Malaria Dengue Fever Typhoid Fever Hepatitis A Definition Protozoa parasite injected by Anopheles mosquitoes multiply in RBCs causing haemolysis, sequestration and cytokine release. RNA flavivirus (4 types) causing sudden fever, extreme myalgias and arthralgias. Bacterial infection with salmonella typhi (G- bacillus), causnig severe diarrhoea Hepatits A virus (HAV), that is not chronic or pregressive and has no permament effect on liver, acutely causes liver damage using body’s own immune response rather than viral cytotoxicity. Mode of Transmission Mosquito vector, transfusion, vertical, needlestick ‘Aedes’ mosquitoes Faecal-oral route, complicated by asymptomatic typhoid (unknowing carriers) Faecal-oral route, Incubation period (link to case) Millsy Signs and symptoms Millsy Ix and Common Findings Basic principles: Parasite = microscopy Bacteria = culture Virus = serology Diagnosis confirmed by: Thick and Thin Blood films Other Common Findings: FBE (anaemia, thrombocytopenia, rarely leukocytosis), LFT derangement, parameters suggestive of haemolysis (haptoglobin, LDH, reticulocyte count), hypoglycemia, ABG (lactic acidosis), UEC (renal failure), Urinalysis (hemoglobinuria, proteinuria, casts). Note: Rapid ward serology tests e.g. ParaSight F, can be performed to identify P. Falciparum, however they are not as sensitive as microscopy, nor do they Diagnosis confirmed by: Serology (e.g. arbovirus serology) and PCR studies Other Common Findings: FBE (thrombocytopenia, leukopenia, hematocrit increased due to plasma leakage), LFT (AST elevated, decreased albumin), deranged coag profile (prolonged PT, APTT and decreased fibrinogen), UEC (electrolyte imbalances- hyponatremia, elevated BUN), ABG (acidosis if dengue shock syndrome), positive tourniquet test (determines capillary fragility/hemorrhagic tendency, by applying blood pressure cuff and inflating it to a point Diagnosis confirmed by: Cultures - blood, stool, urine - bone marrow culture has highest yield Other Common Findings: FBE (anaemia, thrombocytopenia, relative lymphopenia), elevated ESR, coag profile deranged (elevated PT and APTT, decreased fibrinogen), LFT (raised ALT and serum bilirubin), UEC (hyponatremia, hypokalemia), serum ALT:LDH ratio of less than 9:1 helps to distinguish typhoid from viral hepatitis (viral hep has >9:1). PCR studies, and other serologic tests (e.g. Diagnosis confirmed by: Serology for anti HepA IgM Other Common Findings: serum transaminases/ALT rise 22-40d after exposure, IgM rises from approx. day 25 and signifies recent infection. IgG remains detectable for life and appears soon after IgM - IgG means immunity has been acquired and appears normally in immunized patients. LFT (raised ALT, AST and raised ALP in the acute stages of infection, raised bilirubin, decreased serum albumin), Coag derangement (raised PT = very bad - may
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Malaria Dengue Fever Typhoid Fever Hepatitis A
Definition Protozoa parasite injected by Anopheles mosquitoes multiply in RBCs causing haemolysis, sequestration and cytokine release.
Bacterial infection with salmonella typhi (G- bacillus), causnig severe diarrhoea
Hepatits A virus (HAV), that is not chronic or pregressive and has no permament effect on liver, acutely causes liver damage using body’s own immune response rather than viral cytotoxicity.
Mode of Transmission Mosquito vector, transfusion, vertical, needlestick
‘Aedes’ mosquitoes Faecal-oral route, complicated by asymptomatic typhoid (unknowing carriers)
Diagnosis confirmed by: Thick and Thin Blood filmsOther Common Findings: FBE (anaemia, thrombocytopenia, rarely leukocytosis), LFT derangement, parameters suggestive of haemolysis (haptoglobin, LDH, reticulocyte count), hypoglycemia, ABG (lactic acidosis), UEC (renal failure), Urinalysis (hemoglobinuria, proteinuria, casts).Note: Rapid ward serology tests e.g. ParaSight F, can be performed to identify P. Falciparum, however they are not as sensitive as microscopy, nor do they provide a parasite count (required for management).
Diagnosis confirmed by: Serology (e.g. arbovirus serology) and PCR studiesOther Common Findings: FBE (thrombocytopenia, leukopenia, hematocrit increased due to plasma leakage), LFT (AST elevated, decreased albumin), deranged coag profile (prolonged PT, APTT and decreased fibrinogen), UEC (electrolyte imbalances-hyponatremia, elevated BUN), ABG (acidosis if dengue shock syndrome), positive tourniquet test (determines capillary fragility/hemorrhagic tendency, by applying blood pressure cuff and inflating it to a point between systolic and diastolic BPs for 5 mins. The test is positive if there are 10 or more petechiae per square inch). CXR may reveal pleural effusions.
