DENGUE DHF DSS CHIKUNGUNYA LEPTOSPIROSIS HFMD

1. ETIOLOGY4 Serotype of the dengue virus (DEN 1,2,3 &4)

Alphavirus genus- family of togaviridea

Spirochete bacteria- genus leptospira

Human enteroviruses- Picornaviridea

2 VECTORS female Aedes Aegypty use the blood for laying of eggs.

Aedes Aegypty & Aedes Albopictus

Rodents(rats), dogs, livestock, wild animals and catdirect exposer to infected urine/contaminated soil &water

Coxsackie viruses A16( common) & Enteroviruses 17 ( severe form)

3. INCUBATION PERIODS 4-7 Days ( range 3-14 days) 3-7 Days (range

1-12 days)Last about 5-14 days and within a range of 2-30 days

4. Sign & Symptom

Sudden onset of high fever (biphasic), retro-orbital or frontal headache, myalgia& arthralgia, anorexia, abdominal discomfort, nausea, vomiting

Febrile phase- last 2-7 days Critical phase- > 3 days with

degree of plasma leakage, last about 24-48 hrs.

Recovery phase- reabsorption of extravascular fluid.

Sudden onset of high fever (>39 ̊C), severe arthralgia and myalgia, inconstant skin rash.

Anicteric leptospirosis { systemic with aseptic meningitis} -90% cases

Icteric leptospirosis (weil’s ds) {overwhelming ds-vascular collapse. Thrombocytopenia, hemorrhage, hepatic & renal dysfunction} – 10% cases [severe form]

Fever usually >39 C longer ̊ than 3 days, 4 stages.

Stage 1- oral ulcers & vesicular rash

Stage 2- CNS involvement

Stage 3- cardiopulmonary failure, pulmonary edema or hemorrhage

Stage 4- convalescence.

5. Fever ++ +++ +++ +++

6. Tourniquet/hess test ++ ++++ +++ - -

7. Maculopapular rash + ++ + -

8. Confluent rash - + - - -

9. hepatomegaly - +++ ++ - -

10. shock - +

++(pulse volume is small, narrowes pulse pressure with cold extremities)

- -/+ -

11. Investigation

h/o fever with living in endemic area, rash, aches and pain, leukopenia

Abdominal pain, nausea, vomiting, diarrhea, HCT>45(M) >40(F), low plt count.

Pulse pressure <20mmHg, resp rate >24, evidence of plasma leak, Capillary refill >2 sec.

Arthralgia is the key clinical features for dx.(persist for month to years)

Severe myalgia localized to calf muscle with conjunctival congestion/subconjunctival hemorrhage with or w/o jaundice or oliguria. Consider history of contact with contaminated water.

Oral ulcers and vesicular rash appearing on the hands, feet, knees and/or buttocks;, herpangina including oral ulceration over anterior tonsillar pillars, the soft palate, buccal mucosa or uvula.

12. Warning Sign

Abdominal pain/tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleed, restlessness/lethargy, liver enlargement >2cm, lab(increase HCT,rapid decrease in platelet.

-

Anicteric leptospirosis associated with pulmonary haemorrhage & Weil’s ds (meningitis, kidney failure & jaundice)

Lethargy and weakness, refusing feed & passing less urine, rapid breath, vomitting, drowsiness or irritably, fits (Meningitis, encephalitis and neurogenic pulmonary edema.) enterovirus inf.

13. LabRT-PCR (+ day >5),Ig G & Ig M (+ day 4-10)

RT-PCR (+ day 1-8), Ig M (+ day 4- >8),PRNT (+ day >8)

Microscopic agglutination test -MAT (gold standard), Ig M (+ day 5-10), rapid test kit for leptospira, CSF (1st

phase)

Blood serology, swab for viral culture, CSF

14. treatment

Adequate bed rest & fluid intake, paracetamol.

Compensated&decompensated shock therapy

Acetaminophen (Paracetamol)- antipyretic & NSAID (ibuprofen)-relieve the arthritic component.

Antibiotic(essential)- Penicillin/ doxycyclin/tetracyclin/ampicillin/amoxicillin.

Self-limited ds.Proper hygiene control,