A Simple Guide to Cytomegalovirus

A Simple Guide to Cytomegalovirus
-----------------------------------

What is Cytomegalovirus?
---------------------------

Cytomegalovirus is an acute viral disease of all ages which can be transmitted to the fetus before birth.

It affects people at all ages but seldom causes any symptoms in adults.


What are the causes of Cytomegalovirus?
----------------------------------------

Cytomegalovirus is a virus of the herpes group characterised by its ability to stay dormant in the body over a long period.

It is transmited in body fluid (urine, saliva ,blood, semen, tears and breast milk)


What are Signs and symptoms of Cytomegalovirus?
---------------------------------------------

Adult and children Cytomegalovirus infection do not normally give rise to symptoms except for mild fever and a mononucleosis-like illness.

Congenital Cytomegalovirus infections presents itself at birth:

1.Microcephaly

2.Hepatosplenomegaly with jaundice

3.Hearing impairment

4.Blindness

5.Chorioretinitis

6.Hemolytic anemia with petechiae

7.Seizures

8.Respiratory distress


How is the diagnosis of Cytomegalovirus made?
------------------------------------------

1.blood tests for igG or igM for Cytomegalovirus are positive within 3 weeks of birth

2.Usually appears normal at birth

3.Ultrasound during pregnancy to dentify any brain abnormalities .

4.Saliva , urine may be taken to test if there is presence of the Cytomegalovirus.


What are the complications of Cytomegalovirus?
-----------------------------------------------

1.Respiratory distress

2.Mental retardation

3.Hemolytic anemia

4.Blindness

5.Deafness


What is the treatment of Cytomegalovirus?
--------------------------------------------------

There is no effective treatment of Cytomegalovirus at the present moment.

A antiviral drug ganciclovir which is used to treat AIDS may help babies with Cytomegalovirus infection.

A vacine is also being developed for prevention.


What is the prognosis of Cytomegalovirus ?
------------------------------------------

Prognosis for congenital Cytomegalovirus infection is poor.

Adult Cytomegalovirus infection do not have any problem.


What are the Preventive measures taken for Cytomegalovirus ?
------------------------------------------------------------------

There is no vaccine at the present moment for Cytomegalovirus.

Transmission of Cytomegalovirus infection is always preventable because it is transmitted through body fluid from hand,nose and mouth of a suseceptible person.

People who interacts with children and pregnant mothers shuold practice good safe hygiene methods such as washing of hand and wearing of clothes when changing diapers.

Pregnant women are also advised to practice safe hygiene methods and to seek advice in the presence of a mononucleosis-like illness.

A Simple Guide to Epididymitis and Orchitis

A Simple Guide to Epididymitis and Orchitis
----------------------------------------------------

What is Epididymitis and Orchitis?
---------------------------------------

Epididymitis and orchitis is acute bacterial or viral infection of the epididymis and testis.

The epididymis is the small organ on top of the testis.


Who is affected by Epididymitis and Orchitis?
---------------------------------------------------

1.childhood, usually related to mumps infection

2.sexually active males

3.Epididymitis is more common than Orchitis


What are the Causes of Epididymitis and Orchitis?
-----------------------------------------------------

Bacterial infections:

1.Gonorrhea

2.Chlamydia

3.staphylococcus aureus

4.Streptococcus

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.mumps in childhood

2.measles


What are the complications of Epididymitis and Orchitis?
---------------------------------------------------

1.Orchitis or infection of the testis following epididymitis

2.Abscess formation of the epididymis

3.gangrene of the testis if blood flow is affected.

4.inguinal lymphadenitis


What are the Symptoms and signs of Epididymitis and Orchitis?
-----------------------------------------------------------

1.Pain in scrotum

2.ejaculation of blood

3.hematuria (blood in the urine)

4.Fever

Signs:

1.Scrotal swelling

2.Induration of scrotum wall

3.tenderness of epididymis

4.tenderness of the testis if orchitis is present


How is diagnosis of Epididymitis and Orchitis made?
-----------------------------------------------

1.pain and tenderness of the epididymis and testis

2.Mid stream urine for culture

3.Blood tests( white cell count , blood culture)

4.Ultrasound of the testis


What is the treatment of Epididymitis and Orchitis?
---------------------------------------------------

Acute Epididymitis and Orchitis

1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.

