{
      "model": "book.book",
      "id": "1.1.1",
      "fields": {
        "diseaseName": "Anaphylactic Shock",
        "causes": [
          "Allergy to pollens, some medicines (e.g., penicillins, vac-cines, acetylsalicylic acid), or certain foods (e.g. eggs, fish, cow's milk, nuts, some food additives)",
          "Reaction to insect bites, e.g., wasps and bees"
        ],
        "clinicalFeatures": [
          "Body itching, hives (urticarial rash), swelling of lips, eyes, tongue",
          "Difficulty in breathing (stridor, wheezing)",
          "Hypotension and sudden collapse, excessive sweating, thin pulse",
          "Abdominal cramps, vomiting and diarrhoea."
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "1.1.2",
      "fields": {
        "diseaseName": "Hypovolaemic Shock",
        "causes": [
          "Loss of blood due to internal or external haemorrhage (e.g., post partum haemorrhage, splenic rupture etc.)",
          "Acute loss of fluids, e.g. in gastroenteritis, or extensive burns"
        ],
        "clinicalFeatures": [
          "High heart rate, fast breathing rate",
          "Thin or absent pulse, cold extremities, slow capillary refill",
          "Low blood pressure",
          "Mental agitation, confusion"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "1.1.3",
      "fields": {
        "diseaseName": "Dehydration",
        "causes": [
          "Vomiting and/or diarrhoea",
          "Decreased fluid intake",
          "Excessive loss of fluids, e.g. due to polyuria in diabetes, excessive sweating as in high fever, burns"
        ],
        "clinicalFeatures": [
          "Apathy, sunken eyes/fontanel, loss of skin turgor (especially in children)",
          "Hypotension, tachycardia, deep (acidotic) breathing, dry mu- cosae, poor or no urine output."
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "1.1.4",
      "fields": {
        "diseaseName": "Fluids and Electrolytes Imbalances",
        "causes": [],
        "clinicalFeatures": [
          "Dehydration in mild/moderate fluid (water and electrolytes) deficiency",
          "Hypovolaemic shock in severe fluid deficiency",
          "Oedema (including pulmonary oedema) in fluid excess",
          "Specific effects due to electrolytes imbalances"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "1.1.5",
      "fields": {
        "diseaseName": "Febrile Convulsions",
        "causes": [
          "Malaria",
          "Respiratory tract infections",
          "Urinary tract infections",
          "Other febrile conditions"
        ],
        "clinicalFeatures": [
          "Elevated temperature (>38°C)",
          "Convulsions usually brief and self-limiting (usually <5 min- utes, always <15 minutes) but may recur if temperature re- mains high",
          "No neurological abnormality in the period between con- vulsions",
          "Generally benign and with good prognosis"
        ],
        "investigations": [
          "Blood: Slide/RDT for malaria parasites",
          "Random blood glucose",
          "Full blood count",
          "LP and CSF examination",
          "Urinalysis, culture and sensitivity",
          "Chest X-ray"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "1.1.6",
      "fields": {
        "diseaseName": "Hypoglycaemia",
        "causes": [
          "Overdose of insulin or anti-diabetic medicines",
          "Excessive alcohol intakeSepsis, critical illnesses",
          "Hepatic disease",
          "Prematurity",
          "Starvation",
          "Operations to reduce the size of the stomach (gastrectomy)",
          "Tumours of the pancreas (insulinomas)",
          "Certain drugs e.g. quinine",
          "Hormone deficiencies (cortisol, growth hormone)"
        ],
        "clinicalFeatures": [
          "Early symptoms: hunger, dizziness, tremors, sweating, nervousness and confusion",
          "Profuse sweating, palpitations, weakness",
          "Convulsions",
          "Loss of consciousness"
        ],
        "investigations": [
          "Blood sugar (generally <3.0 mmol/L)",
          "Specific investigations: to exclude other causes of hypoglycaemia"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "1.2.1",
      "fields": {
        "diseaseName": "Bites and Stings",
        "causes": [],
        "clinicalFeatures": [
          "Depend on the cause"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "1.2.2",
      "fields": {
        "diseaseName": "Fractures",
        "causes": [
          "Trauma e.g. road traffic accident, assault, falls, sports",
          "Bone weakening by disease, e.g., cancer, TB, osteomyelitis, osteoporosis"
        ],
        "clinicalFeatures": [
          "Pain, tenderness, swelling, deformity",
          "Inability to use/move the affected part",
          "May be open (with a wound) or closed"
        ],
        "investigations": [
          "X-ray: 2 views (AP and lateral) including the joints above and below"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "1.2.3",
      "fields": {
        "diseaseName": "Burns",
        "causes": [
          "Thermal, e.g., hot fluids, flame, steam, hot solids, sun",
          "Chemical, e.g., acids, alkalis, and other caustic chemicals",
          "Electrical, e.g., domestic (low voltage) transmission linesn(high voltage), lightening",
          "Radiation, e.g., exposure to excess radiotherapy or radio-nactive materials"
        ],
        "clinicalFeatures": [
          "Pain, swelling",
          "Skin changes (hyperaemia, blisters, singed hairs)",
          "Skin loss (eschar formation, charring)",
          "Reduced ability to use the affected part",
          "Systemic effects in severe/extensive burns include shock, low urine output, generalised swelling, respiratory insuffi- ciency, deteriorated mental state",
          "Breathing difficulty, hoarse voice and cough in smoke inha- lation injury – medical emergency"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.1.1",
      "fields": {
        "diseaseName": "Anthrax",
        "causes": [
          "Exposure to B. anthracis spores by handling products from infected animals or by inhaling anthrax spores from contaminated animal products",
          "Anthrax can also be spread by eating undercooked meat from infected animals"
        ],
        "clinicalFeatures": [
          "Cutaneous:  Starts as raised itchy bump that resembles an insect bite   Within 1-2 days, it develops into a vesicle and then a painless ulcer, usually 1-3 cm in diameter, with a characteristic black necrotic (dying) area in the centre (eschar)   Lymph glands in adjacent area may swell   About 20% of untreated cutaneous anthrax results in death",
          "Inhalation:  Initial symptoms resemble a cold After several days, symptoms may progress to severe breathing problems and shock   Inhalation anthrax is usually fatal",
          "Gastro-intestinal:   Acute inflammation of the intestinal tract   Initial signs of nausea, loss of appetite, vomiting and fever   Then abdominal pain, vomiting blood, and severe diarrhoea   Intestinal anthrax results in death in 25% to 60% of the cases"
        ],
        "investigations": [
          "Isolation of Bacillus anthracis from blood, skin lesions,  or respiratory secretions- Smear-many bacilli",
          "Or measure specific antibodies in the blood of persons with suspected infection"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.2",
      "fields": {
        "diseaseName": "Brucellosis",
        "causes": [
          "Brucella abortus (cattle)",
