Infeksi Parasit Pada ODHA PDF

Agnes Kurniawan, dr. PhD.
SpParK
Dept. Parasitologi Fakultas Kedokteran
Universitas Indonesia
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AREA PROGRAM
PERAWATAN, DUKUNGAN DAN PENGOBATAN ODHA
Orang dengan
HIV/AIDS
(ODHA)
HIV / AIDS
Gejala :
-
berat badan menurun > 10% dalam 1 bulan

diare kronis > 1 bulan
demam lama > 1 bulan
gangguan neurologis
batuk menetap > 1bulan
Gangguan makan/minum OPC
Gejala AIDS di RS. Dr. Cipto Mangunkusumo
Gejala
Demam Lama
Batuk
Penurunan berat badan
Sariawan dan nyeri menelan
Diare
Sesak napas
Pembesaran kelenjar getah bening
Penurunan kesadaran
Gangguan penglihatan
Neuropati
Ensefalopati
Frekuensi
100 %
90,3 %
80,7 %
78,8 %
69,2 %
40,4 %
28,8 %
17,3 %
15,3 %
3,8 %
4,5 %
Manifestasi klinis :
- CNS : Toxoplasmosis
- GIT : diare (Parasit patogen & oportunistik)
- Respiratory tract : Cryptosporidium, Strongyloides
stercoralis, Toxoplasmosis
- Mata : Toxoplasmosis
WORKSHOP PERKEMBANGAN D/
LABORATORIUM UTK PERAWATAN
ODHA, ASTON MARINA 29 JULI'09
Pre antiretroviral therapy
Age : 5 months 55 years old
94.5% : males (2140 years)
CD4+ counts <50 cells/mm3.
Parasites positive samples : 84.3%
protozoan pathogens are most commonly
Intestinal protozoan pathogens were detected

more frequently in cases CD4+ 200/mm3
WORKSHOP PERKEMBANGAN D/ LABORATORIUM UTK PERAWATAN ODHA, ASTON MARINA 29 JULI'09
CNS opportunistic infection in

RSCM, Jakarta
(2004 2006), n= 203
Undetermined
24%
CMV
0%
Bacterial
5%
Krypto
13%
Cerebral Toxoplasmosis
31%
TBC
27%
26%
43%
8%
1%
5%
17%
TB = 229
Hepatitis C = 69
Toksoplasmosis = 26
Pneumonitis carinii = 31
Herpes Zoster = 19
Candidiasis Oral = 144

Single parasitic infection: 71.4%

Polyparasitism: 12.9%
Type of Parasites found:

Blastocystis hominis (72.4%)

Cryptosporidium 11.9%,
Cyclospora cayetanensis 7.8%
Giardia duodenalis 3.4%
stercoralis, Ascaris
Isospora belli, Strongyloides stercoralis
lumbricoides, Entamoeba
Kurniawan A, et al. Trans R Soc Trop Med Hyg2009, doi:10.1016/j.trstmh.2009.02.017
Intestinal Parasitic Infection among

the HIV/AIDS in Jakarta (n=328)
80
60
% 40
20
0
Blastocystis
Cryptosp
Cyclospora
Giardia
Collection :
Formed stool : thumb size
Liquid stool
: 5 ml
Container : plastic, clean, dry , wide mouthed,
screw capped
Free of urine, antiseptic, soil
Transport :
Distant place : fixative 10% formalin , PVA,
SAF
Liquid stool, blood +, mucus +

examined within 30 of voiding
Semi-liquid examined within 1 hour of
voiding so that motile forms of the
protozoans can be examined, permit the
culture of low infections

Parasit patogen
Parasit oportunistik

Preservation of trophozoites and cysts : use

PVA : stool = 3:1 in a vial with a plastic cap
For trichrom staining
DO NOT USE VIALS WITH ALLUMINIUM CAPS
Other Staining ??
Faeces contains magnesia, powdered

aluminium salts, barium, bismuth, oil, or
antibiotics may be unsatisfactory for
identification of protozoans.
Visual examination
Colour : black (occult blood), brown, pale

yellow (fat), white (obstructive jaundice).
consistency : formed (normal shape), soft

formed, unformed or liquid (watery).
Macroscopic blood ? Exudate?
Saline
suspension : to detect motile

trophozoites; and cysts; erythrocytes,
cellular debris or excess fat.
Lugol solution : stain the nucleus
Eosin solution : stain the whole field
except the protozoa (eg) amoebae
Microscopic ExaminationAttention :
Select unformed or liquid faeces when using
direct microscopy for detection of trophozoites
and direct examination of any external blood or
mucus.
Formed stools : take from the centre and the
surface
Stools with mucus / liquid: take the portion from
the surface of mucus / liquid
Examine the whole area with 10 X objective,

