Mau jadi relawan Aceh? Atau mau berkunjung ke Aceh? Simak dulu informasi
berikut ini....
Informasi dari salah satu alumni SMA4 ('84) berprofesi dokter dan team-nya
yg ikut terlibat sbg relawan agar relawan yg lain berhati-hati:
=======================================================
Mangatas Manalu <[EMAIL PROTECTED]<[EMAIL PROTECTED]> > wrote:
Date: Fri, 31 Dec 2004 07:35:29 -0800 (PST)
Subject: [Batu3_84_Jkt]
HIMBAUAN UTK WASPADA KEPADA PARA RELAWAN KE ACEH
(MOHON DISEBAR LUASKAN)
Dear Sahabats,
Ternyata apa yang ditengarai tentang penyebaran penyakit menular sudah
terjadi di Aceh. Tim relawan dari Bali yang gue pantau semalam suntuk,
melaporkan adanya kasus pembusukan jari tangan 2 orang relawan warga aceh,
dengan
pembentukan gas pada luka tersebut. Hal ini terjadi akibat kontaminasi dari
mayat saat melakukan evakuasi jenazah kemarin 30/12-04 malam di Sigli.
Sejawat di bagian bedah terpaksa melakukan amputasi sampai pergelangan
tangan pada Muh Chaerudin (24) dan Usman Yacobi (21), karena kedua relawan
asal Langsa (?) tersebut, sudah demam hebat menggigil (>39 drjt C) bahkan
Usman sempat kejang2. Penduduk sekitar tidak mengenal kedua orang tersebut
dan tadi siang keduanya raib entah kemana.
Isunya simpang siur, ada yang mengatakan mereka anggota GSA, tapi mrk
membawa KTP merah putih yang sayangnya nggak sempat diperiksa (boro2 mau
meriksa KTP, untuk makan aja tentaranya bingung; lagipula kasihan mereka
tetap saudara kita yang telah berkorban untuk membantu sesama)
Kemungkinan mereka terkena infeksi bakteri Clostridium perfringens (BUKAN
HERPES; Virus herpes tidak menempati jaringan yang membusuk dan sangat
jarang fatal). Menurut penduduk setempat sejak 2 hari kedua orang itu
mengangkat mayat2 dari halaman sekitar RS Kab; mayat2 tersebut telah
meleleh).
Untuk itu mohon disebarkan pada instansi2 yang terkait yang
menerima/merekrut para relawan, yang membuka posko dan untuk para calon
relawan itu sendiri, khususnya yang mengangkut mayat; beberapa saran dari
tim kami yaitu :
1. Siapkan Spiritual, fisik dan mental. Yakinkan anda benar2 mau melakukan
ini demi menolong dan beramal kepada sesama manusia. Sudah ada 32 relawan
"swasta" asal Sumbar dan Sulsel yang pulang kembali karena muntah2 dan
kesurupan. Katanya karena diganggu roh2 korban bencana.
2. Perlengkapan utama selain keperluan untuk survival (senter, pisau, korek
gas, jas hujan) ialah MASKER, dan seperti kasus SARS usahakan masker standar
minimal W.H.O (tipe N-95), Bukan masker kamar operasi (apalagi saputangan
yang dilipat seperti yang ada sekarang, bukan juga masker penggergajian kayu
yang ada filternya tapi tidak efektif untuk menyaring kuman di udara).
Selain itu bila akan mengevakuasi mayat, pakailah corpses gloves seperti
standar petugas kamar mayat. Bukan menggunakan handschoen karet tipis
(gammex) yang mudah robek, yang mestinya dipakai untuk menangani
pasien hidup di RS.
3. Pakailah topi untuk mencegah cipratan cairan tubuh dari tubuh mayat, yang
lengket dan dapat melekat pada rambut anda dan kemudian meleleh ke makanan
saat anda makan. Beberapa relawan telah kena diare yang ditengarai
disebabkan kuman2 Clostridia melalui jalan tersebut diatas.
