Report in Microbio

Pulmonary Tuberculosis Pulmonary Dissemination Pulmonary Meningitis Potts Disease Leprosy SARS H1N1 Dengue Fever

Charmain Beatriz A. Atos

Pulmonary Tuberculosis

Etiology
Mycobacterium tuberculosis caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. M. tuberculosis requires oxygen to grow. It does not retain any bacteriological stain due to high lipid content in its wall, and thus is neither Gram positive nor Gram negative; hence Ziehl-Neelsen staining, or acid-fast staining, is used. While mycobacteria do not seem to fit the Gram-positive category from an empirical standpoint (i.e., they do not retain the crystal violet stain), they are classified as acidfast Gram-positive bacteria due to their lack of an outer cell membrane.[ M. tuberculosis divides every 1520 hours, which is extremely slow compared to other bacteria Gene Causing Pulmonary Tuberculosis

Mode of transmission
it is transmitted by inhalation of the M. tuberculosis organism dispersed as droplet nuclei from a person with pulmonary TB whose sputum is positive. The bacteria may float in the air for several hours. Other modes of transmission is by direct hand or mouth (kissing) contact with infected saliva.

Pathophysiology
Mycobacterium Tuberculosis

May float in the air

Inhalation
Bacteria are picked up by Dendritic Cells M. Tuberculosis multiply every 1520hours
-Cough(usually cough of mucus) -Cough of blood -Excessive sweating, usually at night

Direct hand or mouth contact

TB begins when the bacteria reach the pulmonary alveoli

-Breathing difficulty

-Fatigue -Fever -unintentional weight loss

-chest pain -wheezing

Death

Treatment: -Anti Tb drugs

Cure

Sign And Symptoms

The primary stage of TB usually doesn't cause symptoms. When symptoms of pulmonary TB occur, they may include: Cough (usually cough up mucus) Coughing up blood Excessive sweating, especially at night Fatigue Fever Unintentional weight loss Other symptoms that may occur with this disease: Breathing difficulty Chest pain Wheezing

Diagnostic Test
Chest X-ray: The most common diagnostic test that leads to the suspicion of infection is a chest X-ray. The Mantoux skin test also known as a tuberculin skin test (TST or PPD test): This test helps identify people infected with M. tuberculosis but who have no symptoms. A doctor must read the test. QuantiFERON-TB Gold test: This is a blood test that is an aid in the diagnosis of TB. This test can help detect active and latent tuberculosis. The body responds to the presence of the tuberculosis bacteria. By special techniques, the patient's blood is incubated with proteins from TB bacteria. If the bacteria is in the patient, the immune cells in the blood sample respond to these proteins with the production of a substance called interferongamma (IFN-gamma). This substance is detected by the test. If someone had a prior BCGvaccination (a vaccine against TB given in some countries but not the U.S.) and a positive skin test due to this, the QuantiFERON-TB Gold test will not detect any IFNgamma. Sputum testing: Sputum testing for acid-fast bacilli is the only test that confirms a TB diagnosis. If sputum (the mucus you cough up) is available, or can be induced, a lab test may give a positive result in up to 30% of people with active disease. *sputum or other bodily secretions such as from your stomach or lung fluid can be cultured for growth of mycobacteria to confirm the diagnosis. *It may take one to three weeks to detect growth in a culture, but eight to 12 weeks to be certain of the diagnosis.

Treatment
The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best. The most commonly used drugs include: Isonizid Rifampin Pyrazinamide Ethambutol Other drugs that may be used to treat TB include: Amikacin Ethionamide Moxifloxacin Para-aminosalicylic acid Streptomycin You may need to take many different pills at different times of the day for 1 year or longer. It is very important that you take the pills the way your health care provider instructed. When people do not take their tuberculosis medications as recommended, the infection becomes much more difficult to treat. The TB bacteria may become resistant to treatment, and sometimes, the drugs no longer help treat the infection.

Prevention
If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won't transmit tuberculosis to anyone else. Protect your family and friends If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you're not contagious anymore. Follow these tips to help keep your friends and family from getting sick: Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis. Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn't move. If it's not too cold outdoors, open the windows and use a fan to blow indoor air outside. Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. Wear a mask. Wearing a surgical mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission.

Finish your entire course of medication This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat. Vaccinations In countries where tuberculosis is more common, infants are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn't recommended for general use in the United States because it isn't very effective in adults and it causes a falsepositive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.

