Saturday, July 2, 2011

Jangkitan Penyakit Melioidosis and Leptospirosis (Air Kencing Tikus)

Posted at  9:07 PM  |  in  

Baru-baru ini jangkitan penyakit Melioidosis dan Leptospirosis (air kencing tikus), bagi pengunjung di kawasan perkelahan sungai di Pahang, semakin meruncing sehingga meragut beberapa nyawa.

Orang ramai mungkin tidak berapa tahu mengenai kedua-dua jenis penyakit berjangkit yang berbahaya ini, yang mana boleh menyebabkan kematian dalam tempoh yang singkat.

Berikut dipanjangkan artikel-artikel perubatan mengenai jangkitan kedua-dua penyakit berbahaya yang disebabkan oleh bakteria ini.

MELIOIDOSIS

~ By: Rebecca J. Frey

Melioidosis is an infectious disease of humans and animals caused by a gram-negative bacillus found in soil and water. It has both acute and chronic forms.

Description of Melioidosis

Melioidosis, which is sometimes called Pseudomonas pseudomallei infection, is endemic (occurring naturally and consistently) in Southeast Asia, Australia, and parts of Africa. It was rare in the United States prior to recent immigration from Southeast Asia. Melioidosis is presently a public health concern because it is most common in AIDS patients and intravenous drug users.

Causes and symptoms of Melioidosis

Melioidosis is caused by Pseudomonas pseudomallei, a bacillus that can cause disease in sheep, goats, pigs, horses, and other animals, as well as in humans. The organism enters the body through skin abrasions, burns, or wounds infected by contaminated soil; inhalation of dust; or by eating food contaminated with P. pseudomallei. Person-to-person transmission is unusual. Drug addicts acquire the disease from shared needles. The incubation period is two to three days.

Chronic melioidosis is characterized by osteomyelitis (inflammation of the bone) and pus-filled abscesses in the skin, lungs, or other organs. Acute melioidosis takes one of three forms: a localized skin infection that may spread to nearby lymph nodes; an infection of the lungs associated with high fever (102°F/38.9°C), headache, chest pain, and coughing; and septicemia (blood poisoning) characterized by disorientation, difficulty breathing, severe headache, and an eruption of pimples on the head or trunk. The third form is most common among drug addicts and may be rapidly fatal.

Diagnosis of Melioidosis

Melioidosis is usually suspected based on the patient’s history, especially travel, occupational exposure to infected animals, or a history of intravenous drug use. Diagnosis must then be confirmed through laboratory tests. P. pseudomallei can be cultured from samples of the patient’s sputum, blood, or tissue fluid from abscesses. Blood tests, including complement fixation (CF) tests and hemagglutination tests, also help to confirm the diagnosis. In acute infections, chest x rays and liver function tests are usually abnormal.

Treatment of Melioidosis<

Patients with mild or moderate infections are given a course of trimethoprim-sulfamethoxazole (TMP/SMX) and ceftazidime by mouth. Patients with acute melioidosis are given a lengthy course of ceftazidime followed by TMP/SMX. In patients with acute septicemia, a combination of antibiotics is administered intravenously, usually tetracycline, chloramphenicol, and TMP/SMX.

Prognosis of Melioidosis

The mortality rate in acute cases of pulmonary melioidosis is about 10%; the mortality rate for the septicemic form is significantly higher (slightly above 50%). The prognosis for recovery from mild infections is excellent.

Prevention of Melioidosis

There is no form of immunization for melioidosis. Prevention requires prompt cleansing of scrapes, burns, or other open wounds in areas where the disease is common and avoidance of needle sharing among drug addicts.

BOOKS

“Bacterial Diseases: Melioidosis.” In The Merck Manual of Diagnosis and Therapy. 16th ed. Ed. Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1992.

“Ceftazidime.” In Nurses Drug Guide 1995, ed. Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.

Pollock, Matthew. “Infections Due to Pseudomonas Species and Related Organisms.” In Harrison’s Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

“Trimethoprim-sulfamethoxazole.” In Nurses Drug Guide 1995, ed. Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.

LEPTOSPIROSIS

~ By: Belinda Rowland, PhD

Leptospirosis is a febrile disease (fever) caused by infection with the bacteria Leptospira interrogans. The disease can range from very mild and symptomless to a more serious, even life threatening form, that may be associated with kidney (renal) failure.

Description of Leptospirosis

An infection by the bacterium Leptospira interrogans goes by different names in different regions. Alternate names for leptospirosis include mud fever, swamp fever, sugar cane fever, and Fort Bragg fever. More severe cases of leptospirosis are called Weil’s syndrome or icterohemorrhagic fever. This disease is commonly found in tropical and subtropical climates but occurs worldwide.

