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AWAS

R Rabies

PENYAKIT

MENULAR

DARI

SATWA

LIAR

Penyakit mematikan yang disebabkan oleh virus ini dikenal juga sebagai penyakit
anjing gila. Penyakit yang menyerang susunan syaraf pusat ini dapat ditularkan ke
manusia lewat gigitan satwa. Kasus gigitan hewan penyebar rabies adalah anjing
(90%), kucing (3%), kera (3%) dan satwa lain (1%).
Gejala yang ditimbulkan bila terinfeksi rabies pertama-tama adalah tingkah laku
yang abnormal dan sangat sensitif (mudah marah), kelumpuhan dan kekejangan
pada anggota gerak. Penderita akan mati karena kesulitan untuk bernafas dan
menelan dalam kurun waktu 2-10 hari.
Leptospirosis
Penyakit yang disebabkan oleh sejenis kuman ini menyerang semua jenis satwa
termasuk manusia. Organ tubuh yang paling disukai oleh kuman ini tumbuh subur
adalah ginjal dan organ reproduksi. Penularan penyakit berawal dari adanya luka
yang terbuka dan terkontaminasi dengan air kencing atau cairan dari organ
reproduksi. Bakan makanan atau minuman yang tercemarpun dapat menyebakan
infeksi masuk dalam tubuh.
Gejala yang mudah diamati bila terinfeksi penyakit ini adalah air kencing berubah
menjadi merah karena ginjal penderita mengalami perdarahan. Selain itu kepala
akan mengalami sakit yang luar biasa, depresi, badan lemah bahkan wanita hamil
juga akan mengalami keguguran. Sampai saat ini belum ada vaksin Leptospira untuk
manusia, yang tersedia hanya untuk satwa.
Satwa yang bisa menularkan penyakit mengerikan ini adalah anjing, kucing,
harimau, tikus, musang, jelarang dan tupai.

Paronychia
Paronychia refers to inflammation of the nail fold. It can be acute or chronic.
Acute paronychia
Acute paronychia develops over a few hours when a nail fold becomes painful, red and
swollen. Sometimes yellow pus appears under the cuticle. In some cases acute paronychia
is accompanied by fever and painful glands under the arms.
It is usually due to Staphylococcus aureus, a bacterial infection treated with oral
antibiotics. Sometimes an abscess forms and has to be lanced. it can also be due to the
cold sore virus, herpes simplex, when it is known as herpetic whitlow.
Acute paronychia usually clears completely in a few days, and rarely recurs.

Acute paronychia

Paronychia induced by
isotretinoin

Paronychia in an athlete

Chronic paronychia
Chronic paronychia is a gradual process and much more difficult to get rid of. It may start
in one nail fold but often spreads to several others. Each affected nail fold is swollen and
lifted off the nail plate. It may be red and tender from time to time, and sometimes a little
pus (white, yellow or green) can be expressed from under the cuticle.
The nail plate becomes distorted and ridged as it grows. It may become yellow or green
and brittle. After recovery, it takes up to a year for the nails to grow back to normal.
Chronic paronychia is due to several different micro-organisms. Often a mixture of yeasts
and bacteria are present, particularly candida species and Gram negative bacilli. The
inflammation results in debris which builds up, encouraging more infection.
It mainly occurs in people who have constantly wet hands, such as dairy farmers,
fishermen, bar tenders and housewives. It is more likely to occur, and more difficult to
clear up, in those with poor circulation, especially during the winter months. It can also
be a complication of eczema.

Chronic paronychia

Nail dystrophy

Eczema

Treatment
The following measures may improve paronychia.

Keep the hands dry and warm.

Avoid wet work, or use totally waterproof gloves.
Keep fingernails scrupulously clean.
Wash thoroughly after dirty work with soap and water, rinse off and dry carefully.
Don't let the skin dry out.
Apply a emollient hand cream frequently - dimethicone barrier creams may help.
Apply antiseptics or antifungal lotions regularly twice daily to the nail fold suitable preparations include sulphacetamide, thymol, miconazole, ciclopirox.
Occlusive paints can be useful; flexible collodion can be applied over the nail fold
as a barrier to water and germs.
A course of an oral antifungal agent (itraconazole or fluconazole) may be
recommended by a dermatologist.

It often takes months to clear paronychia, and it can recur in predisposed individuals.

Fungal nail infections

Fungal infection of the nails is known as "onychomycosis". It is increasingly common
with increased age. It rarely affects children.

Responsible organisms
Onychomycosis can be due to:

Dermatophytes such as Trichophyton rubrum (T rubrum), T. interdigitale. The

infection is also known as tinea unguium.
Yeasts such as Candida albicans.
Moulds especially Scopulariopsis brevicaulis and Fusarium species.

