Wednesday, January 23, 2008


MMIC dPBL 2 overview of case

Image: > Image> Indonesia

Indonesia [1] , in southeastern Asia, has a strategic location along major sea-lanes that connect the Indian and Pacific Oceans. The majority of the Indonesia’s islands consist of rugged volcanic mountains covered by dense tropical forests; however, some of the islands have swamps and plains. Indonesia is one of the most volcanically active regions on earth, with more than 100 active volcanoes. The region is subject to frequent earthquakes. The climate is tropical with an average daily temperature range of 21.1°C to 32.2° C with 80 to 90 percent humidity in the lowlands. Temperatures and humidity are lower as elevation increases, and temperatures below freezing can occur at elevations over 9,800 feet. Indonesia’s wet season occurs from November to March, and annual rainfall averages 40-78 inches.

Routes of transmission and entry of microorganism into host
Due to the humid and warm climate which is experienced in Indonesia all year round, bacterial, viral, protozoal and fungi infection can occur frequently in military soldiers.
Some pathogens are transmitted into huamns from wild animals and birds in the jungle. In the case of fungi infections, the infectious spores are carried from the soil to humans by air-borne routes. Food-borne diseases due contaminated water and food, un-cook food can also cause infections in these personnel. In addition, respiratory diseases and vector-borne diseases can also cause illness in these soldiers. Dirty living conditions such as not changing soiled clothes, not cleaning and airing of the feet frequently can also lead to microorganism infections. Other possible routes of transmission include aniaml bites (in the case of rabies), animal excretion, contaminated medications or fomites. [2]

1) indonesia/">>Indonesia
2) Jensen M. M. and Wright D. N. (1993) Introduction to Micobiology for Health Sciences. Prentices-Hall Inc., new Jersey


Presence of bacteria is extremely high in unhygienic conditions. Individuals infected by bacteria will present symptoms that may be infectious to other uninfected individual thus spreading the infection. [1] The soldiers having their army stint in Indonesia are exposed to numerous bacteria e.g. Shigella species, Salmonella species, E. coli, Campylobacter species as hygiene conditions are often overlooked. In addition, they are exposed to more bacteria during their jungle warfare training as soil, streams, rivers, animal feces, uncooked food which contain abundant amounts of bacteria. [1]

Food borne bacteria
In the jungle, military personnel have to prepare food themselves, thus the chances of consuming un-cook or contaminated food is relatively high. Therefore, they are at risk of be infected with various bacteria that are found on food when not cooked or cleaned properly. [5, 6]

Result from undercooking of food especially meat, organisms that are common include:
Campylobacter jejuni
Salmonella spp
Shigella spp
Listeria monocytogenes
Clostridium perfringens
Clostridium botulinium

Symptoms include:
Abdominal cramping

Shigella [3]

Transmission: Most individuals are infected with shigellae when they ingest food or water contaminated with human fecal material. Spread is always from a human source.

Causes: Shigellosis

Signs and symptoms: Fever, abdominal cramping, diarrhea, dehydration, tenesmus (straining of stool)

Salmonella species [2]

Transmission: Salmonella is spread from the carcasses to humans when the poultry is eaten undercooked. Other sources of Salmonellae include milk products, food, and water contaminated with animal feces or urine.

Causes: Salmonellosis, enteritis, Typhoid fever, primary septicemia

Signs and symptoms: Nausea, vomiting, abdominal pain, diarrhea, fever, weight loss, anemia, anorexia, headache.

Campylobacter [1]

Transmission: Campylobacter is usually acquired from food (especially poultry), milk, or contact with infected animals (e.g. dogs) through the fecal-oral route.

Causes: Acute enteritis

Signs and symptoms: Bloody diarrhea, fever, abdominal pain, headache.

Animal vector bacteria [1,3]
As the soldiers are training in the jungle, they will encounter many different forms of wildlife. Bacteria carried by them may be transmitted to the soldiers. Common ones include:

Brucella spp (contact with infected animals e.g. dogs, pigs, cattle, horse)
Francisella sp. (contact with wild animals that carry ticks, mites and lice)
Yersinia spp (contact with rodents that carry fleas that carry the bacteria)
Pasteurella multocida (cat and dog bites)

Soil vector bacteria [2, 3]
In addition to the exposure to various fauna and flora living in the jungle, soldiers may also come in contact with soil. Soil is a place where many bacteria flourished thus they chances of getting an infection casued by a soil organism is also relatively possible

Clostrodium tetani [2]

Transmission: Soils or materials in contact with animal wastes are usually heavily contaminated with C. tetani and offer excellent sources of infections. Soil-contaminated wounds are most frequent source of infection.

Causes: Tetanus

Signs and symptoms: Spasmodic contractions (tetany) in involved muscles that are affected by the toxin and muscle spasms.

Mode of control: Vaccines


1. Levinson, W. (2006). Review of Medical Microbiology & Immunology. San Francisco, California: Lange Medical Books/McGraw-Hill publishing company

2. Elliott T., Hasting M. and Desselberger U. (1997). Lecture Notes on Medical Microbiology. Blackwell Science, Oxford

3. Walker, T.S. (1998). Microbiology. Philadelphia, Pennsylvannia: W.B Saunders Company

4. > Search > food poisoning

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