2.Fever and pain may be treated with paracetamol

3.Scrotal support

4.Ice packs for scrotum

5.Bed rest and Fluids

6.Surgical drainage if there is abscess formation.


What is the prognosis of Epididymitis and Orchitis?
-------------------------------------------------------------

Prognosis with appropriate treatment and antibiotics is generally good.

There is a risk of sterility and decreased male hormone production if treatment is inadequate.


What are Preventive measures for Epididymitis and Orchitis?
-------------------------------------------------------------------

Avoid sexual partners with multiple partners.

Use condoms during sexual intercourse.

A Simple Guide to Bronchitis

A Simple Guide to Bronchitis
-----------------------------------

What is Bronchitis?
---------------------------

Bronchitis is an acute disease which causes inflammation and infection of the trachea, bronchi and bronchioles of the lungs.

The mucous membranes of the bronchi of the lungs becomes inflamed from bacterial or viral infection or irritated by fumes and dust in the air resulting in swelling of the bronchial mucosa with excess mucous discharge causing narrowing of the air passages.

Because of the congestion of the brochi there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .

What are the causes of Bronchitis?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus Bronchitise and Staphphylococcus may be serious and fatal in some cases.

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Viral infections:
--------------------

Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus

Fungal infections:
-----------------------

Cryptococcus neoformans

Non-infectious:
------------------

1.chemicals such as fumes can damage the lungs and cause Bronchitis

2.Othostatic Bronchitis occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs

3.Aspiration Bronchitis occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.

What are Signs and symptoms of Bronchitis?
---------------------------------------------

Symptoms:

1.cold or runny nose is usually the first symptom

2.Fever may be present

3.cough initially dry, followed by productive purulent sputum which can yellow, green or bloody

4.Breathlessness due to airway obstruction

5.chest pain especially the sides of the chest due to coughing and fever

6.Myalgia (bodyaches) and headache which may be related to the fever

Signs:

1.Moist sounds and wheezing on auscultation with sthetoscope due to narrowing of the airways(bronchi)

2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs

3.Reduced breath sounds - air movement is reduced in the lungs

4.Hyporesonance on percussion of the lungs

5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.

This will considered as a medical emergency.

Children and babies with Bronchitis may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.

How is the diagnosis of Bronchitis made?
------------------------------------------

1.Symptoms and signs of fever, breathless and productive cough

2.blood tests (complete blood count, ESR and blood culture)

3.Sputum culture to determine the type of micro-organism

4.Chest X-rays to establish site and character of the bronchial infection

5.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.

What are the complications of Bronchitis?
-----------------------------------------------

1.Pneumonia

2.adult respiratory distress syndrome

3.Emphysema

What is the treatment of Bronchitis?
------------------------------------

1.Rest, fluids and oxygen

2.Bronchidilators such as aminophylline, ventolin, bricanyl

3.Antibiotics depending on the organism found:

a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

c.Tetracycline or erythromycin for mycoplasma and chlamydia

d.Erythromycin and rifampicin for Legionaire's disease.

3.Antivirals such as Tamiflu for Influeza infection
Acyclovir may be given for herpes virus infection

4.High dosages of antifungals may be given for Fungal Bronchitis for a prolonged period of time

5.corticosteroids is useful to reduce complications

6.Humidifiers and steam inhalations

5.cough mixtures and mucolytic agents such as bisolvon

What is the prognosis of Bronchitis ?
------------------------------------------

This depends on the severity and type of infection.

Most cases if treated early and correctly recovered completely with return of normal lung function.

In elderly and debilitated patients, breathing can be a problem and recurrence can occur.


What are the Preventive measures taken for Bronchitis ?
--------------------------------------------------------

1.Avoid smoking and dusty environment.

2.Healthy lifestyle with balanced diet and exercise.

3.Vaccination against the influenza virus may help.

A Simple Guide to Otitis media

A Simple Guide to Otitis media
----------------------------------------------------

What is Otitis media?
---------------------------------------

Otitis media is acute or chronic inflammation of the middle ear.

Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube.

Who is affected by Otitis media?
---------------------------------------------------

1.childhood, usually related to viral upper respiratory tract infection

2.family history of middle ear disease.

