As her viral load is below 50 copies/ml, she is eligible for a vaginal delivery. In the UK, it is advised that babies born to HIV-positive mothers are formula-fed. Despite her CD4 count being above 350 cells/mm³, it is important for her to continue taking ART to minimize the risk of transmitting the virus to her husband.

HIV and Pregnancy: Guidelines for Minimizing Vertical Transmission

With the increasing prevalence of HIV infection among heterosexual individuals, there has been a rise in the number of HIV-positive women giving birth in the UK. In London, the incidence may be as high as 0.4% of pregnant women. The goal of treating HIV-positive women during pregnancy is to minimize harm to both the mother and fetus and to reduce the chance of vertical transmission.

To achieve this goal, various factors must be considered. Guidelines on this subject are regularly updated, and the most recent guidelines can be found using the links provided. Factors that can reduce vertical transmission from 25-30% to 2% include maternal antiretroviral therapy, mode of delivery (caesarean section), neonatal antiretroviral therapy, and infant feeding (bottle feeding).

To ensure that HIV-positive women receive appropriate care during pregnancy, NICE guidelines recommend offering HIV screening to all pregnant women. Additionally, all pregnant women should be offered antiretroviral therapy, regardless of whether they were taking it previously.

The mode of delivery is also an important consideration. Vaginal delivery is recommended if the viral load is less than 50 copies/ml at 36 weeks. Otherwise, a caesarean section is recommended, and a zidovudine infusion should be started four hours before beginning the procedure.

Neonatal antiretroviral therapy is also crucial in minimizing vertical transmission. Zidovudine is usually administered orally to the neonate if the maternal viral load is less than 50 copies/ml. Otherwise, triple ART should be used, and therapy should be continued for 4-6 weeks.

Finally, infant feeding is another important factor to consider. In the UK, all women should be advised not to breastfeed to minimize the risk of vertical transmission. By following these guidelines, healthcare providers can help minimize the risk of vertical transmission and ensure that HIV-positive women receive appropriate care during pregnancy.

Treatment Options for Shigella Infection

Shigella infection is a common cause of diarrhoea, particularly in developing countries. The following treatment options are available for patients with symptomatic Shigella infection:

Oral azithromycin is the preferred first-line option for the treatment of Shigella infection. Quinolones were previously used, but their use is now discouraged due to the risk of seizures and tendon rupture.

Oral metronidazole is the intervention of choice for giardiasis, which presents with symptoms similar to irritable bowel syndrome. However, Shigella infection is not usually treated with metronidazole.

Oral ciprofloxacin is now reserved for serious or life-threatening illness when other options for treatment are unavailable due to significant adverse effects associated with their use.

Single-dose intravenous (IV) ceftriaxone is the preferred option for patients who are severely unwell because of Shigella infection. However, oral azithromycin is considered adequate for most cases.

Given the severity of symptoms and the patient’s activity holiday, antibiotic intervention is warranted to relieve his symptoms.

When a patient with neutropenic sepsis fails to respond to broad-spectrum antibiotics within 48 hours, it is possible that they have a fungal infection. In this case, increasing G-CSF or administering paracetamol will not treat the infection. While adding metronidazole may be helpful, it is not clear if the source of the sepsis is abdominal. Further blood cultures may be necessary, but they will not improve the patient’s condition. The best course of action is to start fluconazole, as fungal causes should always be considered in cases of neutropenic sepsis. The patient’s oral candida and odynophagia suggest the possibility of oesophageal candidiasis, which should be taken into account given the presence of Candida.

Understanding Neutropenic Sepsis in Cancer Patients

Neutropenic sepsis is a common complication that arises from cancer therapy, particularly chemotherapy. It typically occurs within 7-14 days after chemotherapy and is characterized by a neutrophil count of less than 0.5 * 109 in patients undergoing anticancer treatment who exhibit a temperature higher than 38ºC or other signs of clinically significant sepsis. To prevent this condition, patients who are likely to have a neutrophil count of less than 0.5 * 109 should be offered a fluoroquinolone.

