PLENO SKENARIO 2 BLOK AGROMEDICINE

Kelompok Tutorial 17 :

• Alandra Rizhaqi Vastra 1618011160 • Asyraf Vivaldi Wardoyo 1658011002

• Fatimah Azzahra 1618011134 • Kadek Erwin Wijaya 1658011041
• Rima Novisca Jasmadi 1618011146 • Maula Al Farisi 1618011002
• Ghina Risky Juanda 1618011153 • Dina Amalia K. 1618011135
• Reva Dwi Yanty 1618011056 • Ayu Darma Putri 1618011025
• Kinanti Rahmadhita 1618011082

FAKULTAS KEDOKTERAN
UNIVERSITAS LAMPUNG
T.A. 2019-2020
Step 1

Dyspnea : shortness of breath; feeling that

one cannot breathe well enough.

Rhinorrhea : a condition where the nasal

cavity is filled with a significant amount
of mucus fluid; runny nose.
 Step 2

1. What are the steps in

2. What is the
making medical diagnosis
pathophysiology of the 3. What are the type of
of the Patient?
disease that Patient Avian Influenza Virus?
(symptoms, signs,
suffered?
physical examination &
laboratory finding) ?

6. What is the Zoonotic

4. What is the treatment 5. What is the prevention Disease in Agriculture
of Avian Influenza? of Avian Influenza? sector?
 1. Diagnostic

Patient details
Occupation
(e.g. name, Travel history (note if health-
home address, in 7 days
Demographic care worker or
home/mobile before the
information onset of laboratory
telephone
symptoms worker)
numbers)

Contact with
confirmed or Exposure
suspect human Clinical data − Laboratory
H5 cases in the history to symptoms data
7 days before animals
symptom onset
2. Pathophysiology
 3. Type of Avian Influenza Virus

Influenza A viruses
infect humans and
Influenza B viruses
many different
circulates among Influenza C viruses Influenza D viruses
animals. The
humans and cause can infect both primarily affect
ability infect
seasonal humans and pigs cattle and are not
people and have
epidemics. Recent but infections are known to infect or
sustained human to
data showed seals generally mild and cause illness in
human
also can be are rarely reported. people.
transmission, can
infected.
cause an influenza
pandemic

.
Evidence suggests that some antiviral drugs, notably neuraminidase
inhibitor (oseltamivir, zanamivir), can reduce the duration of viral replication
and improve prospects of survival, however ongoing clinical studies are
needed. Emergence of oseltamivir resistance has been reported

In suspected and confirmed cases, neuraminidase inhibitors should be 4.

prescribed as soon as possible (ideally, within 48 hours following symptom Treatment
onset) to maximize therapeutic benefits. of Avian
Influenza?
Treatment is recommended for a minimum of 5 days, but can be extended
until there is satisfactory clinical improvement.

Corticosteroids should not be used routinely, unless indicated for other

reasons, as it has been associated with prolonged viral clearance,
immunosuppression leading to bacterial or fungal superinfection.
Most recent A(H5) and A(H7N9) viruses are resistant to adamantane
antiviral drugs (e.g. amantadine and rimantadine) and are therefore not
recommended for monotherapy.
 5. Prevention
Apart from antiviral treatment, the public health management includes personal
protective measures like:

Good respiratory hygiene –

Regular hand washing with proper covering mouth and nose when
drying of the hands coughing or sneezing, using tissues
and disposing of them correctly

Early self-isolation of those feeling

Avoiding close contact with sick
unwell, feverish and having other
people
symptoms of influenza

Work with poultry/outbreaks : APP

Avoiding touching one’s eyes, nose CDC recommends : seasonal
or mouth influenza vaccination every year,
preferably > least two weeks before
engaging in an outbreak response.
Step 7

2. Management of Avian
1. Type of Zoonosis
Influenza in Hospital
1. A general explanation of zoonoses in agriculture
field

• Diseases and infections that can

naturally be transmitted from
vertebrate animals to humans
and vice versa. This definition
also includes conditions where
Zoonosis an organism can live both in
the human body and animal
body, even though the organism
is not generally transmitted
from one to the other.
 Joint FAO / WHO Expert
Committee on Zoonosis, the • Anthropozoonosis
zoonotic classification can • Zooanthroponosis,
be done on the basis of the • Amphixenosis
type of reservoir , which is a
source of infection of the
disease caused by organism

• Direct zoonoses (direct zoonoses)

Zoonotic classification • Cyclozoonosis
which is based on the life
cycle of the infectious • Metazoonosis
organisms • Saprozoonosis
The nature of zoonotic diseases varies depending on the nature
of the pathogenic agent
Pathogenic agents that are in animals as reservoirs, but
human cases are rare or the infection is "dead-end", such
as Anthrax, Rabies, West Nile and Nipah / Hendra.
Pathogenic agents grow well in animals and humans
such as bovine tuberculosis, salmonellosis.
Pathogenic agents are in an intermediate situation where animals
only act as the main host, but human outbreaks are more common
and the chain of transmission leads to for example Monkeypox,
Hanta, Lassa and Ebola.
Pathogenic agents which gradually transmission from human to human and
currently can be transmitted between humans such as tuberculosis.
Pathogenic agents whose sources are from animals but suddenly appear in
human populations such as HIV, Influenza type A and the possibility of SARS.
 Zoonotic disease in Indonesia

A number of zoonotic diseases that are included in the list of strategic

infectious animal diseases in Indonesia are rabies, anthrax, avian
influenza, salmonellosis and brucellosis. Other important zoonotic
diseases that need attention are schistoso-miasis, cysticercosis /
taeniasis, tuberculosis, leptospirosis, toxoplasmosis, Japanese
encephalitis, streptococosis / staphylococosis, and clostridium
(tetanus).

