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Febrile convulsions

Alternative Names:Fever fit,Febrile seizure,Seizure – fever induced

Definition:
Febrile convulsions are seizures associated with a significant rise in body temperature that occur in a child with a high fever of over 39°C (102.2°F).  They most commonly occur in children between the ages of 6 months and 6 years and are twice as common in boys as in girls (Lissauer, Tom-Illustrated Book of Paediatrics 3rd Ed.).

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These most typically occur during the early stages of a viral infection such as a respiratory infection, while the temperature is rising rapidly.

Febrile convulsions can be frightening but they’re rarely serious,  as   these convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause.

Three per cent of children have at least one febrile convulsion. There may be a genetic predisposition – up to 20 per cent of relatives will have a seizure disorder including febrile convulsions.

Types:–
There are two types of febrile seizures.

*A simple febrile convulsion is one in which the seizure lasts less than 15 minutes (usually much less than this), does not recur in 24 hours, and involves the entire body (classically a generalized tonic-clonic seizure).

*A complex febrile convulsion is characterized by longer duration, recurrence, or focus on only part of the body.

The simpleconvulsion  represents the majority of cases and is considered to be less of a cause for concern than the complex.

Symptoms:-
Febrile convulsions may be as mild as the child’s eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body.

Febrile convulsions may begin with the sudden contraction of muscles on both sides of a child’s body — usually the muscles of the face, trunk, arms, and legs. The child may cry or moan from the force of the muscle contraction. The contraction continues for several seconds, or tens of seconds. The child will fall, if standing, and may pass urine.

The child may vomit or bite the tongue. Sometimes children do not breathe, and may begin to turn blue.

Finally, the contraction is broken by brief moments of relaxation. The child’s body begins to jerk rhythmically. The child does not respond to the parent’s voice.

The seizures are brief, usually lasting only a minute or two and never more than five minutes.  It is usually followed by a brief period of drowsiness or confusion. A complex febrile convulsion lasts longer than 15 minutes, is in just one part of the body, or occurs again during the same illness.

The child loses consciousness, becomes stiff, stops breathing for up to 30 seconds and loses control of their bladder or bowel, wetting or soiling themselves.

Febrile convulsions are different than tremors or disorientation that can also occur with fevers. The movements are the same as in a grand mal seizure.

This stops after a few minutes and the child regains consciousness. Following the seizure they fall into a deep sleep and are often confused or irritable when they finally wake.

Causes:–
The convulsions occur because the electrical systems in the brain have not yet matured sufficiently to cope with the stress of a high temperature.

About 3 – 5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Febrile seizures often run in families.

Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when the fever is highest. The seizure is often the first sign of a fever or illness

Febrile seizures are usually triggered by fevers from:

•Ear infections
•Roseola infantum (a condition with fever and rash caused by several different viruses)
•Upper respiratory infections caused by a virus
Meningitis causes less than 0.1% of febrile seizures but should always be considered, especially in children less than 1 year old, or those who still look ill when the fever comes down.

A child is likely to have more than one febrile seizure if:

•There is a family history of febrile seizures
•The first seizure happened before age 12 months
•The seizure occurred with a fever below 102 degrees Fahrenheit

Complications:
In about 15 per cent of cases, the child will have another febrile convulsion during the same illness. They also have a one in three risk of a convulsion during a subsequent illness.

Onset before the age of one and a family history increase the risk of recurrent problems.

Most children grow out of febrile convulsions without coming to any harm. However, about one per cent of children do subsequently develop epilepsy (this is more likely if the child has a longer than normal convulsion, or recurrent seizures in the same illness). Talk to your doctor if you’re worried.

Diagnosis:–
The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis.

In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, the child will not need a full seizure workup, which includes an EEG, head CT, and lumbar puncture (spinal tap).

To avoid having to undergo a seizure workup:

•The child must be developmentally normal.
•The child must have had a generalized seizure, meaning that the seizure was in more than one part of the child’s body, and not confined to one part of the body.
•The seizure must not have lasted longer than 15 minutes.
•The child must not have had more than one febrile seizure in 24 hours.
•The child must have a normal neurologic exam performed by a health care provider.

