BAB I PENDAHULUAN 1.1 Latar Belakang Penya Penyaki kitt yang yang dise diseba babka bkan n cacin cacing g atau atau bias biasaa dise disebu butt denga dengan n helm helmin inth thia iasi siss meru merupak pakan an sala salah h satu satu penya penyaki kitt yang yang banya banyak k ter terad adi! i! teru teruta tama ma di daer daerah ah tr"pi tr"pis. s. #eberadaan #eberadaan penyakit ini berkaitan berkaitan dengan $akt"r cuaca! tingkat sanitasi lingkungan lingkungan dan s"si"%ek"n"m s"si"%ek"n"mii masyarakat. masyarakat. &acing memerlukan memerlukan suhu dan kelembaban kelembaban udara tertentu untuk hidup dan berkembang biak. Penyebaran penyakit ini dapat teradi secara langsung maupun tidak langsung. #ebiasaan masyarakat dalam mengk"nsumsi sayuran mentah! daging atau ikan yang dimasak setengah matang merupakan salah satu cara penularan secara langsung. Bila dalam bahan makanan tersebut terdapat kista atau lar'a cacing! maka siklus siklus hidup cacing dapat menadi menadi lengkap! dan teradilah teradilah in$eksi in$eksi dalam tubuh manusia. manusia. Berbeda Berbeda dengan in$eksi bakteri! 'irus dan mikr""rgan mikr""rganisme isme lainnya! cacing de(asa tidak bertambah banyak di dalam tubuh manusia. Penyebaran penyakit ini pun dapat teradi melalui perantaraan serangga seperti nyamuk dan lalat pengisap darah yang dapat menyebarkan telur cacing dari $eses penderita cacingan. Di samping itu! kebiasaan penggunaan $eses manusia sebagai pupuk tanaman dapat meningkatkan penyebaran telur cacing! karena dapat mengk"ntaminasi tanah! air rumah tangga dan tanaman pangan tertentu. &acing yang bersi$at parasit pada manusia terbagi atas dua g"l"ngan g"l"ngan besar yaitu cacin cacing g
bulat bulat )nem )nemat athel helmi mint nthe hes* s* dan dan
Nemathelminthes
terbagi
lagi
caci cacing ng pipi pipih h
menadi
kelas
)pla )platy tyhel helmi mint nthe hes* s*..
nemat"de!
sdangkan
platyhelminthes terbagi menadi kelas tremat"da dan cest"da. 1., .
-umusan asalah 1. Apa Apa itu itu cest cest"d "da/ a/ ,. Apa saa saa para parasit sit cest"d cest"daa pada pada manusi manusia/ a/ 0. Apa klasi$ika klasi$ikasi! si! m"r$"l"gi m"r$"l"gi serta serta epidemi"l"gi epidemi"l"gi dari dari parasit parasit cest"da tersebut tersebut//
1
+"l"n +"l"ngan gan g"l"ngan
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. Bagaimana Bagaimana siklus siklus hidup dari masing% masing%masing masing parasit parasit cest"da/ cest"da/ 2. Baga Bagaim iman anaa pat" pat"l" l"gi gi peny penyak akit it!! gea geala la dan dan tand tandaa sert sertaa penc penceg egah ahan an yang yang dapa dapatt dilakukan untuk mengatasi penyakit yang disebabkan "leh cest"da / 1.0. 3uuan Penulisan 1. ,. 0. . 2. 4.
enget engetahui ahui klas klasi$i i$ikas kasii dari cest" cest"da da usus. usus. enget engetahui ahui m"r$"l m"r$"l"gi "gi cest"da cest"da usus. usus. engetahui engetahui epidemi epidemi"l"gi "l"gi dan dan distribus distribusii ge"gra$is ge"gra$is cest"da cest"da usus. usus. enget engetahui ahui siklus siklus hidup hidup cest" cest"da da usus. usus. engetahui engetahui pat"l"g pat"l"gii penyakit penyakit yang yang disebabkan disebabkan "leh cest"da cest"da usus. eng enget etah ahui ui cara cara pence pencegah gahan an dan penge pengend ndal alia ian n penya penyaki kitt yang yang dise diseba babk bkan an "leh "leh cest"da usus.
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BAB II 3inauan Pustaka &acin cing
pit pita
termasuk
subk ubkelas
&E536DA!
kelas
&E536IDEA!
