More awareness needed on Scrub Typhus in India

More awareness needed on Scrub Typhus in India • Disease causes symptoms similar to chikungunya • Timely treatment can prevent death New Delhi, 15 September 2017: A bacterial infection taking a toll on many, scrub typhus causes symptoms that are akin to chikungunya. In 2016, of the 150 tested for the infection, 33 were positive. There are 35% to 40% chances of fatality if the disease is left untreated. As per the IMA, there is a need for greater awareness on scrub typhus among physicians working at the primary and secondary care levels as well as for better availability of diagnostics in the healthcare system. Scrub typhus spreads when chiggers – mites found in forests and, more recently, in urban shrubs – bite the person and inject the bacteria called Orientia (earlier called Rickettsia) tsutsugamushi into the blood. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Scrub typhus may begin insidiously with headache, anorexia, and malaise, or start abruptly with chills and fever. As the illness evolves, most patients develop high fever, worsening of headache severity and myalgias. A characteristic eschar, an ulcerated area with a black necrotic center, may often develop at the site of the bite and is diagnostic. Approximately one-half of all patients develop a characteristically nonpruritic, macular or maculopapular rash, which typically begins on the abdomen and spreads to the extremities. The face is also often involved. Patients treated with appropriate antibiotics typically become afebrile within 48 hours of starting treatment. This response to treatment is useful diagnostically; failure of defervescence within 48 hours is often considered evidence that scrub typhus is not present.” The disease has an incubation period of 6 to 21 days, and lasts for 2 to 3 weeks. Patients with a mild infection may recover without any other symptoms. The differential diagnosis of scrub typhus includes malaria, dengue, leptospirosis, Chikungunya and other rickettsial infections. Adding further, Dr Aggarwal, said, “Several studies have demonstrated that chemoprophylaxis with a long-acting tetracycline is highly effective when used by nonimmune individuals living or working in areas in which scrub typhus is endemic. The use of insect repellants and miticides are highly effective when applied to both clothing and skin. Permethrin and benzyl benzoate are also useful agents when applied to clothing and bedding.” The following tips can help to prevent scrub typhus. • Avoid travelling to places where mites are known to be present in large numbers. • Wear protective clothing when travelling to an endemic area. Long sleeved clothes can prove helpful. • Apply mite repellents to exposed skin. • Those with risk factors and who work in an endemic area can be given once weekly dose of doxycycline.

IMA supports insurance for death due to mosquito bite

IMA supports insurance for death due to mosquito bite Recommends an all-encompassing effort from the community as a whole to address this issue New Delhi, 15 May 2017: According to the South Delhi Municipal Corporation, 79 cases of chikungunya and 24 cases of dengue have been reported in Delhi just three months since 1 January 2017. Of these, 11 patients acquired the infection from neighboring states. It is a fact that we have collectively failed last year in controlling the mosquito menace and consequently, the mosquito menace is back this year. There is a need to over report and act in time and not only when the cases start appearing. Failure to act can be attributed collectively to Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the private sector. It is time that last year's failure is converted into success this year. Speaking on this issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "The mosquito menace requires a community approach which involves every component of the society. Every premise must display that it is mosquito-free. When you are invited to somebody’s place, you should ask 'I hope your premises are mosquito-free' and when you invite somebody, write 'Welcome to my house and it is mosquito-free. This should become a routine in a premises. Just like we do not clean our premises once in a week, it is important to look for and clean the breeding places daily." The fact that mosquito bites are a serious issue has been reiterated via a recent judgement by the National Consumer Disputes Redressal Commission (NCDRC) which ruled that the wife of a man who died due to a mosquito bite was eligible for claiming insurance. The commission ruled that 'It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act of omission on part of the victim'. It further said that death caused by mosquito bite is an accident, and directed the insurer to honor its policy to the widow. Adding further, Dr Aggarwal, said, "The need of the hour is a paradigm shift in the approach towards the dengue menace. We need to follow the formula of 20 to identify dengue fever: if there is a rise in pulse by 20; there is fall in upper blood pressure by 20; if there is a rise in hematocrit by 20%; there is a rapid fall in platelets to less than 20,000 with a rapid rise in hematocrit by 20%; if there is a petechial count of more than 20 in one inch after tourniquet test and a difference of less than 20 between the upper and lower blood pressure, then such patients should be given at least 20 ml of fluid per kg immediately followed by continuous fluids till they pass urine. This is one of the most immediate steps to combat the condition." IMA recommends the following approach to target the mosquito menace: Ghar ke ander maro aur ghar ke bahar maro; din me maro, sham me maro aur raat me maro; deewaron ke niche maro aur deewaron ke upar maro; chote pani ki collection me aur bade pani ke collection me maro; eggs ko maro, larve ko maro, pupa ko maro aur mosquito ko maro; chath me maro, kamre me maro, veranda me maro; container me pani ke niche maro aur container me pani ke upar maro, aedes ko maro, culex ko maro aur anopheles ko maro.