Treatment:–
During the seizure, leave your child on the floor.

•You may want to slide a blanket under the child if the floor is hard.
•Move him only if he is in a dangerous location.
•Remove objects that may injure him.
•Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up.
•If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.
Do NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. Do NOT try to restrain your child or try to stop the seizure movements.

Focus your attention on bringing the fever down:

•Insert an acetaminophen suppository (if you have some) into the child’s rectum.
•Do NOT try to give anything by mouth.
•Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse.
•After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.
After the seizure, the most important step is to identify the cause of the fever.

Prognosis:–
The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties.

A small number of children who have had a febrile seizure do go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures.

Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. The number of febrile seizures is not related to future epilepsy.

About a third of children who have had a febrile seizure will have another one with a fever. Of those who do have a second seizure, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime.

Most children outgrow febrile convulsions by age 5.

Prevention:–
Because  febrile convulsion  can be the first sign of illness, it is often not possible to prevent them. A febrile  convulsion does not mean that your child is not getting the proper care.

Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile convulsions that occur more than once. However, no medication is completely effective in preventing febrile convulsions.

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MoonDragon’s Health & Wellness FEVER …

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/febrileconvulsions2.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000980.htm
http://en.wikipedia.org/wiki/Febrile_seizure

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19076.htm

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Stop Dengue in its Tracks

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Dengue fever is caused by the Aedes egypti mosquito. Culex and Anophelesmosquitoes (which cause diseases like malaria and filaria) are nocturnal — that is, they emerge and bite at night. They can be effectively kept at bay by using mosquito nets while sleeping at night. Aedes egypti, however, is a daytime urban insect. It cannot live above 1,220m or fly more than a hundred metres. It is easily identifiable — its body is striped like that of a tiger. It lives in houses and breeds in stagnant water. This could be in flower vases, old tyres, upturned bottle caps, and even water that collects on leaves and plants.

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Eradication of their breeding grounds is, therefore, a Herculean task, which cannot be achieved by the government alone. Citizens need to do their bit, awaken their civic sense and keep their neighbourhood garbage free. At home, flower vases, water cooler trays, and all sorts of open containers — including broken mugs and bottle caps — should be emptied.

The government often uses frogs or sprays of insecticides to reduce the population of Aedes egypti in populated areas. The sprays need to be used every eight to 10 days to interrupt the cycle of virus transmission. Also, people must leave their doors and windows open so that the insecticide can penetrate indoors, into the nooks and crannies where the mosquitoes rest. We often close all openings to prevent the “harmful chemicals” from entering inside. This negates the effects of spraying.

Once an infected mosquito bites, there is an asymptomatic incubation period of five to six days. After this, dengue sets in abruptly with headache and high fever. There is pain behind the eyes and on moving the eyes. Severe body ache makes it difficult for the person to move, giving dengue the nickname “back breaking” fever. There may be rashes on the skin and inside the mouth. There may also be bleeding into the conjunctiva of the eyes, making them appear blood shot.

After three or four days, the temperature returns to normal. But this is only a temporary respite; the fever returns a few days later with all the previous symptoms but in a milder form. Dengue is, therefore, also called “saddle back” fever.

Unfortunately, there is no specific treatment for dengue. There is no vaccination (as yet) to prevent infection or specific antiviral medication to combat the condition. Affected persons have to ride out the disease with supportive treatment, hoping for the best. Treatment is symptomatic with paracetamol for lowering the fever and fluids for hydration. Aspirin and non-steroidal anti-inflammatory agents like brufen must be avoided. Blood transfusions may have to be given if there is bleeding and shock.

The first attack of dengue usually takes a few weeks to completely recover from. Overall, the disease has a five per cent mortality. It is especially dangerous in children. The dangerous form, called dengue haemorrhagic fever, which is accompanied by shock and bleeding, occurs with subsequent infections with the virus, especially if they are of a different “serotype”.

