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Tropical infections

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The document summarizes several tropical infections, including dengue, malaria, typhoid, Japanese encephalitis, and scrub typhus. It describes the causative organisms, clinical features, diagnosis, and treatment for each. For dengue, it highlights thrombocytopenia and potential bleeding as key symptoms. Treatment involves fluid management and platelet transfusion if needed. For malaria, it notes fever paroxysms and recommends artesunate as the drug of choice. Typhoid may cause abdominal symptoms or bleeding in later stages, and is diagnosed through tests like Typhidot or blood culture.

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TROPICAL INFECTIONS PRESENTED BY: Dr. KAPIL RASTOGI
1- DENGUE 2- MALARIA 3- TYPHOID 4- SCRUB TYPHUS 5- LEPTOSPIROSIS etc.
Fever with thrombocytopenia Antipyretics for control of fever IV fluids Avoid aspirin/anticoagulants Watch for bleeding, dyspnoea, shock Platelet transfusion if the platelet count<20,000 or clinical bleeding No role of steroids Specific therapy once the diagnosis is established
Fever with jaundice Antipyretics for control of fever Injection ceftriaxone 2 g IV BD Tablet doxycycline 100 mg BD IV fluids Watch for urine output, seizures, encephalopathy, bleeding FFP/cryoprecipitate for bleeding Specific therapy once the diagnosis is established
Fever with renal failure Antipyretics for control of fever Injection ceftriaxone 2 g IV BD* Tablet doxycycline 100 mg BD* IV fluids according to CVP Watch for encephalopathy, bleeding, seizures, ARDS Renal replacement therapy (intermittent HD/CRRT) Specific therapy once the diagnosis is established
Fever with encephalopathy Antipyretics for control of fever Injection ceftriaxone 2 g IV BD* IV acyclovir 10 mg/kg in adults (up to 20 mg/kg in children) intravenously every 8 h IV fluids IV mannitol for raised ICP Watch for seizures Specific therapy once the diagnosis is established
Fever with Respiratory distress Antipyretics for control of fever IV fluids Oxygen by Venturi mask Injection ceftriaxone 2 g IV BD* Injection azithromycin 500 mg IV OD* Tablet oseltamivir 150 mg BD, if H1N1 is a possibility Watch for impending respiratory failure, shock, renal failure, alveolar hemorrhage Specific therapy once diagnosis is established
SPECIFIC INFECTIONS DENGUE:Causative organism: Dengue virus (Flavivirus) serotypes 1-4. Vector: Aedes mosquitoes Dengue is endemic throughout India with a recent resurgence of epidemics over the past two decades.
CLINICAL FEATURES: : Incubation period 4-10 days: Dengue fever: Headache, retro-orbital pain, myalgia, arthralgia, rash Dengue Hemorrhagic fever: Thrombocytopenia (<100,000), skin, mucosal and gastrointestinal bleeds, third spacing, rise in hematocrit Dengue shock syndrome: Weak pulse, cold clammy extremities, pulse pressure < 20 mmHg, hypotension Expanded dengue syndrome: Encephalitis, myocarditis, hepatitis, renal failure, ARDS, hemophagocytosis.
Diagnosis: Nonstructural protein 1 antigen detection Sensitivity 76-93%, Speci鍖city >98%. IgM, IgG serology (IgG titer > 1:1280 is 90% sensitive and 98% speci鍖c).
Treatment: Isotonic fluid infusion just sufficient to maintain effective circulation during the period of plasma leakage; guided by serial hematocrit Blood transfusion is done only with overt bleeding/ rapid fall in hematocrit.
MALARIA Causative organism: Plasmodium protozoa (P. falciparum, Plasmodium vivax, Plasmodium malariae [Odisha]). Vector: Anopheles mosquito. Plasmodium species are unevenly distributed across India
Clinical features: Paroxysm of fever, shaking chills and sweats occur every 48 or 72 h, depending on species. Hepatosplenomegaly may be present.
Manifestations of severe malaria: Cerebral malaria (sometimes with coma) Severe anemia Hypoglycemia Metabolic acidosis Acute renal failure (serum creatinine > 3 mg/dl) ARDS Shock DIC Hemoglobinuria Hyperparasitemia (>5%)
Diagnosis: Microscopy: Thick smears parasite detection; Thin smears species identi鍖cation Rapid diagnostic tests (RDTs) histidine rich protein, lactate dehydrogenase antigen based Malaria ruled out if two negative RDTs.