As of the mid 1980s, there were 35-60 cases of leptospirosis reported in the United States each year. Most cases occur in Hawaii, followed by the south Atlantic, Gulf, and Pacific coastal states. However, because of the nonspecific symptoms of leptospirosis, it is believed that the occurrence in the United States is actually much higher. Leptospirosis occurs year-round in the United States, but about half of the cases occur between July and October.

Leptospirosis is a disease of animals and can be a very serious problem in the livestock industry. Leptospira bacteria have been found in dogs, rats, livestock, mice, voles, rabbits, hedgehogs, skunks, possums, frogs, fish, snakes, and certain birds and insects. Infected animals will pass the bacteria in their urine for months, or even years. In the United States, rats and dogs are more commonly linked with human leptospirosis than other animals.

Humans are considered “accidental hosts” and become infected with Leptospira interrogans by coming into contact with urine from infected animals. This is either through direct contact with urine, or through contact with soil, water, or plants that have been contaminated by animal urine. Leptospira interrogans can survive for as long as six months outdoors under favorable conditions. Leptospira bacteria can enter the body through cuts or other skin damage or through mucous membranes (such as the inside of the mouth and nose). It is believed that the bacteria may be able to pass through intact skin, but this is not known.

Once past the skin barrier, the bacteria enter the blood stream and rapidly spread throughout the body. The infection causes damage to the inner lining of blood vessels. The liver, kidneys, heart, lungs, central nervous system, and eyes may be affected.

There are two stages in the disease process. The first stage is during the active Leptospira infection and is called the “bacteremic,” or “septicemic,” phase. The bacteremic phase lasts from three to seven days and presents as typical flu-like symptoms. During this phase, bacteria can be found in the patient’s blood and cerebrospinal fluid. The second stage, or “immune phase,” occurs either immediately after the bacteremic stage or after a one to three day symptom-free period. The immune phase can last up to one month. During the immune phase, symptoms are milder but meningitis (inflammation of spinal cord and brain tissues) is common. Bacteria can be isolated only from the urine during this second phase.

Causes and symptoms of Leptospirosis

Leptospirosis is caused by an infection with the bacterium Leptospira interrogans. The bacteria are spread through contact with urine from infected animals. Persons at an increased risk for leptospirosis include farmers, miners, animal health care workers, fish farmers and processors, sewage and canal workers, cane harvesters, and soldiers. High risk activities include care of pets, hunting, trail biking, freshwater swimming, rafting, canoeing, kayaking, and participating in sports in muddy fields.

Symptoms of Leptospira infection occur within seven to 12 days following exposure to the bacteria. Because the symptoms can be nonspecific, most people who have antibodies to Leptospira do not remember having had an illness. Eighty-five to 90% of the cases are not serious and clear up on their own. Symptoms of the first stage of leptospirosis last three to seven days and are: fever (100-105°F [37.8-40.6°C]), severe headache, muscle pain, stomach pain, chills, nausea, vomiting, back pain, joint pain, neck stiffness, and extreme exhaustion. Cough and body rash sometimes occur.

Following the first stage of disease, a brief symptom-free period occurs for most patients. The symptoms of the second stage vary in each patient. Most patients have a low grade fever, headache, vomiting, and rash. Aseptic meningitis is common in the second stage, symptoms of which include headache and photosensitivity (sensitivity of the eye to light). Leptospira can affect the eyes and make them cloudy and yellow to orange colored. Vision may be blurred.

Ten percent of the persons infected with Leptospira develop a serious disease called Weil’s syndrome. The symptoms of Weil’s syndrome are more severe than those described above and there is no distinction between the first and second stages of disease. The hallmark of Weil’s syndrome is liver, kidney, and blood vessel disease. The signs of severe disease are apparent after three to seven days of illness. In addition to those listed above, symptoms of Weil’s syndrome include jaundice (yellow skin and eyes), decreased or no urine output, hypotension (low blood pressure), rash, anemia (decreased number of red blood cells), shock, and severe mental status changes. Red spots on the skin, “blood shot” eyes, and bloody sputum signal that blood vessel damage and hemorrhage have occurred.

Diagnosis of Leptospirosis

Leptospirosis can be diagnosed and treated by doctors who specialize in infectious diseases. During the bacteremic phase of the disease, the symptoms are relatively nonspecific. This often causes an initial misdiagnosis because many diseases have similar symptoms to leptospirosis. The later symptoms of jaundice and kidney failure together with the bacteremic phase symptoms suggest leptospirosis. Blood samples will be tested to look for antibodies to Leptospira interrogans. Blood samples taken over a period of a few days would show an increase in the number of antibodies. Isolating Leptospira bacteria from blood, cerebrospinal fluid (performed by spinal tap), and urine samples is diagnostic of leptospirosis. It make take six weeks for Leptospira to grow in laboratory media. Most insurance companies would cover the diagnosis and treatment of this infection.

