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Infectious Disease Control Guideline Infectious Disease Control Guideline Government of Nepal Ministry of Health and Population Department of Health Services Epidemiology and Disease Control Division 2073 BS (2016 AD) Infectious Disease Control Guideline Contributors Dr. Baburam Marasini, EDCD Dr. Basudev Pandey, LCD Dr. Guna Nidhi Sharma, EDCD Dr. Ram Raj Panthi, EDCD Mr. Bhim Prasad Sapkota, EDCD Mr. Resham Lal Lamichhane, EDCD Clinical Experts Prof. Dr. Buddha Basnyat, PAHS/OUCRU Prof. Dr. Subesh Raj Kayastha, NAMS Prof. Dr. Sudhamshu KC, NAMS Prof. Dr. Shital Adhikari, CMC Dr. Jitendra Man Shrestha Dr. Vivek Kattel, BPKIHS Dr. Anup Bastola, STIDM Technical Support Mr. Pranaya Kumar Upadhyaya, MOH Dr. Prakash Ghimire, WHO Dr. Keshav Kumar Yogi, WHO Dr. Vivek Dhungana, WHO Dr. Neeta Pokhrel Regmi, WHO Preface Table of Contents Contents Page No. Preface ........................................................................................................................................................... 3 Table of Contents .......................................................................................................................................... 4 Acronyms ....................................................................................................................................................... 7 Chapter I: Introduction .................................................................................................................................. 9 1. Background ........................................................................................................................................ 9 1.1 Health in Constitution of Nepal ....................................................................................................... 9 1.2 National Health policy-2071 ............................................................................................................ 9 1.3 SLTHP 1997-2017 ........................................................................................................................... 10 1.4 Three years plan (2069-72) ........................................................................................................... 11 1.5 Global burden of Infectious Disease ............................................................................................. 12 1.6 Regional Burden of Infectious Diseases ........................................................................................ 14 1.7 National Burden of infectious Disease .......................................................................................... 14 2. Objectives ........................................................................................................................................ 15 Chapter II: Syndromic Approach to Infectious Disease ............................................................................... 16 1. How to approach the patients with fever ....................................................................................... 16 Comprehensive History and Physical Examination ............................................................................. 16 Undifferentiated Febrile Illnesses ....................................................................................................... 18 True vs False Diagnosis of UFIs ............................................................................................................ 19 Empirical Treatment ............................................................................................................................ 20 Algorithm for Fever ............................................................................................................................. 21 Clinical Decision Making ...................................................................................................................... 22 2 How to approach to the patients with Jaundice ............................................................................. 30 How patient present? .......................................................................................................................... 30 History taking in jaundiced patients .................................................................................................... 30 Examination of a jaundice patient....................................................................................................... 31 Physical signs to be seen in patients with jaundice ............................................................................ 31 Approach to a patient with suspected infective jaundice (most likely infective jaundice) ................ 32 ACUTE WATERY DIARRHOEA (rice watery stool with/ without vomiting) .............................................. 36 Definition ............................................................................................................................................. 36 Investigation chart ............................................................................................................................... 36 ACUTE BLOODY DIARRHOEA (with fever) ............................................................................................... 37 Definition ............................................................................................................................................. 37 Investigation chart ............................................................................................................................... 37 HIGH GRADE FEVER WITH DIARRHEA (SUSPECTED ENTERIC FEVER) ...................................................... 38 Definition ............................................................................................................................................. 38 Investigation chart ............................................................................................................................... 38 OTHER DIARRHOEA ................................................................................................................................. 39 Definition ............................................................................................................................................. 39 Investigation chart ............................................................................................................................... 39 SLIGHT FEVER WITH JAUNDICE ............................................................................................................... 40 Definition ............................................................................................................................................. 40 Investigation chart ............................................................................................................................... 40 ACUTE RESPIRATORY INFECTION (ARI/ILI/SARI)...................................................................................... 41 Definition ............................................................................................................................................. 41 Investigation chart ............................................................................................................................... 41 HIGH FEVER WITH OR WITHOUT HEMORRAGE/ RASH (SUSPECTED ARBOVIRAL INFECTION) ............... 42 Definition ............................................................................................................................................. 42 Investigation chart ............................................................................................................................... 42 FEVER WITH CHILLS (SUSPECTED MALARIA) ........................................................................................... 43 Definition ............................................................................................................................................. 43 Investigation chart ............................................................................................................................... 43 Chapter III: Respiratory Illness .................................................................................................................... 44 Severe Acute Respiratory syndrome (SARS)........................................................................................ 44 Nipah virus (NiV) disease ..................................................................................................................... 47 Middle East respiratory syndrome corona virus (MERS-CoV) ............................................................. 50 LEGIONELLOSIS .................................................................................................................................... 52 Influenza .............................................................................................................................................. 56 Crimean Congo Hemorrhagic Fever .................................................................................................... 60 Chikungunya fever ............................................................................................................................... 62 Chapter IV: Zoonotic Diseases ..................................................................................................................... 64 Taeniasis andCysticercosis...................................................................................................................... 64 Toxoplasmosis
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