This document discusses tropical diseases with a focus on dengue and malaria. It provides details on the causative agents, transmission, clinical presentation, diagnosis and management of dengue and malaria. Dengue is caused by the dengue virus and transmitted by the Aedes mosquito. It presents as acute fever and can progress to severe dengue characterized by plasma leakage, bleeding and organ dysfunction. Malaria is caused by Plasmodium parasites and transmitted by Anopheles mosquitoes. It presents with fever and can lead to complicated malaria involving organ dysfunction. Diagnosis involves microscopy, rapid tests and PCR. Management focuses on supportive care, IV fluids and antimalarials depending on disease severity.
1. Dengue is a viral disease spread by mosquitoes that is increasingly prevalent in the Philippines, especially during rainy months in urban areas.
2. There are four distinct serotypes of the dengue virus that cause disease in humans. Infection progresses through febrile, critical, and recovery phases.
3. Treatment depends on disease severity and presence of warning signs like abdominal pain, vomiting, bleeding, or organ impairment. Mild cases can be treated at home with rest, fluids and paracetamol while more severe cases require hospitalization and intravenous fluids.
This document provides an overview of dengue fever management. It discusses the virus and vector, pathogenesis, clinical manifestations, investigations, severity grading, treatment approaches including fluid management, and discharge criteria. Key points include: dengue is caused by a flavivirus with 4 serotypes transmitted by Aedes aegypti mosquitoes; symptoms range from mild fever to potentially fatal shock; grading disease severity is important to determine management; intravenous fluids and monitoring for warning signs are the main treatment approaches.
The document discusses dengue, its causative virus, transmission, clinical manifestations, diagnosis, and management in children. It provides details on:
- The dengue virus having 4 serotypes and being transmitted by the Aedes aegypti mosquito.
- The replication and transmission cycle between humans and mosquitoes.
- Clinical manifestations ranging from dengue fever to the more severe dengue hemorrhagic fever and dengue shock syndrome.
- Diagnosis involving laboratory tests and clinical criteria.
- A stepwise approach to patient assessment and management categorized into outpatient, inpatient, and emergency groups.
1. Dengue fever is a mosquito-borne illness caused by dengue viruses and transmitted by Aedes mosquitoes. It presents with fever, headache, muscle and joint pain, and rash.
2. In Malaysia, dengue incidence increased dramatically from 32 to 361 cases per 100,000 people between 2014. Most cases are reported from urban areas in people aged 15-49 years.
3. Dengue progresses through febrile, critical, and recovery phases. The critical phase involves rapid temperature drop and potential for plasma leakage, bleeding, or organ impairment requiring monitoring for warning signs.
The document discusses dengue, its causative virus, transmission cycle, clinical manifestations, diagnosis, and management in children. It describes how the dengue virus is transmitted between humans and mosquitoes, the four serotypes of the virus, and the typical 3 phase clinical course of dengue fever and dengue hemorrhagic fever. It provides guidelines for classifying and managing patients based on symptoms and severity, including outpatient and inpatient treatment and criteria for discharge.
Dengue diagnosis and management Bangladesh perspective DRIMTIAZ3
This document provides guidelines for the management of dengue fever according to national guidelines. It begins with an introduction to dengue virus and disease. It then describes the clinical manifestations including asymptomatic infection, undifferentiated fever, dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. For treatment and management, it separates patients into three groups - Group A who can be managed at home, Group B who require admission for observation, and Group C who require emergency treatment and referral. It provides detailed recommendations for treatment and monitoring of each group.
This document provides an outline for a presentation on Dengue Fever. It begins with introducing Dengue Fever and its global prevalence. It then covers the pathogenesis, classification (into dengue fever without warning signs, with warning signs, and severe dengue), clinical course over incubation, febrile, critical and recovery phases. The document also discusses assessment, investigations, differential diagnosis, management approaches depending on classification and severity, additional points, and references.
Dengue fever is caused by the dengue virus and transmitted by mosquitoes. It has four distinct serotypes. Symptoms include fever, headache, and joint pain and typically last 2-7 days. While usually mild, it can develop into severe dengue with plasma leakage, fluid accumulation, and shock. Treatment involves fluid replacement and monitoring for warning signs. Prevention focuses on eliminating mosquito breeding sites and avoiding bites. A vaccine is still in development.
1. Dengue is a viral disease spread by mosquitoes that is increasingly prevalent in the Philippines, especially during rainy months in urban areas.
2. There are four distinct serotypes of the dengue virus that cause disease in humans. Infection progresses through febrile, critical, and recovery phases.
3. Treatment depends on disease severity and presence of warning signs like abdominal pain, vomiting, bleeding, or organ impairment. Mild cases can be treated at home with rest, fluids and paracetamol while more severe cases require hospitalization and intravenous fluids.
This document provides an overview of dengue fever management. It discusses the virus and vector, pathogenesis, clinical manifestations, investigations, severity grading, treatment approaches including fluid management, and discharge criteria. Key points include: dengue is caused by a flavivirus with 4 serotypes transmitted by Aedes aegypti mosquitoes; symptoms range from mild fever to potentially fatal shock; grading disease severity is important to determine management; intravenous fluids and monitoring for warning signs are the main treatment approaches.
