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Tropical Diseases PDF
Module 6
MALARIA
Cause
Plasmodium species
Types
P. vivax
P. malariae
P. ovale
P. falciparum
Clinical Features
P. falciparum
P. malariae
P. vivax
P. ovale
Prostration
Impaired consciousness
Respiratory
distress
(acidotic
breathing
or
Kussmauls breathing)
Multiple convulsions
Circulatory collapse
Abnormal bleeding
Jaundice
Hemoglobinuria
Severe anemia
Sim
Poor Prognosis in Falciparum Malaria
Clinical
Marked agitation
Bleeding
Deep coma
Repeated convulsions
Anuria
Shock
Laboratory
Biochemistry
Hematology
Leukocytosis (>12,000/uL)
Coagulopathy
TM
Parasitology
Hyperparasitemia
Pan specific
TM
[Optimal ]
for
Plasmodium
species
Complications
Plasmodium malariae
Glomerulonephritis
Nephrotic syndrome
Application of RDTs
Malaria Diagnosis
Microscopy
stand-by
Objective of Treatment
Sim
Anti-malarial Drugs by Species
P. vivax or P. ovale
Chloroquine
(1 tab contains 150mg of Chloroquine base) for Day 1-3
AND
Primaquine
(1 tab contains 15mg of Primaquine base) for Day 4-17
Uncomplicated P. falciparum Malaria
TM
Day 1
8 hours
Day 2
Adult Dose
4 tabs
4 tabs
4 tabs bid
4 tabs bid and PQ (SD)
Day 4
PQ
1) Use body weight in kgs as basis: use 0.75 mg-base/kg
b.w. single dose
2) If weight cannot be taken, use age as basis
< 1 y.o.
1-3 y.o.
4-6 y.o.
7-11 y.o.
12 y.o.
Contraindicate
d
Primaquine
single dose
Primaquine
tablet
single
dose
Primaquine
tablets single
dose
P. malaria
Chloroquine
(1 tab contains 150mg of Chloroquine base) for Day 1-3
AND
Primaquine
(1 tab contains 15mg of Primaquine base) for Day 4 (single dose)
Primaquine
tablets single
dose
Chemoprophylaxis
Atovaquone/proguanil (Malarone)
Doxycycline
Primaquine
PLUS
Tetracycline/Doxycycline/Clindamycin
(shift to AL if patient can already tolerate oral meds)
Sim
DENGUE VIRUS
4 serotypes
Transmitted by mosquitoes
Aedes albopiticus
Aedes aegypti
A daytime feeder
Epidemiology
Control of Mosquitoes
The combined death toll for these four countries was 4798
(official country reports)
Sim
Pathogenesis
Monocytes, lymphocytes,
macrophages
Kupffer
cells,
alveolar
The dengue virus enters via the skin while an infected mosquito
is taking a blood meal
During the acute phase of illness the virus is present in the blood
and its clearance from this compartment generally coincides with
defervescence.
Virus serotype
Immune status
Age
Genetic predisposition
Severe headache
Retro-orbital pain
Fatigue
Breakbone fever
Sim
Maculopapular rash
Appears near
defervescence
the
time
of
Febrile phase
Critical phase
Recovery phase
pruritus
Differential Diagnosis
Lymphadenopathy
Typhoid fever
Injected conjunctivae
Leptospirosis
Inflamed pharynx
Malaria
Measles, rubella
Chikungunya
Hemorrhagic Manifestations
Gingival bleeding
Nasal bleeding
Rickettsial diseases
Hematuria
Laboratory Diagnosis
Sim
Home Care
LEPTOSPIROSIS
Etiologic Agent
Treatment
Mainly supportive
Use of antipyretics
Fluid resuscitation
Epidemiology
Rodents,especiallyrats, are
the
most
important reservoir,
although other wild mammals as well as domestic and farm
animals may also harbor leptospires.
Transmission
Portal of entry:
Conjunctiva
Sim
Pathogenesis
Hemorrhagic manifestations:
purpura, and ecchymoses
epistaxis,
petechiae,
Laboratory Findings
Clinical Manifestations
Diagnosis
What are the locally available laboratory tests that can be used to confirm
the diagnosis of leptospirosis?
Anicteric Leptospirosis
Sim
Antigen-Antibody Agglutination
Test (Leptospira Serology BioRad)
Detects Leptospira antibody in
human
serum
through
agglutination reaction, which
may persist fro years. This is
used as a screening test but is
NOT sensitive
A positive result should be
confirmed with MAT
Diagnosis
Prevention
Seroconversion or a rise in
antibody titer in the microscopic
agglutination test (MAT)
Rodent control
Vaccination of animals
Definitive diagnosis
TYPHOID FEVER
ENTERIC FEVER
Differential Diagnosis
Dengue fever
Malaria
Enteric fever
Viral hepatitis
Hantavirus infections
Rickettsial diseases
Classic syndrome
Acute illness
relative
TYPHOID FEVER
Transmission
Treatment
Sim
Clinical Features
Symptoms
Fever
Headache
Nausea
Vomiting
Abdominal cramps
Diarrhea
Constipation
Cough
(%)
39-100%
43-90%
23-36%
24-35%
8-52%
30-57%
10-79%
11-86%
Physical Findings
Fever
Abdominal tenderness
Splenomegaly
Hepatomegaly
Relative bradycardia
Rose spots
Rales or rhonchi
Epistaxis
Meningisumus
(%)
98-100%
33-84%
23-65%
15-52%
17-50%
2-46%
4-84%
1-21%
1-12%
Diagnosis
Rose Spots
Laboratory Diagnosis
Clinical Features
Gastrointestinal bleeding (10-20%) and intestinal perforation (13% most commonly occur in the third and fourth weeks of illness
and results from hyperplasia, ulceration, and necrosis of the
ileocecal Peyers patches at the initial site of Salmonella
infiltration
Pathogenesis
10
Sim
Systemic Infections that may Mimic Enteric Fever
Malaria
Septicemic plague
Intestinal anthrax
Leptospirosis
Psittacosis
Ricketsial infection
Ehrlichiosis
Legionella
Dengue
Amebiasis
Intestinal tuberculosis
Abdominal actinomycosis
Mycoplasma pneumoniae
Visceral leishmaniasis
Treatment
Hand hygiene
Typhoid vaccines
Parenteral vaccine
Oral vaccine
Sim