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13. Zoonosis management and therapy algorithm
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- 2. 2 ZOONOSIS Dr. LIZA AFRILIANA,SpKK (K) Department of dermatovenereology Faculty of medicine, Diponegoro University
- 3. 3 ● Zoonosis :skin disease caused by various parasites ● This disease is often found in : o Crowded areas o Low socio-economic condition o Poor sanitation and hygiene ● In the eradication effort, these attempts are needed: ◦ Early diagnosis and prompt treatment ◦ Public health education about : - Prevention - Proper hygiene - Reservoir-host-vector control
- 4. 4 The causes ofthis disease are divided into 3 major groups : 1. PROTOZOA : - Amoebiasis - Trichomoniasis 2. NEMATODA : - Oxyuriasis / enterobiasis - “Ground itch” - Cutaneous larva migrans - Current larva - Filariasis - Dracunculiasis 3. ARTROPODA : - Scabies - Pediculosis
- 5. 5 ● Causative agent: Entamoeba histolytica ● The amoeba may affect the skin through these mechanisms : 1. Direct invasion of intestinal amoeba on the surrounding skin 2. directly from hepatic abscess 3. Direct implantation of trophozoit on skin with / without lesion
- 6. 6 ● Clinical manifestation: - Ulcer : well-defined border, erythema on the surrounding skin, base → necrotic & purulent - Destruction → muscles and bones
- 7. 7 ● Diagnosis : –Material scrapes and biopsy taken from → the edge of the ulcer, including the base of ulcer, necrotic border, & some surrounding skin – Microscopic motile trophozoit → ● Treatment : – Metronidazole : 3 x 750 mg / day 10 days → – Dihydroemetin : 1,5 mg/kgBW/day IM 10 days →
- 8. 8 ● Causative agent: Trichomonas vaginalis
- 9. 9 ● Transmission :sexual contact. ● Clinical manifestation : - Vaginal discharge seropurulent, → yellow / greenish yellow, foul-smelling & fizzy. - Vulva pruritus, irritant dermatitis. → - Strawberry appearance the vaginal wall is → red and swollen. - Infected men : are asymptomatic.
- 10. 10 T. vaginalis infection: “strawberry” appearance of cervix with punctate bleeding erosions
- 11. 11 ● Diagnosis :vaginal discharge / urine + NaCl → microscopic → movement of T.vaginalis ● Treatment : - Metronidazole 3 x 250 mg 7 – 10 days → - Metronidazole single dose 2 gr
- 12. 12 ● Causative agent: Enterobius vermicularis ● Often affects children aged 5 – 14 years old. ● The transmission is through : - food / beverage - egg-infested hands ● Clinical manifestation : - Perianal/perineal pruritus, especially at night - Perineal intertrigo → excoriation & superinfection
- 13. 13 ● Diagnosis :Worm (+) or egg (+), obtained through the “scotch tape” method. ● Treatment : - Mebendazole : 100 mg, SD - Piperazine citrate : 65 mg/kgBW/day, max. 2 gr → 7 days - Thiabendazole 25 mg / kgBW / day
- 14. 14 ● Causative agent: Necator americanus & Ancylostoma duodenale ● Pathogenesis : penetration of filariform larvae → plantar skin blood circulation → ● Clinical manifestation : - Skin lesion : maculae, papule, vesicle, bulae, sometimes urticaria and oedema. - 2 weeks self-limiting, except in the events → of secondary infections.
- 15. 15 ● Diagnosis :microscopic egg (+) → ● Treatment : ○ Secondary infection on the skin AB → ○ Intestinal infection : - Mebendazole 2 x 100 mg/day 3 days → - Albendazole 200 mg/day 3 days →
- 16. 16 ● Causative agent: Ancylostoma braziliensis, Ancylostoma caninum, & Uncinaria stenocephala ● Mostly affects children, miners and farmers.
- 17. 17 Pathogenesis : Adult hookwormin dogs’ / cats’ small intestines ↓ Eggs (in animal faeces) ↓ Rhabditiform larvae (soil) ↓ Filariform larvae (soil) ↓ penetrate The skin ↓ “Creeping eruption”
- 18. 18 Clinical features : -Common locations are on the buttocks, feet, & hands. - The diameter of the lesion is 1 – 4 mm, red in color, a bit raised, like a coiled thread.
- 19. 19 Typical track ofCLM located on plantar aspect of foot.