What are the Causes of Otitis media?
-----------------------------------------------------

Bacterial infections:

1.Streptococcus pneumoniae

2.Haemophilus influenzae

3.staphylococcus aureus

4.Moraxella catarrhalis, a gram-negative diplococcus.

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.common cold.

2.measles

What is the Types of Otitis Media?
-----------------------------------------------------

1. Acute otitis media

Acute otitis media ia an acute infection of the middle ear which usually occurs as a result of viral upper respiratory tract infection that can occur at least twice a year

2.Chronic otitis media

Chronic otitis media occurs following acute otitis media with chronic infection of the middle ear and ear perforation.

3.Otitis media with effusion:

Otitis media with effusion occurs when fluid occurs in the middle ear due to blockage of the eustachian tube.

What are the complications of Otitis media?
---------------------------------------------------

1.mastoiditis

2.labrynthitis

3.facial nerve palsy

4.meningitis,

5.brain abscess,

6.febrile seizures.

7.death if a severe infection goes untreated long enough


What are the Symptoms and signs of Otitis media?
-----------------------------------------------------------

1. cold: stuffy nose

2. earache - The pain lasts a day or two.

3. high fever - may cause seizures if very high

4. discharging pus from the ruptured eardrum
Usually the ruptured drum will usually heal spontaneously

5.Eustachian tube becomes blocked resulting in hearing loss

Signs:

1.Ear drum (tympanic membrane) inflamed and bulging with loss of normal outline

2.Decreased or displaced light reflex of ear drum

3.perforation of ear drum

4.mucopurulent discharge from ear after perforation

How is diagnosis of Otitis media made?
-----------------------------------------------

1.Inflamed ear drum with loss of normal outline, decreased light reflex, bulging and perforation and purulent discharge.

2.Culture and sensitivity of pus swab

3.Nasal and pharyngeal swabs my also be done

4.X-rays or MRI of the mastoid air cells

5.Audiogram for hearing loss

What is the treatment of Otitis media?
---------------------------------------------------

Acute otitis media

1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.

2.Fever and pain may be treated with paracetamol

3.Antihistamines may be given for rhinitis or runny nose.

4.Decogestants may be necessary for blockage of eustachian tube

5.Bed rest and Fluids

6.Myringoplasty -Puncture of bulging ear drum if painful and aspiration of pus or fluid in the middle ear.

7.Tympanoplasty for eardrum whose perforation does not heal.

8.Mastoidectomy to remove cholesteatoma(growing of skin into middle ear cavity) in chronic otitis media with mastoiditis.


What is the prognosis of Otitis media?
-----------------------------------------

Prognosis with appropriate treatment is generally good.

Ear drum perforation usually heal spontaneously in most cases.

What are Preventive measures for Otitis media?
----------------------------------------------------

Avoid swimming and diving.

Proper ear hygiene.

A Simple Guide to Infectious Mononucleosis

A Simple Guide to Infectious Mononucleosis
-------------------------------------------------

What is Infectious Mononucleosis?
-------------------------------------------

Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.

What is the cause of Infectious Mononucleosis?
-------------------------------------------------------

The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.

It is more common in young adults.

The incubation period (from contact to illness) is 10-15 days.

It is usually sporadic but may be epidemic.


What are Signs and symptoms of Infectious Mononucleosis?
------------------------------------------------------------------

The triad of symptoms which are common to Infectious Mononucleosis are:

1.Neck and axillary lymph nodes are enlarged

2.Fever with headache

3.sore throat with sometimes extensive tonsillar exudates and swelling

Other symptoms are:

4.fatigue

5.bodyaches

6.jaundice(rare)

Signs:

1.Throat is red and inflamed with enlarged tonsils

2.Pinpoint petechiae at junction of hard and soft palate

3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region

4.Swelling of lacrimal glands and eyelids

5.Spleen is enlarged in 50% of cases

6.Generalized maculopapular rash may occur

Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.

Disease usually lasts for 2-3 weeks.

How is the diagnosis of Infectious Mononucleosis made?
---------------------------------------------------------------

1.Classical symptoms and signs as above especially lymph nodes enlargement.

2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.

3.Blood for Epstein Barr antibody

3.X-rays of chest and abdomen

4.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.

