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This collection was published to provide pertinent information on the status of diseases and disorders of gastrointestinal tract research in Myanmar to the scientists feldene 20 mg with mastercard arthritis pain relief gnc, health care personnel generic feldene 20 mg visa arthritis leg pain, administrators and decision- makers 20mg feldene overnight delivery arthritis in upper back. The compilers simply wish that it will of benefit to those who want to learn about gastrointestinal problems in the context of Myanmar people generic 20 mg feldene free shipping arthritis pain back treatment. The authors greatly appreciate the help provided by librarians of the various libraries and the staff of the Central Biomedical Library, Department of Medical Research (Lower Myanmar). Epidemics of cholera were rampant in the Kingdom of Myanmar th since the 18 century and global pandemics of cholera invaded the Kingdom of th Myanmar and also British Burma from time to time, the 6 pandemic reaching Myanmar in 1901. They were a threat to the health of the colonial army, the administrators, their families and the European community which followed the British flag into Myanmar, as well as to the proper conduct of administration and trade. By the time Myanmar Kingdom was annexed to the British Empire in 1886, the cholera vibrio had already been discovered by Koch in 1883 and the water borne nature of the disease was known. The classic studies of Snow in London in 1855 and others in India had shown that it is possible to prevent cholera by providing clean water. After Independence in 1948, the Myanmar health authorities continued to focus attention on and study different aspects of cholera, according to need and opportunity. Diarrhoea (non-choleric or non-specified diarrhoea) became gradually recognized as a highly prevalent and important cause of mortality and morbidity in Myanmar, especially in children including neonates and was listed among the top priority diseases in successive National Health Plans. Although people in the community and general practitioners would have always been aware of its pervasiveness and health impact, it was only from around the 1960 s that the focus of attention of the health authorities shifted from cholera to diarrhoea and it became the subject of intense scientific study in scope and depth, from the medical as well as socio-economic aspects, throughout the later decades. Intestinal helminthic infections are easily recognized and known to be highly prevalent in children in Myanmar and like diarrhoea, they have been the subject of intense scientific study from about the 1950 s onwards. Dysentery is also easily recognized, very common and has been scientifically studied to some extent and depth from about the 1950 s onwards. The exception was Peptic ulcer, where the new concept 1 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar regarding etiology (Helicobacter pylori infection) gave the stimulus and theme for a series of in-depth studies. Epidemiological methods were at first elementary and descriptive but soon progressed to analytical epidemiological methods to find causal relationships, like between intestinal helminthiasis and nutrition, diarrhoea and climate. Epidemiological modeling methods were used to predict and confirm the results of public health interventions such as mass chemotherapy on intestinal helminthiasis. Special techniques were used to investigate the action of microbial toxins - such as invasiveness, adherence and intestinal secretory response. Novel methods were introduced to investigate food iron absorption:- such as radioactive labeling of rice grown by hydroponic culture, double radio-labeled iron tracers to measure rice iron absorption and quantification of intestinal mucosal iron content. Radio-active tracers were used to investigate biochemical activity in intestinal mucosal cells such as effect of cholera toxin on amino-acid uptake by the gut. Anatomical methods - for study of gross and microscopic gut structure for academic purposes were those routinely available in college anatomy departments. Pathological methods ranged from routine histological methods to hitherto unused approaches like dissecting microscopy of intestinal villi obtained by Crosby intestinal capsule; and special histological stains to detect and measure intestinal mucosal cell contents like lactase enzyme. Aung Than Batu 3 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar 4 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar Introduction This bibliography was compiled with the aim to accumulate all available data on diseases and disorders of gastrointestinal tract research studies carried out in Myanmar. An extensive literature review was carried out to collect all published data on diseases and disorders of gastrointestinal tract research in country. In collection, literature written in English with research findings on human gastrointestinal diseases, and conducted by a research team which included at least one Myanmar investigator was compiled. Abstracts published in international and local conference/ seminars/ symposium/ were also compiled. All publications on diseases and disorders of the gastrointestinal tract recorded by biographies as mentioned in Who s Who in Medicine in Burma (1972) and Who s Who in Health and Medicine in Myanmar (2003) were included. The search was further