IPHREHAB : INFECTION, TYPHOID

IPHREHAB

TYPHOID

• Very common disease in our country
• Outbreaks are known to occur from time to time
• Pollution & Insanitary condition
• Present in animals except S.Typhi
• Transmitted by food, water, Milk
•  May be directly from one person to another

AETIOLOGY

• Caused by Salmonella Group of Organisms
• Reservoir are animals except for S.Typhi which is seen only in human beings
• There are 2000 Serotypes
• Faeco-oral route
• Tranmission through food, Flies & Fomites
• It involves Payer’s patches of small Intestines

CLINICAL PICTURE

• Fever is most common presenting symptom
• Fever is step ladder pattern
• Onset is insidious
• There is Malaise, Headache, Cough,  Drowsiness & Bodyaches
• Constipation common
• Relative Bradycardia
• Rash may appear on fifth day
• Toxaemia is Max. in 2nd Week
• Spleen is palpable
• Toxaemia increases in 3rd Week
• Coma may set in & may lead to death
• Antibiotics give the best results
• Carriers are well known

INVESTIGATIONS

• Complete Blood Leukopenia Increase in Lympho
• Blood Culture +ve  first week
• Widal’s  Test  2nd Week Rising titer is diagnostic
• Urine & Stool Culture

COMPLICATIONS

• Perforation
• Haemorrhage
• Osteomyelitis
• Meningitis
• Myocarditis
• Pneumonia
• Nephritis
• Hepatitis

MANAGEMENT

• General Management :- Analgesics for fever, Antiemetics (Perinorm) for vomiting
• Antibiotics Ciproflxacillin 500mg BD
• Cotrimoxazole 
• Amoxycillin
• Carrier Ciproflox for 4 weeks
• Prevention - Vaccination

IPHREHAB : INFECTIONS, MEASLES AND MUMPS

IPHREHAB

INFECTIONS

MEASLES

• It is caused by Virus ( Paramyxo)
• It is usually seen in children
• One attack give permanent immunity
• It is in in severe form in malnourished person ( in our country)
• Very high mortality
• Incubation period is 10 days

CLINICAL  PICTURE

• Catarrhal Stage    High Fevere    Severe Nasal Catarrh Sneezing, Redness of Eyes- Conjuctivitis Kapolick Spots in mouth
• Cough Hoareseness of Voice Photophobia
• Child is very irritable & in Miserable Stage
• Exanthematous stage  Koplik  spots disappear  Rash appear on 2-4 day  Rash is maculo papular initially on back of   ear
• It rapidly spread over the body – become blotchy
• Rash settle down in one week Fever subside

COMPLICATIONS

• Stomatitis Entertitis Pneumonia Keratitis
• Otitis Media, Conjunctivitis
• Brochopneumonia
• Encephalitis
• Malnutrition Vitamin A deficiecy
• Severe weight loss

MANAGEMENT

• Bed Rest No schooling for 10 days
• Symptomatic Treatment
• Antibiotics
• Prevetion – active immunisation
• Passive immunisation in serious cases  250 mg IM

MUMPS

• Common disorder in our country
• Caused by virus
• Incubation period 18 days
• Spread by droplet infection
• Not very virulent
• Infectivity ver low
• May remain subclinical

CLINICAL  PICTURE

• Fever
• Pain in the jaw
• Trismus
• Swelling of Parotid Gland subside in 2-3 days
• Meningitis Encephalitis
• Pancreatitis
• Orchitis

MANAGEMENT

• Treat the symptoms
• Antibiotics if bact. Infection is present
• In orchitis cases give predisolone 40 mg daily
• Vaccination for prevention- MMR

IPHREHAB : INFECTIONS, DIPHTHERIA

IPHREHAB

INFECTIONS

DIPHTHERIA

• It is disease caused by Gram + Bacteria
• Bacteria produces Exotoxin – which damages Heart & Nervous system
• It is common in India usually affecting children
• Sore Throat is presenting symptom
• Disease spread by droplet Infection

CLINICAL PICTURE

• Incubation period is 2-4 days
• Infection can occur over the Conjunctiva, Genital tract, Wounds & Abrasions
• Fever is high
• Grayish Green Membrane on Tonsils
• Membrane is firm & adherent
• Swelling of Neck (Bull’s Neck)
• Nasal Infection Common 
• Nasal Discharge ++ – May be Bloody in nature
• Husky voice due to Laryngitis
• Respiratory Infection can lead to death
• ECG may show tachycardia & T-wave changes
• Palatal Paralysis
• Accommodation may be paralysed
• Polyneuritis is seen in few cases

MANAGEMENT

• Inform the Public Health Department
• Give anti-toxin 4000-32000 IM
• Benzyl Penicillin -4 lacs Units 6 hourly for one week
• Treat Complications -  Resp. & Cadiac
• Protect Close relatives Erythromycin Immunization.

IPHREHAB : HOW TO READ ECG

IPHREHAB

HOW TO READ ECG
Name                        Age                   Sex
Clinical  Diagnosis
Drugs taken
Rate      /mt Rhythm          Axis
P-wave PR interval     sec.
QRS duration ST segment
T-wave
DIAGNOSIS

PERSISTENT JUVENILE PATTERN

PROMINENT U WAVES

P - WAVE:

• IT INDICATES ATRIAL ACTIVATION
• BEST SEEN IN LEAD II & v1
• DURATION 0.08 to 0.11 SECONDS
• IT IS BIPHASIC IN v1
• FIRST RISE IS DUE TO RIGHT ATRIAL CONTRACTION
• SECOND RISE IS DUE TO LEFT ATRIAL CONTRACTION