BackgroundPreviously thought to be rabies free, Bali experienced an outbreak of animal and human rabies cases in November 2008. We describe the epidemiological and clinical data of human rabies cases occurring in the first two years of the outbreak.MethodsWe analysed the patient records of all rabies cases from the Sanglah General Hospital in Denpasar, and district hospitals in Buleleng and Tabanan. A conventional reverse transcriptase polymerase chain reaction was developed to detect the rabies virus genome in saliva, corneal swabs, and ante- and post-mortem cerebrospinal fluid (CSF).ResultsThere were 104 human rabies cases in Bali during November 2008-November 2010. Patients' mean age was 36.6 years (range 3-84 years; SD 20.7), most were male (56.7%), and originated from rural districts. Almost all (92%) cases had a history of dog bite. Only 5.8% had their wounds treated and received an anti-rabies vaccine (ARV) after the bite incident. No patients received rabies immunoglobulin (RIG). The estimated time from dog bite to the onset of signs and symptoms was 110.4 days (range 12-720 days; SD 118.2). The mean length of medical care until death was 21.8 hours (range 1-220 hours; SD 32.6). Less than 50% of patients had prodromal symptoms. The most frequent prodromal symptom was pain or paraesthesia at the bite site (37.6%). The two most common central nervous system infection signs were agitation (89.2%) and confusion (83.3%). Signs of autonomic nervous system dysfunction included hydrophobia (93.1%), hypersalivation (88.2%), and dyspnea (74.4%). On admission, 22 of 102 patients (21.6%) showed paralytic manifestations, while the rest (78.4%) showed furious rabies manifestations. The case-fatality rate was 100%. The rabies virus genome was detected in 50 of 101 patients (49.5%) with the highest detection rate from post-mortem CSF samples.ConclusionsRabies is a major public health problem in Bali. Human fatalities occur because of a lack of knowledge regarding rabies risk, the poor management of dog bites, and the limited availability of RIG. Increasing public awareness of dog bite management, increasing the availability of ARV and RIG, and implementing an island-wide dog vaccination campaign will help prevent human rabies cases.
SUMMARYThe emergence of human and animal rabies in Bali since November 2008 has attracted local, national and international interest. The potential origin and time of introduction of rabies virus to Bali is described. The nucleoprotein (N) gene of rabies virus from dog brain and human clinical specimens was sequenced using an automated DNA sequencer. Phylogenetic inference with Bayesian Markov Chain Monte Carlo (MCMC) analysis using the Bayesian Evolutionary Analysis by Sampling Trees (BEAST) v. 1.7.5 software confirmed that the outbreak of rabies in Bali was caused by an Indonesian lineage virus following a single introduction. The ancestor of Bali viruses was the descendant of a virus from Kalimantan. Contact tracing showed that the event most likely occurred in early 2008. The introduction of rabies into a large unvaccinated dog population in Bali clearly demonstrates the risk of disease transmission for government agencies and should lead to an increased preparedness and efforts for sustained risk reduction to prevent such events from occurring in future.
BACKGROUND: Streptococcus suis is an emerging zoonotic pathogen. This bacterium commonly causes meningitis in human and is often associated with hearing and vestibular dysfunction. S. suis tends to be misidentified, leading to under-diagnosis. CASE PRESENTATION: A previously healthy 50-year-old man was admitted to one of the district hospitals in Bali Province, Indonesia, due to meningitis. He had a history of consuming homemade raw pork product two days before the onset of illness. Streptococcus mitis was identified from the cerebrospinal fluid culture by using VITEX 2 COMPACT (Biomeriuex) with a 99% probability score. This patient had clinical symptoms and risk factor identical to S. suis infection. Therefore, we performed confirmation tests for the cerebrospinal fluid by PCR (using primer specific for gdh and recN) and sequencing of those PCR products. Both of the confirmation tests showed a positive result for S. suis. CONCLUSION: There are few reports of S. suis infections in Indonesia, but we believe that the cases in Indonesia, especially Bali, are not uncommon. The under-reported cases are perhaps due to the difficulties in differentiating S. suis from other Streptococcus species by culture method, particularly Streptococcus mitis. Therefore, confirmation by PCR is necessary.
