Va
ri
ce
ll
a
N
o
.
ICPC
-
2
:
A
72
C
hi
c
k
e
npox
N
o
.
ICD
-
10
:
B
01
.
9
Va
ri
ce
ll
a W
ithout
C
ompli
ca
tion
(
Va
ri
ce
ll
a NOS
)
Ab
ility l
e
v
e
l
:
4
A
Hea
lth pro
b
l
e
ms
P
rim
a
ry
ac
ut
e
inf
ec
tion
b
y th
e Va
ri
ce
ll
a Z
ost
e
r virus th
a
t
a
tt
ac
ks th
e
skin
a
n
d
mu
c
os
a
,
c
lini
ca
lly th
e
r
e a
r
e
symptoms of
c
onstitution
,
polymorphi
c
skin
d
isor
de
rs
,
e
sp
ec
i
a
lly
L
o
ca
t
ed
in th
e ce
ntr
a
l p
a
rt of th
e b
o
d
y
.
T
h
e
in
c
u
ba
tion p
e
rio
d
is
14
-
21
da
ys
.
T
r
a
nsmission through
A
ir
(
A
ir
-
B
orn
e
)
a
n
d d
ir
ec
t
c
ont
ac
t
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Fe
v
e
r
,
Ma
l
a
is
e
,
a
n
d
h
eadac
h
e
s
.
T
h
e
n follow
ed b
y skin l
e
sions
I
n th
e
form of
E
rit
e
m
Pa
pul whi
c
h in
a
f
e
w hours turn
ed
into
a
v
e
si
c
l
e
.
U
su
a
lly
acc
omp
a
ni
ed b
y it
c
hing
.
R
isk f
ac
tor
1
.
C
hil
d
r
e
n
.
2
.
C
ont
ac
t history with
Va
ris
e
l
a
suff
e
r
e
rs
.
3
.
c
on
d
itions of immuno
de
fi
c
i
e
n
c
y
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
Pa
tognomist sign
E
ruption of th
e
skin in th
e
form of
e
ryth
e
m
a
tous p
a
pul
e
s within
a
f
e
w hours
turn into v
e
si
c
l
e
s
.
T
his form of th
e
v
e
si
c
l
e
is typi
ca
l in th
e
form of
de
w
d
rops
(
Tea
r
d
rops
).
T
h
e
v
e
si
c
l
e
will
be c
lou
d
y
a
n
d
th
e
n
bec
om
e a c
rust
.
W
hil
e
th
e
this pro
ce
ss t
a
k
e
s pl
ace
,
th
e
n
e
w v
e
si
ce
l
-
v
e
si
c
l
e a
pp
ea
rs
A
typi
ca
l polymorphi
c
pi
c
tur
e
for
Va
ris
e
l
a
.
De
ploym
e
nt o
cc
urr
ed
ce
ntrifug
a
l
,
a
n
d ca
n
a
tt
ac
k
e
y
e
mu
c
ous m
e
m
b
r
a
n
e
s
,
mouth
,
a
n
d c
h
a
nn
e
ls
T
op
b
r
ea
th
.
S
upport
I
f n
eeded
,
mi
c
ros
c
opi
c e
x
a
min
a
tion
b
y fin
d
ing
a
tz
a
n
c
ky
a ce
ll
Da
ti
a ce
lls intim
a
t
e
m
a
ny
.
A
tt
ac
hm
e
nt
D
i
a
gnosis
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis is
e
nfor
ced ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
D
i
a
gnosis of
A
pp
ea
l
1
.
Va
riol
a
2
.
He
rp
e
s
S
impl
e
x
D
iss
e
min
a
t
a
3
.
C
oxs
ac
ki
e
virus
4
.
R
i
c
k
e
ttsi
a
lpox
C
ompli
ca
tions
P
n
e
umoni
a
,
e
n
ce
ph
a
litis
,
h
e
p
a
titis
,
e
sp
ec
i
a
lly o
cc
ur in p
a
ti
e
nts with
I
mmun
e d
isor
de
rs
.
