Drug side effects

Certain drugs like primaquine which is used in Rx of malaria can cause bone marrow toxicity. This can lead to reduction in platelet production causing thrombocytopenia. This leads to easy bruising, easy bleeding in internal organs like fundus of eye, brain, etc

Symptoms of Dengue

Dengue causes severe headache,backache,bodyache.It is called as "bone breaking fever".
Rash is characteristically bright red petechia and appears first on the lower limbs and the chest

There may be gastritis with associated abdominal pain, nausea, vomiting or diarrhea.

Dengue hemorrhagic fever -DHF-
DHF can manifest as bleeding tendencies, thrombocytopenia. Thrombocytopenia is a condition in which platelet counts are low. Platelets play an important role in blood clotting.As clotting gets impaired,bleeding occurs through various body tissues/organs. Platelet transfusion (Platelet concentrate or fresh blood) may need rarely in situations when count falls below 20,ooo without bleeding or below 50,000 with bleeding
DHF can lead to dengue shock syndrome

Management

Main management is supportive one. Antipyretics are useful.
Monitor platelet counts by peripheral blood smear. Watch for bleeding occurring from gums, wounds, fundus of eye, etc.

Malaria & Dengue

One has to be careful about these 2 diseases.
Both the diseases are very common in developing & underdeveloped countries due to poor hygiene & poor disposal of wastes.
Malaria is spread from mosquito bite. Anopheles mosquito is responsible for spread.
Plasmodium vivax & falciparum are the 2 commonest species of malarial parasite.

Stagnant water gives a breeding site for mosquitoes.Proper cleanliness , use of drugs to kill mosquitoes (various sprays are available) is very important.Use of mosquito repellants (odomos, good knight) helps in decreasing chances of mosquito bites.
Malaria manifests as -fever with chills.Patient may have headache,bodyache,malaise & other constitutional symptoms.One has to do peripheral blood smear ideally when one has fever to diagnose malarial parasite-plasmodium vivax
Plasmodium falciparum is a dangerous species.Cerebral malaria is a serious complication of disease.This is the major cause of mortality

Chloroquine is the traditional drug used in treatment.The dosage is as follows-Initially 4 tablets stat,then 2 tab after 6 hours.Then 1 tab 2 times a day for next 2 days.So a course of 10 tab total.This tab can cause gastritis. So take tablets with milk or antacid like ranitidine, omeprazole, etc
But resistant forms to chloroquine are known.In such cases,physician has to use other drugs.All this Rx has to be done under supervision of a qualified physician
Malaria can lead to
1.Coma
2.Renal (kidney)failure
3.Hepatospleenomegaly
4.Cerebral ischemia
5.Anaemia due to hemolysis
6.Hemoglobinuria
7.Convulsions-in layman's language known as fits
Common species which cause malaria -
P. falciparum,
P. malariae,
P. ovale,
P. vivax
Chloroquine resistant P.Falciparum is the one which is really dangerous form of malaria
Various other drugs used in Rx are
Quinine
Artemether-lumafantrine
Artemether-mefloquine
Artesunate-mefloquine
Sulfa with pyrimethamine
Doxycycline



Prevention
1. Its extremely important to use mosquito nets,repellants,etc to reduce chances of mosquito bites.
2.Avoid water getting stagnated
3.One can use larvicidal fish known as "gambusia" fish in ponds,stagnant water
4. Use of insecticides like DDT, pyrethrin, etc, at home is recommended.
National malaria eradication programme ( NMEP) is implemented by Govt to reduce the % of this disease.Health care workers in primary health centres are trained to check peripheral blood smears & tab chloroquine are freely available at Govt hospitals.
Development of vaccine for malaria- efforts are going on & scientists will be able to develop it in future
Tulsi oil shows larvicidal activity against malarial larva.