TREATMENT Drug of choice: Artesunate Dose: 2.4 mg/kg i.v. bolus at admission, 12 h and 24 h; followed by once a day for 7 days + Doxycycline 100 mg p.o. 12 hourly. Alternative: Quinine 20 mg/kg loading dose, followed by 10 mg/kg i.v. infusion 8 hourly + Doxycycline 100 mg p.o. 12 hourly.
ENTERIC FEVER Causative organism: Salmonella typhi, serovar paratyphi A, B or C Transmission: focally contaminated food and water Most prevalent in urban areas, with high incidence in children 15 years of age and younger.[30]
Clinical features: Incubation period 1-14 days. Manifestations: 1week - fever, headache, relative bradycardia 2nd week - Abdominal pain, diarrhea, constipation, hepatoslenomegaly, encephalopathy 3rd week - Intestinal bleeding, perforation, MODS
Diagnosis: Typhidot (RDT) Sensitivity 95-97%, Speci鍖 city > 89%, Widal test-non-speci鍖c Blood culture Gold standard, positive in 40-80% of patients Bone marrow cultures sensitivity 80-95%; may remain positive even after 5 days of pre-treatment
Treatment: First line: Ceftriaxone i.v. 50-75 mg/kg/day for 10-14 days to cover MDR S. typhi. Azithromycin and Cipro鍖oxacin are alternatives Consider dexamethasone 3 mg/kg followed by 1 mg/kg 6 hourly for 48 h in selected cases with encephalopathy, hypotension or DIC
JAPANESE ENCEPHALITIS Causative organism: Japanese encephalitis virus Vector: Culex tritaeniorhynchus Clinical features: Incubation period averages 6-8 days, with a range of 4-15 days. Prodromal period-fever, headache, vomiting and myalgia. Neurological features
Diagnosis: IgM capture ELISA Serum: sensitivity 85-93%, Specifcity 96-98%, CSF: Sensitivity 65-80%, Speci鍖city 89-100%. Treatment: Supportive-Airway management, seizure control and management of raised intracranial pressure.
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Tropical infections

  • 2. 1- DENGUE 2- MALARIA 3- TYPHOID 4- SCRUB TYPHUS 5- LEPTOSPIROSIS etc.
  • 3. Fever with thrombocytopenia Antipyretics for control of fever IV fluids Avoid aspirin/anticoagulants Watch for bleeding, dyspnoea, shock Platelet transfusion if the platelet count<20,000 or clinical bleeding No role of steroids Specific therapy once the diagnosis is established
  • 4. Fever with jaundice Antipyretics for control of fever Injection ceftriaxone 2 g IV BD Tablet doxycycline 100 mg BD IV fluids Watch for urine output, seizures, encephalopathy, bleeding FFP/cryoprecipitate for bleeding Specific therapy once the diagnosis is established
  • 5. Fever with renal failure Antipyretics for control of fever Injection ceftriaxone 2 g IV BD* Tablet doxycycline 100 mg BD* IV fluids according to CVP Watch for encephalopathy, bleeding, seizures, ARDS Renal replacement therapy (intermittent HD/CRRT) Specific therapy once the diagnosis is established
  • 6. Fever with encephalopathy Antipyretics for control of fever Injection ceftriaxone 2 g IV BD* IV acyclovir 10 mg/kg in adults (up to 20 mg/kg in children) intravenously every 8 h IV fluids IV mannitol for raised ICP Watch for seizures Specific therapy once the diagnosis is established
  • 7. Fever with Respiratory distress Antipyretics for control of fever IV fluids Oxygen by Venturi mask Injection ceftriaxone 2 g IV BD* Injection azithromycin 500 mg IV OD* Tablet oseltamivir 150 mg BD, if H1N1 is a possibility Watch for impending respiratory failure, shock, renal failure, alveolar hemorrhage Specific therapy once diagnosis is established
  • 8. SPECIFIC INFECTIONS DENGUE:Causative organism: Dengue virus (Flavivirus) serotypes 1-4. Vector: Aedes mosquitoes Dengue is endemic throughout India with a recent resurgence of epidemics over the past two decades.
