TUGAS KIMIA AMAMI

TUGAS             : KIMIA AMAMI

NAMA               : AGUS SUSANTO

NO ABSEN      : 02

PROGSUS        : D-III ANALIS ( PROGSUS TULUNGAGUNG)

1 molekul gliserol mengikat 1 asam lemak disebut monogliserida

                                                                                                    O                                                                      

                                                                                                    ||

H₂C  − OH                                                                  H₂C – O − C − R₁

                                                                                                                                                       

                                                                                 

CH   − OH        +      HOOCR₁                                    HC – OH                          +          H₂O

                                                                                                                                                     

                                                                              

H₂C  − OH                                                                  H₂C – OH

Gliserol                   Asam Lemak                          Monogliserida                             air

( 1 molekul )          ( 1 molekul )                           ( 1 molekul )                        ( 1 molekul )

1 molekul gliserol mengikat 2 asam lemak disebut digliserida

                                                                                                  O                                                                      

                                                                                                  ||

H₂C  − OH                                                                H₂C – O − C − R₁

                                HOOCR₁                                                  O                                                                       

                                                                                                ||

CH   − OH      +                                                        HC – O −C − R₂                 +            2H₂O

                                                                                                                                                        

                                HOOCR₂                                               

H₂C  − OH                                                                H₂C − OH

Gliserol                   Asam Lemak                            Digliserida                                       air

( 1 molekul )          ( 2 molekul )                           ( 1 molekul )                         ( 2 molekul )

siklus hidup Schistosoma haematobium

Morfologis dan Siklus Hidup
Cacing jantan, gemuk, berukuran 10-15 x 0,8-1 mm. Ditutupi integumen tuberkulasi kecil, memiliki 2 batil isap berotot, yang ventral lebih besar. Di sebelah belakang batil isap ventral, melipat ke arah ventral sampai ekstremitas kaudal, membentuk kanalis ginekoporik. Persis di belakang batil isap ventral terdapat 4-5 buah testis besar. Porus genitalis tepat di bawah batil isap ventral. Cacing betina, panjang silindris, ukuran 20 x 0,25 mm. Batil isap kecill, ovarium terletak posterior dari pertengahan tubuh. Uterus panjang; sekitar 20-30 telur berkembang pada satu saat dalam uterus. Oviposisi biasa rerjadi dalam venule kecil pada vesica urinaria dan pelvicus seperti venule rectalis. Tempat-tempat ektopik ditemukan pada kelenjar prostat dan jaringan subkutan lipat paha dan skrotum, jaringan kulit sekitar umbilikus, conjuctiva dan kelenjar lakrimalis. Kerusakan dinding pembuluh darah oleh telur mungkin disebabkan oleh tekanan dalam venule, tertusuk oleh duri telur dan mungkin karena zat lisis yang keluar melalui pori kulit telur sehingga telur dapat merusak dan menembus dinding pembuluh darah, menembus mukosa sampai lumen bersama darah yang keluar dari luka, keluar bersama urine terutama pada akhir miksi atau pada tinja disentri. Telur, berwarna coklat kekuningan, memiliki duri terminal, transparan, berukuran (112-170) m x (40-70) m. Pada siput yang sesuai, dalam 4-8 minggu terbentuk sporokista generasi pertama dan kedua, akhirnya menjadi cercaria yang setiap hari akan lobos dart tubuh siput secara herkelompok selama beberapa minggu atau bulan. Setelah meninggalkan siput, cercaria berenang aktif mencari rumah. Cercaria kontak dengan kulit, air menguap, menembus kulit, ekornya dilepaskan. Keadaan hidup bebas ini, tidak lebih dari tiga hari (biasanya 24 jam atau kurang), selama dapat bertahan tidak makan. Kemudian menembus ke bawah permukaan epidermis dengan lincah dalam waktu kurang dari 30 menit. Biasanya dalam 1-2 hari, larva telah sampai venule perifer, terbawa ke jantung kanan, masuk ke dalam pembuluh darah pulmoner. Menjelang dewasa membutuhkan waktu 20 hari sejak penetrasi ke dalam kulit. Mereka masuk ke dalam vena mesenterica inferior, tinggal dan matang dalam vena rektalis, akan tetapi biasanya bermigrasi melalui vena hemorrhoidalis dan v. pudendalis menuju vena vesicalis dan plexus pelvicus, mereka sampai dalam waktu 3 bulan setelah menembus kulit. Periode prepaten biasanya membutuhkan waktu antara 10-12 minggu.
Gejala klinis
Gejala klinis yang disebabkan oleh Schistosoma haematobium polanya sama dengan dua spesies lainnya, tetapi pada kasus haematobium penderita dapat mengalami hematuria dan disuria.

