 Good morning everyone so welcome back to my channel this is Jomar Adams again and I just want to welcome everyone back and I hope you are all doing well. So for today I am very much excited to share to you what our lesson is all about for today and I hope you will be enjoying your opportunity and your moment to learn something new so let's move on. So we are going to talk about your what vector-borne diseases and for this moment I will be discussing a few um introduction to the different vectors and the diseases they cause and at the same time as we go along we will be discussing three of the major vector-borne diseases that are commonly encountered here in the Philippines and those are your dengue, your zika and your malaria okay so let's dig in so first let's define some very important terms for us all the first one is your vector of course so vectors according to WHO are any living organisms that can transmit infectious diseases between humans or from animals to humans so what we're trying to say here are vectors are any living organism be it an insect be it a particular animal so most of the things that we are going to talk about are actually flies, ticks aside from that you also have different insects that will be introduced to you today so those are your vectors so when we say vector-borne diseases on the other hand these are now human illnesses caused by parasites, viruses and bacteria that are transmitted by your vectors so it is not your vectors that actually causes the disease they're actually just the carrier of your agent or your pathogenic agent whether it is parasite a virus or a bacteria all of them are being carried or being transmitted by your vectors and according to WHO we have a couple of vectors that i want to introduce to you today the first one and the first one is actually very much important but before we dig in let us go first to serotype so what do we mean when we say serotype so these are group of organisms that are actually characterized by a common set of antigens so before we discuss what is an antigen and an antibody so these are actually a group of organisms and they are actually being group and on a common set based on their antigens okay so let's go on we also have your incubation period so your incubation period means this is the period between exposure of an infection and the appearance of the first symptom so the moment that you actually was exposed to that particular pathogenic agent and the moment that your first symptoms appear that is your incubation period so we have examples of vectors and i will be showing to you the different vectors and at the same time some of actually some of their the diseases they actually cause first and foremost okay let's go to the most common and the most best thing at times we have your mosquito and your mosquito can actually be a vector for several diseases we could actually have malaria your dengue your filariasis your japanese encephalitis your chickengunya in your zika so this types of actually if you're gonna look at it so most of this are actually from dengue your from dengue down most of this are actually viruses but you also have here your parasites like your malaria so these are actually examples of diseases caused by your most diseases caused by these pathogenic agent being carried by your mosquito so imagine how many diseases does your mosquito is carrying so you really have to be careful but later on will discuss deeper dengue zika and eventually your malaria so let's go to the next we also have your sand fly so your sand fly as you can see it's actually very cute if you're gonna look at it in the picture but you don't want to have this because it actually costs that actually carries the agent that causes your laser maniasis and it is also known as your sand fly fever or your plebotomus fever so your sand fly is actually a vector of your laser mania species that actually causes your laser maniasis on the other hand it also causes your sand fly fever at the same time you also have your triatomine bugs your triatomine bugs causes your chagas disease your chagas disease is actually at a tripanosomal um disease that is also known as your american tripanosomiasis so your chagas disease is also known as your american tripanosomiasis i am very much specific in saying american because as we go along later on we will also be encountering another one which is your african triatom triat tripanosomiasis at the same time i just want you to take down notes i just want you to um drop down in your notes that your triatomine bug is also known as your kissing bugs okay they are also known as your kissing bugs okay kissing all right so let's move on to the fourth example that we have we also have your black flies yeah we also have your black fly that causes your oncho seriasis this is all this is actually a um a disease caused by your oncho serca volvulus your oncho serca volvulus you also know um you also know that the the disease caused by your black fly as your river blindness okay it is also known as your river blindness so we also have aside from your black flies we also have your ticks okay so ticks it causes your Lyme disease and it all okay i'm sorry it actually causes your Lyme disease so it's very important for you to um remember your tick because why why is it because it causes your it causes your Lyme disease and your Lyme disease it's actually called it also known