Treatment of Leptospirosis

Leptospirosis is treated with antibiotics, penicillin (Bicillin, Wycillin), doxycycline (Monodox), ibramycin, or erythromycin (E-mycin, Ery-Tab). As of early 1998, the timing of antibiotic treatment is controversial. It is generally agreed that antibiotic treatment during the first few days of illness is helpful. However, leptospirosis is often not diagnosed until the later stages of illness. The benefit of antibiotic treatment in the later stages of disease is controversial. A rare complication of antibiotic therapy for leptospirosis is the occurrence of the Jarisch-Herxheimer reaction, which is characterized by fever, chills, headache, and muscle pain.

Patients with severe illness will require hospitalization for treatment and monitoring. Medication or other treatment for pain, fever, vomiting, fluid loss, bleeding, mental changes, and low blood pressure may be provided. Patients with kidney failure will require hemodialysis to remove waste products from the blood.

Prognosis of Leptospirosis

The majority of patients infected with Leptospira interrogans experience a complete recovery. Ten percent of the patients will develop eye inflammation (uveitis) up to one year after the illness. In the United States, about one out of every 100 patients will die from leptospirosis. Death is usually caused by kidney failure, but has also been caused by myocarditis (inflammation of heart tissue), septic shock (reduced blood flow to the organs because of the bacterial infection), organ failure, and/or poorly functioning lungs.

Prevention of Leptospirosis

Persons who are at an extremely high risk (such as soldiers who are training in wetlands) can be pretreated with 200 mg of doxycycline once a week. As of early 1998, there were no vaccines available to prevent leptospirosis.

There are many ways to decrease the chances of being infected by Leptospira. These include:

* avoid swimming or wading in freshwater ponds and slowly moving streams, especially those located near farms.
* do not conduct canoe or kayak capsizing drills in freshwater ponds. Use a swimming pool instead.
* boil or chemically treat pond or stream water before drinking it or cooking with it.
* control rats and mice around the home.
* have pets and farm animals vaccinated against Leptospira.
* wear protective clothing (gloves, boots, long pants, and long-sleeved shirts) when working with wet soil or plants

BOOKS

Cook, G. C. Manson’s Tropical Diseases. 20th ed. London: W. B. Saunders Co., 1996.

Gorbach, Samuel L., John G. Bartlett, and Neil R. Blacklow. Infectious Diseases. 2nd ed. Philadelphia: W. B. Saunders Co., 1998.
PERIODICALS

Farr, R. Wesley. “Leptospirosis.” Clinical Infectious Diseases 21 (1995): 1-8.

OTHER

Centers for Disease Control. 20 Apr. 1998 .

Mayo Clinic Online. 5 Mar. 1998 .

10 mangsa Lubuk Yu sah dijangkiti Meliodosis dan Leptospirosis
2010/07/23

KUANTAN: Jabatan Kesihatan Pahang mengesahkan bahawa 10 daripada 19 mangsa yang terbabit dalam operasi mencari dan menyelamat seorang mangsa lemas di Hutan Lipur, Lubuk Yu, dekat Maran, bulan lepas, dijangkiti bakteria ‘melioidosis’ dan ‘leptospirosis’.

Perkara itu dinyatakan oleh Pengerusi Jawatankuasa Kesihatan Negeri, Datuk Hoh Khai Mun yang menerima menerima keputusan ujian sampel darah mangsa semalam.

Katanya, enam mangsa disahkan dijangkit bakteria melioidosis manakala empat lagi dijangkiti oleh kedua-dua bakteria tersebut dan sembilan lain bebas dari jangkitan itu.

Menurutnya, sampel darah diambil terhadap mangsa dan juga enam penduduk kampung yang meninggal dunia dalam tempoh seminggu selepas operasi itu bermulai 26 Jun hingga 30 Jun lalu.

Bakteria melioidosis disebabkan air dan tanah manakala leptospirosis pula ialah virus air kencing tikus.

“Sehingga kini jumlah mangsa yang masih menerima rawatan adalah enam orang iaitu tiga di Hospital Sultan Haji Ahmad Shah Temerloh, dua di Hospital Jengka dan seorang di Hospital Selayang, Selangor,” katanya selepas melancarkan Kempen Tanpa Beg Plastik Peringkat Pahang di sini hari ini.

Menurut Hoh, pihaknya mengesyaki kira-kira 148 orang mengalami simpton jangkitan tersebut berbanding 83 orang sebelum ini.

“Namun mereka hanya disyaki mengalami simpton seperti demam, batuk dan pening,” katanya.

Pada 10 Julai lalu, kawasan perkelahan Lubuk Yu diarahkan ditutup serta- merta selepas enam orang maut manakala 83 orang pula dijangkiti bakteria leptospirosis.

Semalam, seramai 52 kakitangan dan pegawai daripada beberapa agensi kerajaan mula membersihkan kawasan itu bagi memastikannya bebas daripada virus itu.

-Bernama

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