Important Tips Regarding Fever

[ishaquemijee]

Dengue: Symptoms, prevention and treatment:
.
Learn about the symptoms and signs of dengue fever, a disease transmitted by mosquitoes.After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen.
Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.
Dengue (pronounced DENG-gay) strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.
Dengue goes by other names, including "break-bone" or "dandy fever." Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name break-bone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait.
Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome.
Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Cases have also been imported via tourists returning from areas with widespread dengue, including Tahiti, Singapore, the South Pacific, Southeast Asia, the West Indies, India, and the Middle East (similar in distribution to the areas of the world that harbor malaria and yellow fever). Dengue is now the leading cause of acute febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia.
A 2009 outbreak of dengue fever in Key West, Fla., showed that three patients who did not travel outside of the U.S. contracted the virus. Subsequent testing of the population of Key West has shown that up to 55 of the people living in the area have antibodies to dengue. As of July 17, 2010, 17 individuals have been identified that acquired dengue in Key West in 2010.
Dengue fever is common, and statistics show it may be increasing in Southeast Asia. Thailand, Vietnam, Singapore, and Malaysia have all reported an increase in cases. According to the U.S. Centers for Disease Control and Prevention (CDC), there are an estimated 100 million cases of dengue fever with several hundred thousand cases of dengue hemorrhagic fever requiring hospitalization each year. Nearly 40% of the world's population lives in an area endemic with dengue.
The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round. One mosquito bite can inflict the disease.
The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway.
After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen.
Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.
Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic). Rest and fluid intake for adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory drugs should only be taken under a doctor's supervision because of the possibility of worsening hemorrhagic complications. Acetaminophen (Tylenol) and codeine may be given for severe headache and for the joint and muscle pain (myalgia).
Typical dengue is fatal in less than 1% of cases. The acute phase of the illness with fever and myalgias lasts about one to two weeks. Convalescence is accompanied by a feeling of weakness (asthenia), and full recovery often takes several weeks.
Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock). DHF is also called Philippine, Thai, or Southeast Asian hemorrhagic fever and dengue shock syndrome.
DHF starts abruptly with high continuous fever and headache. There are respiratory and intestinal symptoms with sore throat, cough, nausea, vomiting, and abdominal pain. Shock occurs two to six days after the start of symptoms with sudden collapse, cool, clammy extremities (the trunk is often warm), weak pulse, and blueness around the mouth (circumoral cyanosis).
In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present.
Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (bluish) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.
The mortality (death) rate with DHF is significant. It ranges from 6%-30%. Most deaths occur in children. Infants under a year of age are especially at risk of dying from DHF.
The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious.
The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective.
To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.
There is currently no vaccine available for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective. Early results of clinical trials show that a vaccine may be available by 2012.
Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes.
Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever.
Dengue is prevalent throughout the tropics and subtropics. Outbreaks have occurred recently in the Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America.
Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue fever, the treatment is purely concerned with relief of the symptoms (symptomatic).
The acute phase of the illness with fever and myalgias lasts about one to two weeks.
Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).
The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue.
There is currently no vaccine available for dengue fever.

[ishaquemijee]