Immediate antibiotic therapy is crucial in managing neutropenic sepsis. It is recommended to start empirical antibiotic therapy with piperacillin with tazobactam (Tazocin) without waiting for the WBC. While some units add vancomycin if the patient has central venous access, NICE does not support this approach. After the initial treatment, patients are assessed by a specialist and risk-stratified to determine if they can receive outpatient treatment. If patients remain febrile and unwell after 48 hours, an alternative antibiotic such as meropenem may be prescribed, with or without vancomycin. If patients do not respond after 4-6 days, the Christie guidelines suggest ordering investigations for fungal infections (e.g. HRCT) instead of blindly starting antifungal therapy. In selected patients, G-CSF may also be considered.

According to the World Health Organisation, it is crucial to promptly identify and treat severe malaria to prevent the patient’s condition from rapidly deteriorating and potentially leading to life-threatening complications. These complications may include hypoglycaemia, acidosis, coma, convulsions, severe anaemia, and pulmonary oedema. Cerebral malaria may be indicated by coma or convulsions, and the type of parasite and percentage of parasitaemia are important factors in determining the prognosis and treatment of malaria.

Understanding Falciparum Malaria and its Complications

Falciparum malaria is the most common and severe type of malaria. It is characterized by schizonts on a blood film, parasitaemia greater than 2%, hypoglycaemia, acidosis, temperature above 39°C, severe anaemia, and various complications. Complications of falciparum malaria include cerebral malaria, acute renal failure, acute respiratory distress syndrome, hypoglycaemia, and disseminated intravascular coagulation.

In areas where strains resistant to chloroquine are prevalent, the 2010 WHO guidelines recommend artemisinin-based combination therapies (ACTs) as first-line therapy for uncomplicated falciparum malaria. Examples of ACTs include artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate plus sulfadoxine-pyrimethamine, and dihydroartemisinin plus piperaquine.

For severe falciparum malaria, a parasite count of more than 2% usually requires parenteral treatment regardless of clinical state. The WHO now recommends intravenous artesunate over intravenous quinine. If the parasite count is greater than 10%, exchange transfusion should be considered. Shock may indicate coexistent bacterial septicaemia, as malaria rarely causes haemodynamic collapse.

Doxycycline is commonly prescribed to manage typhus. A woman presents with a combination of symptoms including fever, hepatosplenomegaly, encephalitis, and an eschar on her shin. As a returning traveler from Indonesia, she may have contracted various diseases such as malaria or dengue fever. However, the presence of an eschar suggests rickettsia, specifically scrub typhus caused by Orientia Tsutsugamushi. Additional indicators of this diagnosis include low platelets, elevated liver function tests, and bilateral infiltrates on chest x-ray. The recommended first-line treatment is a seven-day course of doxycycline, although azithromycin may be used as a single dose for those who cannot take doxycycline. Mefloquine and Chloroquine are used to treat malaria, while supportive therapy is the recommended treatment for dengue fever.

Understanding Typhus: Types, Symptoms, and Management

Typhus is a group of diseases caused by rickettsia bacteria that are transmitted between hosts by arthropods. There are different types of typhus, including endemic typhus, epidemic typhus, scrub typhus, and spotted fever. Endemic typhus is caused by Rickettsia typhi and is transmitted by fleas on rats. It occurs worldwide, particularly in warm coastal regions. Epidemic typhus, on the other hand, is caused by Rickettsia prowazekii and is transmitted by body lice. It is more common in central and eastern Africa, as well as central and South America. Scrub typhus, caused by Orientia tsutsugamushi, is transmitted by harvest mites on humans or rodents and is more common in Asia. Spotted fever, caused by Rickettsia spotted fever group, is spread by ticks and includes Rocky Mountain spotted fever.

