Field Trip Seminar Group 1 - Mahidol · 17 E.coli cyst, Iodamoeba butschlii cyst,...

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, Supervisors: Assoc. Prof. Dorn Watthanakulpanich, Asst. Prof. Supaluk Popruk, Asst. Prof. Rutcharin Potiwat

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.

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.

http://www.tm.mahidol.ac.th/rtic/?q=node/1

http://www.tm.mahidol.ac.th/rtic/?q=node/1

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

STOOL EXAMINATION

28 June 2017

STOOL EXAMINATION

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

STOOL EXAMINATION FINDINGS

No. Direct Smear Kato Thick Smear1 E.coli cyst, E.nana cyst Not found2 Not found Not found3 Not found Not found4 Not found Not found5 Giardia duodenalis cyst, Iodamoeba butschlii cyst Not found6 Not found Not found7 Not found Not found8 E.coli cyst, E.nana cyst Fertilized Ascaris lumbricoides egg9 E.coli cyst Opisthorchis viverrini-like egg

10 Unfertilized Ascaris lumbricoides egg Unfertilized Ascaris lumbricoides egg11 Fertilized & decorticated Ascaris lumbricoides egg, hookworm egg Fertilized Ascaris lumbricoides egg12 Not found Not found13 Fertilized Ascaris lumbricoides egg Fertilized & unfertilized Ascaris lumbricoides egg14 Hookworm egg Not found15 Unfertilized Ascaris lumbricoides egg, hookworm egg Unfertilized Ascaris lumbricoides egg, Trichuris trichiura egg16 Not found Not found17 E.coli cyst, Iodamoeba butschlii cyst, E.histolytica-like cyst Not found18 Not found Not found19 Giardia duodenalis cyst Not found20 E.nana cyst Not found21 E.nana cyst Not found22 Not found Not found23 E.coli cyst, E.nana cyst, E.histolytica-like cyst Not found24 E.coli cyst, Iodamoeba butschlii cyst, Giardia duodenalis cyst Not found

MICROSCOPIC FINDINGS

Entamoeba coli cyst Entamoeba histolytica-like cyst


Iodamoeba butschlii cyst Giardia duodenalis cyst


Endolimax nana cyst Trichuris trichiura egg


Hookworm egg Ascaris lumbricoides decorticated egg


Opisthorchis-viverrini-like egg

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

Ascariasis Albendazole 400mg SD N/A

Fertilized & decorticated Ascaris lumbricoides egg, hookworm egg

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



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

PHYSICAL EXAMINATION

29 June 2017

BRIEFING AND SETTING UP

AREA MAPPING AND PATIENT FLOW

PATIENT REPORT FORMPATIENT CARD

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: oC

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 : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No.

PHYSICAL EXAMINATION

SUMMARY

! Location: Hwaipha daycare center common grounds

! Time: 9 a.m. - 11 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

PATIENT DEMOGRAPHIC DATA: SEX

Sex Number Proportion (%)

Male 16 41

Female 23 59

PATIENT DEMOGRAPHIC DATA: AGE (YEARS)

Age (years) Number Proportion

(%)

<1 3 8

1-5 5 13

5-10 1 3

11-20 0 0

21-30 9 23

31-40 5 13

41-50 6 15

51-60 6 15

61-70 4 10

PATIENT DEMOGRAPHIC DATA: ETHNICITY

Ethnicity Number Proportion (%)

Karen 29 74

Thai 10 26

PATIENT DEMOGRAPHIC DATA: OCCUPATION

Occupation Number Proportion (%)

Farmer 9 30

House worker 2 7

General worker 13 43

Soldier 1 3

Unemployed 5 17

PATIENT DEMOGRAPHIC DATA: CHIEF COMPLAINT

Chief Complaint Number Proportion (%)

Acute fever (<7d) 7 18

Respiratory symptoms (cough, runny nose)

3 8

GI symptoms (abd. pain, N/V, diarrhea)

6 15

Muscle pain 9 23

Headache 7 18

Skin rash 4 10

Others (trauma, ulcers) 3 8

PATIENT DEMOGRAPHIC DATA: PAST HISTORY OF MALARIA

History of Malaria Number Proportion

(%)

