Dengue fever, a disease caused by mosquitos, was reported in Malaysia since 1902 but it was only known as haemorrhagic dengue when the first severe dengue outbreak occurred in Penang in 1962. Since then, dengue fever has been spreading across the country mainly in the cities and suburban areas.
The overview of dengue fever in Malaysia is much clearer from the distribution of cases according to states, areas, age and gender. The number of dengue fever is relatively high in the more developed and densely populated states like Selangor, Kuala Lumpur and Johor. Actually, dengue fever can be found wherever the mosquito vector is present and introduced, whether in the rural or urban areas, with the risk generally higher in the latter.
Dengue virus is categorized under the Flaviviridae family and it has four cerotypes including DEN-1, DEN-2, DEN-3 and DEN-4. The important vectors for dengue viruses are Aedes aegypti and Aedes albopictus. The transmission of the disease starts when the vector bites the individual who has been infected with the virus. These vectors like to bite early in the morning and late evening. It multiplies in clear and stagnant water indoor or outdoor. Dengue virus needs about eight to ten days ( the incubation period for the virus) to replicate in the vector’s saliva gland. When the vector bites and sucks the blood of any new and healthy individual, this individual will get infected with the virus. Virus can be found in the blood stream about four to six days after the incubation period.
Dengue Haemorrhagic fever (DHF) is a severe and sometimes fatal form of dengue. Typical cases of DHF are characterized by four major clinical manifestations: high fever, haemorrhagic phenomena, hepatomegaly and circulatory failure. Moderate to marked thrombocytopenia with concurrent haemoconcentration is a distinctive clinical laboratory finding of DHF. The major pathophysiological change that determines the severity of disease in DHF is the leakage of plasma, as manifested by an elevated haematocrit (haemoconcentration), a serous effusion or hypoproteinaemia.
Children with DHF commonly present with a sudden rise in temperature accompanied by facial flush and other non-specific constitutional symptoms resembling dengue fever, such as anorexia, vomiting, headache, muscle, bone or joint pain.
Hepatomegaly - enlargement of the liver.
Haemorrhagic – bleeding
Haematocrit – the volume percentage of erythrocytes (red blood cells) in whole blood.
Hypoproteinaemia – deficiency of proteins in the blood.
The Pathophysiology of Tetanus
Tetanus is an acute, often fatal disease caused by an exotoxin produced in a wound by Clostridium tetani. Clostridium tetani is a gram-positive, nonencapsulated, motile, obligatively anaerobic bacillus. It exists in vegetative and sporulated forms. Spores are highly resistant to disinfections by chemical or heat, but vegetative forms are susceptible to the bactericidal effect of heat, chemical disinfectants, and a number of antibiotics.
Allergic Food Reactions
The topic of allergic food reactions is undoubtedly one of the most confused of clinical immunology. The term ‘allergic’ is frequently used inappropriately to describe all conditions where reproducible reactions are triggered by food ingestions, disappear on an elimination diet and recur on a blind challenge. ‘Food intolerance’ is the appropriate term to define the entirety of these conditions.
