Medical Microbiology-dPBL Package 2

There are outbreaks of viral, fungal and protozoa diseases among platoons of army soldiers in Indonesia. Soldiers reported sick after 2 weeks of jungle warfare training. It is of concern to the ministry that there are also sporadic reports of avian flu in the nearby villages. In view of these outbreaks, you have been tasked to conduct a pre-mission briefing with blogs and poster to educate future batches of soldiers.

‘Army soldiers’: Army soldiers are not able to bathe frequently. They are also always perspiring due to the constant training, therefore they are always damp and dirty.

‘Jungle training’: This implies that the environment that the soldiers are in is humid, wet and warm. The army soldiers are also exposed to all sorts of insects and animals. In addition, there is also soil around the place where the soldiers are training. Therefore, there could be any possible vectors to the various infections.

Various protozoa diseases are listed down in the table below:
Table 1: Protozoa

Reasons for identifying these protozoa:

Plasmodium falciparum/vivax: These protozoa is carried by the vector, female anopheles mosquitoes that can be found in tropical areas. Soldiers training in the jungle may be bitten by these female mosquitoes, thereby releasing the protozoa into the bloodstream of the soldiers where they multiple and cause malaria.

Toxoplasma gondii: Soldiers are prone to eating meat that is not cooked thoroughly due to the lack of proper facilities. In addition, soldiers might ingest contaminated water by the river etc. Contamination is due to the presence of of infected cat faeces by the protozoan. Toxoplasmosis can be transmitted to the soldiers due to frequent visits to the neighbouring villages where cats etc may be present.

Leishmania: This protozoa is spread by the bite of sandflies. Sandflies are found in sandy area and sandy areas are a common sight in jungles. As such, soldiers might be bitten by this vector and thus contract leishmaniasis.

Giardia lamblia: This is usually found in soil, food, water, or surfaces that have been contaminated with the feces from infected humans or animals. With unsanitary conditions and lack of proper facilities in the jungle, food might not be properly cooked and this could cause the transmission of Giardia lamblia. In addition, outbreaks among military personnel could also be caused by various infected animal such as birds, dogs and cats that can be found in the neighbouring area.

Entamoeba histolytica: This is found in many tropical countries. The presence of Entamoeba histolytica is due to the unsanitary conditions. In jungle warfare, the condition that the soldiers are in is generally unhygenic, thereby promoting the growth of this protozoan and the transmission of disease such as amoebic dysentery. Due to the unhygeneic conditions, the spread of this protozan is sanitary conditions in the jungle, amoebic dysentery is most commonly spread by water or contaminated, uncooked food or from carriers.

Trypanosoma brucei: This flagellated protozoan enters the blood-stream via the bite of bloodsucking male and female tse-tse. However the parasites are found mainly in Africa therefore it is excluded from being a potential pathogen that could be found in the jungles of Indonesia.

Cyclospora cayentanesis: This protozoa is common in tropical countries as the warm and moist environment found in such country is required for the protozoa (oocytes) sporulate into their infective forms. Thereby infecting the soldiers via contaminated water or food.

Cryptosporidium parvum: This protoza contaminate water supply and due to the lack of proper supplies, soldiers undergoing training may also ingest food that is contaminated. With the close interaction of the soldiers training together, infected soldiers are thus able to transmit the disease cryptosporidiosis to the healthy soldiers.

Various fungal diseases are listed down in the table below:

Table 2: Fungi

Reasons for identifying these fungi:

Ring Worm: Dermatophytes feeds on keratin which is the material found on the outer layer of the skin, hair and nails. These fungi thrive best on moist and hot skin that is hidden from the light. Soldiers undergoing training tends to perspire alot and due to the lack of constant and proper wash-up, the condition of the skin encourage the growth of these fungi. This fungus can exist anyway on the body.

Trichophyton rubrum: Soldiers can experience Athlete's foot (Tenea pedis) as they tend to put on their shoes for very long period of times. These fungi involved attack the feet due to the encouraged growth in the presence of a warm, dark and humid environment. In addition, spreading of fungi can take plac if the feet are not washed adequately with soap and water.