Humans are infective during the first three days when the virus is multiplying in the blood. During this period, it’s important they lie inside a mosquito net all day and night. This is to prevent them from infecting other members of the household.

The diagnosis is made by excluding other causes of fever. Blood tests may show a low white cell count and platelets. There are, however, some confirmatory tests, like complement fixation, Elisa and an increasing number of antibodies.

Dengue is a self-limited disease. The severity of the symptoms depends on the serotype of the virus, immunological status of the host and, to some extent, genetics.

Herbal products — such as fresh leaves and extracts of neem and tulasi — are being investigated for their anti viral and immune boosting properties. The results are not conclusive. Claims and counterclaims about the efficacy of herbal products are difficult to evaluate. Double blind control studies have not yet been done to prove or disprove their efficacy.

One can prevent mosquito bites to a certain extent by wearing long-sleeved clothing, sleeping inside a mosquito net, and using mosquito meshes for windows and doors. Water should not be allowed to stagnate in containers in and around residential areas. Adding a handful of rock salt or pouring kerosene into stagnant water prevents mosquitoes from breeding.

Remember, no vaccine or specific treatment exists — the only way to escape dengue is to prevent being stung by these pesky insects.

Source: The Telegraph (Kolkata, India)

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Chikungunya

Stegomyia aegypti (formerly Aedes aegypti) mos...
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Definition:
Chikungunya is viral fever caused by an alphavirus. Chikungunya is spread by the bite of Aedes and Culex mosquitoes.
This virus belongs to the genus Alphavirus in the Togaviridae family of viruses. Other Alphaviruses include the Sindbis, eastern and western encephalitis, Semliki Forest and Ross River viruses. The Togaviridae family also includes the genus Rubivirus   to which Rubella belongs.

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It is an insect-borne virus, of the genus, Alphavirus, that is transmitted to humans by virus-carrying Aedes mosquitoes. There have been recent outbreaks of CHIKV associated with severe morbidity. CHIKV causes an illness with symptoms similar to dengue fever. CHIKV manifests itself with an acute febrile phase of the illness lasts only two to five days. Followed by a prolonged arthralgic disease that affects the joints of the extremities. The pain associated with CHIKV infection of the joints persists for weeks or months.

It is a rare viral infection transmitted by the bite of an infected mosquito. It is characterized by a rash, fever, and severe joint pain (arthralgias) that usually lasts for three to seven days. Because of its effect on the joints, Chikungunya has been classified among the Arthritic Viruses. It primarily occurs in tropical areas of the world.

Chikungunya was first described in 1955, following an outbreak on the Makonde Plateau, along the border between Tanganyika and Mozambique in 1952.

Chikungunya is found in Africa, southern India, Pakistan, South-East Asia and the Philippines and occurs predominantly during the rainy season. The range of hosts includes humans, primates, other mammals, and birds. In October 2006, the World Health Organization (WHO) reported chikungunya fever outbreaks in eight states in India.

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ChickV Map

Chikungunya virus..

Between March 2005 and February 2006, 1,722 cases of chikungunya were reported in La Reunion, an island in the Indian Ocean east of Madagascar (territory of France). Two-hundred deaths were attributed to chikungunya.

Signs and symptoms:
Symptoms include:

*high fever
*joint pain with or without swelling (arthritis or arthralgia), typically in the knee, ankle and small joints of the extremities
*chills
*headache
*low back pain
*rash
*vomiting
*mild hemorrhaging may be present especially in children

Asymptomatic (“silent”) infections are common, and immunity is long lasting.

The incubation period of Chikungunya disease is from two to four days. Symptoms of the disease include a fever up to 39 C (102.2 F), a petechial or maculopapular rash of the trunk and occasionally the limbs, and arthralgia or arthritis affecting multiple joints. Other nonspecific symptoms can include headache, conjunctival injection, and slight photophobia. Typically, the fever lasts for two days and then ends abruptly. However, other symptoms, namely joint pain, intense headache, insomnia and an extreme degree of prostration last for a variable period; usually for about 5 to 7 days. Patients have complained of joint pains for much longer time periods depending on their age.