extended to all medical subjects and to related science theses such as Zoology. Contact with libraries at Medical Universities, Arts and Sciences Universities, Myanmar Medical Association were made through visits, postal and email services. The information obtained were recorded and analyzed by place of research work, category of research, and type of information provided. The compiled abstracts are arranged according to the year of publication and are arranged according to the name of the first authors. The abstracts are numbered consecutively and continuously from 001 to 537 throughout all decades. Also, there is an Overview and Summing up at the end of each decade describing the nature of studies and the progress of scientific methods during that decade. An Expert Technical Committee for the Study of Intestinal Helminthic Infection in Burma was appointed by the Burma Medical Research Council in 1968. Although there have been several previous prevalence studies of intestinal helminths in Myanmar this Technical Committee conducted the first systemic attempt to review the situation and assess the health impact of intestinal helminthiasis in Myanmar. Its Report provided the framework and guidance for further research on the subject for many years to come. Descriptive epidemiological studies of intestinal helminthiasis were carried out in different urban and rural communities especially among school children. These studies and many more in the following decades provided base-line data on the extent of intestinal helminthiasis in the country. Cholera in epidemic form had been the main concern of the health administration and the people since colonial times. Now, the importance of acute (non-cholera) diarrhoea as a cause of high mortality and morbidity, especially in children, became better recognized and the subject of epidemiological and bacteriological studies. Bacteriological investigations of the responsible etiological agents for diarrhoea in children and cholera were done, using simple routine laboratory methods including serology. Anatomical studies of the stomach and gut were started in human cadavers beginning with description of variation in vascular supply. Physiological studies were begun on apparently healthy subjects - gastric acid secretion was measured using routinely available laboratory method. Clinical trials were undertaken - uncontrolled study of reputed traditional herb (Let-htoke-kyi) on acute amoebiasis and comparative study of two antihelminthic drug on helminthiasis. Surgical studies were undertaken clinical survey of gastro- duodenal hemorrhage in the large teaching hospitals. The types of studies undertaken were descriptive, except for the large analytical epidemiological investigation of diarrhoea. Some were by students from the few post-graduates courses which had started at Institutes of Medicine. Existence of cholera has been demonstrated in Burma in 1783 and in Irrawaddy Division during second pandemic in 1842. There was cholera every year in Burma and every year Irrawaddy Division was affected. In those days cholera was caused by "classical" cholera vibrios till 1963 a new strain, El Tor vibrio was imported. All ages are susceptible and teh highest incidence is observed in adults (age-groups 21-50 years).
Because many traditional medicines have been used for generations 20mg feldene with mastercard can u get arthritis in your neck, disseminated in local communities feldene 20mg online arthritis in neck vertigo, and documented in publicly available sources generic 20mg feldene overnight delivery arthritis pain killers that work, these medicines may fail to qualify for patent protection generic feldene 20 mg otc arthritis in back and chest. The requirement for inventiveness is also a significant barrier to patenting traditional medicines. Pharmaceutical drugs derived from natural products involve some form of alteration or purification, and such compounds may be considered a novel and inventive step over naturally occurring substances. Because herbal medicines typically comprise natural products in their raw form, it may be difficult to claim that these remedies are novel and involve an inventive step (or, in U. Patent Act of 1952, retains the uniquely American grace period but redefines what disclosures an inventor can make. In some legal instruments there is a differentiation between printed publications, oral disclosures and prior use and where the publications or disclosure occurred. Applying for a patent is a complicated process, requiring technical expertise and the services of trained legal professionals. The Protocol establishes more detailed rules regarding the mechanisms for providing information to national patent offices and other stakeholders, and for sharing benefits on mutually agreed terms. This includes herbal preparations, extracts from herbal medicines, foods containing herbal medicines, methods for preparing herbal formulas 151 and new medical indications for traditional formulas. This is an attempt to both shield its large domestic market and to promote exports of biological resource based inventions to foreign markets. The objectives of this legislation include ensuring the sustainable use of biological resources, benefit-sharing and the protection of traditional knowledge. Information in the public domain is often considered in negative terms, as whatever is left over after various tests of legal protection