Zoonotic Diseases - Ministry of Public Healthnih.dmsc.moph.go.th/data/data/58/6_7_58/5.pdf ·...
Transcript of Zoonotic Diseases - Ministry of Public Healthnih.dmsc.moph.go.th/data/data/58/6_7_58/5.pdf ·...
Zoonotic Diseases
Human Animals
Environmental
Figure 1. Flow chart of the pathway from introduction of a zoonotic pathogen to public health impact, represented by 7 criteria
(C1–C7) from which the risk to public health of emerging zoonoses was derived.
Havelaar AH, van Rosse F, Bucura C, Toetenel MA, Haagsma JA, et al. (2010) Prioritizing Emerging Zoonoses in The Netherlands. PLoS ONE 5(11): e13965..
Brucella spp* Brucellosis
Francisella tularensis*
Tularemia
Leptospira Leptospirosis
Borrelia spp Lyme disease
B.pseudomallei*
melioidosis
Coxiella burnetii*
Q fever
Y.pestis Plague etc.
*Biotorrism
• Brucella is a fastidious,
aerobic, small, gram-
negative coccobacillus.
• Biosafety Level 2/3 agent
(once Brucella is suspected,
work should only be done
in a certified Class II
Biosafety Cabinet).
• Biotorrism :
Wimol Petkanchanapong, Thai NIH
Brucella spp*/Brucellosis โรคบรูเซลโลซิส /โรคแท้งติดต่อ
B.suis B.melitensis
B.abortus
B.canis
Symptoms and signs %
Fever 93
Chills 82
Sweats 87
Aches 91
Lack of energy 95
Joint and back pain 86
Arthritis 40
Spinal tenderness 48
Headache 81
Loss of appetite 78
Weight loss 65
Constipation 47
Abdominal pain 45
Diarrhoea 7
Cough 24
Testicular pain/epididymo-orchitis 21a
Rash 14
Sleep disturbance 37
Ill appearance 25
Pallor 22
Lymphadenopathy 32
Splenomegaly 25
Hepatomegaly 19
Jaundice 1
Central nervous system abnormalities 4
Cardiac murmur 3
Pneumonia 1 Wimol Petkanchanapong, Thai NIH
Culture :Specimens
•Blood/ Castaneda’s media
•Urine, sputum, breast milk
•Lymph node biopsy
•Bone marrow aspirate
• EDTA blood • Tissue/BM/spleen/liver
NA detection /PCR
Specimens : clotted blood/
serum •single serum > 1 ml • paired serum >14 day
Antibody detection : IC/LA/RB/ELISA/IFA-IgM-IgG
Brucellosis is a commonly acquired laboratory infection; all work on suspect Brucella spp. cultures should be performed at a minimum under BSL2 conditions with BSL3 practices.
Lab testing
Wimol Petkanchanapong, Thai NIH
สถาบันวิจยัวทิยาศาสตร์สาธารณสขุ •เพาะเชือ้ จากสิ่งสง่ตรวจและตรวจยืนยนั • ตรวจสารพันธกุรรม ด้วยวธิ ีPCR • ตรวจแอนตบิอดดีว้ยวธิ ีRose Bengal Test และ IgG/ IgM-ELISA ให้บริการทุกวนั
Persons at Risk Exposure Activities
PEP Recommendations
Follow up/Monitoring
Person performing
activity and any
person within a 5 ft.
radius
•Work with a
Brucella isolate
•Sniffed or opened
culture plate
•Mouth pipetted
specimen material
•Worked in Class
II biosafety
cabinet or on open
bench without
using BSL-3
precautions
•Doxycycline 100mg
twice daily and
rifampin 600mg once
daily for 3 weeks
•TMP-SMZ should be
considered for patients
with contraindications
to doxycycline
•Persons with
contraindications to
rifampin should consult
with their HCP
•Pregnant women
should consult with
obstetrician
•Sequential
serologic testing at
0, 6, 12, 18 and 24
weeks post exposure
•Symptom watch
(e.g. weekly) and
daily self fever check
for 24 weeks
•No serological
monitoring available
for RB51 and B.