$ilum
PLA37HELIN3E5. &acing de(asanya menempati saluran usus 'ertebrata dan lar'anya hidup di aringan 'ertebrata dan in'ertebrata. Bentuk badan cacing de(asa memanang menyerupai pita! biasanya pipih d"rs"'entral! tidak mempunyai alat pencernaan atau saluran 'askular dan biasanya terbagi dalam segmen%segmen yang disebu pr"gl"tid yang bila de(asa berisi alat repr"d repr"dukti ukti$$ antan antan dan betina. betina. Uung Uung bagian bagian anteri anteri"r "r berubah berubah menadi menadi sebuah sebuah alat alat pelekat pelekat!! disebut sk"leks! yang dilengkapi dengan alat isap dan kait%kait. Pada dasarnya m"r$"l"gi cacing de(asa terdiri dari 8 •
#epala9sc"lec! terdapat batil isap dan leu isap
•
Leher! yaitu tempat untuk pertumbuhan badan
•
5tr"bila! adalah merupakan badan yang terdiri dari segmen pr"gl"tida.
7ang 7ang penting dari klas cest"ida ini ada ad a dua "rd" yang dilap"rkan mengin$eksi manusia ialah 8 •
Pseud"phylidea
•
&ycl"phylidea 5pesies 5pesies penting yang dapat menimbul menimbulkan kan kelainan kelainan pada manusia umumnya umumnya adalah 8
Diphyllobothrium
latum,
Hymenolepis
nana,
Echinococcus
granulosus,
Echinococcus
multilocul multilocularis aris,, Taenia Taenia saginata, dan dan Taenia solium. solium. anusia merupakan h"spes cest"da ini dalam bentuk 8 A. &acing &acing de(as de(asa! a! untu untuk k spesi spesies es Diphyllobothrium Diphyllobothrium latum, Taenia Taenia saginata, Taenia Taenia solium, Hymenolepis nana, Hymenolepis diminuta, Dipylidium caninum.
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5i$at%si$at umum dari cest"da antara lain8 1. Badan Badan caci cacing ng de(a de(asa sa terd terdiri iri atas atas 8 a. 5k"leks! 5k"leks! yaitu yaitu kepala yang merupakan merupakan alat alat untuk untuk melekat! melekat! dilengkapi dilengkapi dengan batil batil isap isap atau dengan lekuk isap. b. Leher! yaitu tempat pertumbuhan badan. c. 5tr"bi 5tr"bila! la! yaitu yaitu badan badan yang yang terdir terdirii atas atas segmen%se segmen%segme gmen n yang yang disebut disebut pr"gl"t pr"gl"tid. id. 3iap 3iap pr"gl"tid de(asa mempunyai susunan alat kelamin antan dan betina yang lengkap sehingga disebut herma$r"dit. ,. 3elur 3elur dilepaskan dilepaskan bersama bersama pr"gl"ti pr"gl"tid d atau tersendiri tersendiri melalui melalui lubang lubang uterus. uterus. 0. Embri" Embri" di dalam telur telur disebut disebut "nk"s$er "nk"s$er berupa berupa embri" embri" heksakan heksakan yang tumbuh tumbuh menadi menadi bentuk in$ekti$ dalam h"spes perantara.
5pesi 5pesies es yang yang term termas asuk uk ke dala dalam m cest cest"da "da usus usus antar antaraa lain lain Diphyllobothrium latum, Hymenolepis nana, Hymenolepis diminuta, Dipylidium caninum, Taenia Taenia saginata, dan dan Taenia
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A.1 #lasi$ikasi #ingd"m
8 Animalia
Phylum
8 Platyhelminthes
&lass
8 &est"da
6rd"
8 Pseud"phyllidea
:amily
8 Diphyll"b"thriidae
+enus
8 Diphyll"b"thrium
5pecies
8 Diphyllobotrium latum
A., "r$"l"gi
+ambar Diphyllobothrium +ambar Diphyllobothrium latum &acing de(asa yang keluar dari usus manusia ber(arna gading atau kuning keabuan merupakan cacing pita yang terpanang pada manusia. Ukuran panangnya 0 sampai 1; m dan terdiri dari 0;;;%;;; buah pr"gl"tid dengan tiap pr"gl"tid mempunyai alat kelamin antan dan betina yang lengkap. Alat kelamin antan berakhir di cirrus yang ber"t"t pada lubang kelamin tunggal. Alat kelammin betina terdiri dari "'arium yang simetris! berl"bus dua! sebuah 'agina yang beralan dari lubang kelamin tunggal dan sebuah uterus yang bermuara di lubang uterus di
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dikeluarkan 1 uta telur yang ber(arna kuning tengguli ke dalam r"ngga usus. Pr"gl"tid ini akan mengalami disintegrasi bila sudah selesai mengeluarkan telur%telurnya.
