Dr. Andi Irawan Asfar, Sp.

FK
DIPHTHERIA
TETANUS
TB CUTIS
LEPROSY
PYODERMA
TYPHOID FEVER
ZOONOSIS
o ANTIBIOTIC
Penicillin can be used for patients who are not
sensitive (allergy), if the patient is sensitive to
penicillin erythromycin can be used.
Duration of administration for 7 days, in group
erithromycin can be used for 7 -10 days.
Antibiotic
The use of antibiotics is not intended to kill
the toxin or antitoxin, but to kill the germs that
cause the production of a toxin by the bacteria
stops.
Antibiotic
The use of antibiotics is not intended to kill
the toxin or antitoxin, but to kill the germs that
cause the production of a toxin by the bacteria
stops.
Antitoxin [ ADS]
Test sensitivity to horse serum antitoxin is
done by:
0.1 ml of antitoxin was diluted 1:1000 in a
solution of salt, given IC and was dropped in
the eye.
Said to be positive if the reaction within 20
minutes found erythema with a diameter >10
mm site of injection, or the eye test
conjunctivitis and tears.
Antitoxin [ ADS]
Test sensitivity to horse serum antitoxin is
done by:
0.1 ml of antitoxin was diluted 1:1000 in a
solution of salt, given IC and was dropped in
the eye.
Said to be positive if the reaction within 20
minutes found erythema with a diameter >10
mm site of injection, or the eye test
conjunctivitis and tears.
If it is found, the provision can be done by the
method of desensitization.
One way that is used is:
0.05 ml of the lar. 1:20 dilution given in S.C.
0.1 ml of the lar. 1:20 dilution given in S.C.
0.1 ml of the lar. 1:10 dilution given 5acara S.C.
0.1 ml without dilution given in S.C.
0.3 ml without dilution given the I.M.
0.5 ml without dilution given the I.M.
0.1 ml without dilution given the I.V
If it is found, the provision can be done by the
method of desensitization.
One way that is used is:
0.05 ml of the lar. 1:20 dilution given in S.C.
0.1 ml of the lar. 1:20 dilution given in S.C.
0.1 ml of the lar. 1:10 dilution given 5acara S.C.
0.1 ml without dilution given in S.C.
0.3 ml without dilution given the I.M.
0.5 ml without dilution given the I.M.
0.1 ml without dilution given the I.V
When the adverse reaction is not found, the
rest of the antitoxin can be given slowly
through an IV.
When you found the adverse reaction of
giving antitoxin, should be immediately
treated with epinephrine (1:1000) in IV
CORTICOSTEROIDS
Some practitioners advocate the use of
corticosteroids in certain circumstances,
such as when there are signs of myocarditis,
and the laryngeal or nasopharyngeal
diphtheria
Prevention of diphtheria vaccination can be
done, which can be started at the 2 month old
infant by administering DPT or DT.
0.5 ml IM given basic immunizations given 3
times giving the administration time interval
6-8 weeks.
Booster one and three years later
Prevention of diphtheria also include
isolation of patients, with the aim to
prevent the spread of the disease to a
minimum to others.
Basil sampling for culture.
Three times repeated negative cultures
are needed before the patient was
released from isolation.
Immunized carriers should be given repeated
injection with diphtheria toxoid, and treated
with:
Penicillin 600,000 U / day for 4 days.
Benzathine penicillin 600,000 U, I.M. single
dose or
Erythromycine, 40 mg / kg BB/24 hours,
administered for 7 -10 days.
Nonimmunized asymptomatic carriers should be
done: Giving diphtheria toxoid and penicillin
Daily examination by a doctor,
If this can not be implemented, providing ADS
10,000 units, should be done.
If the patient has shown symptoms treatments
such as diphtheria patients.
Prophylactic therapy diphtheria toxoid, penicillin
If indicated diphteria antitoxin should be
implemented as soon as possible without first waiting
for culture results.
Tetanus is an acute toxemia caused by
neurotoxins produced by Clostridiumtetani
is characterized by periodic muscle spasms
and severe
Tetanus is also called the "Seven day Disease
Tetanus is usually acute and cause spastic
paralytic caused tetanospasmin.
