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Cases application on
Arthropod borne diseases
By Dalia Bahaa
Under supervision of
Prof Dr Mona Aboserea
Faculty of medicine –Zagazig University
1-Mykel is 35 years old wood cutter in
Africa, he complained from sudden onset of
fever, headache, muscle pain, vomiting and
prostration, on examination the pulse was
slow and there was some jaundice
a)What is the possible diagnosis
b) How can you confirm
B. Travel history
C. Lab investigations as:
*Isolation of the virus from blood
*Demonstration of viral antigen in the blood by ELISA.
*Demonstration of viral genome in blood and liver tissue by PCR.
*Serologic diagnosis by demonstration of specific IgM in early sera or rise in titre of
c)If the traveler comes to Egypt, what are
the measures that should be taken?
International measures: It is one of the quarantinable diseases and
the following measures should be done to prevent introduction of yellow
fever from endemic area (Yellow Fever belt) into receptive area (areas
free of yellow fever, but the vector is present and the population is
susceptible e.g. in Egypt) :
Notification within 24 hours by governments to WHO.
Disinfection of any aircraft leaving an endemic area for receptive area,
by aerosol spray of suitable insecticide, shortly before departure and
also on arrival
Valid vaccination certificate:
a. Is required from all international travelers including children coming from
or going to endemic areas "Yellow Fever belt."
b. Validity starts 10 days after primo-vaccination and lasts for 10 years.
c. Validity starts on same day after re-vaccination and lasts for 10 years.
d. If no certificate is available: traveler is isolated for 6 days from date of
leaving endemic area.
e. If traveler arrives before 10 days of vaccination, i.e. certificate is not valid
yet: traveler is isolated until certificate becomes valid or until the end of
international incubation period calculated from the day of leaving the last
f. Traveler is quarantined in mosquito-proof accommodation in airport.
g. This certificate is required by many countries including Egypt
2-A 50 y old male patient, from Qaliobyia, suffers
from progressive enlargement of his limb. By
history he was suffering from repeated attacks of
enlarged painful lymph nodes in the past 10 years
a)What is possible diagnosis?
Filariasis (Bancroftian filariasis)
b) How can the disease be transmitted?
By the bite of infective mosquito.
In Egypt: female Culex pipiens, but it could be transmitted by the bite of Anopheles
gambia and Aedes. When the mosquito bites an individual the larvae can enter the
Many mosquito bites over several months to years are needed to get lymphatic
People living for a long time in tropical or sub-tropical areas where the disease is
common are at the greatest risk for infection. Short-term tourists have a very low
c)How can you confirm diagnosis
Identification of microfilariae in a blood smear by microscopic examination
during maximum presence (nocturnal), thick smear should be made and
stained with Giemsa
*Patients with active filarial infection typically have elevated levels of antifilarial
IgG4 in the blood and these can be detected using routine assays.
*Because lymphedema may develop many years after infection, lab tests are
most likely to be negative with these patients
d)What is the treatment
Patients currently infected with the parasite
DEC (Banocid, Hetrazan). Treatment results in rapid suppression of most or all
microfilaria from the blood, and some adult worms. Low level of microfilaria may reappear
after treatment. Therefore, treatment must usually be repeated at yearly interval, and
laboratory follow up should be done for treated cases.
Ivermectin kills only the microfilariae, but not the adult worm; the adult worm is
responsible for the pathology of lymphedema and hydrocele.
Some studies have shown adult worm killing with treatment with Doxycycline
(200mg/day for 4–6 weeks).
Patients with clinical symptoms
Lymphedema and elephantiasis are NOT indications for DEC treatment because most
people with lymphedema are not actively infected with the filarial parasite.
The treatment for hydrocele is surgery
e)How can you prevent the disease
1 .Environmental sanitation:
a. Eradication or control of mosquito vector
b.Human protection against mosquitoes: e.g. protective clothing, bed nets, repellents and stay
The mosquitoes that carry the microscopic worms usually bite between the hours of dusk and
dawn. If you live in an area with lymphatic filariasis.
2 .Health education:About modes of transmission and Protection against mosquito bites to
reduce exposure to infection.
Mass drug administration:
In areas where lymphatic filariasis is endemic: WHO currently recommends mass drug
administration, as an annual single dose, of combinations of diethylcarbamizine citrate (DEC)
6mg/kg body weight with 400 mg of albendazole for 4-6 years, or the regular use of DEC-
medicated cooking salt for 1-2 years. Mass administration of these drugs has the two fold
purpose of preventing future cases of lymphatic filariasis and helping those people who are
already suffering from the disease
3-Ahmed is football player return with his
team from championship in Ethiopia with
sudden onset of fever for 3-5 days, intense
headache, rash. Epistaxis, gum bleeding
a)What is possible diagnosis
Dengue fever(Break Bone Fever)
b) How can the disease be transmitted
bite of infective Aedes aegypti mosquito
C) What is DD
2 -Rift valley fever
d)How can you prevent the disease
1) Environmental sanitation:
A) Eradication or control of mosquito vector by:
i. Anti-larval and anti-pupal measures
ii. Anti-adult measures
iii. Jungle mosquitoes: control is impractical.
Human protection against mosquitoes: e.g. protective clothing, bed nets, repellents and stay
2 )Health education about modes of transmission to reduce exposure to infection.
Specific: Dengue fever vaccine
4-A butcher in El Sharkia come to hospital
with fever, influenza like picture and he was
diagnosed as influenza and take some fluids
and antipyretic then return to home after
few days he show hemorrhagic in gum,
impaired liver function, vision problem and
a)What is possible diagnosis?
b) Causative agen?
