What is the prognosis and what are

5. What is the prognosis? And what are other possible complications regardless of treatment?Bautista, Julius RayBautista, VincentWhat is the prognosis?DiseasePrognosis Leptospirosis Mild leptospirosis (90% of all cases) RARELY FATALSevere leptospirosis

Advanced ageClinically evident pulmonary involvementElevated serum creatinine levelOliguriaThrombocytopeniaMalaria Uncomplicated malaria

Plasmodium FalciparuminfectionPOOR PROGNOSISexhibits marked improvement within 48 hrs after initiation of treatment;fever free after 96 hoursPOOR PROGNOSIS if untreatedGOOD PROGNOSIS if diagnosed early and treated appropriatelyMortality rate of 10% (range 5-40%)Harrissons Principles of Internal Medicine, 18th editionThe severity of the illness in terms of pulmonary and renal dysfunction is the most important determinant of prognosis.Liver dysfunction in acute lepto has not been confirmed to be an independent risk factor for death.

Malariap. falciparum carries poor prognosis with high mortality rate if left untreated because most of the complications are caused by p. facliparumGenerally, lepto is considered to leave no permanent sequelae..altho renal dysfunction as manifested by electrolyte imbalances may persist for days or weeks after acute illness resolves2

Harrissons Principles of Internal Medicine, 18th editionWhat is the prognosis?DiseasePrognosis Typhoid fever Prompt treatment

Untreated typhoid fever

InfluenzaUncomplicated influenza

Prevents severe complications; case fatality rate of < 1%Mortality rate of 10-20%10% excrete salmonella typhi in the feces for 3 months1-4% develop chronic asymptomatic carriage sheds the bacteria in the urine or feces for >1 yearAcute illness generally resolves over 2-5 days; most recovered in 1 week

Increase morbidity and mortality ratesHarrissons Principles of Internal Medicine, 18th editionTyphoid feverif appropriate antibiotics is intiated within the first few days of full blown illness, the disease begins to remit after about 2 days and the patient condition markedly improves within 4-5 days.4What is the prognosis?DiseasePrognosis Dengue fever/ dengue Hemorrhagic feverSelf-limiting disease; mortality rate of < 1% (dengue fever)Dengue Hemorrhagic fever

FACTORS THAT AFFECT DISEASE SEVERITY: Age Nutritional status Ethnicity Sequence of infection with different dengue serotypes Genotype of virus Quality and extent of available medical carewhen treated, mortality rate of 2-5%Untreated, mortality rate can be as high as 50%Harrissons Principles of Internal Medicine, 18th editionhttp://emedicine.medscape.com/article/Denguesurvivors usually recover without sequelae and develop immunity to the infecting serotype. Factors that affect disease severity includes patient age, nutritional status,ethnicity (some africans and haitiansgenetic advantage to thevirus), virus genotype,quality and extent of available medical care.Age-susceptibility to dhf and dss drops considereably after >12 y/0Sex-females are more often affected than malesRace-whites more affected than blacksSequence- serotype 1 followed by serotype 2 more dangerous than serotype 4 followed by serotype 2.Genotype of virustype 2 is apparently more dangerous than other seroypesMalnourished children are less likely to develop dhf than well nourished due to impaired cellular immunity.

5Complications of MalariaComa/Cerebral malariaDeath rates of 20% (adults), 15% (children)Follows after a convulsion (usually generalized)Failure to respond to noxious stimuli or coma persistng for >30 min after generalized convulsion

Source(s): Harrissons Principles of Internal Medicine, 18th editionComa is a characteristic feature of falciparum malaria and, despite treatment, is associated with death rates of 20% among adults and 15% among children. The onset of coma may be gradual or sudden following a convulsion.

Convulsions usually generalized and often repeated occur in 10% of adults, 5% in children. More covert seizure activity is common particularly among children and may manifest as tonic-clonic eye movements or even hypersalivation.

5% of children surviving cerebral malaria especially those with hypoglycemia, severe anemia, repeated seizures and deep coma have residual neurologic deficit when they regain consciousness; hemiplegia, cerebral palsy, cortical blindness, deafness, and impaired cognition and learning. Majority of these deficits improve markedly or resolve completely within 6 months.6Complications of MalariaComa/Cerebral malariaResidual neurologic deficit when consciousness is regainedPersistent language deficit, incidence of epilepsy is increased, and life expectancy decreased (in children)

Source(s): Harrissons Principles of Internal Medicine, 18th editionComa is a characteristic feature of falciparum malaria and, despite treatment, is associated with death rates of 20% among adults and 15% among children. The onset of coma may be gradual or sudden following a convulsion.

Convulsions usually generalized and often repeated occur in 10% of adults, 5% in children. More covert seizure activity is common particularly among children and may manifest as tonic-clonic eye movements or even hypersalivation.

5% of children surviving cerebral malaria especially those with hypoglycemia, severe anemia, repeated seizures and deep coma have residual neurologic deficit when they regain consciousness; hemiplegia, cerebral palsy, cortical blindness, deafness, and impaired cognition and learning. Majority of these deficits improve markedly or resolve completely within 6 months.7Complications of MalariaHypoglycemiaQuinine is a powerful stimulant of pancreatic insulin secretion Clinical diagnosis is difficult (usual physical signs of sweating, gooseflesh and tachycardia are absent)Plasma glucose level of