HFMD and First Warning Letter

Morning routine.6AM

7.12AM-Luckily no patients;YET

7.20AM 

Deep laceration wound,alleged industrial injury.

Unable to stop the bleeding.Compression and adrenaline pack doesn’t helps.Gave tranexamic acid stat dose.

Lazy to use diathermy(as it will be more painful ),hence used figure of 8 suture x 3 at different locations.

Managed to secure the bleeding.

8.10AM

Okay now it feels more like an ED

Then something weird came in .Dermatology isn’t my cup of tea to be honest.

He came one week ago,seen by another doctor,given injections and medicines but no improvement.

He diagnosed it as an allergic reaction. 

The rashes was blanchable and very itchy.I felt it’s nodular prurigo.

Most of the cases were HFMD.

HFMD was causes by coxsackievirus.

Coxsackieviruses cause a variety of diseases.

There have many serotypes and unfortunately they don’t have lifelong immunity ,which means patient can get them again later .

At least 24 serotypes of coxsackievirus A and 6 serotypes of coxsackievirus B are recognized.

Group A viruses cause herpangina ,acute hemorhagic conjunctivitis and HFMD where group B viruses cause pleurodynia,myocarditis and pericarditis.

Pleurodynia (fever and severe pleuritic type chest pain)

Myocarditis and pericarditis (fever ,chest pain and sign of congestive failure)

The difference between herpangina and HFMD :

Herpangina -fever and rash or oral ulcer localized in the mouth ,no rashes over limbs but in HFMD,fever ,oral ulcer /rash can be seen in the mouth and limbs.

There is no antiviral therapy for HFMD ,treatment is limited to symptomatic relief and respiratory support if needed.

Other important thing is,we need to notify district health department if someone is diagnosed as HFMD.

While I was in government,the notification will be done by me but at private clinic,the notification will be done by staff.

Influenza doesn’t required any notification but someone went and notified influenza as avian influenza which means bird flu.

Bird flu is something serious and I have no idea why they went and notified influenza in the first place and done it under Avian Influenza.AND they did it under my name.

Hence district health department sent a first warning letter to me.

Hope it will be the first and last.