4.Cucilah tangan anda sebelum dan sesudah mengangkat 1 mayat. Boros? Memang
tapi kita tak ingin ada lagi para relawan yang jadi korban diare atau
pnyakit fatal. Gunakan sabun antiseptik seperti Lifebuoy, Nuovo atau apapun
namanya. Cucitangan selama 5 menit. Lebih baik lagi jika ada sikat pencuci
tangan seperti dikamar operasi (HIBISCRUB BRUSH) untuk menyikat bagian2
lipatan kulit, daerah yang sulit terjangkau dan kuku. Usahakan sabun
antiseptik cair.
5.Betadine kecil, alkohol 70 %, plester/bandaid, kasa gulung, Daryanttulle,
gunting kecil, mata pisau bedah / scalpel - bisa dibeli di Apotik2- dan tali
hendaknya selalu tersedia disamping air bersih pada veldples, sedikit gula
dan garam, dan air mineral atau supplement elektrolit (Pocari Sweat) karena
uap garam dari laut yang bercampur bau mayat merupakan racun yang membuat
kita banyak kencing dan kehilangan cairan dan elektrolit. Jangan pernah
meminum energy drink supplement yang dapat membuat anda tidak cukup tidur
dan pada akhirnya menurunkan daya tahan dan energi anda. Segeralah tidur
pada waktunya. Bersikaplah dewasa dan bertanggung jawab dalam mengemban
amanah rakyat Indonesia yang ada pada pundak anda.
6. Pakai celana katun bukan jeans (berat jika kena air dan lumpur) maupun
bahan parasut (membuat sirkulasi panas tubuh dan aliran keringat tidak baik)
saat anda mengangkut mayat. Pakailah sepatu dan kaus kaki. Jangan enggan
karena takut becek jika masuk ke lumpur, rawa dan kubangan air. Beberapa
penduduk di Meulaboh telah terkena gigitan ular akibat masuk ke rawa-rawa
untuk mengambil mayat tetapi tanpa alas kaki. Gigitan pacet/lintah jarang di
daerah pantai (tapi harus waspada toooohhhhh). Cuci kaki dan jemur sepatu
dan pakaian anda setiap hari. Membawa lebih dari 2 pasang sepatu
adalah hal yang baik. Tidak harus sepatu boot (kalau ada sih mantaaap), yang
penting tertutup.
7, Jika anda luka segera dicuci dengan air mineral dan sabun antiseptik,
disikat dan segera lapor pada pimpinan rombongan dan dokter anda. Jika luka
itu sampai mengeluarkan darah (bukan lecet), lebih baik anda menunda
kerja sampai luka itu kering.
8. Jangan gunakan tissue anti nyamuk (mosquito repelllent) yang dapat
menyebabkan abrasi kulit. Kalau terpaksa sekali gunakan obat nyamuk
semprot/bakar, tentu dengan tetap menjaga agar asapnya tidak mengganggu
saluran nafas. Di Kab Pidie sudah dilaporkan adanya kasus Malaria.
9. Minum obat pencegahan Malaria yaitu Chloroquine (Nama Dagang =
Nivaquine/Malarex/ Resochin) 2 tablet / minggu atau jika tidak alergi sulfa
minum Fansidar (= Sulfadoxin-Pirimetamine) 1 tablet perminggu. Obat2 itu
diminum sejak sebelum keberangkatan, kalau bisa 1 minggu sebelumnya, diminum
selama didaerah itu dan sampai 1 bulan sejak pulang.
Jika diduga terkena serangan malaria, gejala TRIAS yang beturut-turut, ==>
Menggigil ==>Demam==> Banyak berkeringat, segera konsultasi pada dokter
anda. Jika belum sempat bertemu dokter minum 4 tablet Chloroquine pada hari
I, 2 tab pada hari ke II dan 2 tab pada hari ke III. Kurang lebih 1/2 jam
sebelumnya minumlah paracetamol/Panadol dan Metoclopramide/Primperan 1
tablet.
