Tuberculosis and Rabies
Tuberculosis
Tuberculosis or TB (abbreviation which is now abandoned TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. This disease most commonly affects the lungs, although in a third case of attack other organs and is transmitted person to person. It's also one of the oldest diseases known to attack humans. If treated properly tuberculosis caused by Mycobacterium tuberculosis complex, which is sensitive to the drug, practically incurable. Without tuberculosis therapy will result in death within the first five years on more than half the cases.
In 1992 the WHO has declared tuberculosis a Global Emergency. WHO report in 2004 stated that there were 8.8 million new cases of tuberculosis in 2002, one third of world population has been infected with tuberculosis germs according to WHO regional and the largest number of these cases occurred in Southeast Asia that is 33% of all cases in the world.
Indonesia was ranked third worst in the world for the number of TB sufferers. Each year up 500 thousand new cases and more than 140 thousand others died. One hundred years ago, one in five deaths in the United States caused by tuberculosis.
Tuberculosis remains a disease most common respiratory tract infections in Indonesia. Delays in diagnosis and treatment of non-compliance in having a great impact because of tuberculosis patients will transmit the disease to the environment, so the number of sufferers is increasing.
Tuberculosis Treatment lasted long enough that at least 6 months of treatment and subsequently evaluated by a physician whether to continue or quit, because treatment is often long enough to make the patient seek treatment or drop out of treatment runs irregularly, both of these are fatal consequences of unsuccessful treatment and germ become immune called MDR (multi drugs resistance), this case requires the cost of multiple and more difficult in treatment so that patients are expected to seek treatment every discipline in time for the alleviation of tuberculosis in Indonesia
March 24 is celebrated the world as the "Tuberculosis Day" by reason on March 24, 1882 in Berlin, Germany, Robert Koch presented the results of a study on the causes of tuberculosis are found.
Cause
The cause of this disease is the bacterium Mycobacterium tuberculosis complex. Mycobacteria included in the family Mycobacteriaceae and included in the order Actinomycetales. Mycobacterium tuberculosis complex includes M. tuberculosis, M. bovis, M. africanum, M. microti, and M. canettii. From some of the complex, M. tuberculosis is the most important species and the most frequently encountered.
M.tuberculosis rod-shaped, measuring length and width of 3μ 5μ, does not form spores, and including aerobic bacteria. Staining of mycobacteria can be like other bacteria, such as by Gram stain. However, once the mycobacteria are colored by gram staining, the color can not be removed with acid. Therefore, it is referred to as Basil mycobacteria smear or smear. Several other microorganisms that also have acid-resistant properties, namely species of Nocardia, Rhodococcus, Legionella micdadei, and protozoa Isospora and Cryptosporidium. In mycobacteria cell wall, and fat associated with peptidoglycan arabinogalaktan underneath. This structure lowers the permeability of cell walls, thus reducing the effectiveness of antibiotics. Lipoarabinomannan, some other molecules in the cell wall of mycobacteria, a role in the interaction between host and pathogen, making M. tuberculosis can survive in the makrofaga.
Transmission
Transmission of this disease because of contact with sputum or inhaling water droplets from sneezing or coughing of infected persons tuberculosis germs, the children often get transmission from adults around the house or while in public facilities like public transport, hospitals and the environment around the house. Therefore these people in Indonesia need to be aware of when he was diagnosed with tuberculosis so careful when interacting with others in order not to cough at random, not carelessly discard saliva and is highly recommended to be willing to wear a mask or at least a handkerchief or tissue.
In fighting the spread of tuberculosis, especially in young children are still vulnerable his endurance, the government of Indonesia has entered Immunization Tuberculosis in children is referred to as BCG immunization as a priority one mandatory immunization program national along with 4 other types of mandatory immunization of hepatitis B, polio, DPT and measles, immunization schedule in the Schedule.
Clinical Overview
Diagnosis of tuberculosis can be established based on clinical symptoms, physical examination, bacteriological examination, radiological and other investigations
Clinical symptoms of tuberculosis can be divided into two categories, namely local symptoms and systemic symptoms, when the organ affected is the lungs then the local symptoms are symptoms of respiratory symptoms or symptoms that are closely related to the respiratory organs (the other being local symptoms according to according to the organ involved)
Respiratory symptoms of cough is more than 2 weeks, coughing with blood. Can also be chest pain and shortness of breath. Further symptoms are referred to as systemic symptoms including fever, body weakness which is called as malaise, night sweats, anorexia and weight loss becomes increasingly thin. Respiratory symptoms vary widely, ranging from no symptoms until the symptoms are quite severe depending on the lesion area, so on the condition whose symptoms are not clear so that new patients sometimes find themselves diagnosed with tuberculosis during medical check-ups.
