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Dengue, Chinkungunya, Jap Encephalitis and RMSF
Dengue, Chinkungunya, Jap Encephalitis and RMSF
Dengue, Chinkungunya, Jap Encephalitis and RMSF
DENGU E
o Dengue
Fever
2.
3.
sh,&
nd&is&
&
ere&
NV>
but&
A.&
of&
& COURSE
OF
DENGUE
ILLNESS
Course,of,Dengue,Illness,
1. Febrile
Phase
1. Febrile,Phase,
High-grade
fever
that
lasts
2-7
days
Patients&typically&develop&high>grade&fever&
- Accompanied
by
facial
flushing,
skin
erythema,
generalized
- body
Lasts&2&&7&days&and&is&often&accompanied&
ache,
myalgia,
arthralgia
and
headache
by&facial&flushing,&skin&erythema,&
Anorexia,
nausea
and
vomiting
are
common
generalized&body&ache,&myalgia,&arthralgia&
Difficult(to(distinguish(dengue(clinically(from(
non3dengue(febrile(diseases(in(the(early(
febrile(phase(
classification&
Low&sensitivity&of&criteria&in&detecting&DHF&
Does¬&consistently&capture&cases&of&severe&and&
life&threatening&dengue&which&do¬&fulfil&&all&
criteria&for&DHF&
Classifies&all&patients&in&whom&the&requisite&four&
e&24&&48&hours&critical&
criteria&are¬&demonstrated&as&having&DF&by&
ption&of&extravascular&
DIAGNOSIS
OF
DENGUE
default.&(Under>diagnosis&and&under&reporting&of&
&place&in&the&following&48&&
DHF)&
A
diagnosis
of
dengue
fever
derives
from
a
high
index
of
suspicion
and
Poor&management&resulting&to&fatal&outcomes&
oves,&appetite&returns,&knowledge
of
the
geographic
distribution
and
environmental
cycles
of
&
ms&abate,&hemodynamic&
causal
viruses.
NEW,CLASSIFICATION,OF,DENGUE,
esis&ensues&
&a&rash&of&isles&of&
&Hermans,rash&
neralized&pruritus.&
ardiographic&
ring&this&stage&
&or&may&be&lower&
ct&of&reabsorbed&
sually&starts&to&rise&
e&but&the&recovery&
ally&later&than&that&
&
m&massive&pleural&
occur&at&any&time&if&
ids&have&been&
Step
I:
Overall
Assessment
o
History
should
include:
Diarrhea
MANAGEMENT
OF
DENGUE
o
Suggested
criteria
for
early
notification
of
suspected
cases
Group A
Group B
Group
C
GROUP
A
PATIENTS
o
Suspected
dengue
cases
without
warning
signs
particularly
when
fever
subsides
o
Able
to
tolerate
adequate
volumes
of
oral
fluids
and
pass
urine
at
least
once
every
6
hrs
o
Can
be
sent
home
if
hematocrit
is
stable
but
advise
to
return
to
the
hospital
immediately
if
they
develop
any
of
the
warning
signs.
o
Plan
of
Action
for
Group
A
Patients
No clinical improvement
Persistent vomiting
Lethargy / restlessness
rate
accordingly.
Give
the
minimum
intravenous
fluid
required
to
maintain
good
perfusion
and
urine
output
of
about
0.5
ml/kg/hr.
Intravenous
fluids
are
usually
needed
for
only
24
48
hours
Reduce
intravenous
fluids
gradually
when
the
rate
of
plasma
leakage
decreases
towards
the
end
of
the
critical
phase.
This
is
indicated
by
urine
output
and/or
oral
fluid
intake
that
is/are
adequate
or
hematocrit
decreasing
below
the
baseline
value
in
a
stable
patient
Patients
with
warning
signs
should
be
monitored
by
health
care
providers
until
the
period
of
risk
is
over.
