KULIAH

REGULER
2015
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 ZOONOSIS
Prof. Dr. dr. Prasetyowati S, SpKK (K)

Department of dermatovenereology
Faculty of medicine, Diponegoro University

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● Zoonosis : skin disease caused by
various parasites
● This disease is often found in :
o Crowded areas
o Low socio-economic condition
o Poor sanitation and hygiene
● In the eradication effort, these attempts
are needed:
◦ Early diagnosis and prompt treatment
◦ Public health education about :
- Prevention
- Proper hygiene
- Reservoir-host-vector control
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 The causes of this disease are divided into
3 major groups :

1. PROTOZOA : - Amoebiasis
- Trichomoniasis

2. NEMATODA : - Oxyuriasis / enterobiasis

- “Ground itch”
- Cutaneous larva migrans
- Current larva
- Filariasis
- Dracunculiasis

3. ARTROPODA : - Scabies
- Pediculosis 4
● Causative agent : Entamoeba histolytica

● The amoeba may affect the skin through

these mechanisms :

1. Direct invasion of intestinal amoeba on the

surrounding skin

2. directly from hepatic abscess

3. Direct implantation of trophozoit on skin

with / without lesion
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● Clinical manifestation :
- Ulcer : well-defined border,
erythema on the surrounding skin,
base → necrotic & purulent
- Destruction
→ muscles and bones

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● Diagnosis :
– Material → scrapes and biopsy taken from
the edge of the ulcer, including
the base of ulcer, necrotic border,
& some surrounding skin
– Microscopic → motile trophozoit

● Treatment :
– Metronidazole :
3 x 750 mg / day → 10 days
– Dihydroemetin :
1,5 mg/kgBW/day IM → 10 days
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● Causative agent : Trichomonas vaginalis

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● Transmission : sexual contact.

● Clinical manifestation :
- Vaginal discharge → seropurulent,
yellow / greenish yellow,
foul-smelling & fizzy.
- Vulva → pruritus, irritant dermatitis.
- Strawberry appearance → the vaginal wall is
red and swollen.
- Infected men : are asymptomatic.
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T. vaginalis infection : “strawberry” appearance of
cervix with punctate bleeding erosions
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● Diagnosis : vaginal discharge / urine + NaCl
→ microscopic
→ movement of T.vaginalis

● Treatment :
- Metronidazole 3 x 250 mg → 7 – 10 days
- Metronidazole single dose 2 gr

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● Causative agent : Enterobius vermicularis

● Often affects children aged 5 – 14 years old.

● The transmission is through :

- food / beverage
- egg-infested hands

● Clinical manifestation :
- Perianal/perineal pruritus, especially at night
- Perineal intertrigo → excoriation &
superinfection 12
● Diagnosis : Worm (+) or egg (+), obtained
through the “scotch tape” method.

● Treatment :
- Mebendazole : 100 mg, SD
- Piperazine citrate : 65 mg/kgBW/day,
max. 2 gr → 7 days
- Thiabendazole 25 mg / kgBW / day 13
● Causative agent : Necator americanus &
Ancylostoma duodenale

● Pathogenesis : penetration of filariform larvae

→ plantar skin → blood circulation

● Clinical manifestation :
- Skin lesion : maculae, papule, vesicle, bulae,
sometimes urticaria and oedema.
- 2 weeks → self-limiting, except in the events
of secondary infections. 14
● Diagnosis : microscopic → egg (+)

● Treatment :
○ Secondary infection on the skin → AB
○ Intestinal infection :
- Mebendazole 2 x 100 mg/day → 3 days
- Albendazole 200 mg/day → 3 days

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● Causative agent : Ancylostoma braziliensis,
Ancylostoma caninum, &
Uncinaria stenocephala

● Mostly affects children, miners and farmers.

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 Pathogenesis :
Adult hookworm in dogs’ / cats’ small intestines
↓
Eggs (in animal faeces)
↓
Rhabditiform larvae (soil)
↓
Filariform larvae (soil)
↓ penetrate
The skin
↓
“Creeping eruption” 17
Clinical features :

- Common locations are on the buttocks,

feet, & hands.

- The diameter of the lesion is 1 – 4 mm,

red in color, a bit raised,
like a coiled thread.
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Typical track of CLM located on plantar aspect of foot.19
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Vesiculobullous lesion of CLM.
● Diagnosis : typical lesion manifestation

● Treatment :
○ Topical :
- Classic : Chlorethyl spray, CO2, liquid N2
- Thiabendazole 10%
- Albendazole 2%
○ Systemic :
- Thiabendazole 25 mg/kgBW/day → 2 days
- Albendazole 50 mg/kgBW/once a week 21
● Causative agent :
Strongyloides
stercoralis

● Method of
transmission :
autoinfection
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● Clinical features :
- Lesion → urtica ribbon, quickly lengthening,
10 cm / hour

● Location : anus, spreading to the buttocks,

abdomen, or thighs.
● Diagnosis :
- Typical lesion
- Larva in the feces (microscopic)

● Treatment :
- Thiabendazole 25 mg/kgBW/day → 5 days
- Albendazole / Mebendazole 23
● Causative agent : Wuchereria bancrofti
Brugia malayi

● Vector : anopheles, culex, aedes, & mansonia

mosquitos.