Va
ris
e
l
a
in risky pr
e
gn
a
n
c
y to
ca
us
e
inf
ec
tion
I
ntr
a
ut
e
rin in th
e
f
e
tus
,
ca
us
e
s th
e C
ong
e
nit
a
l
Va
ris
e
l
a
syn
d
rom
e
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
S
kin fri
c
tion n
eed
s to
be a
voi
ded
so
a
s not to
ca
us
e a
ruptur
e
of v
e
si
c
l
e
s
.
I
n
add
ition
,
TKTP
nutrition is
ad
minist
e
r
ed
,
r
e
st
a
n
d
pr
e
v
e
nt
C
ont
ac
t with oth
e
rs
.
2
.
P
ro
d
rom
a
l symptoms
a
r
e add
r
e
ss
ed acc
or
d
ing to in
d
i
ca
tions
.
A
spirin is
a
voi
ded beca
us
e
ca
n
ca
us
e Re
y
e
'
s
S
yn
d
rom
e
.
3
.
T
h
e L
otion
Ka
l
a
min
ca
n
be
giv
e
n to r
ed
u
ce
it
c
hing
.
4
.
O
r
a
l
a
ntivirus tr
ea
tm
e
nt
,
a
mong oth
e
rs
:
a
.
A
siklovir
:
Ad
ults
5
x
800
mg
/
da
y
,
c
hil
d
r
e
n
4
x
20
mg
/
kg
bb
(
d
os
a
g
e
m
a
ximum of
800
mg
),
or
b
r
ea
kf
a
st
.
Va
l
ac
y
c
lovir
:
Ad
ults
3
x
1000
mg
/
da
y
.
G
iving th
e d
rug for
7
-
10
da
ys
a
n
d e
ff
ec
tiv
e
ly giv
e
n
a
t
24
hours
F
irst
a
ft
e
r th
e
l
e
sion
a
ris
e
s
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
Ed
u
ca
tion th
a
t v
a
ris
e
ll
a
is
a
s
e
lf
-
limiting
d
is
ea
s
e
in
c
hil
d
r
e
n
th
e
immuno
c
omp
e
t
e
nt
.
L
ight
c
ompli
ca
tions
ca
n
be a bac
t
e
ri
a
l inf
ec
tion
s
ec
on
da
ry
.
T
h
e
r
e
for
e
,
p
a
ti
e
nts shoul
d
m
a
int
a
in
b
o
d
y
c
l
ea
nlin
e
ss
.
S
uff
e
r
e
rs shoul
d be
qu
a
r
a
ntin
ed
to pr
e
v
e
nt tr
a
nsmission
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
T
h
e
r
e
is immun
e d
isor
de
rs
2
.
E
xp
e
ri
e
n
ce
s
e
v
e
r
e c
ompli
ca
tions su
c
h
a
s pn
e
umoni
a
,
e
n
ce
ph
a
litis
,
a
n
d
h
e
p
a
titis
.
E
quipm
e
nt
Ma
gnifi
e
r
P
rognosis
T
h
e
prognosis in p
a
ti
e
nts with immuno
c
omp
e
t
e
nt is
b
on
a
m
,
whil
e
I
n p
a
ti
e
nts with immuno
c
ompromisis
,
th
e
prognosis
bec
om
e
s
D
u
b
i
a Ad B
on
a
m
.
Ma
l
a
ri
a
N
o
.
ICPC
-
2
:
A
73
m
a
l
a
ri
a
N
o
.
ICD
-
10
:
B
54
U
nsp
ec
ifi
ed Ma
l
a
ri
a
Ab
ility l
e
v
e
l
:
4
A
Hea
lth pro
b
l
e
ms
I
s
a
n
ac
ut
e a
n
d c
hroni
c
inf
ec
tion
d
is
ea
s
e ca
us
ed b
y
P
l
a
smo
d
ium p
a
r
a
sit
e
s th
a
t
a
tt
ac
k
e
rythro
c
yt
e
s
a
n
d
m
a
rk
ed
with
T
h
e d
is
c
ov
e
ry of th
e
form of
a
s
e
xu
a
l in th
e b
loo
d
,
with symptoms of f
e
v
e
r
,
S
hiv
e
ring
,
a
n
e
mi
a
,
a
n
d
spl
ee
n
e
nl
a
rg
e
m
e
nt
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Fe
v
e
r is lost
,
wh
e
n th
e
f
e
v
e
r is lost
acc
omp
a
ni
ed b
y shiv
e
ring
,
sw
ea
ting
,
ca
n
be acc
omp
a
ni
ed b
y h
eadac
h
e
s
,
mus
c
l
e
p
a
in
a
n
d
joints
,
T
h
e a
pp
e
tit
e dec
r
ea
s
e
s
,
abd
omin
a
l p
a
in
,
vomiting n
a
us
ea
,
a
n
d d
i
a
rrh
ea
.