Candida Albicans: Such fungus easily "invade" the body through cuts. Soldiers are prone to injuries such as cuts or abrasion while having training in the jungle, thus increasing their exposure to Candida Albicans.

Cryptococcus neoformans: Cryptococcus neoformans var gattii grows in tropical area in the litter around certain eucalyptus trees. This fungus is airborne and the can be breathed in by the soldiers undergoing training in the forest.

Aspergillus fumigatus: Aspergillus fumigatus is a type of fungus found in soil. During training, the soldiers might have to do crawling on the ground, having close contact with the soil. inhalation of the fungi is therefore made possible, resulting in Allergic bronchopulmonary aspergillosis.

Histoplasma Capsulatum: Histoplasma capsulatum is a soil-borne, dimorphic fungus that causes histoplasmosis in human. It is found throughout the world but is most prevalent in countries favoring a warm, moist, and humid climate.

Various viral diseases are listed down in the table below:

Table 3: Virus

Reasons for identifying these virus:

Rabies virus: This virus could infect soldiers through other infected animals such as bats and monkeys. These two animals are commonly found in the jungles of Indonesia. The virus could be spread through the animal bites or due to aerosols from mucous membranes.

Japanese Encephalitis: The virus is transmitted through a mosquito vector known as Culex tritaeniorhynchus. Soldiers in the jungle could acquire the virus from mosquito bites. Disease from the virus is most prevalent in South East Asia.

Hepatitis A virus: Unsanitary conditions easily allow contamination of food and water. Due to the poor hygiene of the soldiers, the virus could be present in dirty utensils that are washed in the contaminated lakes or rivers. HAV is transmitted through the fecal oral route and thus it can be transferred from unwashed hands after the soldiers visited the toilets. In addition, during the training, soldiers will have to be in close contact with one another, therefore infected soldiers can in turn infect other healthy soldiers.

Ross Fever virus: This disease is carried and transmitted by the Southern Saltmarsh mosquito or Aedes camptorhyncus. As most other diseases mentioned, mosquitoes thrive in damp places such as the jungle. This then allows possible infection when an infected mosquito bites a soldier.

Human Immunodeficiency Virus (HIV) : HIV infection is is caused by the transmission of virus through sexual contact or through blood or blood product route. The soldiers could have gone to the village and had sexual intercourse with the female villagers. Also, medical equipments such as syringe might be shared among them, thereby transmitting the virus to each other.

Various viral fever are listed down in the table below:

Table 4: Virus (Fever)

Reasons for identifying these virus:

Yellow fever virus: As soldiers have their trainings in the Indonesia's forests, getting mosquitoes' attacks are inevitable. Aedes aegypti are found in forests. It is caused by Flaviviridae, a positive single-stranded RNA virus whereby soldiers get infected after deposition of viral particles through the skin in infected arthropod saliva(bite).

Dengue fever virus: Dengue, which is caused by the Aedes aegypti mosquito are commonly found in tropical climates e.g. Indonesia thus soldiers have a higher tendency of contracting dengue fever especially during the day as growth of those mosquitoes are enhanced in the presence of a warm and humid environment e.g. Indonesia.

Rift valley virus: As the soldiers have their trainings in the forest, they are bound to have direct or indirect contacts with infected wild animals or consumed contaminated food e.g. chicken. RVF is a viral zoonosis causing fever. It also can be caused by infected mosquitoes. RVF is able to affect primarily domestic livestock and passes down to humans.

Chikungunya virus: Similarly to the cause of Dengue Fever, soldiers are able to get infected with Chikungunya from mosquito bites such as the Aedes and Culex. It is a viral fever caused by an alphavirus, whereby the mosquitoes are commonly found in warm and humid climates e.g. Indonesia.