Diagnosis
Diagnosis yang ditegakkan prinsipnya sama dengan Schistosoma japonicum dan Schistosoma mansoni.
Pengobatan
Sebelum dilakukan pengobatan kemoterapi untuk skistosomiasis, sebaiknya dilakukan perbaikan gizi penderita. Pada kasus Schistosoma haematobium, obat yang memberi hasil sangat efektif adalah kalium dan antimonium tartrat secara intravena pada dosis maksimum dan teratur.
Epidemiologi dan pencegahan
Tentang penyebaran Schistosoma haematobium manusia bergantung pada variasi hospes keong air. Schistosoma haematobium sangat endemis di seluruh lembah Sungai Nil dan boleh dikatakan telah menyebar di seluruh Afrika, pulau Malagasi, dan Mauritius. Sarang endemis ditemukan di Israel, Jordania, Syria, Irak, Arab, Yaman, dan daerah kecil pantai barat India. Di Mesir dan bagian lain Benua Afrika sebanyak 75-95% penduduk telah terkena infeksi.
Kera dan babon mendapat infeksi alami, tetapi hal ini mungkin tidak penting untuk penyebaran infeksi. Penyebaran di Indonesia terdapat di sekitar danau Lindu Sulawesi Tengah. Distribusi Schistosoma haematobium sebagian besar di Sub-Sahara, di lembah Sungai Nil, di Afrika, negara utara lainnya, dan di Timur Tengah. Schistosomajaponicum adalah jenis parasit yang terdapat di Asia dari timur, di Cina, dan Filipina. Upaya pencegahan yang dilakukan prinsipnya samadengan pencegahan pada kasus Schistosoma japonicum dan Schistosoma mansoni.
Pustaka
- Parasitlogi untuk keperawatan Oleh H.M. Muslim, Mkes
- Parasitologi kedokteran:ditinjau dari organ tubuh yang diserang Oleh Djaenudin Natadisastra, dr., Sp.ParK & Prof. Dr. Ridad Agoes, MPH

SCHISTOSOMA HAEMATOBIUM

GENITO-URINARY PARASITES
TREMATODA Order: Strigeata

SCHISTOSOMA HAEMATOBIUM

sm1-ic

Schistosoma spp: life cycle.
The human schistosomes (blood flukes) are digenic trematodes
of the superfamily Schistosomatoidea.
The adult worms inhabit the mesenteric veins
(S.mansoni, S.japonicum, S.mekongi, S.intercalatum)
or the veins of the vesical and pelvic plexuses (S.haematobium).
The life cycle is common to all species with a sexual generation
in vascular system of the definitive host and an asexual generation
in the intermediate hosts (snails).
1) Embrionated eggs are discharged in faeces and urine;
in water miracidia hatch from the egg and penetrate the intermediate hosts:
different genera of snails (see table)


 

Miracidium

mira1-ic

Schistosoma spp.: miracidium

planorbis1	Biomphalaria	Bulinus-ic	Bulinus	Onchomelania

planorbis1-ic	biom1-ic	Bulinus-ic	bul1	sj5-ic

S.mansoni: intermediate host of S. mansoni are snails
 of the genus Biomphalaria (Planorbidae family).
S.haematobium: intermediate host of S.haematobium
are snails of the genus Bulinus
S.japonicum: intermediate host of S.japonicum are snails
of the genus Onchomelania, hupensis spp.

Biomphalaria and Bulinus spp.: Courtesy of Bayer, from Bayer Manual of Pest Control

planorbis1 and Bulinus: Courtesy of Dr. Marc Lontie: Director of the laboratory of the Medisch Centrum voor Huisartsen, Maria Theresiastraat 63a; B-3000 Leuven, Belgium.

 

Schistosome species	Snails
S.mansoni	Biomphalaria spp.
S.haematobium	Bulinus spp.
S.intercalatum	Bulinus spp.
S.japonicum	Oncomelania spp.
S.mekongi	Neotricula spp.

2) after penetration in the snail the miracidium develops into sporocysts and,
in about 4 weeks, thousend of cercariae are produced (asexual multiplication);
3) the infection of the definitive host occurs by penetration of the skin.

Typical transmission site	Contact water 1	Contact water 2	Contact water 3

		Cercaria

sp1-ic                    sp1a-ic                       sp2-ic     

Cercaria sp1-ic: Schistosoma spp.: cercariae are the infective forms.
They measure about 500 micron. After encountering the skin,
the cercariae penetrate and lose the tail transforming into schistosomulae.
sp1a-ic: Cercaria of Schistosoma mansoni from snail.

