Kajian Klinis dan Epidemiologis Leptospirosis pada Sapi di Kabupaten Kulon Progo Daerah Istimewa Yogyakarta

GUNTARI TITIK MULYANI, Prof. Dr. deh. Sri Hartati, SU.

2016 | Disertasi | S3 SAINS VETERINER

Leptospirosis adalah penyakit zoonotik, yang disebabkan oleh Leptospira. Sumber penularan leptospirosis pada manusia adalah tikus, ternak, hewan kesayangan maupun satwa liar. Kejadian Luar Biasa (KLB) leptospirosis pada manusia terjadi di kabupaten Kulon Progo pada tahun 2011. Penelitian leptospirosis pada sapi ini dilakukan di kabupaten Kulon Progo DIY pada akhir 2011 hingga pertengahan 2012. Tujuan penelitian ini adalah untuk: 1) Mengidentifikasi serovar penyebab leptospirosis sapi; 2) Mengetahui infeksi Leptospira pada sapi melalui gambaran klinis, fungsi hati, dan fungsi ginjal; 3) Mengisolasi Leptospira penyebab leptospirosis sapi; 4) Menyidik prevalensi dan memetakan kejadian leptospirosis pada sapi di kabupaten Kulon Progo; 5) Menyidik faktor risiko leptospirosis sapi; 6) Menganalisis pengaruh kedekatan lokasi peternakan dengan sungai terhadap kejadian leptospirosis sapi; dan 7) Mendeteksi secara molekuler Leptospira pada tikus di areal kandang sapi positif leptospirosis. Kajian penelitian ini dilaksanakan pada 1.564 sapi dari 819 peternak yang terpilih, dan menggunakan Microscopic Agglutination Test (MAT) untuk diagnosis leptospirosis. Gambaran klinis sapi diperoleh dengan pemeriksaan klinis, fungsi hati dideteksi dengan mengukur kadar Serum Glutamic Pyruvic Transaminase (SGPT) dan Serum Glutamic Oxaloacetic Transaminase (SGOT), serta gangguan fungsi ginjal dideteksi dengan mengukur kadar Blood Ureum Nitrogen (BUN) dan kreatinin. Isolat Leptospira sapi diperoleh dengan menumbuhkan Leptospira pada medium Ellinghausen and Mccullough modified by Johnson Harris (EMJH) dari sampel urin yang dideteksi dengan PCR dan dark microscope. Prevalensi leptospirosis dihitung dengan membagi hasil MAT positif dengan jumlah sampel yang diperiksa. Peta dikerjakan dengan program ArcGIS 10.2 berdasarkan data Global Position System (GPS) kasus leptospirosis. Faktor risiko yang berpengaruh terhadap leptospirosis sapi diperoleh dari data peternak, ternak, kandang, pakan, kesehatan, dan dilakukan analisis univariat (deskriptif). Data kemudian dianalisis dengan menggunakan Chi Square (χ2) dan peluang-ratio (OR), selanjutnya data dianalisis menggunakan regresi logistik untuk membangun model dan analisis jalur menggunakan Statistix 9.1. Peran kedekatan lokasi peternakan dengan sungai diteliti dari data GPS, buffering pada sungai dan analisis statistik Chi Square. Untuk memastikan peran tikus dalam kandang sapi sebagai reservoar, dilakukan deteksi molekuler LipL32 dengan PCR dari sampel ginjal tikus. Hasil penelitian menunjukkan 3,4% sampel positif terhadap 8 serovar Leptospira interrogans, yaitu serovar hardjo 43%, serovar Ichterohaemorrhagie 19%, serovar