Tetanospamin is a neurotoxin produced by
Clostridiumtetani
1890 found toxins like strichnine, later
known as tetanospasmin, which was
isolated from soil containing anaerobic
bacteria.
( Nicalaier 1884, Behring dan Kitasato 1890 )
Tetanus is caused by gram-positive
bacteria; Clostridiumtetani, sporulating
bacteria, found in the feces of animals,
especially horses, also in humans and also
in soil contaminated with animal feces.
Clostridium tetani spores usually enter the
body through breaks in the skin due to cuts,
burns or punctured and the umbilical cord
infection (Tetanus Neonatorum)
These spores can last several months or
even several years, if a person infected
wounds or in conjunction with other
foreign bodies or bacteria, it will enter
the patient's body and remove toxins
called tetanospasmin.
In the underdeveloped countries, tetanus
is common in neonates, the bacteria enter
through the umbilical cord during birth
which is not good, tetanus is known as
neonatal tetanus.
Opistotonus
Risus sardonicus
Opistotonus dan Risus sardonicus
1. ANTIBIOTICS:
Peniciline given parenterally.
If sensitive to peniciline, drugs can be replaced
with Tetracycline
Antibiotics only kill the vegetative form of
C.tetani, not for the toxin it produces.
Where the presence of complications, can be
given broad spectrum antibiotics
1. ANTIBIOTICS:
Peniciline given parenterally.
If sensitive to peniciline, drugs can be replaced
with Tetracycline
Antibiotics only kill the vegetative form of
C.tetani, not for the toxin it produces.
Where the presence of complications, can be
given broad spectrum antibiotics
TREATMENT
2. ANTITOXIN
Antitoxin which can be used Human Tetanus
Immunoglobulin (TIG) / IM
When TIG does not exist, it is recommended to
use tetanus antitoxin, which is derived from
animal
2. ANTITOXIN
Antitoxin which can be used Human Tetanus
Immunoglobulin (TIG) / IM
When TIG does not exist, it is recommended to
use tetanus antitoxin, which is derived from
animal
TREATMENT
TREATMENT
4. ANTICONVULSANTS
The main causes of death in neonatal tetanus is
a great clonic seizures, muscular and laryngeal
spasm
Sedation or muscle relaxans drug used to
relieve spasms.
For example: Diazepam, Meprobamat,
Klorpromasin, Phenobarbital (IM)
4. ANTICONVULSANTS
The main causes of death in neonatal tetanus is
a great clonic seizures, muscular and laryngeal
spasm
Sedation or muscle relaxans drug used to
relieve spasms.
For example: Diazepam, Meprobamat,
Klorpromasin, Phenobarbital (IM)
TREATMENT
Antibiotics can stop the progression of the
disease or to cure it.
The types of antibiotics:
Dapsone; side effects: skin rashes and anemia
Rifampicin; side effects: liver damage and flu-like
symptoms
Clofazimine
Ethionamide
Misiklin
Clarithromycin
Ofloxacin
TREATMENT
Antibiotics are given some drugs because
there is a possibility resiten against certain
types of leprosy, especially in patients with
leprosy lepramatosa.
Antibiotic therapy should be given some
time, because the bacteria that cause
leprosy was difficult to remove.
