PARASITIC DISEASES IN

RESPIRATORY SYSTEM

dr.Wiwien S Utami, M.Sc

Lffler's syndrome

Loeffler's syndrome is a disease in

which eosinophils accumulate in the lung
in response to a parasitic infection

1932 by Wilhelm Lffler

Eosinophilic pneumonia caused by
the parasites Ascaris lumbricoides,
Strongyloides stercoralis and the
hookworms (Ancylostoma duodenale
and Necator americanus)

Symptoms
Symptoms associated with larvae
migration
Migration of larvae in lungs may cause
hemorrhagic/ eosinophilic pneumonia,
cough (Loeffler's Syndrome)
Breathing difficulties and fever
Complications caused by parasite
proteins that are highly allergenic asthmatic attacks, pulmonary infiltration
and urticaria (hives)

Diagnosis

Stool microscopy :eggs may be seen on

direct examination of feces.

Eosinophilia: eosinophilia can be found,

particularly during larval migration
through the lungs

Eosinophilic pneumonia

Treatment

Mebendazole
Albendazole
Pyrantel pamoate
Ivermectin
Piperazine citrate
Levamisole

Trematod worms(=flukes)

Flat: platyhelminthes
Trematos=pierced with
holes

Leaf-like worm
Not segmented
anymore

Cacing Trematoda:
hermaprodit, atau
uniseks (monocious, atau
diecious)
masih cenderung inbreeding
masih dengan sucker
usus belum punya anus
belum punya body cavity

Habitat cacing bervariasi

intestinum tenue
Intest. crassum
hepar
paru
darah

Paragonimus westermani
Diastoma pulmonum, Oriental
Lung Fluke (Trematoda Paru)
Distribusi ; Jepang, Korea, Asia
selatan&tenggara, Indonesia
(Indonesia di kep.Solomon, Papua,
Jawa, Sumatra)
Hospes : manusia, kucing,
harimau
Host perantara : keong melania,
udang air tawar

Paragonimus westermani
BENTUK : MIRIP BIJI KOPI
UKURAN : 8 16 x 4-8 mm
KUTIKULA TERTUTUP SISIK ,SPT DURI DURI KECIL
PENGHISAP ORAL > VENTRAL
FARING PENDEK MEMBULAT
COECUM TUBULER, TAK BERCABANG
TESTIS 2 BH, BERLEKUK TAK TERATUR
LETAK BERDAMPINGAN
OVARIUM, 6 LOBI, DI SBLH ANTERIOR
KEL.VITELIN GRANULER DI LATERAL BDN

CACING DEWASA
P. westermani

TELUR

UKURAN : 80-118 X
48-60 m
BENTUK : LONJONG
OPERKULUM :
KECIL RATA (AGAK
TERTEKAN KE DALAM
TELUR BERISI SEL-SEL GRANULA

Pathology and
Symptomatology
Adults inhabit lungs, although other
organs are also involved.
Pathological lesions may be classified
into 4 stages:
(1)Invading and migrating stage: After
excystation

the

adolescents

penetrate

the

intestinal wall and migrate to the lungs .

(2) Suppurative stage. The bleeding and

infiltration

of

neutrophils

and

eosinophils

surrounding worms form a capsule, abscess.

(3) Cystic stage, the cyst wall is formed

due

to

the

progressive

fibrosis

of

the

surrounding tissue. The cystic contents

are chocolate or rusty thick fluid with
eggs

and

Charcot-Leyden

crystals,

which looks like sesame paste.

(4) Fibrous-scar stage, the worms are
dead or escape from the cyst. The exudate
and pus are expelled or absorbed and
replaced by fibrous-scar tissue.

Clinical manifestation:
Paragonimiasis may be classified into 4 types
:
(1)Pulmonary type: the symptoms resemble
pulmonary tuberculosis with low fever, loss of
appetite, night sweating, chest pain, loss of
weight and rusty sputum.
(2) Brain type: manifests epilepsy,
hemiplegia,

monoplegia,aphasia,

disturbence

and

resembles

visual
cerebral

(3)Abdominal

type:

abdominal

pain diarrhea or dysentery with blood,

mucus and ova in feces.
(4)Subcutaneous type: the wandering
and painless subcutaneous nodules.