          "Brucella canis (dog)",
          "Brucella melitensis (goats and sheep)",
          "Brucella suis (pigs)"
        ],
        "clinicalFeatures": [
          "Intermittent (fluctuating) fever",
          "Aches and pains",
          "Orchitis (inflammation of the testes)",
          "Vertebrae osteomyelitis (uncommon but characteristic)"
        ],
        "investigations": [
          "Blood: complement fixation test or agglutination test (where possible)",
          "Isolation of the infectious agent from blood, bone marrow, or other tissues by culture"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.3",
      "fields": {
        "diseaseName": "Diphtheria",
        "causes": [
          "Toxin of Corynebacterium diphtheriae"
        ],
        "clinicalFeatures": [
          "Pseudomembranous tonsillitis (grey, tough and very stickly membranes) with dysphagia, cervical adenitis, at times pro- gressing to massive swelling of the neck",
          "Airway obstruction and possible suffocation when infection extends to the nasal passages, larynx, trachea and bronchi",
          "Low grade fever",
          "Effects of the toxin: cardiac dysfunction (myocarditis with heart failure), neuropathies 1-3 months after the onset af- fecting swallowing, vision, breathing and ambulation",
          "Renal failure"
        ],
        "investigations": [
          "Culture from throat swab"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.1",
      "fields": {
        "diseaseName": "Bacterial Meningitis",
        "causes": [
          "Streptococcus pneumoniae Haemophilus influenzae type b (mainly in young children) Neisseria meningitidis Enteric bacilli"
        ],
        "clinicalFeatures": [
          "Rapid onset of fever Severe headache and neck stiffness or pain Photophobia Haemorrhagic rash (N.meningitidis infection) Convulsions, altered mental state, confusion, coma In mycobacterial and cryptococcal meningitis, the clinical presentation can be sub-acute, over a period of several days or 1-2 weeks"
        ],
        "investigations": [
          "CSF: usually cloudy if bacterial, clear if viral. Analyse for white cell count and type, protein, sugar, Indian-ink staining (for Cryptococcus), gram stain, culture and sensitivity Blood: For serological studies and full blood count Blood: for culture and sensitivity Chest X-ray and ultrasound to look for possible primary site"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.1.1",
      "fields": {
        "diseaseName": "Neonatal Meningitis",
        "causes": [
          "Organisms causing neonatal meningitis are similar to those causing neonatal septicaemia and pneumonia, i.e. S.pneumoniae, group A & B streptococci, and enteric Gram-negative bacilli. Meningitis due to group B streptococci: These organisms often colonise the vagina and rectum of pregnant women, can be transmitted to babies during labour, and cause infection."
        ],
        "clinicalFeatures": [
          "Clinical presentation is aspecific with temperature disturbances, lethargy, irritability, vomiting, feeding problems, convulsions, apnoea, bulging fontanel"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.1.1.2",
      "fields": {
        "diseaseName": "Cryptococcal Meningitis",
        "causes": [
          "Fungal meningitis caused by Crypotococcus neoformans and usually occurs in severely immunosuppressed patients (e.g. advanced HIV, usually CD4 < 100)."
        ],
        "clinicalFeatures": [
          "It commonly presents with headache, fever, malaise developing over 1 or 2 weeks, progressing into confusion, photophobia, stiff neck"
        ],
        "investigations": [
          "Diagnosis is through identification of the microorganism in the CSF with Indian Ink stain, antigen in CSF or culture"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.1.3",
      "fields": {
        "diseaseName": "TB Meningitis",
        "causes": [
          "Meningitis caused by M. tuberculosis."
        ],
        "clinicalFeatures": [
          "Onset may be gradual with fatigue, fever, vomiting, weight loss, irritability, headache, progressing to confusion, focal neurological deficits, meningeal irritation, till coma."
        ],
        "investigations": [
          "For diagnosis: check CSF (raised protein, lymphocytosis), look for possible primary TB site"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.2",
      "fields": {
        "diseaseName": "Meningococcal Meningitis",
        "causes": [],
        "clinicalFeatures": [],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.1.3",
      "fields": {
        "diseaseName": "Diphtheria",
        "causes": [
          "Corynebacterium diphtheriae"
        ],
        "clinicalFeatures": [
          "Fever, sore throat Grey membrane on tonsils and pharynx Extremely toxic: can rapidly cause respiratory obstruction, death from heart and nerve lesions"
        ],
        "investigations": [
          "Swab or tissue sample from lesion: for microscopy (gram stain) and C&S"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.4",
      "fields": {
        "diseaseName": "Leprosy/Hansens disease",
        "causes": [
          "A chronic infectious disease caused by Mycobacterium leprae/Hansens bacillus - an acid-fast bacillus. It mainly affects the skin, peripheral nerves and mucous membranes. It is transmitted from one person to another via the respiratory tract (possibly, very rarely, through broken skin)."
        ],
        "clinicalFeatures": [
          "Pale or reddish patches on the skin (The most common sign of leprosy) Loss or decrease in feeling in the skin patch Numbness or tingling of the hands or feet. Weakness of the hands, feet or eyelids Painful or tender nerves Swelling or lamps in the face or earlobes"
        ],
        "investigations": [
          "In most cases, a definite diagnosis of leprosy can be made using clinical signs alone At referral centre: stain slit skin smears for Acid Fast Bacilli (AFB) Skin biopsies NOT recommended as a routine procedure"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.5",
      "fields": {
        "diseaseName": "Meningitis",
        "causes": [
          "Most commonly bacterial: Streptococcus pneumoniae, Haemophilus influenzae type b (mainly in young children), Neisseria meningitidis, Enteric bacilli Viral (HSV, enteroviruses, HIV, VZV etc) Cryptococcus neoformans (in the immune-suppressed) Mycobacterium tuberculosis"
        ],
        "clinicalFeatures": [
          "Rapid onset of fever Severe headache and neck stiffness or pain Photophobia Haemorrhagic rash (N.meningitidis infection) Convulsions, altered mental state, confusion, coma In mycobacterial and cryptococcal meningitis, the clinical presentation can be sub-acute , over a period of several days or 1-2 weeks"
        ],
        "investigations": [
          "CSF: usually cloudy if bacterial, clear if viral. Analyse for white cell count and type, protein, sugar, Indian-ink staining (for Crypotococcus), gram stain, culture and sensitivity Blood: For serological studies and full blood count Blood: for culture and sensitivity Chest X-ray and ultrasound to look for possible primary site"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.5.1",
      "fields": {
        "diseaseName": "Neonatal Meningitis",
        "causes": [
          "Organisms causing neonatal meningitis are similar to those causing neonatal septicaemia and pneumonia, i.e. S.pneumoniae, group A & B streptococci, and enteric Gram-negative bacilli."
