Infectious disease Flashcards
Clinical features of dengue
- High grade fever (2-7 days, associated with chills, saddleback pattern)
- Headache
- Myalgia
- Retro-orbital pain
- Rash
- Nausea, vomiting
- Anorexia
- Weakness, malaise
Warning sign of dengue***
“ALL LoVES”
- Abdominal pain
- Liver tenderness
- Laboratory (raised hematocrit + rapid decrease platelet count)
- Lethargy
- Vomiting/ diarrhea (>= 3 times/ day)
- Effusion
- Spontaneous bleeding tendency
Signs of dengue***
- Vital signs (Eg: tachypnea, tachycardia, hypotension)
- Mental state and GCS score
- Hydration status
- Urine output
- Tourniquet test
- Rashes
- Hand: CCTV-R
- Respiratory (Pleural effusion)
- Abdominal (Hepatomegaly, Ascites)
Investigation for dengue**
> Laboratory
- FBC: WCC and platelet
- LFT: elevation of transaminases, hypoproteinemia, hypoalbuminemia
- Coagulation profile: prolonged PT/aPTT, low fibrinogen, elevated fibrin degradation product
- Renal profile: look for AKI and electrolyte imbalance
- Blood gases and serum lactate: metabolic acidosis, hypoxemia
> Diagnostic test
- Rapid combo test
- Dengue serology test by ELISA
> Imaging
- Ultrasonography: third space fluid loss
Component for hydration status*****
- General appearance* (Alert, irritable)
- Tissue elasticity*
- Extremities
- Eyes*
- Thirst*
- Anterior fontanelle
- Mucous membrane
- Heart rate
- Breathing
- Peripheral pulses
- Capillary refill time
- Skin turgor
- Urine output
- WHO important point
Management of dengue infection**
- Notify the district health office
- Disease monitoring
(Critical phase - frequent adjustment in fluid regime; Recognition onset of reabsorption phase - IV fluid regime needs to be progressively reduced)
> Supportive - Correct dehydration:
Non-obese - 1.2 to 1.5 ml/kg/hour;
Obese - based on adjusted body weight
ABW = IBW + 0.4 (actual weight - IBW)
IBW formula: 45.5kg (Female)/ 50kg (Male) + 0.91 (height in cm - 152) - If persistent warning sign with increasing or persistently high HCT, graded fluid bolus initiated
- AVOID NSAIDs
> If admission not indicated:
- Daily follow-up from day 3 of illness onwards
Monitoring of dengue patient*****
"Dengue assessment checklist" - Monitoring (Dengue assessment checklist) > Clinical - Warning signs - Vital signs - Mental status - Urine output
> Laboratory
- FBC
- BUSE, LFT, RBS, creatinine kinase
Discharge criteria for dengue patient**
- Improve in general wellbeing
- Afebrile for 24-48 hours
- Rising WCC and platelets
- Stable hematocrit
Criteria for severe dengue*
WHO - Defined by one or more of the following:
- Severe plasma leakage leading to:
- shock and/or
- fluid accumulation with respiratory distress - Severe bleeding
- Severe organ involvement
- Liver: AST/ ALT >=1000
- CNS: impaired consciousness
- Heart and other organs
Normal HCT among Malaysian - CPG
- Male <= 60: 46%
- Male >60: 42%
- Female: 40%
Compensated vs Decompensated shock*
> Compensated
- systolic pressure maintained with sign of hypoperfusion
- clear consciousness
- systolic BP maintained with raised diastolic pressure
- postural hypotension
> Decompensated shock
- altered mental status
- hypotension or unrecorded BP
- narrowed pulse pressure (<20mmHg)
> Other components (more vague)
- CRT
- Temperature
- Pulse volume
- Pulse rate
- Respiratory rate
- Urine output
Symptoms of leptospirosis
□ Fever (Sudden onset, High grade, often with chills) □ GI symptoms: Nausea, vomiting, Abdominal pain, Diarrhea, Jaundice □ Musculoskeletal: Myalgia, Arthralgia □ Neurological: Headache , Sign of meningism □ Ocular: Conjunctival suffusion □ Skin: Rash □ Respiratory: Cough
Sign to look for -leptospirosis***
- Vital sign
- Hydration status
- Rash (maculopapular or purpuric)
- Face: conjunctival suffusion, jaundice
- Muscle tenderness: calf, lumbar region
- Abdomen: hepatosplenomegaly
- Respiratory: crepitation
Investigation for leptospirosis***
> For diagnosis
- Positive clinical + ELISA
- Microscopic agglutination test (alternative)
> Organ involvement
- Liver function test: hyperbilirubinemia, raised liver enzyme
- Renal profile: raised creatinine
- UFEME: bilirubin, proteinuria, hematuria
- FBC: leukocytosis, thrombocytopenia
- Coagulation profile
- Lumbar puncture: if suspect aseptic meningitis
Management of leptospirosis***
> Initial assessment
- Vital signs
- Mental status
- Sign of dehydration
- Severity
> Supportive
- Antipyretics
- Oxygen
- Fluid
> Definitive - Abx
- Mild/ Moderate: oral doxycycline 5-7 days
- Severe: IV ceftriaxone 7 days, de-escalate to IV benzylpenicillin 7 days when symptoms improves
> Monitoring for clinical improvement/ deterioration
> Disease notification (within 1 week)
