Soeharyo Hadisaputro, Prof.Dr.dr.Sp.PD-KPTI, FINASIM

PENYAKIT TROPIK & INFEKSI

BATASAN : DAERAH TROPIK ?COMMUNICABLE DISEASES ?INFEKSI : keberadaan kuman dalan tubuh yang mengadakan replikasiRESPONSE : Klinis; Subklinis; Kolonisasi, tergantung : patogenitas, virulensi, antigenitas, infektivitas.KLASIFIKASI : (1) Cara penularan (2) Etiologi (3) Tempat organ yang terkena (4) proses perjalanan penyakit (5) Menimbulkan wabah ?

COMMUNICABLE DISEASE (PENYAKIT INFEKSI TROPIK) (1) EMERGING INFECTIOUS DISEASES (2) RE-EMERGING INFECTIOUS DISEASE (1) EMERGING INFECTIOUS DISEASES (2) RE-EMERGING INFECTIOUS DISEASE (3) NEW EMERGING INFECTIOUS DISEASE ?

DEFINISI Penyakit Infeksi Emerging adalah penyakit infeksi baru atau masalah baru yang menjadi ancaman baru terhadap kesehatan.

Penyakit Infeksi emerging dianggap salah satu penyakit dengan agent baru ditemukan atau baru diidentifikasi sebagai patogen varian baru yang timbul & menyebabkan peningkatan insiden pada manusia selama dua atau tiga dekade belakangan dan merupakan ancaman kesehatan manusia di masa yang akan datang.

Emerging infectious diseasesCDC: Emerging or drug-resistant infections yang insidens meningkat pada manusia dalam tiga dekade belakangan atau merupakan ancaman kesehatan pada waktu mendatang. New Infectious Disease yang muncul pada populasi atau sudah ada sebelumnya tetapi dengan cepat meningkat insidensnya dalam kisaran geografik yang lebih luas.

Ancaman Global Penyakit Infeksi Emerging and Re-emerging diseases

Emerging diseasesRe-emerging diseasesChikungunyaDengueDengue

A/H1N1A/H1N1

?Infectious Diseases: A World in Transition

Transmission of communicable diseases

Agent of Vector Agents Human IndirectDirect contact Contact Number of agents Characteristics of agents Pathogenicity Defense mechanisms Immunity Personal characteristics

Factors Contributing To EmergenceAGENT

Evolution of pathogenic infectious agents (microbial adaptation & change)Development of resistance to drugs Resistance of vectors to pesticides

HOSTHuman demographic change (inhabiting new areas)Human behaviour (sexual & drug use)Human susceptibility to infection (Immunosuppression)Poverty & social inequality

Factors Contributing To Emergence

ENVIRONMENT

Environment sanitation (unsafe water supply, improper disposal, poor hygienic practices and congested living conditions,Climate & changing ecosystemsEconomic development & Land use (urbanization, deforestation)Technology & industry (food processing & handling)Factors Contributing To Emergence

Dr. KANUPRIYA CHATURVEDIInternational travel & commerce Breakdown of public health measure (war, unrest, overcrowding)Deterioration in surveillance systems (lack of political will)

Factors Contributing To Emergence

EMERGING OF INFECTIOUS DISEASE IN INDONESIAVECTOR BORNE DISEASE : (1) DENGUE DAN DHF : Sejak 1968 cenderung meningkat; di daerah perkotaan dan kel.usia anak pedesaan dan dewasa muda. (2) CHIKUNGUNYA : KLB sering di Indonesia; vektor sama dengan DHF, tak sebabkan kematian, tetapi menyebabkan kehilangan jam kerja.

Public Health Impact of Dengue2.5-3 billion people live in areas of risk50-100 million cases/infections/yearMillions hospitalized500,000 cases of dengue hemorrhagic fever20,000 plus deathsIncidence and geographic range are increasingEconomic ImpactNo vaccine or antiviral drugsMosquito control has been largely ineffective

Yearly Average DF/DHF Case by Islands In Indonesia for 3 Years(77.6%)(22.4%)(1.5%)(2.7%)(4.2%)(10.3%)(16.5%)(20.4%)(21.9%)(100.0%)

EMERGING INFECTIOUS DISEASES IN INDONESIA : VECTOR BORNE DISEASE (3) JAPANESE ENCEPHALITIS : JAPANESE ENCEPHALITIS : Endemik di Bali, Sumut, Sulut, Irja dan lokasi peternakan babi; Culex tritaenorrthynchus, C.gellidus, C.fatigans merupakan vektor yang banyak dijumpai di Indonesia.