        ],
        "clinicalFeatures": [
          "Clinical presentation is aspecific with temperature disturbances, lethargy, irritability, vomiting, feeding problems, convulsions, apnoea, bulging fontanel"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.1.5.2",
      "fields": {
        "diseaseName": "Cryptococcal Meningitis",
        "causes": [
          "Fungal meningitis caused by Crypotococcus neoformans and usually occurs in severely immunosuppressed patients (e.g. advanced HIV, usually CD4 < 100)."
        ],
        "clinicalFeatures": [
          "It commonly presents with headache, fever, malaise developing over 1 or 2 weeks, progressing into confusion, photophobia, stiff neck"
        ],
        "investigations": [
          "Diagnosis is through identification of the microorganism in the CSF with Indian Ink stain, antigen in CSF or culture"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.5.3",
      "fields": {
        "diseaseName": "TB Meningitis",
        "causes": [
          "Meningitis caused by M. tuberculosis."
        ],
        "clinicalFeatures": [
          "Onset may be gradual with fatigue, fever, vomiting, weight loss, irritability, headache, progressing to confusion, focal neurological deficits, meningeal irritation, till coma."
        ],
        "investigations": [
          "For diagnosis: check CSF (raised protein, lymphocytosis), look for possible primary TB site"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.6",
      "fields": {
        "diseaseName": "Plague",
        "causes": [
          "Yersinia pestis (a coccobacillus) transmitted from ground rodents to man by bites from infected fleas It may also be spread from person to person by droplet infection and may occur in epidemics"
        ],
        "clinicalFeatures": [
          "Bubonic (A20.0) Involves lymph nodes (usually femoral and inguinal) Rapidly rising temperature with rigors Headache Pneumonic (A20.2) Very infectious and highly fatal: PATIENT MUST BE ISOLATED Death occurs within 2 days if not treated early Infection is localised in the lungs with fever, general malaise, headache, and frothy blood stained sputum May be complicated by respiratory and cardiac distress"
        ],
        "investigations": [
          "Bubo aspirate: for microscopy, C&S Blood and sputum: check for presence of the bacilli"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.7",
      "fields": {
        "diseaseName": "Septicaemia",
        "causes": [
          "Organisms commonly involved are Staphylococcus aureus, Klebsiella, Pseudomonas, Staphylococcus epidermidis, fungal (Candida spp), Coliforms and Salmonella spp, Pneumococci, Proteus spp"
        ],
        "clinicalFeatures": [
          "Fever, prostration (extreme tiredness) Hypotension, anaemia Toxic shock is a complication Signs and symptoms of the primary site of infection (e.g. ,pneumonia)"
        ],
        "investigations": [
          "Look for possible primary source of infection (If identified use SOP for respective sample collection coey to the lab) Blood: WBC count, culture and sensitivity (Use the aseptic technique and collect sample(s) for culture and sensitivity, to RRH (if service present) before initiation of treatment)"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.7.1",
      "fields": {
        "diseaseName": "Neonatal Septicaemia",
        "causes": [
          "Organisms causing neonatal septicemia are similar to the ones causing neonatal pneumonia and meningitis."
        ],
        "clinicalFeatures": [],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.1.8",
      "fields": {
        "diseaseName": "Tetanus",
        "causes": [
          "Exotoxin of Clostridium tetani Common sources of infection: tetanus spores enter the body through deep penetrating skin wounds, the umbilical cord of the newborn, ear infection, or wounds produced during delivery and septic abortions"
        ],
        "clinicalFeatures": [
          "Stiff jaw, difficulty in opening mouth (trismus) Generalised spasms induced by sounds and/or strong light, characterised by grimace (risus sardonicus) Arching of back (opisthotonus) with the patient remaining clearly conscious Fever Glottal spasms and difficulty in breathing Absence of a visible wound does not exclude tetanus"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.1.8.1",
      "fields": {
        "diseaseName": "Neonatal Tetanus",
        "causes": [
          "Caused by infection of the umbilicus through cutting of the cord with unsterile instruments or from putting cow dung or other unsuitable materials on the stump"
        ],
        "clinicalFeatures": [
          "Usually presents 3-14 days after birth with irritability and difficulty in feeding due to masseter ( jaw muscle) spasm, rigidity, generalised muscle spasms. The neonate behaves normally for the first few days before the symptoms appear."
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.1.9",
      "fields": {
        "diseaseName": "Typhoid Fever (Enteric Fever)",
        "causes": [
          "Salmonella typhi and S. paratyphi A & B"
        ],
        "clinicalFeatures": [
          "Gradual onset of chills and malaise, headache, anorexia, epistaxis, backache, and constipation Usually occurring 10-15 days after infection Abdominal pain and tenderness are prominent features High fever > 38°C Delirium and stupor in advanced stages Tender splenomegaly, relative bradycardia, cough Complications may include perforation of the gut with peritonitis, gastrointestinal hemorrhage"
        ],
        "investigations": [
          "Blood culture (most reliable) Stool culture Rapid antibody test (e.g. Tubex, Typhidot) – not very sensitive or specific, possibly useful in epidemics Widal's agglutination reaction is neither sensitive nor specific for typhoid diagnosis: a single positive screening does not indicate presence of infection"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.1.10",
      "fields": {
        "diseaseName": "Typhus Fever",
        "causes": [
          "Epidemic louse-borne typhus fever: caused by Rickettsia prowazeki; the common type in Uganda, which is transmitted to man (the reservoir) by lice Murine (endemic) typhus fever: caused by Rickettsia typhi (mooseri) and transmitted by rat fleas. Rats and mice are the reservoir Scrub typhus fever (mite-borne typhus): caused by R. tsutsugamushi and transmitted by rodent mites"
        ],
        "clinicalFeatures": [
          "Headaches, fever, chills, severe weakness, muscle pains Macular rash that appears on the 5th day on the rest of the body except the face, palms, and soles Jaundice, confusion, drowsiness Murine typhus has a similar picture but is less severe"
        ],
        "investigations": [
          "Blood: For Weil-Felix reaction"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.2.1",
      "fields": {
        "diseaseName": "Candidiasis",
        "causes": [
          "Candida albicans, transmitted by direct contact"
        ],
        "clinicalFeatures": [
          "Oral thrush ",
          "Intertrigo (between skin folds) ",
          "Vulvo vaginitis and abnormal vaginal discharge (vaginal candida is not a sexually transmitted disease) ",
          "Chronic paronychia (inflammation involving the proximal and lateral fingernail folds) ",
          "Gastrointestinal candidiasis may present with pain on swallowing, vomiting, diarrhoea, epigastric and retroster- nal pain"
        ],
        "investigations": [
          "Diagnosis is mainly clinical ",