Types
* Pulmonary Tuberculosis confirmed by bacteriological and histological
* Pulmonary Tuberculosis unconfirmed by bacteriological and histological
* Tuberculosis of nervous system
* Tuberculosis in other organs
* Tuberculosis millier
Rabies
Rabies is an acute infectious disease of the central nervous system caused by rabies virus. This disease is zoonotic, ie can be transmitted from animals to humans. The rabies virus is transmitted to humans through animal bites such as dog, cats, monkeys, raccoons, and bats. Rabies is also called hydrophobia.
Etymology
The word rabies comes from the ancient Sanskrit language meaning rabhas violence / crime. In Greek, called Lyssa or Lytaa rabies, which means madness. In German, called rabies tollwut derived from the language Indojerman Dhvar which means damage and wut that means angry. In French, rabies is called Rage robere derived from the noun which means to go crazy.
History
Rabies is not a new disease in the history of human civilization. A written record of the behavior of dogs that suddenly become wild are found in the Code of Mesopotamia, written 4000 years ago as well as the Babylonian Code Eshunna written in 2300 BC. in 500 BC Democritus also wrote the characteristic disease symptoms that resemble rabies.
Aristotle, in 400 BC, wrote in Natural History of Animals 8th edition, chapter 22
".... mad dog. This causes them to become aggressive and bite all the animals who are also experiencing the same pain. "
Hippocrates, Plutarch, Xenophon, Epimarcus, Virgil, Horace, and Ovid are the ones who never mentioned the characteristics of rabies in his writings. Celsius, a doctor in the Roman era, associate hidrofobia (fear of water) with dog bites, in the year 100 AD. Cardanus, a Roman writer explains the nature of the infection in saliva dog with rabies. At that time the Roman writer described rabies as a poison, which is the Latin word for the virus. Pliny and Ovid was the first to explain the causes other than rabies, which was then called the dog tongue worm (dog tongue worm). To prevent rabies in those days, the surface of the tongue are thought to contain 'worms' cut. The presumption is to survive until the 19th century, when Louis Pasteur finally succeeded in demonstrating the spread of rabies by growing the infected brain tissue in 1885 Goldwasser and Kissling rabies found in a modern way of diagnosis in 1958, with techniques for finding antibodies imunofluoresens rabies antigens in tissues.
Cause
Rabies is caused by rabies virus into the family Rhabdoviridae and genus Lysavirus. The main characteristics of the virus family Rhabdoviridae is to only have one thread that is not segmented RNA negative. The virus lives in several animal species that acts as an intermediary for transmission. an intermediary animal species vary at different geographical location. The animals are known to be a mediator of rabies include raccoons (Procyon lotor) and skunks (Memphitis memphitis) in North America, red foxes (Vulpes vulpes) in Europe, and the dogs in Africa, Asia, and Latin America. Africa, Asia, and Latin America have high levels of rabies are still high Animals infected intermediate host may be other animals or humans through bites. Infection can also occur through intermediaries animal licks on broken skin. After infection, the virus will enter through the nerves to the spinal cord and brain and replicate there. Furthermore, the virus will move back through the nerves to the non-neural tissues, such as salivary glands and into the saliva. Animals infected with rabies may develop savage / malignant or benign rabies / quiet. In the wild rabies / malignant, infected animals appear fierce, aggressive, biting and swallowing all kinds of stuff, kept dripping saliva, nervous howling and then become paralyzed and die. In rabies docile / quiet, the animals are infected through local paralysis or total paralysis, like to hide in dark places, having seizures and difficulty breathing, and show ferocity.
Although very rare, rabies can be transmitted through inhalation of contaminated air rabies virus. The two laboratory workers have confirmed this after they were exposed to air containing the rabies virus. In 1950, reported two cases of rabies occur in cave explorers in Frio Cave, Texas are breathing the air where there are millions of bats living in that place. They allegedly contracted through the air because it was not found at all the signs of bat bites.