Japanese Encephalitis (JE)Acute encephalitis is a medical emergency.Any patient presenting with fever and impaired mental status or neurological exam should be evaluated for encephalitis ;Primarily affects children 1 to 15 years of age.Incubation period is 5 to 14 days.If unrecognized, mortality is up to 30% with half of survivors sustain severe neurological sequelae.

EMERGING INFECTIOUS DISEASES IN INDONESIA : VECTOR BORNE DISEASE (4) MALARIA : The malaria control in Indonesia didnt optimally result. It caused by monetary crisis, environmental changes, plasmodium drug resistance, vector insecticide resistance, migration, etc.

Malaria, masalah kesehatan utama di dunia

Ancaman bagi 40% penduduk dunia

Angka kematian 1 1,5 juta orang per tahun Disebabkan oleh parasit Plasmodium

Ditularkan oleh nyamuk Anopheles Malaria: problema kesehatan masyarakat di Indonesia

EMERGING INFECTIOUS DISEASES IN INDONESIA : VECTOR BORNE DISEASE(5) FILARIASIS : TRANSMITTED by many vectors : Culex fatigans, Mansoni, AnopHeles and Aedes MOSQOITOES. Until END 2011 in Indonesia, it was found 12.066 cases of clinical chronic filariasis spread on 378 municipals with prevalence rate average (Mf rate0 = 19,78)

Cummulative number of Chronic cases reported

ELEPHANTIASIS

EMERGING INFECTIOUS DISEASES IN INDONESIA : VECTOR BORNE DISEASE (6) LEPTOSPIROSIS : caused by Leptospira bacteriae, transmitted by THE CONTAMINATED urine of the rats, Found in 14 provinces in Indonesia.

TRANSMISSION OF INFECTION Direct transmission : contact with urine, tissues of dead animals, transplacentally, sexually (semen) and mothers milk.Indirect transmission : contact with urine contaminated environment (mud and soil, surface water, sewage, (slaughterhouse, drain water); Drinking and inhalation.

EMERGING INFECTIOUS DISEASES IN INDONESIA : VECTOR BORNE DISEASETOXOPLASMOSIS : Caused by Toxoplasma gondii; Clinical manifestation of toxoplasmosis were not specific; spread out among many countries in the world including Indonesia. The prevalence of toxoplasmosis among Indonesian people was 26,3% i pregnant women, 51.48% in abortion women, 24.2-32% in infertile women.

EMERGING INFECTIOUS DISEASES IN INDONESIA :SEXUALLY TRANSMITTED DISEASES (STD) : WHO was approximated 340 million new cases of STD per year in the world (Gonorhoea, Clamydia infection, Syphilis, Trichomoniasis and HIV/AIDS). Prevalence data in Indonesia wasnt adequate, caused by weakness of reporting and recording system.

EMERGING INFECTIOUS DISEASES IN INDONESIA: AIR BORNE DISEASEINFLUENZA : the mutation of influenzae virus to cause difficulty of the preventive efforts in community.(2) TUBERCULOSIS : The emergence of this disease caused by the medical usage wasnt adequate, low awareness and the increase of HIV/AIDS incidence, etc.

MASALAH TUBERKULOSISPROBLEM UTAMAKES MAS

Berada pada ranking ke 3 kasus tb paru dunia Penyumbang 10% kasus tb paru di dunia 28 provinsi belum mencapai target nasional angka Case Detection Rate (CDR) = 70% Hanya 5 provinsi yg mencapai target nasional untuk CDR = 70 % dan CR = 85 %.

*Indonesia : 22 High Burden CountriesIndiaChinaIndonesiaBangladeshNigeriaPakistanSouth AfricaPhilippinesRussiaEthiopiaKenyaDR CongoViet NamUR TanzaniaBrazilThailandZimbabweCambodiaMyanmarUgandaAfghanistanMozambiquePenyebab kematian terbanyak penyakit infeksi (SKRT 1995)583.000 kasus baru/tahun, 140.000 kematian /tahun (WHO)

TB - Infection & DiseaseCategories of TB - ActivePersons with active TB disease usually have some of the following symptoms: cough ( 3 weeks or more), feel weak, have a fever, lose weight, experience night sweats, cough up blood, or have chest pain when coughing.

