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TYPHOID FEVER

Typhoid fever is a bacterial disease, caused bySalmonella typhi. It is transmittedthrough theingestion of food or drink contaminated by thefeces or urine of infected people.Symptoms usually develop 13 weeks afterexposure, and may be mild or severe. Theyinclude high fever, malaise, headache,constipation or diarrhoea, rose-coloured spots onthe chest, and enlarged spleen and liver. Healthycarrier state may follow acute illness.Typhoid fever can be treated with antibiotics.However, resistance to common antimicrobials iswidespread. Healthy carriers should be excludedfrom handling food.

Typhoid fever is a bacterial infectioncharacterized by diarrhea, systemic disease,and a rash -- most commonly caused by thebacteria Salmonella typhi (S. typhi).CausesSymptomsinclude fever, general ill-feeling,and abdominal pain. A high (over 103 degrees)fever and severe diarrhea occur as the diseasegets worse.Some people with typhoid fever develop a rashcalled "rose spots," which are small red spots onthe belly and chest.Other symptoms that occur include: Abdominaltenderness, Agitation, Bloody stools, Chills,Confusion, Difficulty paying attention (attentiondeficit), Delirium, Fluctuating mood,Hallucinations, Nosebleeds, Severe fatigue,Slow, sluggish, lethargic feeling, WeaknessExams and TestsA complete blood count (CBC) will show a highnumber of white blood cells.A blood culture during first week of the fevercan show S. typhi bacteria

Other tests that can help diagnose this conditioninclude:Stool cultureELISA urine test to look for the bacteria thatcauses Typhoid feverPlatelet count (platelet count will be low)Fluoresce antibody study to look for substancesspecific to Typhoid bacteriaTreatmentFluids and electrolytes may be given through avein (intravenously). Appropriate antibiotics aregiven to kill the bacteria. There are increasingrates of antibiotic resistance throughout the

world, so your health care provider will checkcurrent recommendations before choosing anantibiotic.

Outlook (Prognosis)Symptoms usually improve in 2 to 4 weeks withtreatment. The outcome is likely to be good withearly treatment, but becomes poor ifcomplications develop.Symptoms may return if the treatment has notcompletely cured the infection.Possible ComplicationsIntestinal hemorrhage (severe GI bleeding),Intestinal perforation, Kidney failure, PeritonitisWhen to Contact a Medical ProfessionalCall your health care provider if you have hadtyphoid fever and relapse occurs or if severeabdominal pain,decreased urine output, or othernew symptoms develop.PreventionVaccinesAt-risk travelers should drink only boiled orbottled water and eat well cooked food.Adequate water treatment, waste disposal, andprotection of food supply from contaminationare important public health measures. Carriersof typhoid must not be allowed to work as foodhandlers.

DENGUEDengue is a mosquito-borne infection thatcauses a severe flu-like illness, and sometimes apotentially lethal complication called denguehemorrhagic fever.Dengue is found in tropical and sub-tropicalclimates worldwide, mostly in urban and semi-urban areas.The only way to prevent denguevirus transmission is to combat the disease-carrying mosquitoes.TransmissionDengue viruses are transmitted to humansthrough the bites of infective femaleAedes

mosquitoes. Mosquitoes generally acquire thevirus while feeding on the blood of an infectedperson. After virus incubation for eight to 10days, an infected mosquito is capable, duringprobing and blood feeding, of transmitting thevirus for the rest of its life. Infected femalemosquitoes may also transmit the virus to theiroffspring by transovarial (via the eggs)transmission, but the role of this in sustainingtransmission of the virus to humans has not yetbeen defined.Infected humans are the main carriers andmultipliers of the virus, serving as a source of

the virus for uninfected mosquitoes. The viruscirculates in the blood of infected humans fortwo to seven days, at approximately the sametime that they have a fever;Aedes mosquitoes

may acquire the virus when they feed on anindividual during this period. Some studies haveshown that monkeys in some parts of the worldplay a similar role in transmission.CharacteristicsDengue fever is a severe, flu-like il lness thataffects infants, young children and adults, butseldom causes death.The clinical features of dengue fever varyaccording to the age of the patient. Infants andyoung children may have a fever with rash.Older children and adults may have either amild fever or the classical incapacitating diseasewith abrupt onset and high fever, severeheadache, pain behind the eyes, muscle andjoint pains, and rash.Dengue haemorrhagic fever (DHF) is apotentially deadly complication that ischaracterized by high fever, often withenlargement of the liver, and in severe casescirculatory failure. The illness often begins witha sudden rise in temperature accompanied byfacial flush and other flu-like symptoms. Thefever usually continues for two to seven days

