group 6 gcp

Acute fever, body malaise and rashes

in a 25 year old male

Group case presentation

6B

Laxamana, Michael

Laygo, Richard Joseph

Lee, Andria

Lee, Nica Kristine

Lerma, Joshua Dave

Libiran, Jonika Maris

Lim, Janine Abigail

Lim, Jerald Garvin

Lim, Joseph Michael

Module 4 Group 6 3B Med

6A

Joya, Jeb Reinard

Kalaw, Maria Natalia

Kho, Beatriz Barbara

Kimura, Akemi

King, Emmanuel

Koa, Daryl

Lacuna, Dan Paulo

Lalusis, John Kelvin

Lao, Nicole Mae

Laxamana, Jack Rene

Objectives• To present a case of a patient with acute fever• To discuss differential diagnoses• To discuss Dengue infection – Epidemiology– Pathophysiology– Clinical manifestations– Treatment & management– Updates on diagnosis & treatment

GCP: Acute fever, body malaise & rashes in a 25 year old male

History6A Kalaw, Maria Natalia & Kimura, Akemi

6B Laxamana, Michael & Laygo, Richard Joseph


General InformationName of Patient: J.R.P

Address: R. Papa, Manila

Age: 25 years old

Birthday: July 01, 1988

Sex: Male

Civil Status: Single

Religion: Roman Catholic

Nationality: Filipino

Educational Attainment: College level (2nd yr. B.S. in Nursing)

Occupation: unemployed

Date Admitted: November 3, 2013 Bed No. 210 C

Date of Interview: November 8, 2013 (Hospital Day 6)

Informant: Patient

Informant Reliability: 90%


A 25 year old maleChief complaint: Fever

• chills, fever (39oC), body malaise• Self medicated Paracetamol (Biogesic) 500mg/tab 1tab PO

q4h• Amoxicillin 500mg/cap 1cap PO

Admission November 03, 2013

• fever 39.8oC, flushed face, red eyes, dry lips

2 days PTA

• fever (39.1 - 39.9oC), sore throat, • vomiting after meals, anorexia, • headache 5/10, myalgia on upper extremities 6/10, • knee arthralgia 4/10

13 hours PTA

2 hours PTA


Past Medical History

• BIRTH AND DEVELOPMENTAL HISTORY: unrecalled

• CHILDHOOD ILLNESS/HOSPITALIZATIONS: none

• ADULT ILLNESS/HOSPITALIZATIONS: none

• SURGERIES: none

• INJURIES/ACCIDENTS: none

• TRANSFUSIONS/REACTIONS: none

• ALLERGIES: none

• IMMUNIZATION: unrecalled

A 25 year old male


Personal and Social History• Smoking: 0.75 pack years (5 sticks per day since 2010)• Occasional social alcoholic beverage drinker (wine, beer, hard drinks)• No illicit drug use• Nutrition

– No eating difficulties, has good appetite– High salt diet – Usually eats a generous serving of vegetables & fruits

• Sleep Pattern– No difficulty in sleeping– Sleeps for about 9-10 hours a day, no naps in between

Family History(+) Asthma: Father, brother(-) Thyroid problems, DM(-) Hypertension & cardiovascular diseases(-) Cancer


Personal and Social History• Marital status

Single• Living arrangement/ Family structure

Has 2 older brothers and sister; youngest among siblingsLives alone, rents an apartment unit beside older brother’s unit

• Support/secondary gainsMother, older brother and sister-in-law are the primary caregivers. Older brother supports patient financially

• Employment history/Job satisfaction2010 Crew at McDonald’s UAE2011 Promoted to Supervisor in McDonald’s UAE2013 February – finished contract

• Sexual historyHad 1 sexual partner (Filipina OFW, UAE, 2012)

• Significant life events, deaths, hardships2007 death of father due to car accidentdenied having financial hardship thereafter


