Dengue

Dengue is from Swahili phrase 'ki denga pepo' that means 'cramp like seizures caused by an evil spirit'. Dengue virus fever is common in most tropical places of the world namely Asia, Africa, Australia and the Pacific. Aedes mosquitoes spread the infection after biting the infected persons. They usually breed in flowerpots, old oil drums, water storage tins that are close to densely populated areas. Mosquitoes that cause dengue bite during the day. Dengue infection occurs at two levels - dengue fever at normal levels and dengue hemorrhagic fever at extreme levels.

Symptoms of dengue fever

Unexpectedly high fever, headache, rashes, muscle and joint pain, and pain behind the eyes (retro-orbital) are the key symptoms of dengue. The joint pain is so severe that dengue is also termed as 'break bone fever'. Loss of appetite and queasiness are other notable symptoms in dengue. Few patients might also suffer from diarrhea and gastritis. The overall sickness period lasts up to 10 days; total recovery from the illness can take about a month's time. Platelet count drops with the onset of fever and improves as the fever reduces. Dengue can be diagnosed after a blood test.

Treating dengue

People infected with dengue are advised to take good rest and drink plenty of fluids. Patients who are unable to take oral fluids are given intravenous fluids to prevent dehydration of the body. Patients have to be isolated from mosquitoes so as to avoid spread of the infection. With severe cases of dengue hemorrhagic fever, blood transfusion might be recommended to compensate the blood loss from the mouth, nose and gums.

Melioidosis

Though Melioidosis has existed for more than 100 years, health officials and policy makers are paying attention only now. In 2015, Melioidosis killed 53% of infected people. This is almost equal to annual global mortality from Measles and greater than deaths from leptospirosis or dengue. Both measles and leptospirosis or dengue are rated as health priorities for many international health organizations. Furthermore, Melioidosis can become a potential agent for biological warfare and biological terrorism. Naturally Melioidosis is gaining priority attention.

What is Melioidosis?

Pathologist Alfred Whitmore and his assistant C.S. Krishnaswami first described Melioidosis in 1911 in Rangoon. Melioidosis is an infectious disease caused by bacteria. It is also known as Whitmore's disease. Melioidosis is caused by the bacteria Burkholderia Pseudomallei. This is a gram-negative bacterium mostly found in water, soil and on plants. Melioidosis affects humans and animals.

How do people get Melioidosis?

The infection is acquired when an individual comes in direct contact with contaminated soil and surface water. The modes of infection are ingestion, inhalation and inoculation (through local cuts and wounds on the skin). The latter appears to be most common. The disease does not spread from one person to another but may occur through contact with blood fluids of the infected person. Neonatal cases have been reported. It suggests either perinatal transmission or transplacental. Laboratory-acquired infections may rarely occur, especially if procedures produce aerosols.

Is Melioidosis region specific ?

Certain factors, environmental and climate support the microbe to thrive well when introduced. Till recently, the disease was considered to be restricted to Southeast Asia and Northern Australia. Philippines is considered to be endemic country of Melioidosis in Southeast Asia.

In United States, Melioidosis is reported to be rare. But Florida, Louisiana and Texas in United States and Okinawa and Kagoshima prefectures in Japan are rated as Melioidosis compatible based on climate and environmental factors. These regions have similar environmental factors like Caribbean islands and Taiwan. The microbe if introduced in these regions can thrive well.

What is the clear trend about Melioidosis ?

• Diabetic people are more susceptible to Melioidosis.
  
  
• No clear-cut gender bias observed so far.
  
  
• AIDS and intravenous drug users are more susceptible.
  
  
• Renal failure increases chances of Melioidosis.

What are the symptoms of Melioidosis ?

Symptoms are site-specific as symptoms vary depending on the site of infection. The infection can form a cavity of pus (abscess). The infection usually starts in the lung or in the skin and then spreads to other parts of the body. As it spreads Melioidosis can affect lungs, kidneys, liver, heart and circulatory system.

The pulmonary form of infection takes place when bacteria in aerosol form enters the respiratory tract. Symptoms of lung infection include shortness of breath, cough, chest pain, high fever, headache or anorexia and abnormal lung sounds.

Localized form of Melioidosis takes place when the bacteria enters the skin through a laceration or abrasion. This can lead to skin wounds with pain and swelling, fever, ulceration or abscess. There can be increased mucus production in the affected areas.

On entering the blood stream, symptoms differ. Associated symptoms include fever, headache, respiratory difficulties, abdominal pain or discomfort, joint pain, muscle tenderness etc. Disseminated infections of Melioidosis include fever, weight loss, stomach or chest pain, muscle or joint pain, headache and seizures.

When are Melioidosis symptoms noticeable ?

