vectors in endemic areas.
LYMPHATIC FILARIASIS
Disease caused by nematode worms
of the genera Wucheriaand Brugia.
Larval worms circulate in the bloodstream of
infected persons, and adult worms live in the
lymphatic vessels.
Screening.
Blood sample collected
in the middle of the night
with the time of peak microfilariae abundance.
ELISA test
for antigens of the parasite in blood samples
collected any time of the day is now available,
easier.
KRITERIA ENDEMIS /PENULARAN FILARIASIS
Kriteria penularan penyakit
mikrofilarial rate ≥ 1% pada
sample darah di sekitar kasus elephantiasis,
atau adanya 2 atau lebih kasus elephantiasis di suatu
wilayah pada jarak terbang nyamuk yang
mempunyai riwayat menetap bersama/berdekatan
pada suatu wilayah selama lebih dari satu tahun.
Berdasarkan WHO,
mikro filarial rate ≥ 1% pada
satu wilayah maka daerah tersebut dinyatakan
endemis ,harus diberikan pengobatan masal
selama 5 tahun berturut-turut.
GEJALA PENYAKIT FILARIASIS
1.
gejala dan tanda klinis akut :
Demam berulang ulang selama 3-5 hari,
demam dapat hilang bila istirahat dan
timbul lagi setelah bekerja berat
Pembengkakan kelenjar getah bening
(tanpa ada luka) di daerah lipatan paha,
ketiak (limfadenitis) yang tampak kemerahan, panas dan sakit
Radang saluran kelenjar getah bening
yang terasa panas dan sakit yang menjalar
dari pangkal ke arah ujung kaki atau lengan
Abses filaria
terjadi akibat seringnya pembengkakan kelenjar getah bening,
dapat pecah dan dapat mengeluarkan darah serta nanah
Pembesaran tungkai, lengan, buah dada dan alat kelamin
perempuan dan laki-laki
yang tampak kemerahan dan terasa panas.
GEJALA PENYAKIT FILARIASIS
2.
Gejala dan tanda klinis kronis :
Limfedema :
Infeksi Wuchereria mengenai kaki dan lengan, skrotum, penis,
vulva vagina dan payudara, Infeksi Brugia dapat mengenai kaki dan
lengan
dibawah lutut / siku lutut dan siku masih normal
Hidrokel :
Pelebaran kantung buah zakar yang berisi cairan limfe, dapat sebagai
indikator endemisitas filariasis bancrofti
Kiluria : Kencing seperti susu
kebocoran sel limfe di ginjal, j
DIAGNOSA FILARIASIS
DIAGNOSIS FILARIASIS
1.Klinis
diagnosis klinis ditegakkan bila ditemukan gejala dan
tanda klinis akut ataupun kronis
2. Laboratorium
Dinyatakan sebagai penderita falariasis apabila dalam
darahnya positif ditemukan mikrofilaria.
Darah jari yang diambil pada malam hari (pukul 20.00
- 02.00).
Test ELIZA tidak perlu malam hari
PENGOBATAN
1. Pengobatan Masal
di daerah endemis (mf rate > 1%)
Diethyl Carbamazine Citrate (DEC) dikombilansikan
Albendazole
sekali setahun selama 5 tahun berturut-turut.
Pengobatan massal seluruh
penduduk yang usia > 2 tahun
Ditunda usia ≤ 2 tahun, wanita hamil, ibu menyusui
PENGOBATAN
2. Pengobatan Selektif
Dilakukan pada orang yang mengidap mikrofilaria
anggota keluarga yang tinggal serumah
dan berdekatan dengan penderita
(hasil survey mikrofilaria <1% (non endemis)
3. Pengobatan Individual (penderita kronis)
Semua kasus klinis diberikan obat DEC 100 mg, 3x sehari
selama 10 hari sebagai perawatan terhadap organ yang bengkak
SYMPTOMATOLOGY
1.Asymptomatic :
70 % are asymptomatic.
Symptoms usually do not manifest
until adolescence or adulthood,
when worm burden is usually the highest.
Lymphatic filariasis
The symptoms of lymphatic filariasis
predominantly result from the presence of adult worms
residing in the lymphatics.
The clinical course is broadly divided into
1.asymptomatic microfilaremia,
2.acute phases of adenolymphangitis (ADL),
3.chronic irreversible lymphedema.
Three acute syndromes in filariasis, as follows:
1.Acute ADL:
This refers to the sudden onset of febrile painful
lymphadenopathy.
Pathologically, the lymph node is characterized by a retrograde
lymphangitis, distinguishing it from bacterial lymphadenitis.
Symptoms usually abate within one week, but recurrences are
possible.
2.Filarial fever:
characterized by fever without the associated adenitis.
3.Tropical pulmonary eosinophilia (TPE)
Tropical pulmonary eosinophilia TPE
is a form of occult filariasis.
Presenting symptoms include
a paroxysmal dry cough, wheezing, dyspnea, anorexia, malaise, and
weight loss.
Symptoms of TPE are usually due to the inflammatory response to the
infection. Characteristically, peripheral blood eosinophilia
and abnormal findings on chest radiography are observed.
TPE is usually related to W bancrofti or B malayi infection.
Onchocerciasis
This also is known as hanging groins, leopard skin, river
blindness, or sowda.
Symptoms
Microfilariae in the skin and include pruritus, subcutaneous
lumps, lymphadenitis, and blindness.
Patients with onchocerciasis may report impaired visual
acuity due to corneal fibrosis.
Loiasis
The symptoms
Lloa infection are usually to subcutaneous swellings on the
extremities,
localized pain, pruritus, and urticaria.
Microfilaremia tends to be asymptomatic.
Occasionally, the worm is observed migrating through the
subconjunctiva or other tissues.
M ozzardi, M perstans, and M streptocerca
Mansonella infections are usually asymptomatic.
If symptoms are present,
fever, pruritus, skin lumps,
lymphadenitis, and abdominal pain.
MANSONIAMOSQUITO

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