5. What is the prognosis?

And what are other

possible complications
regardless of treatment?

Bautista, Julius Ray

Bautista, Vincent

What is the prognosis?

Disease

Prognosis

Leptospiro Mild leptospirosis (90% of all cases)

RARELY
sis
FATAL
Mortality rate of 10%
Severe leptospirosis
(range 5-40%)

Malaria

Advanced age
Clinically evident pulmonary involvementPOOR
PROGNO
Elevated serum creatinine level
SIS
Oliguria
Thrombocytopenia
Uncomplicated exhibits marked improvement
within 48 hrs after initiation of
malaria
treatment;
fever free after 96 hours
POOR PROGNOSIS if
Plasmodium
untreated
Falciparum
GOOD PROGNOSIS if
infection
diagnosed early and treated
appropriately
Harrissons Principles of Internal
Medicine, 18th edition

Harrissons Principles of Internal Medicine, 18th edition

What is the prognosis?

Disease

Prognosis

Typhoid
fever

Prompt treatment Prevents severe

complications; case
fatality rate of < 1%
Mortality rate of 10-20%
Untreated
typhoid fever 10% excrete salmonella typhi in
the feces for 3 months
1-4% develop chronic
asymptomatic carriage sheds the
bacteria in the urine or feces for
>1 year
Uncomplicated influenza
Acute illness generally
resolves over 2-5 days;
most recovered in 1
week

Influenza

Increase
morbidit
y and
mortality
rates

Harrissons Principles of Internal Medicine, 18th edition

What is the prognosis?

Disease

Prognosis

Dengue
Self-limiting disease; mortality rate of < 1%
fever/
(dengue fever)
when treated,
dengue
Dengue Hemorrhagic fever
mortality rate of 2Hemorrhag
5%
ic fever
Untreated,
mortality rate can be
as high as 50%
FACTORS THAT AFFECT DISEASE SEVERITY:
Age
Nutritional status
Ethnicity
Sequence of infection with different dengue
serotypes
Genotype of virus
Harrissons
Principles
Medicine,
18th edition
Quality
and
extentofofInternal
available
medical
care
http://emedicine.medscape.com/article/

Complications of Malaria
Coma/Cerebral malaria
Death rates of 20%
(adults), 15% (children)
Follows after a convulsion
(usually generalized)
Failure to respond to
noxious stimuli or coma
persistng for >30 min
after generalized
convulsion
Source(s): Harrissons Principles of Internal Medicine,
18th edition

Complications of Malaria
Coma/Cerebral malaria
Residual neurologic
deficit when
consciousness is
regained
Persistent language
deficit, incidence of
epilepsy is increased, and
life expectancy
decreased (in children)

Source(s): Harrissons Principles of Internal Medicine,

Complications of Malaria
Hypoglycemia
Quinine is a powerful stimulant of
pancreatic insulin secretion
Clinical diagnosis is difficult (usual
physical signs of sweating, gooseflesh
and tachycardia are absent)
Plasma glucose level of <2.2 mmol/L
(<40mg/dL)

Source(s): Harrissons Principles of Internal Medicine,

18th edition

Complications of Malaria
Acidosis
Hyperlactatemia commonly coexists
with hypoglycemia
Acidotic breathing (called respiratory
distress)
Arterial pH of <7.25
Plasma bicarbonate level of <15 mmol/L
Venous lactate level of > 5 mmol/L

Source(s): Harrissons Principles of Internal Medicine,

18th edition

Complications of Malaria
Noncardiogenic
pulmonary edema
Develops even after
several days of
antimalarial therapy (in
adults)
Mortality rate is >80%
Often aggravated by
overly vigorous
administration of IV
fluids
Source(s): Harrissons Principles of Internal Medicine,
18th edition

Complications of Malaria
Hemoglobinuria
Passage of dark urine described
as Madeira wine-colored

