Welcome to the session

Differential diagnosis

Public Health Entomological Society

Registration No 367/2009 Chennai, India
R.Asokan B.Dhanraj K.Nagoor pichai
Retd Chief Entomologist Retd .Chief Vector control officer, Retd Chief Entomologist
Corporation of Chennai

President Secretary Treasurer

Contact address: B1/8, Moon Enclave, Mogappair west, Chennai-600037.

+91- 9444328354 (M) •E MAIL. r.asokanphes@Gmail.com

Courtesy World Health Organization

 Differential diagnosis
This differential diagnosis will help the
field staff to suspect a disease during out
break period and to refer for Confirmation
test subsequently.
 Descriptions' of
suspected symptoms
 1.Fever
Malaria
Fever (also known as pyrexia[or a febrile Dengue
response) is defined as a body
DHF
temperature above the normal range due to an
increase in the temperature regulatory set- Chikungunya
point. Leptospirosis
The increase in set-point triggers
Scrub typhus
increased muscle tone and causes a feeling
of cold resulting in greater heat production and Typhoid
efforts to conserve heat. Influenza-A
This results in an increase in body
temperature. When the set-point temperature
returns to normal a person feels hot and may
begin to sweat.
 2.Chills
Chills is a feeling of coldness occurring during a
high fever,. It occurs during fever due to the Malaria
release of cytokines and prostaglandins as part of Dengue
the inflammatory response, which increases
DHF-X
the set point for body temperature in
the hypothalamus. The increased set point causes Chikungunya-X
the body temperature to rise (pyrexia), but also Leptospirosis
makes the patient feel cold or chills until the new
set point is reached. Scrub typhus

Shivering also occurs along with chills because the Typhoid-X

patient's body produces heat during muscle Influenza-A
contraction in a physiological attempt to increase
body temperature to the new set point.
 3.Headache
Malaria
• A headache or cep Dengue
halalgia is pain any DHF
where in the region
Chikungunya
of the head orneck.
Leptospirosis
It can be
a symptom of a Scrub typhus

number of different Typhoid

conditions of the Influenza-A
head and neck.
• [
 4.Myalgia
Malaria
• Myalgia, or muscle pain, is a symptom of
many diseases and disorders. The most Dengue

common causes are the overuse or over- DHF

stretching of a muscle or group of Chikungunya
muscles. Myalgia without a traumatic Leptospirosis
history is often due to viral infections.
Scrub typhus
Longer-term myalgias may be indicative
Typhoid
of a metabolic myopathy, some
nutritional deficiencies or chronic fatigue Influenza-A

syndrome.
 5.Arthralgia
• Arthralgia (from Greek arthro-, joint + -
algos, pain) literally means joint pain. it is Malaria

a symptom Dengue

of injury, infection, illnesses (in DHF

particular arthritis) or an allergic Chikungunya
reaction to medication..
Leptospirosis
• According to MeSH, the term "arthralgia"
Scrub typhus-X
should only be used when the condition
Typhoid-X
is non-inflammatory, and the term
"arthritis" should be used when the Influenza-A_x

condition is inflammatory.
 6.Diarrhea or diarrhoea
Diarrhea or diarrhoea is the condition of
Malaria
having at least three loose or liquid bowel
movements each day. Dengue-X

It often lasts for a few days and can result in DHF-X

dehydration due to fluid loss. Signs of Chikungunya-X

dehydration often begin with loss of the Leptospirosis

normal stretchiness of the skin and changes Scrub typhus-X
in personality.
Typhoid
This can progress to, loss of skin color, a fast
Influenza-A_x
heart rate, and a decrease in
responsiveness as it becomes more severe.
 7.Hepatomegaly
Hepatomegaly is the condition of Malaria
having an enlarged liver. It is a non- Dengue-x
specific medical sign having many DHF
causes, which can broadly be broken
Chikungunya-x
down intoinfection, direct
toxicity, hepatic tumors', or metabolic Leptospirosis
disorder. Scrub typhus
Often, Hepatomegaly will present as Typhoid
an abdominal mass. Depending on the Influenza-A-x
cause, it may sometimes present along
with jaundice.
 8.Splenomegaly
• Splenomegaly is an enlargement of
Malaria
the spleen. The spleen usually lies in the
Dengue-x
left upper quadrant (LUQ) of the human
abdomen. It is one of the four cardinal DHF-x