The document discusses dengue, its causative virus, transmission, clinical manifestations, diagnosis, and management in children. It provides details on:
- The dengue virus having 4 serotypes and being transmitted by the Aedes aegypti mosquito.
- The replication and transmission cycle between humans and mosquitoes.
- Clinical manifestations ranging from dengue fever to the more severe dengue hemorrhagic fever and dengue shock syndrome.
- Diagnosis involving laboratory tests and clinical criteria.
- A stepwise approach to patient assessment and management categorized into outpatient, inpatient, and emergency groups.
1. Dengue fever is a mosquito-borne illness caused by dengue viruses and transmitted by Aedes mosquitoes. It presents with fever, headache, muscle and joint pain, and rash.
2. In Malaysia, dengue incidence increased dramatically from 32 to 361 cases per 100,000 people between 2014. Most cases are reported from urban areas in people aged 15-49 years.
3. Dengue progresses through febrile, critical, and recovery phases. The critical phase involves rapid temperature drop and potential for plasma leakage, bleeding, or organ impairment requiring monitoring for warning signs.
The document discusses dengue, its causative virus, transmission cycle, clinical manifestations, diagnosis, and management in children. It describes how the dengue virus is transmitted between humans and mosquitoes, the four serotypes of the virus, and the typical 3 phase clinical course of dengue fever and dengue hemorrhagic fever. It provides guidelines for classifying and managing patients based on symptoms and severity, including outpatient and inpatient treatment and criteria for discharge.
Dengue diagnosis and management Bangladesh perspective DRIMTIAZ3
This document provides guidelines for the management of dengue fever according to national guidelines. It begins with an introduction to dengue virus and disease. It then describes the clinical manifestations including asymptomatic infection, undifferentiated fever, dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. For treatment and management, it separates patients into three groups - Group A who can be managed at home, Group B who require admission for observation, and Group C who require emergency treatment and referral. It provides detailed recommendations for treatment and monitoring of each group.
This document provides an outline for a presentation on Dengue Fever. It begins with introducing Dengue Fever and its global prevalence. It then covers the pathogenesis, classification (into dengue fever without warning signs, with warning signs, and severe dengue), clinical course over incubation, febrile, critical and recovery phases. The document also discusses assessment, investigations, differential diagnosis, management approaches depending on classification and severity, additional points, and references.
Dengue fever is caused by the dengue virus and transmitted by mosquitoes. It has four distinct serotypes. Symptoms include fever, headache, and joint pain and typically last 2-7 days. While usually mild, it can develop into severe dengue with plasma leakage, fluid accumulation, and shock. Treatment involves fluid replacement and monitoring for warning signs. Prevention focuses on eliminating mosquito breeding sites and avoiding bites. A vaccine is still in development.
1) Dengue fever is caused by dengue virus transmitted by mosquitoes and has four distinct serotypes. It has an incubation period of 4-7 days and may present asymptomatically or with mild to severe symptoms.
2) The clinical course involves a febrile phase with symptoms like fever and rash, followed by a critical phase where vascular permeability increases, and a recovery phase. Shock may occur if plasma leakage is not corrected.
3) Hospital admission is recommended for patients exhibiting warning signs like abdominal pain, vomiting, bleeding, lethargy or clinical signs of shock, organ impairment, inability to tolerate fluids, or those with risk factors.
The document discusses pharyngeal arches, which consist of pharyngeal arches, clefts, and pouches during the 4th week of development. The mesoderm and neural crest cells of the pharyngeal arches give rise to cartilage, bone, connective tissue, muscles, nerves, and arteries. The first pharyngeal arch derivatives include the maxilla and mandible.
Dengue is a mosquito-borne viral infection found in tropical and subtropical regions. It causes symptoms like fever, headache, and rashes. While most cases are mild, it can develop into a severe form with complications like bleeding, shock, and organ impairment. There is no specific treatment, only supportive care. Prevention focuses on controlling mosquito populations and avoiding bites.
This document provides information about Dengue fever, including:
1) It describes Dengue fever as the most rapidly spreading mosquito-borne viral disease in the world, caused by the Dengue virus which has 4 serotypes.
2) Symptoms and classifications of Dengue fever are discussed according to the WHO, including dengue fever without hemorrhage, dengue hemorrhagic fever, and dengue shock syndrome.
3) Diagnosis, treatment, prevention and control of Dengue fever and its vectors are summarized, highlighting supportive care, intravenous fluids, monitoring for complications, and the importance of vector control measures.
- Dengue fever is caused by any of the 4 dengue virus serotypes transmitted through the bites of infected Aedes mosquitoes.
- It presents as an acute febrile illness with fever, rash and bleeding and can progress to severe dengue with plasma leakage and shock.
- Treatment is supportive with antipyretics, fluid management and blood transfusion in severe cases. Close monitoring is needed to watch for complications.
