13. Zoonosis management and therapy algorithm

Zoonosi

1. 1
KULIAH
REGULER 2016

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 of this 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

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● 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.

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● 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 hookworm in dogs’ / cats’ small intestines

↓
Eggs (in animal faeces)

↓
Rhabditiform larvae (soil)

↓
Filariform larvae (soil)

↓
penetrate
The skin

↓
“Creeping eruption”

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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.

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Typical track of CLM located on plantar aspect of foot.

20. 20
Vesiculobullous lesion of CLM.

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● 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

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● 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

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● 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

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● 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

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3. Chronic obstructive stage :
- 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 :

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● 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

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Clinical features :
Erythema, urticaria, itch, several hours
→
papule vesicle bullae
→ → →
erosion / ulceration

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● Diagnosis :
Radiology examination
→
calcification of the dead worms
● Treatment :
- Thiabendazole 50–100 mg/kgBW 2 days
→
- Metronidazole 30–40 mg/kgBW/day 3 days
→

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● Method of transmission :
- 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

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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.

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Clinical variations :
 “Incognito” scabies
 Scabies in infants &
children
 Noduler scabies
 Scabies transmitted
by animals
 Scabies “in a clean”
 Norwegian scabies

34. 34

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● 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
→

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● 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

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•P. capitis → P. humanus var capitis
•P. corporis → P. humanus var corporis
•P. pubis → Phtirus pubis
Pathogenesis :
-Direct contact
-Indirect contact

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P. CAPITIS
● Clinical manifestation : 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

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P. PUBIS
● Mites pubic hair, eyebrows, eyelashes,
→
axillae region, sometimes body hair
● Clinical features :
- itch excoriation / secondary infection
→
- Characteristic “maculae cerulae”
→

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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

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● Causative agents :
-Oestrus
-Gasterophillus
-Hypoderma
-Chrysomya
● Predisposing factors :
-Open suppurative lesion
-Habit of sitting down / sleeping on the ground
-Unclean environment

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● 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

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● Based on the locations :
- The skin
- The orifices (nose, ears, eyes)
- Internal organs → digestive tract,urinary tract

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● 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

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● Causative agents : Cimex lectularis
Cimex hemipterus
● Clinical features :
- Mite bite papule with punctum
→
- Hemorrhagic bulla
→

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● Treatment :
- Eradication of mites with malathion / DDT
- Lesion with antipruritic lotion

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TERIMA
KASIH