Despite their differences, all types of typhus share common symptoms such as fever, headache, and malaise. A rash is also a common feature, typically maculopapular, and begins on the trunk before spreading to the extremities. Later complications may include meningoencephalitis. Management of typhus involves the use of doxycycline.

In summary, understanding the different types of typhus, their symptoms, and management is crucial in preventing and treating this group of diseases.

Based on the patient’s lack of natural immunity and the presence of schizonts in the blood film, this is likely a case of severe malaria with a low level of parasitaemia. Therefore, early intravenous therapy is necessary, and options B, C, and D can be excluded. Additionally, chloroquine is not typically used for falciparum malaria. The WHO recommends using intravenous artesunate for at least the first 24 hours until the patient can tolerate oral medication.

Understanding Falciparum Malaria and its Complications

Falciparum malaria is the most common and severe type of malaria. It is characterized by schizonts on a blood film, parasitaemia greater than 2%, hypoglycaemia, acidosis, temperature above 39°C, severe anaemia, and various complications. Complications of falciparum malaria include cerebral malaria, acute renal failure, acute respiratory distress syndrome, hypoglycaemia, and disseminated intravascular coagulation.

In areas where strains resistant to chloroquine are prevalent, the 2010 WHO guidelines recommend artemisinin-based combination therapies (ACTs) as first-line therapy for uncomplicated falciparum malaria. Examples of ACTs include artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate plus sulfadoxine-pyrimethamine, and dihydroartemisinin plus piperaquine.

For severe falciparum malaria, a parasite count of more than 2% usually requires parenteral treatment regardless of clinical state. The WHO now recommends intravenous artesunate over intravenous quinine. If the parasite count is greater than 10%, exchange transfusion should be considered. Shock may indicate coexistent bacterial septicaemia, as malaria rarely causes haemodynamic collapse.

The recommended treatment duration for bone and joint tuberculosis is 6 months, with the first 2 months involving quadruple therapy and the remaining 4 months involving dual therapy. There is some controversy regarding whether treatment should be extended for residual complications such as spinal deformities.

Managing Tuberculosis: Treatment and Complications

Tuberculosis is a serious infectious disease that requires prompt and effective treatment. The standard therapy for active tuberculosis involves an initial phase of two months with a combination of four drugs: rifampicin, isoniazid, pyrazinamide, and ethambutol. The continuation phase lasts for four months and involves rifampicin and isoniazid. For latent tuberculosis, treatment involves three months of isoniazid and rifampicin or six months of isoniazid with pyridoxine. Patients with meningeal tuberculosis require prolonged treatment of at least 12 months with the addition of steroids.

Directly observed therapy may be necessary for certain groups, such as homeless individuals, prisoners, and patients with poor concordance. However, treatment can also lead to complications. Immune reconstitution disease can occur 3-6 weeks after starting treatment and often presents with enlarging lymph nodes. Drug adverse effects can also occur, such as hepatitis, orange secretions, flu-like symptoms, peripheral neuropathy, agranulocytosis, hyperuricaemia causing gout, arthralgia, myalgia, and optic neuritis. It is important to monitor patients for these complications and adjust treatment as necessary.

The appropriate treatment for tick-borne encephalitis is supportive care. Therefore, stopping ceftriaxone and aciclovir and managing the patient’s symptoms is the correct course of action. The patient’s recent travel to an endemic region and presentation with flu-like symptoms followed by neurological dysfunction, as well as the CSF testing revealing specific antibodies against a flavivirus, confirm the diagnosis. There is no specific antiviral treatment for tick-borne encephalitis, so patients require admission to the hospital for supportive care, including pain relief, fever management, fluid and electrolyte management, and intensive care if necessary. Continuing aciclovir and ceftriaxone is not appropriate, as they do not benefit the patient’s condition.