Dengue and chikungunya hit the capital again

Dengue and chikungunya hit the capital again IMA warns of a possibly larger breakout unless immediate action is taken along with community participation New Delhi, April 13, 2017: A recent report by the South Delhi Municipal Corporation (SDMC) on vector-borne diseases has revealed about 79 cases of chikungunya in the national capital this year. In the last three months, 24 cases of dengue have been reported, of which 11 patients acquired the infection from one of the neighbouring states. According to the SDMC, there were 9 new cases of chikungunya this week. All these patients were from the neighbouring states. Although chikungunya and dengue cases had tapered off by the first week of December last year, this year has again brought back many such cases. Speaking about this Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "IMA had already indicated that the cases of vector-borne diseases in the capital will be as predicted last year. Dengue and chikungunya cases in Delhi so far have been a matter of great concern. Dengue cases create panic among the public every year. We must all agree that collectively we have failed in controlling the mosquito menace and consequently, Delhi today is in the midst of an increasing number of dengue and malaria patients. This is a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the Private sector. Dengue is preventable and the very first step towards this is its management. However, to make this possible, community participation is a must." Both dengue and chikungunya are viral diseases transmitted by Aedes mosquitoes. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Most of the symptoms associated with both diseases are the same, with some key differences. High fever is the primary symptom of dengue along with the at least two of the following: severe headache, severe eye pain, joint, muscle or bone pain, rash, mild bleeding from the nose or the gums, small spots caused by bleeding into the skin, and low white cell count. In severe cases, plasma leakage can lead to shock, hemorrhage (internal bleeding), and organ impairment. At this stage, the disease is potentially fatal. On the other hand, chikunguniya symptoms include high fever, severe joint pain, joint swellings, muscle pain, headaches, and rashes and this disease is mostly non-fatal. Highlighting the importance of community participation in taking action against vector-borne diseases, Dr K K Aggarwal added, "Individuals, families, and communities need to be more involved in the planning and conduct of local vector control activities. It is not possible for the government to employ enough people to search every backyard and identify and destroy breeding sites. At IMA, we are committed to raising awareness amongst the medical fraternity and the public in general about the prevention and management of vector-borne diseases.“ Some do's and dont's for the prevention and management of these diseases are as follows. Do's Take plenty of rest and avoid getting dehydrated if you have any of the above-mentioned symptoms. Get tested immediately. In case of high-grade fever for more than 24 hours, it is a must to go and visit the doctor. Use mosquito nets and cover yourself well to avoid being bitten by mosquitoes. Keep the surroundings clean, and dispose of waste and stagnant water regularly. Don'ts Aedes mosquitoes breed in clean water. Therefore, don't let water stagnate anywhere in or near your home. Don't use mosquito repellents on children below two months of age. Use insect repellents containing 10% DEET on children older than two months. Don't apply mosquito repellent on your palms, or near your eyes or mouth. Avoid dark-colored clothing as it attracts mosquitoes. Avoid wearing tight clothes as it is easier for the mosquitoes to bite through such garments.

Dengue and chikungunya hit the capital again

Dengue and chikungunya hit the capital again IMA warns of a possibly larger breakout unless immediate action is taken along with community participation New Delhi, April 13, 2017: A recent report by the South Delhi Municipal Corporation (SDMC) on vector-borne diseases has revealed about 79 cases of chikungunya in the national capital this year. In the last three months, 24 cases of dengue have been reported, of which 11 patients acquired the infection from one of the neighbouring states. According to the SDMC, there were 9 new cases of chikungunya this week. All these patients were from the neighbouring states. Although chikungunya and dengue cases had tapered off by the first week of December last year, this year has again brought back many such cases. Speaking about this Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "IMA had already indicated that the cases of vector-borne diseases in the capital will be as predicted last year. Dengue and chikungunya cases in Delhi so far have been a matter of great concern. Dengue cases create panic among the public every year. We must all agree that collectively we have failed in controlling the mosquito menace and consequently, Delhi today is in the midst of an increasing number of dengue and malaria patients. This is a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the Private sector. Dengue is preventable and the very first step towards this is its management. However, to make this possible, community participation is a must." Both dengue and chikungunya are viral diseases transmitted by Aedes mosquitoes. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Most of the symptoms associated with both diseases are the same, with some key differences. High fever is the primary symptom of dengue along with the at least two of the following: severe headache, severe eye pain, joint, muscle or bone pain, rash, mild bleeding from the nose or the gums, small spots caused by bleeding into the skin, and low white cell count. In severe cases, plasma leakage can lead to shock, hemorrhage (internal bleeding), and organ impairment. At this stage, the disease is potentially fatal. On the other hand, chikunguniya symptoms include high fever, severe joint pain, joint swellings, muscle pain, headaches, and rashes and this disease is mostly non-fatal. Highlighting the importance of community participation in taking action against vector-borne diseases, Dr K K Aggarwal added, "Individuals, families, and communities need to be more involved in the planning and conduct of local vector control activities. It is not possible for the government to employ enough people to search every backyard and identify and destroy breeding sites. At IMA, we are committed to raising awareness amongst the medical fraternity and the public in general about the prevention and management of vector-borne diseases.“ Some do's and dont's for the prevention and management of these diseases are as follows. Do's Take plenty of rest and avoid getting dehydrated if you have any of the above-mentioned symptoms. Get tested immediately. In case of high-grade fever for more than 24 hours, it is a must to go and visit the doctor. Use mosquito nets and cover yourself well to avoid being bitten by mosquitoes. Keep the surroundings clean, and dispose of waste and stagnant water regularly. Don'ts Aedes mosquitoes breed in clean water. Therefore, don't let water stagnate anywhere in or near your home. Don't use mosquito repellents on children below two months of age. Use insect repellents containing 10% DEET on children older than two months. Don't apply mosquito repellent on your palms, or near your eyes or mouth. Avoid dark-colored clothing as it attracts mosquitoes. Avoid wearing tight clothes as it is easier for the mosquitoes to bite through such garments.