Tuberculosis Disseminated

Etiology
Miliary tuberculosis is a form of tuberculous infection in the lung that is the result of erosion of the infection into a pulmonary vein. Once the bacteria reach the left side of the heart and enter the systemic circulation, the result may be to seed organs such as the liver and spleen with said infection. Alternatively, the bacteria may enter the lymph node(s), drain into a systemic vein and eventually reach the right side of the heart. From the right side of the heart, the bacteria may seedor re-seed as the case may bethe lungs, causing the eponymous "miliary" appearance.

Mode of transmission
Respiratory This is the main mode of transmission, Mycobacterium discharge of tuberculosis patients from respiratory droplets containing the TB core, that is, droplets, suspended in the air, who are close contacts around the inhalation, particularly in the 4-micron particle size droplets less than nuclear, more likely to be inhaled , which leads to lung infections. Bacteria were discharged with normal breathing droplets of nuclear fewer, and in coughing, sneezing or talking loudly can emit large amounts of droplets. a cough droplets can be discharged 3500, a sneeze droplets emitted up to one million foreign. So cough, sneezing is an important mode of airborne insatiable. The droplets continue to migrate farther from the source of infection droplets less chance of respirable droplets with TB also smaller, such as the distance of 2 meters or more, the chance of infection was much less. digestive tract when ingested food is TB infection, TB in the gastrointestinal tract such as most of them were killed or acid excreted in large or repeated several times into fresh TB, the TB into the gut wall by digestive tract lesions in lymphoid follicles.

Pathophysiology
Inhalation Pulmonary Dissemination
May float in the air

-When ingested food is TB infected

Direct hand or mouth contact

After initial inhalation of TB bacilli, military tuberculosis may occur as primary Tb or may develop years after the initial infection.

Devt of pulmonary lymphagitis

Hilar lymphadenopathy

-Swollen liver -low grade fever -Swollen lymph nodes cough -Swollen spleen

Sign and symptoms

A patient with miliary tuberculosis will tend to present with non-specific signs such as low grade fever, Cough

enlarged lymph nodes. enlarged liver (40% of cases) enlarged spleen (15%) inflammation of the pancreas (<5%) multiple organ dysfunction with adrenal insufficiency (adrenal glands do not produce enough steroid hormones to regulate organ function). Stool may also be diarrheal in nature and appearance.

Diagnostic test
Tests for TB include: Biopsies and cultures of affected organs or tissues Bronchoscopy for biopsy or culture Chest x-ray CT scan of the affected area Fundoscopy may reveal retinal lesions Lung biopsy Mycobacterial culture of bone marrow or blood Pleural biopsy Sputum cultures Tuberculin skin test This disease may also alter the results of the following tests: Complete blood count (CBC) Peripheral blood smear Blood calcium level

Treatment
The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best. The most commonly used drugs include: Isoniazid Rifampin Pyrazinamide Ethambutol Other drugs that may be used to treat TB include: Amikacin Ethionamide Moxifloxacin Para-aminosalicylic acid Streptomycin

Prevention
If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won't transmit tuberculosis to anyone else. Protect your family and friends If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you're not contagious anymore. Follow these tips to help keep your friends and family from getting sick:

Stay home Ventilate the room. Cover your mouth. Wear a mask. Finish your entire course of medication Vaccinations In countries where tuberculosis is more common, infants are vaccinated with bacillus CalmetteGuerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn't recommended for general use in the United States because it isn't very effective in adults and it causes a false-positive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.

TB Meningitis

Etiology
Mycobacterium tuberculosis Meningococcus Neisseria meningitidis, or meningococcus, is most commonly known as a causative agent of bacterial meningitis. However, this bacterium can also cause pneumonia,

Mode of transmission
TB is transmitted mainly by inhalation of infectious droplets produced by persons with pulmonary or laryngeal tuberculosis during coughing, laughing, shouting or sneezing. Invasion may occur through mucous membranes or damaged skin. It is generally not communicable. Urine is infectious in cases of renal tuberculosis. Bovine tuberculosis results mainly from ingestion of unpasteurized milk and dairy products. Aerosol transmission has been reported among abattoir workers.