signs of hypersplenism, some reduction in Chikungunya-x

the number of circulating blood cells Leptospirosis
affecting granulocytes, erythrocytes or plat Scrub typhus
elets in any combination; a compensatory
Typhoid
proliferative response in the bone marrow;
and the potential for correction of these Influenza-A-x

abnormalities by splenectomy .
 Splenomegaly

CT scan showing Splenomegaly

in a patient with chronic lymphoid
leukemia
 9.Jaundice
• Jaundice is a yellowish pigmentation of the
Malaria
skin, the conjunctiva membranes over
the sclerae (whites of the eyes), and Dengue-x
other mucous membranes caused by high blood DHF-x
bilirubin levels. This Hyperbilirubinemia
Chikungunya-x
subsequently causes increased levels of
bilirubin in the extracellular fluid. Leptospirosis
Concentration of bilirubin in blood plasma is Scrub typhus-x
normally below 1.2 mg/dL(<25µmol/L). A
concentration higher than approx. 3 mg/dL Typhoid-x
(>50µmol/L) leads to jaundice. The term Influenza-A-x
jaundice comes from the French word jaune,
meaning yellow.
 Jaundice

Jaundice of the skin caused by hepatic failure

 10.Haematuria
Malaria
• If blood in the urine is obvious
Dengue-x
with the naked eye, it is called DHF
"macroscopic", or "visible Chikungunya-x
haematuria". If the blood can Leptospirosis
only be detected with Scrub typhus
laboratory testing, it is called Typhoid-x

"microscopic", or "non-visible". Influenza-A-x

 11.Retro-orbital pain
• Eye pain, periorbital and retro- Malaria-x

orbital pain, and headache or Dengue

facial pain referred to the orbital DHF

region are common presenting Chikungunya-x
complaints. Leptospirosis-x
Scrub typhus-x
Typhoid-x
Influenza-A-x
.12.A subconjunctival hemorrhage
• A subconjunctival Malaria-x

hemorrhage (or subconjunctival Dengue-

haemorrhage) also known DHF-
as hyposphagma, is bleeding Chikungunya-x
underneath the conjunctiva. The Leptospirosis-x
conjunctiva contains many small,
Scrub typhus-x
fragile blood vessels that are easily
ruptured or broken. When this happens, Typhoid-x
blood leaks into the space between the Influenza-A-x
conjunctiva and sclera.
12.Subconjunctival hemorrhage
 13.A rash
A rash is a change of the skin which Malaria-x

affects its color, appearance, or texture. Dengue

A rash may be localized in one part of DHF

the body, or affect all the skin. Chikungunya
Rashes may cause the skin to change Leptospirosis
color, itch, become warm,
Scrub typhus
bumpy, chapped, dry, cracked
Typhoid-x
or blistered, swell, and may be painful.
Influenza-A-x
A diffuse rash on the back of a male
 14.Lymphadenopathy

• Lymphadenopathy or lymphadenitis Malaria-x

refers to lymph nodes which are Dengue
abnormal in size, number or DHF-x
consistency . and is often used as a
Chikungunya
synonym for swollen or enlarged lymph
nodes. Leptospirosis

Common causes of Lymphadenopathy Scrub typhus

are infection, autoimmune disease, Typhoid-x
or malignancy. Influenza-A-x
 Lymphadenopathy

Neck lymphadenopathy associated with

infectious mononucleosis
 15.(CNS) involvement
Malaria
• Incidence — The exact incidence Dengue-x
of central nervous system (CNS) DHF-x
involvement in patients with acute
Chikungunya-x
myeloid leukemia (AML) is
Leptospirosis
unknown, but is thought to be
Scrub typhus
considerably less common than
Typhoid-x
CNS involvement in both adults
Influenza-A-x
and children with acute
lymphoblastic leukemia
 16.Conjunctival suffusion
• Conjunctival suffusion is Malaria-x

an eye finding occurring early in Weil’s Dengue-x

disease, which is caused by Leptospira DHF-x
interrogans. Conjunctival suffusion is Chikungunya-x
characterized by redness of
Leptospirosis
the conjunctiva that
Scrub typhus-x
resembles conjunctivitis, but it does not
involve inflammatory exudates. Swelling of Typhoid-x

the conjunctiva (chemosis) is seen along Influenza-A-x

the corners of the eye
16.Conjunctival suffusion
 17.Abdominal pain
Abdominal pain (or stomach pain) is a Malaria-x
common symptom associated with both temporary, Dengue-x
non-serious disorders and more serious
DHF
conditions.
Common causes include: Chikungunya-x

gastroenteritis and irritable bowel syndrome. In a Leptospirosis

third of cases the exact cause is unclear. About
Scrub typhus
10% of people have a more serious underlying
condition such Typhoid
as: appendicitis or diverticulitis.[1]Determining the Influenza-A
cause can be difficult, because many diseases can
cause this symptom
 Abdominal pain