Tick-borne Encephalitis: A Viral Infection Transmitted by Ticks

Tick-borne encephalitis is a viral infection caused by the Flavivirus and transmitted by ticks that are hosted by native wildlife. The virus is transmitted to the host through the bite of an infected tick. The infection manifests as a biphasic illness, with the first phase characterized by constitutional upset, including headaches, myalgia, and fevers. This is followed by an asymptomatic period before the disease progresses to phase two, which is characterized by symptoms of central nervous system involvement, such as meningitis or encephalitis. The incubation period can be up to a month, and long-term neurological sequelae may persist for months to years following infection.

There are three species of flavivirus implicated in tick-borne encephalitis: European, Far Eastern, and Siberian. The Far Eastern species typically causes the most severe illness, often progressing rapidly to central nervous system involvement with no asymptomatic period. Diagnosis is made on the basis of clinical suspicion, with confirmation via cerebrospinal fluid (CSF) analysis demonstrating specific IgM or IgG antibodies. Treatment is supportive, with the addition of doxycycline or a cephalosporin advised if Lyme disease is considered a differential diagnosis until confirmation via CSF sampling can be obtained.

A vaccination is available and recommended for those travelling to endemic areas and planning to engage in high-risk outdoor activities, such as hiking in rural forested areas and/or grasslands. Precautions to avoid tick bites are recommended to all travellers to endemic areas.

Adverse Effects of Antiretroviral Therapy on HIV Patients

Antiretroviral therapies are commonly used to treat HIV-positive patients, but they can also cause adverse effects. One of the most frequent side effects is anaemia, which is often caused by zidovudine (AZT). This drug can suppress bone marrow function, leading to severe cases of anaemia that may require blood transfusions. In addition to anaemia, AZT can also cause myalgia, myopathy, myositis, pancytopenia, and lactic acidosis. Although rare, blue discolouration of the nails has also been reported as a side effect of AZT.

Macrocytosis, or the presence of abnormally large red blood cells, is a common finding in patients taking AZT. This can be used as a parameter to monitor adherence to therapy. It is important for healthcare providers to be aware of these potential adverse effects and to monitor patients closely for any signs of anaemia or other complications. By doing so, they can provide appropriate treatment and support to help patients manage their HIV infection and maintain their overall health and well-being.

HIV and Bronchopneumonia: Clinical Indicators and Treatment Considerations

Patients with HIV are more susceptible to bronchopneumonia, making it an important clinical indicator for HIV testing. Those with abnormal CD4 counts are at risk for invasive streptococcal infection secondary to streptococcal pneumonia, highlighting the need for routine pneumococcal vaccination in all HIV patients. However, in patients with well-controlled HIV and normal CD4 counts, pneumonia can be managed as an outpatient using CURB scoring and antimicrobial prescribing guidelines, with caution for potential drug interactions.

When assessing a patient with bronchopneumonia, their CURB score can determine the need for admission and intravenous antibiotics. In this case, a score of 0 indicates that hospitalization is not necessary. It is important to note that a patient’s well-controlled HIV does not affect their CURB score.

When prescribing antibiotics, it is crucial to consider potential drug interactions. Clarithromycin, for example, is a CYP3A4 inhibitor and should not be used in patients taking efavirenz, nevirapine, or protease inhibitors.

It is important to remember that bronchopneumonia does not necessarily indicate treatment failure in HIV patients. However, their HIV physician should be informed so they can ensure the patient is up to date on their pneumococcal and influenza vaccinations.

While HIV patients may have unique medical considerations, general physicians should still be able to treat common conditions. Therefore, admitting directly to an infectious diseases unit may not always be necessary.

Overall, the relationship between HIV and bronchopneumonia, as well as considering potential drug interactions and vaccination status, can aid in the effective management of pneumonia in HIV patients.