10. Bawalah Obat2an pribadi seperti Amoksisilin, tetrasiklin, oralit,
bactrim,bisolvon,benadryl, obat semprot asma dsb, agar anda tidak merepotkan
anggota tim lainnya. Toh obat itu bisa dipakai oleh saudara2 kita korban
bencana disana.
Demikian yang bisa saya sampaikan. Mohon Maaf jika ada kekurangan. Mohon
agar teman2 / Bapak Budi Aditya, Yoyok, Said, Tammy, yang punya akses ke
Institusi/lembaga perekrutan tenaga relawan, misalnya MEDIA INDONESIA GROUP,
atau media elektronik (RCTI,TransTV atau SCTV) atau mempunyai website
pribadi atau apa saja termasuk memforward email ini untuk menyebarkan
informasi ini, karena saya tidak punya akses untuk itu.
Disini saya lampirkan juga petikan dari Jurnal Textbook kedokteran
Harrison's Principles of Internal Medicine tentang infeksi Clostridium
Perfringens yang hobbinya berkubang di Mayat/Jaringan/Makanan busuk.
Perjuangan masih panjang, apalagi mengingat baru 4000-an mayat yg telah
terkubur dari krglbh 85.000 yg meninggal.
Ini sekaligus masukan kepada para Dermawan untuk membantu pembelian obat2an
khususnya antibiotika injeksi seperti ampicilline, Cefotaxime, cairan infus,
alkohol, betadine dan kassa (Gaas), disamping makanan siapsantap.
NB.
Untuk Said dan Yoyok, bagus sekali jika loe mau nulis tentang teori hidup di
alam bebas/survival, untuk para relawan yang (maaf) banyak baru mau belajar
hidup dialam bebas. Mayat2 bukan cuma di Banda Aceh saja, diluar kota ke
arah BlangBintang masih banyak.
Apabila ada yang kurang kelas dapat menghubungi saya di
[EMAIL PROTECTED] <[EMAIL PROTECTED]> .
Kiranya Tuhan Allah Yang Maha Pengasih dan Penyayang selalu memberi kekuatan
kepada seluruh bangsa ini, khususnya buat saudara2 kita di NAD dan Sumut.
Amin
Salam Sejahtera
Mangatas SM Manalu
Bag Peny Dalam FK Univ Udayana / RS. Sanglah
RS Sanglah, Denpasar - Bali
=========================================================
^ 145. GAS GANGRENE, ANTIBIOTIC-ASSOCIATED COLITIS, AND OTHER
CLOSTRIDIAL
INFECTIONS - Dennis L. Kasper, Dori F. Zaleznik
<http://www.harrisonsonline.com/> http://www.harrisonsonline.com/ <
<http://www.harrisonsonline.com/> http://www.harrisonsonline.com/>
DEFINITION
Bacteria of the genus Clostridium are gram-positive, spore-forming,
obligate
anaerobes that are ubiquitous in nature, saprophytic. Some of these
species
are pathogenic for humans and animals. Infections associated with
these
organisms range from localized wound contamination to overwhelming
systemic
disease. The four major disease categories for which clostridia are
responsible are intestinal disorders, deep tissue suppurative
infections,
skin and soft tissue infections, and bacteremia (menyebarnya kuman
dalam
darah). Toxins play a major role in some of these syndromes.
ETIOLOGY (PENYEBAB)
In humans, clostridia normally reside in the gastrointestinal tract
and in
the female genital tract, although they occasionally are isolated
from the
skin or the mouth. Clostridia characteristically produce abundant
gas. C.
perfringens, one of the most important species, is nonmotile and the
spores
can usually be destroyed by boiling.
Clostridia are present in the normal colonic flora. These organisms
are
universally present in soil at concentrations of up to 10.000 per
gram.
C. perfringens is the most common of the clostridial species isolated
from
tissue infections and bacteremias. C. perfringens is associated with
food
poisoning (type A) and enteritis necroticans (type C).