Differentiating Chikungunya from dengue

Differentiating Chikungunya from dengue New Delhi, September 06, 2016: Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache. Both the illness are caused by the bite of an infected Aedes Aegypti mosquito. Given the rise in the incidence of both the ailments in the city, IMA & HCFI raise awareness about the essential differences between the two, prevention and management. Speaking about the need for prevention Dr. SS Agarwal, National President IMA & Padma Shri Awardee Dr. K.K. Aggarwal, President HCFI and President Elect IMA said, “Community participation is vital to prevent and control the spread of diseases transmitted by the Aedes aegypti mosquito, which includes Zika, Chikungunya and yellow fever besides dengue. In community participation, individuals, families and communities are involved in the planning and conduct of local vector control activities. The Government cannot employ enough persons to search every backyard to identify and destroy breeding sites on a consistent basis to prevent this mosquito from breeding. We are committed to raising awareness amongst the medical fraternity as well as the public about the need for prevention and proper management of diseases caused due to the Aedes Aegypti.“ Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis. Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness. Dengue should be ruled out in patients with acute febrile illness and suspected of having dengue or Chikungunya. Evaluate patients for the warning signs of severe dengue such as persistent vomiting, severe abdominal pain, tachycardia, restlessness, hypotension, and narrow pulse pressure. If present, patients should be hospitalized for close monitoring and management. Ways to protect yourself from the bite of the Aedes Aegypti • Use Environmental Protection Agency-registered insect repellents that contain DEET, picaridin, oil of lemon eucalyptus or IR3535. • Use insect repellent with 20% to 35% of the chemical DEET; more than 35% of the chemical known as diethyltoluamide can irritate skin. • Make sure you apply it to all exposed skin. • Apply insect repellent correctly. Apply sunscreen before repellent, not on top of it. • Apply and let sunscreen dry before using insect repellent. You want the mosquito to land on the repellent, not your sunscreen. • Minimize exposed skin and wear light-colored long sleeved shirts and pants. Mosquitoes are drawn to dark colors, floral patterns and sweet perfumes. • Wear clothing treated with permethrin, a chemical used as an insecticide. • Treat your own clothes, shoes, tents, etc. with a permethrin spray. • Sleep under mosquito nets with windows and doors closed or securely screened if there is no air conditioning. • Make sure there's no standing water outside your lodging because mosquito eggs hatch in water. • Make yourself less appealing to mosquitoes by wearing deodorant and by avoiding drinking quite so much beer

Myths and facts about the outbreak of Dengue in the National Capital

Myths and facts about the outbreak of Dengue in the National Capital New Delhi, August 29, 2016: Given the large-scale panic that the increasing incidence of dengue has created, it is essential that awareness is raised about the myths and facts of the disease. Clearing common misconceptions Padma Shri Awardee Dr. K K Aggarwal, President HCFI & Honorary Secretary General IMA said, “Dengue incidence will continue to exist in the coming one month and instead of creating unnecessary chaos and panic, it is essential that awareness is created about prevention and timely steps are taken towards disease management. One must remember that only 1% of the dengue cases are life-threatening. Most dengue cases can be handled on an outpatient basis and do not require hospitalization". Dengue Myths vs. Facts Myth: We are facing a dengue epidemic Fact: Delhi is at present going through a dengue outbreak, and it is not yet epidemic Myth: All dengue cases are the same and must be dealt with in the same manner Fact: Dengue can be classified as dengue fever and severe dengue. A person is said to be suffering from severe dengue when there is capillary leakage. Patients who have dengue fever do not have capillary leakage. Type 2 and type 4 dengue are more likely to cause capillary leakage. Myth: Everyone suffering from dengue must be hospitalized Fact: Dengue fever can be managed on an outpatient basis and patients who do not have severe abdominal pain or tenderness, persistent vomiting, abnormal mental status or extreme weakness, do not need hospitalization. Only patients suffering from severe dengue need hospitalization basis the discretion of their consulting doctor. One must always remember that 70% of the dengue fever cases can be cured just through the proper administration of oral fluids. Patients must be given 100-150 ml of safe water every hour, and it must be ensured that they must pass urine every 4-6 hours. Myth: Dengue can never re-occur if you have had it once in the past Fact: There are four types of dengue infections, which exist in our country. While dengue from the strain cannot re-occur, that from a different strain can. A second occurrence dengue (secondary) is more serious than first infection (primary). In the primary infection, IgM or NS1 will be positive and in secondary infection IgG will also be positive. Myth: Platelet transfusion is the primary treatment option for people suffering from dengue fever Fact: Platelet transfusion is only needed in cases where the patient's counts are less than 10,000, and there is active bleeding. Unnecessary platelet transfusion can cause more harm than good. The best treatment for dengue is to administer large amounts of oral fluids to patients. For patients who are unable to take oral fluids, intravenous administration may be necessary. Myth: Machine platelet count is accurate Fact: Machine platelet count reading may be less than the actual platelet count, and a difference of about 30,000 can occur Myth: Testing platelet levels alone accounts for complete and effective management of dengue Fact: A complete blood count (especially hematocrit) is needed to monitor prognosis and increased capillary permeability, which is the starting point of all complications. Falling platelet counts with rising hematocrit levels are most important

