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Chancroid
Umar Zein
Synonyms
Over View
Most common, underdiagnosed zoonosis
Indonesia almost area could be endemic
Source - Animals (rodents and domestic
animals)
Epidemiological factors
Contaminated environment, Rainfall, flood
High risk groups, endemic in all states of
Indonesia
First description by Weil in 1886
Epidemiology
Rainfall; Contaminated environment
Poor Sanitation; Inadequate drainage
facilities
Presence of rodents, cattle & stray
dogs
Walking/ working bare foot poses high
risk
Difficult to pinpoint the source of
infection
Any person can get infected, if exposed
to contaminated and environment
Risk Groups
Occupational exposure
Farmers Rice, Sugarcane, Vegetables,
Cattle, Pigs
Sewerage workers; Abattoirs, Butchers
Vetenarians, Lab staff, Miners, Soldiers
Fishermen Inland (not on the sea)
Recreational activities
Swimming, Sailing, Marathon runners,
Gardening
Reservoirs of Infection
Rodents
(Rattus rattus, Rattus
norvegicus,
Mus musculus)
Dogs
Wild animals
Domesticated animals
Caged game animals
Leptospira are excreted in the
urine
Modes of Transmission
1. Direct contact with urine or tissue of
infected animal
Through skin abrasions, intact mucus
membrane
2. Indirect contact
Broken skin with infected soil, water or
vegetation
Ingestion of contaminated food & water
3. Droplet infection
Inhalation of droplets of infected urine
Transmission
Natural History
Leptospira
Damage to small
blood vessels
Vasculitis
Clinical Illnesses
Clinical Presentation
Anicteric Presentation
Icteric Leptospirosis
Icteric Leptospirosis
KIDNEYS Mild to Severe
Urinalysis : Hematuria / Pyuria / Proteinuria
Renal Failure: Pre renal azotemia, ATN / AIN
Oliguric / Non Oliguric
Mechanism
Nephrotoxicity Endotoxin, (Direct )
Bacterial migration, Toxic
Metabolites
Hypoperfusion Hypotension, Fluid loss/
Fluid shift
G.I. Bleed, Myocarditis
Hemorrhagic Manifestations
Hemorrhagic Fever - Vascular injury
Respiratory, Alimentary, Renal & Genital
tracts
More common in Icteric & with Renal Failure
Reported in Korea, Andamans & Brazil
Hemorrhagic Pneumonitis
Hemoptysis / Respiratory failure
CXR : Single/ Multiple ill defined opacities
Occurs in 2nd week (as early as 24-48 hours)
Reported in Korea, Andamans & Nicaragua
Atypical Pneumonia
Cardiac Form
Cardiac manifestations
Hemorrhagic Myocarditis
Cardiomyopathy / Cardiac failure
Arrhythmias, Hypotension / Death
Atrial fibrillation / Conduction
defects
ECG changes
Non Specific ST-T changes
Low voltage complexes
Reported in Srilanka, Barbados &
Portugal
Other Manifestations
Aseptic Meningo-encephalitis
It is rare; It occurs in the Immune phase
CSF proteins , lymphocytes
Convulsions, Encephalitis, Myelitis &
Polyneuropathy
Ocular manifestations
Late complication; Conjunctival
suffusion/hemorrhage
Anterior uveitis, Iritis, Iridocyclitis, chorioretinitis
Occurs in 2 weeks to 1 yr. (average 6 months)
Differential Diagnosis
Laboratory Tests
Problems in Diagnosis
Interpretation of Tests
Interpretation of Tests
ELISA or SAT
Approach to Diagnosis
Treatment
Oral Treatment 7 to 10
day
IV Treatment 5 to 7
days
Special Measures
Prevention
PES
PLAQUE
SAMPAR
BLACK DEATH
Origins
Originated in Mongolias Gobi desert
Moved along the Silk Road to Black Sea
Bacteria carried by fleas, lived on black rats
Major trade/commercial cities were good hosts
Sicily in 1347, England 1348, culminating in Russia 1352
Unstoppable Force
Victims ate lunch with their friends and dinner with their ancestors
in paradise."
History of Plague
Justinians Plague (541-542) killed pop. of Mediterranean
6th & 8th C. breakouts
16th, 17th, 18th C. Pandemics
Italian, London, Vienna, Marseilles, Russia
3rd Pandemic (Asian Plague) 19th, 20th C.
~15 million dead (India, China, Russia)
Biological Weapon (Japanese, WWII)
Looked at Medieval Styles of Catapulting Infected Bodies into
Castles
Myth or Fact?
(Song)
Effect on European
Civilization
DISASTER STRIKES
Estimated population of
Europe from 1000 to
1352.
1000 38
million
1100 48
million
1200 59
million
1300 70
million
1347 75
million
1352 50
million
Black Death
Carried by Ships throughout Europe
Rats infested the goods on board
Early Theories
Some blamed invisible particles in the air.
Some blamed poisoned wells.
Many inevitably and unfairly blamed the Jews.
WHY?
Ignorance Surrounded Cause and Cure
Europeans were Frantic
Blames
Alignment of Planets
Infected Clothing, Humans
Gods Wrath aimed at Sin
Jews
Cures/Remedies
Pomanders
Mixture of Molasses & Chopped Snake
Repentance
Flagellants
Plague
(Black
Death)
Pathogenesis
Masses of organism obstruct digestive tract of
rat fleas
Flea regurgitates infected material into bite
wound
Pla is essential to spread from site of entry
Organisms multiply within macrophages
Produce F1 capsule while in macrophages
SYMPTOMS
3rd Coughing
Once coughing starts the plague has become airborne
Deat
h
PNEUMONIC PHASE
SEPTICEMIC PHASE
BUBONIC PHASE
Most Common
Egg-sized swellings (buboes)
Neck, armpits, groin (dark blisters)
Headaches, Weakness, Nausea/Vomiting
Severe Fever and Delirium
The Pneumonic Plague was the second most commonly seen form of the Black Death.
Mortality Rate: 90-95%
(Today if Treated 5-10%)
It infected the lungs, and
the symptoms included
slimy snot tinted with blood!
Many times victims choked
on their own Blood (ew).
Septicemic Plague
Most Rare form of all!
Mortality rate was close to 100%(Even today
there is no treatment)
Symptoms: High Fever and
skin turning deep
shades of purple!
Victims usually died
the same day the
symptoms appeared.
Chancroid
Chancroid ulcers
Treaatment
Azithromycin 1g stat.
Ciprofloxacin 500 mg (p.o.) b.d. for 3 days
Erythromycin 500 mg (p.o.) q.d.s for 7 days
Ceftriaxone 250 mg (i.m.) stat.
Spectinomycin 2 g (i.m.) stat.
In known low resistance areas:
Trimethoprim 80 mg/Sulphamethoxazole 400 mg
2 tablets (p.o.) b.d. for 7 days
Aspirate fluctuant nodes as required
Chancroid