Rachmati 19%, serovar Bataviae 5%, serovar Celledoni 5%, serovar Tarrasovi 3%, serovar Pomona 3%, dan serovar Javanica 2%. Semua sapi yang terdiagnosis leptospirosis tidak menunjukkan gejala klinis. Sebanyak 18,9% sapi terdiagnosis leptospirosis memiliki kadar SGPT di atas normal (P<0,05); 3,8% memiliki kadar SGOT di atas normal (P>0,05); 15,0% memiliki kadar kreatinin di atas normal (P>0,05); sedangkan kadar BUN tidak mengalami peningkatan. Deteksi keberadaan Leptospira dengan PCR berdasarkan gen LipL32 diperoleh hasil 58,3% sampel positif dengan memperlihatkan adanya pita pada 506 bp. Inokulasi Leptospira pada medium semisolid EMJH tidak menunjukkan pertumbuhan. Hasil analisis faktor risiko menunjukkan bahwa faktor risiko yang berpengaruh langsung : adanya drainase (OR 0,2), pakan jerami dan rumput (OR 18,7), tikus di kandang (OR 2,28), umur 2-5th (OR 2,29), dan umur >5th (OR 2,33) mempunyai hubungan dengan kejadian leptospirosis pada sapi. Dengan analisis jalur diketahui faktor yang berpengaruh tidak langsung, yaitu: adanya pengolahan limbah (koefisien regresi 0,71907), penggunaan air sungai/telaga/air hujan (-0,19923 dan 0,09338); adanya 1-5 tikus di kandang (0,03529), jarak pembuangan limbah <5m ( -0,04210) dan adanya drainase (-0,03439 dan -0,1678). Model leptospirosis sapi mengikuti persamaan Log Lepto (Yl1x) = -3,74169 - 1,62459 DRAIN_1+ 2,89433 PAKAN_4 + 0,82519 TKSKDG_1 + 0,82687UMUR_2 + 0,84436 UMUR_3. Model ini memiliki spesifisitas tinggi (89,18%), namun memiliki sensitivitas yang rendah (41,51%). Analisis kedekatan lokasi peternakan terhadap sungai memberikan gambaran bahwa terdapat hubungan antara zona peternakan dan kejadian leptospirosis pada sapi (P<0,1). Sebanyak 21,9% tikus dalam kandang sapi positif leptospirosis positif leptospirosis dengan pemeriksaan PCR. Hasil penelitian dapat disimpulkan bahwa: leptospirosis pada sapi disebabkan oleh Leptospira berbagai serovar, dan sebagian besar disebabkan oleh serovar Harjo. Sapi positif leptospirosis tidak menunjukkan gejala klinis, dan sebagian kecil mengalami peningkatan SGPT (P<0,05); Sebagian besar sapi terdiagnosis leptospirosis positif dengan PCR melalui gen LipL32, sapi dapat berperan sebagai sumber penularan leptospirosis; Prevalensi leptospirosis pada ternak dan peternak sapi rendah, kejadian leptospirosis sapi lebih banyak terjadi di dataran tinggi dengan populasi rendah; Faktor risiko leptospirosis yang menurunkan kejadian leptospirosis adalah adanya drainase (OR 0,2); faktor risiko yang meningkatkan kejadian leptospirosis adalah pakan jerami dan rumput (OR 18,7), tikus di kandang (OR 2,28), umur 2-5th (OR 2,29) dan umur >5th (OR 2,33); Kedekatan lokasi peternakan dengan sungai berpengaruh terhadap kejadian leptospirosis sapi; Tikus dalam kandang sapi positif leptospirosis ditemukan positif leptospirosis sehingga memiliki peran dalam penularan leptospirosis.

