ZOONOTIC helminthiasis Prof Pratiwi TS Semester V They are like monsters!!!! NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Parasitic zoonoses Fleas Mites Ticks Hydatids Visceral larva migrans (Toxocara canis, T cati, Toxascaris leonina?) Cutaneous larva migrans (Ancylostoma caninum, Uncinaria stenocephala) Trichinellosis Fascioliasis Swimmer’s itch (Cercaria longicauda) NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Helminth: parasitic worm (Greek) Platyhelminthes (flukes, tapeworms) Nematodes- (roundworms) literally means “thread-like” Pathogenic helminths are some of most common parasites Worlwide distribution NEMATODA -ZOONOSIS-1 pts

ZOONOTIC HELMINTHIASIS Toxocariasis (visceral/ocular larval migrans) Toxocara canis, T. cati Meningoencephalitis Balysascaris procyonis Trichinosis Trichinella spiralis Taeniasis Taenia soleum, T. saginata Hydatid disease Echinococcus granulosus, E. multilocularis NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts NEMATODES Life cycle Reproduction Amphimictic (sexual) Parthenogenetic (from eggs without fertilization) Hermaphroditic (possess both male and female organs or reproduction) Oviparous – eggs hatch after laid Ovoviviparous – eggs hatch within uterus, live young expelled Types of life cycle Direct- intermediate host not required Indirect – intermediate host required NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts TRICHINOSIS (1) Agent: Trichinella spiralis - intestinal nematode of many wild and domestic carnivores and omnivores T. nativa - Arctic bears T. pseudospiralis - mammals and birds T. nelsoni - African predators and scavengers T. britovi - carnivores in Europe, Western Asia Other names for disease: trichinellosis trichiniasis NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Larva from Alaskan bear Larva in cyst from muscle NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Agent: Larva from Alaskan bear Larva in cyst from muscle NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Life cycle: larva released from ingested cyst invade mucosa of small intestine where they develop into adults after 4 weeks (life span in intestine), females release larva that migrate to striated muscle encystment complete in 4-5 weeks note: T. pseudospiralis does not encyst may remain viable for several years NEMATODA -ZOONOSIS-1 pts

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NEMATODA -ZOONOSIS-1 pts Epidemiology Reservoir: swine, dogs, cats, rodents, many wild animals, especially bears, boars, marine mammals, and large felids Occurrence: worldwide, most common in Europe and US age adjusted incidence rate:  2% NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Epidemiology Transmission: ingestion of raw or undercooked meat pork and pork products bear meat marine mammal meat hamburger adulterated with pork NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Clinical features Incubation period: generally 8-14 days; up to 45 days Symptoms: from inapparent to highly fatal myalgia edema - periorbital and facial edema conjunctivitis fever eosinophilia gastrointestinal - diarrhea, pain, vomiting NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Clinical features Life threatening symptoms: myocarditis CNS involvement pneumonitis NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Diagnosis Serology EIA ES (excretory-secretory) products - TLS-1 surface antigens conserved in all species, can be used for detection in animals or humans Ab levels not present until 3-5 weeks post infection - IgM, IgG, IgE; peak in 2-3 months IgG most sensitive used for routine screening Bentonite flocculation Muscle biopsy Microscopic examination NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts TRICHINOSIS Diagnosis: detection of larvae in muscle NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts TRICHINOSIS Treatment Anthelmintics mebendazole (Vermox®) only effective against intestinal stages, not encysted stage Corticosteriods decrease severity of symptoms during muscle invasion phase NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts TRICHINOSIS Prevention Proper cooking of pork and pork products and meat from wild animals internal temperature should reach 160ºF (71ºC) Irradiation of food effective low level gamma - sterilization higher levels - effectively kills trichinae Freezing will inactivate larvae of T. spiralis but not of T. nativa (arctic strains) NEMATODA -ZOONOSIS-1 pts