Pathophysiology
Mycobacterium tuberculosis Meningococcus

Inahlation
Increase in size of a Rich focus until it ruptures into the subarachnoid space. The location of the expanding tubercle determines the type of CNS involvement. Tubercles rupturing into the subarachnoid space causes meningitis
Bacilli seeds to the meninges or brain parenchyma,resulting the formation of subependymal foci of metastatic caseous lesion, termed Rich foci

Localized infection escalates within the lungs, with dissemination to the regional lymph nodes

-slight headaches often accompanied by fever

(Under 30yo) -Stiff neck seizures -Vomiting sleepiness -Nausea

Death

Treatment: Antibiotics(may admit you during treatment)

Cure

Sign and Symptoms

slight headache often accompanied by a fever
If you are younger, generally under or around the age of 30, you may also experience: Stiff neck Nausea and vomiting Sleepiness and seizures

Diagnostic

Diagnosis of TB meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture. When collecting CSF for suspected TB meningitis, a minimum of 1ml of fluid should be taken (preferably 5 to 10ml) ELISPOT( Enzyme-linked immunosorbent spot ) testing is not useful for the diagnosis of acute TB meningitis and is often false negative, but may paradoxically become positive after treatment has started, which helps to confirm the diagnosis

*More than half of cases of TB meningitis cannot be confirmed microbiologically, and these patients are treated on the basis of clinical suspicion only. The culture of TB from CSF takes a minimum of two weeks, and therefore the majority of patients with TB meningitis are started on treatment before the diagnosis is confirmed. Imaging Imaging studies such as CT or MRI may show features strongly suggestive of TB meningitis, but cannot diagnose it.

Treatment
The treatment of TB meningitis is isoniazid, rifampicin, pyrazinamide and ethambutol for two months, followed by isoniazid and rifampicin alone for a further ten months. Steroids are always used in the first six weeks of treatment (and sometimes for longer). A few patients may require immunomodulatory agents such as thalidomide.
*Treatment must be started as soon as there is a reasonable suspicion of the diagnosis. Treatment must not be delayed while waiting for confirmation of the diagnosis. Hydrocephalus occurs as a complication in about a third of patients with TB meningitis and will require a ventricular shunt. The addition of aspirin may improve mortality, possibly by reducing complications such as infarcts.

Prevention
In areas where tuberculosis is more common, the BCG vaccine may help prevent severe forms of tuberculosis, such as meningitis, in very young children.
Protect your family and friends If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you're not contagious anymore. Follow these tips to help keep your friends and family from getting sick: Stay home Ventilate the room. Cover your mouth. Wear a mask. Finish your entire course of medication Vaccinations In countries where tuberculosis is more common, infants are vaccinated with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn't recommended for general use in the United States because it isn't very effective in adults and it causes a false-positive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.

Potts disease / Tuberculosis of Spine

Etiology
Mycobacterium Tuberculosis

Mode of transmission
Tuberculosis spreads by droplet infection. This type of transmission means that when TB patient exhales, coughs, or sneezes, tiny droplets of fluid containing tubercle bacilli are released into the air. This mist, or aerosol as it is often called, can be taken into the nasal passages and lungs of a susceptible person nearby. Tuberculosis is not, however, highly contagious compared to some other infectious diseases. Only about one in three close contacts of a TB patient, and fewer than 15% of more remote contacts, are likely to become infected. As a rule, close, frequent, or prolonged contact is needed to spread the disease. Of course, if a severely infected patient emits huge numbers of bacilli, the chance of transmitting infection is much greater. Unlike many other infections, TB is not passed on by contact with a patient's clothing, bed linens, or dishes and cooking utensils. The most important exception is pregnancy. The fetus of an infected mother may contract TB by inhaling or swallowing the bacilli in the amniotic fluid.

Pathophysiology
TB begins when the bacteria reach the pulmonary alveoli

Mycobacteri um Tuberculosis

TB begins when the bacteria reach the pulmonary alveoli

Cure

Inhalation
Treatment: Antibiotic 4-drug therapy Surgery

Death
Infection spreads from two adjacent vertebrae into adjoining disc space

-Back pain -Night sweats -Fever -kyphosis

Causes Potts disease

One vertebra is affected and the intervertebral disk can no longer receive nutrients

Generates to spinal damage

Disk tissue dies and broken down by caseation

This leads to vertebral narrowing

Vertebral collapse

Sign and symptoms

Symptoms The onset is gradual. Back pain is localised. Restricted spinal movements. Fever. Night sweats. Anorexia. Weight loss. Signs There may be kyphosis. (spinal curvature) Muscle wasting. A paravertebral swelling may be seen. They tend to assume a protective upright, stiff position. If there is neural involvement there will be neurological signs. A psoas abscess may present as a lump in the groin and resemble a hernia

Diagnostic test
blood tests elevated erythrocyte sedimentation rate tuberculin skin test radiographs of the spine bone scan CT of the spine bone biopsy MRI

Treatment
Surgical Surgery plays an important part in the management. It confirms the diagnosis, relieves compression if it occurs, permits evacuation of pus, and reduces the degree of deformation and the duration of treatment. However, a Cochrane review found that routine surgery in addition to chemotherapy had not been shown to improve outcome but the problem was that the evidence was poor. A study from India suggested that surgery is not mandatory.