REVIEW OF SYSTEMSGeneral Conscious, coherent, not in respiratory distress

Skin (-) pigmentation, (-) pruritus, (-) jaundice, (-) pallor

HEENT (+) blurring of vision, (-) ear discharge, (-) ear pain, (-) epistaxis, (-) gum bleeding, (-) hoarseness, (-) ulcers

Cardiovascular (-) palpitations, (-) cyanosis, (-) chest pain, (-) PND, (-) orthopnea, (-) easy fatigability

Respiratory (-) cough, (-) colds, (-) exertional dyspnea

Gastrointestinal (-) constipation, (-) diarrhea, (-) melena

Genitourinary (-) urgency, (-) hematuria, (-) oliguria, (-) dysuria, (-) nocturia,

Musculoskeletal (-) swelling, (-) Inflammation

Neurologic (-) seizures, (-) tremors, (-) sleep disturbance, (-) alterations of mood

Hematologic (-) easy bruisability, (-) anemia

Endocrine/Metabolic (-) polyphagia, (-) polyuria, (-) polydipsia, (-) heat/cold intolerance

Psychiatric (-) depression, (-) hallucinations


Physical Examination6A Kalaw, Maria Natalia & Kimura, Akemi

6B Laxamana, Michael & Laygo, Richard Joseph


On Admission (November 3, 2013) Upon PE (November 8, 2013)

•Conscious, coherent, awake

•GCS 15

•Ambulatory

•not in respiratory nor cardiac distress

•oriented to time, place and person

• cooperative, neutral mood, broad affect

• no agitation

• judgment and insight intact

• intact memory for recent and remote events

•Conscious, coherent, awake

•GCS 15

•Ambulatory

•not in respiratory nor cardiac distress

•oriented to time, place and person

• cooperative, neutral mood, broad affect

• no agitation

• judgment and insight intact

• intact memory for recent and remote events

General surveyGCP: Acute fever, body malaise & rashes in a 25 year old male


•BP = 110/80 mmHg (Sitting)

• PR = 107 bpm, regular

• RR = 20 breaths per min, regular

• Temp 38.7 °C (Axillary)

•Height = 165 cm

•Weight = Kg

•BMI = 18.5 (Normal)

•BP = 100/80 mmHg (Sitting)

• PR = 65 bpm, regular

• RR =19 breaths per min, regular

• Temp 36.0 °C (Axillary)

•Height = 165 cm

•Weight = 53 Kg

•BMI = 18.5 (Normal)

Vital Signs & AnthropometricsGCP: Acute fever, body malaise & rashes in a 25 year old male


•(-) petechiae

• Warm, moist

• no facial flushing

• no palmar erythema

• pink nail beds, no clubbing

•(+) petechiae on both lower extremities

• Warm, moist

• no facial flushing

• no palmar erythema

• pink nail beds, no clubbing

SkinGCP: Acute fever, body malaise & rashes in a 25 year old male

On Admission (November 3, 2013) Upon PE (November 8, 2013)• Head : round, symmetrical & no deformities, no lesions or masses Eyes : no ptosis & exophthalmos pink palpebral conjunctiva anicteric sclera

pupils 2-3mm equally reactive to light, (+) ROR

•Ears : no ear deformities and tenderness, gross hearing intact, intact tympanic membranes, nonhyperemic external auditory canals•Nose: no alar flaring, no nasal discharge• Mouth: pinkish lips, moist buccal mucosa, no cyanosis•no oral ulcers•Throat: non hyperemic posterior pharyngeal wall•tonsils not enlarged•Tongue not deviated•uvula in midline•Supple neck, no limitation in motion•no palpable cervical masses and lymph nodes

• Head : round, symmetrical & no deformities, no lesions or masses hair is black, ample in volume & with smooth texture