PATHOGENESIS (Proses terjadinya kelainan)
The isolation of clostridial species from many serious traumatic
wounds.
When C. perfringens grows in necrotic tissue (jaringan mati), a zone
of
tissue damage due to the toxins elaborated by the organism allows
progressive growth.
C. perfringens possesses at least 17 possible virulence factors,
including
12 active tissue toxins and enterotoxins. This species has been
divided into
five types (A through E) on the basis of four major lethal toxins: a,
b, e,
and i. The a toxin is a phospholipase C (lecithinase).
This a toxin has been associated with gas gangrene (kaki busuk
berwarna
hitam yg mengandung gas) and is known to be hemolytic (menghancurkan
sel
darah merah), destroy platelets (keping pembekuan darah) and
polymorphonuclear leukocytes (sel darah putih), and to cause
widespread
capillary (pembuluh darah halus) damage. It causes massive
intravascular
hemolysis and damages liver.
The a toxin may be important in the initiation of muscle infections
that may
progress to gas gangrene. The other major toxins, b, e, and i, are
known to
increase capillary permeability.
CLINICAL MANIFESTATIONS
Intestinal Disorders :
- Food Poisoning
C. perfringens, primarily type A, is the second or third most common
cause
of food poisoning in the United States. Outbreaks generally have
resulted
from problems in the cooling and storage of food cooked in bulk. The
food
sources primarily involved are meat, meat products, and poultry.
Generally, the implicated meats have been cooked, allowed to cool,
and then
recooked the following day, often in a stew or hash. Strains of C.
perfringens that contaminate meat manage to survive initial cooking.
During reheating, the organisms sporulate and germinate.
The disease is associated with an attack rate that is often as high
as 70%.
Symptoms of food poisoning from type A strains develop 8 to 24 h after
ingestion of foods heavily contaminated with the organism.
The primary symptoms include epigastric pain, nausea, and watery
diarrhea
usually lasting 12 to 24 h. Fever and vomiting are uncommon.
C. perfringens has also been implicated in a more severe form of
diarrhea.
It tends to occur in the elderly and has been associated with
antibiotic use
in hospitalized populations.
In this form of disease, diarrhea is generally more profuse, of longer
duration, and accompanied by abdominal pain. Blood and mucus have been
detected in the feces of the affected patients.
Widespread environmental contamination with C. perfringens spores was
documented.
-Enteritis necroticans
Necrotizing enteritis (enteritis necroticans, or pigbel) is caused by
b
toxin produced by type C strains of C. perfringens following
ingestion of a
high-protein meal in conjunction with trypsin inhibitors (e.g., in
sweet
potatoes).
Epidemic in Germany after World War II because of necrotic corpses.
Clinical features include acute abdominal pain, bloody diarrhea,
vomiting,
shock, and peritonitis (radang hebat pada selaput pembungkus organ
perut);
40% of patients die. The source of the organisms may be the patient's
own
intestinal flora.
- Suppurative Deep Tissue Infections :
Clostridia are frequently recovered from various suppurative
conditions
(bernanah) in conjunction with other anaerobic and aerobic bacteria
but can
also be the only organisms isolated.
These suppurative conditions, which exist with severe local
inflammation but
usually without the characteristic systemic signs induced by
clostridial
toxins, include intraabdominal sepsis, pelvic abscess, subcutaneous
abscess,
frostbite with gas gangrene, infection of a stump in an amputee (pada
luka
bekas amputasi), perianal abscess, conjunctivitis (radang selaput
mata)
- Suppurative infections of the female genital tract
The majority of cases of clostridial empyema (nanah pada mukosa/
bagian
berwarna merah, seperti pada bagian dalam dinding mulut/kelamin kita)
in
female genital tract are secondary to trauma.
-Skin and Soft Tissue Infections :
Simple contamination
Clostridia are cultured most often from wounds in the absence of
clinical
signs of sepsis (infeksi yang sangat berat).