Leptospirosis is a zoonotic disease, caused by Leptospira. A source of transmission of human leptospirosis are rodents, livestock, pets and wild animals. An extraordinary event was occurred in Kulon Progo district in 2011. The research was conducted in Kulon Progo district of Yogyakarta in late 2011 to mid 2012. The purposes of this study were to: 1) identify the serovar that causes bovine leptospirosis; 2) determine the effects of bovine leptospirosis through clinical sign, liver function and kidney function; 3) isolate of Leptospira that causes bovine leptospirosis; 4) investigate the prevalence and map the incidence of bovine leptospirosis; 5) investigate the risk factors of bovine leptospirosis; 6) investigate the role of the proximity of the river farm with cattle against leptospirosis cases; (7) detect the molecular Leptospira in rats in the stall area of bovine leptospirosis. The research used 1.564 cattles kept by 819 farmers, using Microscopic Aglutination Test (MAT) for diagnosis of leptospirosis. The clinical sign obtained by clinical examination, liver function detected by measuring the levels of Serum Glutamic Pyruvic transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT). Renal function detected by measuring levels of Blood Urea Nitrogen (BUN) and creatinine. Bovine Leptospira isolates were obtained by growing in Ellinghausen and McCullough modified by Johnson Harris (EMJH) medium from urine samples that had been detected by PCR and dark-field. The prevalence of leptospirosis was calculated by dividing the result of MAT positive by the number samples examined. The risk factors that affect the cattle leptospirosis were obtained from the data: ranchers, cattle, cages, feed, health, and conducted univariate analysis (descriptive). The data were subsequently analysed using Chi Square (X2) and odds-ratio (OR), which were ultimately analyzed means of logistic regression to build up a model and path analysis using Statistix 9.1. A map illustrating the location of bovine leptospirosis cases using GPS data created with ArcGIS 10.2 program. The role of river watershed was studied by using GPS data, buffering the stream, and statistical analysis of Chi Square. To ensure the role of rats was perform as a reservoir, molecular detection by PCR on LipL32 were done.The results showed that 3.4% samples were positive against 8 serovar Leptospira interrogans, which Hardjo 43%, Ichterohaemorrhagie19%, Rachmati 19%, Bataviae 5%, Celledoni 5%, Tarrasovi 3 %, Pomona 3%, and Javanica 2%. Bovine leptospirosis cases was more prevalent in the highlands to population less of 1.000 cattles. All cattles were diagnosed leptospirosis showed no clinical symptoms. Eighty poin nine percent samples had high levels of SGPT (P <0.05); 3.8% samples had high levels of SGOT (P> 0.05); 15% (8/53) samples had high levels of creatinine (P> 0.05); and BUN levels were not increased. Detection of the presence of Leptospira using PCR based on LipL32 gene from urine samples was obtained that 58.3% samples showing a band at 506 bp. Inoculation of Leptospira in semisolid medium EMJH showed no growth. Risk factors of bovine leptospirosis showed that directly affect were: the drainage (OR 0.2), feed hay and grass (OR 18.7), rats in cages (OR 2.28), age 2-5th (OR 2.29), and age> 5th ( OR 2.33). Path analysis indicated that: indirectly affect were the sewage treatment (regression coefficient 0.71907), the use of water of the river /lake /rainwater (-0.19923 and 0.09338); the 1-5 rat in a cage (0.03529), the distance waste disposal <5m (-0.04210 ), and the drainage (regression coefficient -0.03439 and -0.1678). Model leptospirosis Log Lepto (Yl1x) = -3,74169 - 1,62459 drainage_1 + 2,89433 feed hay and grass + 0,82519 rats in cage_1 + 0,82687 age 2-5th + 0,84436 age> 5th. This model had a high specificity (89.18%), but had a low sensitivity (41.51%). Environmental analysis of the location of the maintenance of the river illustrates that there is a correlation between the proximity of the zone of maintenance with the incidence of bovine leptospirosis (P< 0.1). A total of 21.9% of mice in the cowshed positive leptospirosis with PCR. From the results can be concluded that: most cattles in Kulon Progo distric were infected Hardjo serovar of Leptospira interrogans; Bovine leptospirosis showed no clinical symptoms, and less SGPT increased; Most of urine from bovine leptospirosis were positive by PCR through LipL32 gene, but did not show growth in the medium EMJH; Prevalence of bovine leptospirosis was small in cattle and farmers, the incidence of bovine leptospirosis were more prevalent in the highlands with a low population. Risk factors to decrease of bovine leptospirosis were the drainage; and to increase of bovine leptospirosis were feed hay and grass, rats in cages, age 2-5th (OR 2.29), and age> 5th; There is a relationship between the proximity zone maintenance locations with bovine leptospirosis cases; Rats in the cowshed positive leptospirosis have a role in the transmission of leptospirosis.

Kata Kunci : leptospirosis, sapi, Kulon Progo, tikus, sungai/ bovine leptospirosis, cattles, Kulon Progo, rats, river