What are the complications of Infectious Mononucleosis?
---------------------------------------------------------------

1.Obstruction to airway from enlarged lymph nodes

2.thrombopenic purpura

3.myocarditis

4.pericarditis

5.lymphocytic meningitis

6.encephalitis

7.polyneuritis

8.hepatitis

What is the treatment of Infectious Mononucleosis?
------------------------------------------------------------

1.Bed rest in isolation ward

2.Adequate fluids

3.Antipyretic medicines such as paracetamol for fever

3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis

4.High-flow oxygen and tracheostomy in airway obstruction

What is the prognosis of Infectious Mononucleosis?
-----------------------------------------------------------

Prognosis of Infectious Mononucleosis is generally good.

Epstein Barr infections has been associated with nasopharyngeal cancer.

What are the Preventive measures taken for Infectious Mononucleosis?
------------------------------------------------------------------------

Isolation of cases at home or in hospital.

Avoid contacts.

A Simple Guide to Pneumonia

A Simple Guide to Pneumonia
-----------------------------------

What is Pneumonia?
---------------------------

Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.

The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.

Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .

It is one of the top causes of death in the world.


What are the causes of Pneumonia?
----------------------------------------

Bacterial Infections:
----------------------------

1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.

Viral infections:
--------------------

Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus

Fungal infections:
-----------------------

Cryptococcus neoformans

Non-infectious:
------------------

1.chemicals such as asbestos can damage the lungs and cause pneumonia

2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs

3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.

This occurs in comatose patients and people having seizures or stroke.

What are Signs and symptoms of pneumonia?
---------------------------------------------

Symptoms:

1.cold or runny nose is usually the first symptom

2.Fever is usually high

3.cough with productive purulent sputum which can yellow, green or bloody

4.Breathlessness due to congestion of the lungs

5.chest pain especially the sides of the chest due to coughing and fever

6.Myalgia (bodyaches) and headache which may be related to the fever

7.abdominal discomfort

8.lethargy especially in small children

Signs:

1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs

2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs

3.Reduced breath sounds - air movement is reduced in the lungs

4.Hyporesonance on percussion of the lungs

5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.

This will considered as a medical emergency.

Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness

How is the diagnosis of Pneumonia made?
------------------------------------------

1.Symptoms and signs of fever, breathless and productive cough

2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease

3.Sputum culture to determine the type of micro-organism

4.Chest X-rays to establish site and character of the lung infection

5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.

6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.

What are the complications of Pneumonia?
-----------------------------------------------

1.Pleural effusion

2.septic shock,

3.adult respiratory distress syndrome

4.seizures also more in children

5.Emphysema

6.Pericarditis

What is the treatment of pneumonia?
------------------------------------

1.Hospitalization should be immediate as pneumonia can be a life threatening condition.

2.Antibiotics depending on the organism found:

a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

c.Tetracycline or erythromycin for mycoplasma and chlamydia

d.Erythromycin and rifampicin for Legionaire's disease.

3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection

4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time

3.corticosteroids is useful to reduce complications

4.High-flow oxygen

5.intravenous fluids

What is the prognosis of pneumonia ?
------------------------------------------

This depends on the severity and type of infection.

Most cases if treated early and correctly recovered completely.

The elderly, babies and bedridden has a higher mortality.

What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------

Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.

Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.

Vaccinations are recommended in:

Adults age 65 or older

Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys

2. health problems like diabetes, alcoholism, AIDS

3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy

A Simple Guide to Chikungunya Fever

A Simple Guide to Chikungunya Fever
--------------------------------------

What is Chikungunya Fever?
-------------------------------

Chikungunya fever is an acute illness caused by the chikungunya virus transmitted to humans by the bite of an infected Aedes mosquito.

How is the Chikungunya Fever transmitted?
-----------------------------------------

Chikungunya virus is transmitted to humans by the bite of infected Aedes mosquito.

Monkeys and other wild animals may be possible source of the virus.

Infected mosquitoes will spread the virus to other humans when they bite their skin.

The condition was first detected in Eastern Africa in the 1950 and recently has also outbreaks in India, Africa, Indonesia and Malaysia.

What are the Symptoms of chikungunya fever?
-----------------------------------------------

The incubation period in mosquito is 3-5 days and 1-12 days in humans.