as your Lyme Borreliosis which is an infectious disease caused by your Borrelia okay it is actually caused by your Borrelia and to be specific what type of Borrelia species are we talking about this is actually an example of your um an example of um a tick born disease okay so actually what you see here are actually your that specific ticks that actually causes your that carries your Lyme disease are your isodes isodes species okay so going back again your Lyme disease is caused by your Borrelia is a type of Borreliosis specifically your Borrelia burgdorferi okay your Borrelia burgdorferi so if you are i hope you also have access to um handouts that i have given you so you can listen to me and work hand-in-hand alongside with your notes so again for your black fly we have your oncho seriasis also known as your river blindness again caused by your oncho serca volvulus your ticks also known also um specifically your ticks your isodes ticks cause carry your disease your Lyme disease also known as your Lyme Borreliosis that is being caused by your Borrelia burgdorferi all right so aside from that we also have your Cheche flies yes we have your Cheche fly and that is it actually causes your sleeping sickness okay it causes your sleeping sickness most commonly known um most um commonly known as well as your african tripanosomiasis okay a while back we were talking about your sand fly that causes your uh your triatomind bug rather your triatomind bug or your kissing bug causes your amer- american tripanosomiasis here your Cheche fly causes your sleeping sickness also known as your african tripanosomiasis and we also have here your mites okay your mites that causes either your scrub typus or all right your scrub your mites that causes your scrub typus your scrub typus is actually being caused the are you ready to hear this because this is kind of um this is actually kind of cool because the the causative agent for your scrub typus actually sounds like more of a harry potter spell and that is your oryensha chuchugamushi okay your scrub typus is being caused by your um gram negative bacteria also known as your oryensha chuchugamushi okay it's oryensha chuchugamushi that causes your scrub typus being carried by your mites all right let's move on you also have your snails all right okay so your snails can actually be carrying your schistosomiasis or your schistosomes rather that causes your schistosomiasis so we have your snails which are freshwater snails and so let me first um go deeper to your snail so most of our snails um are actually um found on freshwater and they can actually carry your schistosomes so most of the time the larva of your schistosomes are released in the water and it penetrates the skin the skin of humans so if you have heard of your elepentiasis your uh no your elepentiasis your the the philarial worm that causes your elepentiasis can also be found in your snail or your puhol aside from that you also have your other schistosomes that can actually cause your schistosomiasis aside from that we also have your lice okay your lice can actually cause two things your loose borne relapsing fever that is actually caused by another borrelia species which is your borrelia recurrentis okay so your borrelia recurrentis causes again your loose borne relapsing fever okay your loose borne relapsing fever so this is usually transmitted through small wounds in your mucous membrane or all the nose and mouth done by crushing the lice so sometimes it's not really that advisable that you crush your the lice with your with your fingers or or anything that is unprotected because it can actually be liberating the bacteria that is inside your lice aside from that um aside from your loose borne relapsing fever again caused by borrelia recurrentis we also have your typus fever okay so what about your typus fever on the other hand your typus fever is also being carried by your lice so the vector is again your lice but this one your epidemic typus fever is actually caused by another um pathogenic agent which is your riketsha prowazeki it's your riketsha prowazeki so it is actually transmitted through again similarly on how your your loose borne relapsing fever is being transmitted okay so as you can see your lice can actually carry i two pathogenic agent one is your borrelia recurrentis causing your relapsing fever and you also have your epidemic typus caused by your riketsha prowazeki so those are actually different examples of your vectors and there are still a lot if we're gonna name a lot more but for the sake of our discussion i will only be um we only covered those nine so from the mosquito that causes your dengue malaria so on and so forth down to your lice aside so today let's dig in now to a more specific disease or a more specific vector borne disease which is your dengue so your dengue is also known as your break bone fever so it is actually a severe flu-like illness that affects infants young children and adults so in short it actually chooses um it actually all member of the community is actually vulnerable to your dengue okay so it is actually used um being transmitted by two vector or to be specific two types of mosquito mosquito we have your aegis aegypti which is actually the primary vector of your dengue virus and you also have your aegis albopictus on the say on the other hand so your aegis aegypti is also known as your yellow fever mosquito