Eyes : no ptosis & exophthalmos pink palpebral conjunctiva anicteric sclera

pupils 2-3mm equally reactive to light, (+) ROR

•Ears : no ear deformities and tenderness, gross hearing intact, intact tympanic membranes, nonhyperemic external auditory canals•Nose: no alar flaring, no nasal discharge

•septum at midline

•non-congested nasal turbinates

•moist nasal mucosa

• Mouth: pinkish lips, moist buccal mucosa, no cyanosis

•no oral ulcers

•Throat: non hyperemic posterior pharyngeal wall

•tonsils not enlarged

•Tongue not deviated

•uvula in midline

•Supple neck, no limitation in motion

•no palpable cervical masses and lymph nodes

HEENTGCP: Acute fever, body malaise & rashes in a 25 year old male


•Symmetrical chest expansion•Not in respiratory distress•no tenderness upon palpation of chest•normal tactile and vocal fremiti on all lung fields•no adventitious breath sounds on all lung fields•symmetrically resonant on all fields

•Symmetrical chest expansion•no chest deformities•trachea midline•regular pattern of breathing•no use of accessory muscles, SCM not prominent•no tenderness upon palpation of chest•normal tactile and vocal fremiti on all lung fields•no adventitious breath sounds on all lung fields•symmetrically resonant on all fields

Thorax/LungsGCP: Acute fever, body malaise & rashes in a 25 year old male


•JVP 3 cm at 30 degrees•carotid artery pulse with rapid upstroke and gradual downstroke•adynamic precordium•no murmurs, no thrills, heaves or lifts•S1 > S2 at apex, S2 > S1 at base, no S3 or S4•(+)2 on radial, dorsalis pedis, posterior tibialis, brachial and popliteal pulses

•JVP 3 cm at 30 degrees•carotid artery pulse with rapid upstroke and gradual downstroke,•adynamic precordium•no murmurs, no thrills, heaves or lifts• apex beat 11.5 cm from sternum at 6th ICS, on the Left, 1 fingerbreadth soft in characteristic• S1 > S2 at apex, S2 > S1 at base, no S3 or S4•(+)2 on radial, dorsalis pedis, posterior tibialis, brachial and popliteal pulses

Chest/HeartGCP: Acute fever, body malaise & rashes in a 25 year old male


•abdomen is flat and symmetrical•umbilicus in midline •normoactive bowel sounds•tympanitic at all quadrants•No tenderness on light & deep palpation

•abdomen is flat and symmetrical•no visible pulsations and peristalsis•umbilicus in midline and inverted •normoactive bowel sounds, no borborygmi•tympanitic at all quadrants•No tenderness on light & deep palpation•Liver span = 9 cm Right MCL•Traube’s space is not obliterated

Abdomen/GastrointestinalGCP: Acute fever, body malaise & rashes in a 25 year old male

On Admission (November 3, 2013) Upon PE (November 8, 2013)•(-) CVA tenderness •(-) CVA tenderness

•non palpable kidneys

GenitourinaryGCP: Acute fever, body malaise & rashes in a 25 year old male

On Admission (November 3, 2013) Upon PE (November 8, 2013)Cranial NervesCN I No anosmia•CN 2 : pupils 2-3 mm ERTL, (+) direct and consensual light reflex on both eyes, corneal reflex intact, (+) accommodation, (-) visual field defect, (-) ptosis •CN 3 4 6: EOMs full & equal• No nystagmus, no drooping of eyelids•CN 5: no sensory deficit on the left of face•CN 7: Can clench teeth, can smile, can frown•CN8 : Gross hearing intact•CN 9 10: (+) gag reflex, Uvula midline on phonation•CN 11: Can shrug both shoulders•CN 12: No deviation of the tongue on protrusion

Cerebrum: •GCS 15 (E4 V5 M6)•Conscious, coherent, awake•Oriented to time, place & person•Follows commands

