Presentation on theme: "CURICULUM VITAE Job Description (History) :"— Presentation transcript:
1 CURICULUM VITAE Job Description (History) : Name :Suharyo Hadisaputro, Prof.Dr.dr..Sp.PD-KPTI, FINASIBorne : Juana, March 10 , 1945;Position : Professor in Medicine Medical Faculty Diponeoro UnivEducation : Doctoral in Medical (Public Helath),1990;Cosultan of Tropical Infectious Disease, 1986;Internal Medicine Spesialist, 1981;Medical Doctor, 1972;Job Description (History) :Chief I of Researcher Tropical Infectious Disease Jkt;Chief of Researcher Tropical Infectious Disease SemgChief of Program of Doctoral Medical & Health Undip.Chief Program of Magister Epidemiologiy Undip.Director of Postgraduate Program Diponegoro Univ;Interest of Science :Field and Clinical EpidemiologyTropical I nfectious Disease;Epidemiology of Communicable Disease;Epidemiologiy of Non Communicable Disease;Epidemiology of Iodine Disorder Deficiency
2 (Food & Water Borne Disease) INFECTIOUS DIARRHEA(Food & Water Borne Disease)Suharyo HadisaputroInternational Seminar of Food and Water Borne DiseaseSeptember 17, in Semarang, Indonesia
5 FACTORS INFLUENCED TO INCREASED OF INFECTIOUS DISEASES IN INDONESIA (1) Economic Development, Changed of Demografic and Life Style in Community;(2) Development of Transportation Increased of Traveller inter-region, island, and city in Indonesia.(3) Environmental changed Disaster in many areas in Indonesia, and many projects irigations ?(4) Limitation of manpower and health sevices in community;Non hygiene of foodhandling transmission of bacteriae (Salmonella typhi);Mutation and Evolution of organism new strain emerge and antibiotics resistancy.
6 EMERGING INFECTIOUS DISEASES IN INDONESIA Vector borne Disease : (1) DF/DHF (2) Chikungunya (3) Japanese Encephalitis (4) Malaria (5) Filariasis (6) Leptospirosis (7) Toxoplasmosis;Sexual Transmitted Disease (STD);Airborne Disease : (1) Tuberculosis (2) Influenza.Food and Water borne Disease : (1) Typhoid Fever (2) Diarrhoae.
7 FOOD AND WATER BORNE DISEASES. (1) TYPHOID DAN SALMONELLOSIS : The sanitary factor and hygienic food and water take was responsibility on the increase of the morbidity of typhoid fever.DIARRHOEA : Many causes of diarrhoea, and the strain of Cholera Vibrio O 139 from Bangladesh was a potentially factor to increase the case of diarrhoea in Indonesia.
8 Causes of Death Worldwide Pneumonia8.5%Diarrhea5.8%TB3.9%Measles2.1%• Infections %• Ischemic Heart Disease %Malaria1.7%Tetanus1.1%Pertussis0.7%HIV0.6%2468PercentLancet 1997;349:1269
10 TEN MAIN DISEASES OF CAUSED OF DEATH IN INDONESIA
11 Risks in 3rd World Lack of safe water supply Contaminated foods Poor sanitationOvercrowdingMalnutrition
12 Global Risks in the World Traveller DiarrhoeaHIV infection & immunosuppressionDay Care Centers: fomite spreadAlso affects staff, household contactsNursing Home/Chronic Care FacilitiesAntibioticsAchlorhydria/H2 blocker
13 Factors in Emergencies Lack of safe, clean water supplyContamination of food supplyPoor sanitationOvercrowdingMalnutritionHIV infection & immunosuppression
14 Overall Significance One of most common diseases in world 3-5 billion cases of acute infectious diarrhea annuallyKills 5-10 million people/yearIn the U.S., more than 8 million seek medical attention for diarrhea; costs $23 billion in medical expenses & lost wages
15 DIARRHEADiarrhea is a common symptom that can range in severity from an acute, self-limited annoyance to a severe, life-threatening illness. Patients may use the term "diarrhea" to refer to increased frequency of bowel movements, increased stool liquidity, a sense of fecal urgency, or fecal incontinence
17 Definition διάρροια; literally meaning "through-flowing" Stool looses its normal consistenceWeight usually increases: >235g/d (♂), >175g/d (♀)Frequency increases: >2/dOften associated with imperative urge to defecateCan contain blood, pus and mucous
18 DefinitionIn the normal state, approximately 10 L of fluid enter the duodenum daily, of which all but 1.5 L are absorbed by the small intestine. The colon absorbs most of the remaining fluid, with only 100 mL lost in the stool. From a medical standpoint, diarrhea is defined as a stool weight of more than 250 g/24 h
19 Input Absorption Fecal Water 100-200 mL/d Diet/Saliva : 3 L/d Stomach : 2 LJejunum : 5 L/dBile : 1 LPancreas : 2 LBowel : 1 LIleum : 2-3 LColon : 1-2 LTotal LTotal LFecal Water mL/dThus, diarrhea is defined as >200 mL liquid excretion per day. In extremus,the gastrointestinal tract can both absorb and secrete 20 L of water per day.
