A Simple Guide to Dengue Fever

A Simple Guide to Dengue Fever
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What is dengue fever?
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Dengue fever is a acute viral infection caused by the dengue virus which is transmitted by the bite of an infected female Aedes msoquito.

What are the Types of Dengue Fever?
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The dengue virus has 4 strains called serotypes 1, 2, 3 and 4.

An infection with one serotype does not protect you from the other serotypes.

A second dengue infection, especially with serotype 2, can cause an even worse infection such as Dengue Haemorrhagic Fever and Dengue Shock Syndrome which can be fatal.

What are the Symptoms of Dengue Fever?
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The incubation period in mosquito is 8-12 days and 3-14 days in humans.

Symptoms usually last 3-14 days.

1.High, acute, prolonged fever (usually lasts for 5 to 7 days)

2.Severe headache

3.Pain behind the eyes

4.Muscle and joint pains

5.Rashes

6.Nausea , vomiting

7.Abdominal discomfort

8.Loss of appetite

9.Fatigue

10.Diarrhoea

A rash usually appears 3-4 days after the fever.

There are 3 types of dengue rash.

1.Petechial Rash:
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This is the most common with the petechial rash appearing as red dots under the skin.
The rashes are usually found on the limbs and lower abdomen and is due to the bleeding under the skin.

2.Diffuse erythematous rash with areas of normal skin:
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The whole skin becomes reddish with scattered, small areas of normal skin .

3.Maculopapular rash:
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The last type of rash appears as red flat or raised leisons(Maculopaular).
The rash can be itchy .

What are the Complications of Dengue Fever?
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The complications of Dengue Fever are:

1.Dengue Hemorrhagic Fever
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a. Fever

b.bleeding likely to occur from the nose, mouth, and gums.
Bruises and ecchymosis may appear as a sign of bleeding under the skin.
There are small red spots on the skin.

c.the urine may contain blood.

d.vomiting of blood and malena(black stools) indicate bleeding in the stomach.

e.low plalelet count of <100,000

f.Hypoalbuminaemia

g.pleural effusion

h.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain

2. Dengue Shock Syndrome
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Without prompt treatment for the bleeding, the person can go into

a.shock

b.hypotension

c.narrowed pulse pressure(< 2omm Hg)

d.impaired organ perfusion which result in organ failure and death.

Dengue Haemorrhagic Fever and Dengue Shock Syndrome is fatal in about 5 percent of the cases, mostly among children and young adults.

How do you diagnose Dengue Fever?
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1.History of acute fever and bleeding signs

2.A low platelet count (<100,000)is suggestive of dengue fever.

3.Specific blood test(IgG and IgM antibody) for dengue virus can also be conducted. IgM antibodies occur on the 5th day of illness and last for 2 months.

What is the treatment of dengue fever?
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There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the dengue virus.

Treatment is mainly supportive.

1. Rest

2.drinking lots of water to prevent dehydration will help.

3.Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.

4. Intravenous fluids for hypotension and dehydration.

5.Daily blood tests (platelets and hematocrit)may be necessary to monitor the risk of bleeding

6. Platelets transfusion when the the platelet count is less than 20,000.


The illness can last up to 10 days, but complete recovery can take as long as a month.

How is dengue fever spread?
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Dengue Fever is spread only through the bite of the infected Aedes mosquitoes.

The transmission cycle for dengue starts when:

1.Infected Aedes mosquito bites a healthy person.

2.4-7 days later,the infected person develops fever

3..When fever starts, the person is infectious for about 5 days.

4.If an Aedes mosquito bites the person during this time when he is infectious, it will be infected by the the dengue virus.

5.The virus will multiply in the second mosquito for 5-7 days.

6.The mosquito then becomes infective.

7.The cycle starts again when it bites another person.


How can you prevent being infected with the dengue virus?
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To prevent dengue fever, you must prevent the breeding of its carrier, the Aedes mosquitoes.