+ambar sc"leks Diphyllobotrium sc"leks Diphyllobotrium latum 5c"leks yang kecil dan berbentuk buah badan )alm"nd*! dengan ukuran ,%0 < 1 mm! mempunyai dua lekuk isap yang dalam dan letaknya d"rs"'entral. 3elur cacing ini berukuran 22% =4 < 1%24 mikr"n! mempunyai selapis kulit telur dengan "perkulum yang tidak tampak elas pada satu kutub dan sering terdapat sebuah penebalan pada kutub lain seperti ben"lan kecil.
+ambar telur Diphyllobothrium telur Diphyllobothrium latum
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+ambar siklus hidup Diphyllobothrium hidup Diphyllobothrium latum 3elur dikeluarkan melalui lubang uterus pr"gl"tid gra'id dan ditemukan dalam tina. Pada suhu yang sesuai telur menetas dalam (aktu >%1, hari setelah sampai di air. Embri" didalam embri"$"r yang bersilia keluar melalui lubang "perkulum. #"rasidium bersilia yang berenang bebas dimakan dalam (aktu 1%, hari "leh binatang yang termasuk c"pep"da seperti Dalam h"spes h"spes perant perantara ara ini lar'a lar'a kehilan kehilangan gan siliany silianya! a! menemb menembus us Cycl Cyclop opss dan Diaptomus. Dalam dindi dinding ng deng dengan an bant bantua uan n kait kait%k %kai aitny tnyaa dan dan samp sampai ai ker"ng ker"ngga ga badan badan.. Disi Disini ni lar'a lar'a ters terseb ebut ut bertambah besar dari 22 sampai 22; mikr"n dan dibentuk lar'a pr"serk"id yang memanang. Bila c"pep"da yang mengandung lar'a ini dimakan "leh h"spes perantara II yaitu spesies
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Parasi Parasitt ini dapat dapat ditemu ditemukan kan di daerah daerah dengan dengan iklim iklim dingin dingin!! dimana dimana ikan ikan air ta(ar merupakan bagian penting dari makanan. Parasit ini ditemukan di Amerika! #anada! Er"pa! daerah danau di 5(iss! -umania! 3urkestan! Israel! ancuria! ?epang! A$rika! alagasi! dan 5iberia. Penyakit ini di Ind"nesia tidak ditemukan tetapi banyak diumpai di negara%negara yang banyak makan ikan salem mentah atau kurang matang. Banyak Ban yak binatang seperti aning! kucing! dan babi bertindak sebagai h"spes reser'"ar dan perlu diperhatikan. Pembuangan air k"t"r yang tidak mencukupi! adanya h"spes perantara di air ta(ar yang sesuai! dan kebiasaan makan ikan mentah atau setengah matang menyebabkan timbulnya daerah endemi endemi.. Penyeli Penyelidik dikan an epidem epidemi"l i"l"gi "gi menun menunukka ukkan n bah(a bah(a daerah daerah%da %daerah erah di Ameri Amerika ka Utara Utara menad menadii semaki semakin n teran terangki gkit. t. :akt"r :akt"r terpent terpenting ing yang menyeb menyebabka abkan n bertam bertambah bahnya nya in$eks in$eksii di daerah daerah itu itu adalah adalah kebiasa kebiasaan an untuk untuk membia membiarka rkan n tina tina segar segar memasu memasuki ki air ta(ar ta(ar.. Ikan%i Ikan%ikan kan didalam danau yang tidak