TREATMENT
Treatment can be continued until 6
months or more, depending on the
severity of infection
Most types of lepromatous leprosy
patients get lifetime dapsone therapy
TREATMENT
Drug DDS (4,4-diamino-diphenyl sulfone,
Dapsone)
Mechanism of action as dihidrofolat synthetase enzyme
inhibiting bacteriostatic, work as PABA antimetabolite
A single dose (up to 6 months):
50-100 mg / day
For adults:
2 mg / kg for children
Side effects: Insomnia, neuropatia, drug eruption, toxic
epidermal necrolysis, hepatitis, Leukopenia, hemolytic
anemia, methemoglobinemia
TREATMENT
Rifampicin
is the most potent drug with potent
bactericidal properties for BTA
inhibit the enzyme RNA polymerase with
irreversible bonds, the price is expensive
Monotherapy should not be given, because it
can lead to resistance
TREATMENT
Rifampicin
Dose:
600 mg / day (5-15 mg / kg / day)
900 - 1200 mg / week flu-like
syndrome
600 or 1200 / monthgood effect
and tolerance
Side effects:
Gastrointestinal disorders
skin eruption
Hepatotoxic and nephrotoxic
TREATMENT
Klofazimin (B-663, Lamprene)
Derivatives of iminofenazin with
bacteriostatic effects by disrupting
the metabolism of oxygen radicals
Anti-inflammatory effects useful for
leprosy reactions, the price is
relatively expensive
TREATMENT
Klofazimin (B-663, Lamprene)
Dose:
50 mg / day or 100 mg / 3 times a week (1 mg / kg
daily)
300 mg / month to prevent leprosy reaction type 1
and 2.
Side Effects
Skin pigmentation red sweat & tears
GIT disorder anorexia, vomiting, diarrhea,
abdominal pain sometimes
TREATMENT
For Pausi-bacillary
Rifampicin 600 mg / month (supervised)
Dapsone 100 mg / day (self-management) 6
months (dose of 1-2 mg / kg/day).
For Multi-bacillary
Rifampicin 600 mg / month (supervised)
Dapsone 100 mg / day (self-management)
Lamprene 50 mg / day or 100 mg/3x week or
300 mg / month (supervised)
Derived from the most effective
fluoroquinolones against Mycobacterium
leprae in vitro.
Mechanism of action of inhibiting the enzyme
DNAgyrase mycobacteria
Optimal daily dose is 400 mg (1 month)
Given a single dose will kill germs live
M.leprae of 99.99%.
Side effects: nausea, diarrhea, and other
gastrointestinal disorders, a variety of CNS
disorders including insomnia, headache,
dizziness, nervousness, and hallucinations.
Use in children, adolescents, pregnant women,
and lactating women must be careful, because
in young animals cause atropati quinolones.
Tetracycline class which has a bactericidal
effect, but lower than rifampicin.
Inhibit protein synthesis
Active against M.leprae due to the nature
lipofiliknya that can penetrate the cell wall of
germs
This drug can penetrate the skin and reach the
neural networks that contain many germs
Clinical trial dose: 100 mg / day for 2 months
Adverse effects: staining teeth of infants and
young children, sometimes on the skin and
mucous membranes, various gastrointestinal
symptoms and organization of the central
nervous, including dizziness and unsteadiness.
Therefore it is not recommended for children
or during pregnancy.
Is a macrolide antibiotic group and has
bactericidal activity against M.leprae in mice
and humans.
Mechanism of action of inhibiting protein
synthesis
Clinical trial dose: 500 mg / day
In the lepromatous leprosy patients, a daily
dose of 500 mg can kill 99% of germs live in
28 days and more than 99.9% within 56 days.
Side effects: nausea, vomiting and diarrhea
that proved often found when the drug is given
at a dose of 2000 mg.
In ancient times the lepers were isolated
Now no need for insulation because that
can not be treated lepromatous not easily
transmitted
Avoid contact that lasts a very long time
with the patient. For example: a house
A. Staphylococcus
aureus
B. Streptococcus beta
hemolyticus
Impetigo bulosa
(= Impetigo vesico-bulosa)
Impetigo neonatorum
Staph. Scalded Skin Syndr.
