ZOONOTIC DISEASES ( PENYAKIT ZOONOSIS )

Budi Utomo IKM-KP FK Unair

Manfaat dan deskripsi mata kuliah (UMUM) :

Bekal tugas dan fungsi dokter di masyarakat : medical care provider, decision maker, manager, dan community leader zoonosis Konsep penanggulangan masalah kedokteran dan kesehatan masyarakat (zoonosis)

ZOONOTIC DISEASES ( PENYAKIT ZOONOSIS ) Definition: WHO "Those diseases and infections which are naturally transmitted between vertebrate animals and man". From the Greek: Zoon: Noson: Animal Disease

Diseases and infections which are naturally transmitted between vertebrate animals and humans - WHO 1959

 EPIDEMIOLOGI Some important zoonotic diseases in Indonesia are Rabies, Plague, Anthrax, Taeniasis/ Cysticercoids and Japanese encephalitis (geographically distributed in some provinces in Indonesia and each disease have its control program) Other Zoonoses which are under intensive surveillance are Toxoplasmosis, Leptopirosis, Brucellosis, Bovine tuberculosis and Hemorrhagic Hanta viruses (epidemic potential) Plague known foci are in Boyolali Central Java, Sleman Yogyakarta and Bromo area East Java.

 There are about 300 zoonotic diseases in the world ~ + 50 in Indonesia e.g. : rabies, pes, anthrax, taeniasis/cysticercosis, JE, leptospirosis, toxoplasmosis, bovine tubercullosis, schistosomiasis, flu burung (AI), sapi gila (BSE) Zoonotic Diseases (acc to spread area/infection): 1. Endemic Zoonotic : leptopirosis, anthrax 2. New Emerging (Epidemic) Zoonotic : SARS, Flu Burung (HPAI), and Virus Nipah. 3. Reemerging Zoonotic : rabies.

Impact of zoonotic disease Illness Delay or terminate Monetary loss Adverse effect on morale of personnel Unfavorable publicity Medico legal implications Man-hours lost

Zoonoses
Does NOT include Fish and reptile toxins Allergies to vertebrates Diseases in which animal-derived food serves as a vehicle (e.g. hepatitis A contaminated deli meat) Experimentally transmitted diseases

Zoonoses
> 50 zoonotic diseases Environmental and personal hygiene Multiple pets in the home Human-animal bond Exotic species as pets/ hobbies

Zoonoses Spectrum of Disease Severity

Death = rabies Severe illness = plague Chronic illness = Q-fever Mild illness = psittacosis

Zoonoses: Importance
Surveillance
Animals are sentinels/ center of surveillance

Prevention and Control

Animal = key component Complications (e.g. Lyme disease) Unknown reservoirs (e.g. Ebola)

Zoonoses: Etiologic Classification

Viral Bacterial Parasitic Mycotic

Zoonoses: Viral Examples

Colorado tick fever Ebola Equine encephalitides (WEE, EEE, VEE) Hantaviruses Hendra Herpesvirus B Influenza Japanese encephalitis Monkeypox Nipah Rabies* Rift Valley fever West Nile virus Yellow fever

Zoonoses: Bacterial Examples

Anthrax* Brucellosis Campylobacteriosis Cat-scratch disease Leptospirosis Listeriosis Lyme disease Yersiniosis Plague Psittacosis Q fever Relapsing fevers Salmonellosis

Zoonoses: Parasitic Examples

PROTOZOAL Trypanosomiasis Babesiosis Cryptosporidiosis Leishmaniasis Giardiasis Toxoplasmosis HELMINTHIC Baylisascariasis Cysticercosis Hydatidosis Schistosome dermatitis Trichinosis Visceral larva migrans and toxocariasis

Zoonoses: Mycotic Examples

Aspergillosis Blastomycosis Cryptococcosis Dermatophytosis Histoplasmosis Sporotrichosis

Zoonoses: Animal Species

Dogs & Cats
Rabies Roundworm Ringworm Lyme Disease (dogs only) Cat Scratch Disease (cats only)

Food Animals
Salmonella E. coli Brucellosis

Zoonoses: Animal Species

Birds:
Psittacosis West Nile Cryptococcus

Reptiles, Fish, & Amphibians

Salmonella Mycobacterium

Wild Animals
Hantavirus Plague Tularemia

Routes of Transmission
Direct
Droplet or Aerosol Oral Contact

Indirect
Food-borne Water-borne Vomits Vector-borne Environmental

Zoonoses - Life Cycle

ORTHOZOONOSES/ DIRECT ZOONOSIS
May be perpetuated in nature by a single vertebrate species E.g.: rabies, brucellosis, anthrax

Zoonosis: Rabies Life Cycle

Virus inoculation (bite)

Salivary gland excretion

Zoonoses - Maintenance Cycle

CYCLOZOONOSES
Requires more than one vertebrate species but no invertebrate host Most are cestodiases (tapeworm diseases) Taenia saginata and T. solium require man to be one of vertebrate hosts Others, such as hydatidosis, man is accidentally involved