have been 159 applied. This common understanding of the public domain ignores some critical distinctions. On the other hand, the public domain can be thought of in 164 positive terms as a valuable resource. Information in the public domain serves as the foundation for the creation of new knowledge, and as a rich source of content for 165 education. The Government of India, on the other hand, has chosen to restrict information it is documenting on Ayurveda. Chi-Ham, Defensive Publishing and the Public Domain, in Intellectual Property Management in Health and Agricultural Innovation: A Handbook of Best Practices, (Krattiger A. Today, many large pharmaceutical companies make kava based products, 169 and genetic elements of the kava plant have been patented in Europe. Two German companies have obtained a patent for Kava as a prescription drug for treating strokes, insomnia and Alzeimer s disease. The modern concept of property rights belonging to one or more identifiable individuals may be poorly suited to capture the shared development of ideas within an indigenous community. Some national sui generis regimes provide special rules for collective ownership of traditional knowledge. This can be accomplished through individual ownership 168 Some sui generis regimes may still provide some method for compensation. Law Introducing a Protection Regime for the Collective Knowledge of Indigenous Peoples Derived from Biological Resources, supra note 157, Art. Page 18, Forthcoming 2010 in Annette Kur & Vytautas Mizaras (eds), Can one size fit all? Even a national government can be treated as a person for purposes of ownership. Collective marks are owned by one entity, but they may be used and enforced by multiple individuals. Geographical indications allow a group to identify a good as originating in a territory, region or locality, where a given characteristic of the good is essentially attributable to its geographical origin. For patents and copyrights, multiple individuals usually share joint undivided interests in the subject matter. It is more difficult, though sometimes possible, to have joint ownership of trade secrets and trademarks. Because trademarks, for example, are designed to designate origin from an enterprise, joint ownership is only possible where joint owners are structured to assure joint control over the goods or services sold under the mark. Each clan has its own sacred place known as a kaya, a shrine for prayer, sacrifices and other religious rituals, located deep in the surrounding forests. The Mijikenda have not generally transmitted traditional knowledge to foreigners or 176 non-villagers, although a council of elders may grant consent in special circumstances. However, such beliefs may not be shared by third parties, leaving communities vulnerable to misappropriation. Recently, there has been criticism that customary Mijikenda laws have been modified 177 or completely lost. Loss of traditional territories due to commercial use and conservation efforts, growing integration with western society, and the extension of the government have been criticized for undermining time-honored authorities and values. As clans become 178 westernized, a number of traditional healers have begun practicing commercially. In one case, permission to access a Mijikenda kaya for research purposes was granted by the local government authority without the tribal community s prior informed consent. Today, the cultural survival of many indigenous communities is threatened, and some traditional systems of disseminating knowledge may already be lost. Modern lifestyles and the disruption of traditional ways of life may cause younger generations to lose interest in learning about traditional medicine. Traditional languages used to pass down information may no longer be as widely understood. Documentation may also facilitate investment and innovations related to traditional medicine. For example, the Indian government provided information to the European Patent Office to invalidate a patent granted on the anti-fungal properties of Neem, a traditional Indian medicine. The Indian government presented documentation of the traditional use of Neem, and the patent was revoked in 2008. Information on Ayurveda may be publicly available in India, however it is difficult for patent examiners in other countries to search prior art and determine if a claimed invention is novel. Traditional knowledge may be documented in languages such as Sanskrit that are not accessible to international patent examiners. For example, a foreign manufacturer might choose to market a traditional herbal medicine for traditionally contraindicated symptoms. In addition to safety concerns, such marketing efforts may negatively affect the reputation of the traditional medicines or groups involved. Ownership claims may be brought by members of the healing community, members of the larger indigenous community or even the national government. It can be further challenging to identify who qualifies as a community member or practitioner trained in the art. Should groups maintain traditional organization, or should modern notions of fair representation take precedence? Is knowledge being documented to assist researchers in finding new uses for traditional medicines or to develop new drugs from medicinal plants? Is knowledge being developed for widespread dissemination in order to promote and improve traditional medicine use?
