Filariasis

Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms. The adult worms only live in the human lymph system. The lymph system maintains the body's fluid balance and fights infections. Lymphatic filariasis is spread from person to person by mosquitoes.

People with the disease can suffer from lymphedema and elephantiasis and in men, swelling of the scrotum, called hydrocele. Lymphatic filariasis is a leading cause of permanent disability worldwide. Communities frequently shun and reject women and men disfigured by the disease. Affected people frequently are unable to work because of their disability, and this harms their families and their communities.




Epidemiology and Risk Factors

There are three different filarial species that can cause lymphatic filariasis in humans. Most of the infections worldwide are caused by Wuchereria bancrofti. In Asia, the disease can also be caused by Brugia malayi and Brugia timori.

The infection spreads from person to person by mosquito bites. The adult worm lives in the human lymph vessels, mates, and produces millions of microscopic worms, also known as microfilariae. Microfilariae circulate in the person's blood and infect the mosquito when it bites a person who is infected. Microfilariae grow and develop in the mosquito. When the mosquito bites another person, the larval worms pass from the mosquito into the human skin, and travel to the lymph vessels. They grow into adult worms, a process that takes 6 months or more. An adult worm lives for about five to seven years. The adult worms mate and release millions of microfilariae into the blood. People with microfilariae in their blood can serve as a source of infection to others.

A wide range of mosquitoes can transmit the parasite, depending on the geographic area. In Africa, the most common vector is Anopheles and in the Americas, it is Culex quinquefasciatus. Aedes and Mansonia can transmit the infection in the Pacific and in Asia.

Many mosquito bites over several months to years are needed to get lymphatic filariasis. People living for a long time in tropical or sub-tropical areas where the disease is common are at the greatest risk for infection. Short-term tourists have a very low risk.

Programs to eliminate lymphatic filariasis are under way in more than forty countries. These programs are reducing transmission of the filarial parasites and decreasing the risk of infection for people living in or visiting these communities.

Geographic distribution

Lymphatic filariasis affects over 120 million people in 80 countries throughout the tropics and sub-tropics of Asia, Africa, the Western Pacific, and parts of the Caribbean and South America. in the Americas, only four countries are currently known to be endemic: Haiti, the Dominican Republic, Guyana and Brazil.



Disease

Although the parasite damages the lymph system, most infected people have no symptomos and will never develop clinical symptoms. These people do not know they have lymphatic filariasis unless tested. A small percentage of persons will develop lymphedema. This is caused by fluid collection because of improper functioning of the lymph system resulting in swelling. This mostly affects the legs, but can also occur in the arms, breasts, and genitalia. Most people develop these symptoms years after being infected.

The swelling and the decreased function of the lymph system make it difficult for the body to fight germs and infections. These people will have more bacterial infections in the skin and lymph system. This causes hardening and thickening of the skin, which is called elephantiasis. Many of these bacterial infections can be prevented with appropriate skin hygiene and exercise.
Men can develop hydrocele or swelling of the scrotum after the death of an adult worm.

Filarial infection can also cause pulmonary tropical eosinophilia syndrome, although this syndrome is typically found in persons living with the disease in Asia. Symptoms of pulmonary tropical eosinophilia syndrome include cough, shortness of breath, and wheezing. The eosinophilia is often accompanied by high levels of IgE (Immunoglobulin E) and antifilarial antibodies.

Diagnosis

The standard method for diagnosing active infection is the identification of microfilariae in a blood smear by microscopic examination. The microfilariae that cause lymphatic filariasis circulate in the blood at night (called nocturnal periodicity). Blood collection should be done at night to coincide with the appearance of the microfilariae, and a thick smear should be made and stained with Giemsa or hematoxylin and eosin. For increased sensitivity, concentration techniques can be used.
Serologic techniques provide an alternative to microscopic detection of microfilariae for the diagnosis of lymphatic filariasis. Patients with active filarial infection typically have elevated levels of antifilarial IgG4 in the blood and these can be detected using routine assays. Because lymphedema may develop many years after infection, lab tests are most likely to be negative with these patients.

Treatment

Diethylcarbamazine (DEC) is the drug of choice in the United States. The drug kills the microfilaria and some of the adult worms. DEC has been used world-wide for more than 50 years. Because this infection is rare in the U.S., the drug is no longer licensed by the Food and Drug Administration (FDA) and cannot be sold in the U.S. Physicians can obtain the medication from CDC after confirmed positive lab results. CDC gives the physicians the choice between 1 or 12-day treatment of DEC (6 mg/kg/day). One day treatment is as effective as the 12 days regimen. DEC is generally well tolerated. Side effects are in general limited and depend on the number of microfilariae in the blood. The most common side effects are dizziness, nausea, fever, headache, or pain in muscles or joints.

Caution is needed with patients who may also have onchocerciasis and loiasis. DEC can worsen onchocercal eye disease and can cause serious adverse reactions in patients with loiasis, including encephalopathy and death. The risk and severity of the adverse reactions are related to Loa loa microfilarial density. Another treatment option is ivermectin which kills only the microfilaria.

Patients with clinical symptoms

Lymphedema and elephantiasis are not indications for DEC treatment because most people with lymphedema are not actively infected with the filarial parasite.

To prevent the lymphedema from getting worse, patients should ask their physician for a referral to a lymphedema therapist so they can be informed about some basic principles of care such as hygiene, exercise and treatment of wounds.
Patients with hydrocele may have evidence of active infection, but typically do not improve clinically following treatment with DEC. The treatment for hydrocele is surgery.

Prevention

The best way to prevent lymphatic filariasis is to avoid mosquito bites. The mosquitoes that carry the microscopic worms usually bite between the hours of dusk and dawn. If you live in an area with lymphatic filariasis:

• Sleep under a mosquito net.
  
• Wear long sleeves and trousers.
  
• Use mosquito repellent on exposed skin between dusk and dawn.
  

Another approach to prevention includes giving entire communities medicine that kills the microscopic worms -- and controlling mosquitoes. Annual mass treatment reduces the level of microfilariae in the blood and thus, diminishes transmission of infection. This is the basis of the global campaign to eliminate lymphatic filariasis.

Control

Experts consider that lymphatic filariasis can be eradicated and a global campaign to eliminate lymphatic filariasis as a public health problem is under way. The elimination strategy is based on annual treatment of whole communities with combinations of drugs that kill the microfilariae. As a result of the generous contributions of these drugs by the companies that make them, tens of millions of people are being treated each year. Since these drugs also reduce levels of infection with intestinal worms, benefits of treatment extend beyond lymphatic filariasis. Successful campaigns to eliminate lymphatic filariasis have taken place in China and other countries.

Disadur, diringkas dan diedt dari: CDC (Centers for Disease Control and Prevention)

Rubella

Rubella — commonly known as German measles or 3-day measles — is an infection that primarily affects the skin and lymph nodes. It is caused by the rubella virus (not the same virus that causes measles), which is usually transmitted by droplets from the nose or throat that others breathe in. It can also pass through a pregnant woman's bloodstream to infect her unborn child. As this is a generally mild disease in children, the primary medical danger of rubella is the infection of pregnant women, which may cause congenital rubella syndrome in developing babies.

