DENGUE

Definition and mode of transmission []

Dengue is a mosquito-borne viral disease. This disease is associated with the

rainy season. The sudden change of pattern may attribute to climate change and
urbanization, since the vector of the disease proliferates in congested urban areas.

This disease is carried by an infected female Aedes mosquitoes. Aedes Aegypti, also
known as yellow mosquito or tiger mosquito is the principal vector predominant in
urban areas seen in tropical and subtropical countries. These mosquitos proliferate
in clean, clear and unpolluted stagnant bodies of water used for domestic water
storage or rain filled habitats like flower vases, earthen jars, concrete water tanks,
discarded vehicle tires, ant traps, metal drums, water barrel, tin cans and any other
containers that can accumulate water up to 7 days. Typically, this mosquitos fly within
100- meter radius from the breeding place with a flight range of 50 meters and are
low flying vectors and normally harbor below the knees. This disease is transferred
to human through the bite of an infected Aedes mosquito.

Signs and Symptoms []

All individuals regardless of age or gender are at risk. The incubation period
of this disease is 3-14 days, but commonly 3-7 days. Symptoms, usually begin four
to six days after infection and last for up to 10 days, may include:

1. Sudden, high fever

2. Severe headaches
3. Pain behind the eyes
4. Severe joint and muscle pain
5. Fatigue
6. Nausea
7. Vomiting
8. Skin rash, which appears two to five days after the onset of fever
9. Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

Sometimes, symptoms are mild and can be mistaken for those of the flu or another
viral infection. Younger children and people who have never had the infection before
tend to have milder cases than older children and adults. However, serious problems
can develop. These include dengue hemorrhagic fever, a rare complication
characterized by high fever, damage to lymph and blood vessels, bleeding from the
nose and gums, enlargement of the liver, and failure of the circulatory system. The
symptoms may progress to massive bleeding, shock, and death. This is called dengue
shock syndrome (DSS).

People with weakened immune systems as well as those with a second or

subsequent dengue infection are believed to be at greater risk for developing
dengue hemorrhagic fever.

Treatment []

Treatment for dengue is symptomatic and supportive. Follow-up is also

important for proper observation and monitoring of patients.
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  Dengue Fever
Give paracetamol every 6 hours, if the patient still has high fever do tepid
sponge bath. DO NOT give acetylsalicylic acid (aspirin), ibuprofen, or other
nonsteroidal anti-inflammatory agents, as these drugs may aggrevate
bleeding.
 Dehydration
Encourage oral intake of oral rehydration solution (ORS), fruit juices and
other fluids containing electrolytes and sugar to replace losses from fever
and vomiting.
 Hemorrhage
Ensure strict bed rest and protect patient from trauma to reduce the risk of
bleeding.
 Nose Bleeding
Maintain an elevated position and apply ice compress to promote
vasoconstriction. If there is gum bleeding, give ice chips, and advice the
patient to use soft-bristled toothbrush. For gastrointestinal bleeding place the
patient on NPO. In case of shock, place patient in dorsal recumbent position
to promote circulation.

Preventive Measures

Primary Prevention: []

 Regularly removing all sources of stagnant water to prevent mosquito

breeding grounds being established.
 Preventing mosquito bites by wearing appropriate clothing to cover exposed
areas of the skin, especially during the day, and the use of insecticides,
mosquito repellents, mosquito coils, and mosquito nets.

Secondary Prevention: []

1. Tourniquet Test Or Rumpel-Leads Test.

This test measures the coaguability of the blood. This is done by applying a
tourniquet on a client’s extremity and observing the amount of petechiae
produced. It is the presumptive test for dengue, which is used to assess
bleeding tendencies of a patient suspected to have the disease. Before doing
the test, the public health nurse must explain the procedure and purpose, and
he or she must assess the individual’s arm for petechaae, ecchymoses, or
infections that may affect the result. The tourniquet test is also contraindicated
for individuals with fistula, those with arteriovenous shunt, and those who have
undergone a mastectomy.