termasuk danau besar di Amerika 5erikat bagian utara! tengah dan &anada sering menderita in$eksi berat. In$eksi dengan cacing ini kebanyakan terdapat pada "rang -usia! :inlandia! dan 5kandina'ia! yang mempunyai kebiasaan makan ikan mentah atau ikan yang tidak dimasak sempurna. A.2 Pat"l"gi Parasit ini menyebabkan penyakit pen yakit yang disebut di$il"b"triasis. Penyakit ini biasanya tidak menimbulkan geala berat! mungkin hanya geala saluran cerna seperti diare! tidak na$su makan! dan tidak enak perut. Bila cacing hidup di permukaan usus halus! mungkin timbul anemia hiperkr"mmakr"siter! karena cacing itu banyak manyerap 'itamin B1,! sehingga timbul geala
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dapat menyulitkan menyulitkan masalah masalah pemberantas pemberantasan an sumber sumber in$eksi. in$eksi. Pembuangan Pembuangan tina tina segar didalam k"lam air ta(ar harus dihindarkan. Penualan ikan dari danau yang banyak mengandung parasit harus dilarang! (alaupun ada kesukaran dalam pelaksanaan adiministrasi. Pendinginan sampai %1;" & selama , am! memasak dengan sempurna selama paling sedikit 1; menit pada suhu 2;" & ! mengeringkan dan mengasinkan ikan secara baik akan mematikan lar'anya. Penduduk harus diberi penerangan tentang bahaya makan ikan mentah atau ikan yang tidak dimasak dengan baik. 6bat 6bat piliha pilihan n adalah adalah Nicl"s Nicl"sami amid d )7" )7"mesan* mesan*!! diberi diberikan kan tablet tablet ), gram* gram* dikunya dikunyah h sekaligus setelah makan hidangan ringan. 6bat lain yang uga e$ekti$ adalah par"m"misin! yang diberikan diberikan dengan d"sis 1 gram setiap am sebanyak sebanyak d"sis. d"sis. 5elain daripada itu dapat dipakai dipakai paraikuantel d"sis tunggal 1; mgr9kg berat badan. Penderita diberikan "bat Atabrin dalam keadaan perut k"s"ng! disertai d isertai pemberian Na%bikar"nas! d"sis ;!2 gr. B. Hymenolepis B. Hymenolepis nana B.1 #lasi$ikasi #ingd"m
8 Animalia
Phylum
8 Platyhelminthes
&lass
8 &est"da
6rd"
8 &ycl"phyllidea
:amily
8 Hymen"lepididae
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+ambar sk"leks Hymenolepis sk"leks Hymenolepis nana 5k"leks berbentuk bulat kecil! mempunyai batil isap dan r"stelum yang pendek dan berkait%kait. Bagian leher panang dan halus. 5tr"bila dimulai dengan pr"gl"tid imatur yang sangat pendek dan sempit! lebih ke distal menadi lebih lebar dan luas. Pada uung distal str"bila membulat. Didalam pr"gl"tid gra'id uterus membentuk kant"ng meng andung @;%1@; telur. 3elur keluar dari pr"gl"tid paling distal yang hancur. Bentuknya l"n"ng! ukurannya 0;%= mikr"n! mempunyai lapisan yang ernih dan lapisan dalam yang mengelilingi sebuah "nk"s$er dengan penebalan pada kedua kutub! dari masing%masing kutub keluar %@ $ilamen. Dalam "nk"s$er terdapat 0 pasang duri )kait* yang berbentuk lanset.