          "In case of vaginitis, sample collection –a high vaginal swab (protected by a speculum), pH, KOH , wet preparation and Gram stain, C&S ",
          "Smear examination with potassium hydroxide (KOH)"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.3.1",
      "fields": {
        "diseaseName": "Avian Influenza",
        "causes": [
          "Avian (bird) influenza Type A viruses"
        ],
        "clinicalFeatures": [
          "Conjuctivitis ",
          "Flu symptoms: fever, cough, sore throat, muscle aches ",
          "Gastrointestinal (diarrhoea) and neurological symptoms ",
          "In some cases, severe acute respiratory syndrome (SARS)"
        ],
        "investigations": [
          "Blood and respiratory specimens, nose swab: lab test for influenza and rule out bacterial infection   Testing must be in a special laboratory"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.3.2",
      "fields": {
        "diseaseName": "Chicken pox",
        "causes": [
          "Varicella Zoster virus (VZV) by droplet infection"
        ],
        "clinicalFeatures": [
          "Incubation period is 14 days, but shorter in immuno- com- promised host ",
          "Mild fevers occur 10-20 days after exposure ",
          "Prodromal symptoms consisting of low fever, headache, and malaise occurring 2 to 3 days before the eruption ",
          "Eruptive phase: they appear as macules, papules, vesicles, pustules and crusts. The most characteristic lesion is a vesi- cle looking like a drop of water on the skin. Vesicles rupture easily and may become infected ",
          "The rash begins on the trunk and spreads to the face and extremities ",
          "Lesions of different stages (crops) exist together at the same time in any given body area ",
          "Complications may include septicaemia, pneumonia, ful- minating haemorrhagic varicella, and meningoencephalitis"
        ],
        "investigations": [
          "Virus isolation possible but not necessary ",
          "Diagnosis is practically clinical"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.3.3",
      "fields": {
        "diseaseName": "Measles",
        "causes": [
          "Measles virus spreads by droplet infection and direct contact"
        ],
        "clinicalFeatures": [
          "Catarrhal stage: high fever, Koplik's spots (diagnostic) run- ny nose, barking cough, conjunctivitis ",
          "Misery, anorexia, vomiting, diarrhoea ",
          "Later: generalised maculopapular skin rash followed by des- quamation after few days"
        ],
        "investigations": [
          "Clinical diagnosis is sufficient though virus isolation is possible"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.3.4",
      "fields": {
        "diseaseName": "Poliomyelitis",
        "causes": [
          "Polio virus (enterovirus) types I, II, and III"
        ],
        "clinicalFeatures": [
          "Majority of cases are asymptomatic, only 1% result in flac- cid paralysis ",
          "Non-paralytic form: minor illness of fever, malaise, head- ache, and vomiting, muscle pains, spontaneous recovery in 10 days ",
          "Paralytic form: after the aspecific symptoms, rapid onset (from morning to evening) of asymmetric flaccid paralysis, predominantly of the lower limbs, with ascending progres- sion ",
          "Paralysis of respiratory muscles is life threatening (bulbar polio) ",
          "Aseptic meningitis may occur as a complication"
        ],
        "investigations": [
          "Isolation of the virus from stool samples ",
          "Viral culture ",
          "Ensure that Giardia intestinalis, Entamoeba histolytica, Cryp- tosporidium, Cyclospora, sarcocystis, Toxoplasma gondii are included in the investigations"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.3.5",
      "fields": {
        "diseaseName": "Rabies",
        "causes": [
          "Rabies virus. Incubation is average 20-90 days but can be shorter in severe exposure (multiple bites, bites on face/ neck) of even longer (> a year) in a few cases"
        ],
        "clinicalFeatures": [
          "Itching or paraesthesiae (abnormal sensation) around site of exposure, malaise, fever ",
          "Neurologic phase   Furious form: psychomotor agitation or hydrophobia (throat spasm and panic, triggered by attempt to drink or sight/ sound/touch of water) and aerophobia (similar response to a draft of air) ",
          "Paralytic form (rarer): progressive ascending paralysis"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.3.6.1",
      "fields": {
        "diseaseName": "Ebola and Marburg",
        "causes": [
          "Ebola and Marburg viruses. Transmission to humans hap- pens through contact with meat or body fluids of an in- fected animal. The disease can then be transmitted from human to human through body fluids (including semen for months after recovery) and it is highly contagious."
        ],
        "clinicalFeatures": [
          "Early signs (non specific): sudden fever, weakness, headache, muscle pains, loss of appetite, conjunctivitis ",
          "Late signs:   Diarrhoea (watery or bloody), vomiting   Mucosal and gastrointestinal bleeding: chest pain, respiratory distress, circulatory shock ",
          "CNS dysfunction, confusion, seizures ",
          "Miscarriage in pregnancy ",
          "Elevated AST and ALT, kidney injury, electrolyte abnormalities Note: Haemorrhage is seen in less than a third of Ebola patients"
        ],
        "investigations": [
          "Send blood sample to a referral laboratory for specific test- ing (taking off blood samples from patients suspected of viral hemorrhagic fever should be done by a trained healthcare worker in appropriate PPE. ",
          "Notify district surveillance focal person"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.3.6.2",
      "fields": {
        "diseaseName": "Yellow Fever",
        "causes": [
          "Yellow fever RNA virus"
        ],
        "clinicalFeatures": [
          "First stage:   Fever, chills, headache, backache, muscle pain, prostration, nausea, vomiting, fatigue. Usually resolves within 3-4 days. ",
          "Second stage:   About 15% of cases enter into a second or toxic stage af- ter 1-2 day of remission: high fever, prostration, signs and symptoms of hepatic failure, renal failure and bleeding ( jaundice, nose bleeding, gingival bleeding, vomiting blood, blood in stool)   About half of these patients die within 7-10 days"
        ],
        "investigations": [
          "PCR in early phases ",
          "ELISA in the late stageIt is a notifiable disease."
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.3.7",
      "fields": {
        "diseaseName": "COVID-19 Disease",
        "causes": [],
        "clinicalFeatures": [
          "Early symptoms are non-specific and may include:  fever, cough, myalgia, fatigue, shortness of breath, sore throat, headache, flu-like symptoms, diarrhea, nausea, respiratory distress, features of renal failure, pericarditis, and Disseminated Intravascular Coagulation (DIC). ",
          "It is important to know that many individuals with COVID-19 are asymp- tomatic. It is therefore paramount that all health workers observe strict infection prevention and control (IPC) measures at all times."
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.4.1",
      "fields": {
        "diseaseName": "Intestinal Worms",
        "causes": [
          "Intestinal worms enter the human body through ingestion of the worm eggs in food or water via dirty hands or through injured skin when walking barefoot."