Symptoms usually last 3-10 days.

Symptoms may be the same as denque fever:

1.fever of sudden onset

2.severe and prolonged joint pains with or without swelling

3.muscle pain

4.headache

5.chills

6.rash -no petechiae, more of a maculopaular rash

7.fatigue

8.nausea

9.vomiting.

The most severe symptom is the severe and prolonged joint pains which can even last up to 1 month.

Unlike dengue fever,there has been no documented cases of hemorrhagic (bleeding) or shock syndrome reported in chikungunya infection.

The chikungunya virus also does not affect the nervous system.

How do you diagnose chikungunya fever?
---------------------------------------

Diagnosis is made on the basis of :

1.high fever

2.severe and prolonged joint pain

3.blood tests for chikungunya fever

What is the treatment for chikungunya fever?
-------------------------------------------------

There is at present no specific medication or vaccine to treat chikungunya fever.

TREATMENT IS THEREFORE SYMPTOMATIC:

1.rest,

2.plenty of fluids and

3.pain medication such as paracetamol may relieve symptoms of joint pain, body aches and fever.
Aspirin and NSAIDs should be avoided if possible.

What is the prognosis of chikungunya fever?
--------------------------------------------

The illness is usually self-limiting.

Most symptoms lasts for 3-10 days and the joint pain may last for weeks to months.

Rarely does it cause death(through high fever and dehydration).

How can you prevent being infected with the chikungunya virus?
---------------------------------------------------------------------

The best way to prevent chikungunya infection is to avoid bites from the Aedes Mosquito.

Preventive measures are the same as dengue fever such as getting rid of mosquito breeding places.

A Simple Guide to Dengue Fever

A Simple Guide to Dengue Fever
--------------------------------

What is dengue fever?
------------------------

Dengue fever is a acute viral infection caused by the dengue virus which is transmitted by the bite of an infected female Aedes msoquito.

What are the Types of Dengue Fever?
----------------------------------------------------

The dengue virus has 4 strains called serotypes 1, 2, 3 and 4.

An infection with one serotype does not protect you from the other serotypes.

A second dengue infection, especially with serotype 2, can cause an even worse infection such as Dengue Haemorrhagic Fever and Dengue Shock Syndrome which can be fatal.

What are the Symptoms of Dengue Fever?
----------------------------------------

The incubation period in mosquito is 8-12 days and 3-14 days in humans.

Symptoms usually last 3-14 days.

1.High, acute, prolonged fever (usually lasts for 5 to 7 days)

2.Severe headache

3.Pain behind the eyes

4.Muscle and joint pains

5.Rashes

6.Nausea , vomiting

7.Abdominal discomfort

8.Loss of appetite

9.Fatigue

10.Diarrhoea

A rash usually appears 3-4 days after the fever.

There are 3 types of dengue rash.

1.Petechial Rash:
----------------

This is the most common with the petechial rash appearing as red dots under the skin.
The rashes are usually found on the limbs and lower abdomen and is due to the bleeding under the skin.

2.Diffuse erythematous rash with areas of normal skin:
----------------------------------------------------

The whole skin becomes reddish with scattered, small areas of normal skin .

3.Maculopapular rash:
--------------------

The last type of rash appears as red flat or raised leisons(Maculopaular).
The rash can be itchy .

What are the Complications of Dengue Fever?
------------------------------------------

The complications of Dengue Fever are:

1.Dengue Hemorrhagic Fever
---------------------------------------------

a. Fever

b.bleeding likely to occur from the nose, mouth, and gums.
Bruises and ecchymosis may appear as a sign of bleeding under the skin.
There are small red spots on the skin.

c.the urine may contain blood.

d.vomiting of blood and malena(black stools) indicate bleeding in the stomach.

e.low plalelet count of <100,000

f.Hypoalbuminaemia

g.pleural effusion

h.neurological disturbances(seizures,cranial nerve signs and coma) may indicate bleeding in the brain

2. Dengue Shock Syndrome
-----------------------------

Without prompt treatment for the bleeding, the person can go into

a.shock

b.hypotension

c.narrowed pulse pressure(< 2omm Hg)

d.impaired organ perfusion which result in organ failure and death.

Dengue Haemorrhagic Fever and Dengue Shock Syndrome is fatal in about 5 percent of the cases, mostly among children and young adults.

