MedUrgent

   Management of Severe Malnutrition Admission criteria: 1) Children 6-59 months: - Bilateral pitting oedema +++ - Severe wasting with any grade of oedema - Severe malnutrition with any of the following medical complications:   • Anorexia / No appetite • Intractable vomiting  • Convulsions • Lethargy/ Not alert • Unconsciousness • Hypoglycemia • High fever • Hypothermia • Severe dehydration • Lower respiratory tract infection  • Severe anemia  • Skin lesions  2)  Infants <6 months:  - Bilateral pitting oedema - Visible wasting - Inadequate feeding - Weight <4 kg  *Initial Phase:  1- Document:  - The presence of Wasting, Oedema and Dermatosis  - Weight-for-Height/Weight -for-Length - Z-sore (SD/%) 2- Temperature:  (check every 30 min)  - Axillary temp. <35 C, start active worming (Kangaroo position) 3- Hypoglycemia:  - Blood glucose <3 mmol/l -Alert patient:...

 LEPROSY (Hansen's disease) Armauer Hansen in Bergen (Norway) in 1873 descried Mycobacterium leprae as the first reported bacterial pathogen in humans in a fresh mount of scraping from a leproma of a Norwegian leprosy patient. M.Leprae is an acid-fast bacillus that does not grow on the routine mycobacteriologic media. It multiplies slowly and when killed leads to strong reactions as in tuberculoid leprosy patients while lepromatous patients do not show this reaction. It is the most common communicable disease affecting the peripheral system and the skin world-wide, but now it is mainly confined to the developing world.  Pathogenesis: In Sudan, it is endemic in the South, Nuba Mountains and Central Sudan. The mode of transmission is not uniform and skin-to-skin contact, nasal secretions, breast feeding, flies, sexual intercourse and blood transfusion and prolonged contact by a susceptible subject with a source, as in the case of husband and wife and children are all possible ro...

 ِBURULI ULCER   This is a chronic type of ulcers that is commonly seen in Uganda (Buruli County area), Sudan, West Africa, New Guinea, South East Asia, South America and Australia. The disease is caused by Mycobacterium ulcerans and transmitted via aquatic areas. Pathogenesis It starts as a painless subcutaneous nodule in any part of the body especially exposed areas. Infection of the subcutaneous fat leads to skin ulceration due to the toxin produced by the Mycobacterium ulcerans. In severe forms or super-infected ulcers, there is pain and fever. Ulceration heals by granulation leading to scarring and contractures. Investigations - Culture of a swab  - Ziehl-Neelsen stain - PCR Treatment - Rifampicin+ Streptomycin for 8 weeks (or clarithromycin) - Surgical excision - Local heat at 40 C Prevention - BCG vaccination

  YAWS Yaws is a non-venereal spirochaetal disease caused by treponema pertenue. The disease is transmitted by direct contact through skin abrasions. It is common in children (70% of cases) and adults in Africa, South America, South East Asia, South Pacific Islands and Australia, mostly in worm and humid areas. Clinical Picture The Primary lesion starts as a papule that ulcerates and increase in size and may get secondary infected, develop into secondary lesion or heals spontaneously. The Secondary lesion appears after weeks to years from the primary lesion. It may present as crops of papules, rounded framboesial granuloma, papilloma, ulcers, hyper-keratosis of palms and soles, osteitis, dermatitis and lymphadenopathy. The Tertiary lesions appear after a latent period and manifests as necrotic lesions of the skin and bones (saber tibia and boomerang leg), palatal destruction, bursitis and secondary infections. Goundou (boney thickness of the maxilla) and Gangosa (ulcerative...

 TRACHOMA (Greek: roughness)   Trachoma is a leading cause of blindness in the world. It is caused by the bacteria Chlamydia trachomatis. Pathogenesis: Chlamydia trachomatis is spread by flies and fomites through wet secretions from the eyes, nose and throat. A single attack may resolve spontaneously but repeated attacks end up with entropion, corneal ulceration and complete blindness. Clinical Incubation period is 5-7 days followed by conjunctival inflammation, appearance of conjunctival follicles in the under surface of the upper eye lid and watery discharge that may become purulent with secondary bacterial infection. The condition is associated with intense itching, eye discharge, photophobia and local lymphadenopathy. Cicatricial trachoma is a late manifestation that includes distortion of the eye lid (entropion), trichiasis (eye lid hair scratching the cornea), corneal ulceration, scarring and blindness. Treatment   -Azithromycin 20mg/kg once oral -Topi...

  PLAGUE Plague is a zoonotic infection of rodents which is caused by the gram negative coccobacillus Yersinia pestis. The disease is transmitted by fleas that feed on rats or through direct contact with infected tissues and body fluids. Incubation period is 2-8 days. Pathogenesis: After a flea bite or exposure through other methods, the bacteria migrate to the lymph nodes leading to lymphadenopathy (Buboes) and it may spread systemically leading to bacteremia or pneumonia. Clinical picture: Plague may present in any of the following forms: 1- Bubonic: This is the commonest form. Two to eight days after a flea bite, the inguinal lymph nodes enlarge and may be associated with fever, rigors, headache and prostration. Other lymph nodes e.g. axillary and cervical may also be involved. DIC, purpura, gangrene and death may soon follow. 2- Septicemia : This form may follow bubonic plague or results from direct contact with infected fluids and tissues. It presents with severe t...

VIRAL HAEMORRHAGIC FEVERS Viral Hemorrhagic Fever defines a syndrome caused by 4 different families of RNA viruses. Though they have constant features in common, yet there are particular clinical features associated with different viruses. They can cause disastrous epidemics with case fatality rate up to 50%. Classification 1. Arenaviruses e.g. Guanarito, Junin, Machupo and Lassa. They have rodent reservoir. Humans are infected by aerosols of rodent excreta or other close contacts with rodents. 2. Bunyaviruses e.g. Rift Valley, Criean-Congo and Hantaan. Transmission through mosquito bites, aerosols or contact with blood of domestic animals, tick bite and rodent excreta. 3. Filovirus e.g. Ebola and Marburg. Mode of transmission is by person to person through body fluids 4. Flaviviruses e.g. yellow fever, Dengue and Kyanasur forest disease. Mode of transmission is through mosquito and tick bites.  Clinical features After contracting the disease, the incubation period ...