Localized infection of the skin and soft tissue without systemic
signs.
These infections tend to be relatively indolent (mula-mula tidak
nyeri),
spreading slowly to contiguous areas. Localized infections are
relatively
free of pain and edema (bengkak). If inadequately treated, these
localized
infections advance by extension through subcutaneous tissue and
fascial
planes (sarung pembungkus otot dan urat) into muscle and may produce
severe
systemic disease with signs of toxemia and very bad pain.
-Spreading cellulitis and fasciitis with systemic toxicity
Patients present with the abrupt onset of a syndrome that progresses
rapidly
(within hours) through the fascial planes. In cases with suppuration
and gas
in soft tissues as well as overwhelming toxemia, the infection is
rapidly
fatal.
The systemic toxic effects include hemolysis and injury of capillary
membranes.
Usually, this infection is uniformly fatal within 48 hours, despite
intensive therapy involving antitoxin and exchange transfusion.
The syndrome characteristics are : (1) rapid mortality, (2) rapid
tissue
invasion, and (3) the systemic effects of the toxin, typified by
massive
hemolysis.
-Clostridial myonecrosis (gas gangrene)
Clostridial myonecrosis occurs when bacteria invade healthy muscle
from
adjacent traumatized muscle or soft tissue.
The infection originates in a wound contaminated with clostridia. In
civilian cases, gas gangrene can follow trauma, surgery, or
intramuscular
injection.
The trauma need not be severe; however, the wound must be deep,
necrotic,
and without communication to the surface.
The incubation period of gas gangrene is usually short: almost always
<3
days and frequently <24 h.
Some 80% of cases are caused by C. perfringens. Typically, gas
gangrene
begins with the sudden onset of pain in the region of the wound.
Once established, the pain increases steadily in severity but remains
localized to the infected area and spreads only if the infection
spreads.
Soon after pain develops, local swelling and edema accompanied by a
thin,
often hemorrhagic exudate appear.
Patients frequently develop marked tachycardia (berdebar hebat), but
elevation in temperature may be only minimal.
Gas is usually not obvious at this early stage and may be completely
absent.
Frothiness of the wound exudate (cairan kental dari luka) may be
noted. The
skin is tense, white, often marbled with blue, and cooler than
normal.
The symptoms progress rapidly with swelling, edema, and toxemia
(penyebaran
racun kedalam sirkulasi darah), and a profuse serous (mencair/meleleh)
discharge, which may have a peculiar sweetish smell.
Patients with myonecrosis frequently have a heightened awareness of
their
surroundings until just before death, when they lapse into toxic
delirium
and coma.
In untreated cases, as the local wounds progress, the skin becomes
bronzed;
bullae (kantong berisi cairan) appear, become filled with dark red
fluid,
and are accompanied by dark patches of cutaneous gangrene. Gas
appears in
later phases
-Bacteremia and Clostridial Sepsis :
The relatively common entity of transient clostridial bacteremia can
arise
in any hospitalized patient but is most common with a predisposing
focus in
the gastrointestinal tract, biliary tract (saluran empedu), or uterus
(rahim).
Fever frequently resolves within 24 to 48 hours without therapy.
DIAGNOSIS
The diagnosis of clostridial disease, in association with positive
cultures,
must be based primarily on clinical findings. Because of the presence
of
clostridia in many wounds, their mere isolation from any site,
including the
blood.
The diagnosis of clostridial myonecrosis can be established by
frozen-section biopsy of muscle.
X-ray examination sometimes provides an important clue to the
diagnosis by
revealing gas in muscles, subcutaneous tissue. However, the finding
of gas
is not pathognomonic (tidak memastikan/tidak khas) for clostridial
infection. Other anaerobic bacteria, frequently mixed with aerobic
organisms, may produce gas.
^TREATMENT
Traumatic wounds should be thoroughly cleansed and debrided (membuang
jaringan mati).