Before a vaccine against rubella became available in 1969, rubella epidemics occurred every 6 to 9 years. Kids ages 5 to 9 were primarily affected, and many cases of congenital rubella occurred as well. Now, due to immunization of children, there are much fewer cases of rubella and congenital rubella.

Most rubella infections today appear in young, non-immunized adults rather than children. In fact, experts estimate that 10% of young adults are currently susceptible to rubella, which could pose a danger to any children they might have someday.

Signs and Symptoms



Rubella infection may begin with 1 or 2 days of mild fever (99–100° Fahrenheit, or 37.2–37.8° Celsius) and swollen, tender lymph nodes, usually in the back of the neck or behind the ears. A rash then appears that begins on the face and spreads downward. As it spreads down the body, it usually clears on the face. This rash is often the first sign of illness that a parent notices.

The rubella rash can look like many other viral rashes. It appears as either pink or light red spots, which may merge to form evenly colored patches. The rash can itch and lasts up to 3 days. As the rash clears, the affected skin occasionally sheds in very fine flakes.

Other symptoms of rubella, which are more common in teens and adults, may include: headache; loss of appetite; mild conjunctivitis (inflammation of the lining of the eyelids and eyeballs); a stuffy or runny nose; swollen lymph nodes in other parts of the body; and pain and swelling in the joints (especially in young women). Many people with rubella have few or no symptoms at all.

When rubella occurs in a pregnant woman, it may cause congenital rubella syndrome, with potentially devastating consequences for the developing fetus. Children who are infected with rubella before birth are at risk for growth retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone marrow problems.

Contagiousness

The rubella virus passes from person to person through tiny drops of fluid from the nose and throat. People who have rubella are most contagious from 1 week before to 1 week after the rash appears. Someone who is infected but has no symptoms can still spread the virus.

Infants who have congenital rubella syndrome can shed the virus in urine and fluid from the nose and throat for a year or more and may pass the virus to people who have not been immunized.

Prevention

Rubella can be prevented by a rubella vaccine. Widespread immunization against rubella is critical to controlling the spread of the disease, thereby preventing birth defects caused by congenital rubella syndrome.

The vaccine is usually given to children at 12 to 15 months of age as part of the scheduled measles-mumps-rubella (MMR) immunization. A second dose of MMR is generally given at 4 to 6 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor will have the most current information.

The rubella vaccine should not be given to pregnant women or to a woman who may become pregnant within 1 month of receiving the vaccine. If you are thinking about becoming pregnant, make sure that you are immune to rubella through a blood test or proof of immunization. If you're not immune, you should receive the vaccine at least 1 month before you become pregnant.
Pregnant women who are not immune should avoid anyone who has the illness and should be vaccinated after delivery so that they will be immune during any future pregnancies.

Incubation

The incubation period for rubella is 14–23 days, with an average incubation period of 16–18 days. This means that it can take 2–3 weeks for a child to get rubella after they are exposed to someone with the disease.

Duration

The rubella rash typically lasts 3 days. Lymph nodes may remain swollen for a week or more, and joint pain can last for more than 2 weeks. Children who have rubella usually recover within 1 week, but adults may take longer.

Professional Treatment

Rubella cannot be treated with antibiotics because antibiotics do not work against viral infections. Unless there are complications, rubella will resolve on its own.

Any pregnant woman who has been exposed to rubella should contact her obstetrician immediately.

Home Treatment

Rubella is typically a mild illness, especially in kids. Infected children usually can be cared for at home. Monitor your child's temperature, and call the doctor if the fever climbs too high.

To relieve minor discomfort, you can give your child acetaminophen or ibuprofen. Avoid giving aspirin to a child who has a viral illness because its use in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death.

When to Call the Doctor

Call the doctor if your child develops a fever of 102° Fahrenheit (38.9° Celsius) or above (in a child younger than 6 months, call for a fever above 100.4° Fahrenheit, or 38° Celsius), or if your child appears to be getting sicker than the mild course of symptoms described above.

Reviewed by: Larissa Hirsch, MD
Source: KidsHealth, picture from Wikipedia.

Leptospirosis

What is leptospirosis?

Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus Leptospira. In humans it causes a wide range of symptoms, and some infected persons may have no symptoms at all. Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, and vomiting, and may include jaundice (yellow skin and eyes), red eyes, abdominal pain, diarrhea, or a rash. If the disease is not treated, the patient could develop kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, and respiratory distress. In rare cases death occurs.

Many of these symptoms can be mistaken for other diseases. Leptospirosis is confirmed by laboratory testing of a blood or urine sample.

How do people get leptospirosis?

Outbreaks of leptospirosis are usually caused by exposure to water contaminated with the urine of infected animals. Many different kinds of animals carry the bacterium; they may become sick but sometimes have no symptoms. Leptospira organisms have been found in cattle, pigs, horses, dogs, rodents, and wild animals. Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water or through skin contact, especially with mucosal surfaces, such as the eyes or nose, or with broken skin. The disease is not known to be spread from person to person.

How long is it between the time of exposure and when people become sick?

The time between a person's exposure to a contaminated source and becoming sick is 2 days to 4 weeks. Illness usually begins abruptly with fever and other symptoms. Leptospirosis may occur in two phases; after the first phase, with fever, chills, headache, muscle aches, vomiting, or diarrhea, the patient may recover for a time but become ill again. If a second phase occurs, it is more severe; the person may have kidney or liver failure or meningitis. This phase is also called Weil's disease.

The illness lasts from a few days to 3 weeks or longer. Without treatment, recovery may take several months.

Where is leptospirosis found?

Leptospirosis occurs worldwide but is most common in temperate or tropical climates. It is an occupational hazard for many people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, fish workers, dairy farmers, or military personnel. It is a recreational hazard for campers or those who participate in outdoor sports in contaminated areas and has been associated with swimming, wading, and whitewater rafting in contaminated lakes and rivers. The incidence is also increasing among urban children.

How is leptospirosis treated?

Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which should be given early in the course of the disease. Intravenous antibiotics may be required for persons with more severe symptoms. Persons with symptoms suggestive of leptospirosis should contact a health care provider.

Can leptospirosis be prevented?

The risk of acquiring leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine.

Protective clothing or footwear should be worn by those exposed to contaminated water or soil because of their job or recreational activities.

Content source: National Center for Immunization and Respiratory Diseases: Division of Bacterial Diseases

Dengue and Dengue Hemorrhagic Fever (DHF)

What is dengue?

Dengue (pronounced den' gee) is a disease caused by any one of four closely related viruses (DEN-1, DEN-2, DEN-3, or DEN-4). The viruses are transmitted to humans by the bite of an infected mosquito. In the Western Hemisphere, the Aedes aegypti mosquito is the most important transmitter or vector of dengue viruses, although a 2001 outbreak in Hawaii was transmitted by Aedes albopictus. It is estimated that there are over 100 million cases of dengue worldwide each year.

What is dengue hemorrhagic fever (DHF)?