Diagnosis:
Common laboratory tests for chikungunya include RT-PCR, virus isolation, and serological tests.

*Virus isolation provides the most definitive diganosis but takes 1-2 weeks for completion and must be carried out in Biosafety level 3 laboratories. The technique involves exposing specific cell lines to samples from whole blood and identifying chikungunya virus-specific responses.

*RT-PCR using nested primer pairs to amplify several Chikungunya-specific genes from whole blood. Results can be determined in 1-2 days.

*Serological diagnosis requires a larger amount of blood than the other methods and uses an ELISA assay to measure Chikungunya-specific IgM levels. Results require 2-3 days and false positives can occur with infection via other related viruses such as O’nyong’nyong virus and Semliki Forest Virus.

Causes:
Chikungunya virus is indigenous to tropical Africa and Asia, where it is transmitted to humans by the bite of infected mosquitoes, usually of the genus Aedes. CHIK fever epidemics are sustained by human-mosquito-human transmission. The word “chikungunya” is thought to derive from description in local dialect of the contorted posture of patients afflicted with the severe joint pain associated with this disease. The main virus reservoirs are monkeys, but other species can also be affected, including humans.

Treatment:
There are no specific treatments for Chikungunya. There is no vaccine currently available. A Phase II vaccine trial, sponsored by the US Government and published in the American Journal of Tropical Medicine and Hygiene in 2000, used a live, attenuated virus, developing viral resistance in 98% of those tested after 28 days and 85% still showed resistance after one year.

Chikungunya fever is not a life threatening infection. Symptomatic treatment for mitigating pain and fever using anti-inflammatory drugs along with rest usually suffices. While recovery from chikungunya is the expected outcome, convalescence can be prolonged (up to a year or more), and persistent joint pain may require analgesic (pain medication) and long-term anti-inflammatory therapy.

A serological test for Chikungunya is available from the University of Malaya in Kuala Lumpur, Malaysia.

Chloroquine is gaining ground as a possible treatment for the symptoms associated with chikungunya, and as an anti-inflammatory agent to combat the arthritis associated with Chikungunya virus. A University of Malaya study found that for arthritis-like symptoms that are not relieved by aspirin and non-steroidal anti-inflammatory drugs (NSAID), chloroquine phosphate (250 mg/day) has given promising results. Research by an Italian scientist, Andrea Savarino, and his colleagues together with a French government press release in March 2006 have added more credence to the claim that chloroquine might be effective in treating chikungunya. Unpublished studies in cell culture and monkeys show no effect of chloroquine treatment on reduction of chikungunya disease. The fact sheet on Chikungunya advises against using aspirin, ibuprofen, naproxen and other NSAIDs that are recommended for arthritic pain and fever.

DNA vaccine: ….>click  &  see
DNA vaccination is a technique for protecting an organism against disease by injecting it with genetically engineered DNA to produce an immunological response. Nucleic acid vaccines are still experimental, and have been applied to a number of viral, bacterial and parasitic models of disease, as well as to several tumour models. DNA vaccines have a number of advantages over conventional vaccines, including the ability to induce a wider range of immune response types.A recent study report that a novel consensus-based approach to vaccine design for Chikungunya virus, employing a DNA vaccine strategy. The vaccine cassette was designed based on CHIKV Capsid and Envelope specific consensus sequences with several modifications, including codon optimization, RNA optimization, the addition of a Kozak sequence, and a substituted immunoglobulin E leader sequence. Analysis of cellular immune responses, including epitope mapping, demonstrates that these constructs induces both potent and broad cellular immunity in mice. In addition, antibody ELISAs demonstrate that these synthetic immunogens are capable of inducing high titer antibodies capable of recognizing native antigen. Taken together, these results support further study of the use of consensus CHIKV antigens in a potential vaccine cocktail.