Trichinella spiralis – trichinellosis Rodent > pig cycle Human infection from eating undercooked pork NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Roundworms Dogs, cats Toxocara sp., Toxascaris Horses Parascaris equorum Swine Ascaris suum Cattle Neoascaris (Toxocara) vitulorum NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Toxocariasis (2) Toxocara canis Toxocara catti Toxocara vitulorum NEMATODA -ZOONOSIS-1 pts

TOXOCARA VITULORUM Studi epidemiology 54,24%-76% Garut (Simon dan Syahrial, 1992) 70-100 % Srilanka (Robert, 1992) 89 % Myanmar (Lorh et al, 1986) 75 % Bali (Gunawan dan Putra, 1982) Hasil Pengamatan UB 76 % Malang Selatan (Ifar dan Pratiwi, 1991 – INRES) 89 % Nganjuk (Pratiwi, dkk 1993 - STD3 ) NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts SIKLUS HIDUP NEMATODA -ZOONOSIS-1 pts

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Visceral larva migrans NEMATODA -ZOONOSIS-1 pts

Cutaneous larva migrans Uncinaria stenocephala Ancylostoma caninum Direct penetration of the skin by hookworm 3rd stage larvae, which develop in the environment from eggs shed in dog or cat faeces. NEMATODA -ZOONOSIS-1 pts

Ascarids of dogs and cats Toxocara canis, T. Cati Toxascaris leonina Very common & important roundworms virtually all puppies & kittens are infected early in life zoonotic: cause visceral & ocular larval migrans in humans NEMATODA -ZOONOSIS-1 pts

Cutaneous Larval Migrans Hookworms (Ancylostoma and Uncinaria) can produce cutaneous larval migrans Eggs are passed Larva develop and penetrate human skin- cases of walking barefoot in yard- Australia Ingestion of worms leads to intestinal problems NEMATODA -ZOONOSIS-1 pts

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NEMATODA -ZOONOSIS-1 pts Toxocara cati Common roundworm of wild and domestic felids Very common in kittens, Rare in dogs Common in feral cats, wild felids as result of ingesting paratenic hosts rodents, chickens, birds, earthworms, cockroaches, ruminants etc Milk based transmission only NO transplacental transmission NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Life cycle of T. canis Adults in small intestine → eggs (lots!) in feces Infective larva develops within egg in ~2-4 weeks Egg with larva ingested Larva hatches in duodenum NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Life cycle of T. canis Larval migration: pathway & fate of larvae varies with host age and susceptibility young hosts<12 weeks: liver-lungtracheal migration older hosts > 12 weeks: liver-lungsomatic migration NEMATODA -ZOONOSIS-1 pts

Summary: T. canis transmission Transplacental transmission to fetal liver via activated hypobiotic larvae in bitch Ingestion of: * Egg in environment with infective larva NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Larvae from colostrum or milk of dam Hypobiotic larvae in paratenic host tissues Eggs, larvae or immature worms in puppy vomit or feces NEMATODA -ZOONOSIS-1 pts

Hookworms of dogs and cats NEMATODA -ZOONOSIS-1 pts

Hookworms & Roundworms NEMATODA -ZOONOSIS-1 pts

Hookworms & Roundworms Carried by dogs and cats Kids often get infected from playing in sand boxes which animals have defecated Or by putting toys in their mouth which have been on the ground NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Hookworms (3) Can penetrate the skin and gain entry into the human body Bare feet are a common route of entry NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Wearing shoes is one of the best ways to prevent parasites from entering your feet!!! You should wear shoes wherever animals go to the bathroom on the ground. NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Hookworm transmission L3 (infective larvae) can be acquired by: 1. Skin penetration 2. Ingestion * In food or water * Lactogenic transmission: major source of infection of puppies * Ingestion of arrested larvae in paratenic hosts 3. Transplacental route ~unimportant NEMATODA -ZOONOSIS-1 pts