        ],
        "clinicalFeatures": [
          "Ascariasis: Ascaris lumbricoides (round worm)   Oro-faecal transmission   Usually few or no symptoms   Persistent dry irritating cough   Patient may pass out live worms through the anus, nose, or mouth   Pneumonitis- Loeffler's syndrome   Heavy infestations may cause nutritional deficiencies   Worms may also cause obstruction to bowel, bile duct, pancreatic duct, or appendix",
          "Enterobiasis: (threadworm) Enterobias vermicularis   Transmitted by faecal-oral route   Mainly affects children   Intense itching at the anal orifice",
          "Hook worm Caused by Necator americanus and Ancylostoma duodenale   Chronic parasitic infestation of the intestines   Transmitted by penetration of the skin by larvae from the soil   Dermatitis (ground itch)   Cough and inflammation of the trachea (tracheitis) common during larvae migration phase   Iron-deficiency anaemia   Reduced blood proteins in heavy infestations",
          "Strongyloidiasis Strongyloides stercoralis   Skin symptoms: Itchy eruption at the site of larval penetration   Intestinal symptoms e.g. abdominal pain, diarrhoea, and weight loss   Lung symptoms due to larvae in the lungs, e.g. cough and wheezing   Specific organ involvement, e.g. meningoencephalitis   Hyperinfection syndrome: Occurs when immunity against auto-infection fails, e.g. in immunosuppressed cases",
          "Whip worm Infests human caecum and upper colon   May be symptomless   Heavy infestation may cause bloody, mucoid stools, and diarrhoea   Complications include anaemia and prolapse of the rectum"
        ],
        "investigations": [
          "Stool examination for ova, live worms or segments",
          "Full blood count"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.4.1.1",
      "fields": {
        "diseaseName": "Taeniasis (Tapeworm)",
        "causes": [
          "Adult Tapeworms: intestinal infestation, by ingestion of undercooked meat containing cysticerci (larval form of the worm)",
          "Larvae forms (cysticercosis): by ingestion of food/water contaminated by eggs of T.solium. The eggs hatch in the intestine, the embryos invade the intestinal walls and disseminate in the brain, muscles or other organs"
        ],
        "clinicalFeatures": [
          "T. saginata, T.solium (adult tapeworm)   Usually asymptomatic, but live segments may be passed   Epigastric pain, diarrhoea, sometimes weight loss",
          "Cysticercosis   Muscular: muscle pains, weakness, fever, subcutaneous nodules   Neurocysticercosis: headache, convulsions, coma, meningoencephalitis, epilepsy   Ocular: exophthalmia, strabismus, iritis",
          "D. latum   Usually asymptomatic, but mild symptoms may occur   Megaloblastic anaemia may occur as a rare complication"
        ],
        "investigations": [
          "Laboratory: eggs, worm segments in stool or collected from perianal skin (scotch tape method)",
          "Cysticercosis: hypereosinophilia in blood and CSF"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.4.2",
      "fields": {
        "diseaseName": "Echinococcosis (Hydatid Disease)",
        "causes": [
          "Tissue infestation by larvae of Echinococcus granulosus. It is transmitted through direct contact with dogs or by ingesting water and food contaminated by dog faeces."
        ],
        "clinicalFeatures": [
          "Cough, chest pain",
          "Liver cysts may be asymptomatic but may also give abdominal pain, palpable mass and jaundice (if the bile duct is obstructed)",
          "Rupture of cysts may cause fever, urticaria, or anaphylactic reaction",
          "Pulmonary cysts can be seen on chest X-ray and may rupture to cause cough, chest pain and haemoptysis"
        ],
        "investigations": [
          "Skin test",
          "Ultrasound",
          "Chest X-ray: for pulmonary cysts",
          "Serological tests",
          "Needle aspiration under Ultrasound Sonography (US) or CT-scan guidance"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.4.3",
      "fields": {
        "diseaseName": "Dracunculiasis (Guinea Worm)",
        "causes": [
          "Dracunculus medinensis, transmitted to man by drinking water containing cyclops (waterflea or small crustacean) infected with larvae of the guinea worm"
        ],
        "clinicalFeatures": [
          "Adult worm may be felt beneath the skin",
          "Local redness, tenderness, and blister (usually on the foot) at the point where the worm comes out of the skin to discharge larvae into the water",
          "There may be fever, nausea, vomiting, diarrhoea, dyspnoea, generalised urticaria, and eosinophilia before vesicle formation",
          "Complications may include cellulitis, septicaemia, and aseptic or pyogenic arthritis; tetanus may also occur"
        ],
        "investigations": [
          "Recognition of the adult worm under the skin",
          "X-ray may show calcified worms"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.4.4",
      "fields": {
        "diseaseName": "Lymphatic Filariasis",
        "causes": [
          "Wuchereria bancrofti"
        ],
        "clinicalFeatures": [
          "Acute   Adenolymphangitis- inflammation of lymph nodes and lymphatic vessels (lower limbs, external genitalia, testis, epididymis or breast)   With or without general signs like fever, nausea, vomiting   Attacks resolve spontaneously in one week and recur regularly in patients with chronic disease",
          "Chronic   Lymphoedema (chronic hard swelling) of limbs or external genitalia, hydrocele, chronic epididymo orchitis, initially reversible but progressively chronic and severe (elephantiasis)"
        ],
        "investigations": [
          "Blood slide for Microfilaria (collect specimen between 9 pm and 3 am)"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.4.5",
      "fields": {
        "diseaseName": "Onchocerciasis (River Blindness)",
        "causes": [
          "Onchocerca volvulus, transmitted by a bite from a female black fly (Simulium damnosum, S. naevi and S. oodi, etc), which breeds in rapidly flowing and well-aerated water"
        ],
        "clinicalFeatures": [
          "Skin   Onchocercoma: painless smooth subcutaneous nodules containing adult worms, adherent to underlying tissues,usually on body prominences like iliac crests, pelvic girdle, ribs, skull   Acute papular onchodermatitis: Intense pruritic rash, oedema (due to microfilariae)   Late chronic skin lesions: dry thickened peeling skin (lizard skin), atrophy, patchy depigmentation",
          "Eye   Inflammation of the eye (of the cornea, uvea, retina) leading to visual disturbances and blindness"
        ],
        "investigations": [
          "Skin snip after sunshine to show microfilariae in fresh preparations",
          "High eosinophils at the blood slide/CBC",
          "Excision of nodules for adult worms",
          "Slit-lamp eye examination for microfilariae in the anterior chamber of eye"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.4.6",
      "fields": {
        "diseaseName": "Schistosomiasis (Bilharziasis)",
        "causes": [
          "The larvae form (cercariae) of Schistosoma penetrate the skin from contaminated water and they migrate to different parts of the body, usually the urinary tract (Schistosoma haematobium) and the gut (S. mansoni)"
        ],
        "clinicalFeatures": [
          "S. haematobium (urinary tract)   Painless blood stained urine at the end of urination - terminal haematuria   Frequent and painful micturition   In females: low abdominal pain and abnormal vaginal discharge   Late complications: fibrosis of bladder and ureters with increased UTI risks, hydronephrosis, infertility",
          "S. mansoni (gastrointestinal tract)   Abdominal pain, frequent stool with blood-stained mucus, hepatomegaly   Chronic cases: hepatic fibrosis with cirrhosis and portal hypertension, haematemesis/melena are frequent"
        ],
        "investigations": [
          "History of staying in an endemic area (exposure to water bodies)",
          "Urine examination (for S. haematobium ova)",
          "Stool examination (for S. mansoni ova)",
          "Rectal snip (for S. mansoni)"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.5.1",
      "fields": {
        "diseaseName": "Leishmaniasis",
        "causes": [
          "Flagellated protozoa Leishmania species"
        ],
        "clinicalFeatures": [
          "Visceral Leishmaniasis (Kala-azar)   Chronic disease characterized by fever, hepatosplenomegaly, lymphadenopathy, anaemia, leucopenia, progressive emaciation and weakness   Fever of gradual onset, irregular, with 2 daily peaks and alternating periods of apyrexia   The disease progresses over several months and is fatal if not treated   After recovery from Kala-azar, skin (cutaneous) leishmaniasis may develop",
          "Cutaneous and Mucosal Leishmaniasis (Oriental sore)   Starts as papule, enlarges to become an indolent ulcer   Secondary bacterial infection is common"
        ],
        "investigations": [
          "Stained smears from bone marrow, spleen, liver, lymph nodes, or blood to demonstrate Leishman Donovan bodies",
          "Culture of the above materials to isolate the parasites",
          "Serological tests, e.g. indirect fluorescent antibodies",
          "Leishmanin skin test (negative in Kala-azar)"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.5.2",
      "fields": {
        "diseaseName": "Malaria",
        "causes": [
          "There are five Plasmodium species of malaria parasites which infect humans namely: P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.",
          "P. falciparum is the most virulent and also the most common malaria parasite in Uganda."