This document provides an overview of dengue, including its epidemiology, life cycle, pathogenesis, clinical features, diagnosis, management, prognosis, and prevention. Some key points:
- Dengue is a self-limited viral infection transmitted by mosquitoes that infects 50-100 million people yearly and is a major public health challenge due to lack of vaccines or treatments.
- There are four serotypes of the dengue virus. Infection causes an acute febrile illness that in some cases progresses to severe dengue with plasma leakage and potential complications including shock.
- Diagnosis is based on virus detection, serology, or PCR. Management focuses on supportive care and fluid management. Prevention emphasizes mosquito control
This document provides information on dengue fever. It discusses the dengue virus, which is a flavivirus transmitted by Aedes aegypti mosquitoes. It outlines the clinical presentation of dengue fever and dengue hemorrhagic fever. It also discusses pathogenesis, diagnosis, management including fluid therapy, and prevention through vector control measures targeting the Aedes mosquito. The distribution of dengue is global in tropical and subtropical regions. India has a major burden of dengue disease.
Dengue Fever, epidemiology, diagnosis and managementWasantha13
This document provides an overview of dengue fever, including its epidemiology, clinical presentation, phases, prevention, control, and management. It notes that dengue is a rapidly spreading mosquito-borne illness causing acute fever that can lead to severe symptoms and death. It is found in tropical and subtropical regions worldwide, with 390 million estimated infections annually. The presentation outlines the virus, mosquito, incubation period, phases of infection, clinical features, complications, and criteria for differentiating dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. It discusses prevention, treatment approaches based on severity, intravenous fluid management, and discharge criteria.
This document discusses guidelines for diagnosing and treating dengue. It notes that dengue is the fastest spreading mosquito-borne viral disease, infecting 50 million people annually. It has increased geographic spread and incidence. The virus has 4 serotypes. Symptoms include fever, rash and bleeding. Management involves fluid replacement and blood transfusion for severe bleeding. Patients are classified into groups A, B or C depending on severity of symptoms and need for hospitalization.
This document provides guidelines for the diagnosis and treatment of dengue. It discusses the epidemiology, transmission, clinical presentation and management of dengue. Some key points:
- Dengue is a rapidly spreading mosquito-borne viral disease that infects 50 million people annually. Incidence has increased 30-fold with expansion into new areas.
- Clinical presentation ranges from mild fever to severe bleeding. Patients are classified into groups A, B or C depending on severity of symptoms to determine treatment.
- Management involves fluid resuscitation and blood transfusion if bleeding occurs. The goal is to prevent fluid overload while replenishing plasma losses. Complications include shock, hemorrhage and organ impairment.
This document discusses dengue fever, including its diagnosis and management. It notes that dengue is a mosquito-borne viral illness characterized by fever, headache, joint pain and rash. There are four serotypes of the dengue virus. Clinical manifestations range from asymptomatic infection to classical dengue fever to the more severe dengue hemorrhagic fever. Management involves assessing severity, monitoring vital signs and blood work, and providing fluid support. Platelet transfusions may be indicated for severe bleeding or low platelet counts. Proper fluid management is important to avoid complications in the critical and recovery phases of illness.
This document provides information on dengue, including its case definition, epidemiology, pathophysiology, clinical features, investigations, management, complications, and treatment. A probable dengue case is defined as an acute febrile illness with two or more symptoms like headache and retro-orbital pain. A confirmed case requires virus isolation or serology testing. Dengue is endemic in over 100 countries and is transmitted by the Aedes aegypti mosquito. It has four serotypes and causes a spectrum of disease from mild fever to severe dengue hemorrhagic fever and dengue shock syndrome. Management involves fluid management and supportive care. There is currently no approved vaccine for dengue.
This document provides guidance on diagnosing and managing dengue fever (DF) and dengue hemorrhagic fever (DHF). It defines the different phases of dengue infection and outlines criteria for differentiating DF from DHF. Management involves supportive care during the febrile phase and careful fluid management to prevent shock during the critical leakage phase. Common causes of death from dengue include fluid overload, hemorrhage, profound shock, and multi-organ failure. Proper outpatient treatment, monitoring for warning signs, and administering the right amount of fluids or blood transfusions as needed can help prevent dengue deaths.
This document provides information on recognizing and managing dengue infections. It discusses the pathogenesis, clinical course, diagnosis and differential diagnosis of dengue. The clinical course is divided into the febrile, critical and recovery phases. Classification of dengue cases and recommendations for clinical management are also provided, including fluid management and treatment for different severity groups (A, B and C). Group C requires emergency treatment for severe manifestations like shock. Overall the document aims to guide healthcare professionals in appropriately diagnosing and treating dengue infections.
This document summarizes fever and febrile syndromes. It discusses the physiology of temperature regulation in the body and the pathogenesis of fever. It describes the different causes of fever including exogenous and endogenous pyrogens. It then discusses specific infectious causes of fever like malaria, enteric fever, dengue, leptospirosis, and scrub typhus. For each condition, it summarizes the causative organism, transmission, clinical features, diagnosis, and treatment. It also discusses complications, investigations, and management principles for febrile illnesses.