20 ACUTE DIARRHEADiarrhea that is acute in onset and persists for less than 3 weeks is most commonly caused by infectious agents, bacterial toxins (either ingested preformed in food or produced in the gut), or drugs
22 Toxicogenic/Secretory Other classifacationViralProtozoanCMV, Rota, adeno, enterovirus, NorwalkGiardia, Amy the Ameba, Cryptosporidium“Invasive”Toxicogenic/SecretoryE. Coli 0157:H7, ShigellaSalmonella, Vibrios, Campy Low-Backed Her,Staph, noninvasive E. Coli, Be Serious, C. Difficile, Cholera*lumps together invasive, inflammatory, non-amebic dysenteries, etc.
23 Pathogenesis Stimulation of net fluid secretion Mucosal destruction with increased permeabilityNutrient malabsorptionIncreased propulsive contraction
26 Vibrio Cholera Spread in water, undercooked seafood Secretion of fluid in small intestineMalabsorption of fluid in large intestineRice water stools—large volume, high electrolyte contentMore info: Cholera
27 Shigella Spread by contaminated food, water Bloody diarrhea characteristicFever commonSome carriers asmptomatic; symptoms usually occur in 2-3 daysMore info: Shigella
28 ETEC (Enterotoxigenic EC) Major cause of diarrhea in developing countries & travelersTwo toxins, one cholera-likeCauses watery diarrhea, nausea, cramps, low-grade feverRx: TMP-SMX or Bismuth salicylateMore info: ETEC
29 EHEC (Enterohaemorrhagic EC) Toxin from undercooked food, especially beefMay be mild or asx, but fever, severe cramps & bloody diarrhea commonCause of hemolytic uremic syndromeMore info: EHEC-O157
30 C. difficileAntibiotics facilitate overgrowth of normal bowel inhabitantWatery diarrhea +/- blood, cramps, feverTreatment: oral vancomycin or FlagylMore info: C. difficile
31 Invasive Bacteria EIEC (enteroinvasive E. coli) Salmonella CampbylobacterYersinia
32 Enteroinvasive E. coliSymptoms mimic Shigella: bloody diarrhea, fever, crampsThought to be spread by food contaminationTherapy supportive, usually self-limited without requiring antibioticsMore info: EIEC
33 Salmonella Contaminates raw eggs, dairy products, poultry, other meats Fever, diarrhea, +/- vomiting, can enter bloodstreamMore common in children, in summerMore info: Salmonella
34 Enteric FeverA severe systemic illness manifested initially by prolonged high fevers, prostration, confusion, respiratory symptoms followed by abdominal tenderness, diarrhea, and a rash is due to infection with Salmonella typhi or Salmonella paratyphi, which causes bacteremia and multiorgan dysfunction
35 Campylobacter Spread by contaminated water or raw milk Causes patchy destruction of walls of small and large intestinesDiarrhea +/- blood, fever, vomiting, HA, abd painMore info: Campylobacter
36 Yersinia Contaminates dairy products, poultry, & other meat Multiple syndromes, including sepsis in immunosuppressed; appendicitis-like; fever/diarrhea/abd pain in children; & extra-intestinal infectionsMore info: Yersinia
39 Entamoeba histolytica Diarrhea, oftenBloody, fever, abdcrampsOnset usually 2-4wks, range days-mosTreat w/ FlagylMore info: Amoeba
40 Cryptosporidium Watery diarrhea, emesis, cramps, fever Transmitted in water or fecal-oralMore pathogenic in immunosupressed, especially AIDSBest treatment is restoring immune fn, (e.g., several drugs for HIV), azithromycin shows some efficacyMore info: Cryptosporidium
42 Rotavirus Epidemiology Most common cause of acute gastro-enteritis in children worldwideInfects almost all children by age 4Kills nearly one million annuallyFecal-oral transmission, lasts for days on toys & countertopsMore common in winter
43 Rotavirus features Ranges from asymptomatic to severe 3-9 days’ fever, abd. pain, diarrheaWheel-shaped RNA virus, seen in stool on EM, or diagnosed by ELISAPrevent w/ handwashing & hygieneRx severe cases w/ ORS or IV fluidsMore info: Rotavirus
44 CalcivirusesKnown as Norwalk-like viruses—small, single-stranded RNA virusesAssociated with ingestion of raw shellfish, fecal-oral transmissionCause diarrhea, vomiting, fever, headache
45 DIAGNOSTIC APPROACH Often based on clinical grounds alone Diagnostic studies often unavailableSymptoms often resolve, or require prompt treatment, before results can be obtainedClinical features that may be helpful include exposure/risk factors; stool volume, presence of blood, associated symptoms
46 DIAGNOSTIC STUDIES If available, may include: Fecal leukocytes Stool cultureOva and parasitesC. difficile titerAmoeba titers