then with 40X
Protozoa is a single cell microorganism

Maybe found in stool as :
- vegetative / trophozoite form OR
- cysts
Classification :
1. pathogenic : E. histolytica, G. intestinalis,
B. coli, Cyclospora
2. non pathogenic : Entamoeba coli
3. opportunistic: Cryptosporidium,
Microsporidia, Isospora
Motile :
1. slow movement amoebae
2. rapid movement
flagellate, cilliate
note : size, shape, motility,

cytoplasm, nucleus, presence
of erythrocytes
Non motile, well-defined shells
eosin sol : can be seen as transparent shiny

globules standing out clearly against a red
background.
40 X objective : size ~ 13 erythrocytes.
Note: size, shape, membrane, nuclei,

karyosome, cytoplasm
Can be found in vegetative form as well as cyst

stage in stool
Method :
1. detection of trophozoite : wet mount with
saline / eosin solution trophozoite movement
2. detection of cyst : wet mount with eosin, lugol
or MIF solution. Mature cysts are infective. Cysts
bearer do not show any clinical signs carrier
Entamoeba histolytica cyst:

should be differentiated from E. coli cyst
cannot be differentiated from E. dispaar cyst
Definitive diagnosis :
stool antigen detection
Trichrome
Lugol
Lugol

It is an opportunistic parasite
Formerly : AIDS defining disease
Clinical manifestations in immune competent
individuals are not obvious, light diarrhoea
Immunocompromised : chronic diarrhoea, profuse
diarrhoea, abdominal cramps, wasting, (fever)
Mode of infection : oro-fecal, food and water borne
Infective form : mature oocyst
Severe immune deficiency: extraintestinal lungs,
billiary
EPIDEMIOLOGY
Common
May
in tropical countries
cause travellers diarrhea
Endemic
in children, may cause epidemic

in community/institution
Several
outbreak due to contamination of

drinking water sources
Standard :
1. Modified Acid Fast (mAF) / Safranin
Staining on Direct smear of stool or after
concentration with ether-formaldehyde/ ethylacetate
2. lugol solution for Isospora and Cyclospora
Advance : fluorescence microscope UV

excitation, Auramine phenol stain, mAb
labelling, PCR

Direct wet smear : helminth eggs, larvae

Culture : Strongyloides, Hook worm
Always include a positive control
Always put on face mask and gloves
Cryptosporidium oocysts excreted in stool may

have been sporulated and infectious
Cryptosporidium oocysts are resistant to most

desinfectant except hypochlorite sol.
Choice of diagnostic technique depends on

available equipment, reagents, experience,
time & cost
Battery tests :
- direct wet smear stool examination
- concentrated stool
- acid fast staining from direct / concentrated
stool
Hot / fresh stool: check immediately for the

trophozoites form

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Agnes Kurniawan, dr. PhD.

berat badan menurun > 10% dalam 1 bulan

Gejala AIDS di RS. Dr. Cipto Mangunkusumo

Pre antiretroviral therapy

Age : 5 months 55 years old

94.5% : males (2140 years)

CD4+ counts <50 cells/mm3.

Parasites positive samples : 84.3%

protozoan pathogens are most commonly

Intestinal protozoan pathogens were detected

CNS opportunistic infection in

Candidiasis Oral = 144

Single parasitic infection: 71.4%

Type of Parasites found:

Blastocystis hominis (72.4%)

Kurniawan A, et al. Trans R Soc Trop Med Hyg2009, doi:10.1016/j.trstmh.2009.02.017

Intestinal Parasitic Infection among

WORKSHOP PERKEMBANGAN D/ LABORATORIUM UTK PERAWATAN ODHA, ASTON MARINA 29 JULI'09

Liquid stool, blood +, mucus +

WORKSHOP PERKEMBANGAN D/ LABORATORIUM UTK PERAWATAN ODHA, ASTON MARINA 29 JULI'09

Preservation of trophozoites and cysts : use

Faeces contains magnesia, powdered

Colour : black (occult blood), brown, pale

consistency : formed (normal shape), soft

Macroscopic blood ? Exudate?

suspension : to detect motile

Examine the whole area with 10 X objective,

Protozoa is a single cell microorganism

note : size, shape, motility,

Non motile, well-defined shells

eosin sol : can be seen as transparent shiny

40 X objective : size ~ 13 erythrocytes.

Note: size, shape, membrane, nuclei,

Can be found in vegetative form as well as cyst

Entamoeba histolytica cyst:

cause travellers diarrhea

in children, may cause epidemic

outbreak due to contamination of

Advance : fluorescence microscope UV

Direct wet smear : helminth eggs, larvae

Always include a positive control

Always put on face mask and gloves

Cryptosporidium oocysts excreted in stool may

Cryptosporidium oocysts are resistant to most

Choice of diagnostic technique depends on

Hot / fresh stool: check immediately for the

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