By: Jenny Babe R.

Barrera
BSN-II

Disease Study: MALARIA

Definition
Malaria is a mosquito-borne infectious disease of humans and other animals caused by
parasitic protozoans (a group of single-celled microorganism) belonging to the
genus Plasmodium. The disease is transmitted by the biting of mosquitos, and the symptoms
usually begin ten to fifteen days after being bitten. . Five species of Plasmodium can infect and
be spread by humans. Most deaths are caused by P. falciparum because P. vivax, P. ovale,
and P. malariae generally cause a milder form of malaria. The species P. knowlesi rarely causes
disease in humans.

Signs and Symptoms

The signs and symptoms of malaria typically begin 825 days following infection;] however,
symptoms may occur later in those who have taken antimalarial medications as
prevention. Initial manifestations of the diseasecommon to all malaria speciesare similar
to flu-like symptoms and can resemble other conditions such as septicemia, gastroenteritis,
and viral diseases. The presentation may include headache, fever, shivering, joint
pain, vomiting, hemolytic anemia, jaundice, hemoglobin in the urine, retinal damage,
and convulsions.
The classic symptom of malaria is paroxysma cyclical occurrence of sudden coldness followed
by shivering and then fever and sweating, occurring every two days (tertian fever)
in P. vivax and P. ovale infections, and every three days (quartan fever)
forP. malariae. P. falciparum infection can cause recurrent fever every 3648 hours or a less
pronounced and almost continuous fever.
Severe malaria is usually caused by P. falciparum (often referred to as falciparum malaria).
Symptoms of falciparum malaria arise 930 days after infection. Individuals with cerebral
malaria frequently exhibit neurological symptoms, including abnormal
posturing,nystagmus, conjugate gaze palsy (failure of the eyes to turn together in the same
direction), opisthotonus, seizures, or coma.

Pathophysiology

the bite of an infected female Anopheles mosquito

injects 8 to 15 malarial sporozoites, which rapidly enter hepatocytes

Reproduction by asexual fission (tissue schizogony) takes place to form a pre-erythrocytic

schizont.

After a period of time, 30 to 40 thousand merozoites are released into the blood stream to
penetrate erythrocytes after attaching via receptors.

Most merozoites undergo blood schizogony to form trophozoites, evolving to schizonts, which
rupture to release new merozoites.

These then invade new erythrocytes and the 48-hour cycle continues, sometimes resulting in
periodicity of fever. The rupture of erythrocytes releases toxins that induce the release of
cytokines from macrophages, resulting in the symptoms of malaria

Diagnostic Test
Owing to the non-specific nature of the presentation of symptoms, diagnosis of malaria in nonendemic areas requires a high degree of suspicion, which might be elicited by any of the
following: recent travel history, enlarged spleen, fever, low number of platelets in the blood,
and higher-than-normal levels of bilirubin in the blood combined with a normal level of white
blood cells.
Malaria is usually confirmed by the microscopic examination of blood films or by antigenbased rapid diagnostic tests (RDT). Microscopy is the most commonly used method to detect the
malarial parasite.

Medical Management

Malaria is treated with antimalarial medications; the ones used depends on the type and
severity of the disease. While medications against fever are commonly used, their effects
on outcomes are not clear.

Uncomplicated malaria may be treated with oral medications. The most effective
treatment for P. falciparum infection is the use of artemisinins in combination with other
antimalarials (known as artemisinin-combination therapy, or ACT), which decreases
resistance to any single drug component.

These additional antimalarials include:amodiaquine, lumefantrine, mefloquine

or sulfadoxine/pyrimethamine.

Another recommended combination is dihydroartemisinin and piperaquine.

To treat malaria during pregnancy, the WHO recommends the use of quinine
plus clindamycin early in the pregnancy (1st trimester), and ACT in later stages (2nd and
3rd trimesters).

Recommended treatment for severe malaria is the intravenous use of antimalarial drugs.
For severe malaria, artesunate is superior to quinine in both children and adults.

Treatment of severe malaria involves supportive measures that are best done in a critical
care unit. This includes the management of high fevers and the seizures that may result
from it. It also includes monitoring for poor breathing effort, low blood sugar, and low
blood potassium.

Nursing Management
Health education
To prevent mosquito bites, follow these guidelines:
Wear protective clothing (long pants and long-sleeved shirts).
Use insect repellent with DEET (N,N diethylmetatoluamide). The repellent is available in
varying strengths up to 100%. In young children, use a preparation containing less than
24% strength, because too much of the chemical can be absorbed through the skin.
Use bed nets (mosquito netting) sprayed with or soaked in an insecticide such
as permethrin or deltamethrin. But make sure that these insecticides still work against the
mosquitoes where you are.
Use flying-insect spray indoors around sleeping areas.

 Avoid areas where malaria and mosquitoes are present if you are at higher risk (for
example, if you are pregnant, very young, or very old).