Syndromes
- Movement difficulties (ataxia)
- Liver failure
- Shock, including rapid heart rate or falling blood pressure
- Hearing loss from loud noises
- Diarrhea
- Acute renal failure
- Glaucoma
- Combined small cell carcinoma
- Noninvasive mechanical ventilation (BiPAP or other modes) through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)
- Cough
Histamine is stored in the cytoplasm of mast cells and basophils buy generic feldene 20mg line rheumatoid arthritis relieve home remedies, attached to anionic carboxylate and sulfate groups on secretory granules ( 5) cheap feldene 20mg on line rheumatoid arthritis research 2015. Histamine is released from mast cell and basophil secretory granules after aggregation of high-affinity immunoglobulin E (IgE) receptors 20mg feldene free shipping rheumatoid arthritis wheelchair. IgE receptors are coupled to G proteins 20 mg feldene with visa arthritis treatment vinegar honey, which, when activated, lead to a sequence of chemical reactions with the end result being histamine release. This speculation was confirmed by Black and co-workers in 1972, who used the experimental histamine antagonists mepyramine and burimamide to block histamine-induced reactions in animals ( 8). They observed that each of these antagonists inhibited different physiologic responses, suggesting that there were at least two histamine receptors, now referred to as H 1 and H2 (8). Arrang and colleagues discovered a third histamine receptor (H3) with unique physiologic properties, raising the possibility that additional, yet unrecognized, histamine receptors exist ( 9). Effect of histamine on human histamine receptors The first histamine antagonist was serendipitously discovered in 1937 by Bovet and Staub who found that a drug originally being studied for its adrenergic antagonistic properties in guinea pigs also had potent antihistaminic activity ( 3). By 1942, safe and effective antihistamines developed for human use became available. H2 antagonists were first synthesized in 1969 for the purpose of developing a drug capable of inhibiting gastric acid secretion ( 13). These agents have a closer structural resemblance to histamine because most are simple modifications of the histamine molecule itself ( 14,15). Histamine is composed of a single imidazole heterocyclic ring linked to an ethylamine group, whereas H1 antagonists consist of one or two heterocyclic or aromatic rings joined to a linkage atom (nitrogen, oxygen, or carbon) ( 3) (Table 5. Generally, these compounds are rapidly absorbed orally or intravenously, resulting in peak serum concentrations within 2 to 3 hours and symptomatic relief within 30 minutes. They have large volumes of distribution, have slow clearance rates, and are metabolized primarily by hydroxylation in the hepatic cytochrome P-450 system. Most of the parent drug is excreted as inactive metabolites in the urine within 24 hours of dosing. The lipophilic nature of these antihistamines allows them to cross the placenta and the blood brain barrier. Pharmacokinetics of H1 receptor antagonists in healthy young adults Pharmacodynamics The first-generation H1 antagonists compete with histamine for binding to histamine receptors. This competitive inhibition is reversible and, therefore, highly dependent on free drug plasma concentrations. As these agents are metabolized and excreted into the urine as inactive metabolites, the histamine receptors become desaturated, allowing surrounding histamine to bind. This mechanism emphasizes the need to instruct patients in using these agents on a regular basis to achieve a maximal therapeutic benefit (3,22). Interestingly, smaller doses of H 1 antagonists have been found to inhibit mast cell activation in vitro, whereas larger doses cause mast cell activation and histamine release ( 23). Before the availability of pharmacokinetic data, these agents were believed to have short half-lives, which necessitated frequent dosing intervals in order to be effective ( 22). The availability of sustained-release preparations of shorter half-life agents has also allowed less frequent dosing, thereby improving patient compliance and minimizing side effects. Whether treatment with sustained-released formulations of conventional agents with shorter half-lives offers any advantages over conventional agents with longer half-lives when dosed similarly remains unclear ( 25,26 and 27). Chemical derivations of second-generation H1 receptor antagonists and dual-action antihistamines Second-generation Agents Structure Because the new nonsedating antihistamines do not fit into one of the existing structural classification categories of first-generation antagonists, they have been placed into a separate category referred to as second-generation antagonists. Their structural and pharmacokinetic profiles are responsible for their milder side effects and better tolerance among patients (3,28,29). The two available agents in the United States are fexofenadine, the acid metabolite of terfenadine, and loratadine. Terfenadine and astemizole are no longer available in the United States because of safety concerns. Both of these agents were associated with serious interactions with drugs that