Date post: | 13-Apr-2017 |
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Syndromic approach in
Diagnostic virology
Present by
Faris K-2013 MSc MLT Microbiology
Moderator
Mr. T. Gopakumar, Asst. Professor
Dept of MLT, GMCT
Syndrome
A syndrome is a set of medical signs and symptoms that are correlated with each other and, often, with a specific disease.
There is no single step diagnostic procedure in viral disease – we rule out a viral disease in syndrome based testing.
What we discus here?
Different types of syndromes Syndrome related viral infection
Major Clinical Syndromes
1.Fever
2. Influenza like illness(ILI)
3. Severe acute respiratory illness (SARI)
4. Dengue like illness DLI(fever + myalgia)
5. Fever + Arthralgia
6. Fever + rash(measles like)
7. Fever + parotitis(mumps like)
Syndromes
8. Acute encephalitis syndrome(AES)
9. Acute Respiratory Distress Syndrome(ARDS)
10. Acute jaundice syndrome
11. Acute diarrhea syndrome
12. Acute hemorrhagic fever syndrome
13. Syndromes involving conjunctivitis
Syndromes
Congenital viral infections
1.Fever
Elevation of body temperature that exceeds the normal daily variation. Shift from normothermic to febrile levels
Normal body temperature
Normal body temp. in healthy humans(18-40yrs) mean oral temp=36.8◦ C (98.2◦F+/_0 .7◦F) Normal daily temp.variation-0.5-0.9◦C Rectal temp.-0.4◦C or 0.7◦F higher than oral readings
Fever without a focus Diagnostic challenge Fever may be due to many reason • Bacteremia/Sepsis • Secondary to a focal infection • Any non specific presentation of a disease • Parasitic, Fungal infection • Viral (acute onset) hyper/hypothermia tachypnea/tachycardia Shock
INFLUENZA LIKE ILLNESS
Case Definition: Sudden onset of fever>100 0F
Cough and or/ sore throat AND An absence of other diagnosis
Severe Acute Respiratory Illness (SARI)
Case definition for persons> 5years - Sudden onset of fever, and Cough or sore throat, AND Shortness of breath/difficulty in breathing
OR Any child <5yrs old clinically suspected of having pneumonia or severe /very severe pneumonia
Causes of ILI & SARI
DLI(fever+myalgia)
Definition:
• A diagnosis of DLI is established on the basis of clinical features and supporting non serologic laboratory investigations •With negative /incomplete serologic testing can be included
Differential diagnosis-Denguefever
Conditions that mimic febrile phase of dengue viral infection
FLU LIKE SYNDROMES
FEVER WITH DIARRHEA RASH
Iillnesses with Neurological manifestations
Others
INFLUENZA CHIKUNGUNYA
HIV (seroconversion state)
Rubella Measles Chikungunya Drug reactions
Meningococca l infection
Rota virus other enteric infections
Other causes of meningoencephalitis
Febrile seizures
Leptospirosis Rickettsial infection Enteric fever Malaria Viral hepatitis Brucellosis
Conditions that mimic critical phase
Bacterial Viral Parasitic
Leptospirosis Rickettsial infections
Acute gastero enteritis
Typhoid Bacterial sepsis
Septic shock
Viral hepatitis Other causes of Viral hemorrhagic fevers like Kayasanur forest disease ,Crimean congo hemorrhagic fever
Malaria
Others- acute leukemia
-other malignancies -other causes of acute
abdomen -platelet disorders
Fever with rash (measles like illness) rash is an area of skin that has become redden/swollen/irritated
Measles rash-early
Measles -late rash
RUBELLA RASH
ENTEROVIRUS RASH
Hand foot mouth disease
Hand foot mouth disease
Hand foot mouth disease
Exanthem subitum (Roseola infantum)
• Human Herpes Virus HHV-6/HHV-7
Chicken pox rash
Erythema infectiosum(ParvovirusB19)
Dengue rashes
Dengue rashes
• • fev Dengue
HemorrhagicFever(DHF)
Rickettsial infection
Rickettsial infection-eschar
Fever with parotitis (mumps like infection)
Acute encephalitis syndrome(AES)
Definition • A person of any age, at any time of the year with acute onset of fever, a change in mental status (confusion, disorientation, coma, inability to talk) AND/OR New onset seizures(excluding simple febrile seizure)
Acute encephalitis syndrome causing agents
AES in immunocompromised
Fever with ARDS
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the air sacs (alveoli) lungs. less oxygen can reach bloodstream.
Acute onset PaO2 /FiO2 (fraction of inspired oxygen) <200mmHg. X-ray bilateral infiltrates. Pulmonary arterial occlusion.
ARDS causing agents
Acute Jaundice syndrome
• Definition :acute onset of jaundice and severe illness AND
• Absence of known predisposing factors
Causes acute Jaundice syndrome
Acute Diarrhea Syndrome
• Definition :Acute diarrhea and severe illness AND absence of known predisposing factors •Diarrhea :Increased frequency of defecation or recent change in consistency and character of stools •If lasts more than 3 weeks it is known as chronic diarrhea . Viral infections cause watery diarrhea
Causes of watery diarrhoea
Acute hemorrhagic fever syndrome
DEFINITION: Acute onset of fever of less than 3 weeks duration And any two of the following. Hemorrahagic or purpuric rash Epistaxis (bleeding from nose) Hemoptysis (coughing up of blood)
Blood in stool Other hemorrhagic symptoms AND absence of known predisposing factors
Viral conjunctivitis
Acute hemorrhagic conjunctivitis
Signs are similar in EV70,CoxsackieA24,A24v Oedematous swelling of lids in 72-100% cases
(swelling subsides in 3-4 days) Pre-auricular lymph node enlargement - majority
are tender Upper conjunctiva becomes inflamed with
injection, infiltration, and follicle formation. Follicular conjunctival response
Acute hemorrhagic conjunctivitis
Enterovirus Diffuse patchy conjunctival
haemorrhage Hemorrhagic patches
diffusely distribute in the bulbar conjunctiva -3 days after onset
Complication of AHC
Moderate epithelial keratitis and conj. hyperemia
0.3-3% in AHC
Molluscum contagiosum
Produced by Pox virus Transmission-direct contact in children Sexual activity in adults Round, whitish-pink, nodules (2-3mm) with
umblicated centre Frequent in eye lid margin Unilateral lesions Multiple in immunocompromised
Molluscum contagiosum
Congenital infections
Rubella CMV Herpes Varicella Parvovirus B19 infection
Non immune hydrops
Conclusion
Syndromic approach in diagnosis means choosing a diagnosis process based on clinical presentations, sign and symptoms.
Syndromic approach is necessary for the diagnosis of viral infections.