and can be as high as 41C, possibly withconvulsions and other complications.In moderate DHF cases, all signs and symptomsabate after the fever subsides. In severe cases,the patient's condition may suddenlydeteriorate after a few days of fever; thetemperature drops, followed by signs ofcirculatory failure, and the patient may rapidlygo into a critical state of shock and die within 12to 24 hours, or quickly recover followingappropriate medical treatmentPrevention and controlAt present, the only method of controlling or

preventing dengue virus transmission is tocombat the vector mosquitoes.Dengue is transmitted by the bite of anAedesmosquito infected with any one of the fourdengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear314 days after the infective bite. Denguefever is a febrile illness that affects infants,young children and adults.Symptoms range from a mild fever, toincapacitating high fever, with severe headache,pain behind the eyes, muscle and joint pain, andrash. There are no specific antiviral medicines

for dengue. It is important to maintainhydration. Use of acetylsalicylic acid (e.g.aspirin) and non steroidalanti-

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inflammatory drugs (e.g. Ibuprofen) is notrecommended.Dengue hemorrhagic fever (fever, abdominalpain, vomiting, bleeding) is a potentially lethalcomplication, affecting mainly children. Earlyclinical diagnosis and careful clinicalmanagement by experienced physicians andnurses increase survival of patients.How is dengue fever contracted?The virus is contracted from the bite of a stripedAedes aegypti mosquito that has previouslybitten an infected person. The mosquitoflourishes during rainy seasons but can breed inwater-filled flower pots, plastic bags, and cansyear-round. One mosquito bite can inflict thedisease.The virus is not contagious and cannot bespread directly from person to person. Theremust be a person-to-mosquito-to-another-person pathway

What is dengue fever?Dengue fever is a disease caused by a family of

viruses that are transmitted by mosquitoes. It isan acute illness of sudden onset that usuallyfollows a benign course with symptoms such asheadache, fever, exhaustion, severe muscle andjoint pain, swollen glands (lymphadenopathy),and rash. The presence (the "dengue triad") offever, rash, and headache (and other pains) isparticularly characteristic of dengue. Othersigns of dengue fever include bleeding gums,severe pain behind the eyes, and red palms andsoles.Dengue (pronounced DENG-gay) strikes peoplewith low levels of immunity. Because it is

caused by one of four serotypes of virus, it ispossible to get dengue fever multiple times.However, an attack of dengue producesimmunity for a lifetime to that particularserotype to which the patient was exposed.Dengue goes by other names, including"breakbone" or "dandy fever." Victims ofdengue often have contortions due to theintense joint and muscle pain, hence the namebreakbone fever. Slaves in the West Indies whocontracted dengue were said to have dandyfever because of their postures and gait.Dengue hemorrhagic fever is a more severe

form of the viral illness. Manifestations includeheadache, fever, rash, and evidence ofhemorrhage in the body. Petechiae (small red orpurple blisters under the skin), bleeding in the

nose or gums,black stools, or easy bruising areall possible signs of hemorrhage. This form ofdengue fever can be life-threatening and canprogress to the most severe form of the illness,dengue shock syndromeWhat are dengue fever symptoms and signs?After being bitten by a mosquito carrying thevirus, the incubation period ranges from threeto 15 (usually five to eight) days before thesigns and symptoms of dengue appear. Denguestarts with chills, headache, pain upon movingthe eyes, and low backache. Painful aching inthe legs and joints occurs during the first hoursof illness. The temperature rises quickly as highas 104 F (40 C), with relative low heart rate(bradycardia) and low blood pressure(hypotension). The eyes become reddened. Aflushing or pale pink rash comes over the faceand then disappears. The glands (lymph nodes)in the neck and groin are often swollen.Fever and other signs of dengue last for two tofour days, followed by a rapid drop in bodytemperature (defervescence) with profusesweating. This precedes a period with normal

temperature and a sense of well-being that lastsabout a day. A second rapid rise in temperaturefollows. A characteristic rash appears along withthe fever and spreads from the extremities tocover the entire body except the face. Thepalms and soles may be bright red and swollen.What is the treatment for dengue fever?Because dengue fever is caused by a virus,there is no specific medicine or antibiotic totreat it. For typical dengue, the treatment ispurely concerned with relief of the symptoms(symptomatic). Rest and fluid intake foradequate hydration is important. Aspirin and