Small wild mammals,cattle, sheep, goats, birds and man.
D)Mode of transmission?
-Occupational as veterinarians, meat processing, sheep and dairy workers and
farmers through direct contact with domestic animals especially while animals are
-Air borne by rickettsia present in dust contaminated by placental tissues, birth
fluids and excreta of infected animals.
-Ingestion of raw milk
e)How can you prevent the disease
Control of the disease in domestic animals either by vaccination or by antibiotics.
Milk pasteurized at high temperature.
Health education: about necessity for adequate disinfection and disposal of animal
By inactivated vaccine Q 34, given in 1ml dose as 3 weekly subcutaneous. For high
risk workers as laboratory workers and workers in contacts with animals and animal'
5-Many students in slum area come to
unit with abrupt onset of high fever,
rigors, body aches. Cyanotic face, dull
and confused. They show skin rash on
folds of axilla, anterior part of forearms
then trunk and back.
a)What is possible diagnosis?
b)How can you confirm diagnosis?
-suggestive clinical picture
-lab investigation as weil-felix reaction (agglutination
c)How can you prevent and control the disease?
-Health education for personal cleanliness.
-Delousing of population by washing facilities & dusting with a suitable insecticide.
typhus vaccine (live attenuated vaccine), Madrid E typhus vaccine a single IM dose, giving
immunity for 5 years.
-Notification to LHO.
-Isolation in hospital after dusting.
-Terminal disinfection by dusting (to kill any lice) & steam disinfection for clothes & bedding
(to kill rickettsia).
-Treatment by tetracycline 500 mg / 6hs for seven days.
-Release after clinical recovery of the case.
-Delousing by bathing & dusting.
-Surveillance for 2 weeks, for case-finding.
*Epidemic measures :-
-Delousing of confined groups and underdeveloped communities
by washing facilities & dusting.
-Vaccination of high risk groups.
-Searching for the source of infection
6-Emad is a cattle merchant return from Brazil
from one month he came to hospital with fever,
chills, malaise, headache, nausea, lassitude,
muscle and joint pain, rigor sensation and the
fever rapidly rising ending by profuse sweating.
The cycle of fever, chills, sweating is repeated
a)What’s possible diagnosis?
Possible diagnosis: Malaria
b)How to Confirm diagnosis?
•Demonstration of malaria parasites in thick blood film.
•Repeated microscopic examination every 12-24 hours may be necessary to
cover all parasite species.
•Several tests have been developed: The most promising are:
-Rapid diagnostic tests that detect plasmoidal antigens in the blood.
-PCR is the most sensitive method.
-Demonstrating antibodies which appear after first week of infection but may persist for
years denoting past malaria infection.
C) What are the Complications?
-Abortion and fetal infection.
-Falciparum malaria may be associated with respiratory distress, jaundice,
liver failure, encephalopathy, pulmonary and cerebral edema, coma and death.
1 .General preventive measures: of arthropod borne disease.
-Environmental sanitation, vector control and Health education:
*Elimination of the breeding sites of mosquito by filling of swamps, marches and small
collection of water.
*Eradication of larval stages by spraying crude oil and larvicides on water surface.
*Destruction of adult mosquitoes by using suitable insecticides (liquid aerosol, pyrethrium).
*Screening of windows and doors, using bed nets and animal barrier between breeding
places and human habitation.
-using protective cloths.
-Apply of repellents to exposed skin between dusk
-Avoid going outdoors and down when anopheline mosquitoes commonly bite.
-Health education of the public, at risk groups and travelers for the mode of transmission,
protection from exposure and value of prophylaxis and treatment.
-Avoid taking blood from any individual giving history of malaria or a history of travel to, or
residence in, a malarious area
Chemoprophylaxis for international travelers going to endemic areas.
■Chloroquine or hydrroxy chloroquine 5 mg /kg /week or chloroquine phosphate
(500 mg for average adult).
■The drug must be continued for 4-6 weeks after leaving endemic areas.
■In areas with chloroquine-resistant P. falciparum, mefloquine is recommended
(5mg/kg/week) for adults, 1-2 week before travel, during stay and 4 weeks after
leaving the endemic area
Case: Early case finding:
*By laboratory examination of clinically suspected persons.
*By periodic survey.
*Through malaria campaign.
Treatment: Using antimalarial drugs as chloroquine or mefloquine etc.
Contacts:• Investigation for early case findings.
7-Female child in a village in upper Egypt
come with fever, headache, skeletal and
abdominal tenderness with palpable liver
and spleen, jaundice and purpura occur.
Hyperpyrexia, hypotension after
examination doctor found lice in her scalp
A) what is Possible diagnosis?
LOUSE- BORNE RELAPSING FEVER
b) How to Confirm of diagnosis?
by: Dark ground illumination or stained blood films.
Intraperitoneal inoculation or culture in lab animals
C) what is the Prognosis:
Hyperpyrexia, hypotension and cardiac failure
D)What’s the prevention and control?
)Delousing by residual insecticide powder as in typhus.
)Protection of susceptible: use of repellents and protective clothes.
chemoprophylaxis with tetracycline after exposure
Notification : to LHO
Isolation: precautions with blood and body fluids.
Concurrent disinfection : none
Treatment: procaine penicillin injection followed by oral tetracycline
Contacts: Case findings.
Apply insecticides to clothes and houses