  • 9. CLINICAL FEATURES: : Incubation period 4-10 days: Dengue fever: Headache, retro-orbital pain, myalgia, arthralgia, rash Dengue Hemorrhagic fever: Thrombocytopenia (<100,000), skin, mucosal and gastrointestinal bleeds, third spacing, rise in hematocrit Dengue shock syndrome: Weak pulse, cold clammy extremities, pulse pressure < 20 mmHg, hypotension Expanded dengue syndrome: Encephalitis, myocarditis, hepatitis, renal failure, ARDS, hemophagocytosis.
  • 10. Diagnosis: Nonstructural protein 1 antigen detection Sensitivity 76-93%, Speci鍖city >98%. IgM, IgG serology (IgG titer > 1:1280 is 90% sensitive and 98% speci鍖c).
  • 11. Treatment: Isotonic fluid infusion just sufficient to maintain effective circulation during the period of plasma leakage; guided by serial hematocrit Blood transfusion is done only with overt bleeding/ rapid fall in hematocrit.
  • 12. MALARIA Causative organism: Plasmodium protozoa (P. falciparum, Plasmodium vivax, Plasmodium malariae [Odisha]). Vector: Anopheles mosquito. Plasmodium species are unevenly distributed across India
  • 13. Clinical features: Paroxysm of fever, shaking chills and sweats occur every 48 or 72 h, depending on species. Hepatosplenomegaly may be present.
  • 14. Manifestations of severe malaria: Cerebral malaria (sometimes with coma) Severe anemia Hypoglycemia Metabolic acidosis Acute renal failure (serum creatinine > 3 mg/dl) ARDS Shock DIC Hemoglobinuria Hyperparasitemia (>5%)
  • 15. Diagnosis: Microscopy: Thick smears parasite detection; Thin smears species identi鍖cation Rapid diagnostic tests (RDTs) histidine rich protein, lactate dehydrogenase antigen based Malaria ruled out if two negative RDTs.
  • 16. TREATMENT Drug of choice: Artesunate Dose: 2.4 mg/kg i.v. bolus at admission, 12 h and 24 h; followed by once a day for 7 days + Doxycycline 100 mg p.o. 12 hourly. Alternative: Quinine 20 mg/kg loading dose, followed by 10 mg/kg i.v. infusion 8 hourly + Doxycycline 100 mg p.o. 12 hourly.
  • 17. ENTERIC FEVER Causative organism: Salmonella typhi, serovar paratyphi A, B or C Transmission: focally contaminated food and water Most prevalent in urban areas, with high incidence in children 15 years of age and younger.[30]
  • 18. Clinical features: Incubation period 1-14 days. Manifestations: 1week - fever, headache, relative bradycardia 2nd week - Abdominal pain, diarrhea, constipation, hepatoslenomegaly, encephalopathy 3rd week - Intestinal bleeding, perforation, MODS
  • 19. Diagnosis: Typhidot (RDT) Sensitivity 95-97%, Speci鍖 city > 89%, Widal test-non-speci鍖c Blood culture Gold standard, positive in 40-80% of patients Bone marrow cultures sensitivity 80-95%; may remain positive even after 5 days of pre-treatment
  • 20. Treatment: First line: Ceftriaxone i.v. 50-75 mg/kg/day for 10-14 days to cover MDR S. typhi. Azithromycin and Cipro鍖oxacin are alternatives Consider dexamethasone 3 mg/kg followed by 1 mg/kg 6 hourly for 48 h in selected cases with encephalopathy, hypotension or DIC
  • 21. JAPANESE ENCEPHALITIS Causative organism: Japanese encephalitis virus Vector: Culex tritaeniorhynchus Clinical features: Incubation period averages 6-8 days, with a range of 4-15 days. Prodromal period-fever, headache, vomiting and myalgia. Neurological features
  • 22. Diagnosis: IgM capture ELISA Serum: sensitivity 85-93%, Specifcity 96-98%, CSF: Sensitivity 65-80%, Speci鍖city 89-100%. Treatment: Supportive-Airway management, seizure control and management of raised intracranial pressure.