DHF is a more severe form of dengue. It can be fatal if unrecognized and not properly treated. DHF is caused by infection with the same viruses that cause dengue. With good medical management, mortality due to DHF can be less than 1%.

How are dengue and dengue hemorrhagic fever (DHF) spread?

Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue or DHF and after about a week can transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person.



What are the symptoms of the disease?

The principal symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain, and rash. Generally, younger children have a milder illness than older children and adults.

Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. The smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected.

What is the treatment for dengue?

There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician.

Is there an effective treatment for dengue hemorrhagic fever (DHF)?

As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalization is frequently required in order to adequately manage DHF. Physicians who suspect that a patient has DHF may want to consult the Dengue Branch at CDC, for more information.

Where can outbreaks of dengue occur?

Outbreaks of dengue occur primarily in areas where Aedes aegypti (sometimes also Aedes albopictus) mosquitoes live. This includes most tropical urban areas of the world. Dengue viruses may be introduced into areas by travelers who become infected while visiting other areas of the tropics where dengue commonly exists.

In the America region, all dengue virus serotypes are now present. DEN-3 was reintroduced into Central America in 1994 and is now found in several countries in the region. Since this serotype has been absent from the Americas for almost 20 years, the population has a low level of immunity and the virus is expected to spread rapidly.

What can be done to reduce the risk of acquiring dengue?

There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Aedes aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water.
Items that collect rainwater or are used to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and scoured at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas.

For travelers to areas with dengue, a well as people living in areas with dengue, the risk of being bitten by mosquitoes indoors is reduced by utilization of air conditioning or windows and doors that are screened. Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. The risk of dengue infection for international travelers appears to be small, unless an epidemic is in progress.

How can we prevent epidemics of dengue hemorrhagic fever (DHF)?

The emphasis for dengue prevention is on sustainable, community-based, integrated mosquito control, with limited reliance on insecticides (chemical larvicides and adulticides). Preventing epidemic disease requires a coordinated community effort to increase awareness about dengue/DHF, how to recognize it, and how to control the mosquito that transmits it. Residents are responsible for keeping their yards and patios free of sites where mosquitoes can be produced.

Source: Centers for Disease Control and Prevention (CDC)

Chikungunya

Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes. Chikungunya virus was first isolated from the blood of a febrile patient in Tanzania in 1953, and has since been cited as the cause of numerous human epidemics in many areas of Africa and Asia, and most recently in a limited area of Europe.

What causes chikungunya fever?

Chikungunya fever is caused by a virus which belongs to the genus Alphavirus, in the family Togaviridae.

How do humans become infected with chikungunya virus?

Humans become infected with chikungunya virus by the bite of an infected mosquito. Aedes aegypti, a household container breeder and aggressive daytime biter which is attracted to humans, is the primary vector of chikungunya virus to humans. Aedes albopictus has also played a role in human transmission.

What can people do to prevent becoming infected with chikungunya virus?

The best way to prevent chikungunya virus infection is to avoid mosquito bites. There is no vaccine or preventive drug currently available. Prevention tips are similar to those for other viral diseases transmitted by mosquitoes, such as dengue or West Nile:

• Use insect repellent containing DEET, Picaridin, oil of lemon eucalyptus, or IR3535 on exposed skin. Always follow the directions on the package.
  
  
• Wear long sleeves and pants (ideally treat clothes with permethrin or another repellent).
  
  
• Have secure screens on windows and doors to keep mosquitoes out.
  
  
• Get rid of mosquito sources in your yard by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used.
  
  
• Additionally, a person with chikungunya fever should limit their exposure to mosquito bites to avoid further spreading the infection. The person should use repellents when outdoors exposed to mosquito bites or stay indoors in areas with screens or under a mosquito net.

What is the basic chikungunya virus transmission cycle?

Mosquitoes become infected with chikungunya virus when they feed on an infected person. Infected mosquitoes can then spread the virus to other humans when they bite them. Monkeys, and possibly other wild animals, may also serve as reservoirs of the virus. Aedes aegypti, a household container breeder and aggressive daytime biter which is attracted to humans, is the primary vector of chikungunya virus to humans. Aedes albopictus (the Asian tiger mosquito) has also played a role in human transmission is Asia, Africa, and Europe. Various forest-dwelling mosquito species in Africa have been found to be infected with the virus.

What type of illness does chikungunya virus cause?

Chikungunya virus infection can cause a debilitating illness, most often characterized by fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. “Silent” chikungunya virus infections (infections without illness) do occur; but how commonly this happens is not yet known. Chikungunya virus infection (whether clinically apparent or silent) is thought to confer life-long immunity. Acute chikungunya fever typically lasts a few days to a couple of weeks, but as with dengue, West Nile fever, o'nyong-nyong fever and other arboviral fevers, some patients have prolonged fatigue lasting several weeks. Additionally, some patients have reported incapacitating joint pain, or arthritis which may last for weeks or months.

What is the incubation period for chikungunya fever?

The incubation period (time from infection to illness) can be 2-12 days, but is usually 3-7 days.

Can pregnant women become infected with chikungunya virus and pass the infection to their child?

Pregnant women can become infected with chikungunya virus during all stages of pregnancy and have symptoms similar to other individuals. Most infections will not result in the virus being transmitted to the fetus. The highest risk for infection of the fetus/child occurs when a woman has virus in her blood (viremic) at the time of delivery. There are also rare reports of first trimester abortions occurring after chikungunya infection. Pregnant women should take precautions to avoid mosquito bites. Products containing DEET can be used in pregnancy without adverse effects.

Can the virus be transmitted to a child by breastfeeding?

Currently, there is no evidence that the virus is transmitted through breast milk

What is the mortality rate of chikungunya fever?

Fatalities related to chikungunya virus are rare and appear to be associated to increased age.

How is chikungunya virus infection treated?

There is no vaccine or specific antiviral treatment currently available for chikungunya fever. Treatment is symptomatic and can include rest, fluids, and medicines to relieve symptoms of fever and aching such as ibuprofen, naproxen, acetaminophen, or paracetamol. Aspirin should be avoided. Infected persons should be protected from further mosquito exposure (staying indoors in areas with screens and/or under a mosquito net) during the first few days of the illness so they can not contribute to the transmission cycle.

Where does chikungunya virus occur?

The geographic range of the virus is primarily in Africa and Asia. Given the current large chikungunya virus epidemics and the world wide distribution of Aedes aegypti and Aedes albopictus, there is a risk of importation of chikungunya virus into new areas by infected travelers.


--------------------------------------------------------------------------------
Source:
Division of Vector Borne Infectious Diseases
National Center for Zoonotic, Vector-Borne, and Enteric Diseases

Legionnaires' disease

What is Legionnaires' disease?

Legionnaires' disease (LEE-juh-nares) is caused by a type of bacteria called Legionella. The bacteria got its name in 1976, when many people who went to a Philadelphia convention of the American Legion suffered from an outbreak of this disease, a type of pneumonia (lung infection). Although this type of bacteria was around before1976, more illness from Legionnaires' disease is being detected now. This is because we are now looking for this disease whenever a patient has pneumonia.

