mdnh.

Natasya Hayatillah
Learning Objective-Report 1418011146

Scenario II
Modul IV Agromedicine : ZOONOTIC DISEASE
SCENARIO II
 Learning Objective

1. What actually doctor could get from lab.exam? (interpretation)

2. What are signs and symptoms for insect bite and poisonous snake bites,
treatment and management?
3. Anthrax disease (pathogenesis, pathophysiology, comprehensive management)?
 1. What actually doctor could get from lab.exam? (interpretation)

Sumber : jurnal PENGENDALIAN PENYAKIT ANTRAKS: DIAGNOSIS, VAKSINASI DAN INVESTIGASI

 Poisonous Snakes Bites

ELAPIDAE VIPERIDAE COLUBRIDAE

short fixed front
(proteroglyph) fangs
long fangs (solenoglyph) Short fixed fangs geraham
which are normally folded flat belakang
against the upper jaw but,
when the snake strikes, they
are erected

cobras, king cobra, kraits, Ular tanah, ular bandotan Ular pohon
coral snakes, Australasian puspo
snakes and sea snakes.

Sumber : Guideline for management snakes bite WHO SEARO, 2010. IPD penatalaksanaan gigitan ular berbisa
 Clinical sign and symptom poisonous snakes bites
vary according to the species of snake responsible for the bite and the amount of venom injected.

LOCAL SYSTEMIC
General Cardiovascular
(Viperidae) Bleeding and
Nausea clotting disorders
Visual disturbances
Fang marks Vomiting (Viperidae)
Local Dizziness
Malaise
bleeding Faintness Traumaric
blistering Abd pain
Collapse bleeding from
Weakness
Shock bites
Drowsiness
Hypotension Spontaneus
Prostration.
cardiac arrhythmias systemic
pulmonary oedema bleeding
necrotic
Neurological chemosis
(Elapidae,
Local pain, bruising,
Russells viper)
lyphangitis proximal,
inflamation, local infection,
abses formation
Clinical syndromes
of snake-bite in
South-East Asia
(not including West
Papua and Maluku
Islands)
Clinical syndromes
of snake-bite in
South-East Asia
(not including West
Papua and Maluku
Islands)
 Detailed clinical assessment and species
diagnosis poisonous snake bites
In what part of your body have you been bitten?
When and under what circumstances were you bitten?
History taking Where is the snake that bit you?
How are you feeling now?

Physical examination

Examination of the
bitten part

General examination

Neurotoxic envenoming:
Bulbar and respiratory
paralysis
Investigations/laboratory tests

1. 20-minute whole blood clotting test (20WBCT)

2. Other tests
Haemoglobin concentration/haematocrit
Platelet count
White blood cell count : Earlt neutropyl leukositosis
Arterial blood gasses and PH : finger oximeter
Biochem abnormalities :
Antivenom treatment

Snakes : Naja sputatrix, (cobra)

Bungarus fasciatus (belang) ,
Agkistrodon rhodostoma (hemotoksik
: tanah)

2 vial @ 5 mL cairan infus dengan

kecepatan 40-80 tetes/ menit, diulang
6 jam kemudian.

Rp. +- 500k/vial
 Poisonous Insect bites
Laba-laba petapa : Necrosis Arachnidism

Mengandung esterase,
phospatase alkalin protease,
Dan enzim yang sebabkan
nekrosis

Treatment :
1. Bersihkan luka, balut dg balut streril, kompres dingin
2. Bila ada indikasi : analgetik, antihistamin, antibiotik
3. 48-72 jam pertama : dapson 50-100 mg 2x/hari
inhibitor leukosit cegah nekrosis
4. Debridement skin grafting

Sumber : IPD , Sengatan serangga

 Hymenoptera sting
Toxin polipeptide (melitin destruct
membran cell histamin release : apamine
(neurotoksik). Release hyalurodinase
enzyme major venom allrgen.
Iocal inflamation in hours
Multiple sting nausea, vomit, edem
general, dispneu, hypotension, dan
syncope severe : renal failure
Death : 300-500 stings
Treatment :
1. Bersihkan, dg disinfektan
2. Compress with ice
3. Give lotio kalamin topically
4. Glukokortiokoid if broad rection happen
 3. Anthrax disease (pathogenesis, pathophysiology,
comprehensive management)?
pathogenesis 12 hour-19 days

Sumber : CDC anthrax

 Sumber : Jurnal Anthrax Pathogenesis 2015
pathogenesis
pathophysiology

The protective antigen is an 83-kd protein that binds to cell receptors within a target
Role of
tissue. Once it is bound, a fragment is cleaved free to expose an additional binding
Protective
site. The binding of edema factor at this site results in the formation of edema toxin;
antigen
the binding of lethal factor results in the formation of lethal toxin.

Edema toxin acts by converting adenosine triphosphate (ATP) to cyclic adenosine

edema monophosphate (cAMP). Cellular cAMP levels are increased, leading to cellular
edema within the target tissue.

Lethal factor is not well understood; it may inhibit neutrophil phagocytosis, lyse
Necrotic, death macrophages, and cause release of tumor necrosis factor and interleukin-1. Death
from anthrax occurs as a result of the effects of lethal toxin. Near death or just after
death, animals bleed from all body orifices.
 comprehensive management of anthrax

VACCINATION

Pengobatan hewan : Antibiotik IM

Isolasi hewan

Vaksinasi hewan : daerah

kejadian, daerah terancam 1, dan
2

Desinfeksi lingkungan

Pengawasan lalu-lintas hewan

Pemotongan hewan ternak dari daerah anthrax

Penanganan bangkai

Pegawasan, pemantauan dan pelaporan Sumber : jurnal Bacillus anthracis 2003, Pedoman pengendalian dan pemberantasan penyakit hewan
menular (phm) series penyakit anthrax KEMNTAN
ANTIBIOTIC TREATMENT

For mild cases of cutaneous anthrax

ciprofloxacillin (500 mg twice daily), doxycycline (100 mg twice daily), or amoxicillin (500 mg three times
daily) is recommended