Eve B. Hoover is completing a postgraduate academic fellowship at Midwestern University at Glendale, Arizona, and practices at Logistics Health, Inc, in Phoenix. The author has no significant financial relationships to disclose.
FOLLOW-UP Malaria Appropriate follow-up, need for hospitalization, and choice of medical treatment are determined by disease cause, severity of illness, and patient demographics. Follow-up is necessary to ensure improvement and no development of atypical symptoms. Additionally, the clinician needs to keep in mind the risk for malaria strains that can have a dormant stage.
Dengue fever Clinicians must remind convalescing patients to watch for severe abdominal pain, vomiting, difficulty breathing, and signs of bleeding (epistaxis, bruising, bloody stool, and menorrhagia). Clinicians must also be attentive to changing lab values, including a decrease in platelet count and an increase in hematocrit, along with signs of hypovolemic shock, ascites, pleural effusions, and narrow pulse pressure.14
Chikungunya Patients are reminded to keep themselves comfortable by rehydrating and treating the discomfort associated with arthralgias. In a longitudinal study of chikungunya patients, 60% experienced continued arthralgias three years after diagnosis.23,30 Patient education regarding the potential for long-term arthralgia is important, as it may impact activities of daily living and work.
Long-term NSAIDs have been used for patients with recurrent or even chronic arthralgia.31 There are limited data available on beneficial treatments, such as chloroquine sulfate or disease-modifying antirheumatic drugs, for chronic arthralgia associated with chikungunya.23 Depression and recurrent cutaneous lesions also are possible in patients with long-term symptoms.
