Modul KBK/PBL/KT/2011

TROPICAL DISEASES
Yoes Prijatna Dachlan
Departmen of Parasitology
Faculty of Medicine
Airlangga University

TROPICAL DISEASES
The title I have elected to give to this work,
TROPICAL DISEASES, is more convenient than
accurate (Manson, 1898)
Definition 1
If
by
tropical
diseases be meant
diseases peculiar to,
and confined to, the
tropics, then a half a
dozen pages might
have sufficed for their
description

Definition 2

If
the expression
tropical diseases be
held to include all
diseases occuring in
the tropics, then the
work would require to
cover almost the entire
range of medicine
(By Manson, 1898, in the preface to the 1st
edition of the textbook Tropical Diseases)

(Yoes Prijatna Dachlan,

2013)

(Modul Tropis/Interonal Class/KT/2013)

Globalization
Globalization is one of the international key words in
recent years, and medical science is without
exception from it
Emerging and Re-emerging Diseases : that any
single remote area on this planet of the earth is not
existing isolated from other parts of the world, or
free from the threat of newly emerging and reemerging diseases
Three kinds of globalization : transportation,
economy and information system
The challenges facing tropical medicine are created
by the fact that the revolutions exist in immunology,
molecular biology, and information system
(Yoes Prijatna Dachlan,
2013)

(Modul Tropis/Interonal Class/KT/2013)

Definisi Penyakit Tropis (Lokakarya

Pengembangan Kedokteran Tropis di
Indonesia, TDC Unair, 2002):
Penyakit yang kebanyakan terjadi di
daerah
tropik yang meliputi penyakit infeksi
dan non
infeksi
(Yoes Prijatna Dachlan,
2013)

(Modul Tropis/Interonal Class/KT/2013)

History of Tropical Medicine

(1)

European doctors practised in tropical countries

in the early of 17th and 18th centuries, in the
English West Indies, India, East Indies and later
Africa, the western coast of which was widely
termed the white mans grave
Many also produced monographs describing their
experiences the outline of the disease pattern
at these various locations
Many infections which now fall under the tropical
umbrella were widely distributed in nothern
Europe and nothern America during the 17th to
19th centuries
The following diseases were major health hazards
in Britain during that era : malaria vivax, plague,
typhoid fever, cholera, typhus, smallpox, tbc
(Yoes Prijatna Dachlan,
2013)

(Modul Tropis/Interonal Class/KT/2013)

History of Tropical Medicine

(2)
Many historians consider that tropical medicine
originated as a by product of the British Empire
The scientific matters of medicine on the tropics was
exploited the Colonialists in order to that the health of
British personnel, both overseas and following return to
the UK, could be improved
A formal discipline that had its origin (s) in a
multidisciplinary background (during 19th century) :
major areas of progress were
- Public Health (and Hygiene)
- Travel and Exploration
- Natural History
- Evolutionary Theory
- Knowledge of the causation of disease
- Development of Clinical Parasitology by Manson, Ross,
and
others
(Yoes Prijatna Dachlan,
2013)

(Modul Tropis/Interonal Class/KT/2013)

Development of Tropical
Medicine
as a Formal Discipline
- School of Tropical Medicine, London (1899)
- Liverpool School of Tropical Medicine (1899)
- London School of Hygiene and Tropical Medicine
(1929)
- Ross Institute for Tropical Hygiene (1934)
- The Institute of Tropical Medicine, Nagasaki
- Tulane School of Public Health and Tropical Medicine
- Negara-negara lainnya: Jerman, Belanda, Thailand
- Tropical Disease Center (TDC) Unair (1998)
- Program Magister Kedokteran Tropis, FK Unair
(Yoes Prijatna Dachlan,

(Modul Tropis/Interonal Class/KT/2013)

Underlying Factors in Tropical

Medicine
1. Primary care and disease prevention and
control
2. Epidemiology of disease in the tropics
3. Traditional medicine
4. Genetics
5. Immunological aspects of tropical diseases
6. The economics
and financing of
tropical and
infectious disease control
7. Ethics and tropical diseases

(Yoes Prijatna Dachlan,

2013)

(Modul Tropis/Interonal Class/KT/2013)

Primary Health Care

Alma Ata Declaration (Alma Ata,USSR,1978) :
Urgent and effective national and international action
Primary Health Care:
Essential health care based
on practical, scientific and
socially
acceptable
methods and technology
The main social target :
attainment by all people of the world by the year
2000 of a level of health that will permit them to
lead socially and economically productive life
Addresses : the main health problems in the
community Promotive, Preventive, Curative, Rehabilitative
(Yoes Prijatna Dachlan,
2013)

(Modul Tropis/Interonal Class/KT/2013)

Epidemiology of Disease in the

Tropics
The study of epidemiology in the tropics has
now evolved into a dynamic phenomenon

ECOLOGY
INFECTIOUS AGENT- THE HOSTRESERVOIRS - VECTORS

(Yoes Prijatna Dachlan,

2013)

Complex mechanisms
concerned in the spread of
infection and the extent to
which this spread occurs

(Modul Tropis/Interonal Class/KT/2013)