and you also and your aegis albopictus is also known as your um asian tiger mosquito so these two are actually the common um the common vectors of your dengue the primary vector is your aegis aegypti and your aegis albopictus is actually the secondary vector so let's move on so talking about now so we know that your dengue has a break bone also known as a break bone fever some are actually calling it dhf or your dengue hemorrhagic fever as well again caused by aegis aegypti and aegis albopictus so your dengue to be more specific it's actually caused by a virus also known as your dengue virus so it actually it actually belongs to the family of flaviviridae and it actually have three um four serotypes you have your serotypes one two three four so that is dengue one dengue two dengue three and dengue four all of them are actually seen here in the philippines but the most common is actually your serotype three the reason why i had it underlined and also colored differently from the others because your dengue serotype serotype three is actually the most common here in the philippines okay so talking about its incubation period usually it actually around four to ten days before the first symptoms appear so the peak biting periods of our aegis species specifically your aegypti and your albopictus are usually early in the morning and actually evening before dus so most of the time if you actually observe more mosquito or biting at this time this is actually their prime time so might as well be more cautious about that so moving on now we'll let's talk about first the life cycle of our vector or the life cycle rather yeah the life cycle of our vector so adult the adult mosquito to be specific your female mosquito are the one that actually is carrying the diseases so female mosquitoes lay egg inside containers holding water but this is the the the thing here female mosquitoes can only be able to produce their eggs after feeding on human or animal blood okay feeding on human or animal blood so for male mosquito usually they feed on nectar from your flowers okay so they actually are somehow vegetarian if we're gonna say so unlike your female aegis alb aegypti and aegis albopictus they actually feed on human and animal blood to produce eggs so here you actually would observe that they actually feed on human and they can actually feed on animal your aegis aegypti primarily feed on humans only that's why it is a primary vector as well of your dengue but your albopictus can actually um your albopictus can actually feed on human and also in your animals okay so they need to feed on blood for them to produce your eggs eggs that actually usually are being laid on your watery lines so anything where where there is clean water they actually would niche there for their eggs so their eggs can actually hatch from a few days to several months and it actually starts to hatch after being submerged in your water so the eggs of your your your aegis muski species are actually very hard they actually stick to the wall of a container like a glue and they can even survive drying out for up to eight months and after being submerged to water they actually would begin to they actually would begin to um they would actually begin to hatch after being submerged in your water so moving on now moving on now we also have here after your adult after your egg of course next one would be your larva so your larva is the aquatic stage of your mosquito and it will develop into pupae in as little as five days so sa tagalog we actually have it as your kitikiti okay so um it is very important as as you all know most of the uh most of our most of our um most of our mosquito larvae are actually being seen in stagnant water abandoned stagnant water so that's why you have to really um clean up your surrounding when seeing some stagnant water because they can actually niche there so aside from that aside from your larva after being your larva again they will develop to your pupa in five days so in your pupa develop into an adult flying mosquito in just a couple of two to three days so within two to three days they will start pestering us 20 in the morning and early in the evening so again let's have a quick recap so from the egg being laid by again of course only your female mosquito okay your your egg it will now be hatched into your larva and then your pupa and then your adult mosquito now carrying your denge virus so this is actually a quick um a quick picture from the centers of disease control we have here your adult ages egypti so the female mosquito will lay eggs and it will hatch to your larva then it will be um it will develop to your pupa and in two to three days again it will soar and it will spread its wings and pester and feed in your blood so what about your denge virus okay so your denge virus again is a type of a flavivirus so as you can see your your flavivirus is actually an example of your um RNA virus so having said that similarly to your corona virus and similarly to almost all your viruses they do not have the capability to produce their own protein they don't have the machinery to produce their own DNA or in a nutshell their nucleic acid okay so that is the reason why they need to infect a particular cell or they need to infect um a particular cell for them to be able to for them to be able to hijack okay for them to be able to hijack the entire cell and the entire nucleus