NCR is in the grip of Chikungunya

NCR is in the grip of Chikungunya New Delhi September 15, 2016: Chikungunya fever is a non-fatal debilitating viral illness, spreads by the bite of infected female Aedes aegypti / albipecto mosquito. Symptoms develop 3-7 days bite by an infected mosquito. Classical triad is skin rash, joint pains and high fever. Most patients will recover within 1-2 week. Cold compression may easy pain. “There is no vaccine to prevent or drugs to treat. One must take plenty of rest and drink fluids to prevent dehydration. Aspirin or NSAIDS should not be taken until dengue is ruled out. Both ailments may present with similar symptoms”, said Padma Shri Awardee Dr KK Aggarwal – President Elect IMA and President Heart Care Foundation of India. In 20%, joint involvement may persist for weeks and in 10% cases; they tend to persist for months. In 10 %, swelling disappears; pain subsides, but will reappear with every other febrile illness for many months. Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after subsidence of the fever. 92% have symmetric polyarthralgias, 67% arthritis, 75% skin rash. 89% have very good clinical response to NSAIDS. 27% require low-dose steroids & 5% methotrexate therapy. Non-weight bearing exercises may be suggested (slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, milder forms of yoga). Standard treatment is Paracetamol one gram up to four times a day for up to four weeks. At four weeks if pain persists four weeks course of oral steroids can be given. At eight weeks if pain persist specific disease modifying drugs like hydroxychloroquibe may need to be added. Chikungunya can unmask psoriasis arthritis of rheumatoid gathia arthritis in some cases. It can cause in some cases neuro and ocular manifestations (encephalitis, mono neuritis, optic neuritis).

Chikungunya Update

Chikungunya Update Chikungunya fever is a non-fatal debilitating viral illness, which spreads by the bite of infected female Aedes aegypti / albopictus mosquito. Symptoms develop 3-7 days after the bite by an infected mosquito. The classical triad is skin rash, joint pains and high fever. Most patients will usually recover within 1-2 weeks. Cold compressions may easy pain. There is no vaccine to prevent or drugs to treat. Plenty of rest and fluids to prevent dehydration is recommended. Aspirin or NSAIDs should not be taken until dengue is ruled out. Both ailments may present with similar symptoms. In 20% cases, joint involvement may persist for weeks and in 10% cases, they tend to persist for months. While in 10% cases, swelling disappears and the pain subsides, but will reappear with every other febrile illness for many months. Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after the fever subsides. Clinically, about 92% have symmetric polyarthralgias, 67% have arthritis and 75% skin rash. About 89% show a very good clinical response to NSAIDs, some 27% require low-dose steroids and 5% may need methotrexate therapy. Non weight-bearing exercises may be suggested such as slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley-assisted exercises, milder forms of yoga. Standard treatment is paracetamol 1 g up to four times a day for up to 4 weeks. If pain persists at 4 weeks, then a 4-week course of oral steroids can be given. At 8 weeks, if pain persists, then specific disease-modifying drugs like hydroxychloroquine may need to be added. Chikungunya can unmask psoriatic arthritis or rheumatoid arthritis in some cases. It can cause, in some cases, neuro and ocular manifestations (encephalitis, mononeuritis, optic neuritis).

Dengue and Chikungunya are totally preventable diseases

Dengue and Chikungunya are totally preventable diseases Dengue, Chikungunya as well as Malaria and Filaria are mosquito-borne diseases and are totally preventable. Here are some salient points to remember about their prevention. • Malaria is transmitted via the bite of a female Anopheles spp mosquito, which occurs mainly between dusk and dawn. It may rarely spread as a congenitally-acquired disease or via blood transfusion, sharing of contaminated needles and organ transplantation. • The Dengue mosquito (Aedes aegypti) bites in the day time. • The Aedes Dengue mosquito has up to 3 meals in a day, while the malaria mosquito has 1 meal in three days. Malaria may infect only one person in the family; on the other hand, dengue mosquito will infect more than one member in the family in the same day. • Malaria fever often presents with chills and rigors. If fever presents with joint and muscle pains, suspect Chikungunya. • The Dengue mosquitoes may also breed inside houses in fresh collected water; hence, insecticide spraying, in response to dengue outbreaks, is not highly effective. Water should not be allowed to collect inside the house for more than a week. Mosquito cycle takes 7-12 days to complete and if any water collected utensils is scrubbed cleaned properly once in a week, there are no chances of mosquito breeding. • Collection of water in and around the house can occur in flower pots, uncovered water tanks on the terrace, bird drinking pots, broken tires, broken glasses, water coolers or any container where water can stay for 7 days. • Education of the public about discarding tires and other containers that accumulate standing water has shown promise in reducing breeding sites. • Using mosquito nets/repellents in the night may not prevent dengue the mosquito bites during day time. Wearing full sleeves shirt and trousers can prevent the mosquito from biting the body during the day. • Both malaria and dengue mosquito do not produce noise. Therefore, mosquitoes which produce noise do not cause diseases. • There are no vaccines for malaria and dengue. • Comprehensive community and governmental control strategy, including the seeding of water vessels with copepods that feed on mosquito larvae, is successful in eliminating A. aegypti and dengue transmission.