A 4-drug regimen should be used empirically to treat Pott disease. Isoniazid and rifampin should be administered during the whole course of therapy. Additional drugs are administered during the first 2 months of therapy. These are generally chosen among the first-line drugs, which include pyrazinamide, ethambutol, and streptomycin. The use of second-line drugs is indicated in cases of drug resistance.

Prevention
As for all tuberculosis, BCG vaccination. Improvement of socio-economic condition

Leprosy (Hansens disease)

Etiology
Mycobacterium Leprae

Mode of transmission
direct contact, transfer of exudates, . Inhalation of bacilliladen droplets and contact of bacilli-laden droplets on damaged skin is considered to be the most important means of entry.

Pathophysiology
Mycobacteriu m Leprae Direct contact Transfer of exudates

Inhalation
High bacteria load and different infiltration

Low bacteria load and a few skin lesions Leprmatous Leporsy Tubercloid Leprosy

-Yellow or brown infiltrated nodules (protuberances)that affect mucous membranes on the eyes, nose, throat, -general thickening of the of the skin

-benign type -Numbness (usually of the extremities) -Contractures -ulceration

Symmetrical skin rash in the: Elbows, face, knees, ears, buttocks, wrist -thinning of eyebrow and lashes thickened skin on face

-Skin stiffness and dryness -Loss of fingers and toes Eye problems which leads to blindness

24-month treatment: Rifampicin, clofazimine, dapsone

6-month treatment: Rifampicin and dapsone

Sign and symptoms

Tuberculoid Leprosy Symptoms
Tuberculoid leprosy (also known as paucibacillary leprosy) is the mild form of leprosy. Early symptoms can include: one or more light or slightly red patches of skin that appear on the trunk or extremities. This may be associated with a decrease in light-touch sensation in the area of the rash. Other tuberculoid leprosy symptoms can include: Severe pain Muscle weakness, especially in the hands and feet Skin stiffness and dryness Loss of fingers and toes Eye problems, which lead to blindness Enlarged nerves, especially those around the elbow (ulnar nerve) and knee (peroneal nerve).

Lepromatous Leprosy Symptoms Lepromatous leprosy (also known as multibacillary leprosy) is the severe form of the disease. Lepromatous leprosy symptoms can include a symmetrical skin rash more commonly found on the:
Face Ears Wrists Elbows Knees Buttocks. This skin rash can be: Small or large Flat or raised Light or dark.

Other lepromatous leprosy symptoms can include:

Thinning of eyebrows and eyelashes Thickened skin on face Nasal stuffiness Bloody nose Laryngitis Collapsing of the nose Swelling of the lymph nodes in the groin and armpits Scarring of the testes that leads to infertility Enlargement of male breasts (gynecomastia).

Diagnostic test
Skin biopsy. For people with leprosy, this skin biopsy will reveal a particular pathologic pattern and demonstrate the specific "red"-staining bacteria.

Treatment
Leprosy can be cured with antibiotics. Lepromatous (24-month treatment) rifampicin, clofazimine, and dapsone Tuberculoid (6-month treatment) rifampicin and dapsone

Surgery Nerve decompression is indicated when signs of peripheral nerve entrapment have not resolved after 3-4 weeks of steroid therapy and if there are signs of nerve abscess or chronic entrapment. Peripheral nerve reconstruction may help restore sensation to the hands and feet and nerve grafts may be helpful for patients with localised nerve lesions. Arthrodesis or tenodesis may be necessary to correct clawing or stabilise joints and chronically diseased limbs may even require amputation. Cosmetic surgery may be effective for nasal reconstruction, replacement of eyebrows or excision of redundant earlobe or eyelid skin.