to favor them so the first thing that happened is that your virus binds to your cell and it will actually be fusing into your into the cell so that would be the entry of your virus and then it will now be started to liberate the genetic material in our case we have your RNA at the same time you also have here your reverse transcriptase your integrase and your protease at the same time as you can see very much similar again to your corona virus because they are both RNA viruses and the first thing that they need to do is to produce a complementary DNA out of that RNA so that will be the the job of your reverse transcriptase afterwards it will now start to produce the um uh the the after having your complementary DNA the second strand will again be made and then those um viral DNA now will start to will start to will start to replicate within your nucleus so the DNA the DNA virus will enter here and it will be integrated into the host cells DNA and then as long as with that after replication of the viral DNA it will now be trend it will now undergo transcription then translation where your protein starts to be produced and then carrying now the viral DNA here again it will now start to have your variant assembly and then it will now be released thereby liberating more of your dengue virus in your system so that is how your dengue virus um that is how your dengue virus enters your enters your cell okay so afterwards what do we see in patients with dengue by dengue fever your dengue hemorrhagic fever so this are the clinical presentations that they actually have first we have your febrile phase your critical phase and your convalescent phase so these are actually three phases of your um three phases of your dengue fever so let's start with the first let's start with the first one so the first one is your febrile phase so the onset of your the onset of your your febrile phase is actually sudden aside from that aside from that when it comes to your when it comes to your febrile stage the usual duration is from two to seven days it actually from two to seven days so some symptoms include severe headache muscle joint and bone pain we also have your macular and macu popular rash we also have minor hemorrhagic manifestation so as you can see some of the symptoms are actually very much similar to your flu aside from that you also be you will start to observe peticye which are this one and you also have your echinosis and your pa and this is your echinosis your echinosis actually looks more similar to your hematoma but your hematoma that is actually caused by an a um unsuccessful or erroneous phlebotomy but your echinosis this is actually caused by or this is actually a manifestation of a particular disease aside from that you also will observe a positive to trinicate test results so i'll be discussing what is trinicate test as we go along when we reach the different um when we reach the different um when we reach the different tests used for to detect your dengue so aside from that we go to your critical phase so your critical phase will actually occur within 24 to 48 hours so this is now where much of the more serious symptoms starts to appear appear so the first one is the fervescence so the fervescence and then your plasma leakage and then eventually hemorrhagic manifestations like your hematemesis hematokizia and hematemenoragia so menoragia so these are actually the hemorrhagic manifestations that will be observed when it comes to your when it comes to your dengue dengue fever so maybe you're wondering what is plasma leakage what is um what is your what plasma leakage is all about so plasma leakage is actually a process in which the protein reach fluid component of the blood leaks from the blood vessel into its surrounding tissue so you all know now that when in your blood that is actually majority of your blood is actually compost of your plasma okay it is actually composed with your plasma and the moment that your plasma start to leak out out of your blood vessel going to surrounding tissue that is your plasma leakage and your plasma leakage is actually a um is a sign of your critical phase when it comes to your dengue hemorrhagic fever so i'll go through that later after the convalescent um the convalescent phase so convalescent phase this is now the time where resolution there is a resolution of your symptoms symptoms symptom starts to appear in your body start to cope up with the virus so this is now the time where there is a normalization of your blood status and so after that you will start recovering from dengue hemorrhagic fever so for your dengue hemorrhagic fever we actually have a grading for that okay we actually have a grading for that so first we actually um the first thing that we check is the fever with non specific constitutional symptoms so what we do here um is first to perform your tourniquet test so we will now start to observe the appearance of your petic k okay the appearance of your petic k so after that after that is grade grading one we actually grade it two okay so in addition to what you see in in your grading one which is fever and then a positive tourniquet test so that is grade one dhf or dengue hemorrhagic fever dhf grade two is actually um alongside with grade one symptoms and spontaneous bleeding in addition so there is other bleeding so you have your hermone sign your petic ye your gums are bleeding as well