R
isk f
ac
tor
1
.
H
istory of suff
e
ring from m
a
l
a
ri
a be
for
e
.
2
.
L
iving in
a
n
a
r
ea
of m
a
l
a
ri
a e
n
de
mi
c
.
3
.
Bee
n
1
-
4
w
ee
ks in th
e Ma
l
a
ri
a e
n
de
mi
c a
r
ea
.
4
.
H
istory of g
e
tting
b
loo
d
tr
a
nsfusions
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
Pa
tognomist sign
a
.
I
n th
e
f
e
v
e
r p
e
rio
d
:
T
h
e
skin looks r
ed
,
p
a
lp
ab
l
e
,
in
c
r
ea
sing
b
o
d
y t
e
mp
e
r
a
tur
e ca
n
U
p to
ab
ov
e
400
C a
n
d d
ry skin
.
T
h
e
p
a
ti
e
nt
ca
n
a
lso look p
a
l
e
.
Fa
st puls
e
Fa
st
b
r
ea
thing
(
Ta
kipn
e
u
)
b
r
ea
kf
a
st
.
I
n
c
ol
d
p
e
rio
d
s
a
n
d
sw
ea
ting
:
S
kin p
a
lp
ab
l
e c
ol
d a
n
d
sw
ea
ting
.
Nad
i is p
a
lp
ab
l
e
f
a
st
a
n
d
w
ea
k
.
I
n
ce
rt
a
in
c
on
d
itions
ca
n
be
foun
d a dec
r
ea
s
e
in
a
w
a
r
e
n
e
ss
.
2
.
Head
:
a
n
e
mi
c c
onjun
c
tiv
a
,
ikt
e
ri
c
skl
e
r
,
lip
c
y
a
nosis
,
a
n
d
on m
a
l
a
ri
a
ce
r
eb
r
a
l
ca
n
be
foun
d
stiff l
a
ughs
.
3
.
T
or
ac
iz
e
s
:
looks f
a
st
b
r
ea
thing
.
4
.
Abd
om
e
n
:
p
a
lp
ab
l
e E
nl
a
rg
e
m
e
nt of
He
p
a
r
a
n
d S
pl
ee
n
,
ca
n
a
lso
be
foun
d
a
s
c
it
e
s
.
5
.
K
i
d
n
e
ys
:
ca
n
be
foun
d
in
b
l
ac
kish
b
rown urin
e
,
oligouri or
a
nuri
a
.
6
.
E
xt
e
rmity
:
Ac
r
a
l p
a
lp
ab
l
e c
ol
d
is
a
sign of sho
c
k
.
S
upport
1
.
E
x
a
min
a
tion of thi
c
k
a
n
d
thin
b
loo
d e
rosion foun
d
p
a
r
a
sit
e
s
P
l
a
smo
d
ium
.
2
.
Ra
pi
d D
i
a
gnosti
c Te
st for
Ma
l
a
ri
a
(
RDT
).
A
tt
ac
hm
e
nt
D
i
a
gnosis
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
T
h
e d
i
a
gnosis is
e
nfor
ced b
y
A
n
a
mn
e
sis
(
T
ri
a
s
Ma
l
a
ri
a
:
Hea
t
-
S
hiv
e
ring
-
sw
ea
ting
),
physi
ca
l
e
x
a
min
a
tion
,
a
n
d
foun
d
p
a
r
a
sit
e
s
P
l
a
smo
d
ium on mi
c
ros
c
opi
c e
x
a
min
a
tion of thi
c
k
/
thin
b
loo
d
.
C
l
a
ssifi
ca
tion
1
.