canis exposures
All persons present in laboratory room
Occurrence of widespread aerosol generating procedures*
Brucellosis @CDC.org
Risk Level = Low Persons at Risk
Exposure Activities PEP
Recommendations
Follow
up/Monitoring
All persons present
in laboratory room
at distance greater
than 5 ft. from
activity
Present in the lab at
the time of
manipulation of
Brucella isolate on
an open bench, but
who do not have
high risk exposures
as defined above
• Discuss with HCP
•.May consider if
immunocompromis
ed or pregnant
• Sequential
serologic testing at
0, 6, 12, 18 and 24
weeks post exposure
• Symptom watch
(e.g. weekly) and
daily self fever
check for 24 weeks
• No serological
monitoring available
for RB51 and B.
canis exposures
Brucellosis @CDC.org
Risk Level = None
Persons at Risk Exposure Activities
PEP Recommendations
Follow up/Monitoring
None Handling and testing of Brucella isolate in a Class II biosafety cabinet using BSL-3 precautions
None N/A
Brucellosis @CDC.org
Brucella as a Biological Weapon Aerosolized B. melitensis
City of 100,000 people
Inhale 1,000 cells (2% decay per min)
Case-fatality rate of 0.5%
50% hospitalized for 7 days Outpatients required 14 visits
5% relapsed
Results 82,500 cases requiring extended therapy
413 deaths
$477.7 million economic impact
Center for Food Security and Public Health, Iowa
State University, 2012
Q fever/ Coxiella burnetii
• A small obligate intracellular
gram-negative bacterium that is
distributed globally.
• Primary reservoirs; cattle,
sheep, and goats
• Acute and chronic illness in
humans with case fatality rate
is 25-60%. • group B bioterrorism.
Wimol Petkanchanapong, Thai NIH
Signs and symptoms
• Chronic patients may have initially had an asymptomatic and
present months or years after bacterial infection.
• About 80% cases present as blood culture negative
endocarditis.
• Other chronic of infection;
• Vascular infections
• Infections after pregnancy
• Hepatitis
• Osteomyelitis
Wimol Petkanchanapong, Thai NIH
Q fever/ Coxiella burnetii
Tularemia/ F. tularensis
Wimol Petkanchanapong, Thai NIH
Tick –borne disease
Tularemia : -Ulceroglandular/Glandular/Oculoglandular/Oropharyngeal/pneumonic/typhoid form.
Fever/chill/
Risk factor: working closely with animals/ living in forested areas/gardening/
Sources: Rabbit and deer ticks/deerflies/rodents/cats
Route: skin exposure/inalation/eye /ingestion/
Tularemia/ F. tularensis
Wimol Petkanchanapong, Thai NIH
Lab testing
•Antibody detection :
•Skin biopsy/LN biopsy /BM
• PCR •Culture :
เลปโตสไปโรสิส Hardjo or Pomona
เชื้อไปสะสม ที่ไต และออก มากับปัสสาวะ
เชื้อเขา้สูก่ระแสโลหติ และไปอวัยวะอื่นๆ
การติดตอ่ เชื้อเขา้สูร่า่งกายคนโดย การไชเขา้ทางผวิหนงั
ที่มีบาดแผล หรือไชผา่น เยื่อเมอืก เยื่อบตุา
เยือ่บทุางเดนิอาหาร และทางเดนิหายใจ
การก่อโรค ติดเชือ้ในกระแสโลหติ เกิดการอกัเสบทีต่บั ไต สมองและอวยัวะอื่น ท าลายหลอดเลอืด และเนือ้เยือ่
Wimol Petkanchanapong, National Institute of Health, Thailand
ไข้ 90-100%
ปวดเมือ่ยกล้ามเนื้อ 40-93.8%
ปวดศรษีะ 55-74.6%
Conjunctival suffusion 25-60%
Jauandice 16-92.7%
Figure 1 Global annual incidence of human leptospirosis. Colors reflect
incidence, in declining order: red, pink, green, yellow. Gold reflects areas with probable, but not estimated, high incidence. White reflects absence of data.
