FIELD STUDY REPORT GROUP 1

Transcription

1 FIELD STUDY REPORT GROUP 1 Johanna List Sinaro Bun Tianshi Yu Ajib Diptyanusa Hay Mar Su Lwin Abdulrahman Ahmed M. Chantasari Charoenkongsakul Supervisors: Assoc. Prof. Dorn Watthanakulpanich, Asst. Prof. Supaluk Popruk, Asst. Prof. Rutcharin Potiwat

2 INTRO

3 FIELD STUDY DETAILS! Location: Suan Pueng, Ratchaburi Province. Ratchaburi is one of the several provinces that outline Thailand with its neighboring nation, Myanmar. Further into the province is Suan Pueng District that particularly delineates the Thai-Myanmar border.! Date: June 27-30, 2017! Topic: Field work for parasite and vector survey in the community.

4 THE VENUE! Rajanagarindra Tropical Disease International Center (RTIC).! RTIC is situated at the Suan Pueng District, Ratchaburi Province.! The RTIC is located at the southern part of Suan Pueng, where majority of the people who live around are Karen hill-tribe.

5 THE ACTIVITIES 1. Stool examination 2. Physical examination and blood sample collection 3. Blood film examination 4. Aedes larval survey 5. Rodent trapping and collection 6. Ectoparasite examination

6 STOOL EXAMINATION 28 June 2017

7 STOOL EXAMINATION

8 SUMMARY! Stool samples examined: 24 samples! Techniques: direct smear (NS and iodine preparation) and Kato thick smear! Stool samples with positive pathogenic findings: 12 samples! Total number of patients treated: 12 patients

9 STOOL EXAMINATION FINDINGS No. Direct Smear Kato Thick Smear 1 E.coli cyst, E.nana cyst Not found 2 Not found Not found 3 Not found Not found 4 Not found Not found 5 Giardia duodenalis cyst, Iodamoeba butschlii cyst Not found 6 Not found Not found 7 Not found Not found 8 E.coli cyst, E.nana cyst Fertilized Ascaris lumbricoides egg 9 E.coli cyst Opisthorchis viverrini-like egg 10 Unfertilized Ascaris lumbricoides egg Unfertilized Ascaris lumbricoides egg 11 Fertilized & decorticated Ascaris lumbricoides egg, hookworm egg Fertilized Ascaris lumbricoides egg 12 Not found Not found 13 Fertilized Ascaris lumbricoides egg Fertilized & unfertilized Ascaris lumbricoides egg 14 Hookworm egg Not found 15 Unfertilized Ascaris lumbricoides egg, hookworm egg Unfertilized Ascaris lumbricoides egg, Trichuris trichiura egg 16 Not found Not found 17 E.coli cyst, Iodamoeba butschlii cyst, E.histolytica-like cyst Not found 18 Not found Not found 19 Giardia duodenalis cyst Not found 20 E.nana cyst Not found 21 E.nana cyst Not found 22 Not found Not found 23 E.coli cyst, E.nana cyst, E.histolytica-like cyst Not found 24 E.coli cyst, Iodamoeba butschlii cyst, Giardia duodenalis cyst Not found

10 MICROSCOPIC FINDINGS Entamoeba coli cyst Entamoeba histolytica-like cyst

11 MICROSCOPIC FINDINGS Iodamoeba butschlii cyst Giardia duodenalis cyst

12 MICROSCOPIC FINDINGS Endolimax nana cyst Trichuris trichiura egg

13 MICROSCOPIC FINDINGS Hookworm egg Ascaris lumbricoides decorticated egg

14 MICROSCOPIC FINDINGS Opisthorchis-viverrini-like egg

15 TREATMENT Pathogenic Findings on Microscopic Examination Disease Treatment Remarks Fertilized Ascaris lumbricoides egg Ascariasis Albendazole 400mg SD N/A Unfertilized Ascaris lumbricoides egg Ascariasis Albendazole 400mg SD N/A Fertilized & unfertilized Ascaris lumbricoides egg Fertilized & decorticated Ascaris lumbricoides egg, hookworm egg Ascariasis Albendazole 400mg SD N/A Ascariasis + hookworm infection Albendazole 1x400mg for 3 days N/A Unfertilized Ascaris lumbricoides egg, Trichuris trichiura egg, hookworm egg Ascariasis + Trichuriasis + hookworm infection Albendazole 1x400mg for 3 days N/A Hookworm egg Hookworm infection Albendazole 1x400mg for 3 days N/A Giardia duodenalis cyst Giardiasis Metronidazole 3x500mg for 7 days N/A Giardia duodenalis cyst Giardiasis Metronidazole 3x500mg for 7 days N/A Giardia duodenalis cyst Giardiasis Metronidazole 3x500mg for 7 days N/A E.histolytica-like cyst Suspected amebiasis Metronidazole 3x500mg for 7 days Diarrheic stool E.histolytica-like cyst Suspected amebiasis Metronidazole 3x500mg for 7 days N/A Opisthorchis viverrini-like egg Suspected Opisthorchiasis Praziquantel 600mg SD N/A