were also metabolized by the liver cytochrome P-450 enzyme 3A4, such as erythromycin and ketoconazole. This led to accumulation of the parent compound, which caused cardiac side effects such as torsades de pointes. Although this was a rare occurrence and dose dependent, the advent of newer antihistamine drug metabolites that were not dependent on cytochrome oxidase metabolism made them expendable. Pharmacokinetics The pharmacokinetic data available for second-generation agents are summarized in comparison to first-generation agents in Table 5. Data in humans on volumes of distribution for these agents is not available ( 3,17). The major active meta bolite of astemizole is N-desmethylastemizole, which has a half-life of 9. Astemizole is unique because it has a slower elimination half-life of 18 to 20 days, compared with terfenadine, which has a half-life of 4. Even though the half-life of terfenadine in children is only 2 hours, it is equally effective pharmacodynamically as in adults ( 41). Cetirizine and fexofenadine are not extensively metabolized in the cytochrome P-450 system and are therefore less likely to compete for elimination with other medications metabolized by the same cytochrome P-450 enzyme systems. Its elimination can be also impaired in patients with renal insufficiency ( 3,32,40). Food and Drug Administration became aware of numerous reports associating terfenadine with malignant cardiac arrhythmias such as torsades de pointes ( 42). By July 1992, 44 reports of adverse cardiovascular events had been reported, 9 resulting in death, 3 of which occurred after an overdose of terfenadine ( 42). Retrospective analysis of case reports citing terfenadine-induced cardiovascular events has been helpful in defining risk factors in patients prone to these cardiac side effects ( 42). It should be emphasized that terfenadine and astemizole were very safe and effective drugs that were able to be used in most clinical circumstances. Pharmacodynamics In contrast to first-generation agents, second-generation agents do not operate by simple competitive inhibition. Instead, these agents bind to and dissociate from H 1 receptors slowly in a noncompetitive fashion. They are not displaced from H 1 receptors in the presence of high histamine concentrations ( 29,42). However, the second-generation antagonists are potent suppressors of the wheal-and-flare responses, and this feature has been established as a useful method for comparing the clinical potencies of the different agents available ( 38,44). Their lipophobic properties prevent them from crossing the blood brain barrier; thus, their activity on H 1 receptors is restricted to the peripheral nervous system ( 30,45). Pharmacy Second-generation antihistamines are available only as oral formulations. Studies have reported that a single dose of terfenadine (120 mg) or fexofenadine (180 mg) is equally effective as 60 mg given twice a day in improving allergic rhinitis symptom scores and suppressing histamine-induced wheal-and-flare responses ( 46,47). Astemizole and loratadine should be injected on an empty stomach to avoid problems with absorption.
Large epidemics occur every few years in areas with low vaccine 98 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia coverage and where there is an accumulation of persons who have never been infected or vaccinated generic feldene 20mg with amex arthritis pain in elbow. The World Health Organization estimates that measles still causes 45 million cases and 1 million child deaths buy feldene 20mg low price arthritis in dogs today tonight, with over 50% of these in Sub-Saharan Africa generic feldene 20 mg online rheumatoid arthritis diet cure. Transmission: Airborne by droplet spread and direct with nasal or throat secretions of infected persons buy generic feldene 20mg on line arthritis in knee video. Determinants: In the absence of vaccination, every child in an area where measles virus is circulating would be expected to contract measles. Confirmed case: A suspected case with laboratory confirmation (positive IgM antibody) or epidemiological link to confirmed cases in an epidemic. Case management of uncomplicated measles Many children will experience uncomplicated measles and will require only supportive measures: Give vitamin A, first dose in the health facility or clinic; give the mother one dose to give at home the next day. Supplementary measles immunization should focus on areas not yet affected, but where the outbreak likely to be spread. Target age group: during epidemics the recommended age to be included in the supplemental immunization is 6 months to 5 years. Case management of complicated measles In developing countries, at least three-quarters of cases can be expected to have at least one complication and some may have multiple systems involvement. The 1981 epidemic affected the northern and western parts of Ethiopia but that of 1989 affected all regions of the country. The illness becomes far 106 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia less common in those over the age of 30, with 80 to 90 percent of cases occurring in those below this age. Case definitions Suspected case: - Adults A patient with abrupt