Sunteți pe pagina 1din 3

c 

 
     


+ 23%$4     
 
 @@  ? V 
? V     
     „?    D   5
  „? 
  D 
 
       
?       
       
 
   
05
?   „? ""@ D     5
?  „?  

   ? ! 
?    
   „? "0  
 ?   
   +    
  $       

?        


 !" 
#      
     $ %   
   
&  
? V! ' D
 ‘ ‘ 
  
 ? !(  D 
      ‘   
  ‘    
? (( ) D
 ?  ) D   
  
$     
    
 @*   
+  $              
  
                )   
  
 ? 1    $ ! @    
    
    
  ? (
    V
  %  D ,-- ? ,    6 ‘   ‘      
   
 ). D ,--
/V@ %0 D $
 ! %0 D ,
 
          
 1     $  
  1   7&   
? /
    D  
 "0
  
(V@   
    
? /
   "0
  
 
Epidemiology ? cbdominal pain, distention, enlargement,
cc 
and tenderness of the liver
„? 10% dari populasi dunia terinfeksi oleh spesies ? Elevation of diaphragm and atelectasis, or
ù  adalah infeksi parasit yang disebabkan oleh
Entamoeba effusion
Entamoeba Histolytica
„? cmebiasis terjadi pada 50 juta org tiap tahunnya ? Lab findings : slight leukocytosis, moderate
Etiology : Entamoeba Histolytica dengan kematian mencapai 100.000 anemia, high ESR, and non-specific elevation
„? nsidensi amebiasis tinggi pada negara berkembang of hepatic enzyme
-? Mempunyai 2 bentuk : „? aktor-faktor yang berpengaruh pada transmisi :
1.? Trophozoite D colonize the lumen of large intestine edukasi yang rendah, kemiskinan, populasi penduduk ùiagnosis
and may invade its mucosal lining. yang terlalu padat, sumber air yang terkontaminasi.
„? Vergerak aktif 1.? Stools
Manifestasi Klinis -? ùiagnosis is based on detecting the organisms in
„? U : 10-60µ
stool samples, sigmoidoscopically obtained
„? ùapat ditemukan di lumen usus (intraintestinal)
1.? nfeksi asimptomatik smears, tissue biopsy sample.
dan luar usus (ekstraintestinal)
2.? ntestinal cmebiasis -? resh stools samples should be examined within
„? Mengandung beberapa eritrosit di dalamnya
? ccute amebic colitis 30min for detection of trophozoite containing
2.? Kista D infective form
„? May occur within 2 wks of infection or be erythrocyte in saline solution Ddefinitive!
„? Ôval/bulat asimetris
delayed for months 2.? Serologis
„? ùinding halus
„? Ônset is gradual with colicky abdominal pain 3.? Sigmoidoscopy
„? U : 10-20µ and frequent bowel movements (6-8x/day) -? Examined for trophozoite in biopsy taken from the
„? Kista muda : berinti 1 dan mengandung „? Tenesmus (associated with rectosigmoid edge of ulcers.
gelembung glikogen dan batang kromatoid involvement) 4.? Liver aspirate
Kista dewasa : berinti 4 dan hanya terbentuk & 5.? Non-invasive imaging of liver
„? Vloody and mucoid stools with few
dijumpai di lumen usus. 6.? Lab exam
leukocytes
-? Siklus Hidup : - ? n mild cases lab test are normal
„? ever
Kista dan trophozoite akan keluar bersama feses (kista - ? May find Leukocytosis
„? cbdominal tenderness may be localized
biasanya ditemukan pada feses padat, sedangkan - ? cnemia is common, esp. n chronic disease.
anywhere in lower abdomen, but usually
trophozite pada feses yang cair)
over cecum, transverse colon, or sigmoid.
Ë ùifferential ùiagnosis
? ulminant colitis
Kista yang matang termakan oleh manusia
„? s the result of confluent ulceration and
Ë „? Vacterial diarrhea caused by Campylobacter
necrosis of colon
ùi usus kecil, kista akan mengalami ekskistasi (dinding „? Enteroinvasive E.coli, Shigella, Salmonella, Vibrio
„? Vowel is dilated, particularly in transverse
kista hilang dan mengeluarkan amuba dlm stadium
portion Treatment
metakista berinti 4, kemudian membelah menjadi 8
„? Patient is extremely febrile and toxic, and
trophozoit muda
Ë
shows signs of hypovolemia and electrolyte -? Prinsip managementnya :
Parasit terbawa ke usus besar
imbalance „? Metronidazole
? cmeboma D? ùÔC for symptomatic invasive disease.
„? c nodular focus of proliferative D? ùosage : 30-50 mg/kg/day PÔ/V divided
inflammation. in 3 doses for 7-10 days
 
