ASCARIASIS9

(Cacing Gelang)
Etiology: Ascaris lumbricoides
 CLINICAL VIEW FOR INTESTINAL
HELMINTHIASIS
• Ascaris lumbricoides/ C. gelang
• Hookworm/Cacing tambang
Soil-
• Strongyloides stercoralis transmitted
• Trichuris trichiura helminths
• Enterobius vermicularis

• Tapeworm infection/ cacing pita

ASCARIS LUMBRICOIDES Intestinum
dewasa
esofagus
Ke 2 x
Telur (200 rb/hr/induk)

tertelan Farinx
Tinja

Tanah Naik ke trakea

telur
Larva rabditiform Life cycle Sal. Napas > besar

Menembus alveoli
Larva filariform

Menembuskulit
ddg Paru
Menembus
usus

Aliran darah Jantung kanan

 ASCAEIS LUMBRICOIDES
IndukTelur 200 rb/hr

Tinja
  terlur Cacing
Larva rabtiform Dewasa
 Tertelan pertama x 
Larva firafiform Intestinum
 
Menembus ddg intestinum Tertelan 2X
 
Aliran darah Kap. Paru AlveolusbronkusFaryns
 SYMPTOMS AND SIGNS
- Usually no symptoms
- Low grade fever
- Urticaria
- Nonproductive cough
- Blood tinged sputum/blood streak sputum
- Wheezing
- Dyspnea LARVAE THROUGHT THE LUNGS

- Localized rales (Loeffler’s syndrom)

- Substernal pain
- Heavy infection produce symptoms:
- Peptic ulcer symptoms
- Preprandial or postprandial abdominal disconfort
 Complications (1)
• Larvae lodge ectopically in:
– Brain
– Kidney
– Eyes
ECTOPIC
– Spinal cord
– And other sites and may cause
symptoms referable to those organ
• Adult worms: …
 Complications (2)
• Adult worms:
– May migrate with heavy infections  they
may be coughed up, vomited, or emerge
through the nose or anus
– May force themselves into:
• The common bile duct/ductus
choledochus
• Pancreatic duct
• Appendix
• Diverticula and other sites
 Which may lead to:
Choleangitis
Cholecystitis
Cholelithiasis
Pyogenic liver absces
Acute pancreatitis
Or obstruction jaudice
– With very heavy infections …
 Complications (3)
– With very heavy infections, masses of worms
may cause:
• Intestinal obstruction
• Volvulus
• Intussusception or
• Death
• During typhoid fever, worms may
penetrate the weakened bowel wall 
ulcer  perforation  peritonitis
Indomie made in India
 Treatment
• Albendazole: periodic treatment of children with
albendazole for multiple intestinal parasitism has
resulted in improved nutrition
• Albendendazole (400 mg)+Ivermectin (200 mg/kgBB)
• Mebendazole
• Pyrantel pamoate
• Piperazine
• Other drugs (levamizle, Ivermectine)
• Combination:
– Pyrantel (10 mg/kgBB)+Oxantel (10 mg/kgBB)
– Albendazole (400 mg)+Ivermectin (200 mg/kgBB)
– Mebendazole (500 mg)+Levamizole (2,5 mg/kgBB)
 Prognosis
• If there is no complication  good
– The complications caused by wandering adult
worms that all ascaris infections must be
treated and eradicated  may be serious/fatal
 masses of worms may cause:
• Intestinal obstruction, Volvulus, Intussusception or
Death
 Differential Diagnosis XXX
Ascariasis Differential Diagnosis
- Pulmonary ascariasis - Eosinophilia nonparasitic causes
with eosinophylia (asthma, Löffler’s syndrome, eosinophilic
pneumonia, allergic bronchopulmonary
aspergillosis) and parasitic causes (tropical
pulmonary eosinophilia, toxocariasis,
strongyloidiasis, hookworm,
paragonimiasis)
- Ascaris induced - Other causes of inflammation of
pancreatitis, appendisitis pancreas, appendix, diverticel
& diverculitis

- Postprandial dyspepsia -Duodenal ulcer, hiatal hernia, gallbladder

disease, pancreatic diseases  epigastric
pain