Avian flu is listed down in the table below:

Table 5: Virus (Avian Flu)

Reason for identifying this virus:

Avian influenza virus: This virus is found in tropical countries like Indonesia where it is warm and humid. Soldiers, during their free time will have the chance to visit the nearby village where they will be exposed to birds such as chickens. Consuming of infected chickens, thus increase the chance of the soldiers contracting this disease. In addition, the recent outbreak of this disease in the village has further increase the chance of the soldiers contracting this disease. In the jungle, the soldiers are also exposed to various kinds of birds species that could be infected by the virus as well.

References

Fungal Diseases
http://canadiancpd.medscape.com>viewarticle>503661
www.ops-oms.org>>English>AD>DPC>CD>atlanta_july2000.doc
http://cancerweb.ncl.ac.uk>cgi-bin>omd?epidemic+polyarthritis
http://dermnetnz.org>fungal>cryptococcosis.html
http://en.wikipedia.org>wiki>Histoplasmosis http://www.ahc.sa.gov.au>site>page.cfm?u=608
http://www.botany.utoronto.ca>courses>bot405>notes>Lecture%2010.pdf
http://www.candidasupport.org>
http://www.cyh.com>HealthTopics>HealthTopicDetails.aspx?p=114&np=303&id=1907
http://www.dermnetnz.org>fungal>tinea-pedis.html
http://www.faetc.org>PDF>Primary_Care_Guide>Chapter_19-Fungal_Infections.pdf http://www.healthscout.com>ency>68>312>main.html
http://www.histopathology-india.net>CHIKV.htm
http://www.mycology.adelaide.edu.au>Mycoses>Subcutaneous>Lobomycosis>index.html
http://www.nlm.nih.gov>medlineplus>ency>article>000070.htm
http://www.phac-aspc.gc.ca>msds-ftss>msds11e.html
http://www.who.int>mediacentre>factsheets>fs207>en>

Protozoa Diseases
http://deploymenthealthlibrary.fhp.osd.mil>products>Staying%20Healthy%20Guide-%20Soldiers%20Guide%20in%20Indonesia%20and%20Malaysia%20(Tri-fold)%20(125).pdf
http://en.wikipedia.org>wiki>Giardia
http://en.wikipedia.org>wiki>Intestinal_parasite
http://en.wikipedia.org>wiki>Leishmania
http://en.wikipedia.org>wiki>Malaria
http://focosi.altervista.org>pathoprotozoa.htm
http://infectiouspeople.blogspot.com>2007>01>protozoal-infections.html
http://rds.yahoo.com>_ylt=A0oGkm3iYZlH5SsAV8lXNyoA;_ylu=X3oDMTFhNWE2YThkBHNlYwNzcgRwb3MDNQRjb2xvA3NrMQR2dGlkA01BUDAwM185NARsA1dTMQ-->SIG=1214b237g>EXP=1201320802>**http%3a>>iai.asm.org>cgi>content>full>69>9>5940
http://www.cdc.gov>ncidod>dpd>parasites>cyclospora>factsht_cyclospora.htm#symptoms
http://www.cdfound.to.it>HTML>khan.htm#Current%20Prevention
http://www.ndsu.nodak.edu>instruct>brewer>brewer>entomology>topics>disease.htm

Viral Diseases
http://attra.ncat.org>attra-pub>soilborne.html
http://en.wikipedia.org>Ascariasis
http://en.wikipedia.org>wiki>HIV
http://en.wikipedia.org>Tetanus
http://www.cdc.gov>flu>avian>gen-info>facts.htm
http://www.mayoclinic.com>health>bird-flu>DS00566>DSECTION=8
http://www.mayoclinic.com>health>hiv-aids>DS00005>DSECTION=8
http://www.medicinenet.com>bird_flu>article.htm
http://www.medicinenet.com>bird_flu>page5.htm
http://www.metrokc.gov>health>prevcont>yellow.htm#schedule
http://www.umm.edu>patiented>articles>what_causes_encephalitis_000096_2.htm
http://www.who.int>immunization>topics>rabies>en>index.html

http://www.wordtravels.com>Travelguide>Countries>Indonesia>Health