Traditionally, the antibiotic treatment of choice for severe
clostridial
infection has been penicillin G (20 million units a day in adults).
For severe clostridial sepsis, clindamycin may be used at a dose of
600 mg
every 6 h in combination with high-dose penicillin (3 to 4 million
units
every 4 hour).
Clostridia are frequently, but not universally, susceptible to
Antibiotics
like : cefoxitin, carbenicillin, chloramphenicol, clindamycin,
metronidazole, doxycycline, imipenem, minocycline, tetracycline,
third-generation cephalosporins, and vancomycin.
Simple contamination of a wound with clostridia should not be
treated with
antibiotics.
Localized skin and soft tissue infection can be managed by debridement
(pembuangan jaringan mati) rather than with systemic antibiotics.
Drugs are
required when the process extends into adjacent tissue or when fever
and
systemic signs of sepsis are present.
Surgery is a mainstay of therapy for clostridial myonecrosis or gas
gangrene. Amputation may be required for rapidly spreading infection
involving a limb.
Suppurative infections should be treated with antibiotics. frequently,
broad-spectrum antibiotics must be used because of the mixed flora
involved
in these infections.
The use of hyperbaric oxygen in the treatment of gas gangrene is
controversial. Fasciotomy should not be delayed for hyperbaric oxygen
therapy.
BIBLIOGRAPHY
BORRIELLO SP: Clostridial disease of the gut. Clin Infect Dis
20:S242, 1995
CASTAGLIUOLO I et al: Clostridium difficile toxin A stimulates
macrophage-inflammatory protein-2 production in rat intestinal
epithelial
cells. J Immunol 160:6039, 1998
CHAVES-OLARTE E et al: Toxins A and B from Clostridium difficile
differ with
respect to enzymatic potencies, cellular substrate specificities, and
surface binding to cultured cells. J Clin Invest 100:1734, 1997
CLEARY RK: Clostridium difficile-associated diarrhea and colitis:
Clinical
manifestations, diagnosis, and treatment. Dis Colon Rectum 41:1435,
1998
ELLEMOR DM et al: Use of genetically manipulated strains of
Clostridium
perfringens reveals that both alpha-toxin and theta-toxin are
required for
vascular leukostasis to occur in experimental gas gangrene. Infect
Immun
67:4902, 1999
GERDING DN et al: Clostridium difficile-associated diarrhea and
colitis.
Infect Control Hosp Epidemiol 16:459, 1995
JOHNSON S et al: Epidemics of diarrhea caused by a clindamycin-
resistant
strain of Clostridium difficile in four hospitals. N Engl J Med
341:1645,
1999
JUST I et al: Glucosylation of Rho proteins by Clostridium difficile
toxin
B. Nature 375:500, 1995
KYNE L et al: Asymptomatic carriage of Clostridium difficile and serum
levels of IgG antibody against toxin A. N Engl J Med 342:390, 2000
LORBER B: Gas gangrene and other Clostridium-associated diseases, in
Principles and Practice of Infectious Diseases, 5th ed, GL Mandell et
al
(eds). New York, Churchill Livingstone, 2000, pp 2549-2560
PRINSSEN HM et al: Clostridium septicum myonecrosis and ovarian
cancer: A
case report and review of literature. Gynecol Oncol 72:116, 1999
ROOD JI: Virulence genes of Clostridium perfringens. Annu Rev
Microbiol
52:333, 1998
SCHALCH B et al: Molecular methods for the analysis of Clostridium
perfringens relevant to food hygiene. FEMS Immunol Med Microbiol
24:281,
1999
SHARMA AK, HOLDER FE: Clostridium difficile diarrhea after use of
tacrolimus
following renal transplantation. Clin Infect Dis 27:1540, 1998
TIBBLES PM, EDELSBERG JS: Medical progress: Hyperbaric-oxygen
therapy. N
Engl J Med 334:1642, 1996
^ <http://www.harrisonsonline.com/> http://www.harrisonsonline.com/ <
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