you have melena black taris tool you have low platelet counts because the the normal platelet count is 150 000 to 400 000 cubic millimeter of your platelet so aside from that there is an increased hematocrit so the increased hematocrit is actually due to your plasma leakage aside from that so this is actually your your hermone sign or your petic k so that is grade two we call it grade three if circulatory failure is now um being observed in addition to your grade two symptoms so what are the usual signs that we see we have your cold clammy skin so we we say cold clammy skin as alongside with that there is a low blood pressure increased pulse rate and and respiratory rate so cold clammy skin actually if you're gonna i don't know if it's clear on your screen so i a cold clammy skin skin or hand is a palm that is actually very um unusually dumb okay so napapawis ang iyong mga palad okay so aside from that that is for grade three but a more serious um a more serious one would actually be your grade four dengue hemorrhagic fever where there will be there is actually a profound shock a hypovolemic shock in addition to your grade three symptoms so hypovolemic shock profound shock or dengue hemorrhagic your dhf shock is actually because of the plasma leakage so generally this is your grading okay this is your grading so we have your dengue fever or dengue hemorrhagic fever so fever with two or more of the following so leukopenia we say leukopenia when there is a low wbc count trombocytopenia if there is a low platelet count but um so so but with no evidence plasma loss so we call it dengue fever okay dengue fever but we call it now dengue hemorrhagic fever when there is actually a start of a more serious um symptom so that is from grade one grade two grade three grade four so i hope you would actually review this because this might actually come out in your final homework that will be coming out very soon so let's discuss now your plasma leakage so what you see here is actually the the progression of your plasma leakage so what happens first is this one of course after being infected your dengue your dengue virus are present now in vivo inducing widespread mass cell activation so your dengue what happens is that your your your dengue virus your dengue virus will actually start to um be detected by your mass cell okay it will actually induce the activation of your mass cell your mass cell is a type of a wbc that is usually found directly on your vascular endothelium so endothelium that in that can actually increase the permeability thus inducing vascular leakage so your mass cell okay your mass cell your activated mass cell can actually secrete extracellular granules similar to your your vasophil so actually they contain your histamine and your heparin so these are your mass cell so the moment that your dengue virus um activates your mass cell your mass cell now will start to secrete their external your extracellular granules that will now act upon into your your your blood vessel what does this cause so the mass cell derived factors the intracellular granules that has been secreted are actually um the one responsible in increasing vascular permeability promoting now a pathological loss of in of vascular integrity to be exact what happened is that the what happened in your cells is that your vasoactive mediators actually increases the blood vessel size in diameter and it actually um responsible in breaking down the glycocalyx which is a barrier of your endothelial cell so one of the main um mass cells um one of the major mass cell um product here so as you can see serums concentration of your muscle specific product like your timase start to increase which is correlated with the human disease severity so what happens this timase which is a major protease secreted by your mass cell are the one that induces a vasculopathy in within your blood vessel so what you can do is actually to prevent that to reduce that to reduce mass cell by using targeting drugs similar like your monteluca your chromoline and your ketofin okay your ketofin okay so these are the usual drugs that are being used so it is very much important for you to treat it immediately because if not treated it may progress to dengeshock syndrome okay dengeshock syndrome and aside from that it's not just the mass cell that is being um recruited in this blood vessels but also other immunological cells okay so that's how your plasma leakage happen again because of the mass cell the factors that your plat your mass cell have produced or secreted plasma will start to leakage because of the increased permeability of your cell aside you off your blood vessels rather so aside from that we have principal symptoms so again high fever and at least two of this following severe headaches severe eye pain joint pain muscle or bone pain rash mild bleeding and manifestation and low white blood count cell aside from that you also have this warning signs so if you actually observe severe abdominal pain persistent vomiting bleeding gums vomiting of blood rapid breathing fatigue and restlessness you really need to take your patient into the emergency room for a more intensive healthcare service and prevention so how do we diagnose your dengue fever or your dengue hemorrhagic fever we actually have a couple of tests the first you want to do is to screen it you have to screen whether or not this is actually dengue