Each year, between 8,000 and 18,000 people are hospitalized with Legionnaires' disease in the U.S. However, many infections are not diagnosed or reported, so this number may be higher. More illness is usually found in the summer and early fall, but it can happen any time of year.

What are the symptoms of Legionnaires' disease?

Legionnaires' disease can have symptoms like many other forms of pneumonia, so it can be hard to diagnose at first. Signs of the disease can include: a high fever, chills, and a cough. Some people may also suffer from muscle aches and headaches. Chest X-rays are needed to find the pneumonia caused by the bacteria, and other tests can be done on sputum (phlegm), as well as blood or urine to find evidence of the bacteria in the body.

These symptoms usually begin 2 to 14 days after being exposed to the bacteria.

A milder infection caused by the same type of Legionella bacteria is called Pontiac Fever . The symptoms of Pontiac Fever usually last for 2 to 5 days and may also include fever, headaches, and muscle aches; however, there is no pneumonia. Symptoms go away on their own without treatment and without causing further problems.

Pontiac Fever and Legionnaires' disease may also be called "Legionellosis" (LEE-juh-nuh-low-sis) separately or together.

How serious is it? What is the treatment?

Legionnaires' disease can be very serious and can cause death in up to 5% to 30% of cases. Most cases can be treated successfully with antibiotics [drugs that kill bacteria in the body], and healthy people usually recover from infection.

Where do Legionella bacteria come from?

The Legionella bacteria are found naturally in the environment, usually in water. The bacteria grow best in warm water, like the kind found in hot tubs, cooling towers, hot water tanks, large plumbing systems, or parts of the air-conditioning systems of large buildings. They do not seem to grow in car or window air-conditioners.

How do people get Legionnaires' disease?

People get Legionnaires' disease when they breathe in a mist or vapor (small droplets of water in the air) that has been contaminated with the bacteria. One example might be from breathing in the steam from a whirlpool spa that has not been properly cleaned and disinfected.

The bacteria are NOT spread from one person to another person.

Outbreaks are when two or more people become ill in the same place at about the same time, such as patients in hospitals. Hospital buildings have complex water systems, and many people in hospitals already have illnesses that increase their risk for Legionella infection.

Other outbreaks have been linked to aerosol sources in the community, or with cruise ships and hotels, with the most likely sources being whirlpool spas, cooling towers (air-conditioning units from large buildings), and water used for drinking and bathing.

Who gets this disease?

People most at risk of getting sick from the bacteria are older people (usually 65 years of age or older), as well as people who are smokers, or those who have a chronic lung disease (like emphysema).

People who have weak immune systems from diseases like cancer, diabetes, or kidney failure are also more likely to get sick from Legionella bacteria. People who take drugs to suppress (weaken) the immune system (like after a transplant operation or chemotherapy) are also at higher risk.

What should I do if I think I was exposed to Legionella bacteria?

Most people exposed to the bacteria do not become ill. If you have reason to believe you were exposed to the bacteria, talk to your doctor or local health department. Be sure to mention if you have traveled in the last two weeks.

A person diagnosed with Legionnaires' disease in the workplace is not a threat to others who share office space or other areas with him or her. However, if you believe that there your workplace was the source of the person's illness, contact your local health department.

How is Legionnaires’ disease diagnosed?

Most people with Legionnaires’ disease will have pneumonia (lung infection) since the Legionella bacteria grow and thrive in the lungs. Pneumonia is confirmed either by chest x-ray or clinical diagnosis. Several laboratory tests can be used to detect the Legionella bacteria within the body. The most commonly used laboratory test for diagnosis is the urinary antigen test, which detects Legionella bacteria from a urine specimen, or sample. If the patient has pneumonia and the test is positive, then the patient is considered to have Legionnaires’ disease. Additionally, if the Legionella bacteria are cultured (isolated and grown on a special media) from a lung biopsy specimen, respiratory secretions, or various other sites, the diagnosis of Legionnaires’ disease is also considered confirmed. Finally, paired sera (blood specimens) that show a specific increase in antibody levels when drawn shortly after illness and several weeks following recovery, can also be used to confirm the diagnosis.

CDC

FILARIASIS
( Prof Dr Saleha Sungkar MS SpPar DAP&E )

Penyebab
Penyakit ini disebabkan oleh cacing Wuchereria bancrofti, Brugia malayi dan Brugia timori.
Cacing Wuchereria bancrofti dapat hidup sampai 6-10 tahun. Cacing dewasanya hidup di dalam saluran atau kelenjar limfe manusia.
Sedangkan mikrofilaria ( larva cacing ) mempunyai periodisitas tertentu, artinya dapat beredar dalam darah hanya pada saat tertentu.

Penularan
Penularan penyakit ini adalah melalui gigitan nyamuk.
Hampir semua jenis nyamuk dapat menularkan cacing filariasis, oleh sebab itu, berbeda dengan penyakit DBD dan malaria, pengendalian nyamuk sebagai usaha penanggulangan filariasis tidak efektif.

Gejala
Penyakit ini pada stadium awal sering tidak menunjukkan gejal.
Bila ada gejala pada stadium akut, biasanya berupa demam berulang yang disertai radang kelenjar dan saluran limfe.
Gejala tersebut dapat hilang timbul selama beberapa hari sampai 2 minggu.
Pada laki laki sering juga ditemukan radang kelenjar limfe pada alat kelamin.
Sedangkan pada stadium kronis baru penderita mengeluhkan adanya pembesaran akibat penumpukan cairan pada kantung buah zakar ( hidrokel ) atau elephantiasis ( pembesaran akibat penyumbatan dan radang saluran dan kelenjar limfe ) pada seluruh tungkai atau lengan, payudara, kantung buah zakar ( scrotum ) dan daerah sekitar kemaluan wanita ( vulva ).
Pada stadium ini, semua perubahan/pembesaran yang terjadi tidak dapat kembali normal, kecuali dilakukan operasi.

Deteksi dan penapisan
Diagnosis filariasis ditegakkan dengan pemeriksaan darah.
Pemeriksaan penapisan juga menggunakan metode yang sama. Tujuannya adalah untuk mencari mikrofilaria yang beredar dalam darah, karena mencari cacing dewasa sangat tidak mudah, mengingat habibatnya di dalam kelenjar atau saluran limfe.
Pengambilan darah harus dilakukan pada malam hari, pada pukul 8 malam sampai tengah malam, karena pada periode itulah mikrofilaria berkeliaran dalam darah.
Diluar waktu tersebut, mikrofilaria bersembunyi di dalam organ tubuh.

Terapi
Tujuannya adalah membasmi cacing beserta larva yang berkembang dalam tubuh penderita, sehingga tingkat penularannya dapat ditekan.
Dietilkarbamasin ( DEC ) masih menjadi pilihan utama pengobatan filariasis, karena obat ini dapat membunuh cacing dan larva.

PENGOBATAN MASSAL FILARIASIS AMAN
Obat yang diberikan pada pengobatan massal filariasis adalah DEC dan albendazol yang sudah dari dulu digunakan sebagai obat cacing,
Keduanya diberikan satu kali ( dosis tunggal ) setiap 1 tahun selama 5 tahun, dengan dosis 6 mg/kgBB untuk DEC dan 400 mg untuk albendazol.