How do you diagnose Dengue Fever?
---------------------------------

1.History of acute fever and bleeding signs

2.A low platelet count (<100,000)is suggestive of dengue fever.

3.Specific blood test(IgG and IgM antibody) for dengue virus can also be conducted. IgM antibodies occur on the 5th day of illness and last for 2 months.

What is the treatment of dengue fever?
-----------------------------------------

There is no specific anti-viral drug to treat the disease or a vaccine to prevent a person from being infected with the dengue virus.

Treatment is mainly supportive.

1. Rest

2.drinking lots of water to prevent dehydration will help.

3.Paracetamol for fever, severe headaches and body aches( Avoid aspirin and NSAIDs due to the risk of bleeding) to reduce the discomfort.

4. Intravenous fluids for hypotension and dehydration.

5.Daily blood tests (platelets and hematocrit)may be necessary to monitor the risk of bleeding

6. Platelets transfusion when the the platelet count is less than 20,000.


The illness can last up to 10 days, but complete recovery can take as long as a month.

How is dengue fever spread?
-----------------------------

Dengue Fever is spread only through the bite of the infected Aedes mosquitoes.

The transmission cycle for dengue starts when:

1.Infected Aedes mosquito bites a healthy person.

2.4-7 days later,the infected person develops fever

3..When fever starts, the person is infectious for about 5 days.

4.If an Aedes mosquito bites the person during this time when he is infectious, it will be infected by the the dengue virus.

5.The virus will multiply in the second mosquito for 5-7 days.

6.The mosquito then becomes infective.

7.The cycle starts again when it bites another person.


How can you prevent being infected with the dengue virus?
----------------------------------------------------------

To prevent dengue fever, you must prevent the breeding of its carrier, the Aedes mosquitoes.

This will be explained another time

A Simple Guide to Appendicitis

A Simple Guide to Appendicitis
-------------------------------------

What is Appendicitis?
--------------------------

Appendicitis is an infection of the vermiform appendix, a small elongated appendage at the base of the caecum.

What are the causes of Appendicitis?
-------------------------------------------

Appendicitis may occur after:

1.obstruction of the lumen of the appendix by fecalith(small hard faeces), foreign body(eg. seeds), kinking

2.inflammatory oedema of the mucosa

3.infection of the intestine(eg. E. coli) spreading to the appendix

What are the symptoms and signs of Appendicitis?
-------------------------------------------------------------

Symptoms:

1.Pain occurs in the navel region, then moves down to right lower quadrant(McBurney's point-one third from right pelvic protrusion and two thirds from the navel)

2.nausea and vomiting

3.mild fever

4.often a history of constipation, rarely diarrhea

5. loss of appetite

Signs:

1.tenderness,guarding and rebound pain at McBurney's point

2.Positive Psoas and obturator sign in some cases

3.leucocytosis - mainly polymorphs

4.Palpable mass felt at McBurney's point may indicate presence of appendicular
abscess

5.rectal examination may show a palpable tender swelling at the right iliac fossa

What are the complications of Appendicitis?
-------------------------------------------

1.Perforation of the untreated inflammed appendix causes pus to spill into the abdominal cavity

2.Peritonitis(inflammation of the the whole of the internal abdomen) may occur as a result of a ruptured inflammed appendix

3.Septicemia may result from the bacteria entering the blood.

Death may occur in untreated peritonitis and septicemia.

What is the treatment of Appendicitis?
---------------------------------------

All confirmed appenicitis should be treated by surgical removal of the inflammed appendix.

Following surgery, antibiotics are given either intravenously or orally.

What is the prognosis of Appendicitis?
----------------------------------------------

1.Excellent with appropriate surgical intervention

2.Abscesses which developed and are surgical drained and treated with antibiotics recovered rapidly.

3.Peritonitis and septicemia treated early by surgery and antibiotics usually recovered.

Finally there is no such condition such as chronic Appendicitis.
All Appendicitis cases are acute.

A Simple guide to Diphtheria

A Simple guide to Diphtheria
------------------------------------

What is Diphtheria?
-----------------------

Diphtheria is an acute, infectious childhood disease of the respiratory tract caused by the bacillus Corynebacterium diphtheriae, a Gram positive, non-sporulating aerobic micro-organism.