Ma
l
a
ri
a Fa
lsip
a
rum
,
foun
d P
l
a
smo
d
ium
Fa
lsip
a
rum
.
2
.
V
iv
a
x
Ma
l
a
ri
a
foun
d P
l
a
smo
d
ium
V
iv
a
x
.
3
.
O
v
a
l
e
m
a
l
a
ri
a
,
foun
d
pl
a
smo
d
ium ov
a
l
e
.
4
.
Ma
l
a
ri
a
m
a
l
a
ri
ae
,
foun
d P
l
a
smo
d
ium m
a
l
a
ri
ae
.
5
.
Ma
l
a
ri
a K
nowl
e
si
,
foun
d P
l
a
smo
d
ium
K
nowl
e
si
.
D
i
a
gnosis of
A
pp
ea
l
1
.
De
ngu
e
f
e
v
e
r
2
.
T
ifoi
d
f
e
v
e
r
3
.
Le
ptospirosis
4
.
O
th
e
r
ac
ut
e
vir
a
l inf
ec
tions
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
Med
i
c
in
e
for
Ma
l
a
ri
a Fa
lsip
a
rum
1
.
F
irst
L
in
e
:
W
ith
F
ix
ed D
os
e C
om
b
in
a
tion
(
FDC
)
c
onsisting of
D
ihy
d
ro
a
rt
e
misinin
(
DHA
) +
P
i
Pe
rkuin
(
DHP
)
eac
h t
ab
l
e
t
c
ont
a
ins
40
mg
d
ihy
da
y
d
ro
a
rt
e
misinin
a
n
d
320
mg of piw
a
kuin
.
F
or
ad
ults with
We
ight
(
BB
)
up to
59
kg giv
e
n
b
y
DHP
p
e
r or
a
l
3
t
ab
l
e
ts
on
e
tim
e
p
e
r
da
y for
3
da
ys
a
n
d
prim
a
kuin
2
t
ab
l
e
ts on
ce a da
y on
e
gift tim
e
s
,
whil
e
for
bb
> .
60
kg is giv
e
n
4
d
hp t
ab
l
e
ts on
e
tim
e
s
a da
y for
3
da
ys
a
n
d
prim
a
nquin
3
t
ab
l
e
ts on
ce a da
y on
ce
provision of
.
D
h
a d
os
e
=
2
-
4
mg
/
kg
bb
(
singl
e d
os
e
),
P
i
Pe
rkuin
=
16
-
32
mg
/
kg
BB
(
singl
e d
os
e
),
prim
a
kuin
=
0
.
75
mg
/
kg
bb
(
singl
e d
os
e
).
2
.
Sec
on
d
lin
e
(
Med
i
c
in
e Fa
lsip
a
rum m
a
l
a
ri
a
th
a
t
d
o
e
s not r
e
spon
d
to
T
r
ea
tm
e
nt of
DHP
):
K
in
a
+
D
oky
c
lin
/
Te
tr
ac
y
c
lin
e
+
P
rim
a
kuin
.
D
os
e
of
c
in
a
=
10
mg
/
kg
BB
/
tim
e
(
3
x
/
da
y for
7
da
ys
),
d
oxy
c
y
c
lin
e
=
3
.
5
mg
/
kg
BB
p
e
r
da
y
(
ad
ult
,
2
x
/
da
y for
7
da
ys
),
2
.
2
mg
/
kg
BB
/
da
y
(
8
-
14
y
ea
rs
,
2
x
/
da
y for
7
da
ys
),
e
tr
a
siklin
=
4
-
5
mg
/
kg
BB
/
tim
e
(
4
x
/
da
y for
7
da
ys
).
VIVAX a
n
d Ma
l
a
ri
a O
v
a
l
e Med
i
c
in
e
1
.
F
irst
L
in
e
:
D
ihy
d
ro
a
rt
e
misinin
(
DHA
) +
P
i
Pe
rkuin
(
DHP
),
giv
e
n
Pe
ror
a
l on
ce
p
e
r
da
y for
3
da
ys
,
p r im
a
k u i n
=
0
.
2 5
mg
/
kg
/
da
y
(
for
14
da
ys
).