DEC diminum sesudah makan serta aman untuk ibi hamil dan menyusui.
Albendazol tidak boleh diberikan kepada ibu hamil.

Efek samping tidak terjadi pada setiap orang.
Keluhan yang dapat muncul adalah sakit kepala, demam, lemas, mual dan muntah.
Semakin banyak cacing filariasis yang bersemayam dalam tubuh, maka semakin berat efek samping yang dirasakan, tetapi TIDAK PERNAH dilaporkan adanya kematian akibat pengobatan ini di seluruh dunia.

Efek samping yang muncul sebenarnya merupakan reaksi tubuh terhadap mikrofilaria dan cacing yang mati.
Reaksi tersebut biasanya hanya berlangsung 2-3 hari.
Jika keluhan bertahan lebih dari 7 hari maka keluhan tersebut tidak terkait dengan obat filariasis.

Keluhan efek samping akan menjadi lebih ringan pada pengobatan tahun berikutnya dibandingkan dengan pada pengobatan pertama karena mikrofilarianya sudah berkurang jumlahnya.

Obat filariasis tidak boleh diberikan pada orang yang menderita gagal ginjal dan gagal hati ( sirosis )

Meskipun pada penapisan hanya sedikit orang yang ditemukan mikrofilaria dalam darahnya, seluruh penduduk didaerah tersebut harus ikut diobati, meski hasil testnya negatif, karena bisa saja pada saat pemeriksaan hasil test darahnya negatif palsu karena mikrofilaria sedang ngumpet.
Pengobatan massal adalah program WHO.

Sumber: Dokter Kita edisi 1 - Thn V - Januari 2010

40 JUTA PENDUDUK INDONESIA BERPOTENSI KENA KAKI GAJAH
Rabu, 18/11/2009 17:00 WIB Nurul Ulfah - detikHealth
Jakarta, Jika tidak ada penanganan penyakit filariasis secara menyeluruh maka akan ada 40 juta warga Indonesia yang terkena kaki gajah. Penyakit Kaki Gajah sulit dicegah karena gejala awalnya tidak terlihat. Penyakit kaki gajah baru timbul setelah larva cacing ditubuh hidup selama 1 tahun atau lebih. Penyakit kaki gajah tidak datang secara tiba-tiba melainkan butuh waktu bertahun-tahun sampai si larva cacing (mikrofilaria) menyumbat pembuluh limfe yang kemudian menyebabkan pembengkakan organ.

Potensi 40 juta penduduk yang terkena kaki gajah ini berdasarkan hasil survei departemen kesehatan hingga tahun 2008 di 361 kabupaten di Indonesia yang menemukan 11.699 kasus filariasis. "Tapi itu hanya yang terdeteksi, di luar sana masih banyak yang menutup-nutupi penyakitnya itu. Jika dilakukan pemetaan, prevalensi kasus filariasis ini adalah sebesar 19 persen. Artinya 40 juta orang di Indonesia berpotensi mengalami kaki gajah," jelas ujar Menteri Kesehatan RI, Endang Rahayu Sedyaningsih dalam acara jumpa pers hasil investigasi kasus filariasis di gedung Departeman Kesehatan RI, Jakarta, Rabu (18/11/2009).

Terdapat tiga jenis potensi pembengkakan organ akibat cacing filaria yaitu pada bagian kaki, lengan dan alat kelamin. Penyakit ini berasal dari tiga jenis cacing filaria yaitu Wuchereria bancrofti, Brugia malayi dan Brugia timori. Untuk mencegah meluasnya penyakit kaki gajah Depkes akan tetap meneruskan program pengobatan massal yang telah digelar sejak tahun 2002 hingga tuntas 2020. "Pengobatan massal ini sudah dijalankan dari tahun 2002 dan akan tetap dilanjutkan hingga 2020, karena sudah masuk target MDGs (Millenium Development Goals)," ujar Menkes. Menkes mengatakan bahwa kasus meninggalnya 8 warga Bandung serta ratusan lainnya yang harus dilarikan ke rumah sakit tidak ada hubungannya dengan pengobatan massal.

"Kami juga sudah dapat laporan dari BPOM bahwa obat yang diberikan pada warga itu aman, memenuhi syarat dan tidak kadaluarsa. Prosedur yang dijalankan pun sudah benar. Adapun efek samping yang dikeluhkan warga itu adalah efek samping akibat matinya cacing di dalam usus," ujar Menkes. Sementara ahli onkologi Prof Purwanti Astuti mengatakan penyebab meninggalnya 8 orang warga Bandung dan ratusan warga lainnya yang dilarikan ke rumah sakit karena keluhan efek samping setelah pengobatan kaki gajah adalah sebagai berikut:

1. Dari 8 kasus yang meninggal, 3 kasus bukan diakibatkan oleh obat kaki gajah karena ternyata mereka terbukti tidak mengonsumsi obat tersebut. Sedangkan 5 kasus lagi diakibatkan karena kebetulan punya penyakit lain, seperti jantung dan stroke.
2. Warga Bandung banyak yang tidak terbiasa makan pagi-pagi sehingga mengonsumsi obat tanpa makan terlebih dahulu
3. Banyaknya warga yang pergi ke rumah sakit disebabkan karena ketakutan berlebih terhadap efek samping yang mereka rasakan atau sekedar ikut-ikutan terpengaruh tetangga lainnya.

"Banyak warga yang terlalu takut dengan efek samping seperti mual, muntah, pusing dan sesak di ulu hati. Padahal itu adalah pertanda bahwa obat tersebut berhasil membunuh cacing filaria dalam tubuh. Dan efek itu hanya berlangsung selama 3 hari, setelah itu hilang sendiri," jelas Astuti. Astuti juga menambahkan bahwa pemberian obat Diethyl Carbamazine Citrate (DEC) dan Albendazole untuk mencegah penyebaran larva mikrofilaria dari caing filaria sudah dalam dosis yang sangat rendah.

"Kita memberikannya sesuai prosedur WHO, yaitu 6 mg/kg berat badan untuk DEC dan 400 mg untuk Albendazole, dikonsumsi 3 kali sehari. Itu sudah dosis yang menghasilkan efek samping paling rendah. Dulu, obat itu harus diminum 7 hari, sehingga banyak yang malas dan tidak meneruskan minum. Jadi sampai sekarang jumlah penderitanya masih cukup tinggi," tambahnya.

CARA MENGHINDARI PENYAKIT KAKI GAJAH
Rabu, 18/11/2009 18:30 WIB Nurul Ulfah - detikHealth
Jakarta, Kaki gajah adalah penyakit akibat larva cacing filaria yang ditularkan oleh nyamuk, baik itu nyamuk rumah, got, hutan atau rawa. Cari tahu cara menghindarinya karena kalau sudah kena dan kaki terlanjur bengkak seperti gajah sulit untuk kembali normal dan menanggung derita seumur hidup. "Penyakit kaki gajah adalah penyakit yang sangat menyeramkan, karena selain mengganggu penampilan dan menyulitkan aktivitas, penderita juga biasanya mendapat stigma buruk dari lingkungan," ujar ahli penyakit dalam, Prof Nelwan SpPD dalam acara jumpa pers hasil investigasi kasus filariasis di gedung Departeman Kesehatan RI, Jakarta, Rabu (18/11/2009).