Positive 13 33

Negative 26 67

DEMOGRAPHIC DATA: PAST HISTORY OF MALARIA

CLOSING REMARKS

BLOOD FILM STAINING

BLOOD FILM EXAMINATION

PATIENT DEMOGRAPHIC DATA: BLOOD EXAMINATION FINDINGS

Parasite Findings Number Proportion

(%)

Positive 1 4

Negative 22 96

BLOOD EXAMINATION FINDINGS

Thick film Thin film

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%

AEDESLARVAL SURVEY

29 June 2017

AEDES LARVAL SURVEY

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. 2nd edition. 2003. http://www.wpro.who.int/mvp/documents/docs/Guidelines_for_dengue_surveillance_edition2.pdf

http://www.wpro.who.int/mvp/documents/docs/Guidelines_for_dengue_surveillance_edition2.pdf

HOUSE #1

HOUSE #2

HOUSE #3

HOUSE #4

HOUSE #5

HOUSE #6

HOUSE #7

AEDES LARVAL SURVEY RESULTSContainer Type

House Number

1 2 3 4 5 6 7

Drinking waterNo. of surveys - - - - - - 2

No. of positive - - - - - - 0

Bath and toiletNo. of surveys - - 2 1 - 1 1

No. of positive - - 2 1 - 0 0

Utilized waterNo. of surveys - - - 1 - 3 -

No. of positive - - - 1 - 1 -

Non-utilized waterNo. of surveys 1 - - 1 - - -

No. of positive 1 - - 0 - - -

Storage waterNo. of surveys 3 2 1 - 2 2 3

No. of positive 1 0 0 - 1 0 2

Pet feedNo. of surveys 1 2 - - - - -

No. of positive 0 0 - - - - -

TyreNo. of surveys - - - - - 1 -

No. of positive - - - - - 0 -

Lid/bottom up containerNo. of surveys - - - 1 - - -

No. of positive - - - 0 - - -

Discarded containersNo. of surveys - 1 - 1 - - -

No. of positive - 1 - 0 - - -

Drainage/gutterNo. of surveys - - - - - 1 -

No. of positive - - - - - 0 -

Total 5 5 3 5 2 8 6 34

WATER CONTAINER DISTRIBUTION

Location Number Proportion (%)

Outdoor 25 74

Indoor 9 26

TYPE OF WATER CONTAINERS

Water Containers Outdoor Indoor Total Positive % Remarks

Drinking water 2 0 2 0 0

Bath and toilet 0 5 5 3 60

Utilized water 4 0 4 2 50

Non-utilized water 1 1 2 1 50 Outdoor (1)

Storage water 11 2 13 4 31 Outdoor (2); indoor (2)

Pet feed 3 0 3 0 0

Tyre 1 0 1 0 0

Lid/bottom up container 0 1 1 0 0

Discarded containers 2 0 2 1 50

Drainage/gutter 1 0 1 0 0

Total 25 9 34 11Positive outdoor: 6 Positive indoor: 5

WATER CONTAINER WITH LARVAE

Location of Water Container Number Positive %

Outdoor 25 6 24

Indoor 9 5 56

0

5

10

15

20

Positive Negative

19

6

Outdoor

0

1

2

3

4

5

Positive Negative

45

Indoor

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

AEDES DENSITY INDICES



DATA ANALYSIS

! High risk for dengue transmission?

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) (%) 32.35

Breteau Index (BI) 157.1

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.



RODENT TRAPPING

AND COLLECTION

29-30 June 2017

SUMMARY

! Location: Hwaipha daycare center: kitchen and surrounding area

! Number of rodent traps installed: 7

! Number of positive rodent traps: 2

RODENT TRAP INSTALLATION

RODENT TRAP COLLECTION

ECTO-PARASITE

EXAMINATION30 June 2017

SUMMARY

! Indirect examination using samples acquired from trapped rodents

! Direct examination using flagging and dragging methods

INDIRECT ECTOPARASITE EXAMINATION

! Using rodent trapped in the sta! traps around RTIC

! Rodent species of Rattus rattus

INDIRECT ECTOPARASITE EXAMINATION


Mites found: 30

DIRECT ECTOPARASITE SURVEY

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.

OVERALL SUMMARY

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.

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.

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.

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.

Questions?

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.

Thank you!

Field Trip Seminar Group 1 - Mahidol · 17 E.coli cyst, Iodamoeba butschlii cyst,...

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