2
.
Sec
on
d
lin
e
(
VIVAX
m
a
l
a
ri
a
tr
ea
tm
e
nt th
a
t
d
o
e
s not r
e
spon
d
to
DHP
tr
ea
tm
e
nt
):
K
in
a
+
P
rim
a
kuin
.
D
os
a
g
e
of
K
in
a
=
10
mg
/
kg
BB
/
tim
e
(
3
x
/
da
y for
7
da
ys
),
prim
a
kuin
=
0
.
25
mg
/
kg
BB
(
for
14
da
ys
).
3
.
VIVAX
m
a
l
a
ri
a
tr
ea
tm
e
nt th
a
t r
e
l
a
ps
e
s
(
r
e
l
a
ps
e
):
a
.
G
iv
e
n th
e
s
a
m
e DHP
r
e
gim
e
n
a
g
a
in
b
ut th
e
prim
a
kuin
d
os
e
E
nh
a
n
ced
to
0
.
5
mg
/
kg
/
da
y
.
b
r
ea
kf
a
st
.
A
ll
e
g
ed
r
e
l
a
ps
e
on viv
a
x m
a
l
a
ri
a
is if
ad
ministr
a
tion
P
rim
a
kiun
d
os
e
of
0
.
25
mg
/
kg
/
kg
/
da
y h
a
s
bee
n t
a
k
e
n for
14
da
ys
a
n
d
suff
e
r
e
rs
bac
k p
a
in with positiv
e
p
a
r
a
sit
e
s in
3
tim
e
s
S
un
da
y to
3
months
a
ft
e
r tr
ea
tm
e
nt
.
Ma
l
a
l
a
r
e
m
a
l
a
ri
a
tr
ea
tm
e
nt
E
nough giv
e
n
DHP
1
tim
e
p
e
r
da
y for
3
da
ys with th
e
s
a
m
e d
os
e a
s
oth
e
r m
a
l
a
ri
a
tr
ea
tm
e
nt
a
n
d
with th
e
s
a
m
e d
os
a
g
e a
s tr
ea
tm
e
nt
O
th
e
r m
a
l
a
ri
a a
n
d
not giv
e
n
P
rim
a
kuin
.
T
r
ea
tm
e
nt of mix
ed
inf
ec
tions
be
tw
ee
n
Ma
l
a
ri
a Fa
lsip
a
rum
a
n
d Ma
l
a
ri
a VIVAX
/
Ma
l
a
ri
a
ov
a
l
e
with
DHP
I
n suff
e
r
e
rs with mix
ed
inf
ec
tions giv
e
n
DHP
1
tim
e
p
e
r
da
y
d
uring
3
da
ys
,
a
n
d DHP
1
tim
e
p
e
r
da
y for
3
da
ys
a
n
d
prim
a
kuin
d
os
e
s of
0
.
25
M
g
/
kg
BB
for
14
da
ys
.
Ma
l
a
ri
a
tr
ea
tm
e
nt in pr
e
gn
a
nt wom
e
n
1
.
F
irst trim
e
st
e
r
:
kin
a
t
ab
l
e
t
3
x
10
mg
/
kg
bb
+
klin
da
my
c
in
10
mg
/
kg
bb
for
7
da
ys
.
2
.
Sec
on
d
trim
e
st
e
r
a
n
d
thir
d a
r
e
giv
e
n
DHP
t
ab
l
e
ts for
3
da
ys
.
3
.
P
r
e
v
e
ntion
/
prophyl
a
xis
U
s
ed D
oky
c
lin
1
ca
psul
e
100
mg
/
da
y
T
umin
2
da
ys
be
for
e
l
ea
ving up to
4
w
ee
ks
a
ft
e
r l
ea
ving
/
r
e
turning from
E
n
de
mi
c a
r
ea
.
T
h
e ab
ov
e
tr
ea
tm
e
nt is giv
e
n
ba
s
ed
on th
e
p
a
ti
e
nt
'
s w
e
ight
.
C
ompli
ca
tions
1
.
Ce
r
eb
r
a
l m
a
l
a
ri
a
.
2
.
Hea
vy
a
n
e
mi
a
.
3
.