Zoonoses - Life Cycle

METAZOONOSES
Require both vertebrates and invertebrates to complete transmission All arboviral infections West Nile virus, Saint Louis encephalitis Some bacterial diseases Plague, many rickettsia Some parasitic diseases Leishmaniasis, schistosomiasis

Zoonoses: Metazoonoses
Invertebrate Host: Mosquitoes Vertebrate Host: Birds Incidental Hosts:
HUMANS, horses, amphibians, other mammals

Risk Factors
Companion Animal
Dogs & roundworm Rats & Rat Bite Fever

Occupational
Animal control workers & rabies Wildlife biologists & hantavirus

Food borne
Raw meat & E. coli Unpasteurized dairy & Listeria

 Saprozoonoses. To transmit these infections a non-animal development site or reservoir is required, such as food plants, soil, or other organic material. Examples: coetaneous larva migrants and some of the mycosis diseases.

Risk Factors
Recreational Activities
Camping & Lyme disease

Farm Settings
Sheep & Q-fever Cattle & Cryptosporidium

Travel
Maylasia & Nipah Australia & Hendra

Direction of transmission
Anthropo-zoonoses - Infections transmitted to man from lower vertebrates. Zooanthropo-zoonoses - Infections transmitted from animals to man. Amphixonoses - Infections maintained in both man and lower vertebrates, and may be naturally transmitted in either direction. VII. "Emerging zoonoses are defined as zoonotic diseases caused either by apparently new agents, or by previously known

IV. The probability of disease transmission from animals to man is influenced by several factors: Length of time the animal is infective. Length of the incubation period in animals. The stability of the agent. Population density of the animals in the colony. Husbandry practices. Maintenance procedures and control of wild rodents and insects. Virulence of the agent. Route of transmission.

Zoonosis: Take Home Points

Transmitted between animals and humans Zoonoses are common Animals part of everyday life Recognize the risk factors surveillance epidemiology

ANTHRAX
Bersifat zoonosis Disebut juga radang limpa, radang kura, malignant pustula, malignant edema, woolsorters disease, charbon disease berhubungan sangat erat dg pekerjaan . Dikenal sejak zaman mesir kuno, wabah pertama di indonesia tahun 1832 di Kab Kolaka Sultra Endemis di DKI, JABAR, JATENG, NTB,NTT, JAMBI, SUMBAR, SULTRA, SULTENG, dan PAPUA

Etiologi

Agent Bacillus anthracis, berbentuk batang, berkapsul Virulensi : tergantung toksin dan resistensi host Ukuran 1-2 mm x 5 10 mm, non motil Membentuk spora, aktif bila masuk tubuh host. Spora mati : a) Bila dioven pada suhu 140 c selama 3 4 jam b) Dididihkan pada suhu 100 c selama 10 menit c) Dengan Otoklaf suhu 120 c tekanan 2 atm selama 30 menit.

Morfologi

http://www.gsbs.utmb.edu/microbook/ch015.htm

DDistribusi Anthrax
PENULARAN MENURUT DAERAH: Antraks daerah pertanian(agriculture anthrax): terjadi di daerah pertanian karena pencemaran lingkungan tanah, air, sayuran Antraks kawasan industri (industrial anthrax ) : terjadi di daerah industri, misal pabrik wool, industri yang menggunakan bahan dari hewan Antraks laboratorium : terjadi di laboratorium melalui hewan percobaan kelinci, marmut dan alat alat laboratorium

Anthrax distribution in Indonesia

Anthrax is distributed geographically in Jakarta, West Java, Central Java, South Sulawesi, Southeast Sulawesi, West and East Nusa Tenggara and East Timor. Skin and intestinal Anthrax types are to be found in Indonesia. In 1990 on outbreak of anthrax occurred in Central Java and 7 out of 98 cases were fatal.

Jenis anthrax
Antraks kulit ( bila tidak mendapat pengobatan ) : 5 20 % akan meninggal, tergantung luas jaringan kulit yang terinfeksi Antraks gastro intestinal : 25 75 % dalam waktu kurang 2 hari Antraks paru paru :75 90 % Antraks meningitis : sangat tinggi mendekati 100%

 ANTRAKS KULIT Papula ulcus vesikula nekrosis (hitam) disebut malignant pustula sebagai tanda patogonomis antraks. pada penderita yang rentan kuman menyebar melalui sirkulasi darah menimbulkan antraks saluran pencernakan, antraks paru , meningitis antraks

Anthrax: Clinical Features

Cutaneous: malignant pustule
most common form incubation period: up to 12 days mean 5 d with current outbreak painless or pruritic papule->ulcer with vesicles (24h) eschar edema