Disease Study: Dengue Hemorrhagic Fever

Definition
Dengue fever also known as breakbone fever, is a mosquito-borne tropical disease caused by
the dengue virus. In a small proportion of cases the disease develops into the lifethreatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and
blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure
occurs.
Dengue is transmitted by several species of mosquito within the genus Aedes, principally A.
aegypti. The virus has five different types; infection with one type usually gives
lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection
with a different type increases the risk of severe complications. As there is no commercially
available vaccine, prevention is sought by reducing the habitat and the number of mosquitoes
and limiting exposure to bites.

Signs and Symptoms

Symptoms, which usually begin four to six days after infection and last for up to 10 days, may
include
Sudden, high fever
Severe headaches
Pain behind the eyes
Severe joint and muscle pain
Nausea
Vomiting
Skin rash, which appears three to four days after the onset of fever
Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)
The course of infection is divided into three phases: febrile, critical, and recovery.
Febrile stage:
Petechiae (small red spots that do not disappear when the skin is pressed)
caused by broken capillaries
mild bleeding from mucous membranes of the mouth and nose
biphasic or saddleback
involves high fever over 40 C (104 F)
associated with generalized pain and a headache lasts two to seven days, nausea,
vomiting.

rash occurs in 1st or 2nd day of symptoms such as: flushed skin
course of illness (days 47)
measles-like rash
"islands of white in a sea of red

Critical Stage
There may also be organ dysfunction and severe bleeding
typically from the gastrointestinal tract
there is leakage of plasma from the blood vessels lasts 1-2 days
may result in fluid accumulation in the chest and abdominal cavity
depletion of fluid from the circulation and decreased blood supply to vital organs
Recovery Stage
with resorption of the leaked fluid into the bloodstream lasts 2-3 days
accompanied with severe itching and a slow heart rate
rash either a maculopapular or vasculitic followed by peeling of the skin
fluid overload state
if it affects the brain, it may cause a reduced level of consciousness orseizures
fatigue may also occur
During the recovery phase intravenous fluids are discontinued to prevent a state of fluid
overload.
If fluid overload occurs and vital signs are stable, stopping further fluid may be all that is
needed.
If a person is outside of the critical phase, aloop diuretic such as furosemide may be used
to eliminate excess fluid from the circulation

Pathophysiology
The dengue virus is transmitted to humans:
via the bite of an infected mosquito
Only a few mosquito species are vectors for the dengue virus
most common vectors are Arthropods which includes mosquitoes, ticks, lice, flies, and fleas.
some mosquitoes can carry yellow fever and malaria
4 days after being bit by an infected
Aedes aegypti mosquito the person will develop viremia.
5 days after being bit by the infected mosquito, the person develops symptoms of dengue fever,
which can last for a week or longer.

Diagnostic Test
The diagnosis of dengue is typically made clinically, on the basis of reported symptoms
and physical examination; this applies especially in endemic areas A probable diagnosis is based
on the findings of fever plus two of the following: nausea and vomiting, rash, generalized
pains, low white blood cell count, positive tourniquet test, or any warning sign in someone who
lives in an endemic area. The tourniquet test, which is particularly useful in settings where no
laboratory investigations are readily available, involves the application of a blood pressure
cuff at between the diastolic and systolic pressure for five minutes, followed by the counting of
any petechial hemorrhages; a higher number makes a diagnosis of dengue more likely with the
cut off being more than 10 to 20 per 1 inch2(6.25 cm2).
The earliest change detectable on laboratory investigations is a low white blood cell count, which
may then be followed by low platelets and metabolic acidosis. A moderately elevated level
of aminotransferase (AST and ALT) from the liver is commonly associated with low platelets
and white blood cells.

Medical Management

Treatment depends on the symptoms.

Those who are able to drink, are passing urine, have no "warning signs" and are
otherwise healthy can be managed at home with daily follow up and oral rehydration
therapy .
Intravenous hydration, if required, is typically only needed for one or two days. The
smallest amount of fluid required to achieve this is recommended.
Invasive medical procedures such as nasogastric intubation,intramuscular injections and
arterial punctures are avoided, in view of the bleeding risk.
Paracetamol (acetaminophen) is used for fever and discomfort while NSAIDs such
asibuprofen and aspirin are avoided as they might aggravate the risk of bleeding.
Blood transfusion is initiated early in people presenting with unstable vital signs in the
face of adecreasing hematocrit, rather than waiting for the hemoglobin concentration to
decrease to some predetermined "transfusion trigger" level.
Packed red blood cells or whole blood are recommended, while platelets and fresh
frozen plasma are usually not.

Nursing Management
Health education on the prevention of hemorrhage may include:
Avoidance of dark colored foods and liquids

Client is encouraged to prevent from using sharp- bristled toothbrushes, instead advised
to gargle with saline solution
Clients are educated not to use hot liquids for alleviation of chills etc.
Avoidance of sharp objects like razors are emphasized on adults
The use of ASPIRIN is strictly prohibited.
In cases that hemorrhage sets in, nursing care may involve the following:
Keep the client at bed rest and ensure safety to prevent from injury
Client is usually placed in dorsal recumbent position.