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KERACUNAN MAKANAN + ALKOHOL - responsi dr Bogi

Dec 16, 2015

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A Presentation about Food intoxication and Alcohol Abuse, Pathophysiology and its clinical aspects.

KERACUNAN MAKANAN

RESPONSI KASUS GASTROENTEROHEPATOLOGI

INTOKSIKASI MAKANAN & INTOKSIKASI ALKOHOL

ROSRES, LENDY N.M.; LAKSMI, DYAH AYU; SANTOSO, A.M. HENRY

PEMBIMBING:dr. BOGI PRATOMO, Sp.PD-KGEH

LABORATORIUM / SMF ILMU PENYAKIT DALAMFAKULTAS KEDOKTERAN UNIVERSITAS BRAWIJAYARUMAH SAKIT UMUM DAERAH DR. SAIFUL ANWAR MALANGJUNI 2015PENDAHULUAN

INTOKSIKASI MAKANANdefinisiPenyakit akibat mengonsumsi makanan atau minuman yang terkontaminasi oleh bakteri dan/atau racun yang diproduksinya, atau oleh parasit, virus, atau bahan kimia.

Patogen yang paling umum antara lain Norovirus, Escherichia coli, Salmonella, Clostridium prefringens, Campylobacterm dan Staphylococcus aureus.

(Susannah Dewi, 2003)etiologiCDC: 97% kasus keracunan makanan akibat penanganan tidak tepat; 79% kasus akibat disiapkan di perusahaan komersial atau institusional;21% kasus akibat disiapkan di rumah.

Penyebab paling umum meninggalkan makanan siap saji pada suhu yang optimal untuk pertumbuhan bakteri, proses memasak tidak memadai atau pemanasan ulang, kontaminasi silang, dan infeksi pada penjamah makanan (Kontaminasi silang)

Bakteri 75% wabah keracunan makanan

PATOGENESISklasifikasi berdasarkan patogenesis1. Racun yang masuk ke tubuh S. aureus, B. cereus, c. botulinum, C. perfringens2. Bakteri noninvasif, dan melepas racun saat menepel di usus ETEC, V. cholera, C. jejuni3. Invasi ke sel epitel usus Shigella, Salmonella4. Bakteri masuk ke peredaran darah melalui saluran cerna S. typhii, L. monocytogenesi

Toksikosis Vs Food-InfectionsSTAPHYLOCOCCUS AUREUSRoti, ham, daging ayam, daging sapi, susu, daging ikan, salad.Enterotoksin A menempel di dinding usus sensoris n. vagus + simpatis mualEnterotoksin berikatan dengan MHC II pembelahan sel T sitokin (IL-2 + TNF-) - diareBACILLUS CEREUSNasi dan sayuran yang didinginkan pada suhu ruang setelah dimasak.Toksin B. cereus tahan panasInkubasi jangka pendek nasi (enterotoksin tahan panas, berat molekul < 5.000 dalton)Inkubasi jangka panjang sayuran (enterotoksin rentan panas, berat molekul > 50.000 dalton)Enteroktksin aktifkan adenylate cyclase usus sekresi cairan usus watery diarrheaCLOSTRIDIUM PERFRINGENSDaging yang sudah masak lalu tidak disimpan dengan benar selama 1-2 hariSel vegetatif endospora di usus endotoksin12 endotoksin toksin alfa dan teta oleh strain A penumpukan cairan berlebih di usus nyeri perut akut , diare, mual, muntahCLOSTRIDIUM BOTULINUMMakanan kaleng yang tidak disterilisasi dan dikemas dengan benar.Toksin botulinum dilepaskan saat bakteri mati dan lisisToksin botulinum tahan asam dan getah pencernaan lain diserap sal. pencernaan atas peredaran darah NMJ celah presinaps pelepasan Ach kelumpuhan flaksid

ETECMembentuk koloni di proksimal usus halus toksin LT (heat-labile) dan ST (heat-stabile).Toksin LT subunit A dan B. Subunit B + GM1 di permukaan sel usus masuknya subunit A ke dalam sel usus aktifkan adenylate cyclase c-AMP hipersekresi cairan dan elektrolit hambat reabsorbsi natrium.

EHECDaging olahan yang tiak dimasak dengan matang + olahan susu mentahShiga-like toksins (SLT) = verotoksin mematikan sel-sel epitel usus halus

VIBRIO PARAHEMOLYTICUSInvasi langsung ke epitel usus.Daging kepiting, udang, dll, yang tidak matangInfeksi gastroenteritis akut nyeri perut, mual-muntah, demamPeriode inkubasi : 7-48 jam

SALMONELLA ENTERITIDISDaging dan telur unggas, serta produk susu.Bakteri masuk melalui epitel hingga lamina propria usus membelah diri mediator inflamasi demam + prostaglandin sekresi elektrolit + cairan diare

YERSINIA ENETROCOLITICADaging babi yang tdak dimasak hingga matang, susu yang tida dipasteurisasi dengan baik.Memiliki pertahanan terhdap komplemen dan fagistosisSuhu < 30oC Toksin ST demam, sakit perut, diare (bloody type)

CAMPYLOBACTER JEJUNIFecal-oral route berasal dari hewan peternakan, burung, anjing, daging unggasInvasif pada sel dinding usus produksi toksin aktivasi adenylate cyclase demam, nyeri perut, diare, lemas, sakit kepala