This will be explained another time

A Simple Guide to Measles

A Simple Guide to Measles
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What is Measles?
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Measles is usually a contagious childhood infection caused by the measles virus, one of the paromyxovirus.
It is characterised by typical prodromal symptoms, generalised rash and Koplik's spots in the mouth.

Who is at risk for Measles?
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Any one at any age can contract measles but it usually occurs in childhood.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.


What are the Symptoms of Measles?
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There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever

2.coughing,

3.runny nose, stuffy nose,

4.tiredness,

5.red eyes, tearing. ,

6.Koplik's spots (white spots with a red background , located on the inside of the cheeks near the back molars start to appear 2-4 days after the fever.

7.measles rash usually occurs after the appearance of the Koplik's spots.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, and soles. Once it reaches the soles, the rash begins to fade in about four days , first the head and neck, then trunk and limbs. There may be a brownish discoloration in areas of affected skin rashes but this is only temporary.

8. enlarged lymph glands may be felt in the neck and groins

9.inflammation of the eyes (conjunctivitis) with tearing may also occurs.

10. diarrhoea and vomiting may occurs in some patients.

Adults tend to suffer more severe symptoms than children do.

People who have had measles develop a natural immunity and cannot contract it again.

What are the Complications of Measles?
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1.Ear infection (Otitis Media) is a common complication of measles.

2.pneumonia in very young children and older patients may be dangerous.

3.encephalitis (brain infection)may ocur in 1 out of 600 patients putting them at risk of suffering seizures, coma or dying.

4.the digestive organs (including the liver),the heart muscle or the kidneys may be damaged in rare cases

A pregnant woman who develops a measles infection has
1.an increased risk of premature labour,

2.miscarriage

3.delivery of a low birth weight baby.

What is the Treatment for Measles?
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There is no cure for measles.
Treatment is therefore symptomatic.
Fever symptoms are treated with Paracetamol.
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain

Itch may be controlled by antihistamines which can also help to relieve the runny nose.

Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia.

Cough mixtures may be given to relieve the cough.

Plenty of bed rest is necessary.

Lots of fluids helps to prevent dehydration.

A cool-mist humidifier to soothe respiratory passages may help.

Most patients recover completely from measles.

Death is extremely rare (one out of every 1000 cases), usually from pneumonia or encephalitis.

How do You prevent Measles?
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Measles can be prevented with the measles vaccine, which is usually given to children at the age of 15 months as part of the MMR (measles, mumps and rubella) combination.

A second MMR vaccine is now given at the age of 12 years.

A Simple Guide to Epilepsy

A Simple Guide to Epilepsy
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What is epilepsy?
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Epilepsy is a neurological disorder which occurs when the brain malfunctions due to sudden abnormal electrical discharge of brain cells.
If all the brain cells discharge abnormal signals at once, the epileptic fit is called a generalised fit or grand mal.
If only part of the brain is involved in discharging abnormal signals, the fit is called a partial epileptic fit.
Epilepsy is diagnosed only when there are repeated episodes of epileptic fits.

What are the types of epilepsy?
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Epileptic Seizures may vary from the briefest lapses of attention(trance) or muscle jerks to severe and prolonged convulsions.
They may also vary from less than one a year to several per day.
Seizures are classified :

1.Partial or focal seizures
These seizures arise from an electric discharge of one or more localised areas of the brain regardless of whether the seizure is secondarily generalized.
They may or may not affect consciousness.
Partial seizures begin in a localized area of the brain, but then may spread to the whole brain causing a generalized seizure.

2.Generalized seizures
Generalised electrical discharge involves the whole brain.
It may cause loss of consciousness and/or muscle convulsions or stiffness.
They include what used to be known as grand mal convulsion and also the brief petit mal absence of consciousness.

3.Status epilepticus
This is a condition in which a person has very frequent seizures without recovery of consciousness between each episode.
This is a dangerous condition and if not treated may lead to brain damage or death.