Ac
ut
e
ki
d
n
e
y f
a
ilur
e
.
4
.
P
ulmon
a
ry
Ede
m
a
or
ARDS
(
Ac
ut
e Re
spir
a
tory
D
istr
e
ss
S
yn
d
rom
e
).
5
.
H
ypogly
ce
mi
a
.
6
.
Fa
ilur
e c
ir
c
ul
a
tion or sho
c
k
.
7
.
S
pont
a
n
e
ous
b
l
eed
ing from th
e
nos
e
,
gums
,
d
ig
e
stiv
e de
vi
ce
s
a
n
d
or
acc
omp
a
ni
ed
Lab
or
a
tory
ab
norm
a
liti
e
s in intr
a
v
a
s
c
ul
a
r
c
o
a
gul
a
tion
d
isor
de
rs
.
8
.
Re
p
ea
t
ed
s
e
izur
e
s
>
2
tim
e
s
a
24
hours of
ed
u
ca
tion on hyp
e
rth
e
rmi
a
.
9
.
A
si
de
mi
a
(
b
loo
d
p
H
<
7
.
25
)
or
ac
i
d
osis
(
pl
a
sm
a b
ikn
a
t
<
15
mmol
/
L
).
10
.
Mac
ros
c
opi
c
h
e
moglo
b
inuri
a beca
us
e
of
ac
ut
e
m
a
l
a
ri
a
inf
ec
tion
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
I
n th
e ca
s
e
of s
e
v
e
r
e
m
a
l
a
ri
a
it is
de
liv
e
r
ed
to th
e
f
a
mily r
e
g
a
r
d
ing
P
rognosis of th
e d
is
ea
s
e
.
2
.
Ma
l
a
ri
a
pr
e
v
e
ntion
ca
n
be d
on
e b
y
:
a
.
A
voi
d
mosquito
b
it
e
s with mosquito n
e
ts or r
e
p
e
ll
e
nts
b
r
ea
kf
a
st
.
A
voi
d ac
tiviti
e
s outsi
de
th
e
hom
e a
t night
C
..
T
r
ea
t p
a
ti
e
nts to h
ea
l for
e
x
a
mpl
e b
y sup
e
rvision
m
ed
i
ca
tion
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
Ma
l
a
ri
a
with
c
ompli
ca
tions
2
.
P
r
e
vious m
a
l
a
ri
a
,
b
ut p
a
ti
e
nts must first
be
giv
e
n th
e
initi
a
l
d
os
e
A
rt
e
misinin or
a
rt
e
sun
a
t
e
p
e
r intr
a
mus
c
ul
a
r or intr
a
v
e
in with
I
niti
a
l
d
os
e
3
.
2
mg
/
kg
bb
.
E
quipm
e
nt
S
impl
e
l
ab
or
a
tory for m
a
king
b
loo
d
pr
e
ssur
e
,
b
loo
d
t
e
sts
R
outin
e a
n
d
mi
c
ros
c
opi
c e
x
a
min
a
tion
.
P
rognosis
P
rognosis
de
p
e
n
d
s on th
e de
gr
ee
of w
e
ight of m
a
l
a
ri
a
.
I
n g
e
n
e
r
a
l
,
T
h
e
prognosis is
D
u
b
i
a Ad B
on
a
m
.
T
his
d
is
ea
s
e ca
n o
cc
ur
a
g
a
in
I
f th
e b
o
d
y
'
s r
e
sist
a
n
ce dec
r
ea
s
e
s
.
Le
ptospirosis
N
o
.
ICPC
-
2
:
A
78
INFECTION D
is
ea
s
e O
th
e
r
/
NOS
N
o
.
ICD
-
10
:
A
27
.
9
Le
ptospirosis
,
U
nsp
ec
ifi
ed
Ab
ility l
e
v
e
l
:
4
A
Hea
lth pro
b
l
e
ms
Le
ptospirosis is
a
n inf
ec
tious
d
is
ea
s
e
th
a
t
a
tt
ac
ks hum
a
ns is
ca
us
ed
b
y
Le
ptospir
a
int
e
rog
a
ns mi
c
roorg
a
nisms
a
n
d
h
a
v
e c
lini
ca
l m
a
nif
e
st
a
tions
e
xt
e
nsiv
e
.