Cerebellum• Able to do finger-to-nose test & alternate

pronation-supination test

Cranial NervesCN I No anosmia•CN 2 : pupils 2-3 mm ERTL, (+) direct and consensual light reflex on both eyes, corneal reflex intact, (+) accommodation, (-) visual field defect, (-) ptosis •CN 3 4 6: EOMs full & equal• No nystagmus, no drooping of eyelids•CN 5: no sensory deficit on the left of face•CN 7: Can clench teeth, can smile, can frown•CN8 : Gross hearing intact•CN 9 10: (+) gag reflex, Uvula midline on phonation•CN 11: Can shrug both shoulders•CN 12: No deviation of the tongue on protrusion

Neurologic examGCP: Acute fever, body malaise & rashes in a 25 year old male

Subjective Objective

• Fever, chills • body malaise• sore throat, vomiting after

meals, anorexia• headache 5/10 • myalgia on upper extremities

6/10, • knee arthralgia 4/10

• Vital signsBP: 100/80PR: 65 bpmRR: 19 cpmTemp: 36 oC

Salient Features25 y.o. Male


Initial ImpressionAcute Viral Infection


Differential Diagnosis6A King, Emmanuel & Lao, Nicole Mae

6B Lee, Andria & Lee, Nica Kristine


Patient Chikungunya Virus Infection Influenza Rocky Mountain

Spotted Fever

Fever 39oCChills

body malaiseSore throat

Vomiting after meals

anorexiaheadache myalgia, arthralgia

Rashes on both lower extremities

Fever(38oC-39oC) Chills

MyalgiasArthralgiasHeadache

PhotophobiaCoughCoryza

Pharyngitis AnorexiaNausea

VomitingFatigueMalaise

SplenomegalyDark urine/clay-colored stools before the onset

of jaundiceExposure to endemic areas/ contaminated

food/water

Acute Fever not responding to antibiotic

therapyHeadache

Physical Findings:Conjunctival Suffusion

Pharyngeal erythema w/o exudate

Muscle tendernessDullness on lung

percussionRales on lung auscultation

Rash (maculopapular, erythematous, petechial

or ecchymotic)Exposure history

FeverAbdominal pain

HeadachePhotophobia

Vomitting Vertigo

Sore throatMeningeal signs

LethargySomnolence

Disoriented/Intellectual deficit

TremorsLoss of abdominal

reflexesCranial nerve palsies

HemiparesisDifficulty in swallowing

Tick borne

Source: Harrison’s Principles of Internal Medicine 18th edition


Source: Harrison’s Principles of Internal Medicine 18th edition

Patient Hepatitis A Infection Leptospirosis

Fever 39oCChills

body malaiseSore throat

Vomiting after meals

anorexiaheadache myalgia, arthralgia

Rashes on both lower

extremities

Fever(38oC-39oC) Chills

MyalgiasArthralgiasHeadache

PhotophobiaCoughCoryza

Pharyngitis AnorexiaNausea

VomitingFatigueMalaise

SplenomegalyDark urine/clay-

colored stools before the onset of jaundiceExposure to endemic areas/ contaminated

food/water

Acute Fever not responding to antibiotic

therapyHeadache

Physical Findings:Conjunctival SuffusionPharyngeal erythema

w/o exudateMuscle tenderness

Dullness on lung percussion

Rales on lung auscultation

Rash (maculopapular, erythematous, petechial

or ecchymotic)Exposure history

Dengue Fever

FeverHeadacheWeaknessAnorexia

General body pain (arthralgias, myalgias)

Abdominal pain Vomiting

Maculopapular rashSore throat

Mild hemorrhagic manifestations (eg, petechiae, bleeding

gums, epistaxis, hematuria)

Lymphadenopathy Mosquito vector


Course in the ward6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin

6B Lim, Janine Abigail & Lim, Jerald Garvin


0.4

0.3

0.2

0.1

0

200

150

100

50

0

Day 1 (11/03) Day 2 (11/04) Day 3 (11/05) Day 4 (11/06)