Source(s): Harrissons Principles of Internal Medicine,

18th edition

Complications of Malaria
Renal impairment
Common in adults, rare in children
Manifests as acute tubular necrosis;
never cortical necrosis
Renal failure when UO in 24 hours is
<400 mL in adults or <12 mL/kg in
children; serum creatinine of >3 mg/dL

Source(s): Harrissons Principles of Internal Medicine,

18th edition

Complications of Malaria
Hematologic abnormalities
Anemia
Common consequence of
antimalarial drug resistance

Mild thrombocytopenia
<5% significant bleeding with
evidence of DIC

Liver dysfuntion
Mild hemolytic jaundice
Source(s): Harrissons Principles of Internal Medicine,
18th edition

Complications of
Leptospirosis
Generally considered to leave no
permanent sequelae
Hepatic and renal functions return to
normal despite severe dysfunction
during acute illness

Mortality rate in severe form is

10%
Mostly from renal failure
Source(s): Harrissons Principles of Internal Medicine,
18th edition

Complications of
Leptospirosis
Incidence of pulmonary
involvement has increased over
the years affecting up to 70% of
patients
Weils disease

Jaundice
AKI
Hypotension
Hemorrhage (lungs mostly)
Source(s): Harrissons Principles of Internal Medicine,
18th edition

Complications of
Leptospirosis
Hypokalemia, hypomagnesemia
non oliguric renal failure
Hypotension - ATN
During pregnancy, abortion is
likely during the first 2 trimesters
Persistent visual acuity loss
(leptospiral uveitis)
Source(s): Harrissons Principles of Internal Medicine,
18th edition

Complications of
Leptospirosis

Background:Hyphema is usually caused by ocular

trauma. In rare cases, hyphema is due to infectious
agents.
Methods:A 33-year-old male farmer presented to the
Department of Ophthalmology with sudden blurred
vision, pain, redness, and photophobia of both eyes.
Ophthalmologic examination revealed bilateral
iridocyclitis (anterior uveitis).
Results:The combination of fever, myalgia, and
elevated liver enzymes in a farmer with iridocyclitis
strongly suggested leptospirosis. Serological tests
revealed IgM and IgG antibodies againstLeptospira
serjo. l.Conclusions:Uveitis is a dreaded complication
of leptospirosis, possibly causing major permanent
visual impairment. With early treatment and
management of possible complications of uveitis, such
as hyphema, leptospirosis associated iridocylitis usually
shows a favorable outcome. Page 1/1

Hyphema due to Leptospirosis

B. Langner-Wegscheider -MD1,R. Krause -MD2;
1
Dept. of Ophthalmology, Med. Univ. of Graz, Graz,
Austria,2Section of Infectious Diseases, Med. Univ. Graz,
Graz, Austria.
Global Health And Travel Medicine

Complications of DHF
Most DHF patients respond well to
supportive therapy
Overall mortality rate at an
experienced center is probably as
low as 1%

Source(s): Harrissons Principles of Internal Medicine,

18th edition

Complications of DHF
Bleeding
Dengue Shock
Syndrome
20-30% of
patients develop
shock

Source(s): Harrissons Principles of Internal Medicine,

18th edition

Complications of DHF
Complications are rare but may
include
Cardiomyopathy
Seizures, viral encephalopathy
Hepatic injury
Pneumonia

http://emedicine.medscape.com/article/

Complications of Typhoid
Fever
Intestinal hemorrhage &
perforation
2 most common complications

Neuropsychiatric manifestations
Disorientation, delirium (early stage)

Pneumonia
Jaundice due to hepatitis,
hemolyis and cholangitis
Source(s): Harrissons Principles of Internal Medicine,
18th edition

Complications of Influenza
Pneumonia most common
Most frequently in <5 y.o. & >65
y.o.
Influenza during the 2nd or 3rd
trimester increases risk of
complications

Source(s): Harrissons Principles of Internal Medicine,

18th edition