Background: Food contamination is a serious problem. Salmonella sp is one of the main bacteria causing gastrointestinal disease, especially in raw pork, due to the production and distribution process. Traditional markets have high risk of pathogenic microbial contamination. The purpose of this study was to detect contamination of Salmonella sp. on pork sold in traditional markets, particularly in Denpasar, Bali. Method: This research is a cross-sectional descriptive, with the samples coming from the porks sold by traditional market traders in every sub-district in Denpasar, Bali. The sampling technique used is the cluster purposive sampling. The procedure for identification of Salmonella sp. using culture and subculture examination on Salmonella Shigella Agar (SSA), simmon citrate agar media, and identification of the microscope. Results: Based on SSA culture results from 38 samples, 26 samples of pork showed colony growth, but only 10 samples with typical morphology of Salmonella sp. The 16 samples with atypical morphology were examined for SSA subculture, with 9 samples having clear black colonies. In 19 research samples that showed the results were suspected to be contaminated with Salmonella sp. continued to the Simmons citrate test, but only 8 samples were positive. The 19 samples were also examined under a microscope and all samples showed a rod image and red color indicating that the colonies in the sample were gram-negative bacilli which are typical of the morphology of Salmonella sp. Conclusion: Contamination of Salmonella was found in pork sold at Traditional Markets in Denpasar with a prevalence of 21%. Latar belakang: Kontaminasi makanan merupakan suatu masalah serius. Salmonella sp merupakan salah satu bakteri penyebab utama penyakit gastrointestinal, terutama pada daging babi mentah, dikarenakan pada proses produksi dan distribusi. Pasar tradisional merupakan tempat yang sangat rawan dan beresiko cukup tinggi terhadap cemaran mikroba patogen. Tujuan penelitian ini adalah mendeteksi ada tidaknya cemaran bakteri Salmonella sp. pada daging babi yang dijual di Pasar Tradisional, khususnya di Denpasar, Bali. Metode: Penelitian ini merupakan deskriptif potong lintang, dengan sampel penelitian berupa daging babi yang dijual oleh pedagang pasar tradisional di setiap kecamatan di Kota Denpasar, Bali. Teknik penentuan sampel yang digunakan yaitu teknik cluster purposive sampling. Prosedur identifikasi kontaminasi Salmonella sp. menggunakan pemeriksaan kultur serta subkultur pada Salmonella Shigella Agar (SSA), Kultur pada media simmon citrate agar, dan identifikasi mikroskop. Hasil: Berdasarkan hasil kultur SSA dari 38 sampel daging babi, 26 sampel daging babi menunjukan adanya pertumbuhan koloni, namun hanya 10 sampel dengan morfologi khas Salmonella sp. Pada 16 sampel dengan morfologi tidak khas dilakukan pemeriksaan subkultur SSA, dengan 9 sampel memiliki warna koloni hitam bening. Pada 19 sampel penelitian yang menunjukan hasil terduga terkontaminasi Salmonella sp. dilanjutkan ke uji Simmons citrate, namun hanya 8 sampel dengan hasil positif. Pada 19 sampel juga dilakukan pemeriksaan mikroskop dan seluruh sampel menunjukkan gambaran batang serta berwarna merah yang menandakan bahwa koloni pada sampel adalah basil gram negatif yang khas pada morfologi bakteri Salmonella sp. Kesimpulan: Terdapat cemaran patogen Salmonella sp. pada daging babi yang dijual di Pasar Tradisional di Denpasar dengan prevalensi sebesar 21%.
Terdapat banyak informasi hoax di bidang kesehatan yang sangat menyulitkan teman-teman di layanan primer dalam melakukan upaya pencegahan penyakit, terutama penyakit COVID-19. Informasi hoax yang tersebat seperti menyatakan bahwa COVID-19 adalah bentuk konspirasi bisnis, hingga penolakan terhadap vaksinasi membawa dampak pada kesulitan menyelesaikan masalah pandemic ini. Berita hoax yang tersebar lebih banyak dibuat oleh orang-rang yang tidak paham akan kesehatan, seperti kalangan artis atau selebgram yang rata-rata memiliki follower dalam jumlah besar. Sementara para dokter dan tenaga kesehatan yang ahli dalam bidangnya seolah tak bisa meluruskan informasi tersebut karena belum banyak yang paham dan percaya diri untuk memanfaatkan media social dalam edukasi kesehatan. Untuk itulah buku ini kami susun bersama para narasumber pelatihan dengan harapan para dokter dan tenaga kesehatan di layanan primer yang belum sempat mengikuti kegiatan pelatihan juga dapat memiliki pengetahuan, kemampuan dan rasa percaya diri untuk merancang media edukasi online. Buku ini nantinya juga akan kami gunakan sebagai bahan referensi dalam mengajarkan materi promosi kesehatan kepada mahasiswa Fakultas Kedokteran di semua program studi.
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