Antimicrobial Therapy Options for a Neutropenic Patient with Invasive Aspergillosis

Voriconazole is a suitable addition to the antimicrobial therapy of a neutropenic patient with CT findings suggestive of invasive aspergillosis. It has a broad spectrum of activity against both yeasts and moulds and is associated with reduced renal impairment and morbidity compared to amphotericin B. Gentamicin, co-amoxiclav, and ciprofloxacin are unlikely to provide additional cover for the patient who is already receiving broad-spectrum antibiotics. Fluconazole, on the other hand, has no activity against moulds such as Aspergillus, which is the primary concern in this case.

Parvovirus B19 is a virus that causes erythema infectiosum in children, but can also lead to more serious complications such as aplastic crisis in patients with haemoglobinopathies. It can also cause a post-infectious arthritis that affects small joints, particularly in adult women. This arthritis does not cause permanent damage to bones or joints and should be considered before diagnosing rheumatoid arthritis, especially if the patient has been around children with viral illnesses.

Immune Reconstitution Inflammatory Syndrome (IRIS) is a condition where symptoms worsen due to increased inflammation as the immune system recovers. It is commonly seen in patients undergoing anti-retroviral therapy for HIV. To diagnose IRIS, it is important to first confirm the underlying condition, such as tuberculosis (TB), through PCR testing. However, since HIV patients may have multiple opportunistic infections, IRIS is a diagnosis of exclusion. In this case, extensive testing ruled out other possible causes for the patient’s symptoms. The diagnosis of IRIS requires meeting all three criteria: antecedents (such as a confirmed diagnosis of TB and initial response to treatment), clinical symptoms (either one major or two minor criteria), and exclusion of other possible explanations for the worsening symptoms.

Understanding Immune Reconstitution Inflammatory Syndrome

Immune reconstitution inflammatory syndrome (IRIS) is a medical condition that is commonly linked to HIV or immunosuppression. It occurs when the immune system starts to recover, but then reacts to a previous opportunistic infection with an excessive inflammatory response. This response can worsen the symptoms of the infection, leading to a paradoxical situation.

IRIS is a result of the immune system’s attempt to fight off infections that were previously suppressed due to immunosuppression. When the immune system starts to recover, it can overreact to these infections, causing inflammation and tissue damage. This can lead to a range of symptoms, including fever, swollen lymph nodes, and skin rashes.

IRIS can occur in people with a range of opportunistic infections, including tuberculosis, cryptococcal meningitis, and cytomegalovirus. It is most commonly seen in people with HIV who are starting antiretroviral therapy. While IRIS can be uncomfortable and even dangerous, it is a sign that the immune system is starting to recover. Treatment may involve managing symptoms with anti-inflammatory medications or adjusting antiretroviral therapy.

The most reliable method of diagnosing Legionella pneumophilia, which is likely the cause of this patient’s illness, is through the urinary antigen test. This infection is commonly associated with air conditioning and heating systems, and the patient may have contracted it while on vacation. Additionally, the patient’s low sodium levels may be a result of syndrome of inappropriate ADH secretion.

Legionnaire’s Disease: Symptoms, Diagnosis, and Management

Legionnaire’s disease is a type of pneumonia caused by the Legionella pneumophilia bacterium. It is commonly found in water tanks and air-conditioning systems, and is often associated with foreign travel. Unlike other types of pneumonia, Legionnaire’s disease cannot be transmitted from person to person. Symptoms of the disease include flu-like symptoms such as fever, dry cough, confusion, and lymphopaenia. In addition, patients may experience hyponatraemia, deranged liver function tests, and pleural effusion in around 30% of cases.

Diagnosis of Legionnaire’s disease is typically done through a urinary antigen test. Treatment involves the use of antibiotics such as erythromycin or clarithromycin. Chest x-rays may show non-specific features, but often include patchy consolidation in the mid-to-lower zones and pleural effusions. It is important to be aware of the symptoms and risk factors associated with Legionnaire’s disease in order to ensure prompt diagnosis and treatment.