nonsteroidal anti-inflammatory drugs shouldonly be taken under a doctor's supervisionbecause of the possibility of worseninghemorrhagic complications. Acetaminophen(Tylenol) and codeine may be given for severeheadache and for the joint and muscle pain(myalgia).What is the prognosis for typical dengue fever?Typical dengue is fatal in less than 1% of cases.The acute phase of the illness with fever andmyalgias lasts about one to two weeks.Convalescence is accompanied by a feeling ofweakness (asthenia), and full recovery often

takes several weeks.What is dengue hemorrhagic fever?Dengue hemorrhagic fever (DHF) is a specificsyndrome that tends to affect children under 10

years of age. It causes abdominal pain,hemorrhage (bleeding), and circulatory collapse(shock). DHF is also called Philippine, Thai, orSoutheast Asian hemorrhagic fever and dengueshock syndrome.DHF starts abruptly with high continuous feverand headache. There are respiratory andintestinal symptoms with sore throat, cough,nausea,vomiting, and abdominal pain. Shockoccurs two to six days after the start ofsymptoms with sudden collapse, cool, clammyextremities (the trunk is often warm), weakpulse, and blueness around the mouth(circumoral cyanosis).In DHF, there is bleeding with easy bruising,blood spots in the skin (petechiae), spitting upblood (hematemesis), blood in the stool(melena), bleeding gums, and nosebleeds(epistaxis). Pneumonia is common, andinflammation of the heart (myocarditis) may bepresent.Patients with DHF must be monitored closely forthe first few days since shock may occur orrecur precipitously (dengue shock syndrome).

Cyanotic (bluish) patients are given oxygen.Vascular collapse (shock) requires immediatefluid replacement. Blood transfusions may beneeded to control bleeding.The mortality (death) rate with DHF issignificant. It ranges from 6%-30%. Most deathsoccur in children. Infants under a year of ageare especially at risk of dying from DHF.How can dengue fever be prevented?The transmission of the virus to mosquitoesmust be interrupted to prevent the il lness. Tothis end, patients are kept under mosquitonetting until the second bout of fever is over

and they are no longer contagious.The prevention of dengue requires control oreradication of the mosquitoes carrying the virusthat causes dengue. In nations plagued bydengue fever, people are urged to emptystagnant water from old tires, trash cans, andflower pots. Governmental initiatives todecrease mosquitoes also help to keep thedisease in check but have been poorly effective.To prevent mosquito bites, wear long pants andlong sleeves. For personal protection, usemosquito repellant sprays that contain DEETwhen visiting places where dengue is endemic.

Limiting exposure to mosquitoes by avoidingstanding water and staying indoors two hoursafter sunrise and before sunset will help. TheAedes aegypti mosquito is a daytime biter with

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peak periods of biting around sunrise andsunset. It may bite at any time of the day and isoften hidden inside homes or other dwellings,especially in urban areas.There is currently no vaccine available fordengue fever. There is a vaccine undergoingclinical trials, but it is too early to tell if it will besafe or effective. Early results of clinical trialsshow that a vaccine may be available by 2012Dengue Fever At A GlanceDengue fever is a disease caused by a family ofviruses that are transmitted by mosquitoes.Symptoms such as headache, fever, exhaustion,severe joint and muscle pain, swollen glands(lymphadenopathy), and rash. The presence(the "dengue triad") of fever, rash, andheadache (and other pains) is particularlycharacteristic of dengue fever.Dengue is prevalent throughout the tropics andsubtropics. Outbreaks have occurred recently inthe Caribbean, including Puerto Rico, the U.S.Virgin Islands, Cuba, and Central America.Because dengue fever is caused by a virus,there is no specific medicine or antibiotic to

treat it. For typical dengue fever, the treatmentis purely concerned with relief of the symptoms(symptomatic).The acute phase of the illness with fever andmyalgias lasts about one to two weeks.Dengue hemorrhagic fever (DHF) is a specificsyndrome that tends to affect children under 10years of age. It causes abdominal pain,hemorrhage (bleeding), and circulatory collapse(shock).The prevention of dengue fever requires controlor eradication of the mosquitoes carrying thevirus that causes dengue.

There is currently no vaccine available fordengue fever.