  $   1$ $
„? cs a result of repeated invasion of the colon „? Paromomycin
  
by E.histolytica, complicated by pyogenic D? ùÔC for non-invasive disease
infection. D? mse to cure luminal infection
3.? Hepatic cmebiasis (cmoebic Liver cbscess) „? Supportive
? ever (hallmark in children)
D? luid replacement (with plan V for mild- „? Vowel perforation -? nitric oxide appears to be involved in the
moderate dehydration) „? è bleeding pathogenesis of toxic megacolon (toxic colitis).
D? ùietetic treatment (for malnutrition) „? Stricture formation (ameboma)
„? Health education „? istula formation
-? Class of drugs uses to treat amebiasis „? ntussusceptiopn
1.? Luminal amebicides „? cmebic liver abscess
D? mse to treat asymptomatic or mild „? Empyema
intestinal forms of amebiasis, after „? Vrain cbscess
systemic or mixed amebicide to
„? Pericarditis
eradicate infection.
D? Contoh :diloxanide furoate, iodoquinol, Prevention
and paromomycin
2.? Systemic amebicides -? mproved sanitation and clean water supply
D? cgainst invasive amebiasis -? Eating only cooked food or self-peeled fruits in
3.? Mixed amebicides endemic areas. cvoid eating raw fruits and salads.
D? mse for both systemic and intestinal -? Early treatment in carriers.
forms
D? Contoh : metronidazole Prognosis
-? Pharmacological properties of Metronidazole -? ntestinal infection are respond well to appropriate
„? MÔc : nitro group of metronidazole is therapy. Severity increased in :
chemically reduced in anaerobic bacteria „? Children, esp. Neonates
and sensitive protozoans. The reactive „? Pregnant and postpartum women
reduction products is responsible for „? Those using corticosteroid
microbial activity. „? Those with malignancies
„? Clinical uses : „? Malnourished individuals
6? cmebiasis -? Mortality rate in pts with uncomplicated amebic liver
ùÔC for all tissue infection of abscess <1%
E.histolytica. Vut not effective
against extraluminal parasite TÔ C MEècCÔLÔN
6? èiardiasis -? clinical term for an acute toxic colitis with dilatation
6? Trichomoniasis of the colon
„? SE -? hallmarks : nonobstructive colonic dilatation larger
6? Common : Nausea, headache, dry than 6 cm and signs of systemic toxicity.
mouth, or metalic taste -? Criteria :
6? nfrequent : vomit, diarrhea, 1.? radiographic evidence of colonic dilatation.
insomnia, weakness, dizziness, 2.? Ône of : fever (>101.5°), tachycardia (>120
thrush, rash, dysuria, dark urine, beats/min), leukocytosis (>10.5 103/µL), or
vertigo. anemia
6? Should be used with caution in 3.? Ône of : dehydration, altered mental status,
patients with CNS disease. electrolyte abnormality, or hypotension.
-? Rehydration plan V : -? icroscopic hallmark of toxic megacolon (toxic colitis)
ÔRS 700-900 mL in 4 hours + extra fluuid + zinc is inflammation extending beyond the mucosa into
the smooth-muscle layers and serosa.
Complication