Internal Medicine

Dengue fever, also known as breakbone fever, is a mosquito-borne disease transmitted to humans through an infected mosquito's bite. In the tropics and sub-tropics, dengue is a leading cause of illness. About 100-400 million dengue cases are reported globally every year. Dengue Fever Causes Dengue fever is a viral infection that spreads to humans through the bite of a female mosquito, Aedes aegypti. Dengue virus belongs to the flaviviridae family, and there are four closely related viruses that cause dengue ( Dengue virus 1,2,3,4). For this reason, you can be infected with dengue as many as four times in your lifetime. You may be immune to a specific dengue virus but not the other three virus types. The mosquito picks up the virus while biting a person with dengue. Later, when this infected mosquito bites other individuals, the dengue virus enters their bloodstream, resulting in infection. Dengue Fever Symptoms The onset of symptoms is usually observed after 4-10 days of infection. However, 80% of dengue cases are asymptomatic or show mild symptoms. Dengue symptoms will depend on the severity of the condition. Mild Symptoms of Dengue Fever Dengue fever begins with a sudden fever of around 104°F (40°C) with a few other symptoms that include: Headache Red eyes Nausea and vomiting Rashes on the skin Pain behind the eyes Sore throat Aching muscles and joints Most people recover within 2-7 days after the onset of symptoms. However, sometimes, symptoms worsen and become life-threatening. Severe Symptoms of Dengue Fever Although less common, some individuals develop severe dengue, which accounts for about 5% of dengue cases globally. Symptoms include: Fatigue Severe stomach pain Difficulty in breathing Rapid fluctuation in body temperatures Nose or gum bleeding Blood in stool, urine, or vomiting Restlessness or irritability Dengue fever becomes severe when the blood clotting cells (platelets) drop in the bloodstream. This can lead to internal bleeding, plasma leakage, or organ failure. Without proper medical attention, severe dengue has a higher risk of death. Dengue Fever Diagnosis and Tests The symptoms of dengue are much similar to other infections, such as influenza and malaria. So, for a proper diagnosis of dengue fever, the doctor's evaluation includes the following: Examining the symptoms Checking travel and medical history Performing blood test Doctors perform the following tests to confirm whether the person is suffering from dengue fever: Complete blood count (CBC) NS I Antigen Reverse transcriptase - Polymerase chain reaction (RT-PCR) test Antibody test IgG & IgM Liver function test Dengue Fever Treatment There is no specific treatment for dengue fever. Rather, managing the symptoms is the only solution. For patients with mild symptoms, treatment includes: Liberal oral fluids to stay well hydrated Resting Using antipyretic paracetamol to bring down fever & reduce body pains Using non-steroidal, anti-inflammatory drugs such as ibuprofen and aspirin can increase the risk of internal bleeding, so it is best to avoid these drugs. In some severe cases, hospitalization is necessary, where patients are treated depending upon the severity of symptoms: IV fluid administration Platelet transfusion in cases with severe thrombocytopenia (less than 10000/cmm) Blood transfusion Some clinical case reports have been reported to show that papaya leaf extract is an effective treatment for dengue fever, but there are no designed randomised controlled studies to prove it. Timely treatment of severe dengue cases can reduce the risk of death to 1%. Dengue Fever Risks Factors The risk of contracting dengue fever is high due to a few reasons that include: History of dengue fever: Prior infection may increase your symptoms, if you get infected again. Living in or travelling to tropical regions: Travelling to or living around tropical and sub-tropical areas increases the risk of contracting dengue fever. This is more common in areas of northeast Asia, the Pacific islands, Australia, Latin America, and Africa. Dengue Fever Complications In persons suffering from dengue fever, blood pressure drops drastically, leading to shock. Sometimes, severe dengue can cause plasma leakage, internal bleeding, organ failure, and even death. Pregnant women suffering from dengue fever can transmit the infection to the newborn during childbirth. Moreover, babies born to pregnant women with dengue fever have higher chances of low birth weight or pre-term birth. Dengue Fever Prevention The main approach to prevent or control the transmission of dengue fever is to tackle the mosquito vectors in the following ways: Wearing clothes covering whole body Using mosquito repellents Using mosquito nets Avoiding going out in the early morning and evening Removing stagnant water surrounding the home Trying to avoid camping near still water Checking if drains and plant pots are not collecting water Mosquitoes that bite the infected person can spread the infection to other people around them. So, be vigilant and take preventive measures to avoid transmission. Vaccination for Dengue Fever In USA, dengue vaccine known as Dengvaxia is approved by the Food and Drug Administration (FDA) for individuals aged between 9 and 16 with a history of previous dengue infection. However, for people with no history of dengue, administering the vaccine appears to increase the symptoms of dengue fever, which may lead to hospitalization. Therefore no vaccine is as yet available to prevent individuals from contracting dengue. Related Blogs Understanding Dengue: Symptoms, Causes, & Treatment Understanding Chikungunya: Symptoms, Causes, and Prevention & Treatment