Differentiating Chikungunya from dengue

Differentiating Chikungunya from dengue New Delhi, September 06, 2016: Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache. Both the illness are caused by the bite of an infected Aedes Aegypti mosquito. Given the rise in the incidence of both the ailments in the city, IMA & HCFI raise awareness about the essential differences between the two, prevention and management. Speaking about the need for prevention Dr. SS Agarwal, National President IMA & Padma Shri Awardee Dr. K.K. Aggarwal, President HCFI and President Elect IMA said, “Community participation is vital to prevent and control the spread of diseases transmitted by the Aedes aegypti mosquito, which includes Zika, Chikungunya and yellow fever besides dengue. In community participation, individuals, families and communities are involved in the planning and conduct of local vector control activities. The Government cannot employ enough persons to search every backyard to identify and destroy breeding sites on a consistent basis to prevent this mosquito from breeding. We are committed to raising awareness amongst the medical fraternity as well as the public about the need for prevention and proper management of diseases caused due to the Aedes Aegypti.“ Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis. Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness. Dengue should be ruled out in patients with acute febrile illness and suspected of having dengue or Chikungunya. Evaluate patients for the warning signs of severe dengue such as persistent vomiting, severe abdominal pain, tachycardia, restlessness, hypotension, and narrow pulse pressure. If present, patients should be hospitalized for close monitoring and management. Ways to protect yourself from the bite of the Aedes Aegypti • Use Environmental Protection Agency-registered insect repellents that contain DEET, picaridin, oil of lemon eucalyptus or IR3535. • Use insect repellent with 20% to 35% of the chemical DEET; more than 35% of the chemical known as diethyltoluamide can irritate skin. • Make sure you apply it to all exposed skin. • Apply insect repellent correctly. Apply sunscreen before repellent, not on top of it. • Apply and let sunscreen dry before using insect repellent. You want the mosquito to land on the repellent, not your sunscreen. • Minimize exposed skin and wear light-colored long sleeved shirts and pants. Mosquitoes are drawn to dark colors, floral patterns and sweet perfumes. • Wear clothing treated with permethrin, a chemical used as an insecticide. • Treat your own clothes, shoes, tents, etc. with a permethrin spray. • Sleep under mosquito nets with windows and doors closed or securely screened if there is no air conditioning. • Make sure there's no standing water outside your lodging because mosquito eggs hatch in water. • Make yourself less appealing to mosquitoes by wearing deodorant and by avoiding drinking quite so much beer

Beware of Chikungunya Encephalitis: IMA

Beware of Chikungunya Encephalitis: IMA

Severe encephalitis related to chikungunya infection has been reported in Delhi tweeted Padma Shri Awardee Dr K K Aggarwal National President Elect IMA.

Chikungunya virus (CHIKV) disease can cause CHIKV-associated encephalitis. One can detect CHIKV RNA or anti-CHIKV immunoglobulin M in cerebrospinal fluid, warns IMA.

IMA was the first to report chikungunya cases in West Kidwai Nagar in NBCC construction area and is now first to report spurt of cases of encephalitis in Delhi linked to chikungunya, said Dr Aggarwal.

In a U-shaped distribution, children younger than 1 year and adults age 65 or older have the highest incidence of CHIKV-associated encephalitis.

The overall case fatality rate for CHIKV-associated encephalitis as per literature is 16.6%, and the 3-year rate of neurologic sequelae range from 30% to 45%. The risk for death or neurologic sequelae is significantly higher in adults than in children (53% vs. 18%).

CHIKV is an alphavirus transmitted by Aedes species mosquitoes. Symptomatic CHIKV infections typically result in a self-limited systemic febrile illness associated with rash and arthralgia. However, cases of severe disease, including meningoencephalitis and death, have also been reported.

CHIKV may present similarly to numerous other infectious causes of systemic febrile illness in the tropics, including malaria, dengue, and other arthropod-borne infections.

Central India Institute of Medical Sciences, Nagpur in May 2006, during a large Chikungunya virus infection (CHIKV) described various neurological syndromes: Encephalitis, myelopathy, peripheral neuropathy, myeloneuropathy, and myopathy.

Of the 300 patients with CHIKV infection seen during the study period, June-December 2006, 49 (16.3%) [M : F: 42:7] had neurological complications.

The neurological complications included Encephalitis (27, 55%), myelopathy (7, 14%), peripheral neuropathy (7, 14%), myeloneuropathy (7, 14%), and myopathy (1, 2%).

Reverse Transcriptase polymerase chain reaction (RT-PCR) and real-time PCR was positive in the CSF in 16% and 18%, respectively.

It suggest neurotropic nature of the virus. The outcome of the neurological complications is likely to be good.

Literature reports a cumulative incidence rate of 8.6 per 100,000 people.

Differentiating Chikungunya from dengue

Differentiating Chikungunya from dengue

Dr K K Aggarwal

Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache.

Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis.

Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness.

Dengue should be ruled out in patients with acute febrile illness and suspected of having dengue or Chikungunya.

Evaluate patients for the warning signs of severe dengue such as persistent vomiting, severe abdominal pain, tachycardia, restlessness, hypotension, narrow pulse pressure. If present, patients should be hospitalized for close monitoring and management.

Such patients should also be evaluated for other serious conditions, such as malaria, leptospirosis, and other bacterial infections.

(Source: Medscape)

Urgent need to create social awareness on mosquito borne diseases!