Onychomycosis from
T rubrum with
secondary bacterial infection

Complete nail
destruction

Lateral
onychomycosis

Nail infection
due to Microsporum
canis (rare)

All nails are

yellow due to
T rubrum infection

Extensive tinea unguium

due to T rubrum

Clinical features
Tinea unguium may affect one or more toenails and/or fingernails and most often
involves the great toenail or the little toenail. It can present in one or several different
patterns:

Lateral onychomycosis. A white or yellow opaque streak appears at one side of

the nail.
Subungual hyperkeratosis. Scaling occurs under the nail.
Distal onycholysis. The end of the nail lifts up. The free edge often crumbles.
Superficial white onychomycosis. Flaky white patches and pits appear on the top
of the nail plate.
Proximal onychomycosis. Yellow spots appear in the half-moon (lunula).
Complete destruction of the nail.

Tinea unguium often results from untreated tinea pedis (feet) or tinea manuum (hand). It
may follow an injury to the nail.
Candida infection of the nail plate generally results from paronychia and starts near the
nail fold (the cuticle). The nail fold is swollen and red, lifted off the nail plate. White,
yellow, green or black marks appear on the nearby nail and spread. The nail may lift off
its bed and is tender if you press on it.
Mould infections are usually indistinguishable from tinea unguium.

Onychomycosis must be distinguished from other nail disorders such as:

Bacterial infection especially Pseudomonas aeruginosa, which turns the nail black
or green.
Psoriasis.
Eczema or dermatitis.
Lichen planus.
Viral warts.
Onychogryphosis (nail thickening and scaling under the nail), common in the
elderly.

Nail clippings
Clippings should be taken from crumbling tissue at the end of the infected nail. The
discoloured surface of the nails can be scraped off. The debris can be scooped out from
under the nail.
Previous treatment can reduce the chance of growing the fungus successfully in culture
so it is best to take the clippings before any treatment is commenced:

To confirm the diagnosis - antifungal treatment will not be successful if there is

another explanation for the nail condition.
To identify the responsible organism. Moulds and yeasts may require different
treatment from dermatophyte fungi.
Treatment may be required for a prolonged period and is expensive. Partially
treated infection may be impossible to prove for many months as antifungal drugs
can be detected even a year later.

Treatment
Fingernail infections are usually cured more quickly and effectively than toenail
infections.
Mild infections affecting less than 80% of one or two nails may respond to topical
antifungal medications but cure usually requires an oral antifungal medication for several
months. Combined topical and oral treatment is probably the most effective regime.

Topical antifungal medications

Topical antifungal medications can often cure fungal infections. Many suitable creams
can be obtained over the counter without a doctor's prescription.
Many antifungal medications are suitable for both dermatophyte and yeast infections. The
medications available in New Zealand are listed below, with their trade names in
parentheses.

Those unsuitable for dermatophyte fungal infections are marked with an asterix (*).

Preparations for nail fold infections

There are many antiseptic and antifungal preparations to control nail fold infections
(paronychia). They should be applied two or three times daily for several months.

Thymol 3% in chloroform
Sulphacetamide 15% in spirit
Econazole solution (Pevaryl solution)
Miconazole (Daktarin tincture; Fungo solution)

Preparations for nail plate infections

Mild onychomycosis can be treated with antifungal lacquers applied once or twice
weekly. The medication should be applied to the surface of the cleaned nail plate after it
has been roughened using an emery board. Extra lacquer should be applied under the
edge of the nail.
These can be expected to reduce and sometimes cure the infection provided:

No more than 80% of the nail plate is infected

The growing part of the nail plate (the matrix) is not involved
There is no complicating internal disease (such as diabetes) or skin condition
(such as psoriasis)

Available preparations are:

The morpholine, amorolfine (Loceryl, Nail lacquer)

Ciclopirox (Nail Batrafen, )

OVERVIEW
Rat-bite fever (RBF) is an acute febrile illness that is usually accompanied by a skin rash.
Here are two recent cases of RBF; case 1, case 2, and case 3. RBF refers to two similar
diseases caused by different gram-negative facultative anaerobes: streptobacillary RBF
caused by infection with Streptobacillus moniliformis and spirillary RBF (also called
Sodoku) by Spirillum minus.
ETIOLOGY
Streptobacillus moniliformis, (gram negative rod= string of bead appearance)
Spirillum minus ( alternatively named Spirillum minor; gram negative spiral shaped
organism)