"Tapi yang harus diketahui masyarakat adalah, seseorang yang sudah menderita kaki gajah atau yang kakinya sudah bengkak luar biasa, tidak bisa menularkan penyakitnya lagi. Justru mereka yang kelihatannya sehat dan belum mengalami pembengkakan, tapi punya larva mikrofilarialah yang bisa menularkan penyakit itu pada orang lain," ujar Dr Solah, ahli epidemiologi yang juga hadir pada kesempatan itu. Masalahnya adalah, kita tidak pernah bisa tahu orang sehat mana saja yang sudah terinfeksi larva mikrofilaria. Padahal tiap hari nyamuk berkeliaran di sekitar kita. Oleh karena itu, seseorang dianjurkan untuk sebisa mungkin menghindari gigitan nyamuk dimana saja.

Sementara itu, ahli parasitologi Prof. Saleha Sungkar, MD, DAP&E, MS mengatakan bahwa yang menjadi penyebab kaki gajah sendiri bukanlah larva cacing filaria, tapi anak cacing filaria itu, yang disebut dengan larva mikrofilaria. Untuk mengetahui apakah seseorang punya larva itu atau tidak, perlu dilakukan pemeriksaan larva dalam tubuh. Namun larva itu hanya bisa terdeteksi malam hari, karena mikrofilaria hanya keluar pada malam hari saja. "Jadi kalau mau dites harus malam hari, antara waktu magrib sampai subuh," jelasnya.

Menurut Prof. Saleha, cacing yang hidup dalam tubuh manusia itu seperti parasit. "Mereka hanya numpang, tidak berniat membunuh. Tapi dengan kehadiran mereka dalam tubuh, metabolisme tubuh jadi terganggu," katanya. Kalau cacingnya filaria, maka larva mikrofilaria yang dibawa oleh nyamuk akan menyumbat pembuluh dan kelenjar limfe sehingga tidak bisa mengalir ke seluruh bagian tubuh dengan lancar. Akibatnya, terjadilah pembengkakan organ tubuh, seperti pada lengan, kaki atau alat kelamin.

Seseorang yang sudah terinfeksi larva mikrofilaria selam 10-14 hari adalah mereka yang paling berisiko sebagai mesin penular penyakit kaki gajah. "Mereka masih kelihatan normal dan tidak bergejala. Jadi satu-satunya cara untuk mencegah penularannya adalah memutus rantai penyebaran menggunakan obat. Ini akan lebih mudah ketimbang membunuh nyamuk pembawa larva itu yang jumlahnya sangat banyak," jelas Saleha.

Pada tahap awal, biasanya penderita akan mengalami demam berulang, ada benjolan yang terasa nyeri pada lipatan paha atau ketiak, dan teraba adanya urat seperti tali yang berwarna merah dan sakit mulai dari pangkal paha atau ketiak. Sedangkan pada tahap lanjut (kronis) akan terjadi pembesaran yang hilang timbul pada kaki, tangan, kantong buah zakar, payudara dan alat kelamin wanita. "Kalau benjolannya ditekan tapi balik lagi, itu masih bisa diobati dan disembuhkan total. Tapi jika sudah sangat parah bisa dioperasi, tapi itu pun hanya untuk memperbaiki penampilan saja, tidak bisa kembali ke bentuk normalnya," ujar Saleha.

Untuk itu, penggunaan obat Diethyl Carbamazine Citrate (DEC) dan Albendazole untuk mencegah penyebaran larva mikrofilaria sangat dianjurkan, terutama di daerah yang sudah mencapai tingkat endemi. "Disebut daerah endemi jika tingkat penyebarannya mencapai 1 persen. Makanya kami memutuskan melakukan pengobatan massal di daerah Bandung karena tingkat endeminya sudah 2 persen," jelas Dirjen PP&PL, Prof Tjandra Yoga.

Konsumsi obat harus dilakukan terus menerus selama setahun sekali, jika sudah 5 tahun cacing baru benar-benar mati. Meski ada efek samping setelah konsumsi obat, namun efek itu akan hilang dalam waktu 3-4 hari. "Lebih baik menderita 3 hari daripada menderita seumur hidup gara-gara penyakit itu," kata Saleha.
Ada beberapa tempat yang dapat menjadi sarang nyamuk penular kaki gajah yaitu hutan, tanaman air, got/saluran air, rawa-rawa, hutan bakau dan sawah.
Agar aman dari gigitan nyamuk penyebab kaki gajah, cegah dengan cara:

1. Tidur menggunakan kelambu
2. Lubang angin (ventilasi) rumah ditutup kawat kasa halus
3. Memasang obat nyamuk
4. Memakai obat gosok anti nyamuk
5. Membersihkan tempat-tempat perindukan nyamuk
6. Melakukan penyemprotan untuk membunuh nyamuk dewasa
7. Mengikuti program pengobatan massal filariasis di puskesmas
8. Memeriksa diri ke puskesmas atau dokter bila tetangga atau keluarga terkena filariasis

WABAH KOLERA KEMBALI MUNCUL DIDUNIA
Sabtu, 21 Agustus 2010 | 05:37 WIB
GENEVA, KOMPAS.com - Kolera kembali muncul di beberapa bagian dunia. Seorang ahli Organisasi Kesehatan Dunia atau WHO, Kamis (19/Cool, mengatakan, wabah kini sedang terjadi di Nigeria dan Kamerun. Koordinator kelompok WHO mengenai kolera, Claire-Lise Chaignat, mengatakan, tercatat 2.849 kasus kolera di Kamerun, termasuk 222 orang yang tewas sejak Mei. WHO juga mencatat 837 kasus kolera di Nigeria utara sejak pertengahan Juni, termasuk 30 korban tewas. ”Angka kematian akibat kolera di negara-negara itu antara lain 3,6 persen dari total infeksi di Nigeria dan 7,8 persen di Kamerun. Angka ini terlalu tinggi dibandingkan dengan ambang 1,0 persen yang lazim,” tambahnya.

Menteri Kesehatan Nigeria Onyebuchi Chukwu, Kamis, juga mengumumkan jumlah korban yang jauh lebih tinggi. Dia mengatakan, korban tewas telah meningkat menjadi 231 orang dari total 4.600 orang yang terinfeksi. ”Sampai dua atau tiga hari lalu, angka yang kami miliki di Kementerian Kesehatan adalah 4.600 orang terinfeksi kolera di beberapa negara bagian. Dari orang yang terinfeksi itu, 231 telah tewas,” katanya dalam sebuah wawancara BBC.