Prevention
Prevention of leprosy by vaccination would provide a valuable public health tool. However there is currently no specific vaccine effective against leprosy. The bacillus Calmette-Gurin (BCG) vaccine was originally aimed at prevention of tuberculosis but is actually more effective against leprosy. The efficacy of the BCG vaccination against both tuberculosis and leprosy is hugely variable, depending on the study population. The best way to prevent the spread of leprosy is the early diagnosis and treatment of people who are infected. For household contacts, immediate and annual examinations are recommended for at least five years after last contact with a person who is infectious.

H1N1 (Swine Flu)

Etiology
Influenza A virus causes influenza in birds and some mammals and is the only species of Influenzavirus A. Influenzavirus A is a genus of the Orthomyxoviridaefamily of viruses. Strains of all subtypes of influenza A virus have been isolated from wild birds, although disease is uncommon. Some isolates of influenza A virus cause severe disease both in domestic poultry and, rarely, in human

Mode of transmission (in humans)

The human to human mode of transmission of the deadly swine flu virus is likely to occur when an infected person coughs or sneezes in the presence of uninfected people. A single droplet of 0.5 to 5 m in diameter or a single virus is enough to infect a person. A single sneeze releases over 40,000 droplets. The droplets can either remain as aerosol or settle on objects.

Pathophysiology

Sign and symptoms

Swine flu causes all the same symptoms as seasonal flu, which may include: fever and chills cough sore throat congestion headache Body aches and fatigue

However, H1N1 can cause additional symptoms, including: Vomiting and diarrhea, and these may be more severe than those of seasonal flu.

Diagnostic test
Patients with symptoms suggesting H1N1 flu should have respiratory swab for influenza testing obtained and placed in a refrigerator (not a freezer). Swabs are usually obtained from the nasopharynx, though throat swabs, nasal wash or aspirate or bronchial wash or aspirate specimens are also suitable. Dacron or polyester-tipped swabs should be used. Cotton tipped swabs are not advised. Calcium alginate swabs are unacceptable. Ideally, the specimen should be placed in a collection vial containing viral transport media. A specimen that is unsubtypable influenza A will be sent by the lab to the Viral Surveillance and Diagnostic Branch of the CDCs Influenza Division for further diagnostic testing. Rapid diagnostic tests have already been developed and distributed to state health departments by the CDC(Centers for Disease Control), based on real-time reverse transcriptase (RT)-PCR. Test results can be available within several hours.

Treatment
In humans If a person becomes sick with swine flu, antiviral drugs can make the illness milder and make the patient feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms). Beside antivirals, supportive care at home or in hospital, focuses on controlling fevers, relieving pain and maintaining fluid balance, as well as identifying and treating any secondary infections or other medical problems. of Tamiflu (oseltamivir) or Relenza (zanamivir) for the treatment and/or prevention of infection with swine influenza viruses; however, the majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs.

Prevention
Prevention of human to human transmission Influenza spreads between humans when infected people cough or sneeze, then other people breathe in the virus or touch something with the virus on it and then touch their own face. "Avoid touching your eyes, nose or mouth. Germs spread this way." Swine flu cannot be spread by pork products, since the virus is not transmitted through food. The swine flu in humans is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. Diagnosis can be made by sending a specimen, collected during the first five days for analysis.

SARS (Severe Acute Respiratory Syndrome)

Etiology
Potentially life-threatening viral infection caused by a previously unrecognized virus from the Coronaviridae family. This virus has been named the SARSassociated coronavirus (SARS-CoV). Previously, Coronaviridae were best known as the second most common cause of the common cold.

Mode of transmission
Droplet spread through close person to person contact. These droplets travel a distance of about 3 feet from the mouth or nose of an infected person during talking, coughing or sneezing. Recent evidence also indicates that oral-faecal route may be a mode of transmission as increasing numbers of patients also have diarrhoea as a presenting symptom. Therefore attention should be given to correct preparation, cooking and storage of food and communal sharing of food should be avoided as much as possible.