Urgent need to create social awareness on mosquito borne diseases! Prevention measures essential to curb the ongoing dengue and chikungunya menace in the city Despite the best efforts from doctors, the illnesses will continue to exist over the next one month New Delhi, August 28, 2016: Dengue and chikungunya cases are rampant in Delhi and raising preventive awareness crucial. Chikungunya is not life-threatning and symptoms typically exist for 7-10 days. Dengue on the other hand can be easily managed and does not always require hospitilization. Mass public awareness campaigns are essential. Speaking about this issue, Padma Shri Awardee Dr. KK Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India said, “The misconceptions that people have about the mosquito-borne tropical disease has contributed towards making India the ‘Dengue capital’ of the world. Nowadays, individuals ignore the fact that the disease is manageable and preventable. Also, it can be effectively treated with the right kind of first aid, medication, and precautions. In addition to this, people forget that surviving dengue the first time doesn’t make us immune to reinfection with another strain, so one should always take precautions after recovering from the infection. The need of the hour is to raise awareness about prevention, treatment options and busy common myths about the disease. Instead of panicking and spreading panic, we must all work together towards solving the problem and preventing as many cases as possible.“ It is extremely important to note that platelet transfusion is only needed in dengue cases where the platelet count is less than 10,000, and there is active bleeding. Unnecessary platelet count can cause more harm than good. Adequate hydration is the best management approach to dengue while monitoring crucial signs. In most cases, hospitalization is not required, and families must not insist towards this as it deprives seriously ill patients from getting hospital beds. Only severe dengue cases must be admitted basis the treating physicians discretion. One must always remember that 70% of the dengue fever cases can be cured just through the proper administration of oral fluids. Patients must be given 100-150 ml of safe water every hour and it must be ensured that they must pass urine every 4-6 hours. What are symptoms of severe dengue fever? • Abdominal pain or tenderness • Persistent vomiting • Clinical fluid accumulation (pleural effusion/ascites) • Active mucosal bleeding • Severe restlessness or lethargy • Tender enlarged liver How to identify dengue fever by applying the Formula of 20: • If there is rise in pulse by 20 • If there is fall in upper BP by 20 • If the difference between upper and lower blood pressure is less than 20 • If there is rise in hematocrit by 20 percent • If the platelet counts are less than 20,000 • If the petechial count in one inch of the arm is more than 20 after tourniquet test • If all of this happens then it is essential to take 20 ml of fluid per kg body weight in a span of 20 minutes and then approach the doctor. First aid for Dengue patients: • If a person has warning signs of dengue with normal blood pressure 10ml of fluid per kg body weight must be administered in the next 20 minutes (oral or IV). Then the dose should be reduced by 50% in the next hour. If they have low blood pressure than the quantity should be 20ml per body weight • A patient should drink as much fluids as he can • Best oral fluid is one litre of safe water added with six spoons sugar and half spoon salt • Anyone who is ill with dengue shouldn’t cut down on food. Consuming nutritious food in sufficient quantities is important. • Best treatment for dengue is 100 ml of fluids per hour for 48 hours from when the symptoms are noted in patients with normal BP patients and 150 ml per hour in patients with a low BP Dangerous Parameters: When you should be worried? • While first aid will help you control the situation so that it doesn’t reach the extreme. But a patient is advised to consult a doctor in situations like: • When there is an absence of baseline hematocrit value. If hematocrit value is less than 40 percent in adult female and less than 46 percent in the adult male, then a doctor should be consulted, as it might be a case of plasma leakage. • When the platelet counts are rapidly falling. • When the difference between the upper and lower blood pressure is falling. • When liver enzymes SGOT levels are more than SGPT levels. Liver enzyme levels more than 1000 can lead to severe plasma leakage and less than 400 can cause moderate plasma leakage. • When there is a progressive increase in hematocrit with a progressive reduction of platelet count

Whenever Dengue or Chikungunya Case is suspected: Do the followings:

Whenever Dengue or Chikungunya Case is suspected: Do the followings:

Dr K K Aggarwal

• SMS to the RWAs President & Secretary who in turn should send SMS to all RWA Members.
• SMS to be sent to the local IMA Branch President & Secretary who in turn should send a SMS to all the doctors of that respective pin code area.
• SMS to be sent to all the Pathologists of that area.
• Local Councillor/MLA/MP should be informed about the outbreak of dengue in a particular Pin Code area so that necessary Vector Control Programme is under taken by the respective Municipal body.
• All the doctors should make it a point that whenever they see their patients, they do talk about Dengue prevention

IMA and HCFI release guidelines on dengue and chikungunya management

IMA and HCFI release guidelines on dengue and chikungunya management

New Delhi, 18 August 2016: In an attempt to dispel myths and create awareness about the ongoing dengue and chikungunya outbreak in the city, IMA and HCFI today released a set of guidelines on the management of the disease.

Speaking about the issue, Padma Shri Awardee KK Aggarwal – President HCFI and Honorary Secretary General IMA said,” The incidence of dengue and chikungunya will continue to exist this month and instead of creating unnecessary chaos and panic, it is essential that awareness is created about its prevention and timely steps are taken towards disease management. One must remember that only 1% of the dengue cases are life-threatening. Most dengue cases can be handled on an outpatient basis and do not require hospitalization. Chikungunya is not fatal and does not require hospitalization. Wearing long sleeved clothes, wearing mosquito repellent with permethrin and checking for breeding in and outside one’s house is key“

Whenever Dengue or Chikungunya Case is suspected: do the followings:

• RWA should come into action and inform everyone in their colony to check for breeding in and around their houses
• Treating doctor of the dengue or chikungunya patient should inform the local IMA President and Secretary about the disease incidence so that they can send a message to all doctors in that area to stay alert
• The local MLA/MP should be informed about the outbreak of dengue in a particular area so that the necessary Vector Control Programme is put to action by the respective Municipal body.

                                                                                                                              

Dengue pointers released:

• Over ninety five percent people suffer from simple dengue fever, which is not as threatening as severe dengue fever.
• In simple dengue fever there is no capillary leakage, the person requires only oral fluids, 100 ml per hour, and is advised to visit local doctor. Additionally, the patient is recommended to drink 500 ml water at the time of diagnosis
• Only those patients with dengue fever who have vomiting should consume intravenous fluids
• Those suffering from severe dengue develop capillary leakage and intra-vascular dehydration.  Also, they suffer from a rapid fall in the platelet count along with rapid rise in their hematocrit levels
• They will have rapid fall in platelets along with rapid rise in hematocrit levels
• Persistent vomiting, nausea, extreme exhaustion and lethargy are some of the symptoms of dengue. Along with these symptoms, a victim might suffer unrelieved abdominal pain and mental irritability and confusion.
• These people require close daily observation
• Dengue patients are kept under close observation and are recommended to consume 1500 ml fluids (20 ml per kg) immediately
• And in case, when they cannot consume liquids orally, then intra venous fluids are a must