- Dengue virus is transmitted via mosquito bites and causes a febrile illness with three phases: acute, critical, and recovery. Common symptoms include headache, rash, and bleeding.
- Diagnosis is based on symptoms and serology detecting IgM and IgG antibodies or virus. Dengue hemorrhagic fever is diagnosed when hemorrhagic manifestations and plasma leakage are present along with thrombocytopenia.
- Treatment involves fluid resuscitation and management of shock in severe cases. Patients are monitored for warning signs that indicate potential progression to severe dengue or dengue shock syndrome.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
1) Dengue fever is caused by dengue virus transmitted by mosquitoes and has four distinct serotypes. It has an incubation period of 4-7 days and may present asymptomatically or with mild to severe symptoms.
2) The clinical course involves a febrile phase with symptoms like fever and rash, followed by a critical phase where vascular permeability increases, and a recovery phase. Shock may occur if plasma leakage is not corrected.
3) Hospital admission is recommended for patients exhibiting warning signs like abdominal pain, vomiting, bleeding, lethargy or clinical signs of shock, organ impairment, inability to tolerate fluids, or those with risk factors.
The document discusses pharyngeal arches, which consist of pharyngeal arches, clefts, and pouches during the 4th week of development. The mesoderm and neural crest cells of the pharyngeal arches give rise to cartilage, bone, connective tissue, muscles, nerves, and arteries. The first pharyngeal arch derivatives include the maxilla and mandible.
Dengue is a mosquito-borne viral infection found in tropical and subtropical regions. It causes symptoms like fever, headache, and rashes. While most cases are mild, it can develop into a severe form with complications like bleeding, shock, and organ impairment. There is no specific treatment, only supportive care. Prevention focuses on controlling mosquito populations and avoiding bites.
This document provides information about Dengue fever, including:
1) It describes Dengue fever as the most rapidly spreading mosquito-borne viral disease in the world, caused by the Dengue virus which has 4 serotypes.
2) Symptoms and classifications of Dengue fever are discussed according to the WHO, including dengue fever without hemorrhage, dengue hemorrhagic fever, and dengue shock syndrome.
3) Diagnosis, treatment, prevention and control of Dengue fever and its vectors are summarized, highlighting supportive care, intravenous fluids, monitoring for complications, and the importance of vector control measures.
- Dengue fever is caused by any of the 4 dengue virus serotypes transmitted through the bites of infected Aedes mosquitoes.
- It presents as an acute febrile illness with fever, rash and bleeding and can progress to severe dengue with plasma leakage and shock.
- Treatment is supportive with antipyretics, fluid management and blood transfusion in severe cases. Close monitoring is needed to watch for complications.
This document provides an overview of dengue, including its epidemiology, life cycle, pathogenesis, clinical features, diagnosis, management, prognosis, and prevention. Some key points:
- Dengue is a self-limited viral infection transmitted by mosquitoes that infects 50-100 million people yearly and is a major public health challenge due to lack of vaccines or treatments.
- There are four serotypes of the dengue virus. Infection causes an acute febrile illness that in some cases progresses to severe dengue with plasma leakage and potential complications including shock.
- Diagnosis is based on virus detection, serology, or PCR. Management focuses on supportive care and fluid management. Prevention emphasizes mosquito control
This document provides information on dengue fever. It discusses the dengue virus, which is a flavivirus transmitted by Aedes aegypti mosquitoes. It outlines the clinical presentation of dengue fever and dengue hemorrhagic fever. It also discusses pathogenesis, diagnosis, management including fluid therapy, and prevention through vector control measures targeting the Aedes mosquito. The distribution of dengue is global in tropical and subtropical regions. India has a major burden of dengue disease.
Dengue Fever, epidemiology, diagnosis and managementWasantha13
This document provides an overview of dengue fever, including its epidemiology, clinical presentation, phases, prevention, control, and management. It notes that dengue is a rapidly spreading mosquito-borne illness causing acute fever that can lead to severe symptoms and death. It is found in tropical and subtropical regions worldwide, with 390 million estimated infections annually. The presentation outlines the virus, mosquito, incubation period, phases of infection, clinical features, complications, and criteria for differentiating dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. It discusses prevention, treatment approaches based on severity, intravenous fluid management, and discharge criteria.
This document discusses guidelines for diagnosing and treating dengue. It notes that dengue is the fastest spreading mosquito-borne viral disease, infecting 50 million people annually. It has increased geographic spread and incidence. The virus has 4 serotypes. Symptoms include fever, rash and bleeding. Management involves fluid replacement and blood transfusion for severe bleeding. Patients are classified into groups A, B or C depending on severity of symptoms and need for hospitalization.
This document provides guidelines for the diagnosis and treatment of dengue. It discusses the epidemiology, transmission, clinical presentation and management of dengue. Some key points:
- Dengue is a rapidly spreading mosquito-borne viral disease that infects 50 million people annually. Incidence has increased 30-fold with expansion into new areas.