Tanda dan gejala1-6 jam, mual + muntah : S. aureus, B. cereus8-16 jam, nyeri perut + diare : C. perfringens, B. cereus16-48 jam, demam + nyeri perut : Y. enterocolitica16-48 jam, demam + nyeri perut + diare : Salmonella, Shigella, V. parahemolyticus, EIEC, C. jejuni18-36 jam, mual-muntah + diare + kelemahan : C. botulinum16-72 jam, nyeri perut + diare cair : ETEC, V. cholera, V. parahemolyticus, NAG vibrios, Norwalk virus72-120 jam, diare berdarah (tanpa demam) : EHECPATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESS. aureusCustard and cream filed bakery food, ham, chicken, meat, milk, fish, salads, puddings, pie.Since the ingested food contains performed toxin, the incubation period is usually 1-6 hours.Sudden vomiting and diarrhea but no fever. The illness lasts less than 12 hours. There are no complications and treatment is usually not necessary.PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESBacillus cereusCommonly associated with rice and vegetables.1-6 hours in short-incubation form and 8-16 hours in long-incubation form.Emetic-type (short-incubation): nausea, vomiting, abdominal cramps. Diarrheal-type (long-incubation): abdominal cramps, watery diarrhea. PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESC. PerfringensMeat products that are eaten 1-2 days after preparation. Meats that have been cooked (cooled slowly), and then held for some time before eating. Fish pastes and cold chicken.8-24 hoursIllness is characterized by acute abdominal pain, diarrhea, and vomiting. Illness is self-limiting and patient recovers in18-24 hours.PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESC. botulinumHome canned or bottled meat, vegetables and fish, low-medium acid canned food. The anaerobic environment encourage the overgrowth of spores.12-36 hoursVomiting, thirst, dryness of mouth, constipation, ocular paresis, difficulty in speaking and swallowing, coma or delirium, death due to respiratory paralysis. PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESETECFood or water contaminated with ETEC, contamination of water with human sewage, contamination foods, infected food handlers.16-72 hoursSudden watery diarrhea, nausea, vomiting, abdominal cramp, bloating. Known as travelers diarrhea. PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESEHECCattle : undercooked hamburger meat, raw milk, cream, and cheeses made from raw milk. 72-120 hoursInitial symptoms may be diarrhea with abdominal cramps, which may turn into grossly bloody diarrhea in a few days. There is however, no fever. PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESV. parahemolyticusInfections are associated with consumption of uncooked or undercooked crabs, prawns, shrimps and other seafoods. 7-48 hoursThe clinical infection is characterized by a sudden onset of acute gastroenteritis. Infection may also result in diarrhea, abdominal pain, vomiting and fever. PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESS. enteritidisInfected chicken and poultry, including its feces, eggs or flesh of dressed fowl, milk and milk products (ice creams) 12-36 hoursSudden abdominal pain, nausea, vomiting, diarrhea (watery, greenish and foul smelling), headache, chills, prostration, muscular weakness and moderate fever. PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESY. enterocoliticaRaw or undercooked pork products, unpasteurized milk or untreated water.4-7 daysFever, abdominal pain, and bloody diarrhea, pseudoappendicitis, mesenteric lymphadenitis, and terminal ileitis.PATHOGENIC MICROORGANISMINCRIMINATED FOODINCUBATION PERIODCLINICAL FEATURESC. jejuniFecal-oral route, farm animals, birds, dogs, processed poultry, milk, meat products, contaminated water, undercooked poultry and unpasteurized dairy. 2-11 daysAbdominal pain and cramps, diarrhea, malaise, headache, fever. Watery / bloody diarrhea, bacteremia. diagnosisANAMNESISdurasi penyakit, karakteristik dan frekuensi buang air besar, dan hal-hal yang berhubungan dengan perut dan gejala sistemik, dapat memberikan petunjuk untuk penyebab yang mendasari. Adanya sumber yang sama, jenis makanan tertentu, dan penggunaan antibiotik selalu harus diselidiki.

(Levine dan Tarabar, 2015)PEMERIKSAAN FISIK Keparahan dehidrasi: Mulut kering, penurunan produksi keringat, dan penurunan urin ouput dehidrasi ringan-sedangorthostasis, takikardia, dan hipotensi dehidrasi berat. Ditemukan pada pasien muntah atau diare yang cukup sering dan lama: mata cowong, mukosa mulut kering, turgor kulit menurun, tampak haus, penurunan kesadaran. Rectal Toucher: untuk memvisualisasikan tinja, menguji darah samar, dan meraba mukosa dubur untuk setiap lesi. Makula rosea dan hepatosplenomegali infeksi Salmonella typhi. Eritema nodosum dan faringitis eksudatif infeksi Yersinia. Selulitis dan otitis media Vibrio vulnificus atau Vibrio alginolyticusTanda-tanda gagal nafas dan parese saraf-saraf motoris. infeksi toksin botulinum

diagnosis(Levine dan Tarabar, 2015)PEMERIKSAAN PENUNJANG fekal smear mendeteksi telur dan parasitbiakan kuman, pengecatan gram, pewarnaan metilen blue mendeteksi leukosit, membantu membedakan penyakit invasif dari penyakit non-invasifkultur bakteri Salmonella, Shigella, dan Campylobacter (wajib jika feses ada leukosit atau darah disertai demam 3-4 haripengecekan sensitivitas kuman terhadap antibiotik.

diagnosisSTUDI LABORATORIUMCBC dengan differential count, elektrolit serum, BUN/kreatinin STUDI RADIOLOGIRadiografi abdomen supine dan erect

TES LAINSigmoidoskopi/kolonoskopi dengan biopsi dan esophagogastroduodenoscoy (EGD) dengan aspirasi duodenum dan biopsidiagnosis(menilai respon