Abdominal pain can

be characterized by
the region it affects.
 18.Epistasis
• Epistasis is a phenomenon that Malaria-x

consists of the effect of one gene Dengue-x

being dependent on the presence DHF

of one or more 'modifier genes' Chikungunya-x

(genetic background). Leptospirosis-x

Similarly, epistaticmutations have Scrub typhus-x

different effects in combination Typhoid-x

than individually. Influenza-A-x

 19.Pain in shin
Malaria-x

• Shin splints. This type of lower Dengue-x

DHF-x
leg pain happens when connective
tissues and muscles along the Chikungunya-x

edge of the shin bone become Leptospirosis-x

inflamed. Scrub typhus

Typhoid-x

Influenza-A-x
 20.An eschar
Malaria
• An eschar ( Greek: eschara,
Dengue
"scab") is a slough[,or piece
DHF
of dead tissue that is cast off from
Chikungunya
the surface of the skin, particularly
Leptospirosis
after a burn injury, but also seen
Scrub typhus
in gangrene, ulcer, fungal
Typhoid
infections, necrotizing spider bite
Influenza-A
wounds,
 Inoculation eschar on popliteal area and discrete
Maculopapular elements in patient with lymphangitis
infected with Rickettsia sibirica mongolitimonae,
 21.Malaena
Malaria-x

• The passage of black, tarry Dengue-x

DHF
stools composed largely of
Chikungunya-x
blood that has been acted
Leptospirosis-x
on by gastric juices,
Scrub typhus-x
indicative of bleeding in the Typhoid
upper digestive tract. Influenza-A-x
22.Upper respiratory tract infections
Malaria-x
Upper respiratory tract
Dengue-x
infections (URI or URTI) are the illnesses
DHF-x
caused by an acute infection which
involves the upper respiratory Chikungunya-x

tract: nose, sinuses, pharynx or larynx. Leptospirosis-x

This commonly includes: Scrub typhus-x
tonsillitis, pharyngitis, laryngitis, Typhoid-x
sinusitis, otitis media, and the common
Influenza-A
cold.
Upper respiratory tract infections
 23."Petechiae"
A Petechiae ,plural Petechiae ,is a small
Malaria-x
(1 - 2 mm) red or purple spot on the skin,
caused by a minor hemorrhage (broken Dengue-x

capillary blood vessels)., DHF

"Petechiae" refers to one of the three Chikungunya-x

descriptive types of bleeding into the skin Leptospirosis-x
differentiated by size, the other two Scrub typhus-x
being purpura and ecchymosis. Petechiae
Typhoid-x
are by definition less than 3 mm.
Influenza-A-x
The term is virtually always used in the
plural, since a single lesion is seldom
noticed or significant.
 "Petechiae"

Petechia and purpura on the low limb

due to medication induced vasculitis.
 24.Pneumonitis
Malaria-x
Pneumonitis or pulmonitis is
Dengue-x
an inflammation of lung tissue.
DHF-x
Many factors can cause pneumonitis,
including breathing in animal dander, Chikungunya-x

aspiration (inhaling small food particles Leptospirosis-x

or vomit "down the wrong pipe"), and Scrub typhus-x

receiving radiation therapy to the Typhoid-x
chest. Influenza-A
Differential Diagnosis
 Differential Diagnosis
1 2 3 4 5 6 7 8 9 10 11 1 13 1 1 1 1 1 19 2 2 2 2 2
2 4 5 6 7 8 0 1 2 3 4

Malaria 0 0 0 0 0 0 0 0 0 0 0
Dengue 0 0 0 0 0 0 0 0 0
DHF 0 0 0 0 0 0 0 0 0 0 0 0 0
Chikungunya 0 0 0 0 0 0
Leptospirosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Scrub typhus 0 0 0 0 0 0 0 0 0 0 0 0 0
Typhoid 0 0 0 0 0 0 0
Influenza-A 0 0 0 0 0 0 0
Fever 1 Diarrhea 6 Retroorbital pain 11 Conjunctival 16 Malaena 21
suffusion