Prognosis:
Recovery from the disease varies by age. Younger patients recover within 5 to 15 days; middle-aged patients recover in 1 to 2.5 months. Recovery is longer for the elderly. The severity of the disease as well as its duration is less in younger patients and pregnant women. In pregnant women, no untoward effects are noticed after the infection.

Ocular inflammation from Chikungunya may present as iridocyclitis, and have retinal lesions as well.

Pedal oedema (swelling of legs) is observed in many patients, the cause of which remains obscure as it is not related to any cardiovascular, renal or hepatic abnormalities.

Prevention:
The most effective means of prevention are those that protect against any contact with the disease-carrying mosquitoes. These include using insect repellents with substances like DEET (N,N-Diethyl-meta-toluamide; also known as N,N’-Diethyl-3-methylbenzamide or NNDB), icaridin (also known as picaridin and KBR3023), PMD (p-menthane-3,8-diol, a substance derived from the lemon eucalyptus tree), or IR3535. Wearing bite-proof long sleeves and trousers (pants) also offers protection. In addition, garments can be treated with pyrethroids, a class of insecticides that often has repellent properties. Vaporized pyrethroids (for example in mosquito coils) are also insect repellents. Securing screens on windows and doors will help to keep mosquitoes out of the house. In the case of the day active Aedes aegypti and Aedes albopictus, however, this will only have a limited effect, since many contacts between the vector and the host occur outside. Thus, mosquito control is especially important.

Preventive measures include the same as those for other mosquito-associated diseases (e.g. malaria, malaria, yellow fever, west nile virus).

No vaccine is available against this virus infection. Prevention is entirely dependent upon taking steps to avoid mosquito bites and elimination of mosquito breeding sites.

To avoid mosquito bites:
* Wear full sleeve clothes and long dresses to cover the limbs;
* Use mosquito coils, repellents and electric vapour mats during the daytime;
* Use mosquito nets – to protect babies, old people and others, who may rest during the day. The effectiveness of such nets can be improved by treating them with permethrin (pyrethroid insecticide). Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes.

Mosquitoes become infected when they bite people who are sick with chikungunya. Mosquito nets and mosquito nets and mosquito coils will effectively prevent mosquitoes from biting sick people.

To prevent mosquito breeding
The Aedes mosquitoes that transmit chikungunya breed in a wide variety of manmade containers which are common around human dwellings. These containers collect rainwater, and include discarded tires, flowerpots, old oil drums, animal water troughs, water storage vessels, and plastic food containers. These breeding sites can be eliminated by

*Draining water from coolers, tanks, barrels, drums and buckets, etc.;*Emptying coolers when not in use;
* Removing from the house all objects, e.g. plant saucers, etc. which have water collected in them
* Cooperating with the public health authorities in anti-mosquito measures.
Role of public health authorities
* National programme for prevention and control of vector borne diseases should be strengthened and efficiently implemented with multisectoral coordination

* Legislations for elimination of domestic/peridomestic mosquitogenic sites should be effectively enforced

*Communities must be made aware of the disease and their active cooperation in prevention and control measures elicited .
Read about other arboviral infections:

*Rift Valley Fever

*Dengue Fever

*Yellow Fever: The Disease and Symptoms

*Yellow Fever Infection: Historical Perspective

*Yellow Fever Vaccine: Disease Prevention

Epidemiology
Chikungunya virus is an alphavirus closely related to the O’nyong’nyong virus,[15] the Ross River virus in Australia, and the viruses that cause eastern equine encephalitis and western equine encephalitis

Chikungunya is generally spread through bites from Aedes aegypti mosquitoes, but recent research by the Pasteur Institute in Paris has suggested that chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by Aedes albopictus (Tiger mosquito). Concurrent studies by arbovirologists at the University of Texas Medical Branch in Galveston Texas confirmed definitively that enhanced chikungunya virus infection of Aedes albopictus was caused by a point mutation in one of the viral envelope genes (E1). Enhanced transmission of chikungunya virus by Aedes albopictus could mean an increased risk for chikungunya outbreaks in other areas where the Asian tiger mosquito is present. A recent epidemic in Italy was likely perpetuated by Aedes albopictus.