During the penetration process the cercariae lose their tail
and transform into the larval stage: the schistosomulum

Schistosomulum	Eosinophils and schistosomulum

schisto-ic                  eosi-ic

Schistosomulum
Schistosoma spp.: 1) schistosomulum; 2) antibody dependend cytotoxicity
to schistosomulum
4) after penetration schistosomula migrate to the lungs (in 3-4 days),
and after penetration in the pulmonary capillaries they are carried to
the systemic circulation and to the portal system.
In the hepatic circulation schistosomes mature to adult,
and in pairs they migrate to the mesenteric veins (S.japonicum and mansoni)
and to the vesical plexus (S.haematobium).
After 35 days (S.japonicum, S.mansoni) and 70 days (S.haematobium)
embryonated eggs are excreted in faeces and/or urine.

Control of schistosomiasis is difficult.
The control of snails is critical; environmental sanitation,
safety of supply water and education are essential.

Collecting snails	Molluscisciding spraying	Molluscisciding drip feeding

Schistosoma spp.: snail control with spraying and drip feeding.

sh2-ic

S.haematobium: geographic distribution.
S.haematobium is reported from 54 countries in Africa.

(Adapted and redrawn from: The Control of Schistosomiasis, WHO Technical Report Series, No. 830, 1994.)

sm2a-ic

S.haematobium: adult schistosomes live in pairs in the pelvic veins
(especially in the venous plexus surrounding the bladder);
males are 10-15 mm in lenght by 0,8-1 mm in diameter,
and have a ventral infolding from the ventral sucker
to the posterior end forming the gynecophoric canal.
Adult male with female in the copulatory groove.

sm2b-ic

Schistosoma haematobium: Females are slender ( 0,25 mm in diameter)
and longer (up to 20 mm in lenght),
and are held in the ginecophoric canal during copulation.
Each female lays about 150 eggs per day.
Adult male with female in the copulatory groove.

sh3-ic		shLon-ic

Schistosoma haematobium: the diagnosis of urinary schistosomiasis requires
the identification of eggs in urinary sediment.
Eggs measure 115-185 by 40-70 µm and have a terminal spine;
viable eggs contain a motile miracidium. (Urine sediment).

Schistosoma_4X-ic	Schistosoma_10X-ic	Schistosoma_20X-ic	Schistosoma_40X-ic

S.haematobium: 
Young men (35J) from Egypt with infertility and hematuria. 
Schistosoma haematobium eggs are concentrated in the tissue of the bladder.

sh4-ic

Schistosoma haematobium: S.h. eggs can occasionally be found in faeces.
Eggs are the main agent of pathology inducing granuloma formation.

sh5-ic

S.haematobium: bladder wall enlargement on echography.
Hyperplasia of the mucosa due to the presence of granuloma is the first finding;
fibrosis and calcification follow with polips formation in bladder and urether stenosis.
Hydronephrosis and possibly cancer are late complications of the infection..

sh6-ic                          sh7-ic

S.haematobium: eggs of S.haematobium are not uncommonly
found in male genital organs, 
but the significance of this finding has not yet been clarified.
The damage of the seminal vescicles seems to correlate
with the degree of the obstructive uropathy.
Less commonly affected are the prostate, the testes and the epididymis;
a relationship between the presence of eggs in seminal fluid
and male infertility has not been demonstrated.
S.haematobium: eggs of S.haematobium in seminal fluid.

Courtesy of David Raymondo, MLT, CLS(m): Gamma-Dynacare Medical Laboratories, 1095 Carling Avenue, Suite 500; Ottawa, Ontario, Canada K1Y-4P6

sh8-es-ic

Schistosoma haematobium: urine sediment, miracidium hatching
from the egg (400 X).

sm8-ic

S.mansoni: different schistosome stages are used as antigen source
(cercariae, schistosomula, adults, eggs) for standard immunodiagnostic tests:
enzyme linked immunosorbent assay (ELISA), indirect immunofluorescence
test (IFAT), radioimmunoassay (RIA), indirect haemoagglutination (IHA),
circumovale precipitin assay.
Serological tests may be useful for travellers returning from endemic areas
and in patients with light or ectopic infection, with no detectable eggs in
the faeces, urine or intestinal biopsies (i.e. hepatic, CNS infections).
On the contrary, in patients living in endemic areas, the positive test may
reflect previous exposure to the agent rather than an active infection;
a slow decrease in titer after effective treatment is usually observed.
Recently, new tests for the detection of schistosome antigens
have been prepared using monoclonal antibodies.
The larval stage of S.mansoni used as antigen in the indirect fluorescence test.

From the Editor Pietro Caramello, MD