Chikungunya pointers released:

• Chikungunya fever is a non fatal debilitating viral illness
• Common symptoms of Chikungunya develop 3-7 days after being bitten by an infected mosquito include fever and joint pain.
• Classical triad is skin rash, joint pains and high fever.
• Most patients will recover within a week. 
• At present, there is no vaccine to prevent or medicine to treat Chikungunya virus.\
• Patients are advised to get plenty of rest and drink fluids to prevent dehydration. 
• It is important to note that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) should not be taken until dengue is ruled out to reduce the risk of bleeding since both the ailments present similar symptoms.
• Joint involvement seen with Chikungunya fever usually subsides in one to two weeks’ time.
• In 20% cases joint involvement may persist for weeks and in less than 10% cases, they tend to persist for months. 
• In about 10 % cases, the swelling disappears; the pain subsides, but only to reappear with every other febrile illness for many months. 
• Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after subsidence of the fever. 
• Cold compression may easy pain.
• Non weight bearing exercises may be suggested. e. g. slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, milder forms of yoga etc.

Management of arthritis in Chikun Gunya

Management of arthritis in Chikun Gunya

Dr K K Aggarwal 1. The osteoarticular problems seen with Chikungunya fever usually subside in one to two weeks’ time. 2. In approximately 20% cases, they disappear after a gap of few weeks. 3. In less than 10% cases, they tend to persist for months. 4. In about 10 % cases, the swelling disappears; the pain subsides, but only to reappear with every other febrile illness for many months. 5. Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after subsidence of the fever. 6. Complement mediated damage and persistence of the virus in intra cellular sanctuaries have been implicated in occasional studies. 7. Destroyed metatarsal head has been observed in patients with persistent joint swelling. Management of osteoarticular manifestations follow the general guidelines given earlier. 8. Since an immunologic aetiology is suspected in chronic cases, a short course of steroids may be useful. 9. Care must be taken to monitor all adverse events and the drug should not be continued indefinitely to prevent adverse effects. 10. Even though NSAIDS produce symptomatic relief in majority of individuals, care should be taken to avoid renal, gastrointestinal, cardiac and bone marrow toxicity. 11. Cold compresses have been reported to lessen the joint symptoms. 12. Disability due to Chikungunya fever arthritis can be assessed and monitored using one of the standard scales. 13. Proper and timely physiotherapy will help patients with contractures and deformities. 14. Non weight bearing exercises may be suggested.; e. g. slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, milder forms of yoga etc. 15. Surgery may be indicated in severe and disabling contractures. 16. The management plan may be finalized in major hospitals, but the follow-up and long-term care must be done at a domiciliary or primary health centre level. 1. Occupational assistance after detailed disability assessment needs to be provided.


With inputs from Dr Rohini Handa

All you need to know about Chikungunya and the management of arthritis while affected by the disease

All you need to know about Chikungunya and the management of arthritis while affected by the disease New Delhi August 11, 2016: Chikungunya fever is a debilitating, but non-fatal, viral illness that has got Delhi in its grip at the moment. The illness is spread by the bite of infected female Aedes aegypti mosquito. Common symptoms of Chikungunya that develop 3-7 days after being bitten by an infected mosquito include fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. “There is no need to panic since chikungunya is a non-fatal illness. Most patients suffering from it will feel better within a week. In some people however, the joint pain may persist for months. It is thus important to take necessary precautions against getting bitten by the Aedes mosquito known to cause both chikungunya and dengue fever. Those at high risk such as newborns infected around the time of birth, older adults (≥65 years), and people with medical conditions such as high blood pressure, diabetes, or heart disease need to be extra cautious since they can develop disease related complications, said Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA. Said in a joint statements Dr N K Yadav, Training Coordinator GDD-CDC Project, NIHFW New Delhi & Dr V K Monga, IMACGP, the Aedes mosquito breeds in clean water collections making it imperative to regularly water containers and tanks and check discarded material such as buckets, utensils, tyres, flowerpots etc for breeding. While the peak biting times of the Aedes aegypti mosquito are early morning or late evening, however the mosquito can also bite in the night when in a well-lit room making the use of mosquito repellents essential. At present, there is no vaccine to prevent or medicine to treat chikungunya virus. Medicines can be used to ease symptoms. Patients are advised to get plenty of rest and drink fluids to prevent dehydration. It is important to note that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) should not be taken until dengue is ruled out to reduce the risk of bleeding since both the ailments present similar symptoms. Given that joint pain is one of the primary symptoms of the disease, HCFI and IMA released a few points and tips on the management of arthritis in Chikenguniya: • The osteoarticular problems seen with Chikungunya fever usually subside in one to two weeks’ time. • In approximately 20% cases, they disappear after a gap of few weeks and in less than 10% cases, they tend to persist for months. • In about 10 % cases, the swelling disappears; the pain subsides, but only to reappear with every other febrile illness for many months. • Each time the same joints get swollen, with mild effusion and symptoms persist for a week or two after subsidence of the fever. • Since an immunologic aetiology is suspected in chronic cases, a short course of steroids may be useful. • Care must be taken to monitor all adverse events and the drug should not be continued indefinitely to prevent adverse effects. • Even though NSAIDS produce symptomatic relief in majority of individuals, care should be taken to avoid renal, gastrointestinal, cardiac and bone marrow toxicity. • Cold compresses have been reported to lessen the joint symptoms. • Disability due to Chikungunya fever arthritis can be assessed and monitored using one of the standard scales. • Proper and timely physiotherapy will help patients with contractures and deformities. • Non weight bearing exercises may be suggested.; e. g. slowly touching the occiput (back of the head) with the palm, slow ankle exercises, pulley assisted exercises, milder forms of yoga etc. • Surgery may be indicated in severe and disabling contractures. • The management plan may be finalized in major hospitals, but the follow-up and long-term care must be done at a domiciliary or primary health centre level. • Occupational assistance after detailed disability assessment needs to be provided