16 PHYSICAL EXAMINATION 29 June 2017

17 BRIEFING AND SETTING UP

18 AREA MAPPING AND PATIENT FLOW

19 No. PATIENT CARD PATIENT REPORT FORM Name : Sex : Age : Ethnicity : Occupation : Marital status : N / Y Family members: Pregnancy status: Body weight/height: kg / cm! Chief complaint: Present medical history: Past medical history:!! Hypertension! Diabetes! Malaria! Allergy, specify ! Vaccination, specify.....! Surgery, specify ! Smoking,.... packs/day! Alcohol drinking, ! OBGYN ! Others, specify ! Physical Examination: General appearance:!fully conscious!looks weak!pallor!cyanosis!icteric - BP: / mmhg - Pulse: x/min - RR: x/min - Temp: o C HEENT : Lymph node : Heart : Lungs : Abdomen : Extremities :!edema Integument : Others : Laboratory Investigations: - Direct smear : Kato Thick smear : Thin blood film : Thick blood film : Provisional Diagnosis : Treatment :

20 PHYSICAL EXAMINATION

21 SUMMARY! Location: Hwaipha daycare center common grounds! Time: 9 a.m a.m.! Total number of patients: 39 patients! Total number of blood samples collected: 23 samples! Total number of positive blood sample findings: 1 sample

22 PATIENT DEMOGRAPHIC DATA: SEX Sex Number Proportion (%) Male Female 23 59

23 PATIENT DEMOGRAPHIC DATA: AGE (YEARS) Age (years) Number Proportion (%) <

24 PATIENT DEMOGRAPHIC DATA: ETHNICITY Ethnicity Number Proportion (%) Karen Thai 10 26

25 PATIENT DEMOGRAPHIC DATA: OCCUPATION Occupation Number Proportion (%) Farmer 9 30 House worker 2 7 General worker Soldier 1 3 Unemployed 5 17

26 PATIENT DEMOGRAPHIC DATA: CHIEF COMPLAINT Chief Complaint Number Proportion (%) Acute fever (<7d) 7 18 Respiratory symptoms (cough, runny nose) GI symptoms (abd. pain, N/V, diarrhea) Muscle pain 9 23 Headache 7 18 Skin rash 4 10 Others (trauma, ulcers) 3 8

27 PATIENT DEMOGRAPHIC DATA: PAST HISTORY OF MALARIA History of Malaria Number Proportion (%) Positive Negative 26 67

28 CLOSING REMARKS

29 BLOOD FILM STAINING

30 BLOOD FILM EXAMINATION

31 PATIENT DEMOGRAPHIC DATA: BLOOD EXAMINATION FINDINGS Parasite Findings Number Proportion (%) Positive 1 4 Negative 22 96

32 BLOOD EXAMINATION FINDINGS Thick film Thin film

33 INTERESTING CASE! Thai male, 23 y.o., soldier! Acute fever with chills since 26 June 2017! Came to malaria clinic on 27 June 2017, diagnosed without delay as vivax malaria, treated with chloroquine and primaquine! No abnormal findings on physical examination! Degree of parasitemia on day 3 of treatment was 0.24%

34 AEDES LARVAL SURVEY 29 June 2017

35 AEDES LARVAL SURVEY

36 AEDES LARVAL SURVEY! General purposes of surveillance activities are to:! Determine the key containers in the domestic environments so that larval source reduction by community participation may be carried out through health education.! Pinpoint high-risk areas, especially those with high vector density, by plotting vector distribution and numbers of DHF cases on maps. These areas serve as priority areas for control during normal conditions especially during epidemics.! Determine seasonal population fluctuations for special emphasis on control and alertness during peak vector periods.! Monitor the impact of vector control interventions including community participation and insecticidal space spraying on vector population.! Recognize significant changes in vector density, distribution, insecticide susceptibility and vectorial capacity to plan control strategy. WHO Guidelines for dengue surveillance and control. 2 nd edition

37 HOUSE #1

38 HOUSE #2

39 HOUSE #3

40 HOUSE #4

41 HOUSE #5

42 HOUSE #6

43 HOUSE #7

44 AEDES LARVAL SURVEY RESULTS House Number Container Type Drinking water No. of surveys No. of positive Bath and toilet No. of surveys No. of positive Utilized water Non-utilized water Storage water Pet feed Tyre Lid/bottom up container Discarded containers No. of surveys No. of positive No. of surveys No. of positive No. of surveys No. of positive No. of surveys No. of positive No. of surveys No. of positive No. of surveys No. of positive No. of surveys No. of positive Drainage/gutter No. of surveys No. of positive Total