- Clinical presentation ranges from mild fever to severe bleeding. Patients are classified into groups A, B or C depending on severity of symptoms to determine treatment.
- Management involves fluid resuscitation and blood transfusion if bleeding occurs. The goal is to prevent fluid overload while replenishing plasma losses. Complications include shock, hemorrhage and organ impairment.
This document discusses dengue fever, including its diagnosis and management. It notes that dengue is a mosquito-borne viral illness characterized by fever, headache, joint pain and rash. There are four serotypes of the dengue virus. Clinical manifestations range from asymptomatic infection to classical dengue fever to the more severe dengue hemorrhagic fever. Management involves assessing severity, monitoring vital signs and blood work, and providing fluid support. Platelet transfusions may be indicated for severe bleeding or low platelet counts. Proper fluid management is important to avoid complications in the critical and recovery phases of illness.
This document provides information on dengue, including its case definition, epidemiology, pathophysiology, clinical features, investigations, management, complications, and treatment. A probable dengue case is defined as an acute febrile illness with two or more symptoms like headache and retro-orbital pain. A confirmed case requires virus isolation or serology testing. Dengue is endemic in over 100 countries and is transmitted by the Aedes aegypti mosquito. It has four serotypes and causes a spectrum of disease from mild fever to severe dengue hemorrhagic fever and dengue shock syndrome. Management involves fluid management and supportive care. There is currently no approved vaccine for dengue.
This document provides guidance on diagnosing and managing dengue fever (DF) and dengue hemorrhagic fever (DHF). It defines the different phases of dengue infection and outlines criteria for differentiating DF from DHF. Management involves supportive care during the febrile phase and careful fluid management to prevent shock during the critical leakage phase. Common causes of death from dengue include fluid overload, hemorrhage, profound shock, and multi-organ failure. Proper outpatient treatment, monitoring for warning signs, and administering the right amount of fluids or blood transfusions as needed can help prevent dengue deaths.
This document provides information on recognizing and managing dengue infections. It discusses the pathogenesis, clinical course, diagnosis and differential diagnosis of dengue. The clinical course is divided into the febrile, critical and recovery phases. Classification of dengue cases and recommendations for clinical management are also provided, including fluid management and treatment for different severity groups (A, B and C). Group C requires emergency treatment for severe manifestations like shock. Overall the document aims to guide healthcare professionals in appropriately diagnosing and treating dengue infections.
This document summarizes fever and febrile syndromes. It discusses the physiology of temperature regulation in the body and the pathogenesis of fever. It describes the different causes of fever including exogenous and endogenous pyrogens. It then discusses specific infectious causes of fever like malaria, enteric fever, dengue, leptospirosis, and scrub typhus. For each condition, it summarizes the causative organism, transmission, clinical features, diagnosis, and treatment. It also discusses complications, investigations, and management principles for febrile illnesses.
- Dengue virus is transmitted via mosquito bites and causes a febrile illness with three phases: acute, critical, and recovery. Common symptoms include headache, rash, and bleeding.
- Diagnosis is based on symptoms and serology detecting IgM and IgG antibodies or virus. Dengue hemorrhagic fever is diagnosed when hemorrhagic manifestations and plasma leakage are present along with thrombocytopenia.
- Treatment involves fluid resuscitation and management of shock in severe cases. Patients are monitored for warning signs that indicate potential progression to severe dengue or dengue shock syndrome.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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Recomendamos muito.
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3. Tropical Regions
• In terms of climate - hotter and wetter
• 40% of the Earth's surface area.
• home to 40% of the world's population
• Abundant insects and vectors
• Lack of access to safe water, poor sanitation
• Overcrowding, poor housing, dirty environment
• All --- Transmission of Infections.
9. Dengue
Agent- Dengue Virus
• Single stranded RNA Virus
• Family: Flaviviridae
• Genus: Flavivirus
• 5 serotypes: DENV-1, DENV-2,
DENV-3, DENV-4 ,DENV5
Vector- Mosquito
•Aedes aegypti , Aedes albopictus,
Aedes polynsienses, Aedes scrutella
•Day feeders, Recurrent biter
•Fresh water mosquitoes
•White bands or scale patterns on its
legs and thorax
DENV- Dengue virus
10. Man-Mosquito-Man Cycle
Febrile viremia in
a boy infected
with dengue virus
3-7 days
Mosquito bites and
gets dengue virus
in blood meal
Dengue infected
mosquito bites
healthy person and
transmits the virus
Incubation period
in the infected person
2-7 days
Mosquito
with no
dengue virus
Incubation period
within the mosquito
11. Immune-pathogenesis
The First Dengue Infection
T and B memory cells
Reinfection
B cells- Ab production &
Antibody dependent
enhanced replication
Ag-Ab complex formation with
complement activation
Deposition on various tissues,
vessels and platelets
Thrombocytopenia bleeding Vasculopathy capillary leakage
T cell activation
Chemical mediators
Cytokine
Storm/Tsunami
Increased vascular
pathology
Ref: Mongkolsapaya J et al. 2003. Nat Med 9: 921–927
Mathew A et al. 2008. Immunol Rev 225: 300–313
15. CLINICAL FEATURES
Three phases-
• Acute Febrile Phase.