        ],
        "clinicalFeatures": [
          "It may be asymptomatic, mild illness (uncomplicated malaria) or severe illness (severe malaria)",
          "Intermittent fever is the most characteristic symptom of malaria. Three classical stages can be distinguished in a typical attack of malaria:   The cold stage: the patient feels cold and shivers   The hot stage: the patient feels hot   The sweating stage: associated with sweating and relief of symptoms.",
          "A complete physical examination has to be performed in any patient presenting with fever or history of fever.",
          "When people are frequently exposed to malaria, they develop partial immunity. In such people, the classical stages of a malaria attack above may not be observed.",
          "Also, in people who have had partial treatment with antimalarial medicines, these classical stages may not be pronounced."
        ],
        "investigations": [
          "RDT or thick blood slide for diagnosis of malaria",
          "Random blood sugar and Hb level if clinically indicated",
          "Lumbar puncture: in case of convulsion/coma and negative malaria test"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "2.5.2.1",
      "fields": {
        "diseaseName": "Uncomplicated Malaria",
        "causes": [],
        "clinicalFeatures": [
          "Fever: above 37.5°C (taken from the axilla ) or history of fever.",
          "Loss of appetite, mild vomiting, diarrhoea",
          "Weakness, headache, joint and muscle pain",
          "Mild anaemia (mild pallor of palms and mucous membranes); occurs commonly in children.",
          "Mild dehydration",
          "Enlarged spleen (in acute malaria it may be minimally enlarged, soft and mildly tender)"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.5.2.2",
      "fields": {
        "diseaseName": "Complicated/Severe Malaria",
        "causes": [],
        "clinicalFeatures": [
          "Cerebral malaria Deep coma (unable to localise a painful stimulus), Normal CSF, parasitaemia",
          "Severe anaemia Hb <5g/dl with parasitaemia (<7 g/dl in pregnancy)",
          "Respiratory distress Tachypnoea, nasal flaring and intercostal recession in a patient with parasitaemia",
          "Hypoglycaemia Blood glucose <40 mg/dl (2.2 mmol/L) with parasitaemia",
          "Circulatory collapse Clinical shock (systolic pressure <50 mmHg for children and <80mmHg for adults, with cold peripheries, clammy skin) with parasitaemia",
          "Renal failure Urine output < 12 ml/kg in 24 hours and plasma creatinine > 3.0 mg/dl, with parasitaemia",
          "Spontaneous bleeding Parasitaemia with unexplained spontaneous bleeding (haematemesis, melaena, or prolonged bleeding from nose, gum or venipuncture site",
          "Repeated convulsions 2 or more convulsions in 24 hours, with parasitaemia",
          "Acidosis Deep (acidotic) breathing and plasma bicarbonate <15 mmol/L, with parasitaemia",
          "Haemoglobinuria Parasitaemia, haemoglobin in urine (dark coloured urine but no RBC's)",
          "Pulmonary Oedema Deep breathing, fast breathing, laboured breathing (nasal flaring, intercostal recession and chest in- drawing), Cheyne stokes breathing"
        ],
        "investigations": []
      }
    },
    {
      "model": "book.book",
      "id": "2.5.4",
      "fields": {
        "diseaseName": "Human African Trypanosomiasis (Sleeping Sickness)",
        "causes": [
          "Trypanosoma rhodesiense (mostly in the Central and Eastern regions of Uganda)",
          "Trypanosoma gambiense (mostly in West Nile region)"
        ],
        "clinicalFeatures": [
          "May be history of tsetse fly bite and swelling at site of bite after 7-14 days (more often in T. rhodesiense, rarely in T. Gambiense)",
          "T. Rhodesiense Incubation is 2-3 weeks Early stage (haemolymphatic stage): headache not responding to common analgesics, fever, generalised lymphadenopathy, joint pains Late stage (meningoencephalitis stage): after some weeks, neurological and psychiatric symptoms like apathy, day sleepiness, paralysis, seizures If not treated: cachexia, lethargy, coma and death within 3-6 months",
          "T. gambiense Similar to the rhodesiense but less acute and with slower progression Incubation can last several years"
        ],
        "investigations": [
          "Blood: Slides for trypanosomes",
          "CSF: For trypanosomes, lymphocyte count",
          "Aspirate from chancre/lymph node: for trypanosomes"
        ]
      }
    },
    {
      "model": "book.book",
      "id": "3.1",
      "fields": {
        "diseaseName": "HIV Infection and Acquired Immunodeficiency Syndrome (AIDS)",
        "causes": [
          "Human Immunodeficiency Virus"
        ],
        "clinicalFeatures": [
          "The WHO Clinical Staging of HIV for adults and children in the tables shows the typical clinical features of HIV infection."