Ancylostoma caninum(4) 􀁻 Very common in dogs of all ages in midwest 􀁺 More significant problem in south & central US 􀁻 Infectious larval stage (L3) survive best in moist,sandy-loam soils at moderate temperatures 􀁺 do not survive freezing 􀁺 do not survive at temps >37 ºC 􀁻 Clinical cases more common during warm weather NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Hookworms of dogs and cats Ancylostoma caninum 􀁺 common hookworm of dogs 􀁺 very rare in cats 􀁺 most pathogenic hookworm in dogs/cats A. tubaeforme 􀁺 common hookworm of felids 􀁺 rare in dogs NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Uncinaria stenocephala (5) More prevalent in northern US 􀁺 less common & less pathogenic than A.caninum because it sucks less blood 􀁻 Structure eggs slightly larger than A. caninum 􀁻 Lactogenic transmission important 􀁻 No prenatal transmission NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Persistent hookworm infection Source of infection: hypobiotic larvae in SI mucosa or muscles 1. Larvae “leak” out of these sites ~continuously and reach the SI lumen 􀁻 if animal already has adults in SI: probably shed into lumen and expelled 􀁻 if no hookworms present: develop to adults 2. If adult hookworms killed by an anthelmintic, arrested larvae can be activated and quickly repopulate the SI NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Persistent hookworm infection Source of infection: hypobiotic larvae in SI mucosa or muscles 1. Larvae “leak” out of these sites ~continuously and reach the SI lumen 􀁻 if animal already has adults in SI: probably shed into lumen and expelled 􀁻 if no hookworms present: develop to adults NEMATODA -ZOONOSIS-1 pts

Public health importance Cause cutaneous larval migrans (CLM) Hookworms: Public health importance Cause cutaneous larval migrans (CLM) 􀁺 linear, tortuous, erythematous and intensely pruritic eruptions caused by migration of nematode larvae in humans 􀁻 Most commonly caused by A. braziliense 􀁻 A. caninum, U. stenocephala, Bunostomum spp & Strongyloides spp. can also cause CLM 􀁻 Known as “barnyard itch”, “creeping eruption”or “ground itch” NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Typical clinical signs in pups 􀁻 Pot-belly 􀁻 Ill thrift 􀁻 Dull dry hair coat 􀁻 Abdominal discomfort 􀁻 Vomiting 􀁻 Mucoid diarrhea 􀁺 may alternate with constipation 􀁻 Toxocara in vomit/feces NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Trichinella in muscle NEMATODA -ZOONOSIS-1 pts

Pinworm (Enterobius (4)) Extremely common, most notable in young children 400,000,000 worldwide Direct life cycle Female 8-13 mm Male 2-5 mm Image from OSU www.emedicine.com/med/images/18381.jpg NEMATODA -ZOONOSIS-1 pts

Pinworm (Enterobius) Eggs ingested  Larvae hatch in small intestine (2 molts) and migrate to colon Mature and mate Females (containing ~10,000 eggs) migrate out of anus and lay eggs on anal skin after explosive evagination of uterus Eggs become infective (embryonate) after 6 h NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Pinworm (Enterobius) INTENSE ANAL ITCHING – main symptom! but many persons with low level carriage are asymptomatic Diagnosis: characteristic eggs on anal skin - detected using clear sticky tape (Scotch tape test). Sometimes worms seen in feces NEMATODA -ZOONOSIS-1 pts

Whipworm – Trichuris (5) Similar life cycle to pinworm except adults live in colon and females release ~5000 eggs/day directly into feces. Eggs take ~3-4 weeks to become infectious (embryonate) in soil Infection by ingesting embryonated eggs NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Whipworm - Trichuris Often coinfecting with hookworm and Ascaris 1 billion persons Extremely heavy infections can cause rectal prolapse NEMATODA -ZOONOSIS-1 pts

Egg shape and size allows you to identify a helminth. Fecal preps Roundworms Tapeworms Flukes Fluke eggs Often have a cap “operculum” Urine and feces Sputum and feces NEMATODA -ZOONOSIS-1 pts

NEMATODA -ZOONOSIS-1 pts Tugas presentasi NEMATODA -ZOONOSIS-1 pts