Diagnosis confirmed by: Cultures - blood, stool, urine - bone marrow culture has highest yield Other Common Findings: FBE (anaemia, thrombocytopenia, relative lymphopenia), elevated ESR, coag profile deranged (elevated PT and APTT, decreased fibrinogen), LFT (raised ALT and serum bilirubin), UEC (hyponatremia, hypokalemia), serum ALT:LDH ratio of less than 9:1 helps to distinguish typhoid from viral hepatitis (viral hep has >9:1). PCR studies, and other serologic tests (e.g. Widal test) can also be performed to diagnose typhoid, but they are not widely available.
Diagnosis confirmed by: Serology for anti HepA IgMOther Common Findings: serum transaminases/ALT rise 22-40d after exposure, IgM rises from approx. day 25 and signifies recent infection. IgG remains detectable for life and appears soon after IgM - IgG means immunity has been acquired and appears normally in immunized patients. LFT (raised ALT, AST and raised ALP in the acute stages of infection, raised bilirubin, decreased serum albumin), Coag derangement (raised PT = very bad - may indicate hepatic failure, particularly in the setting of encephalopathy), FBE (lymphocytosis, rarely pancytopenia)
Treatment Dobbo
Jenny’s Ix Findings• FBE
• HB 11, WCC 7.0, Plt 110
• HB 10, WCC 7.3, Plt 90
• HB 9, WCC 7.2, Plt 96
• HB 9.5, WCC 7.2, Plt 115
• UECs
• Na 140, K 4.0, Ur 7.0, Cr 110
• LFTs
• Mildly elevated ALT and bilirubin, otherwise normal
Bacterial infection with salmonella typhi (G- bacillus), causnig severe diarrhoea
Hepatits A virus (HAV), that is not chronic or pregressive and has no permament effect on liver, acutely causes liver damage using body’s own immune response rather than viral cytotoxicity.
Mode of Transmission Mosquito vector, transfusion, vertical, needlestick
‘Aedes’ mosquitoes Faecal-oral route, complicated by asymptomatic typhoid (unknowing carriers)
Diagnosis confirmed by: Thick and Thin Blood filmsOther Common Findings: FBE (anaemia, thrombocytopenia, rarely leukocytosis), LFT derangement, parameters suggestive of haemolysis (haptoglobin, LDH, reticulocyte count), hypoglycemia, ABG (lactic acidosis), UEC (renal failure), Urinalysis (hemoglobinuria, proteinuria, casts).Note: Rapid ward serology tests e.g. ParaSight F, can be performed to identify P. Falciparum, however they are not as sensitive as microscopy, nor do they provide a parasite count (required for management).
Diagnosis confirmed by: Serology (e.g. arbovirus serology) and PCR studiesOther Common Findings: FBE (thrombocytopenia, leukopenia, hematocrit increased due to plasma leakage), LFT (AST elevated, decreased albumin), deranged coag profile (prolonged PT, APTT and decreased fibrinogen), UEC (electrolyte imbalances-hyponatremia, elevated BUN), ABG (acidosis if dengue shock syndrome), positive tourniquet test (determines capillary fragility/hemorrhagic tendency, by applying blood pressure cuff and inflating it to a point between systolic and diastolic BPs for 5 mins. The test is positive if there are 10 or more petechiae per square inch). CXR may reveal pleural effusions.
Diagnosis confirmed by: Cultures - bone marrow, blood, stool, urine - bone marrow culture has highest yield Other Common Findings: FBE (anaemia, thrombocytopenia, relative lymphopenia), elevated ESR, coag profile deranged (elevated PT and APTT, decreased fibrinogen), LFT (raised ALT and serum bilirubin), UEC (hyponatremia, hypokalemia), serum ALT:LDH ratio of less than 9:1 helps to distinguish typhoid from viral hepatitis (viral hep has >9:1). PCR studies, and other serologic tests (e.g. Widal test) can also be performed to diagnose typhoid, but they are not widely available.
Diagnosis confirmed by: Serology for anti HepA IgMOther Common Findings: serum transaminases/ALT rise 22-40d after exposure, IgM rises from approx. day 25 and signifies recent infection. IgG remains detectable for life and appears soon after IgM - IgG means immunity has been acquired and appears normally in immunized patients. LFT (raised ALT, AST and raised ALP in the acute stages of infection, raised bilirubin, decreased serum albumin), Coag derangement (raised PT = very bad - may indicate hepatic failure, particularly in the setting of encephalopathy), FBE (lymphocytosis, rarely pancytopenia)
Dx supported by findings in thick and thin film, anemia + thrombocytopenia, raised urea & clinical findings (cyclical fever, myalgia, rigors)
clinical findings un-suggestive (no rash, haemorrhagic signs or arthralgia) and AST is normal.
clinical findings un-suggestive (no rash, diarrhea, constant rising fever, or organomegally)
unlikely due to immunization (hence the positive Ab’s), also clinical findings don’t coincide (no clinical signs of hepatic damage or generalized GI upset)