Sx Fever, sore throat, Abd. Pain Fever Fever Fever

Hgb 132g/L 129g/L 130g/L 141g/L 140g/L

Hct 0.38 0.38 0.37 0.40 0.40

WBC 3.10x109/L(N:0.62, L:0.36, Eo:0.02)

2.50x109/L(N:0.69, L:0.31)

1.90x109/L(N:0.46, L:0.51, Mo:0.03)

3.40x109/L(N:0.19, L:0.78, Mo:0.02,

Eo:0.01)

5.00x109/L(N:0.17, L:0.79,

Mo:0.02, Eo:0.02)

PLT 185x109/L 180x109/L 90x109/L 33x109/L 51x109/L

Na 135mmol/L 141mmol/L

K 3.72mmol/L 3.98mmol/L

Other Crea: 0.93mg/dLALT: 39.42U/L

Dengue NS1: (+)

AST: 51.37 U/LALT: 37.26 U/L

Fecalysis: No significant findings

Paracetamol 500mg Tablet prn

Rx Paracetamol 500mg Tablet IV Fluid (LRS)

Esomeprazole 40mg/tab

Paracetamol 500mg TabletPRN

Paracetamol 500mg Tablet PRN

Paracetamol 500mg Tablet PRN

1 2 3 4 4

0.4

0.3

0.2

0.1

0

200

150

100

50

0

Day 5 (11/07) Day 6 (11/08)

Sx Rashes Rashes

Hgb 137g/L 140g/L 130g/L

Hct 0.40 0.39 0.37

WBC 4.80x109/L(N:0.14, L:0.83, Eo:0.03)

4.10/x109/L(N:0.19, L: 0.75,Mo:0.02,

Eo:0.04)

4.30x109/L(N:0.16, L:0.77,

Mo:0.02,Eo:0.05)

PLT 39x109/L 73x109/L 80x109/L

Rx Paracetamol 500mg Tablet PRNCetirizine 10mg Tablet OD

None

1 2 3 4 4 5 66

Final Clinical DiagnosisDengue Infection

(with warning signs of abdominal pain, vomiting, lethargy, increased Hct & rapid increase in platelet count)


Pathophysiology6A Kho, Beatriz Barbara & Laxamana, Jack Rene6B Lerma, Joshua Dave & Libiran, Jonika Maris


Types of PatientGroup A• are able to tolerate

adequate volumes of oral fluids

• pass urine at least once every six hours

• do not have any of the warning signs, particularly when fever subsides

Group C• severe plasma

leakage leading to dengue shock and/or fluid accumulation with respiratory distress

• severe hemorrhages• severe organ

impairment

Group B• with warning signs

OR• Without warning

signs but with:• co-existing medical

conditions• certain social

circumstances

DOH Revised Dengue Clinical Management Guidelines, 2011


WHO. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control, 2009


FEBRILE PHASE CRITICAL PHASE RECOVERY PHASEFever

HeadacheBody malaise

MyalgiaArthralgia

Retro-orbital painAnorexiaNausea

VomitingDiarrhea

Flushed skinRash

Defervescence

Abdominal pain or tenderness

Persistent vomitingClinical signs of fluid

accumulationMucosal bleeding

Lethargy; restlessnessLiver enlargement

Resorption of extravasated fluid

Hemodynamic status stabilizes

DOH Revised Dengue Clinical Management Guidelines, 2011


Philippines: 7th

WHO Global Strategy For Dengue Prevention and Control .2012

“The incidence of dengue has increased 30-fold over the last 50 years. Up to 50-100 million infections are now

estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk.”


Dengue in the Philippines• 1953- first epidemic of severe dengue• Dengue cases: 110,611(2012) vs 102,192(2013)

Source: Department of Health (DOH)


DENGUE

Human

VirusMosquito

Aedes aegypti

-breed indoors and are capable of biting anyone throughout the day

- less susceptible to climatic variations →increases the mosquitoes’ longevity.