GROUP
C
PATIENTS
o
Patients
with
severe
dengue
who
are
in
the
critical
phase
of
the
disease,
i.e.
when
they
have:
Severe hemorrhages
CH IK UN GUN YA
CHIKUNGUNYA
VIRUS
o
Enveloped,
positive-sense
RNA
Alphavirus
of
Togaviridae
o
Emerging
pathogen
in
the
United
States
carried
by
day
biting
mosquitos
(Aedes
aegypti,
Aedes
albopictus)
CLINICAL
MANIFESTATION
o
Incubation
period
of
3-7
days
o
High
fever
with
severe
symmetric
bilateral
polyarthralgia
or
arthritis
(hands,
feet,
ankles,
wrist)
lasting
for
7-10
days
o
Some
may
have
prolonged
joint
symptoms
(tenosynovitis,
arthritis)
lasting
over
a
year
o
Convulsions
may
occur
during
high
fever
o
Mortality
is
rare
DIAGNOSIS
o
Testing
for
Acute-phase
serum
5
days
after
onset
for
IgM
antibodies
o
Convalescent
sera
tested
for
a
4-fold
or
greater
increase
in
ELISA,
hemagglutination
inhibition
or
neutralizing
igG
antibody
titer
Diagnostic
Criteria
for
Chikungunya
Virus
Fever
PROGNOSIS
o
Generally
good,
resolve
without
residua
o
No
vaccine
available,
killed
vaccine
is
efficacious
but
under
development
JA PA N ES E ENCEPHA LITIS
ETIOLOGY
o
JE
virus
-
positive-sense,
single-stranded
RNA
virus
of
the
family
Flaviviridae
EPIDEMIOLOGY
o
Mosquito-borne
viral
disease
of
humans
o
Asia,
northern
Japan,
Korea,
China,
Taiwan,
the
Philippines,
and
the
Indonesian
archipelago
and
from
Indochina
through
the
Indian
subcontinent.
o
Culex
tritaeniorhynchus
summarosus
Night-biting mosquito
o
o
o
Albuminuria
DIAGNOSIS
o
Should
be
suspected
in
patients
reporting
exposure
to
night-
biting
mosquitoes
in
endemic
areas
during
the
transmission
season
o
Diagnosis:
PCR
TREATMENT
o
No
specific
treatment
o
Intensive
supportive
care,
including
control
of
seizures
PROGNOSIS
o
Fatality
rates
for
JE:
24-42%
Frequency - 5-70%
TRANSMISSION
o
Ticks
are
the
natural
hosts,
reservoirs,
and
vectors
of
R.
rickettsii
o
Ticks
transmit
the
infectious
agent
to
mammalian
hosts
via
infected
saliva
during
feeding
o
Principal
tick
hosts:
Photophobia (18%)
Seizure (17%)
Meningismus (16%)
Fulminant RMSF
LABORATORY
FINDINGS
o
Laboratory
abnormalities
are
common
but
nonspecific
o
Thrombocytopenia
(60%)
o
WBC
count
is
most
often
normal
Leukocytosis (24%)
Leukopenia (9%)
Demonstration
of
seroconversion
TREATMENT
o
Treatment
of
choice
in
patients
of
all
ages
PROGNOSIS
o
Delays
in
diagnosis
and
therapy
are
significant
factors
associated
with
death
or
severe
illness
o
Death
often
occurs
within
14
days
o
Deaths
occur
despite
the
availability
of
effective
therapeutic
agents
o
Early
therapy
in
uncomplicated
cases
usually
leads
to
rapid
defervescence
within
1-3
days
and
recovery
within
7-10
days
o
Slower
response
may
be
seen
if
therapy
is
delayed
o
Fever
subsides
in
2-3
wks
in
those
who
survive
despite
no
treatment
PREVENTION
o
No
vaccines
are
available
o
Prevention
best
accomplished
by
preventing
or
treating
tick
infestation
in
dogs,
avoiding
areas
where
ticks
reside,
using
insect
repellents,
wearing
protective
clothing,
and
carefully
inspecting
children
after
play
in
areas
where
they
are
potentially
exposed
to
ticks
o
Prompt
and
complete
removal
of
attached
ticks