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Questions and Answers
What do Rapid Diagnostic Tests (RDTs) for malaria detect?
How is the presence of antigen indicated in Rapid Diagnostic Tests (RDTs)?
What is the therapeutic dose regimen for treating uncomplicated falciparum malaria with Artemether plus lumefantrine?
What are the components of the fixed-dose formulation of Artemether plus lumefantrine?
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What is the therapeutic dose range for Artesunate in treating uncomplicated falciparum malaria?
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In the combination therapy of Artesunate plus amodiaquine, what is the target dose for amodiaquine per day?
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Which medication is recommended in areas where both P. vivax and P. falciparum malaria transmission co-exist?
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What is a recommended prophylaxis against malaria in areas with varying resistance patterns?
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Which medication is sufficient for treating P. malariae infections?
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What method can be used as personal protection to reduce malaria illness and death in endemic regions?
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In areas with high risk of P. falciparum malaria and reported antimalarial drug resistance, what medication combination can be recommended?
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Which medication regimen is suggested when malaria is due exclusively to P. vivax or fully chloroquine-sensitive P. falciparum?
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What is the primary advantage of parasitological diagnosis in suspected malaria cases?
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Why is microscopy considered the 'gold standard' for diagnosing malaria?
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What is the basis for microscopic diagnosis of malaria?
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What is severe malaria defined as?
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Why is it recommended to perform parasitological diagnosis in all suspected malaria cases?
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What type of staining allows for a high degree of sensitivity and specificity in microscopy for malaria diagnosis?
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What is the main factor hindering the widespread use of ITNs in endemic countries?
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Which mosquito species is the primary transmitter of dengue viruses in the Western Hemisphere?
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Which vaccine is mentioned as the first one to significantly reduce malaria in young children living in moderate-to-high transmission areas?
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What is the main target of the RTS,S vaccine in combating malaria?
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In what region did a 2001 outbreak of dengue occur due to transmission by Aedes albopictus?
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What is the main mode of transmission for dengue to humans?
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Which region has the highest percentage of rabies deaths annually?
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What is a common mode of exposure to rabies from animals?
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What is the most acutely fatal infectious disease in the Philippines?
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How does rabies virus primarily spread within the Central Nervous System (CNS)?
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Which of the following animals pose a risk for rabies infection through bites?
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What is the average incubation period for rabies once exposed?
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How should Category 2 rabies exposures be managed?
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What is the recommended vaccination regimen for infants in the Philippines?
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What is crucial for individuals directly exposed to suspected rabid animals?
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Study Notes
Rabies
- Estimated 55,000 deaths annually worldwide, predominantly in Asia (56%) and Africa (43.6%)
- Highly fatal, with symptoms including consciousness fluctuations, spasms, and autonomic instability
- Neglected disease affecting poor and vulnerable populations
- Limited reporting of deaths, particularly in remote rural communities
- Lack of preventative measures in areas with dog-to-human transmission
- Under-reporting hinders international resource mobilization for rabies elimination
Philippines Scenario
- Rabies remains a public health problem in the Philippines
- Most acutely fatal infectious disease, causing 200-250 deaths annually
- One-third of deaths in children under 15 years
- Two-thirds of cases are males
Modes of Transmission
- Bites from infected animals, particularly dogs and cats, are the most common mode
- Exposure can also come from other domestic and wild animals, including bats
- Non-bite exposures are less common but may include scratches, open wounds, and mucous membranes licked by an infected animal
- Bites from rats, rabbits, rodents, reptiles, and birds do not pose a risk for rabies infection
Pathogens
- Incubation Period: 1-3 months, with 90-95% of cases having an incubation period of less than one year, but longer periods in 5-10% of cases
- Factors influencing incubation: amount of virus, severity, and location of exposure
- Rabies virus multiplies in muscle cells or may directly invade nerves
Diagnosis
- Often based on clinical manifestations and exposure history
- Hydrophobia and/or aerophobia pathognomonic; however, paralytic rabies may pose diagnostic challenges
- Laboratory confirmation is necessary
- Diagnosis performed on fresh tissue specimens stored at appropriate temperatures
Rabies Post-Exposure Prophylaxis
- Crucial for individuals directly exposed to suspected rabid animals
- Initiation should not be delayed, regardless of exposure-to-consultation interval
- Delay increases the risk of rabies and is associated with treatment failure
Categories of Exposure
- Category I: Feeding/touching an animal, licking of intact skin, exposure to patients with signs and symptoms of rabies, casual contact
- Category II: Nibbling of uncovered skin, minor/superficial scratches/abrasions without bleeding, including those induced to blood
- Category III: All Category II exposures on the head and neck area
Management of Exposure
- Category I: Wash exposed skin immediately with soap and water, no vaccine or Rabies Immune Globulin (RIG) needed
- Category II: Wash wound with soap and water, start vaccine immediately, complete regimen until Day 28
- Category III: Wash wound with soap and water, start vaccine and RIG immediately, complete regimen until Day 28
Special Considerations
- Pregnancy and infancy not contraindications to PEP
- Babies born to rabid mothers should receive rabies vaccination and RIG upon birth
- Exposed persons evaluated weeks or months after the bite should be managed as if the exposure occurred recently
Rabies Vaccination in the Philippines
- Vaccine-preventable disease
- Animal Bite Treatment Centers (ABTC) established for PEP
- Intradermal (ID) regimen recommended for cost-effectiveness
- WHO-approved vaccines for ID use required
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Description
Test your knowledge on the parasitological diagnosis required for confirming malaria cases and the classification of populations based on the intensity of transmission. Learn about the signs of severe malaria and the importance of physical examination in identifying vital organ dysfunction.