Folliculitis
( I. Bochart & Sycosis
barbae)
Furuncle & carbuncle
Paronychia
Multiple Absceses of sweats
glands
Hidra-adenitis suppurativa
Impetigo crustosa
(= I.contagiosa; Tillbury
Fox Disease )
Ecthyma
(=Ulcerative Impetigo)
Erysipelas
Cellulitis
Phlegmon
Scarlet Fever
Superficial skin infections
Etiology: Staphylococcus aureus
Staphylococcus pyogenes
If only in the epidermis: Impetigo
If you continue to dermis: Ecthyma
Characterization: crusting erosion or crusting
ulcer
Infection through:
Primary infection in minor lesions on the
skin
Secondary infection of an existing skin
disorders Pre Existing dermatoses - or there
are other causes before occurs
Impetiginization
1. Krustosa Impetigo (Impetigo vulgaris;
impetigo contagiosa; Tillbury Fox)
2. Impetigo Bullosa
3. Impetigo Neonatorum
4. Impetigo Bockhart (Superficial folliculitis)
5. Impetigo Colitis (Ecthyma)
ANTIBIOTIC:
Erythromycin 250-500 mg q.i.d (10 hr)
40 mg / kg / day q.i.d (10 hr)
Cephalexin 250-500 mg q.i.d (10 hr)
40-50 mg / kg / day q.i.d (10 hr)
Contraindicated in pregnant women
Minocyclin b.i.d 100 mg (10 hr)
Ciprofloxacin 500 mg b.i.d (7 hr)
Th / safe For pregnant women: Penicillin
When the fear of injection: ampicillin / amoxycillin
When penicillin allergy, give eritromycin p.c
Contraindications: gastritis
Treatment
Avoid predisposing factors and therapy
Drainage of pus and necrotic tissue
Topical and systemic antibiotics
Folliculitis
Definition:
= Boil =
Acute abscess pd hair follicles that are
caused by S. aureus infection
Furunculosis: more than 1 follicle
Carbuncle: furuncle group / collection
karbunkel
Dicloxacillin 4 d.d 250-500 mg (10 day)
Amox-clav 20 mg/kg/hr t.i.d (10 day)
Cephalexin 40-50 mg/kg/day
Erytromisin 40 mg/kg/hr q.i.d (10 day)
Clarythromycin 250-500 mg b.i.d (10 day)
Azithromycin 250 mg q.i.d 5-7 day
Clindamycin 150-300 mg q.i.d (10 day)
Definition:
Acute inflammation of the lateral and
posterior nail folds commonly caused by
Staphylococcus infection
Etiology
Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa
Clinical symptoms:
Beginning minor injury or damage to the skin
as a port d'entre
Onset of acute and painful in the nail fold area
+ pussy
Swelling redness and pain around the nail
Infection spreads to nail down sub-ungual
abscess nail plate loose and distorted
Paronychia
TREATMENT
Local compresses with antiseptic
solution 5 to 10 minutes
Pus drainage and clean the rest
topical antibiotic
systemic antibiotics
Abscess sub-ungual repeal nails (nail
extraction)
Paronychia
Definition
Acute, spreading infection of the dermal and
subcutaneous tissue
Characterization: red, hot, pain around the
lesion, often at the site of bacterial entry
Common Cause: Streptococcus pyogenes
and other microorganisms that can cause
severe systemic disorders.
ERYSIPELAS
dermis and subcutaneous
Real limits + lymphangitis
CELLULITIS
Involving all the subcutaneous tissue, diffuse
Infiltrate area with raised swelling
PHLEGMON
Experiencing suppurative cellulitis and broken
Erysipelas, Cellulitis, Phlegmon
Management:
Medical treatment for complications RS
Elevating leg rest when lesions on the foot
Local compress + antiseptic solution (Betadine
+ Rivanol)
Systemic antibiotics: penicillin derivatives (iv)
and erythromycin
Outpatient entrance where microorganisms
Erysipelas, Cellulitis, Phlegmon
Definitions:
Typhoid fever is an acute systemic disease caused
by Salmonella infections that have the
characteristic of fever, headache and abdominal
discomfort lasted for about 3 weeks and
accompanied by symptoms of an enlarged spleen
and skin eruptions.
Typhoid fever was also recognized
by other names: Abdominal Typhus,
typhoid fever or Enteric fever
Typhoid fever is caused by
Salmonella typhi (S. typhi),
gram-negative bacilli,
berflagel, and not berspora
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chloramphenicol,
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Cephalosporine
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Meropenem
azithromycin
fluoroquinolone.
Zoonoses are diseases or infections
that are naturally transmitted
between vertebrate animals and
humans
INTRODUCTION
To date, there are no less than 300 animal
diseases that can infect humans.
