MODULE 5.4.3.

CIRCULATORY SYSTEM INFECTIOUS DISEASES

DENGUE HEMORRHAGIC SHOCK SYNDROME

Description: An acute arthropod borne infection leading to massive bleeding.

Etiology: Causative organism is Dengue virus 1, 2, 3 and 4 the primary vector

is Aedes Aegypti other wise known as tiger mosquito because of the
black stripes present at the dorsal legs of the insect. The mosquito
prefers to thrive on clean stagnant water.

Mode of transmission: Bite of the infected vector mosquito

Incubation period: 6 – 7 days

Pathophysiology: The virus is carried by the infected mosquito and transferred through
bites in the victim. Once the proboscis pierced the capillaries it also
leaves the viral organism. The virus mixes in the bloodstream survive
and reproduce causing viremia, which explains the appearance of
generalized flushing. The virus will then successfully enters the bone
marrow and arrest the maturation of megakaryocyte. Since the
precursor of platelets cannot take full course it will result to massive
drop in the patient’s platelet count, which significantly raises the risk
for hemorrhage.

Signs and symptoms Petechiae, bleeding, epitaxis, Herman’s sign and fever

Diagnostic procedure Tourniquet test (20 or more petichiae per square inch), platelet count.

Management Watch out for bleeding. Minimize injections and other parenteral
procedures if possible. Apply pressure for 10 minutes on injection
site.
Avoid aspirin use acetaminophen provide TSB as an adjunct to anti
pyretics.
Monitor platelet closely. Prepare for platelet concentrate or fresh
whole blood as the need may call for it.
Hydrate with PNSS
Preventive measure focuses on 4 o clock habit
Use DEET as an effective mosquito repellant
Use mosquito nets

MALARIA

Description: Another type of mosquito borne infection most common in the tropics

Etiology: The causative organisms are Plasmodium Vivax, Falciparum, Ovale,

and Malariae. The primary vectors are anopheles mosquitoes.
Mode of transmission: Bite of the infected mosquito

Incubation period: For Falciparum 12 days,

For Vivax and Ovale 14 days
For Malariae 30 days

Pathophysiology: From the bite of the infected mosquito the organism enters the body
via bloodstream and immediately proceed to the liver in the form of
sporozoites. Inside the hepatocytes reproduction continues until the
host burst releasing the parasite in the form trophozoites that enters
the RBC, inside it the organism divides and form schizont. This will
later produce merozoites that enter RBC the process causes drop in
the number of circulating RBC leading to anemia and cachexia.

Signs and symptoms A cycle of hot stage (high fever) followed by diaphoretic stage
(sweating) and then cold stage (chilling). The cycle repeats leading to
malarial cachexia

Diagnostic procedure Malarial smear or peripheral blood smear

Management Chloroquine is the drug of choice. Primaquine must be given to

prevent relapse.
Prevent by using mosquito repellant and mosquito net
Chloroquine is the drug of choice for prophylaxis.

FILIRIASIS

Description: A chronic lymphatic disorder that is related to elephantiasis

Etiology: Causative organism is Wuchereria Bancrofti. Primary vector is Culex

Mosquito

Mode of transmission: Bite of the infected mosquito

Incubation period: 6 – 12 months

Pathophysiology: The organism enters the body after the vectors’ bite, it then matures
and migrates on the lymphatic vessels but it usually affects those in
the lower extremity. The protozoal parasite crowds and destroy the
filtering ability of the lymph nodes which then leads to the
accumulation of lymph or body fluids causing edema and at worst
cases gross deformity hence it could lead to elephantiasis.

Signs and symptoms Recurrent low grade fever, lymphangitis, nocturnal asthma and in
worst cases elephantiasis

Diagnostic procedure Microscopic examination of peripheral blood.

Management Use of mosquito repellant and nets

Hetrazan is effective against Filiriasis adverse reaction though are
seen in a number of patients, if such may be present may use
Ivermectin
 Meningococcemia

Description: Bacteria enter the bloodstream then it multiplies. It will damage the
walls of the blood vessels causing bleeding into the skin and internal
organs

Etiology: Neisseria Meningitidis (A, B, C, W, X, Y)

Mode of transmission: Droplet infection (Meningococcal Meningitis) at first then travelling to

the bloodstream to cause further damage

Incubation period: Average of 2-10 days

Signs and symptoms • Fever and chills

• Fatigue (feeling tired)
• Vomiting
• Cold hands and feet
• Severe aches or pain in the muscles, joints, chest, or
abdomen (belly)
• Rapid breathing
• Diarrhea
• In the later stages, a dark purple rash

Diagnostic procedure Lumbar Puncture (identification of microorganism)

Drugs Immediate dose of 3rd Generation Cephalosphorins
Prevention Vaccines:
Menactra, Menveo, Bexsero, Trumenba

Management Provide breathing support

Prompt administration of antibiotics
Surgery to remove dead tissues
Wound care for damaged skin