Laporan Kasus: Diagnosa Sindrom Loeffler dan Nekatoriasis Duodenum Berdasarkan Endoskopi
DOI:
https://doi.org/10.21776/ub.jkb.2014.028.01.13Abstract
Nekatoriasis adalah infeksi cacing tambang yang disebabkan oleh Necator americanus dan terdistribusi luas ke seluruh daerah di negara tropis dan subtropis. Larva migran cacing ini dapat menyebabkan gejala pneumonitis yang disebut sindrom Loeffler. Diagnosis ditegakkan berdasarkan adanya telur cacing dalam tinja, tetapi bisa juga tidak terdiagnosis terutama pada kasus infeksi yang ringan. Pada kasus ini  pria, 60 tahun, suku Jawa, petani, dirawat di rumah sakit karena anemia gravis , sesak napas, melena selama 1 minggu. Foto polos dada menunjukkan infiltrat di paracardial kanan dan kiri. Laboratorium menunjukkan eosinofilia masif, kadar hemoglobin sangat rendah (1,7g/dL), hypochrom mikrositik, penurunan saturasi besi, penurunan kadar albumin. Analisa pada tinja tidak menunjukkan adanya infeksi parasit, hasil endoskopi menunjukkan ulkus gaster duodenum multipel, banyak cacing ditemukan pada duodenum , ukuran 1 cm dan teridentifikasi sebagai Necator americanus. Keluhan pasien membaik  setelah transfusi darah dan pemberian  pirantel pamoat selama 3 hari. Kasus  ini menggambarkan adanya infeksi berat cacing tambang (Necator americanus) yang ditandai dengan  gejala anemia berat, dispepsia, perdarahan saluran cerna bagian atas,  disertai wheezing, rhonki dan infiltrat di area paracardia kanan dan kiri. Analisis tinja metode hapusan langsung menunjukkan tidak adanya infeksi parasit, namun pemeriksaan endoskopi menunjukkan ada banyak infestasi cacing Necator americanus pada duodenum. Hal tersebut mungkin disebabkan karena analisa sampel tinja terbatas pada metode hapusan langsung. Pasien diterapi berdasarkan klinis, temuan endoskopi, dan  menunjukkan respon klinis yang baik.
Kata Kunci: Anemia, endoskopi, melena, Necator Americanus , sindrom  Loeffler
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