Clinical Manifestations
Symptoms of rabies usually starts within 30-50 days after infection. The incubation period until the emergence of viral diseases in dogs is 10-14 days but can reach 9 months in humans When are caused by dog bites, wounds that have a high risk of infection include the mucosa, a cut above the shoulder area (head, face, neck), injury to the fingers or toes, sores on the genitals, wounds or in width, and a lot of injuries. While the low-risk wounds on the skin covering the wound licking, scratching or abrasions, and minor wound around the hands, body, and legs.
Pain symptoms will be experienced by someone who is infected with rabies include four stages:
Prodromal stage
In stage prodomal pain arising in patients with atypical, resemble viral infections in general, which include fever, trouble eating a level toward anorexia, headache and dizziness (nausea), and others.
Stadium sensory
In the sensory-stage patients will generally experience pain in the area of the bite, fever, nervousness, confusion, a lot of saliva out (hypersalivation), dilated pupils, hyperhidrosis, hiperlakrimasi.
Stadium excitation
At the excitation stage the patient became restless, easily startled, convulsions every stimulus from the outside so no place fear in the air (aerofobia), fear of light (photophobia), and fear of water (hidrofobia). Seizures are the result of disorders of the brain regions that regulate the process of swallowing and breathing. Hidrofobia that occurs in people with rabies, especially because of the tremendous pain at the time tried to swallow the water.
Stadium paralytic
In the paralytic stage after going through three stages before entering the stadium paralytic patient shows signs of paralysis of the upper body down progressive.
Because the duration of disease spread fast enough then the fourth stage of the above generally can not be distinguished clearly. The symptoms are evident in patients in whom the pain at the bite wound and the fear of water, air and light, and loud noises. While in the infected animals, gelaja that appears is from the benign to malignant, pets become wild and forgotten the way home, and the tail is curved in the lower abdomen.
Diagnosis
If someone is bitten by an animal, the animal bite should be watched. The only test that produces 100% accuracy for the presence of rabies virus is by direct fluorescent antibody test (direct fluorescent antibody test / DFAT) in brain tissue of infected animals. This test has been used for more than 40 years and used as the standard in the diagnosis of rabies. The principle is that the bond between rabies antigens and specific antibodies that have been labeled with a fluorescent compound that will fluoresce so as to facilitate detection However, the drawback is the test subject should first put to sleep (euthanasia) so it can not be used on humans . However, a similar test can still be made using the serum, spinal fluid, or saliva, although the patient did not give 100% accuracy.In addition, the diagnosis can also be done with the neck skin biopsy or corneal epithelial cells, although the results are not very precise so it will be done again after the post mortem diagnosis of animal or human is infected died.
Handling
When infected with rabies, seek immediate medical help. Rabies can be treated, but it should be done as early as possible before it infects the brain and cause symptoms. When the symptoms begin to appear, there is no treatment to cure this disease.Death typically occurs several days after the first symptoms.
In case of bites by animals suspected or potentially infected with rabies rabies (dogs, skunks, raccoons, foxes, bats) immediately wash the wound with soap or other fat solvent under running water for 10-15 minutes and give a 70% alcohol or an antiseptic betadin . Those who have not been immunized during the last 10 years will be given a tetanus shot. Those who have never received rabies vaccine will be given an injection of rabies immune globulin combined with the vaccine. Half of the dose injected in place of the bite and the other half was injected into muscle, usually in the waist area. In a period of 28 days given 5 injections. The first injection to determine the risk of bites caused by rabies virus. The remaining injections given on days 3, 7, 14, and 28. It sometimes happens pain, redness, swelling, or itching at vaccine injection site.
Prevention
Prevention of rabies in humans should be done as soon as possible after a bite by a potentially rabid animal, because if not can be deadly (lethal)
Measures to prevent rabies virus can be taken before or shortly after exposure to bites For example, vaccination can be given hello to people who are at high risk of contracting the virus, namely:
* Veterinarians.
* Officers who handle laboratory animals are infected.
* People who settled or lived more than 30 days in an area that rabies in dogs is found
* The bat cave explorers.
Vaccination should ideally be able to provide lifetime protection. But as time goes antibody levels would decrease, so that people at high risk of rabies should get a booster dose of vaccine every 3 years. The importance of rabies vaccinations to pets such as dogs is also one way of prevention must be considered.
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