47 MANAGEMENT OF DIARRHOAE Treatment often empiricOral rehydration therapy (ORT)IV hydrationAnti-diarrheals: anti-motility, absorbent, and anti-secretory agentsAntibiotics
48 Oral Rehydration Safe, simple, cheap 1st use: Bangladesh, 1971—dramatic reduction in mortalityPremix, or use H2O, salt, sugarTreats and prevents diarrheaSodium-glucose co-transportMothers can administer ORT
49 Oral RehydrationGlucose-based ORT may paradoxically increase fecal fluid lossRice-based ORT may more quickly relieve symptoms, ? More availableHigh amylose maize (amylase-resistant) based ORT shortens diarrhea duration and reduces stool volume
50 Indications for IV hydration Severe dehydration (hypotension, shock, stupor, coma)Ileus—abd distention a/o absent BSPersistent severe vomitingExcessive stool output (10cc/kg/hr)Severe glucose malabsorption
51 More on IV hydrationReplace fluid deficit as well as continuing lossesTransition to ORT as soon as dehydration improves and/or gut seems to be working again
52 Antimotility AgentsIncrease segmental & decrease propulsive contractionsProlong transit timeLoperamide better than diphenoxylate in clinical trialsOpiates have similar effect on motilityLimit to 48 hours; may prolong illness & can cause ileus or toxic megacolon
53 Absorbent agents Nonabsorbable resins, e.g. cholestyramine Bind C. difficile toxinSpeed toxin clearance, promote mucosal recovery—for multiple pathogensStop 5 days after symptoms resolve
55 Antibiotics in Diarrhoae Not indicated for most cases of simple, watery diarrheaMost helpful for:Shigella, ETEC, ameobiasis, giardia, cholera, S. typhiMay help for cryptosporidium, other salmonellaNot useful for viral, EIEC
56 Special treatment of cholera Oral Rehydration TherapyAntibioticsLimit spread of disease by reducing volume & duration of diarrheaAdults: Doxycycline, 300 mg onceChildren: 6 mg/kg onceAlternatives: TTC, Chloramphenicol, Septra, quinolones, erythromycin
57 CONTROL OF ENTERIC FEVER Applying the principle of hygieneDepend of the improvement of incomeCultural changes of personal hygieneMany effort for control of TF, are :(1) Treatment and control of sources infection : Adequate antibiotic treatment for active patients and carriers, special isolation in the hospital ?, desinfections of the excreta, sterilization of the patient’s linen etc.
58 CONTROL OF ENTERIC FEVER (2) Improved on environment health. To trace the source infection. To investigate of routes transmis. Water purification/chlorination. Control of all exposed foods forsale in the market and store.. Reduction the house-flies density. To avoid of having open garbagepail etc.
59 CONTROL OF ENTERIC FEVER (3) Supervision on food industries and restaurant. Supervision on sanitation of places work andfood processin, equipment etc.. Prohibition to employ people who infected. Routine examination of stool culture. To trace of food, if as medium suspected. All milk and milk products should bepasteurized or boiled.
60 CONTROL OF ENTERIC FEVER (4) Control of healthy population. Supervision on hygiene of food anddrink. Serving the food in hot condition. Health education for community. Providing the places for washing hand. Conducting vaccination of EF in endemicarea, however, improvement ofsanitation and health system is veryimportant role.
61 THE WHO GOLDEN RULES FOR SAVE FOOD PREPARATION Choose foods processing for safety.Cook food thoroughly.Eat cooked food immediately.Store cooked food thoroughly.Reheat cooked food thoroughly.Avoid contact between raw and cooked foods.Wash hands repeately.Keep all kitchen surfaces meticolously clean.Protect foods from insects, rodents & animals.Use pure water.
62 LEVEL OF PREVENTION NO DISEASE ASYMPTOMATIC DISEASE CLINICAL COURSE ORDINARY DETECTIONONSETNO DISEASEASYMPTOMATIC DISEASECLINICAL COURSEPREMORDUnderlying risk factorsPRIMARYRemove of risk factorsSECONDARYEarly detec-tion & prompt treatmentTERTIARYReduce complications
63 SUMMARY OF DIARRHEA CONTROL Diarrheal disease most prevalent in developing countries, and costly.In Indonesia incidence still high.Transmission most of direct route.Empiric treatment with ORT most often effectiveThe strategies of Diarrhea Control
64 SUMMARY OF DIARRHAE CONTROL The strategies of Diarrhea Control are :. Detection and control of source,. Disease surveillance,. Health education in community,. Improvement of hygiene sanitation,. Promotion of water and food borne disease,. Prevention contamination in food/water production,. Conducting vaccination ??.