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+ambar siklus hidup Hymenolepis hidup Hymenolepis nana &acing de(asa hidup di usus halus untuk beberapa minggu. Pr"gl"tid gra'id melepaskan diri dari badan! telurnya dapat ditemukan dalam tina. &acing ini tidak memerlukan h"spes perantara. Bila telur tertelan kembali "leh manusia atau tikus! maka di r"ngga usus halus telur menetas! lar'a keluar dan masuk ke selaput lendir usus halus dan membentuk lar'a sistiserk"id! kemudian keluar ke r"ngga usus dan menadi de(asa dalam (aktu , minggu atau lebih. 6rang de(asa kurang rentan dibandingkan dengan anak. #adang%kadang telur dapat menetas di r"ngga usus halus sebelum dilepaskan bersama tina. #eadaan ini disebut aut"in$eksi interna. Hal ini memberi kemungkian teradi in$eksi berat sekali yang disebut hiperin$eksi! sehingga cacing de(asa dapat mencapai umlah ,;;; ek"r pada se"rang penderita. B. Epidemi"l"gi dan Distribusi +e"gra$is
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ditularkan langsung dari tangan ke mulut dan lebih arang karena k"ntaminasi makanan atau air. #ebiasaan yang kurang bersih pada anak%anak menguntungkan adanya parasit ini pada g"l"ngan umur rendah. Hal ini sering teradi pada anak%anak umur 12 tahun ke ba(ah. #"ntaminasi terhadap tina tikus perlu mendapat perhatian. In$eksi pada manusia selalu disebabkan "leh telur yang tertelan dari benda%benda yang terkena tanah! dari tempat buang air atau langgsung dari anus ke mulut. #ebersihan per"rangan terutama pada keluarga besar dan di perumahan panti asuhan harus diutamakan. B.2 Pat"l"gi Parasit ini biasanya tidak menyebabkan geala. ?umlah yang besar dari cacing yang menempel pada dinding usus halus menimbulkan iritasi muk"sa usus. #elainan yang sering timbul adalah t"ksemia umum karena penyerapan sisa metab"lit dari parasit masuk kedalam sistem peredaran darah penderita. Pada anak kecil dengan in$eksi berat! cacing ini kadang% kadang menyebabkan keluhan neur"l"gi yang ga(at! mengalami sakit perut dengan atau tanpa diare! keang%keang! sukar tidur dan pusing. E"sini$ilia sebesar @%14. 5akit perut! "bstipasi dan an"reksia merupakan geala ringan.
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Phylum
8 Platyhelminthes
&lass
8 &est"da
6rd"
8 &ycl"phyllidea
:amily
8 Hymen"lepididae
+enus
8 Hymen"lepis
5pecies
8 Hymenolepis diminuta
&., "r$"l"gi
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+ambar telur Hymenolepis telur Hymenolepis diminuta
+ambar sistiserk"id Hymenolepis sistiserk"id Hymenolepis diminuta
&acing de(asa berukuran ,;%4; cm mempunyai @;;%1;;; buah pr"gl"tid. 5k"leks kecil bulat! mempunyai batil isap! dan d an r"steum tanpa kait%kait. Pr"gl"tid matang berukuran ;!@ < ,!2 mm. Pr"gl"tid gra'id mengandung uterus yang berbentu kant"ng dan berisi kel"mp"k%kel"mp"k telur. Apabila pr"gl"tid gra'id lepas dari str"bila! menadi hancur dan telurnya keluar bersama tina. 3elurnya agak bulat berukuran 4;%=> mikr"n! mempunyai lapisan luar yang ernih dan lapisan yang dalam yang mengeliilingi "nk"s$er dengan penebalan pada , kutub! tetapi tanpa $ilamen. 6nk"s$er mempunyai 4 buah kait. &acing de(asa hidup di r"ngga usus halus. H"spes perantaranya adalah serangga berupa pinal dan kumbang tepung. Dalam pinal! telur berubah menadi lar'a sistiserk"id. Bila serangga dengan sistiserk"id tertelan "leh h"spes de$initi$ maka lar'a menadi cacing de(asa di r"ngga usus halus.
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&. Epidemi"l"gi dan Distribusi +e"gra$is Penyeba Penyebaran ran cacing cacing ini k"sm"p k"sm"p"li "litt uga uga ditemu ditemukan kan di Ind"nes Ind"nesia. ia. H"spes H"spes de$ini de$initi ti$ $ mendapat in$eksi bila h"spes perantara yang mengandung parasit tertelan secara kebetulan. &.2 Pat"l"gi Parasit ini tidak menimbulkan geala ! in$eksi biasanya teradi secara kebetulan saa. anusia secara kebetulan mendapat in$eksi karena makanan atau tangan yang terk"ntaminasi dengan serangga yang mengandung parasit. In$eksi pada manusia adalah ringan dan angka (aktu hidup cest"da pada manusia pendek. In$eksi perc"baan pada manusia de(asa hanya berlangsung selama 2%= minggu. &.4 Pencegahan dan Pengendalian Upaya pencegahan yang dapat dilakukan adalah menghindari k"ntak dengan h"spes perantara yang memungkinkan teradinya k"ntaminasi. 5elalu mencuci tangan sebelum makan uga dapat mengurangi in$eksi karena k"ntaminan yang menempel pada tangan akan mati ketika
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+ambar sk"leks Dipylidium sk"leks Dipylidium caninum caninum
+ambar Dipylidium +ambar Dipylidium caninum
+ambar telur Dipylidium telur Dipylidium caninum Panang cacing ini kira%kira ,2 cm dan mempunyai 4;%=2 buah pr"gl"tid. 5k"leks kecil!