C
lini
ca
l sp
ec
trum r
a
nging from inf
ec
tion th
a
t is not
c
l
ea
r to fulmin
a
nt
a
n
d
f
a
t
a
l
.
O
n
a
light typ
e
,
l
e
ptospirosis
ca
n
a
pp
ea
r lik
e
influ
e
nz
a
with h
eadac
h
e
s
a
n
d
my
a
lgi
a
.
T
ikus is th
e
m
a
in r
e
s
e
rvoir
a
n
d
Le
ptospirosis
e
v
e
nts
a
r
e
mor
e
foun
d
in th
e
r
a
iny s
ea
son
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
C
ompl
a
ints
:
Fe
v
e
r
acc
omp
a
ni
ed b
y shiv
e
ring
,
h
eadac
h
e
s
,
a
nor
e
xi
a
,
gr
ea
t mi
a
lgi
a
on
Be
tis
,
thighs
a
n
d
w
a
ist
acc
omp
a
ni
ed b
y t
e
n
de
rn
e
ss
.
Na
us
ea
,
vomiting
,
d
i
a
rrh
ea a
n
d
p
a
in
abd
om
e
n
,
photopho
b
i
a
,
dec
r
ea
s
ed c
ons
c
iousn
e
ss
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
Pe
m
e
riks
aa
nfisik
1
.
Feb
ris
2
.
I
k
e
rus
3
.
P
r
e
ssur
e
p
a
in in th
e
mus
c
l
e
4
.
Lea
th
e
r r
a
sh
5
.
lymph
ade
nop
a
thy
6
.
h
e
p
a
tom
e
g
a
ly
a
n
d
spl
e
nom
e
g
a
ly
7
.
Ede
m
a
8
.
B
r
ad
y
ca
r
d
i r
e
l
a
tiv
e
9
.
C
onjun
c
tiv
a S
uffusion
10
.
D
isruption of
b
l
eed
ing in th
e
form of p
e
t
e
ki
e
,
purpur
a
,
e
pist
a
xis
a
n
d
gum
b
l
eed
ing
11
.
R
igi
d
touk
a
s
a
sign of m
e
ningitis
S
upport
Lab
or
a
tory
e
x
a
min
a
tion
1
.
R
outin
e b
loo
d
:
T
h
e
num
be
r of l
e
uko
c
yt
e
s
be
tw
ee
n
3000
-
26000
/
μ
L
,
with
a
shift to
Le
ft
,
light throm
b
o
c
ytop
e
ni
a
o
cc
urs in
50
%
of p
a
ti
e
nts
a
n
d
c
onn
ec
t
ed
with ki
d
n
e
y f
a
ilur
e
.
2
.
U
rin
e
routin
e
:
urin
e
s
ed
im
e
nt
(
l
e
uko
c
yt
e
s
,
e
rythro
c
yt
e
s
,
a
n
d
hy
a
lin
e
or gr
a
nul
a
r
)
a
n
d
L
ight prot
e
inuri
a
,
th
e
num
be
r of
e
rythro
c
yt
e
s
ed
im
e
nts usu
a
lly in
c
r
ea
s
e
s
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis
ca
n
be e
nfor
ced
in p
a
ti
e
nts with su
dde
n f
e
v
e
r
,
shiv
e
ring
T
h
e
r
e a
r
e c
onjun
c
tiv
a
l signs of suffusion
,
h
eadac
h
e
s
,
mi
a
lgi
a
,
j
a
un
d
i
ce a
n
d
p
a
in
P
r
e
ss on th
e
mus
c
l
e
s
.
T
h
e
possi
b
ility in
c
r
ea
s
e
s if th
e
r
e
is
a
history of work
or
e
xpos
ed
to
a c
ont
a
min
a
t
ed e
nvironm
e
nt with urin
a
ting mi
ce
.
D
i
a
gnosis of
A
pp
ea
l
1
.
De
ngu
e
f
e
v
e
r
,
2
.
Ma
l
a
ri
a
,
3
.
He
p
a
titis virus
,
4
.
