Parasitology

Reynaldi Prasetya N
130110180138
Grup A / Tutor 5
CASE LAB A PARASITOLOGY

A 40-year-old man was brought by his family because of severe pain on the upper abdomen. The complaint
was accompanied by fever and fatigue. From history taking, 4 weeks before hospital admission, patient has
frequently bloody diarrhea and relieved after 5 days treated by antibiotics. A week ago, the bloody
diarrhea came again and accompanied with acute severe pain on the upper abdomen.

Physical examination: BP 100/60mmHg, RR 24x/mnt, HR 96x/mnt, T: 38.5 °C, abdominal tenderness (+)

Feces wet mount : https://youtu.be/Qz8miHy49KQ

X ray of thorax cavity, CT Scan and USG
Abdomen

a) Thoracic X-ray of a patient with liver abscess showing the elevation of the right hemi-diaphragm. Ultrasound images
of: b) Single large abscess and c) Three hepatic abscesses cavity. d) Contrasted computed tomography (CT) scan of a
single abscess and e) Three clear liver abscesses

Blood routine examination:

Hb = 8mg/dl, Neutrophil increase

Based on your prior knowledge, please do these tasks:
 Case analysis
 Explain the agent of infection, and its life cycle
 Explain the symptoms related with pathogen life cycle
 Explain the lab finding related with the pathogen
 Explain the Pathogenesis
 Mention the treatment
 Explain the prevention
Case Analysis

Identity : 40 years old man

CC : Severe pain on the upper abdomen
Problems : 
 Fever and fatigue
 Frequently bloody diarrhea
 T: 38.5 °C, abdominal tenderness (+)
 a) Thoracic X-ray of a patient with liver abscess showing the elevation of the right hemi-diaphragm. Ultrasound images of: b)
Single large abscess and c) Three hepatic abscesses cavity. d) Contrasted computed tomography (CT) scan of a single abscess
and e) Three clear liver abscesses
 Hb = 8mg/dl (decreased), Neutrophil increase
Explain the agent of infection, and its life cycle

Infective formnya saat berbentuk cyst

Life cycle nya: 
 Cyst masuk lewat mulut terus bisa melewati acid gastric dan ke small intestine
 Mengalami excystation (kerusakan dari cyst) oleh trypsin
 Terbentuk metacyst akibat kerusakan cyst wall sehingga quadrinucleate amoeba bisa dikeluarkan 
 Terbentuk berupa metacystic trophozoites yaitu nuclei di metacyst akan membentuk 8 nuclei
yang akan berubah jadi 8 amoubulae (metacystic trophozoites) di colon
 Bisa berupa non-invasive trophozoites mengalami encystation pembentukan cyst yang akan
dikeluarkan melalui feses
 Atau invasive yang akan melukai epitel di colon
Explain the symptoms related with pathogen
life cycle

 Fever : karena E. histolyticanya merusak epitel usus → membentuk ulcer → inflamasi → mediator
inflamasi → fever
 Fatigue : mungkin karena diarenya yang menyebabkan makanan tidak terabsorpsi dengan baik sehingga
tidak bisa membentuk energi
 Bloody Diarrhea : karena ulcer → erosi pembuluh darah → terbawa ke stool
 Abdominal Tenderness : pain -> Dari Ulcer gastric
 Wet feces -> Epitel hilang dari colon karena diserang E. histolytica  no rearbsorpsi air.
Explain the lab finding related with the
pathogen

 Lab Findingnya : Liver Abses, Hb Turun, HB TURUN

Neutrofil Naik. Dari blood yang bocor dari diarea

NEUTROFIL
 LIVER ABSES : Extraintestinal infection is Karena terdapat infeksi
metastatic and rarely occurs by direct extension
from the bowel. By far the most common form is
amebic hepatitis or liver abscess (4% or more of
clinical infections), which is assumed to be due to
microemboli, including trophozoites carried
through the portal circulation. It is assumed that
hepatic microembolism with trophozoites is a
common accompaniment of bowel lesions but
that these diffuse focal lesions rarely progress.
Explain the Pathogenesis
Mention the treatment

Amoebiasis diberi pengobatan golongan nitroimidazole drugs, golongan obat ini fungsinya membunuh
amoebas di dalam darah, di dinding usus dan di abses liver. Yang termasuk ke dalam golongan obat ini salah
satunya metronidazole (Flagyl) dan ada tinidazole (Tindamax, Fasigyn). Metronidazole diberi selama 10 hari,
diberikan melalui oral atau IV.
Untuk membunuh amuba sama membatasi kista di intestine, menggunakan 3 obat yang disebut obat luminal
contohnya: iodoquinol (Diquinol and others), paromomycin (Humatin) and diloxanide furoate (Furamide).
Salah satu dari obat ini digunakan bersamaan dengan metronidazole ketika terdapat gastrointestinal symptoms
Explain the prevention

 PHBS
 Sebelum makan cuci tangan
 Minum air yang bersih / telah di rebus
 Tidak makan sembarangan
 Jika memakan buah mentah, lebih baik dicuci dan dikupas terlebih dahulu