In the last 20 years, 75% of new diseases in
humans caused by the displacement of
pathogens from animals to humans or are
zoonotic, and from 1.415 pathogenic
microorganisms in humans, 61.6% originated
from animals (Widodo 2008).
INTRODUCTION
Name of zoonotic
diseases
Cause of
bacterial
Animals that can be
infected
Modes of transmission
Tuberculosis Mycob.TB ,
M.Bovis,M.kansa
si
Cows, goat, wild animals digestive tract,
respiratory patients
Bruselosis Brucella abortus,
B.melitensis, B.
suis, B. canis
Cattle, buffalo, sheep,
goats, horses
milk, raw meat, aerosol
Salmonelosis Salmonella sp., S.
typhi
poultry, cattle, cats,
horses
meat, milk, eggs
Antrax Bacillus anthracis ruminants food, breathing, and skin
contact patients
Q. fever Coxiella burnetii All animals (wild,
domestic, direct contact
with ruminant sources)
dust particles, urine,
feces, milk, blood
transfusion, injury to the
skin
Leptospirosis Leptospira sp. Sapi, anjing, tikus air seni, kulit yang terluka
Sources: Purnomo (1992); Budi (1996); Harjoutomo dan Poerwadikarta (1996); Widarso
and Wilfried (2002); Wardana (2006); Setiono (2007).
Tabel 1. Zoonotic infections in cattle caused by bacteria
Name of disease The cause of
Virus
Animals that can
be infected
Modes of
transmission
Bird flu H5N1 Chickens, birds,
ducks, pigs
Aerosols, splash
fluid and mucus from
sick animals
Swine flu H3N1 subtipe
H1N1,H1N2,
H3NI, H3N2
Pig Direct contact or
inhalation of small
particles in the air that
contains a virus
Rabies Rhabdoviridae
(F), Lyssa virus
(G)
Bats, all warm-
blooded animals
The bite of a dog, cat,
rabbit, guinea pig
Sources: Bell et al. (1988); Mathari (2009)
Tabel 2. Jenis penyakit zoonosis disebabkan oleh virus
LEPTOSPIROSIS
PSITTACOSIS
ANTRAX
SCRUB TYPHUS
BIRD FLU
RABIES
MAD COW DISEASE
Leptospira sp diseases caused by bacteria that can
be transmitted from animals to humans or vice
versa.
Leptospirosis is also known as Disease Weil, Fever
Icterohemorrhage, Disease Swineherd's, Ricefield
fever, fever Cutting sugar cane (Cane-cutter fever),
fever Lumpur, Jaundis bloody, Disease Stuttgart,
Fever canicola, jaundice non-virus, the disease red
water on the calf, and typhoid dog
INDIRECT CONTACT
DIRECT CONTACT
contact with moist
soil or vegetation
contaminated with
urine of infected animals
swimming or wading in
floodwaters
accidental immersion
occupational abrasion
thru tissue or urine of
infected animals
ingestion of contam food
droplet aerosol inhalation
Anicteric Leptospirosis
Icteric Leptospirosis
Weil's Syndrome
First stage
3-7 days
Septicemic
Second stage
0-1 month
Immune
First stage
3-7 days
Septicemic
Second stage
10-30 days
Immune
Myalgia/
Myositis
Abdominal
pain
Conjunctival
suffusion
Meningitis
Uveitis
Rash
Fever
Jaundice
Hemorrhage
Renal failure
Myocarditis
Meningitis
Pulmonary
hemorrhage
Respiratory
failure
Blood
CSF
urine
Blood
CSF
urine
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Signs and Symptoms of Leptospirosis
Icterus and hemorrhage
Acute renal failure
Penicillin 6 million units daily I.V (10-14
days)
Amoxycillin, Erythromycin, & Doxycycline
Patients with MOF(Multi organ failure) to be
observed and treated in intensive care unit
Chemo prophylaxis: Doxycycline can
prevent leptospirosis, if given before
and during exposure.
Psittacosis is an infection caused by
Chlamydia psittaci, a type of bacteria
found in the droppings of birds, such as
parakeets and macaws.
