Myelitis= inflammation of the spinal cord

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2 Polio infection 1 Illustrate the epidemiology of the disease 2 Demonstrate the clinical features of polio infection 3 Enumerate the complications 4 Prevent and treat polio infection MUMPS 1 Identify the epidemiological data 2 Illustrate the clinical picture 3 Enumerate the complication 4 Illustrate the differential diagnosis of parotid swelling 5 Treat and prevent the disease Dengue fever 1 Determine the causative organism and the vector 2 identify the mode of transmission 3 Compare the clinical feature of dengue fever and the dengue hemorrhagic fever 4 Plan for prevention and treatment of dengue fever

3 polio= gray matter Myelitis= inflammation of the spinal cord Polio is caused by a virus that attacks the nerve cells of the brain & spinal cord although not all infections result in sever injuries and paralysis.

4 AGENT: POLIOVIRUS TYPE : THREE SERO TYPES(TYPE-1,TYPE-2,TYPE-3),RNA RESERVOIR: Man INCUBATION PERIOD: 8 TO 12 DAYS( 5-35 DAYS) HOST : AGE : 6 MONTHS TO 3 YEARS MODE OF TRANSMISSION: FAECO ORAL ROUTE

5 Polio infection In apparent infection (SUBCLINICAL) Clinical poliomyelitis Abortive polio (minor illness) Involvement of CNS (major illness) Paralytic polio Non-paralytic polio Spinal polio Bulbar polio polioencephalitis

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7 Paralytic poliomyelitis: Paralysis usually appears within 4 days after the preparalytic stage (around 7-10 days from onset of disease). The case shows fever, headache, irritability, and different paralytic manifestations according to the part of the CNS involved, with destruction of the motor nerve cells, but not the sensory nerve cells. Forms: spinal, bulbar, and bulbospinal.

8 Different spinal nerves are involved, causing tenderness, weakness, and acute flaccid paralysis of the corresponding striated muscles. Asymmetric flaccid paralysis or paresis involving one leg is the most common,proximal distal. Paralysis of L.L is often accompanied by bowel and bladder dysfunction. Sensation is intact.

9 Nuclei of the cranial nerves are involved, causing weakness of the supplied muscles, and maybe encephalitis. Bulbar manifestations include dysphagia, nasal voice, fluid regurgitation from the nose, difficult chewing, facial weakness and diplopia Paralysis of the muscles of respiration is the most serious life-threatening manifestation.

10 complications? Case fatality: varies according to the form of disease (higher in bulbar), complications and age ( fatality increases with age).

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12 Laboratory studies, especially attempted poliovirus isolation, are critical to rule out or confirm the diagnosis of paralytic poliomyelitis. Virus isolation The likelihood of poliovirus isolation is highest from stool specimens,2 samples should be collected in 24-48hr apart. CSF is often normal or minimal changes,typically pleocytosis cell/mm³ nerve conduction velosity and electromyogram and muscle biopsy

13 General prevention: Health promotion through environmental sanitation. Health education (modes of spread, protective value of vaccination). Active immunization: Salk vaccine (intramuscular polio trivalent killed vaccine). Sabin vaccine (oral polio trivalent live attenuated vaccine).

14 No specific treatment All IM and surgery are contraindicated during acute stage Avoid exertion

15 Mumps is acute self limited infection. often in winter and spring. Mumps virus exist as a single immunotype. Mode of spread : person to person by respiratory droplets. Period of maximum infectiousness is 1-2 days before to 5 days after onset of parotid swelling IP : days but is usually days.

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17 CLINICAL PICTURE

18 Parotitis can be caused by (influenza A, para infleunza,cmv,ebv,enterovirus,hiv) Purulent parotitis Non infectious causes (obstruction of stensen duct,collagen vascular disease e.g.sjogren syndrome,sle). Tumors

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20 DIAGNOSIS Treatment : no specific antiviral therapy, symptomatic treatment prevention : MMR vaccine

21 Aedes aegypti, the mosquito that spreads Dengue fever.

22 Do you know Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF) are the most common mosquito-borne viral disease in the world. It can be fatal.

23 One distinct physical feature black and white stripes on its body and legs. Bites during the day. Lays its eggs in stagnant water. Close-up of an Aedes mosquito

24 How Do Aedes Mosquitoes Transmit Diseases... Mosquito bites and sucks blood containing the virus from an infected person. And passes the virus to healthy people when it bites them.

25 Symptoms of Dengue Fever Example of a skin rash due to dengue fever

26 Laboratory finding : Pancytopenia Clotting time, bleeding time,prothrombine time,and plasma fibrinogen value are within normal Mild acidosis Elevated transaminases,decrease protein value

27 Dengue Hemorrhagic Fever Subcutaneous hemorrhage in child with DHF Hemorrhagic conjunctivitis NASAL HEMORRHAGING

28 Laboratory finding : Hemoconcentration,hematocrite 20% Decrease protein value Prolonged bleeding time,decrease prothrombine level Fibrin degradation products increased Elevated transaminases hypocomplementaemia Metabolic acidosis Elevated BUN Decrease Na,CL level X ray chest : pleural effusion

29 High index of suspicion and knowledge about geographical distribution. Increasing antibody titer (Ig G) to four folds or more. Isolation of virus by PCR, complement fixation,enzyme immunoassay.

30 WHO criteria for diagnosis of dengue hemorrhagic fever: 1- fever 2-7 days 2-platelets < 100,000 3-haematocrit 20%,pleural effusion,ascites or hypoalbuminemia Dengue shock fever: Those for dengue hemorrhagic fever, hypotension,tachycardia,narrow pulse 20 and sign of poor perfusion.

31 Prevention: control of breeding sites for the mosquitoes is key to control of the disease through control of the vector. Treatment of dengue fever is supportive bed rest and antipyretic Treatment of dengue hemorrhagic fever and shock: Check vital sign, HCT, S/E Close monitoring in h IV fluid,correct electrolyte Fresh blood,platelets, FFP may be needed Aspirin is contraindicated