In Africa, chikungunya is spread via a sylvatic cycle in which the virus largely resides in other primates in between human outbreaks.

History
The name is derived from the Makonde word meaning “that which bends up” in reference to the stooped posture developed as a result of the arthritic symptoms of the disease. The disease was first described by Marion Robinson and W.H.R. Lumsden[22] in 1955, following an outbreak in 1952 on the Makonde Plateau, along the border between Mozambique and Tanganyika (the mainland part of modern day Tanzania).

According to the initial 1955 report about the epidemiology of the disease, the term chikungunya is derived from the Makonde root verb kungunyala, meaning to dry up or become contorted. In concurrent research, Robinson glossed the Makonde term more specifically as “that which bends up.” Subsequent authors apparently overlooked the references to the Makonde language and assumed that the term derived from Swahili, the lingua franca of the region. The erroneous attribution of the term as a Swahili word has been repeated in numerous print sources. Many other erroneous spellings and forms of the term are in common use including “Chicken guinea”, “Chicken gunaya,” and “Chickengunya”.

Since its discovery in Tanganyika, Africa in 1952, chikungunya virus outbreaks have occurred occasionally in Africa, South Asia, and Southeast Asia, but recent outbreaks have spread the disease over a wider range.

You may click to learn more about Chikungunya.:->.………………(1)………(2)……..(3)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Chikungunya
http://microbiology.suite101.com/article.cfm/chikungunya

http://www.webmd.com/a-to-z-guides/chikungunya

http://www.searo.who.int/en/Section10/Section2246.htm

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Infant Fever

A mother holds her baby while it is immunized

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Fevers are fact of life for most children. In most cases they are nothing to worry about, but it is important to monitor the symptoms closely and to seek medical advice if they persist.

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What is a fever?

Fever has been defined as a body temperature elevated to at least 1F above the ‘normal’ of 98.6F (37.0C).

A baby’s temperature normally varies by as much as 2F, depending on the temperature of his surroundings, clothing worn, degree of stress, level of activity or time of day.

What prompts a fever?

In most cases a fever is the body’s reaction to an acute viral or bacterial infection. Raising the temperature helps create an inhospitable environment for viral or bacterial invaders, it also stimulates the production of disease-fighting white blood cells.

Why are babies prone to fevers?

The body’s temperature control system is not well developed in babies.

Infant and childhood fevers can be caused by a number of different factors including:

* Overexertion
* Dehydration
* Mosquito bites
* Bee stings
* Allergic reactions
* Viral or bacteria infections

What are the symptoms?

Typical symptoms of a fever include coughing, aches or pains, an inability to sleep and shivering.

Other symptoms include poor appetite, lethargy and prolonged irritability.

In some cases breathing may be difficult.

What are the treatments?

Dehydration is a risk for infants, and a feverish baby should always be given lots of fluids.

A child with a temperature of less than 102F (38.8C) does not always require immediate medical attention. The child should be observed, and help sought if the symptoms appear to get worse, or the fever does not subside within 24 hours.

A child with a temperature of 102F or higher should be given paracetamol. A doctor or pharmacist should be consulted for a recommended dose.

A doctor’s advice should always be sought for a child whose temperature is 104F (40C) or higher.

Children should not be given aspirin. Several studies link aspirin use in children with Reye’s Syndrome a severe illness that often is fatal.

Are there danger signs?

Certain symptoms, when combined with a fever, warrant an immediate call to the doctor. These include:

* Red spots on the skin, sensitive eyes and runny nose (measles)
* Red, itchy spots (chicken pox)
* Stiffness in the neck or headache (a sign of a more severe infection)

Febrile seizures

Occasionally, a child with a fever will have a seizure. This is called a febrile seizure, and it demands immediate attention from a doctor.

The seizures do not seem to be related to the height of the fever, or to the rapidity with which it rises, but a small number of children seem to be predisposed to attacks.

About 50% of the children who suffer one febrile seizure will go on to have another one. About 33% will have a third one.