        ],
        "investigations": [
          "CD4 It measures the level of CD4 T lymphocytes, a subtype white blood cell. It reflects the level of compromise of the immune system. It is used for initial assessment pre ART and for monitoring of ART effect.",
          "Viral Load It measures the quantity of virus in the blood. It is used to monitor the effect of ARVs. It is currently done by DBS (Dried Blood Spot)",
          "Genotype Testing HIV genotypic resistance test is a qualitative test that detects mutations associated with ARV drug resistance. The test evaluates if the HIV strain infecting the individual has developed resistance to one or more ARV drugs. This is useful in identifying a combination of ARVs to which the HIV strain is susceptible"
        ]
      }
    }
  ,

  {
    "model": "book.book",
    "id": "3.1.1",
    "fields": {
        "diseaseName": "HIV/AIDS",
        "causes": [
            "HIV is transmitted through:- Unprotected heterosexual or homosexual intercourse- Transfusion of contaminated blood or blood products- Use of contaminated needles/sharp instruments- Mother-to-child transmission during pregnancy, childbirth or breastfeeding"
        ],
        "clinicalFeatures": [
            "Early symptoms:- Fever- Enlarged lymph nodes- Sore throat- Muscle aches- Rash- Headache- Fatigue",
            "Later symptoms:- Significant weight loss- Recurrent fever- Profuse night sweats- Extreme and unexplained fatigue- Prolonged swollen lymph glands- Prolonged diarrhea- Sores of the mouth, anus or genitals- Memory loss- Neurological disorders- Severe fungal, viral and bacterial infections"
        ],
        "investigations": [
            "~ Blood: HIV serological test~ HIV DNA PCR testing of babies~ Viral load testing every 6 months"
        ]
    }
},
{
    "model": "book.book",
    "id": "3.1.2",
    "fields": {
        "diseaseName": "Mother-to-Child Transmission of HIV",
        "causes": [
            "- During pregnancy (15-20%)- During time of labour and delivery (60%-70%)- After delivery through breast feeding (15%-20%)"
        ],
        "clinicalFeatures": [],
        "investigations": [
            "~ Blood: HIV serological test~ HIV DNA PCR testing of babies~ Viral load testing every 6 months"
        ]
    }
},

{
    "model": "book.book",
    "id": "3.2.1",
    "fields": {
        "diseaseName": "Urethral Discharge Syndrome (Male)",
        "causes": [
            "Common: Neisseria gonorrhoea (causing gonorrhoea)",
            "Chlamydia trachomatis and Ureaplasma urealyticum",
            "Uncommon: Trichomonas vaginalis"
        ],
        "clinicalFeatures": [
            "Mucus or pus at the tip of the penis; staining underwear",
            "Burning pain on passing urine (dysuria), frequent urition"
        ],
        "investigations": [
            "Pus swab: Gram stain, culture and sensitivity",
            "Blood: Screen for syphilis and HIV",
            "Examine patient carefully to confirm discharge"
        ]
    }
},
{
    "model": "book.book",
    "id": "3.2.2",
    "fields": {
        "diseaseName": "Abnormal Vaginal Discharge Syndrome",
        "causes": [
            "Can be a variety and often mixture of organisms",
            "Vaginitis: by Candida albicanis, Trichomonas vaginalis or bacterial vaginosis (by Gardnerella vaginalis, Mycoplasma hominis)",
            "Cervicitis: commonly due to gonorrhoea and chlamydia: usually asymptomatic and rarely a cause of abnormal vaginal discharge."
        ],
        "clinicalFeatures": [
            "Increased quantity of discharge, abnormal colour and odour",
            "Lower abdominal pain, itching and pain at sexual intercourse may be present",
            "In Candida albicans vaginitis: very itchy thick or lumpy white discharge, red inflamed vulva",
            "Trichomonas vaginalis: itchy greenish-yellow frothy discharge with offensive smell",
            "Bacterial vaginosis: thin discharge with a fishy smell from the vagina"
        ],
        "investigations": [
            "Speculum examination",
            "Pus swab: microscopy, Gram stain, C&S", 
            "PH, KOH",
            "Blood: syphilis tests (RPR/VDRL)",
            "HIV Testing"
        ]
    }
},
{
    "model": "book.book", 
    "id": "3.2.3",
    "fields": {
        "diseaseName": "Pelvic Inflammatory Disease (PID)",
        "causes": [],
        "clinicalFeatures": [],
        "investigations": []
    }
},
{
    "model": "book.book",
    "id": "3.2.4",
    "fields": {
        "diseaseName": "Genital Ulcer Disease (GUD) Syndrome",
        "causes": [
            "Multiple organisms can cause genital sores, commonly:",
            "Treponema pallidum bacteria: syphilis",
            "Herpes simplex virus: genital herpes",
            "Haemophilus ducreyi: Chancroid",
            "Donovania granulomatis: Granuloma inguinale",
            "Chlamydia strains: lymphogranuloma venerium (LGV)"
        ],
        "clinicalFeatures": [
            "Mixed infections are common",
            "Primary syphilis: the ulcer is at first painless and may be between or on the labia or on the penis", 
            "Secondary syphilis: multiple, painless ulcers on the penis or vulva",
            "Genital Herpes: small, multiple, usually painful blisters, vesicles, or ulcers. Often recurrent",
            "Granuloma inguinale: an irregular ulcer which increases in size and may cover a large area",
            "Chancroid: multiple, large, irregular ulcers with enlarged painful suppurating lymph nodes"
        ],
        "investigations": [
            "Swab: for microscopy",
            "Blood: for VDRL/TPR"
        ]
    }
},
{
    "model": "book.book",
    "id": "3.2.5", 
    "fields": {
        "diseaseName": "Inguinal Swelling (Bubo)",
        "causes": [
            "Chlamydia strains: lymphogranuloma venerium (LGV)",
            "Heamophilus ducreyi: chancroid",
            "Treponema pallidum: syphilis"
        ],
        "clinicalFeatures": [
            "Excessively swollen inguinal glands",
            "Pain, tenderness",
            "Swellings may become fluctuant if pus forms"
        ],
        "investigations": [
            "As for Genital Ulcers",
            "C&S of pus"
        ]
    }
},