High Grade Fever (2-7 Days)
Facial Flushing, Skin Erythema, Petechiae/Mucosal Bleed
Headache, Bodyache, Myalgia, Arthalgia
Nausea, Vomiting.
Tender Hepatomegaly (Risk- Severity)
Thrombocytopenia and Leucopenia
16. • Critical Phase
After 3-7 days of onset of Fever.
Capillary leakage
Thrombocytopenia/ Bleeding
Shock
Multi-Organ Dysfunctions
• Recovery Phase ( After 24-48 hours)
Absorption of extravasated fluids starts
General well bieng, improve in appettite
Heodynamically stabilizes, Urine output improves.
May have- Itching, Bradycardia, Resp. Distress (Pulmonary Edema)
Rashes- Isles of white in the sea of red.
22. CLINICAL CRITERIA FOR DENGUE
• Acute febrile illness of 2-7 days duration with 2 or more features :
• Headache, Retro-orbital pain,
• Rash, Myalgia, Arthralgia/bone pain,
• Haemorrhagic manifestations,
• Leucopenia (WBC ≤5000 cells/mm3),
• Thrombocytopenia (platelet count <100 000 cells/mm3),
• Rising Haematocrit (5 – 10%);
and at least one of following:
• Supportive serology – Antibody test, Antigen test ( Agglutination, ELISA)
• Occurrence at the same location and time as confirmed cases of dengue fever.
23. Clinical Features
• Tourniquet test
• Midpoint between SBP and DBP
• 5 minutes
• positive when 10 or more petechia
per 1 square inch area over forearm
• Definite positive test with > 20 pet.
• 50% cases positive
• Negative in obese and Shock
28. Primary Infection
• NS1 antigen :- Day 1 after onset of fever and up to day 9
• IgM antibody :-
• Day 5 of infection
• IgM levels : peaks in 2 weeks, followed by a 2 week rapid decay.
• Low levels of IgG are detected in the early recovery phase, not during
the acute phase.
29. Secondary Infection
• NS1 antigen : day 1 after onset of fever and upto day 9
• IgM response is variable
• appears quite late during the febrile phase
• High levels of IgG are detectable during acute Phase
30. Recommendation for diagnosis
• NS1 for samples collected from day 1 to day 5;
• IgM ( Sn 84% to 98% ,Sp 100%) after Day 5.
• Govt. Of India recommends confirmation of dengue by ELISA based
Antigen detection ( NS1 ) from Day 1 onwards and IgM antibody
ELISA after day 5 onwards.
31. Course of Dengue
Day of illness 0 1 2 3 4 5 6 7 8 9 10
Dehydration
Bleeding
Shock
Reabsorption and
Fluid Overload
Organ Dysfunction
Capillary permeability
Platelet
Hematocrit
WBC
Viremia
IgM/IgG
Febrile Recovery
Critical
40ᴼC
38ᴼC
Temperature
Potential
clinical
problems
Laboratory
parameters
Virology &
Serology
Ref: WHO-TDR Guidelines for diagnosis, management, prevention and control of dengue 2009
33. Step I Overall assesment
• History : symptoms, past medical and family history
• Physical examination : full physical and mental assessment
• Investigation : routine labs and dengue specific labs
Step III Management
• Disease notification
• Management decisions, depending on the clinical
manifestations and other circumstances, patients may :
Be sent home
Be referred for in- Hospital management
Require emergency treatment and urgent referral
Step II
• Diagnosis
• Assessment of disease phase and severity
A stepwise approach to the management of dengue
36. Dengue without warning signs
• HOME CARE
• MONITORING
• EXPLAIN WARNING SIGNS/WHEN TO RETURN
37. Home care advice for patients
• Patient needs to take adequate bed rest.
• Adequate intake of fluids such as milk, fruit juice, isotonic electrolyte
solution, oral rehydration solution (ORS) and barley/rice water.
• Paracetamol & Tepid sponging
• Paracetamol- 10-15mg/kg/d every 6 hrs.
• Aspirin or NSAID is not recommended.
• Follow-up and reassess the patient every day until the patient has no fever
on two consecutive days without the use of paracetamol.
38. When to return?
• No clinical improvement
• Persistent vomiting, lack of water intake.
• Severe abdominal pain.
• Lethargy and/or restlessness.
• Bleeding
• Pale, cold and clammy hands and feet.
• Less/no urine output for 4–6 hours
39. Management of patients with WARNING SIGNS
• Hospitalize
• Rule out other common causes - AGE, Surgical Abdomen etc.
• Supportive and symptomatic treatment should be given while under
observation
• IVF
• Monitor Vitals, Platelets and PCV/HCT.
41. SEVERE DENGUE
• Shock or fluid accumulation causing Respiratory Distress
• Severe Bleeding
• Impaired consciousness
• Multiple Organ Involvement
42. MANAGEMENT OF Severe Dengue (DHF III)
• Patient is in compensated phase hence can be missed if vitals are not checked
• Hypotension SBP <90 mmHg, pulse pressure < 20 mm Hg, high hct
• iv crystalloids @20 ml/kg/hr over 1 hr.