45 WATER CONTAINER DISTRIBUTION Location Number Proportion (%) Outdoor Indoor 9 26

46 TYPE OF WATER CONTAINERS Water Containers Outdoor Indoor Total Positive % Remarks Drinking water Bath and toilet Utilized water Non-utilized water Outdoor (1) Storage water Outdoor (2); indoor (2) Pet feed Tyre Lid/bottom up container Discarded containers Drainage/gutter Total Positive outdoor: 6 Positive indoor: 5

47 WATER CONTAINER WITH LARVAE Location of Water Container Number Positive % Outdoor Indoor Outdoor Indoor Positive Negative Positive Negative

48 SUMMARY! Location: houses around the Hwaipha daycare center! Total number of houses surveyed: 7 houses! Total number of containers surveyed: 34! Total number of outdoor containers: 25! Total number of positive outdoor containers: 6! Total number of indoor containers: 9! Total number of positive indoor containers: 5! Total number of positive water containers: 11

49 AEDES DENSITY INDICES WHO Guidelines for dengue surveillance and control. 2 nd edition

50 DATA ANALYSIS Total number of surveyed houses 7 Total number of houses positive for larvae 7 Total number of houses positive for pupae 3 Total number of surveyed containers 34 Total number of positive containers 11 House Index (HI) (%) 100 Container Index (CI) (%) Breteau Index (BI) 157.1! High risk for dengue transmission?

51 RESULTS INTERPRETATION! BI and HI are commonly used for the determination of priority areas for control measures.! Generally, HI >5% and/or BI >20 is an indication that the locality is high risk for dengue transmission. WHO Guidelines for dengue surveillance and control. 2 nd edition

52 RODENT TRAPPING AND COLLECTION June 2017

53 SUMMARY! Location: Hwaipha daycare center: kitchen and surrounding area! Number of rodent traps installed: 7! Number of positive rodent traps: 2

54 RODENT TRAP INSTALLATION

55 RODENT TRAP INSTALLATION

56 RODENT TRAP COLLECTION

57 ECTO- PARASITE EXAMINATION 30 June 2017

58 SUMMARY! Indirect examination using samples acquired from trapped rodents! Direct examination using flagging and dragging methods

59 INDIRECT ECTOPARASITE EXAMINATION! Using rodent trapped in the sta! traps around RTIC! Rodent species of Rattus rattus

60 INDIRECT ECTOPARASITE EXAMINATION

61 INDIRECT ECTOPARASITE EXAMINATION

62 MICROSCOPIC FINDINGS Mites found: 30

63 MICROSCOPIC FINDINGS

64 DIRECT ECTOPARASITE SURVEY

65 DIRECT ECTOPARASITE SURVEY! During the direct ectoparasite survey, our group found several ectoparasites from dragging and flagging method.! We performed flagging and dragging on the pavement and on the bushes at the forest edge located behind the RTIC venue during the day (around 11 a.m.).! We were not able to identify the ectoparasites due to limited time.

66 OVERALL SUMMARY

67 FIELD STUDY OVERALL SUMMARY 1. Stool examination: total 24 samples, among which 12 were found positive for parasites and were treated accordingly. 2. Physical examination and blood film examination: total 39 patients; one interesting case with Plasmodium vivax found on blood film examination. 3. Aedes larval survey: the surveyed area is categorized as high risk area for dengue transmission. 4. Rodent trapping and collection: 2 out of 7 traps were positive. 5. Ectoparasite examination: 30 mites were found from one trapped rodent.

68 DIFFICULTIES DURING ACTIVITIES 1. Stool examination: the direct smears dried very quickly; took too much time to examine samples. 2. Physical examination: doctor-patient communication (language barrier); student role rotation. 3. Blood film examination: took too much time to examine samples. 4. Aedes larval survey: identify clearly the purpose of water containers, especially those that were located outdoor. 5. Rodent trapping and collection: no significant issues encountered. 6. Ectoparasite examination: identification of ectoparasites.

69 SUGGESTIONS 1. Stool examination: direct smear examination should be performed soon after the smear is ready; students need to take note on macroscopic appearance of stool samples; students need to practice more to improve microscopic examination skills. 2. Physical examination: time management, redistribution of students role. 3. Blood film examination: students need to practice more to improve microscopic examination skills. 4. Aedes larval survey: simplify the classification of types of water containers. 5. Ectoparasite examination: collect the suspected ectoparasites with little sheets of paper to collect more samples in indirect examination.

70 LEARNING EXPERIENCES! Improve knowledge about health system, especially local primary medical services and referral system as well.! Being able to work and experience providing health services to community in real setting.! Being able to plan and experience a group work, especially during working in the community.! Being able to apply previously learned knowledge from the classes into the real setting.! Strengthening the bond among students and sta!.! Being able to learn about other culture.

71 Questions?

72 ACKNOWLEDGEMENT 1. Assoc. Prof. Dorn Watthanakulpanich, Asst. Prof. Supaluk Popruk, Asst. Prof. Rutcharin Potiwat. 2. Laboratory technicians and all supporting sta! involved in the field study. 3. Local government, o"cers and community.

73 Thank you!