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+ambar siklus hidup Dipylidium hidup Dipylidium caninum Pr"gl"tid Pr"gl"tid gra'id melepaskan diri dari str"bila str"bila satu per satu atau dalam kel"mp"k kel"mp"k terdiri terdiri dari , atau 0 segmen! dan pr"gl"tid ini dapat bergerak dengan kecepatan beberapa inci seam. Pr"gl" Pr"gl"tid tid ini dapat dapat berger bergerak ak keluar keluar secara secara akti$ akti$ dari dari anus anus atau atau dikelu dikeluark arkan an bersam bersamaa tina. tina. 3elurnya dikeluarkan "leh k"ntraksi pr"gl"tid atau karena disintegrasi pr"gl"tid di luar usus!
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alergi. ?arang se"rang penderita menunukkan rasa sakit yang nyata di epigastrium! emasiasi dan pengurangan berat badan. D.4 Pencegahan dan Pengendalian Anak kecil sebaiknya angan diperb"lehkan mencium aning dan kucing yang dihinggapi pinal atau tuma. #ebiasaan mencium kucing dan aning sebaiknya tidak dianurkan. Binatang peliharaan yng disukai ini sebaiknya diberi "bat cacing dan peng"batan dengan insektisida. E. Taenia saginata E.1 #lasi$ikasi
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+ambar sk"leks Taenia saginata 5k"leks hanya berukuran 1%, milimeter! mempunyai empat batil isap dengan "t"t%"t"t yang kuat! tanpa kait%kait. 5tr"bila terdiri dari rangkaian pr"gl"tid yang belum de(asa )imatur*
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+ambar telur Taenia saginata 3elur dibungkus embri"$"r! yang bergaris%garis radial! berukuran 0;%; < ,;%0; mikr"n! berisi suatu embri" heksakan yang disebut "nk"s$er. 3elur yang baru keluar dari uterus masih diseliputi selaput tipis yang disebut lapisan luar' telur. 5ebuah pr"gl"tid gra'id berisi kira%kira 1;;.;;; buah telur. aktu pr"gl"tid terlepas dari rangkaiannya dan menadi k"yak! cairan putih susu mengandung banyak telur mengalir keluar dari sisi anteri"r pr"gl"tid tersebut! terutama bila pr"gl"tid berk"ntraksi (aktu gerak.
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Bagian tubuh ternak yang sering dihinggapi lar'a tersebut adalah "t"t maseter! paha belakang dan punggung. 6t"t di bagian lain uga dapat dihinggapi. 5etelah 1 tahun cacing gelembung ini biasanya mengalami degenerasi! (alaupun ada yang dapat hidup sampai 0 tahun. Bila Bila cacing cacing gelembu gelembung ng yang terdapat terdapat di daging daging sapi sapi yang yang dimasa dimasak k kurang kurang matang matang termakan "leh manusia! sk"leksnya keluar dari cacing gelembung dengan cara e'aginasi dan melekat pada muk"sa usus halus seperti yeyunum. &acing gelembung tersebut dalam (aktu @%1; minggu tumbuh menadi de(asa. Biasanya di r"ngga usus h"spes terdapat seek"r cacing. H"spes de$initi$ dari cacing pita Taenia sagnata adalah sagnata adalah manusia sedangkan he(an memamah biak dari keluarga B"'idae! seperti sapi! kerbau dan lainnya adalah h"spes perantara.
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1. enghil enghilangk angkan an in$eksi in$eksi dengan mneg"bat mneg"batii ""rang ""rang yang mengandung mengandung parasit parasit ini dan mencegah k"ntaminasi tanah dengan tina manusia. ,. Pemeriksaan Pemeriksaan daging sapi akan adanya sistiserk sistiserkus. us. " 0. Pending Pendingina inan n daging daging sapi sapi pada pada suhu suhu %1; %1; & selama 2 hari.
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+ambar Taenia solium
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alaupun cacing ini k"sm"p"lit! kebiasaan hidup penduduk yang dipengaruhi tradisi kebudayaan kebudayaan dan agama! memainkan memainkan peranan penting. penting. Pada "rang bukan pemeluk agama Islam! Islam! yang biasanya memakan daging babi! penyakit ini ditemukan.
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