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Typhoid is a contagious bacterial infection that can cause fever, headache, abdominal pains, and loss of appetite. Typhoid spreads throughout the body and can affect multiple organs. Most people recover quickly with prompt treatment. However, untreated typhoid can be fatal or cause life-threatening complications. Associated Anatomy Multiple organs Alternate Name of Typhoid Typhoid Fever, Enteric Fever Typhoid Causes The bacteria Salmonella typhi (or S. typhi) causes typhoid. While S. typhi is not the bacterium that causes other food poisoning or foodborne illnesses like salmonella, they are related. typhi is transmitted through the oral-faecal route, which spreads through contaminated food or water. Furthermore, the transmission also happens due to direct contact with a patient (or person) who already has a typhoid infection. Typhoid Symptoms Once a person gets infected with typhoid-causing bacteria, the signs of infection will develop only after a week or two. A few prominent signs or symptoms of typhoid are: Persistent high fever or temperature Headache Fatigue (or extreme tiredness) Weakness Confusion Cough Bloating Weight-loss Stomach pain Constipation Poor appetite Rashes Dry cough Diarrhoea Typhoid Stages Typhoid fever has four distinct stages: Stage 1: In the first stage, the patient will have preliminary symptoms of infection, such as headache, dry cough, and mild fever (only in a few cases). Stage 2: This stage is marked by weight loss and a rise in fever. The stomach also becomes bloated. The patient will feel lethargic and have fever dreams or hallucinations. Stage 3: In this stage, holes form in the intestine, leading to an abdominal haemorrhage. This severe stage can also cause encephalitis (inflammation in the brain). Due to acute dehydration, a person may experience a higher intensity of delirium. Furthermore, the person becomes so weak that they cannot stand or walk. Stage 4: This stage involves extremely high fever with several health complications like severe infections, pneumonia, kidney failure, and inflammation of the pancreas. Typhoid Diagnosis To test for typhoid, you must get your stool, urine, and blood samples cultured. A bone marrow culture, which is a sensitive and complex test for Salmonella typhi, can also be done to diagnose typhoid fever. Other tests can also be carried out to confirm typhoid infection, such as an antibodies test or a test to determine the presence of typhoid DNA in your blood. If your typhoid is confirmed, your family members will also need to take the test to check if they have been infected. Typhoid Treatment Antibiotic treatment is effective in the treatment of typhoid. A few common antibiotics that can be prescribed for typhoid include: Ciprofloxacin Commonly used to treat typhoid, doctors often prescribe Ciprofloxacin for adults who are not pregnant. Similar to Ciprofloxacin, Ofloxacin drugs can be prescribed. Azithromycin (Zithromax) If Ciprofloxacin doesn’t work due to bacteria resistance, Azithromycin (Zithromax) can be used. Ceftriaxone Ceftriaxone is used to deal with complicated infections. This injectable antibiotic is for those who cannot consume Ciprofloxacin, such as children. Other typhoid treatments include Drinking fluids Fluids prevent dehydration due to diarrhoea or prolonged fever. Furthermore, if people get severely dehydrated, they may receive fluids intravenously (through a vein). Surgery If your intestines get torn, you need a surgical process to repair them. Risk Factors of Typhoid You are at increased risk of typhoid disease if: You travel or work in typhoid-prone areas or countries, such as India, South America, Southeast Asia, and Africa. Your work requires handling S. typhi bacteria, or you are a clinical microbiologist working around the same bacteria. You come in contact with an infected person. You consume water or food that is affected by Salmonella typhi. Typhoid Preventions Primary Prevention Before travelling to typhoid-prone regions, consider getting vaccinated. The options include: Oral:You can take a live attenuated vaccine for typhoid that consists of four tablets. You may consume one tablet every second day. The medication must be planned accordingly so that the last pill is taken a week before travel. Injection: A vaccine shot for typhoid can be administered 14-15 days (two weeks) before travel. Secondary Prevention for Typhoid Several secondary precautionary measures must be exercised to avoid typhoid: Watch what you drink Avoid drinking tap water or directly from a well. Do not use popsicles or ice cubes if they aren’t made from bottled water. Buy carbonated bottled drinks whenever possible. If you are using non-bottled water, ensure that it is boiled. While consuming milk, tea, or coffee, ensure the milk is pasteurised. Watch what you eat Refrain from eating raw produce (fruits, vegetables). Even if you consume it, ensure you wash your hands and peel them yourself. Avoid street food. Don’t eat undercooked fish or meat. Consume only pasteurised dairy products. Avoid fresh salads and condiments. Practice good hygiene Keep your hands clean. Wash them often or use hand sanitisers, especially before touching food items and after using the washroom. Refrain from touching your face regularly with unwashed hands. Avoid meeting with people who are infected or sick. Epidemiology of Typhoid Typhoid is prevalent in India, South America, Southeast Asia, and Africa. It affects about 2.7 crore people each year. While children remain at higher risk of getting typhoid, they tend to have milder symptoms than adults. Expected Prognosis of Typhoid In several cases, patients experience a relapse of typhoid fever when the symptoms return. This generally happens about a week after the antibiotic treatment has concluded. However, the relapse phase sees milder symptoms, and the illness lasts for a shorter duration than the original illness. An antibiotic treatment works best at this stage. Natural Progression of Typhoid If typhoid is not treated on time and allowed to progress naturally, it can cause life-threatening complications and turn fatal. Pathophysiology of Typhoid The pathogenesis of typhoid is influenced by factors like the patient’s immunity, infectious dose, and infectious dose. Depending on the patient’s immune system, the incubation phase lasts from 3 days to 3 weeks. During the incubation interval, a patient may have minor complaints of abdominal pain or fever. Some might not show any sign. Once the bacterium reaches a critical mass, a patient is infected with active typhoid. Possible Complications of Typhoid If a patient is not treated timely and with the appropriate antibiotics, they may experience complications in the third week of typhoid infection. One common complication is internal bleeding, which occurs in the digestive system. The other is the perforation (splitting) of a few parts of the bowel or digestive system, further infecting nearby tissues. Related Blogs Typhoid Fever: Symptoms and Treatment Understanding Typhoid fever: Everything you need to know Diet For Typhoid: Foods To Eat And Avoid for Fast Recover

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