The incubation period of the bacterium is not clearly defined. The anticipation established is 1 to 21 days. On the other hand, there is a possibility of remaining asymptomatic from 10 days to many years after contracting the bacterium. But, when the symptoms begin, it can be sudden or gradual.

Being informed about Melioidosis is the key to seeking timely medical attention. Melioidosis can be fatal if not treated promptly. If you suspect Melioidosis infection, seek medical attention immediately.

How is Melioidosis diagnosed ?

Misdiagnosis can result in deaths. Distinguishing Melioidosis from pulmonary TB is challenging. The clinical manifestations are similar. Early diagnosis and effective treatment prevents casualties. Expert micro-biologists supervise Melioidosis diagnosis. Healthcare professionals recommend blood culture, skin-lesion sample, urine or sputum examination aided by microscopic evaluation in a laboratory.

Chances of infection are high if the blood test shows an elevated white blood cell count. In cases involving lung infection, chest x-ray is required to study presence of cavitating lesions resembling tuberculosis.

How is Melioidosis treated ?

Melioidosis is a treatable disease. Hospital admission is required only in severe cases. Treatment is entirely dependent on the location of Melioidosis. Treatment involves administering antibiotic therapy that includes intravenous microbial therapy for 10-14 days followed by oral antimicrobial therapy for 3-6 months. If required, surgical drainage of pus is beneficial.

Are there ways to prevent Melioidosis ?

Prevention through vaccination is not available currently. Preventive measures reduce risk of Melioidosis especially in areas where the risk of infection is high.

• Individuals with open wounds, diabetes and renal disease should avoid contact with soil and contaminated water.
  
• Workers in agricultural lands especially in endemic areas should wear boots to prevent infection through foot and legs.
  
• Health care workers should adhere to precautionary measures (protective rubber gloves, protective foot wear or waders) when attending to infected persons.

Fever

Fever is an elevation of body temperature and defined as a core temperature higher than 38 C (100.4 F) in infants and higher than 38.3 C (100.9 F) in adults. Normal body temperature range is between 36 and 37.8 degree C (96.8 and 100.4 degree F). If a person has an oral temperature above 98.6 F (37 C), it is considered as fever. In some cases, there is a variation of up to 1 F (0.6 C). Fever is a symptom and not a disease. Fever, by itself is an indicator that the body is building an immune response to an infection. Most viruses and bacteria cannot survive at higher temperatures and fever is the body's fighting mechanism. Any body temperature up to 100 F is considered low grade fever. It is usually noticed along with sore throat, cough, joint pain, chills and nausea. Most fevers of this nature are self-limiting; and medication is given to provide comfort to the patient. Most of the time fever is only a symptom which can be treated symptomatically with antipyretics. Acetaminophen and ibuprofen are prescribed to control fever.

Fever results from the production of prostaglandin E2 (PGE2) in the hypothalamus due to endogenous or exogenous pyrogens. The cause is identified by physical examination and a thorough history - the onset of fever, level, duration, pattern if any and other symptoms.

Normally a person can sustain a body temperature of up to 104 degree F (40 degree C) with relative safety. But when the fever temperature rises above 104 ° it may cause cellular damage to brain, blood and internal organs. To prevent damage from high fever cooling treatments may be of help. Cold compresses, cold packs or sponge baths or ice bags /chemical cold packs are used to bring down the high fever.

Do not swathe a patient with fever in blankets but keep him comfortable. Bath in tepid water can help, but never ice cold water. The patient must be well hydrated. Some immunosuppressed or elderly patients might not exhibit a big rise in temperature in spite of a serious infection. Most often , CBC (complete blood count) is done to look for raised WBC count. Other useful indicators are urine test, gram stains and chest x-ray. If fever is also accompanied by abdominal pain, CT scan of the abdomen is suggested to look for possible appendicitis, diverticulitis and Cholecystitis.

The degree of fever elevation is not an indicator of the severity of the illness. Fever can be due to dengue, chikungunya, chicken pox, measles, malaria or other infections. Metabolic disturbances can cause body temperature to be elevated. In rare cases, fever is due to heart disease, serious illness, AIDS or cancer. Toxic shock, meningitis and peritonitis are other serious causes for high fever.

In some cases, the cause for fever is not easy to diagnose. Fever due to upper respiratory tract infection usually lasts for about 3-5 days.

Do not confuse fever with Hyperthermia, where the body temperature rises due to external sources. Here fever is also accompanied by palpitations, fainting, shivering, aches and confusion or hallucinations. When fever rises, the respiratory rate and heart rate rise. When children below 1 year suffer fever, they should be examined by a healthcare professional. Never use aspirin in children during a viral infection.