Pathophysiology
SARS-CoV
Droplet Oral-fecal route Direct contact

Growth occurs in epithelial cells -occasionally the liver, kidney, heart, or eyes may be infected

-fever cough -muscle aches headache -chills and shaking

-dizziness -productive cough -nausea and vomiting

-Supplemental oxygen -Chest physiotherapy -Mechanical ventilator

-hospitalized under isolation

-Antiviral medications -high doses of steroids

Sign and symptoms

Clinical Manifestations or S/Sx * Fever * Chills and shaking * Muscle aches * Cough * Headache
Less common symptoms include (also in order): * Dizziness * Productive cough (sputum) * Sore throat * Runny nose * Nausea and vomiting
* Diarrhea

Diagnostic test

The list of diagnostic tests mentioned in various sources as used in the diagnosis of SARSincludes: No official specific SARS tests available yet Influenza A tests Various SARS tests under development Influenza B tests Chest imaging - for identifying pneumonia and Respiratory syncytial virus tests related findings Complete blood count Chest x-rays White blood cell count Pulse oximetry Absolute lymphocyte count Blood cultures Creatine phosphokinase levels Sputum Gram's stain and culture Hepatic transaminase levels

Treatment
SARS treatment requires hospitalization for intensive supportive care. This supportive care can include:
Intravenous (IV) fluids Medications, including antibiotics, steroids, and/or antivirals Breathing support from a ventilator Prevention of secondary infections Good nursing care.

Prevention
There are no vaccines available for SARS-CoV. As a result of the global outbreak of SARS there has been resurgence in interest and prominence of respiratory hygiene and cough etiquette as an attempt to reduce transmission of all forms of respiratory pathogens, including SARS-CoV. This includes encouraging all persons with signs and symptoms of a respiratory infection to: cover the nose and mouth when coughing or sneezing use tissues to contain respiratory secretions dispose of tissues in the nearest waste receptacle after use wash hands after contact with respiratory secretions and contaminated objects and materials.

Health care facilities should ensure the availability of materials for adhering to respiratory hygiene/cough etiquette in waiting areas for patients and visitors: provide tissues and no-touch receptacles for used tissue disposal provide conveniently located dispensers for alcohol-based hand rub Provide soap and disposable towels/hand driers for hand washing where sinks are available.

Dengue Fever/ Dengue hemorrhagic disease

Etiology
Dengue viruses are members of the family Flaviviridae genus Flavivirus. They are small enveloped viruses containing a single-strand RNA genome of positive polarity

Mode of transmission
Vector of Dengue / Dengue Haemorrhagic fever. Aedes aegypti is the vector of Dengue / Dengue haemorrhagic fever. It is a small, black female mosquito with white stripes and is approximately 5 mm in size. It takes about 7 to 8 days to develop the virus in its body and transmit the disease

Pathophysiology
Dengue Virus

Aedes aegypti

Binding of dengue virions to cells, which is mediated by the major viral envelope (E) glycoprotein

-headache -nausea -chills -rash -backache joint pain -fever

-bed rest -maintenance of fluid -aspirin -anti inflammatory -Intravenous fluid

Sign and symptoms

Dengue Fever is an acute febrile illness of 2-7 days duration (Sometimes with two peaks) with two or more of the following manifestations: headache retro -orbital pain myalgia/arthralgia rash hemorrhagic manifestation leukopenia. prolonged fatigue and depression.

Diagnostic test
Evaluate your signs and symptoms Review your medical and travel history Test your blood for evidence of a dengue virus Blood tests Laboratory tests, usually using a sample of your blood, are needed to confirm a diagnosis of dengue fever. If you have dengue fever, your blood may reveal the virus itself. If not, blood tests known as hemagglutination inhibition (HI) assay, enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase-polymerase chain reaction (RT-PCR) can detect antigens, antibodies or nucleic acids specific to the viruses. These tests may take several days.

Treatment
There is no cure for dengue fever or vaccine to prevent the disease. Hospitalization in intensive care is required for people who develop dengue hemorrhagic fever and dengue shock syndrome. Most healthy people who get dengue fever will recover in about two weeks to one month by: Getting plenty of rest Increasing fluid intake Taking acetaminophen (Tylenol) for fever and body aches. People with dengue fever should not take aspirin or medications that contain aspirin because these medications increase the risk for severe bleeding and hemorrhage.

Prevention
At present, there is no specific treatment. No vaccine is current available. The only method of controlling or preventing Dengue Fever is to combat the vector mosquitoes.
Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal, elimination of stagnant water in domestic environment and improved water storage practices. Aerosol and liquid spray has to be applied directly to the adult mosquito for effective killing, e.g. household pesticides. Mosquito coil and electric mosquito mat/ liquid has to be placed near possible entrance, such as window, for mosquito. Wear long-sleeved clothes and long trousers when going outdoors. Bodies could be protected from mosquito bite by applying insect repellent (containing DEET) on the clothes and exposed part of the body especially when you travel to Dengue Fever endemic areas. Mosquito bednet could be used when the room is not air-conditioned.

Thank you for listening!!!!!!