R
i
c
k
e
ttsi
a
'
s
d
is
ea
s
e
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
S
upportiv
e
tr
ea
tm
e
nt with stri
c
t o
b
s
e
rv
a
tion to
de
t
ec
t
a
n
d
O
v
e
r
c
oming
De
hy
d
r
a
tion
S
t
a
tion
,
H
ypot
e
nsion
,
B
l
eed
ing
a
n
d K
i
d
n
e
y
Fa
ilur
e
Ve
ry import
a
nt on l
e
ptospirosis
.
2
.
P
rovision of
a
nti
b
ioti
c
s must
be
gin
a
s soon
a
s possi
b
l
e
.
I
n
ca
s
e
s
lightw
e
ight
ca
n
be
giv
e
n or
a
l
a
nti
b
ioti
c
s su
c
h
a
s
d
oxy
c
y
c
lin
e
,
a
mpi
c
illin
,
A
moxi
c
illin or
e
rythromy
c
in
.
I
n th
e ca
s
e
of h
ea
vy l
e
ptospirosis giv
e
n
H
igh
d
os
e
inj
ec
tion p
e
ni
c
illin
.
C
ompli
ca
tions
1
.
Me
ningitis
2
.
Re
spir
a
tion
d
istr
e
ss
3
.
K
i
d
n
e
y f
a
ilur
e beca
us
e
of
Re
n
a
l
T
u
b
ul
a
r
I
nt
e
rstiti
a
l
Nec
rosis
4
.
L
iv
e
r f
a
ilur
e
5
.
Hea
rt f
a
ilur
e
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
Le
ptospirosis pr
e
v
e
ntion
e
sp
ec
i
a
lly in tropi
ca
l
a
r
ea
is v
e
ry
d
iffi
c
ult
,
beca
us
e
T
h
e
num
be
r of int
e
rm
ed
i
a
ry hosp
e
s
a
n
d
s
e
rotyp
e
s
.
F
or thos
e
who
h
a
s
a
high risk for
c
ontr
ac
ting l
e
ptospirosis must
be
giv
e
n
prot
ec
tion in th
e
form of sp
ec
i
a
l
c
lothing th
a
t
ca
n prot
ec
t it from
C
ont
ac
t with ingr
ed
i
e
nts th
a
t h
a
v
e bee
n
c
ont
a
min
a
t
ed
with urin
e
Re
s
e
rvoir
a
nim
a
ls
.
2
.
T
h
e
f
a
mily must pr
e
v
e
nt l
e
ptospirosis
b
y storing
F
oo
d a
n
d d
rinks w
e
ll to
a
voi
d
mi
ce
,
w
a
sh
Ha
n
d
s with so
a
p
be
for
e ea
ting
,
w
a
sh h
a
n
d
s
,
f
ee
t
a
n
d
p
a
rts
O
th
e
r
B
o
d
i
e
s with
S
o
a
p
A
ft
e
r
W
orking in
R
i
ce F
i
e
l
d
s
/
Ga
r
de
ns
/
Wa
st
e
/
La
n
d
/
s
e
w
e
rs
a
n
d
oth
e
r pollut
ed
pl
ace
s
.
Ra
t
e C
ontinu
e
T
h
e ca
s
e
must
be
r
e
port
ed
to th
e
lo
ca
l h
ea
lth s
e
rvi
ce
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
Pa
ti
e
nts
a
r
e
imm
ed
i
a
t
e
ly r
e
f
e
rr
ed
to
Sec
on
da
ry
Se
rvi
ce
s
(
I
nn
e
r
D
is
ea
s
e S
p
ec
i
a
lists
)
Ha
s h
e
mo
d
i
a
lysis f
ac
iliti
e
s
a
ft
e
r
e
nfor
c
ing
d
i
a
gnosis
a
n
d
initi
a
l th
e
r
a
py
.
E
quipm
e
nt
R
outin
e b
loo
d c
h
ec
ks
a
n
d
urin
e
P
rognosis
P
rognosis if th
e
p
a
ti
e
nt
d
o
e
s not
e
xp
e
ri
e
n
ce c
ompli
ca
tions is g
e
n
e
r
a
lly
D
u
b
i
a ad
b
on
a
m
.