Chills 2 Heptomegaly 7 Subconjunctival 12 Abdominal 17 Upper res tract 22

haemorrhage pain infection

Head ache 3 Spleenomegaly 8 Rashes 13 epitasis 18 Petechiae 23

Myalgia 4 Jaundice 9 lymphadenopathy 14 Pain in shin 19 Pneumonities 24

Arthralgia 5 Haematuria 10 CNS Involvement 15 Eschar 20

Differentiating Dengue &
Chikungunya
Differentiating Dengue from Chikungunya
Clinical Features Chikungunya virus infection Dengue virus infection
Fever (>102°F) +++ ++
Myalgias + ++
Arthalgias/arthritis +++ +/-
Headache ++ ++
Rash ++ +
Bleeding dyscrasias +/- ++
Shock
- +/-
Leukopenia ++ +++
Neutropenia + +++
Lymphopenia +++ ++
Thrombocytopenia + +++
*Mean frequency of symptoms from studies where the two diseases were directly compared among patient
seeking care; +++ = 70-100% of patients; ++ = 40-69%; + = 10-39%; +/- = <10%; - = 0%.
References: Nimmannitya S, et. al. Am J Trop Med Hyg 1969; 18:954-71. Halstead SB, et. al. Am J Trop
Med Hyg 1969; 18:972-83.
Differentiating Dengue from
Malaria
 Differentiating Dengue from Malaria
Clinical Features P. Falciparum P. Vivax Dengue
Fever (≥38°C)* +++ +++ +++

Myalgias + + +++

Headache +++ +++ +++

Rash +/- +/- ++

Jaundice + +/- +/-

Vomiting ++ + +
Abdominal Pain + + +/-
Hepatomegaly + + +/-
Splenomegaly + + +/-
Leukopenia +/- +/- +++

Anemia ++ ++ +

Thrombocytopenia ++ ++ +++
*Mean frequency of symptoms from studies where the two diseases were directly compared among patient seeking care; +++ =
70-100% of patients; ++ = 40-69%; + = 10-39%; +/- = <10%; - = 0%.References: Nimmannitya S, et. al. Am J Trop Med Hyg
 Differential Diagnosis of
Dengue, Chikungunya and
ZIKA
ZikaVirus Compared to Dengue and Chikungunya
Features Zika Dengue Chikungunya
Fever ++ +++ +++
Rash +++ + ++
Conjunctivitis ++ + +
Arthralgia ++ + +++
Myalgia + ++ +++
Head ache + ++ ++
Hemorrhage - ++ -
Shock - + -
Differential Diagnosis of
Dengue
Differential Diagnosis of Dengue
Infectious Etiologies
• Leptospirosis • Enterovirus
• Influenza • Meningococcemia
• Malaria • Bacterial sepsis

• Typhoid fever • Chikungunya

• West Nile Virus
• Measles
• Acute HIV
• Rubella
seroconversion illness
• Rickettsial infections • Other viral hemorrhagic
(typhus, scrub typhus) fevers
Differential Diagnosis of Dengue
The following list of infections are on the differential
diagnosis of dengue (depending on patient history
including recent travel hx):
Leptospirosis-- (think lots of rain and exposure to
puddles/contaminated water or animals/rats)
Influenza -- (Influenza-like –illness fever and cough
or sore throat or rhinnorhea)
West Nile Virus (Puerto Rico has had
asymptomatic cases in blood donors)
Measles – (Puerto Rico has good vaccination rates
but what about our neighbors?)
Rubella
Differential Diagnosis of Dengue
Malaria – (Travel history?)
Typhoid fever (Salmonella typhi)
Enterovirus (Non-polioviruses: Coxsackievirus A &
B, echovirus, enterovirus)
Meningococcemia
Rickettsial infections (Rickettsial disease – R.
akari, R. prowazekii, R. Rickettsii, R. typhi)
Bacterial sepsis
Other viral hemorrhagic fevers
 Dengue Hemorrhagic fever death
happens when a patient becomes
infected with a second of the four
different serotypes
DEN-1, DEN-2, DEN-3, and DEN-4

http://woodshedenvironmen
t.wordpress.com/2010/12/29
/dengue-fever-is-dangerous-
slideshow-v-1-3-is-here/
 Dengue – Clinical Spectrum
• Dengue virus infections have a wide clinical
spectrum that includes asymptomatic infections
and symptomatic infections.

