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