Dengue fever and genus Epidemics. Kader Kochi.

Dengue fever is a viral disease. It is more prevalent during rainy season. It occurs as endemic near seacoast and seaport due to periodic entry of foreign mosquitoes via ship and air cargo.

Symptoms

Dengue means mad in sahali language. Onset of fever is sudden within 3 days from mosquito bite as in yellow fever.

Common manifestations include chilliness, anorexia, weeping, depression, insomnia, severe body pain, backache, retro orbital pain on eye movement, dusky face, rapid pulse; measles like eruption on dorsum of hand and leg, and erythromegalgia.

Cough symptoms are entirely absent.

Temperature falls slowly on fourth day.

Second rise of temperature occurred after 24 hours interval (saddle back temperature).

Bradycardia, severe bone and tendon pain near joint, periarthritis, prostration, and granulocytopenic leucopenia-about 4000/cu mm are other features. 

Maculo-papular eruption seen on abdomen fades on pressure. 

Temperature falls suddenly on 7^thday. Prostration may last for 3 weeks.

Epidemiology

 It depends on three factors

* Density of vector- mosquitoes (presence of water -pH neutral)

* Strength and virulence of virus

* Immunity or susceptibility of individual

Vector

Vectors of dengue fever, chikun gunya and malaria are same.

Word “mos’’ originated from mosquaie (French) means small. Quito means fly. 

Female mosquitoes are only infectious. 

They take blood for longevity and laying eggs. 

Blood sucked female can live more than 4 months.

Mosquitoes are absent in sea and poles. 

They have difficulty to survive in hottest summer, and winter in temperate zone. 

Wet weather with heat of sun favors mosquito multiplication.

Aedes aegypti is responsible for dengue in India.

 Aedes Aegypti is a domestic vector that prefers to breed in rainwater of small artificial container and lays about 25 eggs at a time. 

They are small and have black color with strips.

 Its eggs look like black dots separately.

These mosquitoes cannot fly more than 25 meter while anopheles can fly about 800 meter if wind is favorable. 

It prefer to dark than light colors.

They bite the all vertebrates at dawn, twilight and daytime than night
. 
They are infectious after 12 days from bite on dengue patient. 
 

Aedes albopictus is responsible for dengue in Philippians, and Aedes scutellaris in Guinea.

Dengue fever is an arthropod borne disease caused by filterable virus has 55-milli micron size and belonging to Casal’s B group.

Other viral diseases in this group

Yellow fever (Aedes)

St: Louis encephalitis (Culex- Bird) USA

Russian spring summer fever (Tick)

Japanese B encephalitis (Culex -Bird)

Murray valley encephalitis (Fowl) Australia

O’nyong- nyong (Anopheles -Chickun gunya like symptoms)

Dengue virus is similar to shape of measles and poliomyelitis virus and has 50 milli micron in size (size of chicken pox is about 210mu; Virus has no cell membrane). 

Transovarial route or mosquito-to-mosquito spread of virus not identified.

Four different strains have identified.

Infection through transfusion of blood from dengue patient or through non-sterilized needle contamination was not established.

 

Precaution

Celebrate dry day once in week

Empty the water tank, other materials filled with rainwater and latex-collecting pots on rubber tree once in week. (Microbes are absent in rainwater -Leeuwenhoek).

Replace the water in air cooler.  

Make fogging at school compounds and all depots on Sunday.

Smoke frankincense or camphor inside the house. 

Smoke is very intolerable to mosquitoes.

Do not allow the mosquito multiplication within premise.

Dispose all unnecessary water containers in home premise.

Deposit catfish or Gambusia into aquarium or drainage canal.

Pour crude oil to drainage canal, kerosene oil to domestic well in evening

Add some salt to flower vase.

Aedes aegypti larva cannot grow in impure water.

Apply onion oil, citronella oil, camphorated oil, citric acid lotion locally over undressed part of skin to protect from bite.

Spray body perfumes

Wear school full sleeve uniform of dark color

Add salt to bath tub to maintain alkaline skin PH

Avoid blood of infected dengue patient for transfusion

Avoid visit to infected patient in hospital without proper clothes

Avoid stay with tourists or foreigners in epidemic without taking some precaution.

Special measures

Protect the infected patients from subsequent mosquito bite to prevent hemorrhagic syndromes and to spread to other neighboring healthy individual.

Treatment

Take rest until fever subsides.

Cover the leg and feet with blankets if headache is acute or forehead is warm.

Prefer warm water to drink.

Take sweet or tasty digestible food on early and mild stage of fever.

Make sweating by hot bottles or dry blankets during chill.

Sponge with cold-water over forehead and arm pit if fever is high with insomnia.

Take sufficient rice water in strength of 1:10 if hypotension present.

Take light wheat gruel or light rice porridge.

Take warm tea, zinger tea, or pepper tea if chill persists.

Milk items on chill stage are not favorable.

Sip lime juice if nausea present.

Urinate 5 times daily to expel body toxins as well as virus.