Neutropenic individuals are advised to steer clear of soft cheese as it poses a risk of listeriosis. In this scenario, the patient is suffering from neutropenic sepsis, which makes them highly vulnerable to various organisms. It is recommended that they avoid consuming dairy products and cold meats. The patient experienced gastrointestinal symptoms and a gram-positive bacillus was detected through culturing. This rules out the possibility of salmonellosis and shigellosis. Since the bacillus is gram-positive and not staphylococcus, listeria is the most probable cause of the patient’s illness, as it is commonly found in dairy products.

Understanding Neutropenic Sepsis in Cancer Patients

Neutropenic sepsis is a common complication that arises from cancer therapy, particularly chemotherapy. It typically occurs within 7-14 days after chemotherapy and is characterized by a neutrophil count of less than 0.5 * 109 in patients undergoing anticancer treatment who exhibit a temperature higher than 38ºC or other signs of clinically significant sepsis. To prevent this condition, patients who are likely to have a neutrophil count of less than 0.5 * 109 should be offered a fluoroquinolone.

Immediate antibiotic therapy is crucial in managing neutropenic sepsis. It is recommended to start empirical antibiotic therapy with piperacillin with tazobactam (Tazocin) without waiting for the WBC. While some units add vancomycin if the patient has central venous access, NICE does not support this approach. After the initial treatment, patients are assessed by a specialist and risk-stratified to determine if they can receive outpatient treatment. If patients remain febrile and unwell after 48 hours, an alternative antibiotic such as meropenem may be prescribed, with or without vancomycin. If patients do not respond after 4-6 days, the Christie guidelines suggest ordering investigations for fungal infections (e.g. HRCT) instead of blindly starting antifungal therapy. In selected patients, G-CSF may also be considered.

Leptospirosis: A Tropical Disease with Early and Late Phases

Leptospirosis is a disease caused by the bacterium Leptospira interrogans, which is commonly spread through contact with infected rat urine. While it is often associated with certain occupations such as sewage workers, farmers, and vets, it is more prevalent in tropical regions and should be considered in returning travelers. The disease has two phases: an early phase characterized by flu-like symptoms and fever, and a later immune phase that can lead to more severe symptoms such as acute kidney injury, hepatitis, and aseptic meningitis. Diagnosis can be made through serology, PCR, or culture, but treatment typically involves high-dose benzylpenicillin or doxycycline.

To avoid potential drug interactions with the patient’s current antiretroviral therapy, the recommended treatment for tuberculosis in this scenario is to use rifabutin, isoniazid, ethambutol, and pyrazinamide. Rifampicin, a common rifamycin agent used in tuberculosis treatment, can induce liver enzymes and reduce the absorption of certain medications, including protease inhibitors. As the patient is stable on their current antiretroviral therapy and not willing to switch, substituting rifampicin with rifabutin or rifapentine is suggested by the British HIV Association. Regimes containing rifabutin have shown similar treatment outcomes in small observational studies in patients with HIV/TB co-infection.

Managing Tuberculosis: Treatment and Complications

Tuberculosis is a serious infectious disease that requires prompt and effective treatment. The standard therapy for active tuberculosis involves an initial phase of two months with a combination of four drugs: rifampicin, isoniazid, pyrazinamide, and ethambutol. The continuation phase lasts for four months and involves rifampicin and isoniazid. For latent tuberculosis, treatment involves three months of isoniazid and rifampicin or six months of isoniazid with pyridoxine. Patients with meningeal tuberculosis require prolonged treatment of at least 12 months with the addition of steroids.

Directly observed therapy may be necessary for certain groups, such as homeless individuals, prisoners, and patients with poor concordance. However, treatment can also lead to complications. Immune reconstitution disease can occur 3-6 weeks after starting treatment and often presents with enlarging lymph nodes. Drug adverse effects can also occur, such as hepatitis, orange secretions, flu-like symptoms, peripheral neuropathy, agranulocytosis, hyperuricaemia causing gout, arthralgia, myalgia, and optic neuritis. It is important to monitor patients for these complications and adjust treatment as necessary.