What are the causes of Epilepsy?
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In 70% of cases the cause is unknown.
In such cases, the theory most commonly accepted is that this epilepsy is the result of an imbalance of certain chemicals in the brain (especially chemical messengers known as neurotransmitters) causing them to have a low convulsive threshold.
Epilepsy of unknown or genetic origin are present in children and adolescents.

In the remaining cases, the causes can be found and some may be treated.

1. Brain infection can cause epilepsy at any age. Neurocysticercosis cysts on the brain caused by tapeworm infection, malaria and meningitis are common causes.

2. Febrile illness of any kind can trigger seizures in young children.
Some 3% of children who have febrile convulsions go on to develop epilepsy in later life.

3. Stroke may damage brain cells resulting in seizures.

4. Trauma and head injury may also damage brain cells resulting in seizures.

Certain flashing lights (discos, television, video games etc.), over-breathing, over-hydration, loss of sleep, and/or emotional and physical stress, may stimulate seizures.
Although these are not causes of epilepsy, they may affect the timing and frequency of seizures.

Who are at risk of Epilepsy?
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It occurs in men and women and can begin at any age, but is most frequently diagnosed in infancy, childhood, adolescence and old age.

What are the Symptoms of Epilepsy?
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Symptoms varies depending on the part of the brain which is functioning abnormally.

Generalised Fits
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There are several types of generalised fits.
In the classical Grand mal fit:
1.there is a sudden loss of consciousness and the person fall to the ground.
2.The eyes may roll up.
3.There is body stiffening and convulsions.
4.The tongue may be bitten during the fit
5.The urine may passed out due to loss of bladder control.
6.After the fit the body relaxes and the patient may fall into a sleep for several hours.

In the generalised Petit Mal Fit:
1. There may be a sudden absence of movement or sudden interruption of speech for a few minutes
2. This is followed by the patient picking up the speech or movement where he last stopped.
3. It can be dangerous especially while driving or doing dangerous work which require continous movements.

Partial or focal Fit
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Just as in generalised fits, there are also many types of partial fits.
In a partial fit , there may be changes to the way the person looks at things, feels, smells or taste.
In other cases there may be staring and unusual movement like hand rubbing etc.

What are the investigation for Epilepsy?
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All suspected epileptic cases should undergo the following tests:

1. blood tests - for chemicals imbalance or poisoning
2. MRI of brain (or CAT Scan of the brain) to detect any any abnormal focal area of the brain
3. EEG of brain (which measures the brain electrical waves)

What is the Treatment of Epilepsy?
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It has been shown that 70% of newly diagnosed children and adults with epilepsy can be successfully treated (i.e, their seizures can be completely controlled for several years) with anti-epileptic drugs.
After 2-5 years of successful treatment, drugs can be withdrawn in about 70% of children and 60% of adults without relapses.

Modern drugs used for epilepsy are:
phenytoin
carbamazepine
sodium valproate

Some 30% of people may not respond to drug therapy.
A factor which leads to worse prognosis is the presence of an underlying brain disease.

Partial seizures, especially if associated with a brain disease, are more difficult to control than generalized seizures.
Surgery may be considered when the epilepsy or the brain disease poses a danger to life.

Secondary seizures- not epilepsy- such as those related to an acute, short-lasting brain disease, may run a self-limiting course.
A significant proportion of people may develop established epilepsy.

What are the complications of Epilepsy?
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Epilepsy can be associated with an increased risk of mortality.
Death may be related to:
1.An underlying brain disease, such as a tumour or infection;

2.Seizures in dangerous circumstances, leading to drowning, burns or head injury

3.Status epilepticus;

4.Sudden and unexplained causes, or a possible respiratory or cardio-respiratory arrest during a seizure;

5.Suicide.

How do you prevent another Epilepsy Fit?
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The patient must do the following:
1. take his anti-epileptic medicine exactly as prescribed, avoid stopping his medicine or altering the dosage of medicine.

2. strive for a healthy lifestyle with balanced diet, regular exercise and effective stress management.

3. limit the intake of alcohol

4. get adequate sleep and rest as lack of sleep can trigger a fit

5. avoid operation of heavy machinery

6. carry a card stating his condition and medicines.
This will be helpful in an emergency.