{
    "model": "book.book",
    "id": "3.2.6",
    "fields": {
        "diseaseName": "Genital Warts",
        "causes": [
            "Human papilloma virus (HPV): causes viral warts (condylmata acuminata)",
            "Treponema pallidum: causes syphilitic warts (condylomata lata)", 
            "Molluscum contagiosum virus"
        ],
        "clinicalFeatures": [
            "Penis, foreskin, labia and vagina are the most common sites of the warts",
            "Warts can be variable in number and size, either few or multiple, small to very large",
            "HPV warts: soft fleshy growth on genitals",
            "Syphilitic warts: flat-topped and broad based growth",
            "Molluscum contagiosum: light coloured, umbilicated growths on the face and genital areas"
        ],
        "investigations": []
    }
},


i want to standardise the above clinical features /symptoms to the symptoms below. substitue the above symptoms with a similar symptoms below and reprduce  a new json file

Abdominal Pain, Acute
Abdominal Pain, Chronic Recurrent
Abdominal Rigidity
Abdominal Swelling, Focal
Abdominal Swelling, Generalized
Absent or Diminished Pulse
Acid Phosphatase Elevation
Acidosis (Decreased pH)
Alkaline Phosphatase Elevation
Alkalosis (Increased pH)
Alopecia
Alterations in Serum Iron
Alteration in Serum Uric Acid
Amenorrhea
Amnesia
Anemia
Ankle Clonus
Anorexia
Anosmia or Unusual Odors
Anuria or Oliguria
Anxiety
Aphasia, Apraxia, and Agnosia
Ascites
Aspartate Aminotransferase Elevation
Ataxia
Athetosis
Axillary Mass
Babinski’s Sign
Back Pain
Bleeding Gums
Blindness
Blurred Vision
10

Bone Mass or Swelling
Borborygmi
Bradycardia
Breast Discharge
Breast Mass
Breast Pain
Cardiac Arrhythmia
Cardiac Murmurs
Cardiomegaly
Chest Deformity
Chest Pain
Chest Tenderness
Chills
Choreiform Movements
Clubbing of the Fingers
Coma
Constipation
Convulsions
Cough
Cramps, Menstrual
Cramps, Muscular
C-Reactive Protein
Crepitus
Cyanosis
Deafness
Delayed Puberty
Delirium
Delusions
Dementia
Depression
Diaphoresis
Diarrhea, Acute
Diarrhea, Chronic
Difficulty Urinating
Diplopia
Dizziness
Drop Attacks
Dwarfism
Dysarthria
Dysmenorrhea
11

Dyspareunia
Dysphagia
Dyspnea
Dysuria
Ear Discharge
Earache
Edema, Generalized
Edema, Localized
Enophthalmos
Enuresis
Epiphora
Epistaxis
Euphoria
Exophthalmos
Extremity Pain, Lower Extremity
Extremity Pain, Upper Extremity
Eye Pain
Face Pain
Facial Flushing
Facial Mass
Facial Paralysis
Facial Swelling
Facies, Abnormal
Failure to Thrive
Fatigue
Femoral Mass or Swelling
Fever, Acute
Fever, Chronic
Flank Mass
Flank Pain
Flatulence
Foot and Toe Pain
Foot Deformities
Foot Ulceration
Forehead Enlargement
Free Thyroxine (T4)
Frequency of Urination
Frigidity
Gait Disturbances
Gangrene
12

Gigantism
Girdle Pain
Glycosuria
Gynecomastia
Halitosis
Hallucinations
Head Mass or Swelling
Headache
Heartburn
Heel Pain
Hematemesis
Hematuria
Hemianopsia
Hemiparesis/Hemiplegia
Hemoptysis
Hemorrhoids
Hepatomegaly
Hiccups
Hip Pain
Hirsutism
Hoarseness
Horner’s Syndrome
Hydroxy Vitamin D2 and D3
Hyperactive Reflexes
Hypercalcemia
Hypercholesterolemia
Hyperglycemia
Hyperkalemia
Hyperkinesis
Hypernatremia
Hyperpigmentation
Hypersomnia
Hypertension
Hypertriglyceridemia
Hypoactive Reflexes
Hypoalbuminemia
Hypocalcemia
Hypochondriasis
Hypoglycemia
Hypokalemia
13

Hyponatremia
Hypotension, Chronic
Hypothermia
Hypoxemia
Impotence (Erectile Dysfunction)
Incontinence of Feces
Incontinence of Urine
Increased Serum Bilirubin
Indigestion
Infertility, Female
Infertility, Male
Inguinal Swelling
Insomnia
Intermittent Claudication
Intracranial or Cervical Bruit
Jaundice
Jaw Pain
Jaw Swelling
Joint Pain
Joint Swelling
Knee Pain
Knee Swelling
Kyphosis
Lactic Dehydrogenase Elevation
Leg Ulceration
Leucocytosis
Leucopenia
Lip Pain
Lip Swelling
Lordosis
Lymphadenopathy
Melena
Memory Loss
Menorrhagia
Mental Retardation
Meteorism
Metrorrhagia
Monoplegia
Mouth Pigmentation
Muscular Atrophy
14

Musculoskeletal Pain, Generalized
Nail Abnormalities
Nasal Discharge
Nasal Obstruction
Nausea and Vomiting
Neck Pain
Neck Stiffness
Neck Swelling
Nightmares
Nocturia
Nose, Regurgitation of Food Through
Nystagmus
Obesity, Pathologic
ODOR
Opisthotonus
Orthopnea
Pain in the Penis
Pallor
Palpitations
Papilledema
Paresthesias of the Lower Extremity
Paresthesias of the Upper Extremity
Pathologic Reflexes
Pelvic Mass
Pelvic Pain
Penile Sores
Perineum Pain
Periorbital Edema
Peristalsis, Visible
Photophobia
Plasma Cortisol
Pneumaturia
Polycythemia
Polydipsia
Polyphagia
Polyuria
Popliteal Swelling
Precocious Puberty
Precordial Thrill
Premenstrual Tension
15

Priapism
Prolonged Prothrombin Time
Proteinuria
Pruritus, Ani
Pruritus, Generalized
Pruritus, Vulvae
Ptosis
Ptyalism
Pulsatile Swelling
Pulse Irregularity
Pulses, Unequal
Pupil Abnormalities
Purpura and Abnormal Bleeding
Pyuria
Rales
Rash—Distribution
Rash—Morphology
Raynaud’s Phenomena
Rectal Bleeding
Rectal Discharge
Rectal Mass
Rectal Pain
Red Eye
Regurgitation, Esophageal
Respiration Abnormalities
Restless Leg Syndrome
Risus Sardonicus
Scalp Tenderness
Scoliosis
Scotoma
Scrotal Swelling
Sedimentation Rate
Sensory Loss
Serum Albumin
Shoulder Pain
Skin Thickening
Sleep Apnea
Sleepwalking
Sneezing
Snoring
16

Sore Throat
Spasticity
Speech Abnormalities
Splenomegaly, Acute or Subacute
Splenomegaly, Chronic
Squint
Steatorrhea
Strangury
Stress Incontinence
Stretch Marks (Striae)
Stridor
Stupor
Succussion Sounds
Syncope
Tachycardia
Taste Abnormalities
Testicular Atrophy
Testicular Pain
Testicular Swelling
Thirst
Thrombocytopenia
Thyroid Enlargement
Tinnitus
Tongue Mass or Swelling
Tongue Pain
Tongue Ulcers
Tooth and Gum Abnormalities
Transient Ischemic Attacks
Tremor
Trismus
Uremia
Urethral Discharge
Urine Color Changes
Vaginal Bleeding
Vaginal Discharge
Varicose Veins
Vitamin B12
Vulval or Vaginal Mass
Vulval or Vaginal Ulcerations
Weight Loss
17

Wheezing
Part 3 Diseases That Are Symptoms of Other Diseases
Acne Vulgaris
Asthma
Atrial Fibrillation
Carpal Tunnel Syndrome
Cataracts
Cirrhosis
Congestive Heart Failure
Neuropathy
Peptic Ulcer
Pharyngitis
Pleural Effusion
Recurrent Renal Calculi
Recurrent Urinary Tract Infection
Stroke
Upper Respiratory Infection (URI)
Appendix A
Suggested Orders for the Workup of Common Symptoms
Appendix B
The Laboratory Workup of Disease