Conference Review – Tropical Diseases

Tropical Diseases- Malaria, Dengue, Zika, West Nile by Anand Patel, MD.

 Malaria

  • Presentation (General Infection)
    • Asymptomatic 12-35 days
    • Generalized Viral Symptoms
      • achycardia, tachypnea, chills, malaise, fatigue, diaphoresis (sweating), headache, cough, anorexia, nausea, vomiting, abdominal pain, diarrhea, arthralgias, and myalgias
    • Anemia
    • Splenomegaly
    • Cyclic Fevers every 1 to 3 days depending on strain
      • Can rise to greater than 104
    • Presentation Severe infection (micro infarct in organ systems)
      • Symptoms
        • AMS w/w/o Seizures
        • ARDS
        • Circulatory collapse/Severe Anemia
        • Renal/Hepatic Failure
        • DIC
        • Hypoglycemia
      • Physical/Lab findings
        • Transaminitis, Anemia, thrombocytopenia
        • Pallor, jaundice, petechia
        • Hepato/splenomegaly.
      • Cerebral Malaria
        • Highest risk
      • Risk Factors
        • Pregnancy
        • VFRs(Visiting Friends/Relatives)
        • Military
        • Immunocompromised(HIV)
        • Extremes of age.
        • Splenectomy

Diagnosis

  • Smear
  • Antigen tests
  • PCR

Treatment

 


 

Dengue Fever

  • Transmission
    • Mosquitos

 

  • Risk
    • Young age
    • Prior exposure
    • Genetic Factors
    • Viral type.

 

  • Primary vs Secondary
    • Increased risk of DHF or DSS
      • Antibody-dependent enhancement of infection
      • Enhanced immune complex formation,
      • Accelerated T lymphocyte responses.

 

  • Symptoms – General Infection
    • Fever
    • Headache
    • Retro-ortibal pain
    • Muscle/joint pain
    • Abdominal pain
    • Rash
    • Lab findings
      • Leukopenia, Thrmobocytopeina, Elevated AST

 

  • Symptoms – Dengue Hemorhaggic Fever
    • Hemoconcentration due to vascular permeability (pleural effusions, ascitie)
    • Marked Thrombocytopenia
    • Fever 2-7 days
    • Positive Tourniquet Test
    • Spontaneous bleeding (GI, mucous membrines)

 

  • Symptoms – Dengue Shock Syndrome
    • DHF+Shcok.
    • Sometimes associated with liver failure/Neuro changes

 

  • Diagnosis
    • Day 0-5 from initial fever
      • CDC DENV- 1-4 Real-Time RT-PCR
        • Typically positive in days 3-5
      • Day 6-10 from initial fever
        • IgM Elisa
          • Typically positive in days 8-10
          •  Treatment
            • Supportive

 

Zika

  • Location
    • In the US, cased confirmed in Florida. Specifically Wynwood.
  • Symptoms
    • Viral symptoms
      • Rash, fever, joint pain, conjunctivitis, headache
    • Tests
      • Urine/Blood
    • Treatment
      • None
      • F/U with OBGYN/PCP if concerned

 

West Nile

  • Transmission
    • Mosquito

 

  • Risk factors
    • Age extremes
    • Malignancy
    • Organ transplant
    • Genetic Factors
    • Male, renal disease, alcohol abuse, hypertension, DM.

 

  • Clinical Symptoms Classic
    • Fever
    • Eye pain
    • Pharyngitis
    • N/V/D
    • Abdominal pain
    • Rash

 

  • Clinical Symptoms – Neuroinvasive
    • Encephalitis
    • Meningitis
    • Flaccid paralysis
    • Demylination,
    • Myasthenia Gravis
    • GBS equivalent

 

  • Clinical Symptoms – Occular
    • Chorioretinitis
    • Vitreitis
    • Retinal hemorrhages

 

  • Diagnosis
    • Serologic testing
    • CSF analysis –Viral
  • Treatment
    • Supportive
    • Interferon, IVIG

 

Advertisements