● Method of transmission :
Wuchereria bancrofti (adult form)
↓ lymphatic glands
Microfilaria (peripheral lymphatic glands /
blood vessels)
↓
Mosquito (infective)
↓
Human
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● Clinical features :

1. Asymptomatic stage :
- Incubation period 8 – 12 months
- Lab : microfilaria in the blood,
eosinophilia

2. Acute inflammation stage :

- Lymphangitis on the extremities/scrotum,
pain, rigid, glossy skin, heat.
- Lymphadenitis
- Orchitis, funiculitis, epididimitis
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● Clinical features :
3. Chronic obstructive stage :
- Repetitive inflammations & fibrosis of the
lymphatic glands → obstruction
- Obstruction → disturbance of the
lymphatic drainage → liquid accumulation
in the tissue and lymphatic glands →
progressive in nature due to repetitive
inflammations.
– Manifestations : varicose lymph &
lymphedema
– Chronic edema → connective tissues →
deformity & elephantiasis 26
 Lymphatic elephantiasis secondary
● Diagnosis : to Wuchereria bancrofti

- Examination of the
peripheral blood vessels
at night-time →
microfilaria
- Examination of the
hydrocele’s liquid or
urine

● Treatment :
Diethylcarbamazine
2 mg/kgBW/day → 3 weeks
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● Causative agent : Dracunculus medinensis

● Intermediate host :
Crustacea species from the Cyclops genus

Consumption of Cyclops-infested
water / beverage
↓
Intestinal walls & retroperitoneal tissues
(adult worms)
↓
Sub-cutaneous tissues (body part that has
contact with the water / feet)
↓
Larvae 28
Clinical features :
Erythema, urticaria, itch, several hours →
papule → vesicle → bullae →
erosion / ulceration

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● Diagnosis :
Radiology examination →
calcification of the dead worms

● Treatment :
- Thiabendazole 50–100 mg/kgBW → 2 days
- Metronidazole 30–40 mg/kgBW/day → 3 days

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● Method of transmission :
- Direct → handshake, sexual contact
- Indirect → through objects

● Etiology : Sarcoptes scabiei var hominis

Life cycle : Female mites in stratum corneum

↓
Eggs
↓ 3–4 days
Larvae 10–14
↓ days
Mites
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Clinical features :

- Predilection : in-between fingers,

flexor of the wrists,
genitalia, axillae folds,
lower abdomen, buttocks.

- Lesion → papule, vesicle,

excoriation/secondary infection,
sometimes forming burrows.
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Clinical variations :
 “Incognito” scabies
 Scabies in infants &
children
 Noduler scabies
 Scabies transmitted
by animals
 Scabies “in a clean”
 Norwegian scabies
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● Additional examinations :
- Microscopic → mites, eggs, faeces
- Burrows → tetracycline
- Skin biopsy

● Diagnosis :
- Itch, especially at night-time
(nocturnal itching)
- History of infection on members of the
family / people living under the same roof
- Characteristic distribution of lesion
- Characteristic lesion → burrows
- Definite diagnosis → mites, eggs, faeces 35
- Tx antiscabies → improvement
● Treatment :
– Gamexan 1%
– Crotamiton 10%
– Sulfur 5 – 10%
– Benzoil benzoate 20 – 35%
– Permethrin 5%
● To achieve treatment success :
- Treat every contact person
- Correct drug administration
- Washing clothes and towels with hot water,
air mattress under the sun
- Avoid excess treatment 36
• P. capitis → P. humanus var capitis
• P. corporis → P. humanus var corporis
• P. pubis → Phtirus pubis

Pathogenesis :
- Direct contact
- Indirect contact

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P. CAPITIS
● Clinical manifestation : often affects children
● Symptoms :
- itch, especially on the occipital &
temporal parts → excoriation, erosion /
secondary infection
- swelling of the lymph glands

P. CORPORIS
● Clinical features :
- hemorrhagic macules / papules with
punctum in the middle 38
- urtica
P. PUBIS
● Mites → pubic hair, eyebrows, eyelashes,
axillae region, sometimes body hair
● Clinical features :
- itch → excoriation / secondary infection
- Characteristic → “maculae cerulae”

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Diagnosis :
P. capitis : shiny eggs on hair, mites
P. corporis : eggs / mites on clothes’ folds
P. pubis : eggs / mites on pubic hair,
eyelashes, body hair
Treatment :
P. capitis : - gamexan 1% shampoo
- permethrin 1% cream
- crotamiton 10% cream / lotion
P. corporis : - gamexan 1%
- Washing clothes / bed sheets
using hot water / ironing them
P. pubis : - petrolatum
- physostigmine 0,025% eye oint
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● Causative agents :
- Oestrus
- Gasterophillus
- Hypoderma
- Chrysomya

● Predisposing factors :
- Open suppurative lesion
- Habit of sitting down / sleeping on the ground
- Unclean environment 41
● Myasis classification :
1. Specific
2. Semi specific
3. “Accidental”

● Clinical features, based on the type of lesion :

- Subcutaneous burrows → pinkish papules,
followed by spiraling lines
- On the wound → untreated lesion
- Subcutaneous → shifting nodule / tumour
- Furunculoid → papule → pustule → incision →
larvae
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● Based on the locations :
- The skin
- The orifices (nose, ears, eyes)
- Internal organs → digestive tract,urinary tract

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● Diagnosis : Larva on the lesion (+)

● Treatment :
- Furunculoid :
○ Seal with petrolatum / paraffin,
then press → larvae will be squeezed out
- On the wound : irrigation with chloroform /
ether
- Classic : fish the larvae out with
clover liquid
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● Causative agents : Cimex lectularis
Cimex hemipterus

● Clinical features :
- Mite bite → papule with punctum
- Hemorrhagic → bulla

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● Treatment :
- Eradication of mites with malathion / DDT
- Lesion with antipruritic lotion 46
TERIMA
KASIH

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