Treating tropical disease yellow fever:
.
What is yellow fever? Yellow fever is a tropical disease that is spread to humans by infected mosquitoes.
What is the infectious agent that causes yellow fever?
Yellow fever is caused by the yellow fever virus.
Where is yellow fever found?
Yellow fever is found only in parts of South America and Africa. There are two kinds of yellow fever, spread by two different cycles of infection.
Jungle yellow fever is mainly a disease of monkeys. It is spread from infected mosquitoes to monkeys in the tropical rain forest. People get jungle yellow fever when they put themselves in the middle of this natural cycle and are bitten by mosquitoes that have been infected by monkeys. Jungle yellow fever is rare and occurs mainly in persons who work in tropical rain forests.
Urban yellow fever is a disease of humans. It is spread by mosquitoes that have been infected by other people. Aedes aegypti is the type of mosquito that usually carries yellow fever from human to human. These mosquitoes have adapted to living among humans in cities, towns, and villages. They breed in discarded tires, flower pots, oil drums, and water storage containers close to human dwellings. Urban yellow fever is the cause of most yellow fever outbreaks and epidemics.
 How do people get yellow fever?
People get yellow fever from the bite of an infected female mosquito. The mosquito injects the yellow fever virus into the bite.
What are the signs and symptoms of yellow fever?
Many yellow fever infections are mild, but the disease can cause severe, life-threatening illness. Symptoms of severe infection are high fever, chills, headache, muscle aches, vomiting, and backache. After a brief recovery period, the infection can lead to shock, bleeding, and kidney and liver failure. Liver failure causes jaundice (yellowing of the skin and the whites of the eyes), which gives yellow fever its name.
 How soon after exposure do symptoms appear?
Symptoms start 3 to 6 days after being bitten by an infected mosquito.
How is yellow fever diagnosed?
Yellow fever is diagnosed by a blood test.
 Who is at risk for yellow fever?
People are at risk if they travel to an area where there is yellow fever in humans or monkeys and there are mosquitoes to spread the virus.
What complications can result from yellow fever?
Severe yellow fever infections can be fatal.
What is the treatment for yellow fever?
There is no specific treatment for yellow fever. Persons with yellow fever should rest and drink plenty of fluids. They should be kept away from mosquitoes for the protection of others. Most people get better after a long recovery period.
How common is yellow fever?
Yellow fever is common in West and Central Africa and in parts of South America. Periodic epidemics in Africa lead to hundreds of thousands of cases. Yellow fever is a very rare cause of illness in U.S. travelers.
Is yellow fever an emerging or re-emerging infectious disease?
Yes. There has been a dramatic re-emergence of yellow fever in Africa and South America since the 1980s.
How can yellow fever be prevented?
Yellow fever can be prevented by vaccination. Travelers should also take precautions against mosquito bites when in areas with yellow fever transmission.
If necessary, get vaccinated for yellow fever before travel.
Travelers should get vaccinated for yellow fever before visiting areas where yellow fever is found. In the United States, the vaccine is given only at designated yellow fever vaccination centers.
International regulations require proof of yellow fever vaccination for travel to and from certain countries. People who get vaccinated should be given an International Certificate of Vaccination.
Avoid mosquito bites when traveling in tropical areas.
Mosquitoes that spread yellow fever usually bite during the day. Travelers should take steps to reduce contact with mosquitoes when outdoors and inside.
When outside:
Wear long-sleeved clothing and long pants. For extra protection, treat clothing with the insecticide permethrin.
Use insect repellent on exposed skin. The most effective repellents contain 20% to 35% DEET (N,N-diethylmethyltoluamide). Follow application instructions carefully when using these products.
When inside:
Stay in well-screened areas as much as possible.
Spray living and sleeping areas with insecticide.
Use a bednet when sleeping in a room that is not screened or air conditioned. For extra protection, treat the bednet with the insecticide permethrin.

[ishaquemijee]

Viral fever:
.
Viral fever refers to a broad spectrum of conditions where viral infections are associated with elevations of body temperature. The term encompasses a wide variety of viral infections, some of which can be clearly identified by their symptoms and signs. These viral infections may show generalized symptoms, but may target specific organs.
Headaches, body aches and a skin rash characterize most of these viral fevers. They may affect any age group, and are seen world-wide. They require only symptomatic treatment. Some are highly contagious. Most of them are not dangerous and self-limited, but some can progress rapidly leading to death.
Cause and Pathogenesis
Most viral infections are spread by inhalation of aerosolised particles, by intake of contaminated water or food, or by direct contact. Infection then spreads locally and thereafter into the blood stream or lymph channels. Some of the viral infections can be transmitted sexually or by direct inoculation into the blood stream.
The duration of the primary infection may vary from days to several weeks. Manifestation of the disease clinically is usually a consequence of the virus multiplying at a specific site. Even though the fever comes down, in some infections the virus continues to multiply and cause persistent infection.
Symptoms and Signs
Once the virus enters the body, there is an incubation period when the virus multiplies to a level high enough to cause infection. This is followed by a prodromal phase of fatigue, malaise and body and muscle aches that may lead to the onset of fever. The fever may be low grade or high grade and remittent. Inflammation of the pharynx, a running nose, nasal congestion, headache, redness of the eyes, cough, muscle and joint pains and a skin rash could be present.
The fatigue and body pain could be disproportionate to the level of fever, and lymph glands may swell up. The illness is usually self-limited but the fatigue and cough may persist for a few weeks. Sometimes pneumonia, vomiting and diarrhea, jaundice or arthritis (joint swelling) may complicate the initial viral fever. Some viral fevers are spread by insects, for example, arbovirus, can cause a bleeding tendency, which results in bleeding from the skin and several other internal organs and can be fatal.
Investigations and Diagnosis
The diagnosis and management of viral fevers is based more on the clinical presentation than by laboratory investigations. Since these infections are commonly self-limited, investigations are unnecessary. The diagnosis is made by the typical history of fever with severe muscle and joint pains. Skin rash and lymph gland swellings have to be specifically looked for.
Laboratory investigations are undertaken to rule out other bacterial infections rather than to confirm viral fever. Blood tests will not show any increase in the white blood cells, which typically occurs with bacterial infections. The numbers of lymphocytes may be increased. The Erythrocyte Sedimentation Rate (ESR) is not elevated. Confirmation is by culture of virus from the relevant specimens such as nasal swabs, and skin rash or by increase in antibody levels in serial blood samples.
Treatment and Prognosis
Treatment of viral fever is purely symptomatic with antipyretic and analgesic drugs. Bed rest and adequate fluid intake is advised. Nasal decongestants may be beneficial. Specific antiviral therapy is not routinely recommended. Steroids are not advised as it may lead to bacterial super-infection. Only in cases of super-infection do antibiotics need to be prescribed. It is important that antibiotics are NOT routinely used for prophylaxis.
Complications of viral infections like pneumonia (viral or super-infection by bacteria) need to be addressed specifically by clearance of respiratory secretions and utilizing ventilator assistance if hypoxia is severe. Symptoms of gastroenteritis should be managed with anti-motility agents. Most viral fevers recover completely in a week although fatigue may persist for a few weeks.
Prevention
Viral fevers are difficult to prevent. They occur as epidemics of infection depending on their mode of spread. Vaccines have been tried targeting the respiratory and gastrointestinal viruses with little success due to several sub-groups of viruses with different forms of antigenicity, all of which cannot be covered with a single vaccine. Fortunately since most infections are mild and self-limited, we can be assured of a full recovery.