Wimol Petkanchanapong, Thai NIH
18/07/2013 W. Petkanchanapong, Leptospirosis Laboratory, National Institute of Health. 16
Laboratory investigations / PUO
Different approaches of laboratory diagnosis
Culture*
Isolation
Microscopy
•Dark Field Microscopy
•Immunofluorescence
Microscopy
•Silver Impregnation techniques
Immunology
Latex*, ICT*
ELISA, IHA, IFA*
Microscopic Agglutination Test (MAT)*
Molecular
•Polymerase
Chain Reaction
(PCR)*
• LAMP**
•MALDI TOP
mass
spectrophotometr
y
•Next generation sequencing
Emerging Zoonosis Research Project
Determine the incidence of
leptospirosis, brucellosis,melioidosis,
murine and scrub typhus, parasites in
animals with close contact to human
(dogs, cats, rats)
Development of new techniques for lab
identification of zoonoses using
multiplex approach; multiplex real-time
PCR, multi-dot IFA
Development incidence of bartonellosis,
Q fever and tularemia in wildlife and risk groups
Sample collection : 1. Identify rodents and ectoparasites 2. Specimen collection: clotted
blood, EDTA blood, blood smear
3. kidney/spleen/liver: culture,
PCR for ---------------
ตารางที ่1 ผลการตรวจหาการติดเชื้อโรคในกลุม่ Zoonoses *
ชนิดสัตว์
จ านวน
สัตว์ (ตัว)
Leptospirosis/ MAT
+/ToTal (%)
Brucellosis/ Agglutination
+/ToTal (%)
Melioidosis/IHA
+/ToTal (%)
Q fever/ IFA /ELISA
+/ToTal (%)
Bartonellosis /IFA
+/ToTal (%)
Scubtyphus/ IFA+/ToTal
(%)
Murine typhus/
IFA+ /ToTal (%)
Trypanosome * +/Total (%)
หนู 238 2/112 (1.8) 0/28 (0)
12/125 (9..6)
1/85 ( 1.2 )
1/85 (1.2)
0/44 (0)
0/44 (11.8)
10/85 (11.8)
สุนัข 255 20/255 (7.8)
31/167 (18.6)
15/160 (9.4)
0/17 (0)
0/167 50/82 (60.9)
3/82 (3.7)
8/167 (4.8)
แมว 93 1/70 (1.4)
2/33 (6.1)
2/57 (3.5) 1/33 (3.0 )
0/33 (0)
8/11 (72.7)
0/11 (0)
0/35 (0)
รวม 586 23/420 (6.1)
Bandicota
indica R. norvegicus Rattus rattus Rattus exulans
Suncus
murinus Total
ภูเกต็ - 5 23 11 39
+ (%) 5 (12.8) A 5 (12.8) ระนอง - 56 21 2 35 114 + (%) 17 (14.9) B 8 (7.0) C 25 (21.9)
นครพนม -- 3 7 14 44 + (%)
ตาก 4 1 1 25 10 41 + (%)
รวม 4 65 52 52 45 238 (+ %) ของชนดิหนู 0 17 (26.2) 13 (25.5) 0 (0) 0 (0)
(+%) ของทัง้หมด 0 (7.1) (5.5) 0 0 30 (12.6)
serogroup ท่ีพบ A B C %
Bataviae 1 12 5 18 (7.6) Canicola 2 2 1 5(2.1)
Celledoni 2 3 2 7(2.9)
ตารางท่ี 2 ผลการตรวจหาการติดเช้ือโรคในกลุ่ม Zoonoses
Test kit
Multiplex real-time PCR for detection of 9
vector-borne diseases and zoonoses;
1. leptospirosis, brucellosis, melioidosis, and tularemia
2. bartoneloses, scrub typhus, murine typhus, and rickettsial
spotted fever
3. Q fever, leptospirosis, scrub typhus, and brucellosis
Thanks for your attention
Plague/ Yersinia pestis Very severe disease in humans, with 30-60% case-fatality
ratio
Develop ‘flu- like” symptoms after an incubation period
of 3-7 days.
3 forms of plague infection:
Bubonic/septicemic/pneumonic
783 cases and 126 deaths reported worldwide in 2013
Most endemic countries : Madagascar, Congo, Peru
Wimol Petkanchanapong, Thai NIH
ตารางที ่2 ประเมินความถกูต้องของวิธ ีMultidot IFA เปรียบเทยีบกบัวิธอี้างองิ Brucellosis
(%) Leptospirosis
(%) Melioidosis
(%) Murine typhus
(%) Scrub typhus
(%)
Sensitivity 93.1 (27/29)
89.6 (26/29)
100 (17/17)
92 (23/25)
100 (25/25)
Specificity 82.5 (137/166)
92.2 (153/166)
88.2 (157/178)
94.7 (161/170)
95.3 (162/170)
Blood donors
97.1 (68/70)
100 (70/70)
95.7 (67/70)
98.6 (69/70)
98.6 (69/70)
Other infection
71.9 (69/96)
86.4 (83/96)
83 (90/108)
92.0 (92/100)
93.0 (93/100)