3.entamoeba histolytica.ppt
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Entamoeba histolityca
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Morfologi• Memiliki bentuk trofozoit dan kista• Bentuk trofozoit:
1. Ukuran 10 – 60 mcm2. Sitoplasma bergranular & mgd eritrasit3. 1 inti entamoeba, ditandai dg
karyosom padat yg terletak di tengah inti, kromatin tersebar di pinggiran inti
4. Bergerak dg alat gerak ektoplasma pseudopodia
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• Bentuk kista1. Bentuk memadat mendekati bulat,
ukuran 10 – 20 mcm2. Kista matang mpy 4 buah inti
entamoeba3. Tidak dijumpai lg eritrosit di dlm
sitoplasma4. Kista yg blm matang memiliki glikogen
(chromatoidal bodies) yg menghilang setelah kista matang
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Siklus Hidup
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Cara Penularan
• Makanan & minuman yg terkontaminasi kista
• Bentuk trofozoit tidak berbahaya bila tertelan krn akan dirusak oleh asam lambung
• Kista bertahan di tanah lembab 8 – 12 hr, di air 9 – 30 hr, di air temp 4°C 3 bln. Rusak oleh pengeringan & pemanasan 50°C
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Cara Kontaminasi Mak & Min
1. Persediaan air yg terpopulasi2. Tangan or infected food handler yg
terkontaminasi3. Kontaminasi oleh lalat & kecoa4. Penggunaan pupuk tinja utk
tanaman5. Higiene yg buruk pd tempat dg
populasi tinggi6. Hubungan seksual terutama kaum
homoseksual 6
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Patogenesis
• Masa inkubasi bbrp hr ad bbrp bln• Amoebiasis dpt berlangsung
asimptomatis• Penderita kronis toleransi thd
parasit symptomless carrier• Gejala: abdominal discomfort,
sindroma disentri (bloody diarrhea & tenesmus)
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Lesi Tipikal di Usus Besar• Lesi terjadi krn kemampuan amoeba
utk menginvasi dinding ususa. Lesi primer:
1. Terjadi di sekum, apendiks, sekitar kolon asendens
2. Kedalaman lesi: submukosa lamina muskularis lamina serosa perforasi ad rongga peritoneum
3. Gambaran ulkus:
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Lanjutan lesi
a. Lesi sekunder1. Berkembang dr lesi primer2. Tjd di bag usus lain, organ, jar
ekstraintestinal3. Kdg2 berbentuk masa tumor
granulomatosa (ameboma) di usus besar gambaran Ro & endoskopi menyerupai karsinoma
4. Lesi ekstraintestinal tjd melalui jln aliran darah (hematogen)
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5. Lesi ekstraintestinal– Amebic liver abses berlangsung mell vena
porta, mayoritas berkembang di lobus kanan– Amoebiasis di paru mrpk akibat dr perforasi
abses hepatik mell diafragma– Amoebiasis kulit tjd akibat penjalaran abses mell
kulit– Organ lain yg dpt terkena abses: limpa dan otak– Abses karena hub seksual (anal sek) dpt tjd di
serviks, vulva, vagina, penis
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Diagnosis• Ditegakkan mell pemeriksaan
spesimen• Spesimen dpt berupa tinja, enema,
aspirat (pd abses hati), biopsi• Metode pemeriksaan spesimen:
1. Teknik konsentrasi & pembuatan sediaan permanen dg trichom stain
2. Sed basah dg saline & diwarnai dg lugol
3. Prosedur serologis: IHA, ELISA, IFA12
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Pengobatan 1. Tissue amebicide
a. Metronidazol, 500 – 750 mg, tdd, 5 – 10 hrb. Tinidazol, 2 g, OD, 3 hr
2.Luminal amebicidea. Paromomycin, 500 mg, tdd, 10 hrb. Iodoquinol, 650 mg, tdd, 20 hrc. Diloxanide furoate
3. Amebic liver abscessa. Metronidazol, 400 mg, tdd, 10 hrb. Tinidazol, 2 g, OD, 6 hrc. Diloxanide furoate, 500 mg, tdd, 10 h
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Mekanisme Aksi Obat• Metronidazole: merusak DNA &
mhambat sintesis DNA• Paramomycin: mhambat sintesis
protein di ribosom• Iodoquinol: melawan btk tropozoid
EH, bersifat amubisid pd tempat infeksi karena absorbsi yg buruk shg konsnt tinggi di usus *
• Diloxanide fuorate: prodrug, pilihan untuk penderita inf EH asimptomatik, diduga menghambat protein 14
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Epidemiologi
• Tersebar di seluruh dunia, terutama daerah tropik & subtropik
• Frekuensi antara 0,2 – 50%• Frekuensi infeksi diukur dg jumlah
pengandung kista• Perbandingan macam amoebiasis:
amoebiasis kolon, amoebiasis hati, amoebiasis otak
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Pencegahan1. Pengobatan thd symptomless carrier2. Perlindungan sumber air dr
kontaminan jarak jamban & sumur3. Menjaga kebersihan perorangan &
linkungan4. Menghindari pemakaian pupuk tinja
utk tanaman5. Fecal borne infection6. Pendidikan kesehatan
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