2. Capillary Refill Test Or Nail Blanch Test.

Capillary refill is the rate where at which blood refills empty capillaries, it
measures dehydration and decreased peripheral perfusion for patient with
dengue. It can be measured by holding a hand higher than heart-level, then
the soft pad of the thumb nail or toe nail is pressed until it turns white or until
blanching occurs. Pressure is then released and the time needed for the color
to return once pressure is released is measured. Normal refill time is more
than 3 seconds is a warning sign.

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 3. Platelet Count And Hematocrit (Hct) Test.
To confirm the diagnosis of dengue, a laboratory test such as platelet and
hematocrit count should be performed. A rapid decreased of platelet count in
parallel in with a rising haematocrit is a suggestive of progress to the critical
phase of dengue. If no proper laboratory services are available, the minimum
standard is the point-of-care testing of haematocrit by capillary blood sample
with the use of a microcentrifuge.

4. Hemagglutination-Inhibitition (Hi) Test.

This test is frequently used for patients admitted in the hospital, as this test
would require pair sera. The HI test is based on the ability of dengue virus
antibodies to inhibit agglutination.

Tertiary Prevention: []
 Continuity of 4’s
 Dengvaxia vaccine only to those individuals who experienced dengue is the
only suitable for this kind of vaccine.

LEPTOSPIROSIS

Definition []

It is a worldwide zoonotic disease caused by a bacteria called leptospires,

leptospira interrogans. These leptospira interrogans are fine spiral bacteria about 0.1
urn in diameter and 6-20 urn in length. The locomotion is achieved in a fluid medium
by a whirling motion around the longitudinal axis and by a serpentine or cockscew
motion in semisolid medium. Having an incubation period that ranges to 7-days.

Mode of transmission []

Contact of the skin, especially open wounds with water, moist soil or
vegetation contaminated with urine of infected host.

Signs and symptoms: [

 Fever
 Headache
 Myalgia
 Nausea
 Vomiting
 Cough
 Chest pain

Treatment: []
 Penicillins and other relatef B lactam antibiotics
 Tetracycline
 Erythromycin

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Prevention and control: []
 Improved education and awareness
 Use pf protective clothing boots and gloves
 Stringent community-wide rat eradication program
 Avoid contact with flood water

Primary Prevention: []

Specific Protection
• Pest/ Rodent Control
• Drinking Safe/ Potable Water
• Vaccination
• Use of protective covering
• Avoiding contact with flood waters
• Droxycycline Prophylaxis

Health Promotion
• Health education/awareness
• Good sanitary practice
• Proper drainage of water

Secondary Prevention []

1. Immunoflouresence Staining - is a sensitive method that enables

detection of Leptospires in sections of Formalin-fixed tissues, even when only
small numbers of organisms were present. All immunofluorescent stainsf ade
with storage or prolonged examination, which is a practical disadvantage.

2. Immunoperoxide Staining - Immunoperoxidase methods were developed

to overcome these dificulties. However, leptospires could only be visualized
when present in large numbers, as the contrast between leptospires and the
tissue background was poor.

3. Silver Staining - has been found to be more sensitive than

immunoperoxidase techniques for the detection of immunoglobulin in reactive
human tonsil.

4. Blood Culture - detection of Leptospires in blood.

5. Polymerase Chain Reaction - detection of Leptospira DNA in urine of

humans.

6. Enzyme Linked Immunosorbent Assay (Elisa) - a test that relies on

detection of IgM antibodies which appear in the blood a day.

7. Leptospirosa/Microscopic Agglutination Test - is a sensitive method and

is considered to be the golden standard in the diagnosis of Leptospirosis,
because of its unsurpassed diagnostic specificity.

Tertiary Prevention []

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Symptomatic Rehabilitation

 Rest Kidneys (Avoid strenous activities)

 Maintain Fluid and Electrolyte Homeostasis