Cryptococcal Meningo-Encephalitis: A Fungal Infection in Immunocompromised Patients

Cryptococcus meningo-encephalitis is a severe fungal infection caused by Cryptococcus neoformans, which affects patients with weakened cell-mediated immunity. This illness is considered an AIDS-defining condition and is commonly observed when the CD4 count is below 100. The symptoms of this infection develop gradually over one to two weeks. The diagnosis of Cryptococcal meningo-encephalitis is made by examining the cerebrospinal fluid (CSF) with India ink, which reveals the presence of encapsulated yeast forms.

The treatment of Cryptococcal meningo-encephalitis involves the use of intravenous amphotericin B, which may be combined with flucytosine in some cases. In certain instances, a prolonged course of fluconazole may be prescribed. It is crucial to diagnose and treat this infection promptly to prevent severe complications.

A returning traveller with symptoms of retro-orbital headache, fever, facial flushing, rash, and thrombocytopenia is likely suffering from dengue fever. Other possible differentials include typhoid fever, which presents with a skin rash and gastrointestinal symptoms, and gonorrhoeae, which typically causes migratory arthritis and tenosynovitis with discharge. Leucopenia, a common symptom of dengue fever, does not necessarily indicate immunodeficiency or HIV.

Understanding Dengue Fever

Dengue fever is a viral infection that can lead to viral haemorrhagic fever, which includes diseases like yellow fever, Lassa fever, and Ebola. The dengue virus is an RNA virus that belongs to the Flavivirus genus and is transmitted by the Aedes aegypti mosquito. The incubation period for dengue fever is seven days.

Patients with dengue fever can be classified into three categories: those without warning signs, those with warning signs, and those with severe dengue (dengue haemorrhagic fever). Symptoms of dengue fever include fever, headache (often retro-orbital), myalgia, bone pain, arthralgia (also known as ‘break-bone fever’), pleuritic pain, facial flushing, maculopapular rash, and haemorrhagic manifestations such as a positive tourniquet test, petechiae, purpura/ecchymosis, and epistaxis. Warning signs include abdominal pain, hepatomegaly, persistent vomiting, and clinical fluid accumulation (ascites, pleural effusion). Severe dengue (dengue haemorrhagic fever) is a form of disseminated intravascular coagulation (DIC) that results in thrombocytopenia and spontaneous bleeding. Around 20-30% of these patients go on to develop dengue shock syndrome (DSS).

Typically, blood tests are used to diagnose dengue fever, which may show leukopenia, thrombocytopenia, and raised aminotransferases. Diagnostic tests such as serology, nucleic acid amplification tests for viral RNA, and NS1 antigen tests may also be used. Treatment for dengue fever is entirely symptomatic, including fluid resuscitation and blood transfusions. Currently, there are no antivirals available for the treatment of dengue fever.

Hepatitis E is the Likely Diagnosis for Acute Symptoms

Based on the patient’s acute symptoms and lack of exposure to potential viruses through bodily fluids, hepatitis E is the most probable diagnosis. This virus is transmitted through the fecal-oral route, with genotypes 3 and 4 causing disease in humans. While the mortality rate is low for the general population, pregnant women may experience a higher mortality rate of up to 20%. There is no vaccine for hepatitis E, and treatment is supportive as immunoglobulin is ineffective.

Hepatitis D, on the other hand, always coexists with hepatitis B, which the patient has been vaccinated against. Therefore, there is no chance of the patient having hepatitis D. The Epstein-Barr virus is associated with pharyngitis and abnormal liver function tests, but the large increase in ALT seen in this case is not typical of this virus. Hepatitis C is unlikely as there is no history of exposure to contaminated blood products or bodily fluids. Typhoid fever is associated with intermittent diarrhea, headaches, high fever, and a non-productive cough, but it does not typically cause a significant rise in transaminases as seen in this case.