Treatment:
Doxycycline
Macrolides (kids, pregnant women)
Treat for 10-21 days
Prevention anthrax vaccine.
Antibiotics: Amoxicillin, Vanomycin, Ciprofloxacin,
Doxicyline, Eritromycin, Penicillin, Tetracycline,
Streptomycine, Chloramphenicol
Dose:
- Cutaneous anthrax: Procaine penicilline 2 x 1.2 million
International Units (intra-muscular)
for
5-7 days.
or: Benzyl penicilline 250,000
International
Unit (intramuscular) every 6 hours.
Digestive tract: Tetracycline 1 gram per day
Respiratory tract: Penicilline-G 18-24 million IU per
day IVFD, coupled with Streptomycine 1-2 grams.
In addition to antibiotics should be given also other
drugs symtomatis.
Skin Test before delivery AB
If hypersensitive to penicilline be given Tetracycline,
Chloramphenicol or Erytromycine.
Rabies is an infectious disease of animals
caused by viruses, acute attacks the
central nervous system as well as warm-
blooded animals and humans.
Rabies is zoonosa means that the
disease can be transmitted from animals
to humans
Rabies is very dangerous.
Rabies has no cure.
If clinical symptoms are arising, always
followed by death, in both animals and
humans.
All warm-blooded animals can transmit
rabies.
Dogs, cats and apes / monkeys in
Indonesia potentially transmit rabies to
humans.
More than 90% of cases of human rabies
transmitted by dogs.
Therefore a main object of activity the dog
rabies eradication
Every bite of infectious animal rabies cases
should be dealt with quickly and promptly as
possible.
To reduce / deadly rabies virus that enter the
bite wound, the most effective effort is to
wash the bite wound with water (preferably
water) and soap or diteregent for 10-15
minutes, then given an antiseptic (70%
alcohol, betadine, iodine)
The bite is not warranted to be sewn, except
stitching situation.
If it is necessary once for stitches (sutures
seams situation), then was given Anti-Rabies
Serum (ARS) in accordance with the dosage,
which is injected infiltration around the
wound as much as possible and the rest is
injected intra muscular.
Besides, it should be considered whether or
not granting serum / anti-tetanus vaccine,
antibiotics to prevent infections and providing
analgesic
(Chigger- borne Typhus)
reservoir
Larval stage
vector
Mite
Rats & Mice
Humans
Mite
No direct person to person transmission
Mite Islands
(Accidental host)
Drug of choice: Tetracycline
Doxycycline orally or Chloramphenicol in
more severe cases.
Azithromycin has been used in resistant cases
and may be better than doxycycline -
especially in children and pregnant women.
Bovine Spongiform Encephalopathy (BSE)
Creutzfeldt-Jakob
Bovine Spongiform Encephalopathy (BSE)
disease is not a 'real' Indonesia and until now
has not been reported in Indonesia.
The disease was first discovered in Britain
during the 1980s, then spread to other parts of
the world, including to the United States.
Creutzfeldt-Jakob
Mad cow disease is not only harmful to cattle, but also
for humans.
About mad cow disease in humans with a disease
called Creutzfeldt-Jakob.
Humans are usually infected by eating meat due to
the brain, bone marrow or an infected cow offal.
Incubation period 5-20 years from the
consumption of beef infected until symptoms arise
neurological disorders.
Early symptoms:
senile
do not care about the state of her body, apathetic,
irritable, forgetful and often confused myself
fatigue, sleepiness, and disturbed sleep
The muscles of the patients also experienced a twitch
and spasm.
The patient looked shaky and awkward body
movements.
In addition, the vision becomes blurred.
So far have not found a cure for mad cow
disease.
To relieve symptoms, doctors usually give
"sedative".
106
BIRD FLU
Infectious disease caused by influenza virus
type A (H5N1) which commonly infects birds
and can also infect humans to cause death.
DEFINITION DEFINITION
BIRD FLU
Perjalanan
Penyakit ????
Perjalanan
Penyakit ????
TREATMENT
1. Fowl vaccine 1. Fowl vaccine
2. Human
Vaccine not available
Medication not available
Prevention TAMIFLU
110