fever or dhf or not or just a simple flu so what you do is your ternicate test okay your ternicate test and of course your complete blood count your blood will be collected by your medical technologist process it in the laboratory check your wbc and your platelet counts aside from that you have your ternicate test so i'll i'll go on with the ternicate test afterwards so we also have your confirmatory test your confirmatory test are actually your dengue ns1 antigen where we detect the particular um antigen that is specific to the dengue virus again i mentioned it to you that your antigen or your epitopes are very specific to a particular organism although some can cause cross reactivity it is actually very much specific still aside from that we also have your dengue immunoglobulin g and immunoglobulin m again with first this during the class we had this cause the five classes of your immunoglobulin so the most abundant is your igg although your igg is usually seen so please write it down your igg is actually the type of immunoglobulin that is usually found during the later stage of the disease and the igm is the first one that increase or the first antibody or immunoglobulin to be produced by your plasma cells that produces your antibodies so aside from that you also have your gold standard we have your polymerase chain reaction okay and you also have your nucleic acid test so your polymerase chain reaction is very important why because um specifically your reverse your rtpcr your reverse transcriptase polymerase chain reaction so we have your rapid gates this is the first one on top is your ns1 rapid gate and your dengue igg igm we call it in the laboratory as dengue duo because you're trying new you're trying to detect two antibodies so you're trying to figure out whether it is a a new or an early infection dengue early dengue fever or already on its later stage aside from that we go now to your ternicate test so what the what do we do during ternicate test is of course we take the patient's blood pressure so we inflate the cough to appoint midway between your systolic and your diastolic and maintain that for five minutes and afterwards you reduce and wait for two minutes and you wait for the appearance of your petic yay to be honest i actually experienced this when i was a kid i actually had dengue before and the first thing that they do is actually your ternicate test and then your complete blood count what they did is actually to similar to what they did here your rumple did test that they actually used a blood blood pressure cough and then inflate it in a particular systolic diastolic and they actually start to rubber band to rubber band that and then i would actually have to to have my hands close open it's actually very painful at that time but it actually was their way to induce the appearance or induce the the appearance of your petic yay so afterwards there is a positive ternicate test so again this is grade 1 dhf positive um ternicate test when there is a greater than or equal to 10 petic yay per one square inch of your skin so usually you're gonna observe that in your mid anti cubital fossa okay your anti cubital fossa you will be observing that there okay maybe you're wondering where is your anti cubital fossa i cannot show it to you right now but i trust that you know this so remember you are finding the basilic vein okay when you're doing your blood pressure so you find your basilic vein the one towards your the mid chagital plane so the one nearest to your body the one that is actually just on top of your your radial your brachial artery so that that one is your anti cubital fossa all right so blood transfusion so maybe you're asking sir when does a patient with dengue fever needs blood transfusion to be exact um to be exact the thing that they need is actually your um either a platelet concentrate or a fresh frozen plasma but sell them do they request for a whole blood or a pack red cell okay so that are different components of your blood so when do they need to be transfused with with blood so this now um will happen when the platelet count in your adult start to drop as low as 50 000 cubic millimeter and for your pediatric patient as low as 20 000 cubic millimeter so imagine the normal is actually 150 000 to 400 000 cubic millimeter and they only have 50 okay so that is actually um very very low okay so you have to have your you need to have your blood transfusion immediately so both with active bleeding okay so adult with low platelet count and with active bleeding so that is all about your dengue fever and your vector-borne disease i'm cutting it here um i'm cutting it here so i'll be discussing on our next video your zika virus and your malaria so thank you very much for um watching this video don't forget to hit the like to share it to your classmates to share it to anyone that you know would really need it and do not forget to subscribe to my channel to be updated for the latest video uploads that i will be making this week so thank you very much for um for watching and have a great day ahead of you so again do not forget to sign up with a google form so that i would know that for if you're my student and you watch this please do not forget to sign in in your google in your google form for you to be able to have your attendance recorded thank you so much so i will be seeing you on my next video so thank you and god bless