Textbook of Military Medicine

Cutaneous Anthrax
95% of anthrax infections occur when the bacterium enters a cut or scratch on the skin due to handling of contaminated animal products or infected animals. May also be spread by biting insects that have fed on infected hosts. After the spore germinates in skin tissues, toxin production initially results in itchy bump that develops into a vesicle and then painless black ulcer.

http://science.howstuffworks.com/anthrax1.htm

Cutaneous Anthrax

CDC, Cutaneous AnthraxVesicle Development

 ANTRAKS SALURAN PENCERNAKAN Kuman/spora limfadenitis hemorragik Edema pada dinding usus gangren

Gastrointestinal Anthrax
GI anthrax may follow after the consumption of contaminated, poorly cooked meat. There are 2 different forms of GI anthrax: 1) Oral-pharyngeal 2) Abdominal Abdominal anthrax is more common than the oralpharyngeal form.

http://science.howstuffworks.com/anthrax1.htm

 ANTRAKS PARU Spora hidung/tenggorokan gejala sub klinis. Spora dinding alveoli pneumonia/ peradangan pleura trombosis pembuluh darah kapiler paru gagal paru. Produk toksin dari kuman juga mempengaruhi susunan syaraf pusat yang berakibat pada sentrum pernafasan

Inhalation Anthrax
The infection begins with the inhalation of the anthrax spore. Spores need to be less than 5 microns (millionths of a meter) to reach the alveolus. Macrophages lyse and destroy some of the spores. Survived spores are transported to lymph nodes. At least 2,500 spores have to be inhaled to cause an infection.

Inhalation Anthrax, Introduction, DRP, Armed Forces Institute of Pathology

Kewaspadaan dini
Menjelang idul fitri dan idul adha kebutuhan daging meningkat, sehingga sering terjadi pemotongan hewan tidak lewat rumah potong hewan (RPH) Perubahan musim dari kemarau ke musim hujan. permukaan tanah yang tererosi air hujan, maka spora muncul kepermukaan bersama tunas rumput yang kemudian termakan hewan ternak.

PELAPORAN Sesuai Undang Undang wabah nomor : 04 tahun 1984 dan permenkes no : 560 tahun 1989, kasus antraks harus dilaporkan dalam 24 jam.

DIAGNOSIS Gejala klinik Laboratorium - mikroskopis sediaan hapus dari tempat infeksi : Antraks kulit : spesimen dari eksudat les Antraks paru : sputum atau cairan pleura

How is anthrax diagnosed?

Gram stain Culture of B. anthracis from the blood, skin lesions, vesicular fluid, or respiratory secretions X-ray and Computed Tomography (CT) scan Rapid detection methods - PCR for detection of nucleic acid - ELISA assay for antigen detection - Other immunohistochemical and immunoflourescence examinations - These are available only at certain labs

 Antraks meningitis : pungsi lumbal Antraks intestinal : faeses atau cairan ascites - serologis : ascoli test, fat, elisa - Biakan

 TATA CARA PENGAMANAN BARANG DIDUGA MENGANDUNG ANTRAKS Jangan membuka lebih lanjut amplop/ bungkusan/ paket yang mengandung bahan diduga antraks. Jangan menggoyang atau mengosongkan amplop/ bungkusan/ paket yang diduga mengandung bubuk antraks. Hindari semaksimal mungkin bahan yang diduga mengandung kuman antraks tersebar atau tertiup angin atau terhirup.

 Gunakan sarung tangan atau masker hidung dan mulut, bila tangan atau badan tercemar bubuk yang diduga mengandung spora antraks , cuci tangan atau mandi dengan sabun dan air yang mengalir. Masukkan amplop atau bungkusan seluruhnya kedalam kantong plastik yang kedap udara atau dapat diikat dengan keras, lebih baik bila menggunakan kantong plastik 2 lapis atau lebih. Masukkan kantong plastik kedalam wadah kaleng / stoples kaca berikut sarung tangan, masker dan barang barang lain yang mungkin telah tercemar bakteri antraks dan beri label berbahaya jangan dibuka

 Bila bubuk yang diduga mengandung antraks tercecer diruangan, dilakukan penutupan dengan handuk yang dibasahi bahan pemutih cucian/ hypocloride. Letakkan dos dan stoples dalam ruangan yang tidak banyak digunakan oleh orang lain atau ruangan khusus yang terkunci.

KEPUSTAKAAN
Centers for Disease Control and Prevention. West Nile Virus http://www.cdc.gov/ncidod/ dvbid/westnile/index.htm. Accessed 8 September 2008 Jernigan DB, 2002. Investigation of bioterrorism-related anthrax, United States, 2001:epidemiologic findings. Emerg Infect Dis. Kandun N, 2000. Manual pemberantasan penyakit menular. Depkes R.I. Jakarta. Simanjuntak G, 1997. Prevention and control of zoonotic new emerging and re-emerging diseases in Indonesia. NIHRD Jakarta Suharsono, 2002. Zoonosis: Penyakit menular dari hewan ke manusia. Kanisius, Jogjakarta.