Post on 11-Nov-2015
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Infections
Dr. Ashit V Hegde (MD, MRCP)
Consultant Physician,
P.D. Hinduja Hospital & MRC
What is an Infection
Infection is a process in which bacteria, viruses, fungi or other organisms enter the body, attach to cells, multiply and cause tissue damage.
To cause an infection these organisms need to overcome the bodys natural defenses
Infections could be: Community acquired or Hospital Acquired
Some Common Infections in our country
Respiratory Infections
Malaria
Dengue
Typhoid
Gastroenteritis
Chikungunya
Tuberculosis
HIV , Hepatitis
When to consider admission
Blood Pressure has decreased
Breathlessness
Altered Mental state
Immunocompromised Patient
Co Morbidities (Heart , Lung , Liver etc )
Recent Admission to Hospital
Elderly
Respiratory Infections
Most Infections viral
Most cases do not need antibiotics
(Just Rest , Fluids , Paracetamol)
Vaccination
Swine Flu (H1N1) Infection
In Most patients , like another flu
Most patients can be managed at home
Certain High risk groups
Tamiflu not mandatory
SWINE FLU PRECAUTIONS Stay Home
Contain Your Cough Cough or sneeze into the crook (inside elbow) of your arm. This way you do not transfer the germs to your hands and then to every object you touch.
Wash Hands Frequently
Avoid shaking hands or other hand to hand contact whenever possible.
Dengue
Dengue virus is transmitted via the bite of Aedes mosquitoes
There are four types of dengue virus (DEN-1, DEN-2, DEN-3 and DEN-4).
Elicit only transient partial cross-
Barking up the wrong tree
Dengue fever
Fever , severe body ache , retroorbital pain (pain behind eyes)
Low WBC count and platelet count
Focus on capillary leak ( Rising Hemoglobin) NOT PLATELET count
Platelet transfusions usually not indicated
(But patients may need to stop blood thinners and BP medications temporarily )
Warning signs in Dengue
Abdominal pain or tenderness
Persistent vomiting
Mucosal bleed
Lethargy, restlessness
Laboratory: increase in HCT
Dengue precautions
Remove all stagnant water and containers Keep all drains well maintained and repair all chokes Cover all water containers properly Change flower vase water once a week Wrap all unused plastic tyres Use mosquito repellents to avoid mosquito bite Use mosquito screen to prevent mosquito attack Wear long sleeve and fully covered clothes Use mosquitoes net around bed while sleeping
Bite just after sunrise and just before sunset
Classically, CHIKV infections are characterized by high fever, nausea, rash, and severe joint pain
Chikungunya fever can be difficult to differentiate from dengue fever.
The origin of the name chikungunya, derives from the East African Makonde language and means that which bends up.
Malaria
May come with respiratory symptoms
Chills , Rigors etc not diagnostic
May Mimic Dengue
Peripheral smear and RDT (rapid Diagnostic Test) useful in diagnosis
May need to repeat Tests
Vivax malaria may relapse unless the patient is given drug to prevent relapse (primaquin)
Precautions against Mosquito bites only preventive measure
Typhoid Fever
Widal useless in first week ( and probably later too )
Blood Cultures Needed to Diagnose
Preceeding diarrhoeal illness ,Zero Eosinophil count , cough , profuse sweating suggestive
Oral treatment :
High dose cefixime ( 400mg thrice) or Azithromycin 500 mg twice
Gastroenteritis
Usually self limited
No need for antibiotics in most cases (except if high fever , blood in stools)
Stop BP medications temporarily
Plenty of oral liquids ( avoid milk)
Probiotics may help
Tuberculosis
Hardly any role for empiric treatment nowadays
Culture and DST (drug sensitivity testing) very desirable
Antibody tests and Mantoux useless
Only sputum positive TB is contagious
Very very important to strictly adhere to therapy
HIV and Hepatitis B & C
Acquired sexually , during delivery or through transfusions
Hepatitis B may be acquired through ear piercing tattooing etc.
Better to undergo vaccination against Hepatitis B
Is Fever Harmful
Only in elderly
Or if Co Morbidities