onset of fever (> 38. Threshold level for epidemic An epidemic of meningitis can be declared when 15 cases are reported per 100,000 inhabitants per week. An increase in the number compared to the same time in previous years is also adequate to declare an epidemic of meningitis. General management If criteria for epidemic threshold rates are met the following actions are necessary: Intensify active surveillance for the detection of cases. Specific management Assure rapid and appropriate treatment for cases with oily chloramphenicol/ treat according to the treatment protocol. Standard treatment of meningitis in urban area: Drugs Dosage: Average Route Duration Per kg Individual Per 24 dose hrs. The required dosage should be split in to two volumes, each half to be given at separate site. If there has been no improvement, re-assess the patient, and re-evaluate the initial diagnosis. Infants: Ceftriaxone Advantages: In infants other (Haemophilus Influenza, Streptococcus Pnuemoniae) are common even during the course of outbreak. It is characterized by periods of fever lasting 2-9 days alternate with afebrile periods of 2-4 days; the number of relapses varies from 1 to 10 or more. In Ethiopia it occurs mainly in 114 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia highland areas, especially during the cold rainy season. Transmission: humans acquire infection when infected body lice are crushed and their fluids contaminate mucous membranes or breaks in the skin. Spirochetes are not transmitted directly by the bite of a louse or by inoculation of louse feces. Determinants: Epidemics are common in wars, in famine or in other situations where malnourished, overcrowded populations with poor personal hygiene, such as in prisons. Investigation Investigate the case to determine the risk factors contributing for the transmission. Specific Management Treat any individual suspected and confirmed cases with appropriate therapy in closely monitored setting. Single dose of penicillin, is usually accompanied by less frequent and less severe reaction. While single dose of Tetracycline is associated with more frequent and severe reaction, there is little treatment failure or few or no relapse. Close monitoring of fluid balance in cases of Jerish-Herxhemier reaction that may occur following antibiotics treatment. Food handlers, especially if they are intermittent carriers are particularly dangerous and have been responsible for many epidemics. Transmission: infection is acquired through ingestion of contaminated water and food by feces 118 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia and urine of patients and carriers. Flies may infect foods in which the organism multiplies to achieve an infective dose. Confirmed case: A suspected case with widal test, O titer of 1/160 and more is very suggestive. General management Report the suspected case to the next higher level of the health system. Specific management Treat the suspected cases with antibiotics based on recent susceptibility results, if available. Pediculus humanus corporis (body and head louse), which is peculiar to humans, is the only important vector of epidemic typhus. Cases of epidemic typhus now occur in significant numbers in Ethiopia and probably in highland areas of impoverished countries. Transmission: Human beings generally are infected when rickettsia laden louse feces are rubbed into the broken skin, scratching the louse bite facilities this process. Pathogenic rickettsias reside for a long period of time in patients with epidemic typhus. Case definition Suspected case: Any person with an abrupt onset of headache, chills and rapidly mounting fever, malaise, prostration and rash. Visceral leishmaniasis is 125 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia distributed throughout the low lands of Ethiopia with varying degree of endemicity. The most important foci are the Metema and Humera low lands in the north-west, the Segen valley and its surroundings in Konso (South-west) and the lower Omo plains (South-west). The north eastern part of the country along the Awash valley to the Ethio-Djiboutic border is as well potentially enedemic. The leshimaniases are parasitic diseases with a wide range of clinical symptoms: of mainly cutaneous, mucocutaneous and visceral. The leishmaniases are caused by different species of protozoan parasites belonging to the genus leishmania. Visceral leshimaniasis is characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anemia (occasionally serious). In epidemic visceral leishmaniasis, people of all ages are susceptible except those who acquired 126 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia immunity during a previous epidemic. Transmission: the disease is transmitted to humans by the bite of a tiny 2 to 3 millimeter-long insect vector, the phlebotomine sandfly. Risk factors: Movement of non-immune people into potential visceral leishmaniasis endemic; areas Malnutrition; Ecological change in favour of the sand fly vector. Case definition Suspected case: Any person with irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anemia. Investigation Investigate the case to determine risk factors contributing to transmission.
