Giardiasis dan Leismania

Dewi Puspita Apsari, S.Farm., M.Farm., Apt

GIARDIASIS
 OUTLINE GIARDIASIS

Morfologi
Introduction dan Daur Gejala Klinis
Hidup

Prevention
Diagnosis Pengobatan
and control
REFERENCES
1. Centers for Disease Control and Prevention :
http://www.cdc.gov/parasites/giardia/index.html
2. Drugs for Parasitic Infections: The Medical Letter; 2013
3. Centers for Disease Control and Prevention :
https://www.cdc.gov/parasites/leishmaniasis/
4. Practical Guidline : for Specimen Collection and Reference
Diagnosis of Leishmaniasis
INTRODUCTION
 Giardiasis  Giardia intestinalis/
Lamblia intestinalis/ Giardia
duodenalis  Diare
 Protozoa parasit flagellata
 Dalam tubuh manusia  Hidup
di usus halus dan ada dalam
feses
 Distribusi global (tertinggi pada
negara berkembang)
 It infects nearly 2% of adults
and 6% - 8% of children
Giardiasis can be spread by
People become infected when they swallow
the parasite. It is not possible to become
infected through contact with blood.

 Drinking water or using ice made from water sources where

Giardia may live; Swallowing water while swimming
 Eating uncooked food that contains Giardia organisms
 Having contact with someone who is ill with giardiasis
 Traveling to countries where giardiasis is common
MORFOLOGI DAN DAUR HIDUP
 Memiliki 2 stadium yakni :
1. Stadium trofozoit (Trophozoite) : simetris bilateral seperti
buah jambu monyet , 4 pasang flagel, mempunyai sepasang inti
yang letaknya di bagian anterior,  usus halus
2. Stadium kista (cyst) : oval, Kista yang baru terbentuk
mempunyai 2 inti; yang matang mempunyai 4 inti  feses
Cont...
1. Infection occurs by the
ingestion of cysts in
contaminated water, food, or by
the fecal-oral route or fecal oral
2. In the small intestine, each
cyst produces two
trophozoites  excystation
asam dan enzim pankreas
3. Trophozoites multiply 
binary fission
4. Encystation occurs as the
parasites transit toward the
colon  pH netral dan asam
empedu
5. the cysts are infectious when
passed in the stool or shortly
afterward, person-to-person
transmission is possible
GEJALA KLINIS
 Symptoms of giardiasis normally begin 1 to 3 weeks after
becoming infected.
 Symptoms of giardiasis may last 2 to 6 weeks.
 In some cases, people infected with Giardia have no symptoms
 Acute symptoms include
 Diarrhea
 Gas
 Greasy stools that tend to float
 Stomach or abdominal cramps
 Upset stomach or nausea/vomiting
 Dehydration (loss of fluids)
DIAGNOSIS
 Giardia cysts  excreted
intermittently  multiple stool
collections  three stool
specimens collected on separate
days  fresh or preservation with
10% formalin/ polyvinyl alcohol
 Tes lab normal (CBC dan nilai
elektrolit)
 The methods are :
1. Concentration methods 
mikroskopik
2. Trichrome staining  mikroskopik
3. Fecal immunoassays
4. Polymerase chain reaction (PCR)
TREATMENT
Cont...
 Managemen cairan dan elektrolit  diare
 Jangan mengobati pasien yang
asimptomatis
 Hati-hati dengan infeksi kembali terapi
rutin
 Pastikan untuk memeriksa orang terdekat
pasien  penyebaran
 DISKUSI
COBA BANDINGKAN EFEKTIVITAS
ALBENDAZOL DENGAN METRONIDAZOL
UNTUK TERAPI INFEKSI GIARDIA
DUODENALIS?? MANA YANG LEBIH
EFEKTIF
How about pregnancy
condition with giardiasis?
Drug Toxicity in Pregnancy Recommendations/
FDA
Tinidazole Increased fetal mortality in rats Caution (C)
Metronidazole None known – carcinogenic in Caution (B)
rats and mice
Nitazoxanide (Alinia) None known Probably safe (B)
Paromomycin Poorly absorbed; toxicity in fetus Oral capsules probably
unknown safe (C)
Furazolidone None known; carcinogenic in Caution*;
(Furoxone) rodents; hemolysis with G6PD contraindicated (N/A)
deficiency in newborn
Quinacrine (Atabrine) Safety not established Caution* (N/A)
Cont...
1. If possible, terapi dihindari selama trisemester 1
2. Gejala ringan  terapi ditunda hingga melahirkan
3. Jika terapi sangat diperlukan, paromycn dapat
digunakan karena absorbsi sistemiknya rendah
4. jika pasien dibiarkan tanpa terapi  nutrisi yang
adequate untuk mencegah dehidrasi
How about reinfection??