• If hct falls and vitals improve taper fluid and stop after 24 – 48 hrs.
• If hct increases with no improvement in vitals, give second bolus, still no
improvement, give blood transfusion
• If hct falls with non improving vitals, suspect bleeding.
43.
44. MANAGEMENT OF Severe Dengue (DHF IV)
• Signs of shock, undetectable BP and pulse, high hct
• iv crystalloid @20 ml/kg/hr over 15- 30 minutes
• If hct falls and vitals improve taper fluid and stop after 24 – 48 hrs
• If no improvement, give second bolus over 15- 30 min
• if hct rises give third bolus with either colloid or crystalloid over 1 hour.
• if hct falls after this step or after first bolus with no improvement in vitals,
consider blood transfusion
45.
46. Discharge criteria
All of the following conditions must be present:
• Clinical
• No fever for 24 hours
• Improvement in clinical status (general well-being, appetite, haemodynamic
status, urine output)
• No respiratory distress
• Laboratory
• Increasing trend of platelet count
• Stable haematocrit without intravenous fluids
48. Clinical Features
Similar to Dengue Fever.
• Acute onset High grade Fever,
• Headache, Rash, nausea, Vomiting
• Muscle Pain, Joint Pain
• Joint pain- Severe, Polyarticular, Migratory, Small joints of hands and
lower limbs.
• Maculopapular rashes 4-8 day, affecting trunk and limb
49. • Thrombocytopenia not severe.
• Capillary leakage and shock rarely seen
• Diagnosed via
• Virus culture, PCR (2-4 Days)
• ELISA IgM (5-7 Days of illness)
53. ETIOLOGY
CAUSED BY- 4 species if plasmodium genus
P.Vivax
P. Falciparum
P. Ovale
P.Malariae
TANSMITTED BY - female anopheline mosquito
Anopheles stephensi
Anopheles culicifacies
54.
55. Clinical features
•Fever
•Classical cycle of cold, hot and sweating may not be present
•Muscleache
•Bodyache
•Vague abdominal pain
O/E-
•Pallor
•Hepatomegaly
•splenomegaly
56. Complicated / severe malaria
Defined as symptomatic malaria with signs of severity or evidence of vital organ
dysfunction
• Cerebral malaria -Unrousable coma / multiple convulsions in last 24 hrs
• Severe normocytic anemia - Hb <5 g/dL, hct < 15%
• Renal failure (Serum creatinine >3 mg/dl, UO < 0.5 ml/kg/hr)
• Hypoglycemia (<40 mg/dl)
• Circulatory collapse/ Shock (Systolic blood pressure less than 50 mmHg in
children below 5 years)
• Respiratory distress due to metabolic acidosis- pH < 7.35 / s. bicarbonate < 15
mmol/l
57. • Spontaneous bleeding/Disseminated intravascular coagulopathy
• Pulmonary edema
• Hemoglobinuria
• Jaundice- S. bil > 3mg/dl or clinical jaundice
• Hyperparasitemia (>5% RBC infected)
58. Microscopic diagnosis
• Light microscopy of well stained thick and thin films by a skilled
microscopist has remained the "gold standard" for malaria
diagnosis.
• Thick films are nearly 10 times more sensitive
• larger amount of blood are there in a given area as compared to
thin films.
• Species identification is better with thin films as morphology of
the parasite and RBC are well preserved.
59. Collection of blood Sample
• As soon as malaria is suspected.
• Any time irrespective of fever
• Before administration of antimalarials.
• Smears prepared soon after collection cause minimal
distortion of parasites and red cells.
60. Examination of blood film
• Smear should be examined with 100X
oil immersion objective.
• A minimum of 100 fields should be
examined before concluding the slide to
be negative.
• Once negative, samples may be
examined for at least three consecutive
days where clinical suspicion of malaria
persists.
61. Advantage of microscopy
• Species identification along with characterization of the
stage of parasite is possible thereby helping in adequate
treatment and prognostication.
• Determining the parasite density. The parasite load is
utilized to determine the severity of malaria along with
prognosis and assessing the response to treatment.
62. Rapid diagnostic tests (RDTs)
• These are immunochromatographic test
(ICT) to detect plasmodium specific
antigens in blood sample. Test employ
monoclonal antibodies directed against
targeted parasite antigens.
• Histidine rich protein II (HRP-II) is actively
secreted by asexual stages and young
gametocytes of P. falciparum but not by
mature gametocytes.
63. • A metabolic enzyme Parasite lactate dehydrogenase (pLDH) is
produced by all four species of plasmodia, both asexual and
sexual (gametocytes) stages provided they are viable.
64. • HRP-II tests can remain positive for
7-14 days following successful
malaria treatment even when blood
doesn't show parasitemia by
microscopy.
• On the other hand as pLDH is
produced by only viable parasite so
the tests detecting this antigen
becomes negative within 3-5 days
of treatment.
