Agen Parasitik Penyebab Gangguan Sistem Reproduksi - Dr. Erwin

Agen Parasitik Penyebab Gangguan Sistem ReproduksiForman Erwin SiagianDepartemen Parasitologi FKUKIEmail: [email protected] 16 Juli 2013

5 tahap pemenuhan kesehatan

Scope of discussionCandida sppTrichomonas vaginalisToxoplasma gondiiWuchereria bancroftiPthirus pubis

Concepts

Vulvoaginitis symptoms may include:

Change in color, odor or amount of discharge from your vagina Vaginal itching or irritationPain during intercoursePainful urinationLight vaginal bleeding or spotting

Vulvovaginal Candidiasis (VVC)

Size of the problem55% of women by age mid 20s have had VVC Geiger AM, Foxman B, Gillespie BW. AmJ Pub Hlth 1995;85:1146-1148.Up to of all women at least 1 lifetime episode$58.4 million per year $19.8 in medication costs Foxman B, et al STDs 2000;27:230-235.

ConsequencesNot directly life threatening but can caused ..Poor self esteem.Psychosexual problems.Stewart DE, Whelan CI, et al Obstetrics & Gynecology 1990;76 :852-856. Irving G et al. STIs. 74(5):334-8, 1998 Oct. 99210932 Socially unacceptable to discussOften misunderstood/dismissed by health professionals

Causative agentC. albicans 85-90%C. glabrata 5-10%Others: C.tropicalis, C.krusei, C. kefyr,

Cassone et al.Infect. Immun. 2007, 75(10):4675

Recurrent VVC (RVVC)defined as 4 or more symptomatic infections per year or 3 episodes not related to the administration of antibiotics occurring within a year.Recurrent disease occurs in 5% of women, and in the majority of cases recurrence occurs within 3 months of the initial infection.Between 10% and 33% of recurrent candidal vulvovaginitis is due to species other than C albicans, such as Candida glabrata (the most common), Candida tropicalis, Candida krusei, Candida parapsilosis, and Saccharomyces cerivisiae.

Theories about RVVCbased on the intestinal reservoir of Candida species, though this has not been demonstrated in subsequent studies, sexual transmission, as 20% of sexual partners have colonization of the mouth, genitalia, and fingers by the same species. The most widely accepted theory at the present time is that recurrent candidal vulvovaginitis is due more to persistence of the pathogen in the vagina than to reinfection; this is supported by the isolation of microorganisms with an identical karyotype in recurrences

Trichomonads on vaginal epithelial cells.T. vaginalis has the ability to attach to host cells (cytoadherence) thereby establishing infection as the organism overcomes the constant secretion of the vagina.

Two classes of proteins are involved in cytoadherence of T. vaginalis, these are the four adhesion proteins AP65, AP51, AP33 and AP23 and Cysteine proteinase.Adegbaju et al. Cytoadherence and pathogenesis of Trichomonas Vaginalis. Scientific Research and Essay Vol. 3 (4), pp. 132-138, April 2008exact mechanism of its pathogenesis has not been clearly elucidated, many mechanisms are thought to be involved. These include (1) cell-to-cell adhesion, hemolysis, (2) cell detaching factors, (3) excretion of soluble factors and (4) evasion of the host immune system.

Faktor resiko (STI/STD/PMS secara umum)Memiliki 1 hal dibawah ini:

Toxoplasma gondiiToxoplasmosis is an infestation caused by an obligate intracellular protozoon, Toxoplasma gondii

The classic triad of signs suggestive of congenital toxoplasmosis includes chorioretinitis, hydrocephalus, and intracranial calcifications. However, other clinical manifestations also are associated with the disease nonspecific

Possible Signs and Symptoms of Congenital Toxoplasmosis in Infancy and Later in Life*

*MOST NEONATES WITH CONGENITAL TOXOPLASMOSIS ARE ASYMPTOMATIC AS DETERMINED BY ROUTINE NEWBORN EXAMINATION.SIGN IN THE CLASSIC TRIAD SUGGESTING THE PRESENCE OF CONGENITAL TOXOPLASMOSIS. Prevention of Toxoplasmosis in Pregnant Women

Abnormal spinal fluidAnemiaChorioretinitisConvulsionsDeafnessFeverGrowth retardationHepatomegalyHydrocephalusIntracranial calcifications

JaundiceLearning disabilitiesLymphadenopathyMaculopapular rashMental retardationMicrocephalySpasticity and palsiesSplenomegalyThrombocytopeniaVisual impairment

W. bancrofti Hydrochele

Acquired hydroceles in migratory male subjects.The typically unshaped, nontender and transilluminated hydroceles were considered as acquired to the W. bancrofti adult worm infection.

The 37 years old subject (TM6A99136;A) of grade 1 unilateral hydrocele (dart) was microfilaremic, antigenemic and himself discovered the hydrocele for 20 years despite living in the village for 4 years.

The 42 years oldsubject (TM6A99128; B) of grade 1 unilateral hydrocele with experience of chyluria was negative of circulating microfilariae and antigen of W. bancrofti. The abnormal penis with nontender nodules (dart) was evident.

The 36 years old subject (TM6A99168; C) of grade 2 bilateral hydrocele (dart) was amicrofilaremic, antigenemic and, as long as he lived in the village, hydrocele was discovered by himself for 2 years.Bhumiratana et al. SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH. Vol 33 No. 1 March 2002

The objective of this series was to show that the sonographic appearance described as the filarial dance is not characteristic of filariasis but occurs in nonendemic areas as a manifestation of epididymal obstruction.

An experienced observer documented cases after initial observation of the filarial dance in routine clinical practice using high-frequency linear array transducers. The filarial dance was described as excessive to-and-fro movement of echogenic particles within a prominent epididymis and graded 1 to 4 according to the extent and distribution of the abnormality.

The current assumption is that these echogenic particles (may represent adult filarial worms or microfilaria, the larval form of filarial worms) that represent filarial worm nests within obstructed and dilated lymphatic channelsJ Ultrasound Med 2011; 30:11451150

Pthirus pubisSucking lice are small wingless external parasites that feed on blood. Three types of sucking lice infest humans: the body louse, Pediculus humanus humanus Linnaeus, also known as Pediculus humanus corporis; the head louse, Pediculus humanus capitis De Geer; and the crab louse or pubic louse, Pthirus pubis (Linnaeus).

Diagnosis and management

Picture Courtesy of National Institute for health www.stanford.edu

Equivocal = samar-samar

Treatment:Treatment is not needed for a healthy person who is not pregnant. Symptoms will usually go away within a few weeks. Treatment may be recommended for (1) pregnant women with active infection, (2) persons who have weakened immune systems, or (3) persons with ocular disease or (4) severe illness.

The presence of eggs (nits) is the most important indication of a problem because they are easier to see and inactive, whereas the lice are near the skin feedingDelousing methods practiced for many years prior to and during the early part of World War II were cumbersome and usually expensive. Methyl bromide, a fumigant which would destroy all stages of the louse, but which is dangerous to use, was developed in the interval between the two World WarsUsually treatments effective against head lice can be used also against crab lice. The liquid or powder must be applied to the pubic and anal regions of the body, underarms, and wherever the body is hairy. In particularly hairy persons, the lousicide should be applied from neck to foot, perhaps also to eyebrows and beard. The material should be well distributed and should reach the skin.

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