Korban tewas
Para pejabat Nigeria di Bauchi dan Borno sebelumnya menyebutkan jumlah korban tewas 107 orang.
Kolera menyebabkan diare dan muntah parah. Hal ini mengakibatkan dehidrasi. Dengan masa inkubasi singkat, kolera bisa fatal kalau tidak ditangani tepat waktu.
Chaignat mengatakan, ”Secara global, kolera berkembang di seluruh dunia.” Wabah juga dilaporkan terjadi di Provinsi Sud-Kivu, Republik Demokratik Kongo, serta di Laos, Uganda, Djibouti, Afganistan, Nepal, dan Papua Niugini. ”Ini adalah penyakit orang miskin, sebuah tanda ketiadaan akses ke air minum bersih dan buruknya higiene,” tambah Chaignat. ”Kolera berbeda dengan penyakit-penyakit lain, bisa menimbulkan panik karena kematian bisa terjadi dalam beberapa jam.”

Air tercemar
Kolera ditularkan melalui air dan melalui makanan yang telah tercemar air tidak bersih. Penyakit ini juga sedang endemis di beberapa negara, seperti Pakistan yang telah terlanda banjir besar pada bulan lalu. Chaignat mengatakan, penyebaran kolera di seluruh dunia mungkin sebagian ada hubungannya dengan perubahan iklim.

Kuman itu hidup terutama di air dengan suhu 37 sampai 38 derajat celsius dan tanpa sinar matahari langsung. Infeksi sangat menular, tetapi dapat mudah dicegah dengan air bersih dan sanitasi. Pejabat kesehatan Negara Bagian Bauchi, Dr Musa Mohammed, mengatakan, lebih dari 1.700 kasus kolera dilaporkan dalam pekan-pekan terakhir. Mohammed mengatakan, infeksi itu kemungkinan besar datang dari sumur-sumur dan sumber-sumber air yang tercemar yang digunakan di daerah itu. Menurut perkiraan Badan Kesehatan PBB, sekitar 120.000 orang tewas setiap tahun di dunia karena kolera. (AFP/AP/DI)

KOLERA
Kolera adalah suatu infeksi usus kecil karena bakteri Vibrio cholerae.
Bakteri kolera menghasilkan racun yang menyebabkan usus halus melepaskan sejumlah besar cairan yang banyak mengandung garam dan mineral.
Karena bakteri sensitif terhadap asam lambung, maka penderita kekurangan asam lambung cenderung menderita penyakit ini.

Kolera menyebar melalui air yang diminum, makanan laut atau makanan lainnya yang tercemar oleh kotoran orang yang terinfeksi.
Kolera ditemukan di Asia, Timur Tengah, Afrika dan Amerika Latin. Di daerah-daerah tersebut, wabah biasanya terjadi selama musim panas dan banyak menyerang anak-anak. Di daerah lain, wabah bisa terjadi pada musim apapun dan semua usia bisa terkena.

PENYEBAB
Bakteri Vibrio cholerae.

GEJALA
Gejala dimulai dalam 1-3 hari setelah terinfeksi bakteri, bervariasi mulai dari diare ringan-tanpa komplikasi sampai diare berat-yang bisa berakibat fatal.
Beberapa orang yang terinfeksi, tidak menunjukkan gejala.

Penyakit biasanya dimulai dengan diare encer seperti air yang terjadi secara tiba-tiba, tanpa rasa sakit dan muntah-muntah.
Pada kasus yang berat, diare menyebabkan kehilangan cairan sampai 1 liter dalam 1 jam. Kehilangan cairan dan garam yang berlebihan menyebabkan dehidrasi disertai rasa haus yang hebat, kram otot, lemah dan penurunan produksi air kemih.

Banyaknya cairan yang hilang dari jaringan menyebabkan mata menjadi cekung dan kulit jari-jari tangan menjadi keriput.
Jika tidak diobati, ketidakseimbangan volume darah dan peningkatan konsentrasi garam bisa menyebabkan gagal ginjal, syok dan koma.
Gejala biasanya menghilang dalam 3-6 hari.
Kebanyakan penderita akan terbebas dari organisme ini dalam waktu 2 minggu, tetapi beberapa diantara penderita menjadi pembawa dari bakteri ini.

DIAGNOSA
Diagnosis ditegakkan berdasarkan gejala-gejalanya.
Untuk memperkuat diagnosis, dilakukan pemeriksaan terhadap apusan rektum atau contoh tinja segar.

PENGOBATAN
Yang sangat penting adalah segera mengganti kehilangan cairan, garam dan mineral dari tubuh.
Untuk penderita yang mengalami dehidrasi berat, cairan diberikan melalui infus.
Di daerah wabah, kadang-kadang cairan diberikan melalui selang yang dimasukkan lewat hidung menuju ke lambung.

Bila dehidrasi sudah diatasi, tujuan pengobatan selanjutnya adalah menggantikan jumlah cairan yang hilang karena diare dan muntah.
Makanan padat bisa diberikan setelah muntah-muntah berhenti dan nafsu makan sudah kembali.
Pengobatan awal dengan tetrasiklin atau antibiotik lainnya bisa membunuh bakteri dan biasanya akan menghentikan diare dalam 48 jam.
Lebih dari 50% penderita kolera berat yang tidak diobati meninggal dunia.
Kurang dari 1% penderita yang mendapat penggantian cairan yang adekuat, meninggal dunia.

PENCEGAHAN
Penjernihan cadangan air dan pembuangan tinja yang memenuhi standar sangat penting dalam mencegah terjadinya kolera.
Usaha lainnya adalah meminum air yang sudah terlebih dahulu dimasak dan menghindari sayuran mentah atau ikan dan kerang yang dimasak tidak sampai matang.
Vaksin kolera hanya memberikan perlindungan parsial dan secara umum tidak dianjurkan.
Pemberian antibiotik tetrasiklin bisa membantu mencegah penyakit pada orang-orang yang sama-sama menggunakan perabotan rumah dengan orang yang terinfeksi kolera.

Sumber: Medicastore

CARA MENCEGAH PENYAKIT KOLERA
Senin, 15/11/2010 11:45 WIB Irna Gustia - detikHealth
Jakarta, Ratusan orang mati mengenaskan di Haiti karena kolera. Penyakit ini memang lebih banyak terjadi di negara-negara berkembang yang fasilitas sanitasinya buruk. Bagaimana cara mencegah agar tak terkena kolera? Kolera disebabkan oleh bakteri Vibrio cholerae yang menyerang usus besar manusia dan akhirnya menjadi terinfeksi. Minimnya air bersih dan proses MCK (mandi-cuci-kakus) yang tidak memadai membuat kolera tumbuh subur. Kebiasaan makan makanan laut yang mentah atau belum matang seperti kerang juga menjadi pemicunya.

Dilansir dari Medicine.net, Senin (15/11/2010) kolera memang mirip dengan diare hanya saja tingkat keparahannya lebih tinggi atau diare akut. Tanda-tanda kolera paling umum adalah diare (buang-buang air berupa cairan) yang terus menerus, muntah dan kram kaki. Kolera bisa merenggut nyawa dalam hitungan jam jika penderita sangat cepat mengeluarkan cairan yang membuatnya dehidrasi dan shock. Diperkirakan lebih dari 100.000 kasus dan kematian terjadi setiap tahunnya di seluruh dunia.