Source: WHO. Programmes and Projects: Dengue Control. http://www.who.int/denguecontrol/en/

PathophysiologyGCP: Acute fever, body malaise & rashes in a 25 year old male

http://www.who.int/denguecontrol/en/

Ashley, L. et.al. Barriers to preclinical investigations of anti-dengue immunity and dengue pathogenesis. Nature Reviews 11, 420–426 (2013)


Viral replication in white blood cells: Cytokine production= IL-1, IL-6, TNF, IFN → Inflammatory response

Fever: ↑PGE2 in hypothalamus→↑cAMP→ altered thermoregulatory set point

Myalgia: Perivascular mononuclear infiltrates + Lipid accumulation Microbiology

Nausea and vomiting: bloodborne emetic stimuli (H1 and 5-HT)

Increased endothelial permeability• Rashes/petechiae (pinpoint hemorrhages)• Induced vasodilatation = dopamine and 5-HT release → headache

Goals of Therapy,Treatment & Management

6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin6B Lim, Janine Abigail & Lim, Jerald Garvin


Treatment and Management• Revised Dengue Clinical

Case Management Guidelines

• DOH• 2011


Monitoring– Temperature pattern– Volume of fluid intake and losses– Urine output – volume and frequency– Warning signs– Hematocrit, WBC and Platelets counts

Source: DOH A.O. No. 2012-0006, Revised Dengue Clinical Management Guidelines 2011

Discharge Criteria• ALL of the following must be

present No fever for 48 hours Improvement in clinical status

General well-being Appetite Hemodynamic status

Urine output No respiratory distress

Increasing trend of platelet count Stable hematocrit without IV fluids


Home Care for Dengue• Adequate bed rest• Adequate fluid intake (>5 glasses for average-sized adult or accordingly in children)

– Milk, fruit juice (caution with diabetes patient) and isotonic electrolyte solution (ORS) and barley/rice water

– Plain water alone may cause electrolyte imbalance• Take paracetamol (not more than 4 grams per day for adults and accordingly in

children)• Tepid sponging• Look for mosquito breeding places in and around the home and eliminate them

• AVOID: NSAIDs, Acetylsalycylic acid (aspirin), Mefenamic acid, Steroids (If already taking, consult physician)

• Antibiotics are not necessary

Source: DOH A.O. No. 2012-0006, Revised Dengue Clinical Management Guidelines 2011


D.E.N.G.U.E.D aily monitor the patient’s status

E ncourage intake of oral fluids like oresol (oral rehydration solution), water and juices

N ote any warning signs of dengue like persistent vomiting and bleeding

G ive paracetamol to the patient, NOT aspirin as it induces bleeding

U se mosquito nets/repellants

E arly consultation with doctors for any warning signsSource: DOH A.O. No. 2012-0006, Revised Dengue Clinical

Management Guidelines 2011



Euphorbia hirta Linn. (Euphorbiaceae) “Tawa-tawa”

• To determine the validity of the anti-thrombocytopenic effect of E. hirta in animal models with subnormal platelet counts due to ethanol.

• The platelet count (Micros Counter), bleeding time (Duke’s method), and clotting time was determined

• Histopathological analysis of the liver and spleen

Thrombocytopenia induction by ethanol

Euphorbia hirta decoction (100 mg/kg

by oral gavage) Administration

Blood Collection on Day 7 and 14

Platelet CountBleeding TimeClotting Time

Histopathological Exam

• Platelet count increased by 38.9 ± 9.6%• Bleeding time improved by 59.38 ± 6.44%• Clotting time improved by 46.6 ± 11.3%• Histopathological Exam– Less dilated liver sinusoids in ethanol + E. hirta decoction

group – No notable difference in spleen

• This was most likely due to the short duration (1 week) of induction of thrombocytopenia may have caused liver damage but was insufficient to cause any significant changes to the spleen.