While waiting for a doctor to arrive, it is important to follow basic instructions:

* Keep the child upright and make sure they are breathing well
* Stay with the child and talk reassuringly
* Watch for changes in breathing, and make sure that the airways are kept open
* Clear the area to prevent injury
* Do not restrain as this can cause additional injury
* Try placing a soft pillow or blanket under the child’s head
* Loosen clothing to prevent injury and ease discomfort
* If vomiting occurs, turn the head to the side so there is no risk of his choking on inhaled vomit

You may click to learn more about Infant Fever:->Infants Fever

>Fever Quiz

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Sources:BBC NEWS:2nd.June,1999

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Dengue Fever

Definition:

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the “dengue triad”) of fever, rash, and headache (and other pains) is particularly characteristic of dengue.

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Dengue (pronounced DENG-gay) strikes people with low levels of immunity. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that particular serotype to which the patient was exposed.
Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics and Africa, and caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. The geographical spread is similar to malaria, but unlike malaria, dengue is often found in urban areas of tropical nations, including Puerto Rico,Singapore,Malaysia, Taiwan, Indonesia, Philippines, India and Brazil. Each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes aegypti (rarely Aedes albopictus) mosquito, which feeds during the day.

How is dengue contracted?
The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round.

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Aedes aegypti mosquito

One mosquito bite can inflict the disease.
The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway.

Signs & symptoms:

Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104° F (40° C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen.

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This infectious disease is manifested by a sudden onset of fever, with severe headache, muscle and joint pains (myalgias and arthralgias—severe pain gives it the name break-bone fever or bonecrusher disease) and rashes. The dengue rash is characteristically bright red petechiae and usually appears first on the lower limbs and the chest; in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting or diarrhea.

Other symptoms include:

* fever;
* bladder problems;
* constant headaches;
* severe dizziness; and,
* loss of appetite.
* uncontrollable laughing,
* extreme constipation

Some cases develop much milder symptoms which can, when no rash is present, be misdiagnosed as influenza or other viral infection. Thus travelers from tropical areas may inadvertently pass on dengue in their home countries, having not been properly diagnosed at the height of their illness. Patients with dengue can pass on the infection only through mosquitoes or blood products and only while they are still febrile.

The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the disease (the so-called “biphasic pattern”). Clinically, the platelet count will drop until the patient’s temperature is normal.

Cases of DHF also show higher fever, haemorrhagic phenomena, thrombocytopenia, and haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate.

Diagnosis:

The diagnosis of dengue is usually made clinically. The classic picture is high fever with no localising source of infection, a petechial rash with thrombocytopenia and relative leukopenia.

The WHO definition of dengue haemorrhagic fever has been in use since 1975; all four criteria must be fulfilled:

1. Fever, bladder problem, constant headaches, severe dizziness and loss of appetite.
2. Hemorrhagic tendency (positive tourniquet test, spontaneous bruising, bleeding from mucosa, gingiva, injection sites, etc.; vomiting blood, or bloody diarrhea)
3. Thrombocytopenia (<100,000 platelets per mm³ or estimated as less than 3 platelets per high power field)
4. Evidence of plasma leakage (hematocrit more than 20% higher than expected, or drop in haematocrit of 20% or more from baseline following IV fluid, pleural effusion, ascites, hypoproteinemia)

Dengue shock syndrome is defined as dengue hemorrhagic fever plus:

* Weak rapid pulse,
* Narrow pulse pressure (less than 20 mm Hg) or,
* Cold, clammy skin and restlessness.

Serology and polymerase chain reaction (PCR) studies are available to confirm the diagnosis of dengue if clinically indicated.

Treatment:

Because dengue is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic).

The mainstay of treatment is supportive therapy. Increased oral fluid intake is recommended to prevent dehydration. Supplementation with intravenous fluids may be necessary to prevent dehydration and significant concentration of the blood if the patient is unable to maintain oral intake. A platelet transfusion is indicated in rare cases if the platelet level drops significantly (below 20,000) or if there is significant bleeding.

