CE/CME
The Challenges of Normal Pressure Hydrocephalus: A Case-Based Review
Although accreditation for this CE/CME activity has expired, and the posttest is no longer available, you can still read the full article.
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SIGNS AND SYMPTOMS
Malaria
Signs and symptoms of malaria can vary greatly from none to illness causing death. The classic clinical features of malaria (fever, headache, back pain, chills, sweating, myalgia, nausea, vomiting, and cough) are caused by the parasite developing in RBCs, causing toxins to accumulate.18 Following the mosquito bite, there is typically an incubation period of seven to 30 days.
When first diagnosing malaria, the clinician needs to determine if the cause is P falciparum (the most severe form of malaria). If so, the clinician then must determine if the case is severe or nonsevere.7 In P falciparum infections, symptom onset can be later, especially if the patient took prophylaxis.7 Longer incubation periods are often seen with P vivax, P malariae, and P ovale infections. P vivax and P ovale can lie dormant in hepatic cells and reactivate after months or even years.7
Adults and children may experience different malaria symptoms, particularly with severe forms of the disease. Pediatric patients with severe falciparum malaria may experience respiratory distress, convulsions, and hypoglycemia more commonly than adults. More than half of adults with severe falciparum experience acute respiratory distress syndrome and acute renal failure.7 Pregnant women are at increased risk for complications.
Dengue fever
Approximately 75% of patients infected with DENV are asymptomatic.14 However, if symptomatic, the most common symptoms (fever, myalgia, headache, rash, arthralgia, abdominal pain, and nausea) begin abruptly after an incubation period of four to seven days.
Dengue can also present with atypical manifestations. In a prospective study by Nimmagadda and colleagues involving 150 participants with confirmed dengue fever, more than half of subjects had at least one atypical symptom along with more typical symptoms.10 The most common atypical manifestation was abnormal liver function, which was present in 40.6% of participants. Other atypical symptoms seen were febrile diarrhea (12%), renal failure (8%), acalculous cholecystitis (6.6%), and conduction abnormalities of the heart (6%). Less common atypical manifestations observed in this study included encephalitis, seizures, acute respiratory distress syndrome, disseminated intravascular coagulation, acute pancreatitis, myositis, and atrial fibrillation. The authors recommended that clinicians maintain a high level of vigilance for atypical manifestations of dengue fever, noting that most of the severe complications of dengue can be avoided if the disease is diagnosed correctly early in the course of illness.
Chikungunya
The typical presentation of CHIKV infection is a patient who abruptly develops fever, headache, polyarthralgia, and myalgia. The joint pain most frequently affects the small joints, such as the interphalangeal joints of the hands as well as the ankles and wrists.15 Back pain is also common, and rash is present in more than half of cases. The rash in adults can be maculopapular and in children is more often bullous. Fever, rash, and headache typically last seven to 10 days, while the arthralgia can last much longer—three to four months in a third of patients and three to five years in 10%.15
CHIKV infection that presents with typical clinical manifestations is usually self-limited; however, more severe atypical symptoms can occur and may lead to long-term morbidity. These atypical manifestations of chikungunya, which are rare, include acute disseminated encephalomyelitis, aseptic meningitis, meningoencephalitis, sensorineural hearing loss, myelitis, myeloradiculopathy, and Guillain-Barré syndrome.19 Chikungunya also has been associated with bleeding manifestations, acute renal failure, and electrolyte disturbance.19
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