 

Other infectious fevers

Word epidemic (epi-demo) means about the people.

History of earthquake, volcano, etc was present just before epidemic broke out in some countries.

 

Influenza

Peoples of Italy had believed that seasonal fevers are occurring due to influence of heavenly bodies. 

Two core people had died in pandemic influenza occurred in 1918.

Take complete rest during early days of fever.

Take easily digestible food.

Avoid chicken, turkey and egg yolk during epidemic.

Avoid drinking cold water in excess during rainy season.

Cholera

10 thousand people were died and 100 thousand were affected in Indonesian cholera occurred in 1961. 

Sixty people died in Alleppy Kerala due to cholera in 1996.

Avoid acid foods or drinks in cholera epidemic (pickles,fish, meat and tea).

Avoid fasting.

Reduce the quantity of food at night as saliva become acid during night.

Chew food many times during daytime.

Hepatitis

Jaundice appears usually in head foot order.

Hepatitis E infection is more transmitted through shellfish and river fish in tropical.

This virus has special affinity to pregnant women. 

Hepatitis A is self-limiting. 

Avoid ice cream and ready made soft drinks during epidemic. 

Hepatitis B was first developed in 1965 in those had taken vaccination against yellow fever primarily in 1945.

 Incidence of Yellow fever is less.

Leptospirosis

It is one of the common causes for hepatitis.   

Symptoms of hemorrhagic dengue fever are similar to Leptospirosis.

It was epidemic in period between 1998 and 2002; and 446 people had died in south India. 

Lepto spirochetes enter into body through wound in skin and mouth. 

One core spirochete may present in one ml of rat urine.

It also transmitted through dog and cattle’s urine. 

Spirochetes cannot survive in soap water.

Plague

Main symptom of Black Death was bleeding like dengue hemorrhagic fever.

Plague had occurred in AD 542 to 552 in Palestine and Egypt of Rome Empire. 

(This region was the cultural centre of world on that century). 

Black Death also occurred in AD1365 and 1665 in Europe. 
(This was cultural centre of that century). 

Twenty-five core people were died (total world population was 100 core). 

Reservoir was rat. Vector was fleas,bacteria was Yersinia pestis.

Pneumonia, lymph adenitis, and fever are the common symptoms.

Kill rats by giving small cake made of ½ kg of barium carbonate mixing with1 kg of wheat flour. 

Place non-poisons cake on first 3 days to attract rats.

Use trap box.

Avoid bath in open pool near paddy field especially those have wound.

Sprinkle bleaching powder into pool.

Noises are intolerable to rats.

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Seasonal fever

Simple fever is not a disease. 

It is not a symptom.

It is a physiological phenomenon.

Fever lasting for few days only does not make any health problems.

Hippocrates (456-377) said “Give fever, I shall cure all diseases”

 Homoeostasis

Human cells can identify own cells and foreign particle.

Individual become susceptible to disease factors when toxins are increased and settled in body. 

Toxins formed or entered in body are different in each individual constitution and each seasons-winter, spring, summer, monsoon, and autumn.

Homoeostasis is the state of equilibrium of seven elements skin, blood, muscle, fat, bone, bone marrow and semen. When the equilibrium of elements is altered (excess or deficiency) or contaminated by toxins, some suitable medicines are essential to correct it rapidly.

Eliminate the toxins from the body in early stage through the nearest orifice on the last two weeks in each season with least and effective medicines.

When toxins spread to different parts and undergo different metabolism, symptomatic treatment both eliminations and alleviations are required.

Arrange life style according to age, constitution, location, climate and seasons. 

Take fast twice during early weeks of each season.

Body immunity will increase following toxin elimination.

Genus epidemicus

The medicine that effective for large number of patients during epidemic can give to healthy individual in small dose for prophylaxis.

It gives immunity for some months.

Symptoms will be less acute and cure will take place with few days if infection occurs.

It helps to prevent hemorrhagic fever in subsequent periods with same or other strains.

It protects infections through other source like transfusion or catheter inoculation.

It prevents transformation of periarthritis to chronic rheumatic arthritis.

It gives immunity to health staff and gives confidence to attend and treat infected patients.

Other Prophylaxis

Avoid stress.

Make inter lock of all fingers many times.

Press on thumb with index finger frequently during epidemics.

Take camphorated bakery (ledu).

Some medicines

Word thadarthakari means likes, suitable,  and similar.

Take Baptisia 3x for first 3 days in repeated doses.

Take Eupatorium perfoliatum 3x or Cimicifuga3x for 3 days.

Prefer cinchona next three days. 

Other symptomatic medicines are Arsenic album3xand Bryonia alb3x

PreferDulcamara 3x for influenza during rainy season.

Other medicines:Allium sativa and Zingeber

Thrombocytopenia:Alfalfa and Adathoda vasika

Death rate due to both the life style disorders and communicable diseases are decreasing on high standard of living.

“Mortality become less, morbidity become high”.

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