Diagnosis
1. Sputum examination: (1) Alkali
digestive method (10%NaOH), (2)
Direct sputum smear
2. Stool examination: (1) Alkali
digestion , (2) Water sedimentation
method, (3) Direct fecal smear
3. Biopsy for Subcutaneous type
4. CT for brain type
5. Immunological tests for reference.

PARAGONIMIASIS PARU

Paragonimiasis paru,
Ro

Distribusi geografis
Paragonimiasis

Treatment and Prevention

1.Treatment:
praziquantel.
include

Drug

Other

of

choice

effective

hexachloroparaxylol,

is

drugs

bithionol

(bitin).
2. Prevention:
(1) Health education,
(2) Avoid eating raw fresh

water crabs

and crayfishes.
(3) Avoid sputum and stool getting into
water.

Epidemiology
This disease is prevalent in Far
East,

Africa

There

are

and

South

endemic

foci

America.
in

22

provinces in Northeast, East and

Southwest of China.
Its prevalence is related to eating
raw crabs and crayfishes and the
natural foci.

PNEUMOCYSTIS CARINII

Deadly AIDS Opportunist

Pneumocystis carinii pneumonitis

(PCP) is a common opportunistic
disease that occurs almost exclusively
in persons who have profound
immunodeficiency.
PCP was and still is the most common
life-threatening opportunistic infection
occurring in patients with HIV disease.

The taxonomy of P carinii has not been

established. It is either a protozoan or a fungus.
Recent studies show P carinii more closely
resemble fungi than protozoa.

rRNA sequences
thymidylate synthase
dihydrofolate reductase
beta tubulin
mitochondrial DNA
chitin in the cell wall

O E Eriksson has a treatise which places P

carinii in a new family, Pneumocystidaceae, and
in a new order, Pneumocystidales
(Ascomycota).

Life Cycle

http://www.doctorfungus.org

Pneumocystis carinii

Genus/Species:
Image Type:
Legend:

Pneumocystis carinii

Microscopic Morphology

Title:
Disease(s):

An electron micrograph of P. carinii cyst from rat lung tissue.

EM Image of Pneumocystis carinii

Pneumocystis pneumonia

http://www.doctorfungus.org

Pneumocystis carinii

Genus/Species:
Image Type:

Pneumocystis carinii

Microscopic Morphology

Title:
Disease(s):

Pneumocystis carinii-infected
Rat Lung Tissue

Pneumocystis pneumonia

Legend:
An H&E stain of a rat lung infected with P. carinii. It does not show any organisms, but shows the
proteinaceous exudate which results from Pneumocystis infection, and ultimately causes reduced gas exchange.

http://www.doctorfungus.org

Pneumocystis carinii

Genus/Species:
Image Type:
Legend:

Pneumocystis carinii

Microscopic Morphology

Title:
Disease(s):

Pneumocystis carinii Silver Stain

Pneumocystis pneumonia

A silver stain of P. carinii cysts from rat lung tissue showing the typical 'deflated ball' shape.

Clinical Presentation

Causes Pneumonitis, Pneumocystis

pneumonia (PCP)
Lung epithelium becomes desquamated

alveoli fill with foamy exudate containing

parasites

Fever, non productive cough, breathing

difficulty on exertion, respiratory failure,
cyanosis
Death by asphyxia

Diagnosis

Clinical symptoms
Sputum or bronchial lavage
Special staining with toluidine blue,
methenamine silver
Gram-Weigert stain for cysts
ELISA, immunofluorescence assay, DNA
amplification being developed

 Four drugs currently available for therapy of P

carinii pneumonitis are:

pentamidine isethionate
trimethoprim-sulfamethoxazole
atovaquone
trimetrevate

Trimethoprim-sulfamethoxazole is
preferred because of its low toxicity
and greater efficacy.

Selamat Belajar