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- 21. 21 ● Diagnosis :typical lesion manifestation ● Treatment : ○ Topical : - Classic : Chlorethyl spray, CO2, liquid N2 - Thiabendazole 10% - Albendazole 2% ○ Systemic : - Thiabendazole 25 mg/kgBW/day 2 days → - Albendazole 50 mg/kgBW/once a week
- 22. 22 ● Causative agent: Strongyloides stercoralis ● Method of transmission : autoinfection
- 23. 23 ● Clinical features: - Lesion urtica ribbon, quickly lengthening, → 10 cm / hour ● Location : anus, spreading to the buttocks, abdomen, or thighs. ● Diagnosis : - Typical lesion - Larva in the feces (microscopic) ● Treatment : - Thiabendazole 25 mg/kgBW/day 5 days → - Albendazole / Mebendazole
- 24. 24 ● Causative agent: Wuchereria bancrofti Brugia malayi ● Vector : anopheles, culex, aedes, & mansonia mosquitos. ● Method of transmission : Wuchereria bancrofti (adult form) ↓ lymphatic glands Microfilaria (peripheral lymphatic glands / blood vessels) ↓ Mosquito (infective) ↓ Human
- 25. 25 ● Clinical features: 1. Asymptomatic stage : - Incubation period 8 – 12 months - Lab : microfilaria in the blood, eosinophilia 2. Acute inflammation stage : - Lymphangitis on the extremities/scrotum, pain, rigid, glossy skin, heat. - Lymphadenitis - Orchitis, funiculitis, epididimitis
- 26. 26 3. Chronic obstructivestage : - Repetitive inflammations & fibrosis of the lymphatic glands obstruction → - Obstruction disturbance of the → lymphatic drainage liquid accumulation → in the tissue and lymphatic glands → progressive in nature due to repetitive inflammations. – Manifestations : varicose lymph & lymphedema – Chronic edema connective tissues → → deformity & elephantiasis ● Clinical features :
- 27. 27 ● Diagnosis : -Examination of the peripheral blood vessels at night-time → microfilaria - Examination of the hydrocele’s liquid or urine ● Treatment : Diethylcarbamazine 2 mg/kgBW/day 3 weeks → Lymphatic elephantiasis secondary to Wuchereria bancrofti
- 28. 28 ● Causative agent: Dracunculus medinensis ● Intermediate host : Crustacea species from the Cyclops genus Consumption of Cyclops-infested water / beverage ↓ Intestinal walls & retroperitoneal tissues (adult worms) ↓ Sub-cutaneous tissues (body part that has contact with the water / feet) ↓ Larvae
- 29. 29 Clinical features : Erythema,urticaria, itch, several hours → papule vesicle bullae → → → erosion / ulceration
- 30. 30 ● Diagnosis : Radiologyexamination → calcification of the dead worms ● Treatment : - Thiabendazole 50–100 mg/kgBW 2 days → - Metronidazole 30–40 mg/kgBW/day 3 days →
- 31. 31 ● Method oftransmission : - Direct handshake, sexual contact → - Indirect through objects → ● Etiology : Sarcoptes scabiei var hominis Life cycle : Female mites in stratum corneum ↓ Eggs ↓ 3–4 days Larvae 10–14 ↓ days Mites
- 32. 32 Clinical features : -Predilection : in-between fingers, flexor of the wrists, genitalia, axillae folds, lower abdomen, buttocks. - Lesion papule, vesicle, → excoriation/secondary infection, sometimes forming burrows.
- 33. 33 Clinical variations : “Incognito” scabies Scabies in infants & children Noduler scabies Scabies transmitted by animals Scabies “in a clean” Norwegian scabies
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- 35. 35 ● Additional examinations: - Microscopic mites, eggs, faeces → - Burrows tetracycline → - Skin biopsy ● Diagnosis : - Itch, especially at night-time (nocturnal itching) - History of infection on members of the family / people living under the same roof - Characteristic distribution of lesion - Characteristic lesion burrows → - Definite diagnosis mites, eggs, faeces → - Tx antiscabies improvement →
- 36. 36 ● Treatment : –Gamexan 1% – Crotamiton 10% – Sulfur 5 – 10% – Benzoil benzoate 20 – 35% – Permethrin 5% ● To achieve treatment success : - Treat every contact person - Correct drug administration - Washing clothes and towels with hot water, air mattress under the sun - Avoid excess treatment
- 37. 37 • P. capitis→ P. humanus var capitis • P. corporis → P. humanus var corporis • P. pubis → Phtirus pubis Pathogenesis : - Direct contact - Indirect contact
- 38. 38 P. CAPITIS ● Clinicalmanifestation : often affects children ● Symptoms : - itch, especially on the occipital & temporal parts excoriation, erosion / → secondary infection - swelling of the lymph glands P. CORPORIS ● Clinical features : - hemorrhagic macules / papules with punctum in the middle - urtica
- 39. 39 P. PUBIS ● Mitespubic hair, eyebrows, eyelashes, → axillae region, sometimes body hair ● Clinical features : - itch excoriation / secondary infection → - Characteristic “maculae cerulae” →
- 40. 40 Diagnosis : P. capitis: shiny eggs on hair, mites P. corporis : eggs / mites on clothes’ folds P. pubis : eggs / mites on pubic hair, eyelashes, body hair Treatment : P. capitis : - gamexan 1% shampoo - permethrin 1% cream - crotamiton 10% cream / lotion P. corporis : - gamexan 1% - Washing clothes / bed sheets using hot water / ironing them P. pubis : - petrolatum - physostigmine 0,025% eye oint
- 41. 41 ● Causative agents: - Oestrus - Gasterophillus - Hypoderma - Chrysomya ● Predisposing factors : - Open suppurative lesion - Habit of sitting down / sleeping on the ground - Unclean environment
- 42. 42 ● Myasis classification: 1. Specific 2. Semi specific 3. “Accidental” ● Clinical features, based on the type of lesion : - Subcutaneous burrows pinkish papules, → followed by spiraling lines - On the wound untreated lesion → - Subcutaneous shifting nodule / tumour → - Furunculoid papule pustule incision → → → → larvae
- 43. 43 ● Based onthe locations : - The skin - The orifices (nose, ears, eyes) - Internal organs → digestive tract,urinary tract
- 44. 44 ● Diagnosis :Larva on the lesion (+) ● Treatment : - Furunculoid : ○ Seal with petrolatum / paraffin, then press larvae will be squeezed out → - On the wound : irrigation with chloroform / ether - Classic : fish the larvae out with clover liquid
- 45. 45 ● Causative agents: Cimex lectularis Cimex hemipterus ● Clinical features : - Mite bite papule with punctum → - Hemorrhagic bulla →
- 46. 46 ● Treatment : -Eradication of mites with malathion / DDT - Lesion with antipruritic lotion
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