• Symptomatic infections can be mild or

moderately severe (for example dengue fever or
dengue fever with haemorrhage) to severe
forms including dengue hemorrhagic fever
(DHF) and dengue shock syndrome (DSS)
 2009 New Dengue Classification
Dengue case classification by severity
Dengue ± warning signs Severe dengue
1. Severe plasma
With leakage
Without warning 2. Severe hemorrhage
3. Severe organ
signs impairment
Criteria for dengue ± warning signs Criteria for severe dengue
Probable dengue Warning signs* 1. Severe plasma leakage leading
Live in/travel to dengue • Abdominal pain or tenderness to:
endemic area. Fever and 2 of • Persistent vomiting • Shock (DSS)
following criteria: • Clinical fluid accumulation • Fluid accumulation with
• Nausea, vomiting (New) • Mucosal bleed respiratory distress
• Rash • Lethargy; restlessness 2. Severe bleeding
• Aches and pains (Combined) • Liver enlargement >2cm as evaluated by clinician
• Tourniquet test positive • Increase in HCT with rapid 3. Severe organ involvement
• Leucopenia decrease in platelet count • Liver: AST or ALT>=1000

WHO/TDR 2009
• Any warning sign * Requiring strict observation and • CNS: Impaired consciousness
Laboratory confirmed dengue medical intervention • Heart and other organs
(important when no sign of plasma leakage)
 So in November of 2009 WHO Proposed
Dengue Classification
Dengue case classification by severity
• Dengue with or without (less common – therefore small,
narrow arrow) warning signs.
Fever and 2 of the following criteria:
• Nausea, vomiting (NEW)
• Rash (old, 1997 case definition too)
• Aches and pains (NEW = headache + eye pain +
myalgia + arthralgia)
• Tourniquet test positive (old was in 1997 as
hemorrhagic manifestation)
• Leucopenia (old too)
• Any warning sign (NEW)
 2009 New Dengue Classification
Dengue case classification by severity
Dengue ± warning signs Severe dengue

1. Severe plasma
With leakage
Without warning 2. Severe
signs hemorrhage
Criteria for dengue ± warning signs
3.Criteria
Severe organ
for severe dengue
Probable dengue Warning signs* impairment
1. Severe plasma leakage
Live in/travel to dengue endemic area. leading to:
• Abdominal pain or tenderness
Fever and 2 of following criteria: • Shock (DSS)
• Nausea, vomiting (New) • Persistent vomiting
• Fluid accumulation with
• Rash • Clinical fluid accumulation
respiratory distress
• Aches and pains (Combined) • Mucosal bleed
2. Severe bleeding
• Tourniquet test positive • Lethargy; restlessness
• Liver enlargement >2cm
as evaluated by clinician
• Leucopenia
• Increase in HCT with rapid 3. Severe organ involvement
• Any warning sign
• Liver: AST or ALT>=1000

Laboratory confirmed dengue
(important when no sign of plasma leakage)
decrease in platelet count
* Requiring strict observation and
medical intervention
WHO/TDR 2009
• CNS: Impaired consciousness
• Heart and other organs
 Probable dengue
• Live in/travel to dengue endemic area. Fever and 2
of following criteria:
• Nausea, vomiting (New)
• Rash
• Aches and pains (Combined)
• Tourniquet test positive
• Leucopenia
• Any warning sign
• Laboratory confirmed cases
• (important when no sign of plasma leakage
 2009 New Dengue Classification
Dengue case classification by severity
Dengue ± warning signs Severe dengue

1. Severe
With plasma leakage
Without warning
2. Severe
signs hemorrhage
Criteria for dengue ± warning signs 3.Criteria
Severe for severe
organ dengue
1. Severe plasma leakage leading to:
Probable Warning signs* impairment
• Shock (DSS)
• Abdominal pain or tenderness
dengue • Persistent vomiting
• Fluid accumulation with respiratory
distress
Live in/travel to dengue endemic
• Clinical fluid accumulation
area. Fever and 2 of following
• Mucosal bleed 2. Severe bleeding
criteria:
• Lethargy; restlessness as evaluated by clinician
• Nausea, vomiting (New)
• Rash • Liver enlargement >2cm
3. Severe organ involvement
• Aches and pains (Combined) • Increase in HCT with rapid • Liver: AST or ALT>=1000