[ishaquemijee]

Malaria vaccine hope after blood entry route discovered:

Malaria is transmitted by mosquitoes. The route all strains of the most deadly malaria parasite use to enter red blood cells has been identified by researchers at the Sanger Institute in Cambridge.
The scientists involved said the finding offered "great hope" for the development of a vaccine, which had the potential to be hugely effective. Other experts said they were surprised and impressed. Malaria affects 300 million people each year. One million die, mostly children in sub-Saharan Africa.

There are many malaria parasites. Plasmodium falciparum is the most deadly and researchers at the Sanger Institute acknowledge it as a "very complex and cunning foe".
It is exceptionally good at evading and bamboozling the immune system. Within five minutes of being bitten by a malaria-carrying mosquito, the parasite is already hiding inside the liver.
It then emerges from the liver at a different stage in its life cycle and infects red blood cells, where it starts reproducing.

Difficulty:
The human immune system struggles to build up resistance to malaria and researchers have struggled in the laboratory.

There is still no approved vaccine against malaria. Large scale trials of the most advanced prototype - RTS,S - showed it halved the risk of getting malaria.

The parasite reproduces in red blood cells (infected cell on the right).
This study, published in Nature, looked at the moment the parasite infected a red blood cell.
They were looking for proteins on the surface of Plasmodium and red blood cells which were necessary for the parasite to identify its target and invade.
Others had been found before, but none were universally used.
 
The team at the Sanger Institute discovered that "basigin", a receptor on the surface on red blood cells, and "PfRh5", a protein on the parasite, were crucial.
In all strains of Plasmodium falciparum tested so far, interrupting the link protected the blood cells from attack.

One of the researchers, Dr Julian Rayner, said: "We were able to completely block invasion using multiple different methods, using antibodies targeting this interaction we could stop all invasion of red blood cells.
"It seems to be essential for invasion."
The plan is to develop a vaccine which will prime the immune system to attack PfRh5 on the parasite
Fellow researcher Dr Gavin Wright said a vaccine would have great potential as the target was so essential.

"As a starting point for developing a vaccine you couldn't hope for better," he said.
Prof Adrian Hill, director of the Jenner Institute at Oxford University, said that after 25 years studying malaria he was "surprised" and "intrigued" by the findings.
He said textbooks and academic research suggested that if you blocked one pathway into the red blood cells, the parasite would choose another.

He added: "It remains to be seen how easy it will be to translate into a vaccine, but [for blood stage vaccines] PfRh5 is now at the top of the list.
"Vaccine candidates will come. If I had to bet, I'd say you'd get some partial efficacy from it."