THE SIX DEADLY KILLERS

perinatal
Maternal,
itional
and nutr
s
condition

Injuries

RESPIRATORY
HIV/AIDS
DIARRHOEAL
TB
MALARIA
MEASLES

Infectious
diseases

~Infectious diseases
account 45% of death in
low-income countries
~worldwide, up to 63% of
deaths in children < 4 yyrs
of age

Non-communicable
diseases

Main causes of death in low-income countries, 2002

(WHO 2003)
(Yoes Prijatna Dachlan, 2013)

(Modul Tropis/Interonal Class/KT/2013)

VACCINE-PREVENTABLE
INFECTIOUS DISEASES :
Measles, Hepatitis B, Neonatal
tetanus
EMERGING and RESURGENT
INFECTIOUS DISEASES
~ many diseases widely believed to
be under control, such as
cholera, dengue and diphtheria,
have re-emerged in many areas
or spread to new regions or
populations throughout the world
~New and resurgent infections
include

Ebola, DHF, Rift Valley fever,

Cholera, Nipah virus, West Nile,
SARS, AI, Swine Flu

(Yoes Prijatna Dachlan,

2013)

NEGLECTED TROPICAL DISEASES :

~ The big three : HIV/AIDS, Tb, malaria
(MDGs 6)
~ Kala Azar, Africans sleepingn sickness,
Chagas disease, Schistosomiasis,
lymphatic filariasis, Onchocerciasis,
Trichuriasis,AFFORDABLE,
Hookworm
~AAscariasis,
LACK OF EFFECTIVE,
or EASY TO USE DRUG TREATMENTS

NON-COMMUNICABLE DISEASES (NCDs)

Four of the most prominent NCDs :
~ Cardiovascular disease, Cancer,
Chronic Obstructive Pulmonary
Disease, Diabetes
(Modul Tropis/Interonal Class/KT/2013)

TRADITIONAL
TRADITIONAL MEDICINE
MEDICINE

National and International policies:

are calling for partnerships between
conventional
and traditional health
practitioners in order to provide adequate
health care coverage in the face of limited
resources
In tropical countries, there are a greater percentage of
the population use traditional medicine than use
conventional medicine, or than use complementary
medicine in the industrialized countries
Traditional health systems is mainly part of the culture,
history, and beliefs of the peoples. And the system is also
inherited from generation to generation
Collaborative partnership : research-based practice. In all cases,
research ethics and medical ethics clearly take priority in evaluating
and applying traditional treatments

(Yoes Prijatna Dachlan,

(Modul Tropis/Interonal Class/KT/2013)

TRADITIONAL MEDICINE and

MALARIA
WHO recommends combination therapies as
the treatment policy for falciparum malaria in
all countries experiencing such resistance
The preferred combinations contain a
derivative of the plant Artemisia annua,
which is presently cultivated mainly in China
and Vietnam
Artemisinin-based
combination
therapies
(ACTs) are most highly efficacious treatment
regiments now available
(Yoes Prijatna Dachlan,
2013)

(Modul Tropis/Interonal Class/KT/2013)

GENETICS
(1)

The scientific efforts is now

being put into
investigating
the many
genetic
different
factors
Genetics may influence
susceptibility to common
diseases
To provide fundamental
insights into
molecular
pathogenesis
Ultimately lead to better
ways of
disease prevention

(Yoes Prijatna Dachlan,

(Modul Tropis/Interonal Class/KT/2013)

GENETICS
(2)

The challenges for the 21th century is to

unravel the genetic basis of common human
diseases revolutionized by the sequencing
of the human genome analysis of many
thousands of genetic variants at the
epidemiological level
Genetic Epidemiology provides a potentially
powerful way of identifying :
~ the critical molecular events required for an
infectious agent to invade the human host,
and
~ for for the host to erradicate or succumb to
the infection
(Yoes Prijatna Dachlan,

(Modul Tropis/Interonal Class/KT/2013)

IMMUNOLOGICAL
IMMUNOLOGICAL ASPECTS
ASPECTS
The malnutrition-infection cycle

Malnutrition
produces
Diminished food
absorption
intake
micronutrient stores

Increased food
requirement
utilizatio
Diarrhoea

induces
(Yoes Prijatna Dachlan 2013)

reduces
-Cell-mediated immunity
-Humoral immunity
-Secretory IgA
-Complement
-Neutrophil function
-External barriers

Infection

increases

(Modul Tropis/Interonal Class/KT/2013)

ECONOMIC and FINANCING SYSTEM

Poverty is the most important factor
underlying poor health in the tropics
Approaches :
1. Concepts of efficiency
2. Take advantage of existing sources of
funding (grants from bilateral agencies,
and from international agencies)
3. Professionals at making the case for
tropical and infectious disease control

(Yoes Prijatna Dachlan 2013)

(Modul Tropis/Interonal Class/KT/2013)

Ethics
Ethics
Global consideration on the issue of equity, fairness,
the North-South divide and morality of the current
world order
Powerful nations need to resolve to deal with the
root causes of intolerable economic disparities

Should be kept in an increasingly interdependent

world

Moral sensitivity, sustainable development and

respect for human rights and human dignity are in
the interest of all world wide

(Yoes Prijatna Dachlan 2013)

(Modul Tropis/Interonal Class/KT/2013)