WHO/TDR 2009
• Tourniquet test positive decrease in platelet count • CNS: Impaired consciousness
• Leucopenia * Requiring strict observation and • Heart and other organs
• Any warning sign medical intervention
 So in November of 2009 WHO Proposed
Dengue Classification
•Warning signs  need strict observation
in hospital.
•Abdominal pain or tenderness
Persistent vomiting
•Clinical fluid accumulation
Mucosal bleed
•Lethargy; restlessness
Liver enlargement >2cm
•Laboratory: Increase in HCT concurrent
with rapid decrease in platelet count
 2009 New Dengue Classification
Dengue case classification by severity

Dengue ± warning signs Severe dengue

1. Severe plasma
With leakage
Without warning 2. Severe hemorrhage
3. Severe organ
signs impairment
Criteria for dengue ± warning signs Criteria for severe dengue
1. Severe plasma leakage leading to:
Probable dengue Warning signs* • Shock (DSS)
Live in/travel to dengue endemic • Abdominal pain or tenderness
• Fluid accumulation with respiratory
area. Fever and 2 of following • Persistent vomiting
criteria: distress
• Clinical fluid accumulation
• Nausea, vomiting (New)
• Mucosal bleed 2. Severe bleeding
• Rash
• Lethargy; restlessness as evaluated by clinician
• Aches and pains (Combined)
• Liver enlargement >2cm
• Tourniquet test positive 3. Severe organ involvement
• Increase in HCT with rapid
• Leucopenia • Liver: AST or ALT>=1000

WHO/TDR 2009
decrease in platelet count
• Any warning sign • CNS: Impaired consciousness
* Requiring strict observation and
Laboratory confirmed dengue • Heart and other organs
medical intervention
(important when no sign of plasma leakage)
 So in November of 2009 WHO Proposed
Dengue Classification
No more DHF or DSS. Focus on severe
manifestations. Patients may fit 1 or all 3
categories.
1. Severe plasma leakage leading to:
1.) Shock (DSS) and 2.) Fluid accumulation
with respiratory distress
2. Severe bleeding
as evaluated by clinician
3. Severe organ involvement
1.) Liver: AST or ALT>=1000, OR
2.) CNS: Impaired consciousness, OR
3.) Heart and other organs
 Dengue Fever - Symptoms

• Fever: continuous for 3 to 7 days

• Severe headache
• Joint pain, muscle pain, pain behind
eyeballs
• Nausea, vomiting, and rash
• In very rare cases, the condition may
worsen into dengue hemorrhagic fever,
leading to internal bleeding, shock, or
even death.
 Dengue’s symptoms include a sudden high
fever, a flat rash, and other flu like symptoms.

Fever 104-105 degrees 4 to 7 days after infection

Rash 2-5 days after fever
A second rash appears after the first that looks like measles
Dengue Hemorrhagic fever death happens
when a patient becomes infected with a
second of the four different serotypes
DEN-1, DEN-2, DEN-3, and DEN-4
The more severe form of Dengue is
Dengue Hemorrhagic Fever.

http://woodshedenvironment.wordpres
s.com/2010/12/29/dengue-fever-is-
dangerous-slideshow-v-1-3-is-here/
 Bleeding spots in skin

Normal

Dengue
Skin bleeds
Bleeding into the eye
Large bleed into skin
Without surveillance, control becomes a matter
of luck.

With surveillance, mosquito control becomes more

targeted, more effective, and more economical.
68
Dear friends,
Greetings from Public Health Entomological Society ,
Chennai,
This characters' were collected from many contributors. We
,Public Health Entomological Society , Chennai, India
sincerely convey our thanks to each one of them. This is
reproduced and send to our friends only on academic
interest on free. If you feel the same is use ful, the same
may be send your friends also.
With kind regards,
R.Asokan, President , Public Health Entomological Society, Chennai .
E mail. r.asokanphes@Gmail.com
THANK
YOU
FOR
LISTENING
 Thanking you

Public Health Entomological Society

Registration No 367/2009 Chennai, India
R.Asokan B.Dhanraj K.Nagoor pichai
Retd Chief Entomologist Retd .Chief Vector control officer, Retd Chief Entomologist
Corporation of Chennai

President Secretary Treasurer

Contact address: B1/8, Moon Enclave, Mogappair west, Chennai-600037.

+91- 9444328354 (M) •E MAIL. r.asokanphes@Gmail.com