Dimana kasus kolera paling banyak ditemukan?
Bakteri kolera biasanya ditemukan di dalam sumber air atau makanan yang telah terkontaminasi oleh feses (kotoran) dari orang yang terinfeksi kolera. Paling banyak terjadi pada daerah yang pengolahan airnya tidak memadai, sanitasi dan kebersihan yang buruk. Jarak kakus misalnya dekat dengan sumber air minum atau air sungai yang dipakai untuk MCK digunakan juga untuk memasak. Bakteri kolera juga dapat hidup di lingkungan seperti sungai payau dan perairan pesisir.Kebiasaan lain yang menimbulkan kolera adalah makan makanan kerang mentah yang banyak dilakukan masyarakat di daerah pesisir.

Bagaimana orang bisa kena kolera?
Seseorang bisa terkena kolera karena minum air atau makan makanan yang terkontaminasi dengan bakteri kolera. Ketika terjadi wabah kolera biasanya sumber kontaminasi dari kotoran (feses) orang yang terinfeksi kolera yang lalu kotoran tersebut mencemari air yang digunakan untuk makanan. Penyakit ini dapat menyebar dengan cepat di daerah yang tidak punya sistem pengelohan limbah limbah dan air minum yang memadai. Orang tidak akan terkena kolera jika hanya bersentuhan.

Berapa lama gejalanya muncul setelah orang terkena infeksi?
Jika orang terkena infeksi kolera gejalanya bisa muncul dalam beberapa jam sampai 5 hari. Tapi umumnya gejalanya muncul dalam waktu 2-3 hari.

Bagaimana dokter mendiagnosis kolera?
Untuk menguji kolera, dokter harus mengambil sampel tinja atau mengusap dubur pasien dan mengirimkannya ke laboratorium untuk mencari bakteri kolera.

Apa pengobatan untuk kolera?
Pengobatan kolera sebenarnya sangat sederhana yakni dengan segera mengganti cairan dan garam yang hilang karena pasien mengalami diare akut. Pasien dapat diobati dengan larutan gula dan garam dan diminum dalam jumlah banyak. Solusi ini digunakan di seluruh dunia untuk mengobati diare. Untuk kasus yang parah dibutuhkan penggantian cairan intravena (infus). Penggantian cairan yang cepat (rehidrasi) bisa menekan kurang dari 1 persen dari pasien meninggal akibat kolera.

Adakah vaksin untuk mencegah kolera?
Saat ini, ada dua vaksin kolera oral yang tersedia yaitu Dukoral (diproduksi oleh PME Vaksin) yang telah mendapat lisensi dari WHO untuk 60 negara. Satu lagi ShanChol (diproduksi oleh Shantha Biotec di India) dan sedang menunggu tahap prakualifikasi WHO.

Bagaimana mencegah kolera?
1. Hanya minum air matang
2. Gunakan air bersih untuk memasak, mencuci piring, sikat gigi, mandi, mencuci baju
3. Hati-hati jika mencampur minuman dengan es batu jangan menggunakan es batu dari air mentah
4. Jangan makan daging mentah atau makanan laut yang kurang matang seperti kerang
5. Kupas buah atau sayuran saat akan memakannya
6. Selalu cuci tangan sebelum dan sesudah makan.
7. Miliki fasilitas MCK dengan pembuangan limbah yang baik agar tidak mengontaminasi air bersih di sumur.

KOLERA TEWASKAN 4 WARGA PALU
Kamis, 11 Februari 2010 | 10:20 WIB
PALU, KOMPAS.com - Empat warga Desa Petimbe, Kecamatan Palolo, Kabupaten Sigi, Sulawesi Tengah, meninggal dunia akibat terkena penyakit kolera. Kepala Puskesmas Kecamatan Palolo Alexander Kantiadagho yang dihubungi wartawan dari Palu, Kamis, sebanyak 58 warga lainnya dilaporkan terjangkit penyakit mematikan itu. Keempat korban tewas adalah Koi (70), Saly (40), Ulivina (33), dan Nolfi (Cool. Mereka meninggal dunia pada hari yang berbeda. Koi dan Nolfi meninggal dunia pada Minggu (7/2), sedangkan Sally dan Ulivina meninggal dunia pada Senin (8/2). Sally dan Ulivina sendiri adalah pasangan suami istri. Keempat korban tewas itu sudah dimakamkan oleh pihak keluarganya masing-masing. Alexander Kantiadagho mengatakan, saat ini pihaknya masih merawat puluhan warga yang terserang kolera tersebut.

Sebanyak 52 pasien yang dirawat tersebut berasal dari RT VII yang total penduduknya berjumlah 80 orang. RT VII adalah daerah terpencil yang berjarak 10 km dari pusat Desa Petimbe. Sementara Petimbe berjarak 25 kilometer dari Kota Palu, Ibukota Provinsi Sulawesi Tengah. Kantiadagho menuturkan, penyebab banyaknya penderita kolera adalah minimnya kesadaran masyarakat melakukan pola hidup bersih dan sehat. Masyarakat di RT tersebut hanya mengandalkan sungai kecil untuk memenuhi kebutuhan hidup sehari-harinya, termasuk mencuci makanan.

"Berdasarkan informasi, masyarakat juga melakukan kegiatan MCK (mandi, cuci, dan kakus) di sungai itu. Itulah yang menyebabkan kolera mewabah," katanya. Kantiadagho mengatakan saat ini Dinas Kesehatan setempat sudah mendirikan posko untuk melayani warga yang terkena kolera atau yang mengalami gejala penyakit itu. "Kami juga sudah memberikan obat-obatan kepada korban guna mencegah wabah penyakit itu tidak meluas ke desa tetangga," ujarnya.

KOLERA MEWABAH 6 ORANG MENINGGAL
Kamis, 17 September 2009 | 16:29 WIB
SUKABUMI, KOMPAS.com - Wabah kolera menyerang delapan desa di Kecamatan Caringin, Kabupaten Sukabumi sejak 2 minggu lalu. Kolera menyebabkan 123 orang terserang, 6 di antaranya meninggal dunia. Kepala Dinas Kesehatan kabupaten Sukabumi Adrialti, Kamis (17/9) mengatakan, kepastian mengenai kolera sebagai penyebab diare itu diperoleh dari diagnosa Rumah Sakit Umum Daerah Sekarwangi.

"Untuk penanganan jangka pendek, sudah dibuat jamban darurat dan penyebaran kaporit di sumber-sumber air," kata Adrialti.
Untuk penanganan jangka panjang, Dinas Kesehatan berencana membuat saluran air bersih agar warga tak lagi menggunakan air kolam atau air sungai. Kepala Puskemas Caringin Lenny Novitasari mengatakan, keenam pasien kolera yang meninggal dunia merupakan pasien usia lanjut. "Umur mereka di atas 60 tahun. Di usia seperti itu, daya tahan tubuh manusia memang sudah menurun dan diperparah oleh dehidrasi yang amat cepat," kata Lenny.