THÔNG TIN TÀI LIỆU
Type Asymptomatic Clinical presentation Approximately 50% of infected individuals remain asymptomatic Undifferentiated Relatively benign febrile illness fevers Typically in young children experiencing their first infection Many go undiagnosed because of similarities with other febrile illnesses Dengue fever Fever and develop two or more of the following: without warning • Nausea or vomiting signs • Myalgias and/or arthralgias • Diffuse erythematous maculopapular rash • Leukopenia • Positive tourniquet test (inflation of a blood pressure cuff for results in >10–20 petechiae per square inch; a measure of capillary fragility) Dengue with Symptoms of dengue without warning signs with any of warning signs the following additional symptoms: • Abdominal pain or tenderness • Persistent emesis • Fluid overload (ascites, pleural effusion) • Mucosal bleeding • Lethargy • Hepatomegaly (liver edge appreciable cm below costal margin) • Increased hemoglobin (from hemoconcentration) and thrombocytopenia Severe dengue Symptoms of dengue with warning signs with any of the fever or dengue following: shock syndrome • Severe plasma leakage with resultant: • Shock • Fluid accumulation resulting in respiratory distress or failure • Severe bleeding • Severe end-organ involvement: • Hepatic transaminases >1,000 IU/L • Impaired consciousness • End-organ failure e-TABLE 94.20 INFLAMMATORY VERSUS NONINFLAMMATORY DIARRHEA Mechanism Symptoms Stool quality Anatomic site Pathogens Inflammatory Noninflammatory Destruction of enteric mucous membranes resulting in inflammatory response Release of neutrophils and erythrocytes in stool Abdominal pain, fever, tenesmus Small volume, frequent, blood and mucus present Distal ileum and colon Enteroinvasive E coli Enterohemorrhagic E coli Campylobacter spp Salmonella spp Shigella spp Clostridium difficile Entamoeba histolytica Osmotic: inability to breakdown disaccharides Secretory: intestinal epithelial cells are stimulated to secrete fluid Abdominal pain, nausea, vomiting Large volume, watery stool Proximal small intestine Enterotoxigenic E coli Vibrio cholera Campylobacter spp Salmonella spp Bacillis cereus Cryptosporidium hominis Giardia intestinalis e-TABLE 94.21 INDICATIONS FOR POSTEXPOSURE PROPHYLAXIS FOR RABIES Scenario a Recommendation Livestock, rodents, rabbits, hares Rarely require prophylaxis; verify with local health authorities to see if cases have been reported in these animals in your region Prophylaxis is only needed if animal displays signs of rabies Dogs, cats, ferrets known to be vaccinated or available for 10-day observation period Dogs, cats, ferrets who are unavailable Consult with local health authorities to for observation see if cases have been reported in these animals in your region Any mammal available for Immediate immunization and RIG observation who develops signs of rabies Contact with bats, woodchucks, or Immediate immunization and RIG wild carnivores (coyotes, foxes, unless animal available for skunks) observation Bat found in room with a sleeping or Immediate immunization and RIG nonverbal child unless animal available for observation Contact with rabies patient Touching an infected patient or contact with noninfected body fluids does not require prophylaxis a Exposure is defined as a bite, scratch, open wound or contact with saliva, cerebrospinal fluid, or brain tissue RIG, rabies immune globulin e-TABLE 94.22 COMMON CAUSES OF DYSENTERY IN THE RETURNED TRAVELER
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