Delhi is in a grip of Chikungunya

Delhi is in a grip of Chikungunya
 Symptoms, Diagnosis & Treatment of Chikungunya

Symptoms

• Most people infected with chikungunya virus will develop some symptoms.
• Symptoms usually begin 3 to 7 days after being bitten by an infected mosquito.
• The most common symptoms are high-grade fever and severe arthralgia (joint pain).
• Other symptoms may include headache, fatigue, throat discomfort, muscle pain, joint swelling, or skin rash.
• Chikungunya disease does not often result in death, but the symptoms can be severe and disabling.
• Symptoms usually resolve within a week. But, the joint pain may persist for months in some people.
• People at risk for more severe disease include newborns infected around the time of birth, adults aged 65 years or older and people with medical conditions such as high blood pressure, diabetes, or heart disease.
• Once a person has been infected, he or she is likely to be protected from future infections.

Diagnosis

• The symptoms of chikungunya are similar to those of dengue and Zika, diseases spread by the same mosquitoes that transmit chikungunya.
• A history of travel or residence in areas where chikungunya is found in a suspected case.
• Blood tests to look for virus specific antibodies for chikungunya or other similar viruses like dengue and Zika. 

Treatment

• There is no vaccine to prevent or medicine to treat the Chikungunya virus.
• Treatment is symptomatic and supportive.
• - Plenty of rest.
• - Adequate fluids to prevent dehydration.
• - Paracetamol to reduce fever and pain.
• -  Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) until dengue can be ruled out to reduce the risk of bleeding).
• - If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication. 
• Patients with Chikungunya should take precautions to prevent mosquito bites for the first week of the illness.
• - During the first week of infection, Chikungunya virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites.
• - An infected mosquito can then spread the virus to other people

Monsoon fever can be deceptive

Monsoon fever can be deceptive

New Delhi, July 31, 2016: Fever during the monsoon season in India can be deceptive as malaria, viruses causing dengue, chikungunya and jaundice, and bacteria causing typhoid can all produce fever in this season, said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.

Following are the Dos and Don’ts to follow if you have fever in the monsoon season:

1. No antibiotic should be started unless a diagnosis of typhoid is confirmed.
2. Cough, eye redness and nasal discharge can also be present in viral disorders.
3.  In dengue, one may have pain with the eye movement.
4.  In chikungunya, patients may have fever, rashes and joint pains. The joint pains will typically increase on compression of the wrist joint.
5. Malaria fever may present with chills and rigors, with no toxemia in between the fever episodes.
6. In jaundice, fever normally disappears by the time jaundice appears clinically.
7. In typhoid, patient looks toxic and the pulse rate may be relatively low compared to the fever.
8. Fever medicines like aspirin should not be given in monsoon season as many fevers may have low platelet counts.
9. Most viral disorders are self–limiting and resolve within a week.
10.  In most monsoon related viral disorders, treatment is adequate hydration.
11. Fever in the setting of chronic medical disease should not be ignored and shown to the doctors at the earliest.

Take special care of your health during the upcoming monsoon season

Take special care of your health during the upcoming monsoon season

During the Monsoon season, the body’s immunity levels dip

New Delhi: 15 June 2016: Monsoon is a season which brings respite from the dreaded summer months and helps revive the dying crops. However the season also brings with itself a host of diseases. The immunity levels of a person are found to be at its lowest during this season making people vulnurable to illness.

 “The most common diseases associated with the monsoon season are malaria, dengue, Chikungunya, jaundice and gastrointestinal infections like typhoid and cholera. Apart from these, viral infections like cold and cough are also common”, said Padma Shri Awardee, Dr KK Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Patients with Chikungunya, typically complain of joint pains and can get relief from the pain by flexing their limbs. Chikungunya, though not fatal, can cause chronic debilitating joint pains lasting for years and adequate prevention must be taken against it.

Dengue, most commonly caused by the breeding of the aedes mosquite if not adequately managed, can be fatal in 1-4% of cases. Management of dengue involves fluid resuscitation and not platelet resuscitation. If enough fluids are given, mortality rates are negligable. Inappropriate misuse of anti fever medicines can precipitate bleeding in dengue patients. Awareness must be raised about how the aedes mosquito breeds in clean collected water and people must ensure that they wear full-sleeves clothing during the monsoon season, do not let water collect outside their house and that they use mosquito repellents.

One of the most common occurances in the monsoon season is the contamination of drinking water making people prone to diarrhea and gastrointestinal infections. People must ensure that they only drink safe and clean drinking water during these months and avoid eating at places where the water has been left out in the open for hours.

Walking in dirty water during the rainy season leads to numerous fungal infections. Diabetic patients must take special care to keep their feet clean and dry. They must walking in dirty water. 

During the monsoons, precautions have to be taken to prevent dampness and growth of fungus (mold) on and around the house were asthmatic patients are living. Avoid fumigation for mosquitos in case of asthmatic patients as it can aggrevate their condition.

Underground works come to the surface and contaminate surface vegetables during the rainy season. This can cause gastric disturbances in people with low immunity. It is because of this reason that community lunches and marriages are usually not held during this season.

Overall, one must enjoy the weather and the respite of the rains, while taking necessary precautions against diseases which might dampen the celebrations.