65. Advantages of RDTs in comparison to
Microscopy
• Simple
• Objective
• less time consuming
• requiring no special equipment or skill/training.
• They can detect P. falciparum infection even when the parasite
is sequestered in the deep vascular compartment.
66. Polymerase chain reaction PCR
• Highly sensitive and specific for detecting all
species of malaria.
• Not commercially available and hence limited
practical utility.
67. Tests for disease management and
assessing severity
• Blood counts and culture,
• PT, PTT, Blood glucose, electrolytes, pH, bicarbonate and
lactate.
• Chest X-ray for respiratory distress syndrome,
• Serum bilirubin, transaminases and creatinine.
• Urine Hb,
• Lumbar puncture.
68. Management of uncomplicated malaria
in children
• Presumptive-
A case of fever treated for malaria without parasitological diagnosis
with an aim to prevent mortality and morbidity due to delay in
treatment.
• Curative-
Treatment given after diagnosis but without 8-aminoquinolines
because of contraindication.
• Radical-
Therapy after parasitological confirmation to eliminate all the forms
of parasite from all possible host tissues
69. Uncomplicated P. vivax
Recommended treatment
•Chloroquine 10 mg base/kg stat followed by 5 mg/kg at 6, 24 and 48
hours
OR
•Chloroquine 10 mg base/kg stat followed by 10 mg/kg at 24 hours and
5 mg/kg at 48 hours. (Total dose 25 mg base/kg)
AND
primaquine- 0.25 mg/kg/day for 14 days.
70. • Chloroquine should not be given in empty stomach and in high
fever. Bring down the temperature first.
• If vomiting occurs within 45 minutes of a dose of chloroquine that
particular dose is to be repeated after taking care of vomiting by
using Domperidone/Ondansetron.
• As primaquine can cause hemolytic anemia in children with G6PD
deficiency they should be preferably screened for the same prior
to starting treatment.
71. • As infants are relatively G6PD deficient it is not
recommended in this age group and children with 14 days
regime should be under close supervision to detect any
complication.
• In cases of borderline G6PD deficiency once weekly dose of
primaquine 0.6 - 0.8 mg/kg is given for 6 weeks.
72. Uncomplicated P. falciparum
Recommended treatment
•Artesunate 4 mg/kg of body weight once daily for 3 days
AND
•sulfadoxine/pyrimethamine (SP) as 25 mg/kg of sulfadoxine and 1.25 mg/kg of
pyrimethamine as a single dose ON DAY 1
OR
•Mefloquin 25 mg/kg divided in two(15 + 10) doses on day 2 and 3
OR
• ARTEMETHER + LUMIFANTRINE FOR 3 DAYS.
AND
•A single dose of Primaquine (0.75 mg/kg) is given for
gametocytocidal action.
73. TREATMENT OF COMPLICATED / SEVERE
MALARIA
• Artesunate2.4 mg/kg IV (loading dose), f/by 1.2 mg/kg at 12 and
24 hours, then 1.2 mg/kg daily for 6 days.
OR
• Artemether 3.2 mg/kg (loading dose) IM, f/by 1.6 mg/kg daily for 6 days.
• If the patient is able to swallow, then the daily dose can be given orally.
AND
• At the end of the therapy
a single dose of SP
OR
Mefloquine
74. QUININE BASED
Recommended treatment
•Quinine, 10 mg salt/kg/dose3 times daily for 7-10 days.
•In case of cinchonism,
•Quinine, 10 mg salt/kg/dose 3 times daily for 3-5 days
+
•Tetracycline (if age >8 yrs) 4 mg/kg/dose 4 times daily for 7-10 days OR
•Doxycycline (if age >8 yrs) 3 mg/kg/day 2 times daily for 7-10 days OR
•Clindamycin 20mg/kg/day divided 3 times daily for 7-10 days.
•A single dose of primaquine above 1 year age (0.75mg/kg) is given for gametocytocidal
action.
75. SUPPORTIVE MANAGEMENT
Clinical Monitoring
Repeat the necessary investigations
Intravenous fluid therapy
Oxygen therapy
PCV Transfusion Cautiously if Hb< 4, with use of Furosemide.
Nursing care
77. • Caused by Intracellular obligate gm –ve bacteria
• Transmitted to man by arthropod
• Classified-
Typhus Group – Epidemic/Endemic/Scrub
Spotted Fever Group- Indian Spotted/ Rocky Mountain
Q Fever
Trench Fever
Ehrlichiosis
78. Found in INDIA
• Scrub typhus – R. Tsutsugamushi
• Indian spotted Fever- R. conorii
• Q Fever- C Brunetii
79. Clinical Manifestations
• Triad – Fever, Rash and Headache
• GI symptoms
• Rash in spotted fever – after 4-5 days of fever macular or
maculopapular, pink to red in color, initially over extremeties then
entire body.
• Rash in scrub typhus- painless eschar (where the tick attaches can be
seen, rashes can be seen over trunk.
• Complications – hepatic, renal, myocardial, brain