Transmisi TBTerbanyak : Pasien TB dewasa dgn BTA (+)

Cara transmisi :Airborne: > 90%, droplet nuclei 1-5 mOral :minum susu sapi yang terinfeksiKontak langsung:luka di kulitKongenital: selama kehamilan sangat jarang

Kandungan dropletbicara : 0 210 partikelbatuk : 0 3500 partikelbersin : 4500 1 juta partikel

EMERGING INFECTIOUS DISEASES IN INDONESIA(D) FOOD AND WATER BORNE DISEASES.(1) TYPHOID DAN SALMONELLOSIS : The sanitary factor and hygienic food take was responsibility on the increase of the morbidity of typhoid fever.DIARRHOEA : The strain of Cholera Vibrio O 139 from Bangladesh was a potentially factor to increase the case of diarrhoea in Indonesia.

NEW EMERGING INFECTIOUS DISEASES IN INDONESIA

HIV/AIDSSARS (SEVERE ACUTE RESPIRATORY SYNDROME) AVIAN FLUE (H5N1)MENINGITIS MENINGOCOCCUS HAND FOOT & MOUTH DISEASE (HFMD)HANTA VIRUS INFECTIONSWINE FLUE (H1N1)

FENOMENA KERBAU MANDI

The Percentage of Reported AIDS by Risk Factor

Persentase AIDS yang dilaporakn (pekerjaan)

SULITNYA MEMISAHKAN ANTARA LINGKUNGAN HEWAN & MANUSIA

NEW EMERGING OF VIRAL INFECTIOUS DISEASE IN INDONESIA HAND, FOOT & MOUTH DISEASE (HFMD) EV-71, Dilaporkan di Jakarta & kota-kota lain th 2001. Di Cina Timur dan Cina Selatan, Mei 2008 terjadi 24.932 kaus yang menewaskan 34 anak < 1 th Symptom Flue Like Syndrome, headache, nyeri tenggorok, Characteristic symptom and sign are bercak merah pd telapak tangan, telapak kaki dan mulut dengan gelembung isi cairan dpt ke jaringan otak dan selaput otak. Saat ini diduga terjangkit di Indonesia di RSCM dirawat beberapa kasus ??

Hantavirus (HV) Infections In South East Asia, evidence of HV in human has been reported from Korea, Phillipines, Singapore, and ThailandIn Indonesia, a serological study indicated the presence of Seoul-like virus in wild ratsSo far, no human cases have been reported ? (01, any cases in Semarang, 04 in Bandung)Hantavirus Infection is challenge of the outbreak in Indonesia. (rhodent control is difficult in community)

RE-EMERGING INFECTIOUS DISEASES IN INDONESIA RABIES PLAQUE (PEST) ANTHRAX TAENIASIS/CYSTICERCOSIS SCHISTOSOMIASIS FASCIOLOPSIS BUSKI

***Dr. KANUPRIYA CHATURVEDI*Dr. KANUPRIYA CHATURVEDI*Increasing virulence of microbes like Influenza A virus, which exhibits frequent changes in its antigenic structure giving rise to new strains with endemic and pandemic propensities.Dr. KANUPRIYA CHATURVEDI*Host factors contributing to emergence are: Mass migration of people provoked by natural and man made disaster with concomitant rehabilitation of displaced people in temporary human settlements under unhygienic conditions.Uninhibited and reckless industrialization leading to migration of labor population from rural to urban areas in unhygienic squatter settlementsInternational travel as a result of trade and tourism contributing to global dispersion of disease agents, disease reservoirs and vectorsChanges in lifestyle that promote unhealthy and risk prone behavior patterns affecting food habits and sexual practices.Declining immunity of as a result of HIV infection, which make him vulnerable to a host of infections.Dr. KANUPRIYA CHATURVEDI*Environmental sanitation characterized by unsafe water supply , improper disposal of solid and liquid waste, poor hygienic practices and congested living conditions all contribute to emergence of infection.Climatic changes resulting from global warming inducing increased surface water evaporation , greater rainfall changes in the direction of bird migration and changes in the habitat of disease vectors are also contributory factors.

Dr. KANUPRIYA CHATURVEDI*************

ISTC Training Modules 2008**

ISTC Training Modules 2008**********