How to help a person having a Epilepsy Fit?
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As a person having an epileptic fit may be unconscious or drowsy, you should :
1.keep the person safe from injury - protect him from falling to the ground, remove any sharp objects near the drowsy epileptic person

2. do not place any object in his mouth - this may cause injury like chipped teeth or even a broken jaw

3. put him in a prone position with the mouth sideways to avoid any blockage of his airway - may sure that he is able to breathe properly

4. Call an ambulance if the fit lasts more than 5 minutes, or if there is repeated seizures, or if the person is pregnant or has diabetes

A Simple Guide to Rubella

A Simple Guide to Rubella
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What is Rubella?
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Rubella is a infectious viral disease characterised by fever, generalised rash and swollen glands behind the ears and in the neck.
It can be spread through the air or by contact.
It can also be transmitted to a foetus by a mother with an active infection.
The disease is usually mild and may even go unnoticed. It is also called German Measles.

What are the Symptoms of Rubella?
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Most children have few symptoms.
Adults may experience a prodrome (warning symptom) of a fever, headache, malaise, runny nose, and inflamed eyes, that lasts from 1 to 5 days before the rash appears.

A person can transmit the disease from 1 week before the onset of the rash until 1 week after the rash disappears.

The child with rubella may not look or act sick, but symptoms may include:
1. low-grade fever

2.swollen glands behind the ears and at the back and sides of the neck.

3.Loss of appetite, irritability, loss of interest in personal care.

4.Rash (maculopapiular) which appears on the face and torso and spreads to the arms and legs, lasting 3 to 5 days.

5.Rarely joint pain and arthritis (more common in adult women).

Lifelong immunity to the disease follows infection.

What is the danger of Rubella?
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The disease is potentially dangerous because it is able to produce defects in a developing foetus if the mother is infected during early pregnancy.
About 10 to 15% of women in their childbearing years are susceptible to infection.

Congenital rubella syndrome occurs in 25% or more of infants born to women who acquired rubella during the first trimester of pregnancy.
Defects may occur in an infected foetus and include deafness, cataracts, microcephaly, mental retardation, congenital heart defects, and other defects.
A miscarriage or stillbirth may occur.
Defects are rare if the infection occurs after the 20th week of pregnancy.
Risk factors include lack of immunisation and exposure to an active case of rubella.

What is the Treatment of Rubella?
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The infected child should stay at home while sick or up to a week after the rash disappears.
There is no cure for Rubella.
Treatment of a child with rubella is usually symptomatic .

Keep your child quiet, especially if she has a fever.
Children should be kept at home while any rash is visible and for a week thereafter.
Avoid scratching the rash.
Apply Calamine lotion or give the child some antihistamine to stop the itch.
Cool sponging will help relieve fever and discomfort from a rash.
An acetaminophen-based pain reliever may also help.

If you are pregnant and are exposed to rubella, you should contact your doctor immediately.
The risk of birth defects is higher the earlier the exposure occurred in your pregnancy.
In some cases, your doctor may advise you to consider a therapeutic termination of your pregnancy.

How do you Prevent Rubella?
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Two doses of the MMR vaccine are recommended for children.
The MMR (measles, mumps, and rubella vaccine) is now given at 15 months, with a booster at the age of 12.

If your child has rubella, notify any at-risk individuals who have had contact with your child during the illness and up to 10 days before symptoms appeared, so they can seek appropriate care.

Pregnancy Concerns
If you are pregnant, and uncertain of your immunity to rubella, and suspect you have been exposed, contact your doctor immediately. There is a risk the virus can be passed to your unborn child.

If any household member is pregnant and there is any question of her not being immune, your doctor will recommend delaying immunisation of your children to prevent exposing the mother-to-be to the live, though weakened, virus in the vaccine.

At least three months before trying to become pregnant, a woman should have a blood test to see if the rubella antibodies are present.
If antibodies are not present, she should be immunised or reimmunised.