“Although there were small amount of phenolic compound in tawa-tawa, this was sufficient to exert effect promoting quality and quantity of

platelets,” Mr. Raynes said.

Because of the study’s significant findings, it won the first prize in the PCHRD – Gruppo Medica Award held during the 6thPhilippine National Health Research System (PNHRS) Week held at Sofitel Manila last 10 August

2012. PCHRD – Gruppo Medica Award is given to undergraduate students engaged in herbal medicine research that have potential for practical or commercial applications.

http://www.worldngayon.com/2012/08/gruppo-medica-award/

Updates on Diagnosis6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin




Clinical Question• What test can I utilize to confirm a

diagnosis of Dengue in my patient?• Key Words: Dengue, Rapid Diagnosis

AppraisalAre the results of the study valid?

- Patients were all selected during a Dengue outbreak in 2011- Selected patients presented with a history of fever within the past 7

days with at least one of the following : rash, severe headache, retro-orbital pain, myalgia, joint pains, bleeding

- Patients were randomly selected, with a maximum of 10 hospitalized patients per hospital per week

- All patients were sampled twice (early and late), with early samples tested by PCR, viral isolation, HIA and MAC-ELISA, while late samples were tested with only HIA and MAC-ELISA

What were the results?- In a comparison between hospital laboratories and a

national reference laboratory, the sensitivity, specificity, PPV and NPV of the NS1/IgM/IgG combination tests were capable of early detection of Dengue infection

- optimal performance of the tests require adequate training and quality assurance as there was a significant difference in the values between hospital laboratories and the national reference laboratory.

The results also showed that the sensitivity of the combined diagnostic kit did not vary

significantly between the serotypes and was unaffected by the patient’s immune status or by the interval of time between fever onset

and sample collection

Are the results applicable for your patient?- Given our patient’s presentation and history,

performing a diagnostic test capable of confirming the diagnosis of Dengue early will contribute to an optimal clinical management of the patient, and avoid unnecessary use of antibiotics and other drugs/ancillaries, limiting patient expenses in the process.

Updates on Prevention6A Koa, Daryl, Lacuna, Dan Paulo & Lalusis, John Kelvin



The graphic will identify the type of pest the product is expected to repel & the amount of time the repellent will be effective.

Source: United States Environmental Protection Agency http://www.epa.gov


Technological InitiativesGCP: Acute fever, body malaise & rashes in a 25 year old male

Technological Initiatives• Dengue Vaccine– Final stage of clinical development– Sanofi Pasteur dengue vaccine

• Only vaccine entered Phase III clinical study• Mexico, Colombia, Honduras, Puerto Rico, Peru, Vietnam,

Singapore, Australia, Thailand and the Philippines• Initial data showed very satisfactory results in terms of

safety profile and balance immune system response to the four dengue serotypes (serotype 1,2,3 and 4) among children, adolescents and adults tested

Source: http://www.pchrd.dost.gov.ph


Source: http://www.pchrd.dost.gov.ph

Technological Initiatives• Ovicidal Larvicidal

Trap– Ordinary tin can

painted black– Strip of lawanit

board– Solution


Source: www.cdc.gov; www.dost.gov.ph

Technological Initiatives

Dengue Vector Surveillance websites– Mosquito population nationwide– Dengue incidence, other mosquito-related facts


Technological Initiatives

Biologic Agents– Larvivorous fishes

• Gumbusia affinis, a fresh water fish species, commonly known as “gambusia”, “kataba”, “bubundat” or “mosquito fish,”

• Poecilia reticulate, commonly known as “guppy fish,” can also consume about 80 to 100 mosquito larvae per day

– Predatory copepods like water bugs• Diplonychus indicus

– Sterile male mosquito

Source: http://www.dost.gov.ph

Thank you!

group 6 gcp

Health & Medicine