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ZOONOSIS

INTRODUCTION
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 : o Early diagnosis and prompt treatment o Public health education about : Prevention Proper hygiene Reservoir-host-vector control

The causes of this disease are divided into 3 major groups :


1.

PROTOZOA :

- Amoebiasis - Trichomoniasis - Oxyuriasis / enterobiasis - Ground itch - Cutaneous larva migrans - Current larva - Filariasis - Dracunculiasis
: - Scabies

2.

NEMATODA:

3.

ARTROPODA

- Pediculosis

AMOEBIASIS CUTIS
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 Clinical manifestation : Ulcer : well-defined border, erythema on the surrounding skin, base necrotic & purulent Destruction muscles and bones Diagnosis : Material scrapes and biopsy taken from the edge of the ulcer Microscopic trophozoit Treatment : Metronidazole 3 x 750 mg / day 10 days Dihydroemetin : 1,5 mg/kgBW/day IM 10 days

TRICHOMONIASIS
Causative agent : Trichomonas vaginalis Clinical manifestation : Vaginal discharge seropurulent, yellow / greenish yellow, foul-smelling and fizzy. Vulva pruritus, irritant dermatitis Strawberry appearance the vaginal wall is red and swollen. Diagnosis : vaginal discharge / urine + NaCl microscopic movement of T.vaginalis Treatment : Metronidazole 3 x 250 mg 7 10 days Metronidazole single dose 2 gr

OXYURIASIS / ENTEROBIASIS
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. 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

GROUND ITCH
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. Diagnosis : microscopic egg (+) Treatment : Secondary infection on the skin AB Intestinal infection : o Mebendazole 2 x 100 mg/day 3 days o Albendazole 200 mg/day 3 days

CUTANEOUS LARVA MIGRANS (CREEPING ERUPTION)


Causative agent : Ancylostoma braziliensis, Acaninum & Uncinaria stenocephala Mostly affects children, miners and farmers. Pathogenesis : Adult hookworm in dogs / cats small intestines Eggs Rhabditiform larvae Filariform larvae The skin Creeping eruption

Clinical features : Common locations are on the buttocks, feet and hands The diameter of the lesion is 1 4 mm, red in color, a bit raised, like a coiled thread. Diagnosis : typical lesion manifestation Treatment : Topical o Classic : Chlorethyl, CO2, liquid N2 o Thiabendazole 10% o Albendazole 2% Systemic o Thiabendazole 25 mg/kgBW/day 2 days o Albendazole 50 mg/kgBW/once a week

CURRENT LARVAE
Causative agent : Strongyloides stercoralis Method of transmission : autoinfection 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

FILARIASIS
Causative agent : Vector Wucheria bancrofti Brugia malayi : anopheles, culex, aedes and mansonia mosquitos.

Method of transmission : Wecheria bancrofti (adult form) lymphatic glands Microfilaria (peripheral lymphatic glands / blood vessels) Mosquito (infective) Human Clinical features : 1. Asymptomatic stage - Incubation period 8 12 months - Lab : microfilaria in the blood Eosinophilia 2. Acute inflammation stage - Lymphangitis on the extremities / scrotums, pain, rigid, glossy skin, heat.
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- Lymphadenitis - Orchitis, funiculitis, epididimiti3 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 Diagnosis : Examination of the peripheral blood vessels at night-time microfilaria Examination of the hydroceles liquid or urine Treatment : Diethilcarbamazine 2 mg/kgBW/day 3 weeks

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DRACUNCULIASIS
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 Clinical features : Erythema, urticaria, itch, several hours papule vesicle bullae erosion / ulceration Diagnosis : Radiology examination calcification of the dead worms
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Treatment : Thiabendazole 50 100 mg/kgBW 2 days Metronidazole 30 40 mg/kgBW/day 3 days

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HUMAN SCABIES
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 1014 days Mites 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 and children Noduler scabies Scabies transmitted by animals Scabies in a clean Norwegian scabies Additional examinations : Microscopic mites, eggs, faeces Burrows tetracycline Skin biopsy Diagnosis : Itch, especially at night-time 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% - Permitrin 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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PEDICULOSIS
P. capitis P. humanus var capitis P. corporis P. humanus var corporis P. pubis Phtyrus pubis Pathogenesis : - Direct contact - Indirect contact

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 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 - permetrin 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 ointment

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

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Furunculoid papule pustule incision larvae Based on the locations : The skin The orifices (nose, ears, eyes) Internal organs digestive tract, urinary tract Diagnosis : Larva on the lesion (+) Treatment : Furunculoid : o 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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CIMICOSIS
Causative agent : Cimex lectularis Cimex hemipterus

Clinical features : Mite bite papule with punctum Hemorrhagic bulla Treatment : Eradication of mites with mallation / DDT Lesion with anti-itch lotion

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