 Riwayat pengobatan seperti apa?? 

apakah karena gagal terapi
Terapi yang baru dapat berupa
1. Obat sama dengan periode yang lebih
panjang atau dosis yang lebih tinggi
2. Menggunakan obat alternatif diduga
efektif mengatasi hal tersebut
3. Terapi kombinasi
PREVENTION AND CONTROL
1. Practice good hygiene.
2. Avoid water (drinking and recreational)
that may be contaminated.
3. Avoid eating food that may be
contaminated.
4. Prevent contact and contamination with
feces (poop) during sex.
5. Clean and disinfect your home
1. Practice Good hygiene
 Everywhere  Wash hands
 At childcare facilities  children with diarrhea
should be removed from child care  reduce the
risk of spreading the disease
 At recreational water venues (for example,
pools, beaches, fountains)  If diagnosed with
giardiasis, do not swim for at least 1 week after
diarrhea stops
 Around animals  Minimize contact with the
feces (poop) of all animals and Wash hands after
any contact with animals
 Outside  Wash hands after gardening, even if
wearing gloves.
2. Avoid water (drinking and recreational)
that may be contaminated.

 Do not swallow water while swimming

 Do not drink untreated water
 If the safety of drinking water is in doubt  Drink
bottled water, Disinfect tap water by heating it to a
rolling boil for 1 minute
3. Avoid eating food that may be contaminated.

 uncontaminated water to wash all food

that is to be eaten raw.
 Avoid eating raw or uncooked foods
when traveling in countries with poor food
and water treatment.
4. Prevent contact and contamination
with feces (poop) during sex.

Use a barrier during oral-anal sex.

Wash hands right after handling a condom
used during anal sex and after touching the
anus or rectal area.
Overview materi
1. Diare disebabkan oleh....
2. Giardiasis menyebar melalui...
3. Bagaimana daur hidup giardiasis
4. Sebutkan terapi utama dan alternatif yang dapat anda
sarankan pada penderita giardiasis...
5. Cara mencegah penularan giardisis....
LEISHMANIASIS
 OUTLINE LEISHMANIASIS

AGEN
Introduction Epidemiology
PENYEBAB

MORFOLOGI DAUR HIDUP Gejala Klinis

Diagnosis Terapi Pencegahan

INTRODUCTION

 Leishmaniasis  Leishmania parasites  disebarkan oleh

gigitan phlebotomine sandfly ((Phlebotomus papatasi))
 Sering terjadi pada penduduk di daerah pedesaaan
 Bentuk Leishmaniasis yang paling sering :
a. Cutaneous leishmaniasis  luka/borok pada kulit 
jumlah kasus 0,7-1,2 juta
b. Visceral leishmaniasis  menyerang organ internal
(limpa, sumsum tulang dan hati)  jumlah kasus 0,2-0,4
juta
EPIDEMIOLOGI
AGEN PENYEBAB
 Intracellular protozoa  genus Leishmania  vector-
borne disease  ditransmisi oleh females sandflies  senja
hingga malam
 Ada 21-30 spesies leishmania 

L. donovani L. chagasi
L. mexicana L. amazonensis L. venezuelensis
L. major L. aethiopica
L. tropica
L. (V.) L. (V.) guyanensis L. (V.) panamensis L. (V.) peruviana
braziliensis
 MORFOLOGI
 Tahap tanpa flagelata
 Terdapat dalam host
vertebrata
 Binarry fission pada suhu 37oC
 Bentuk bulat atau oval ; 2-4µm
sepanjang longitudinal axis
 Nukleus relatif lebih besar dan
terletak di tengah
 Tahap dengan flagelata
 terdapat dalam sandflies
 Binarry fission pada suhu 27oC
 Spindle shaped (kumparan);
panjang 15-20µm ; lebar 1-
2µm
 Nukleus lebih kecil dan terletak
di tengah sel atau sepanjang
dinding sel
DAUR HIDUP
 GEJALA KLINIS
Cutaneous Visceral
leishmaniasis leishmaniasis
 kulit borok, nyeri  mengenai organ internal (hati,
limpha, sumsum tulang)
 Papula / Nodula  luka yang  panas, BB turun,
ditutupi sisik pembengkakan limpa dan hati
 Pembengkakan kelenjar  Anemia, leukopenia,
trombositopenia
 DIAGNOSIS
Mikroskop
 Kulit borok/luka (cutaneous
leishmaniasis) atau sumsum
tulang (visceral leishmaniasis)
 sampel jaringan diambil 
dikultur  diperiksa dibawah
mikroskop
Tes darah
 Mendeteksi antibodi (respons
imun) terhadap parasit 
visceral leishmaniasis
TERAPI
 KONTROL DAN PENCEGAHAN
 Tidak ada vaksin atau profilaksis untuk leishmaniasis
 Cara terbaik mencegah infeksi  melindungi
diri dari gigitan sand fly
 Cara menurunkan risiko gigitan :
a) Hindari aktivitas di luar ruangan, khususnya dari senja
hingga malam
b) Minimalkan bagian kulit yang terbuka dengan pakaian
lengan panjang
c) Apply insect repellent
d) Semprotkan obat nyamuk
e) Stay in well-screened or air-conditioned areas.
Quiz of leishmaniasis
 http://wwwf.imperial.ac.uk/theoreticalimmunology/exhibit2010
/quiz/
 http://quiz.thefullwiki.org/Leishmaniasis
Overview materi
1. Jelaskan mengapa sand flies disebut sebagai intermedite
vector?
2. Sebutkan bentuk leishmaniasis yang sering terjadi?
3. Sebutkan cara mencegah penularan atau infeksi dari
leishmaniasis...
4. Sebutkan obat utama yang dapat diberikan pada penderita
visceral leishmaniasis...
5. Jelaskan daur hidup leishmaniaisis....