Zoonotic diseases related to food safety (food borne disease) in

Indonesia are camphylobacteriosis, salmonellosis, shigella, yersinia,
verocyto toxigenic Escherichia coli (VTEC), and listeriosis. Exotic
zoonotic diseases for Indonesia are bovine spongiform
encephalopathy (BSE), Nipah / Hendra virus, ebola, and rift valley
fever (RVF)
 Policy to control and eradicate zoonotic diseases
There are 4 (four) subsystems that are very important in their role
as supporters of the national animal health system (siskeswannas)
especially in relation to controlling and eradicating zoonotic
diseases

National
Early warning
surveillance
and disease
and monitoring Animal health Veterinary
emergency
system for information public health
system (early
zoonotic system system
warning system
diseases in (Sikhnas). (Siskesmavet).
and emergency
livestock and
preparedness).
wildlife.
 A. MANAGEMENT IN POLYCLINICS

Performs anamnesis symptoms and may be in high-risk groups. Patients at

high risk for Avian Influenza, patients are sent to the Avian Influenza
(H5N1) triage room to be further evaluated by the Avian Influenza
(H5N1) team.
 B. MANAGEMENT IN EMERGENCY ROOM

2. The doctor on duty at the

1. The doctor who referred
referral hospital emergency
consulted the emergency room
room consulted with the avian
doctor of the referral hospital
influenza (H5N1) referral
referral
hospital team.

3. The bird flu team doctor (H5N1)

referral hospital communicates with the
doctor who will refer to the symptoms
of avian influenza (H5N1), leukocyte
values ​and chest X-ray images.
4. Patients with suspected bird flu (H5N1) are sent immediately to the
nearest referral hospital if it is suitable to transport If transport is not
feasible, stabilization and isolation are carried out in accordance with
the guidelines while still communicating with the avian influenza
(H5N1) referral hospital team.

5. Patients without referral take history and examination in a separate

place / special triage of Avian Influenza (H5N1). If it turns out a
suspect patient is sent to the Avian Influenza isolation room (H5N1).

6. Pediatric patients who are accompanied by their parents then their

parents must continue to use PPE according to the procedure.
EVACUATION TO THE ISOLATION ROOM

The patient is transferred to a gurney or

wheelchair and wears a surgical mask.
Health workers use PPE.
 C. MANAGEMENT IN ISOLATION ROOM

• Pay attention to
general conditions,
Supporting
awareness, vital signs examination
(blood pressure,
pulse, breathing • Perform supporting
frequency, examinations in accordance Definitive
temperature). Monitor with Athe needs and (antiviral) therapy
conditions of the patient.
oxygen saturation
with pulse oxymetry

Clinical
Assessment

Oxygen
Other therapies:
therapy, fluid
therapy, • Amoxicillin is the first choice for oral a
ntibiotics in children <5 years. Alternati
adequate
ves are co-amoxiclav, ceflacor, erythro
nutrition etc. mycin, clarithromycin and azithromycin
Antipyretics • Giving corticosteroids on a regular bas
is is not recommended because there
the first choice i are no clinical trials, even potentially h
s armful, which can extend the period of
viral replication and increase the risk o
paracetamol. f opportunistic infections.
• Under the above conditions, corticost
eroids are considered for
Supportive and sy
• Adult: Hydrocortisone or equivalent
mptomatic therapy methylprednisolone 0.5 1 mg /kg/day
divided in 3-4 doses in 24 hours (in di
vided doses every 8-6 hours).
• Children: Hydrocortisone 2 mg / kg I
V or equivalent Dexamethason 0.5 m
g / kg BW every 8 hours or Methylpre
dnisolone 1-2 mg / kg IV every 6 h.
For adult patients All patients who meet t
he criteria for severe sepsis and septic sho
ck: Acute Lung Injury (ALI), Acute Respi
ratory Distress Syndrome (ARDS). - Seve
re sepsis is sepsis accompanied by one of
the disorders of organ functions, as below
1. Hypotension
2. Hyperlactatemia
3. Renal: acute increase in serum creatini
ne> 176.8 mmol / l (2.0 mg / dl) or uri
ne output <0.5 ml / kg / hour for> 2 ho
urs
4. Lung: Acute Lung Injury (ALI) with P
aO2 / FIO2 300 mmhg (P/F ratio)
5. Liver: acute increase in bilirubin> 34.
2 µmol / l (2 mg / dl)
6. Thrombocytopenia
7. Coagulopathy
ICU entry criteria
 Antivirals
- Treatment There are antiviral drugs that work as inhibitors of
neuramidase such as oseltamivir and zanamivir while Amantadin
and Rimantadin inhibit M2 protein.

-Adult or Weight> 40kg: Oseltamivir 2x75 mg per day for 5 days.

-Children 1 year oseltamivir dose 2 mg / kg, 2 times a day for 5

days.

-The dosage of oseltamivir can be given according to body

weight as follows:
• > 40 kg: 75 mg 2x / day ; > 23 - 40 kg: 60 mg 2x / day ; > 15-
23 kg: 45 mg 2x / day ; ≤ 15 kg: 30 mg 2x / day
-The use of oseltamivir in pregnant women is given at the
beginning of treatment, with an explanation given first and
monitored until delivery
 Daftar Pustaka
1. Soedarto. 2003. Zoonosis Kedokteran. Surabaya: Airlangga
University Press.
2. Suharsono. 2002. Zoonosis Penyakit Menular dari Hewan ke
Manusia. Yogyakarta : Penerbit Kanisius.
3. Rusdi A., Syahrurachman A., Agustiningsih., Suka A.K. Suka., et
all. 2010. Pedoman Tatalaksana Klinis Flu Burung (H5N1) di
Rumah Sakit. Jakarta: Kementerian Kesehatan RI.