Learning

Objective
nd
2 Scenario
By:
Salsabila Ardhani
1418011195
 Zoonotic Disease
Etiological agents
Anthrax, Brucellosis, plague, leptospirosis, salmonellosis, lyme
Bacterial agents disease

Viral zoonoses Rabies, arbovirus infection, KFD, yellow fever, influenza

protozoal Toxoplasmosis, trypanosomiasis, leishmaniasis

Helminth Echinococcosis, taeniasis, schistosomiasis, dracunculiasis

Fungal Deep mycosis, crytococcosis, dermatophytes

Ectoparasite Scabiesis, myasis

 Insect Bites
The species of insect: dragonflies, grasshoppers, true
bugs, flies, fleas, bees, wasps, ants, lice, butterflies,
moths, and beetles
Bite vs Sting?

Bite Sting

From: mouth parts From: sharp organ of offense or

Occurs: defend itself/seek a feed defense
Effect: itching > pain Occurs: when connected with a
In: mosquitoes, fleas, bed bugs, and venom gland
mites Effect: pain>itching
In: bees, wasps, hornets, and
scorpions
 Pathophysiology (Insect
Bites)
Mouthparts of insect: piercing, sponging, and biting

inject saliva while biting-> saliva (+) secret -> (+) immune
response

Immediate reaction: toxin

Spingomyelinase D: (+) histamin, serotonin, asam formic atau kinin-> itching
& lesions
Enzim hyluronidase: destroyed dermis-> spread the toxin through all body
 Clinical Presentation
Local Lesion: eritema-> edema-> necrosis of local tissue
Systemic: itching, severe pain, tendernes, warmth
reaction

generalized rash, urticaria, pruritus, and angioedema.

anxiety, disorientation, weakness, gastrointestinal
anaphylactic disturbances (eg, cramping, diarrhea, vomiting),
uterine cramping in women, urinary or fecal
reaction incontinence, dizziness, syncope, hypotension,
stridor, dyspnea, or cough -> respiratory/heart failure
 Physical Examination:
o Location: all body
o Efloresension: Eritema morbiliformis(bula arround eritema&iskemia)

Necrosis
Eritema
widely &
morbiliformis
gangren

Laboratory examination
o Blood test: eosinofil
o Skin test: prict test with allergent
 ial
Diagnose

Chronic papul/nodul &

Prurigo itching

Urtikaria (-) insect bites

Contact (+) contact material

dermatitis Lesion base on contact
 Treatment
Local mild reaction:
compress with borat acid 3%

Topical Cortikosteroid: hirocortison cream 1-2%

Severe reaction with systemic symptomp:
Put the tourniquet in proximal from the bites
Systemic drugs

Antihistamine: ctm 10 mg/difenhidramin 50 mg (injection)

systemic Adrenalinee 1% 0,3-0,5 ml (subcutaneous)

Kortikosteroid systemic for unprogressive impairment with
antihistamin/adrenaline
 SnakeBite
Large fangs
Vertical slits for pupils
Characteristic
Heat sensitive pit between the eye
of venomous (pit viper)
snake Triangular head is larger than neck
Certain color blotches on scales

Atractaspididae
Classification Elapidae: The Naja species(ular
kobra)
of venomous
Viperidae: daboia siemens,
snake cryptelytrops albolabris,
calloselasma rhodostoma
 Pathogenesis &
Pathophsyiology
Hyaluronidase: spread of
venom(subcutaneous tissues) by
Venom: disrupting
mucopolysaccharides

(+) phospholipase A2: hemolysis on

red cell membranes and
promotes muscle necrosis
Enzymatic thrombogenic enzymes promote
the formation of a weak fibrin

protein clot, which, in turn, activates

plasmin-> consumptive
coagulopathy-> haemorragic
 Clinical manifestation
Severity of a snakebite is determined by:
o Location of the bite
o Presence of disease-causing organisms in venom
o Size and weight of victim
o Health condition of victim
o Physical exertion of victim following bite
Signs and symptoms of a snakebite
o Two distinct fang marks
o Immediate severe burning pain with swelling
o Purplish discoloration and blood-blisters around the
bite
o Numbness around the site

Clinical manifestation
local : bleeding local pain, swelling, local skin
necrosis-> tissue loss->amputated
Systemic:
o Cobra: (+) neurotoxixity

Pre synaptic Beta-bungarotoxin(b-BuTx)

Degeneration of motor nerve
Depletion of synaptic vessels
neurotoxins Destruction of motor nerve

Post synaptic Alpha neurotoxins (+) ach receptor

Neuromucular blocade: ptosis, facial weakness, paralysis,
neurotoxin resporatory muscle weakness
 Diagnose
Anamnesis:
o The location of the bite
o The time patient got bitten: to determine local effect/ develope to
systemic effect
o The symptomp
o The characteristic of snake:
Venomous: tringularheads, heat sensing pits, elliptical pupil, typical
bites fangs puncture in skin
Non: round head, round pupil, typical bites: small puncture uin rows
 Physical examination
o Vital signs: Initial stabilization
(ABC)
o Fang marks or scratches:
Determine the venom/non
snake
o Local tissue destruction: Soft
pitting edema generally
develops over 6-12 hours but
may start within 5 minutes;
not bullae, streaking,
erythema or discoloration,
and contusions.
o Systemic toxicity:
hypotension; petechiae,
epistaxis, and hemoptysis;
and paresthesias and
dysesthesias, respiratory
distress (more common with
coral snakes).
o Neurological: cranial nerve,
motor&sensory exam
Laboratory studies:
CBC count with manual
differential and
peripheral blood smear
Prothrombin time and
activated partial
thromboplastin time,
international normalized
ratio (INR).
Fibrinogen and split
products
Blood type and cross-
match
Blood chemistries,
including electrolytes,
BUN, creatinine
Urinalysis for
myoglobinuria
Arterial blood gas
determinations and/or
lactate level for patients
with systemic symptoms
 Snakebite Management
First aid:
o Pressure bandage with immobilization-> blocking lymphatic flow without
compromising arterial or venous blood flow-> (-) spreading
o HARMFULL-> venome absorption
Incision
Rubbing at the site of the bite
Herbal remedy
Tying tight tourniquet
Sucking out venom with mouth
 In hospital management
o ABC
o Decrease anxiety (chlorpromazine 25-50 mg)
o Pain reliever: paracetamol&opioid
o Tetanus prophylaxis: toksoid
o Antibiotic:
Staphylococcus aureus (1st common pathogen)
E.coli (2nc common pathogen)
DOC: ciprofloxacin
 Antivenom
o Indication: hemostatic abnormality, neurotoxic signs, cdv abnormalities,
AKI, hemoglobinuria, myoglobinuria, swelling >48 hours, rapid extension of
swelling& enlarged lymph nodes
o biosave by biofarma-> equine serum
o First dose: 2 vial @5ml diluted with normal saline 2% (infuse 40-80
drops/min)
o Another dose: 6 hours
o symptom[p still persist: give every 24 hours (max dose: 80-100ml)
o Allergict test must be done pre/post administration
o Effective for: The Naja species, Bungarus fasciatus, Agstrodon rhodostoma
 Source
Saripati penyakit kulit
Medscape Snakebite & Insec Bites
Zoonotic disease of public health importance
Sentra informasi keracunan nasioonal badan POM
Snakebite Indonesia, The Indonesian Journal of
Internal Medicine, Acta Medica Indonesia