EPIDEMIOLOGY
RBF is rare in the United States. The most common cause of RBF in the U.S. is due to S.
moniliformis.
Most cases in the United States are caused by S. moniliformis acquired through rat bites
or scratches. Nasopharyngeal carriage rates in healthy laboratory rats range from 10% to
100%; carriage rates in wild rats range from 50% to 100%. It has been estimated that
10% of rat bites result in some form of RBF.
Cases of RBF also have been associated with the bites of mice, squirrels, and gerbils and
exposure to animals that prey on these rodents (e.g., cats and dogs)
Sporadic cases have been reported in children without histories of direct rodent contact
but who lived in rat-infested dwellings.
S. moniliformis can also be transmitted by contamination of food and water with rat feces
and/or urine. One rat produces 20-50 droppings per day and excretes 14 ml of urine per
day. Outbreaks of RBF in Haverhill, Mass. in 1926 and an epidemic in England in 1983
were associated with ingestion of raw milk contaminated by rat feces and/or urine. The
disease is called Haverhill fever when S. moniliformis is transmitted by drinking ratexcrement contaminated milk or water. S. minus is not transmitted by the ingestion of
contaminated food or water.
PATHOGENESIS
Rat bite
Minimal local inflammation, prompt healing, little lymphadenitis.
Bacteremia may occur with disseminated lesions appearing 1-3 days after the bite and
later becoming pyogenic (pus formation).
MANIFESTATIONS
Streptobacillary RBF caused by infection with S. moniliformis
Incubation period can range from 1 to 22 days, but onset usually occurs 2-10 days after
the bite of a rat.
The clinical syndrome is characterized by flu-like symptoms including irregularly
relapsing fever (101-104oF) accompanied by chills, vomiting and headaches, and
asymmetric polyarthritis generally affecting the large joints followed within 2 to 4 days
by a maculopapular rash on the extremities, palms and soles. The WBC count of those
suffering from streptobacillary RBF ranges between 6,000 and 30,000. VDRL tests
(syphilis serology) are false-positive in 25% of the cases

The wound from the bite heals spontaneously. Headache, nausea, vomiting, myalgia,
minimal regional lymphadenopathy, anemia, endocarditis, myocarditis, meningitis,
pneumonia, and focal abscesses have been reported. Although most cases resolve
spontaneously within 2 weeks, 13% of untreated cases are fatal.
Bacterial endocarditis, myocarditis, pericarditis and abscesses in the brain or other tissues
are rare but serious complications.
It is often confused with Rocky Mountain Spotted fever, infection with coxsackie B virus
and meningoccemia. RBF due to S. moniliformis can usually be differentiated from
spirillary RBF (Sodoku) clinically.
Spirillary RBF or Sodoku caused by infection with Spirillum minus.
Occurs worldwide, but is most common in Asia. This form of RBF is characterized by a
longer incubation period (4 to 28 days but usually longer than 10 days). The initial wound
may persist with edema and ulceration or may heal only to reappear at the onset of
symptoms. Sodoku is characterized by a recurrent fever (101-104oF). Cycles of fever
lasting from 2 to 4 days recur generally for 4 to 8 weeks but may continue for months.
These febrile cycles rarely last longer than one year. A roseolar-urticarial rash sometimes
develops. It is generally less prominent than the rash produced by S. moniliformis.
Arthritis is rare.
Regional lymphadenitis and lymphangitis with malaise, headaches, and enlargement of
the lymph nodes adjacent to the wound are also common. The WBC count ranges
between 5,000 and 30,000.
Sodoku may easily be confused with diseases characterized by relapsing fever such as
malaria, meningoccemia or Borrelia recurrentis infection especially if there is no history
of rodent bite. VDRL tests (syphilis serology) are false-positive in half the cases.
Complications may include endocarditis, myocarditis, hepatitis, splenomegaly, and
meningitis. If left untreated mortality results in 6% to 10% of the cases.
Haverhill fever
Clinically similar to streptobacillary RBF but is usually accompanied by more severe
gastrointestinal symptoms (nausea, abdominal pain, and/or vomiting) and pharyngitis.
DIAGNOSIS
S. moniliformis infection can be diagnosed by blood culture only. the organism is
characterized by strict growth requirements and slow growth, making it difficult for most
laboratories to culture. No serologic test is available for S. moniliformis; the previous
slide agglutination test is no longer available because of performance limitations.

S. minor infection is diagnosed by dark-field preparations of blood smears or tissue or

from exudates from lesions or adjacent lymph nodes where it exhibits darting motility.
Giemsa and Wright stains are most often used for staining. If this is unsuccessful, then
blood from inoculated mice is examined using dark-field microscopy (rarely done). No
specific serological test is available.
THERAPY
Penicillin is the drug of choice. Doxycycline or tetracycline may be given for penicillinallergic patients. Recommended treatment by the Center for Disease Control is
intravenous penicillin for 5-7 days followed by oral penicillin for 7 days. Other
antibiotics such as erythromycin, chloramphenicol, clindamycin and cephalosporins have
been used with success however the effectiveness of these agents has not been assessed
rigorously.
PREVENTION
Prompt cleaning of wounds with antiseptic solution, and reducing the risk of rat bites.
The effect of chemoprophylaxis following rodent bites or scratches on RBF is unknown.
No vaccines are available for these diseases.
Improve conditions to minimize rodent contact with humans is the best preventative
measure for RBF. Animal handlers, laboratory workers, sanitation and sewer workers
must take special precautions against exposure. Wild rodents, dead or alive, should not be
touched and pets must not be allowed to ingest rodents.
Those living in the inner cities where overcrowding and poor sanitation cause rodent
problems are at risk for RBF. Half of all cases reported are children under 12 living in
these conditions.