The presence of melena may indicate internal gastrointestinal bleeding requiring platelet and/or red blood cell transfusion.

Aspirin and non-steroidal anti-inflammatory drugs should be avoided as these drugs may worsen the bleeding tendency associated with some of these infections. Patients may receive paracetamol preparations to deal with these symptoms if dengue is suspected.

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Emerging treatments

Emerging evidence suggests that mycophenolic acid and ribavirin inhibit dengue replication. Initial experiments showed a fivefold increase in defective viral RNA production by cells treated with each drug. In vivo studies, however, have not yet been done.

Prevention:

Vaccine development

There is no commercially available vaccine for the dengue flavivirus. However, one of the many ongoing vaccine development programs is the Pediatric Dengue Vaccine Initiative which was set up in 2003 with the aim of accelerating the development and introduction of dengue vaccine(s) that are affordable and accessible to poor children in endemic countries. Thai researchers are testing a dengue fever vaccine on 3,000–5,000 human volunteers after having successfully conducted tests on animals and a small group of human volunteers. A number of other vaccine candidates are entering phase I or II testing.

Mosquito control
A field technician looking for larvae in standing water containers during the 1965 Aedes aegypti eradication program in Miami, Florida. In the 1960s, a major effort was made to eradicate the principal urban vector mosquito of dengue and yellow fever viruses, Aedes aegypti, from southeast United States. Courtesy: Centers for Disease Control and Prevention Public Health Image Library
A field technician looking for larvae in standing water containers during the 1965 Aedes aegypti eradication program in Miami, Florida. In the 1960s, a major effort was made to eradicate the principal urban vector mosquito of dengue and yellow fever viruses, Aedes aegypti, from southeast United States. Courtesy: Centers for Disease Control and Prevention Public Health Image Library

click to see the picture

Primary prevention of dengue mainly resides in mosquito control. There are two primary methods: larval control and adult mosquito control. In urban areas, Aedes mosquitos breed on water collections in artificial containers such as plastic cups, used tires, broken bottles, flower pots, etc. Continued and sustained artificial container reduction or periodic draining of artificial containers is the most effective way of reducing the larva and thereby the aedes mosquito load in the community. For reducing the adult mosquito load, fogging with insecticide is somewhat effective.

Prevention of mosquito bites is another way of preventing disease. This can be achieved either by personal protection or by using mosquito nets. In 1998, scientists from the Queensland Institute of Research in Australia and Vietnam’s Ministry of Health introduced a scheme that encouraged children to place a water bug, the crustacean Mesocyclops, in water tanks and discarded containers where the Aedes aegypti mosquito was known to thrive. This method is viewed as being more cost-effective and more environmentally friendly than pesticides, though not as effective, and requires the ongoing participation of the community.

Personal protection

Personal prevention consists of the use of mosquito nets, repellents containing NNDB or DEET, covering exposed skin, use of DEET-impregnated bednets, and avoiding endemic areas.

Dengue is caused by the bites of the tiger striped Aedes aegypti mosquito, which, unfortunately, is a daytime mosquito. It hides in dark corners in houses and breeds in clean water in flowerpots and even bottle caps. Also, there is no immunisation as yet against dengue.

One could make sure there is no stagnant water in  his or her  house. The house should be “mosquito proofed” with mesh covered windows and doors. Wear protective clothing and apply mosquito repellent ointment or liquid on the clothes. The vapourising mosquito repellents will drive away the mosquitoes, but the smoke is toxic to humans also.

Potential antiviral approaches

In cell culture experiments and mice Morpholino antisense oligos have shown specific activity against Dengue virus.

The yellow fever vaccine (YF-17D) is a related Flavivirus,[clarify] thus the chimeric replacement of yellow fever vaccine with dengue has been often suggested[clarify] but no full scale studies have been conducted to date.

In 2006, a group of Argentine scientists discovered the molecular replication mechanism of the virus, which could be attacked by disruption of the polymerase’s work

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Dengue_fever
http://www.medicinenet.com/dengue_fever/article.htm#1whatis

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