How is Diphtheria transmitted?
--------------------------------------

Diphtheria is transmitted by droplets from the throat of infected patients or clothes soiled by discharges from the patients.
It is highly infectious.
Incubation period is 2-4 days.

The organism multiplies in the upper respiratory tract, secreting toxins which produce necrosis and fibrinous exudate.
This fibrinous exudate can form a leathery membrane which extends through the throat, tonsils, nasopharynx, larynx and trachea.
Through the blood, the toxin can spreadto the heart, nervous system and kidneys. Infections may also be localised in wounds in the skin,conjunctiva and rarely the vagina.
The infections occur in persons of all ages.

What are the Signs and Symptoms of Diphtheria?
----------------------------------------------------------

The incubation peroid is usually 2-4 days after contact with an infected patient.

Symptoms start off with:
1. sudden onset of malaise

2. mild fever

3. sore throat

4. Thick white or grayish tonsillar exudate

5. Membrane may spread to nasopharynx

5. cervical lymphadenopathy

6. difficult breathing

7. respiratory stridor,

8. hoarseness of voice

9. brassy cough

10.dilirium and coma

What are the complications of Diphtheria?
---------------------------------------------------

The worst affected are children below the 1 year old.

Some serious complications are:
1.myocarditis

2.cranial nerve paralysis, especially the soft palate and oculomotor nerves

3.peripheral neuritis

4.laryngeal obstruction

5.death can occur if there is obstruction to breathing.

Serious complications are less with older children or adults.

Adults rarely get Diphtheria because their immunity from vaccination usually last 10 years after the last dose.
When adults get Diphtheria, there is only slight inflammation with little or no exudates.

What are the investigations necessary to diagnose Diphtheria?
--------------------------------------------------------------------------

Pharyngeal and nasal swabs for culture in Loeffler medium
Methylene blue stain of membrane

What is the Treatment of Diphtheria?
--------------------------------------------

Isolation in hospital is necessary.

1.Antibiotics (erythromycin or Penicillin) are used in the treatment of Diphtheria.

2.Antitoxin can be given by intramuscular or intravenous injection

3.Intravenous fluids given for dehydration

4.Tracheostomy if breathing obstruction is bad

5.Oxygen therapy in cases of breathing difficulty

6.Cardiac failure should be treated


Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change

What is the Prevention for Diphtheria?
-------------------------------------------------

Vaccination against Diphtheria is the best prevention .
Since vaccination began, the worldwide incidence of Diphtheria has declined.

Vaccination against diphtheria, pertussis (whooping cough), tetanus (DPT) is usually given to a baby at 3 months of age and repeated at 4 and 5 months of age.

There is also a booster vaccination at 18 months.

What is the prognosis in Diphtheria?
-------------------------------------------

Death occurs in 10% of cases.

Mortality is highest in children under 10 and adults over 50.

One attack usually confers immunity.

A Simple Guide to Measles

A Simple Guide to Measles
--------------------------------

What is Measles?
---------------------

Measles is usually a contagious childhood infection caused by the measles virus, one of the paromyxovirus.
It is characterised by typical prodromal symptoms, generalised rash and Koplik's spots in the mouth.

Who is at risk for Measles?
--------------------------------

Any one at any age can contract measles but it usually occurs in childhood.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.


What are the Symptoms of Measles?
-------------------------------------------

There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever

2.coughing,

3.runny nose, stuffy nose,

4.tiredness,

5.red eyes, tearing. ,

6.Koplik's spots (white spots with a red background , located on the inside of the cheeks near the back molars start to appear 2-4 days after the fever.

7.measles rash usually occurs after the appearance of the Koplik's spots.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, and soles. Once it reaches the soles, the rash begins to fade in about four days , first the head and neck, then trunk and limbs. There may be a brownish discoloration in areas of affected skin rashes but this is only temporary.

8. enlarged lymph glands may be felt in the neck and groins

9.inflammation of the eyes (conjunctivitis) with tearing may also occurs.

10. diarrhoea and vomiting may occurs in some patients.

Adults tend to suffer more severe symptoms than children do.

People who have had measles develop a natural immunity and cannot contract it again.

What are the Complications of Measles?
------------------------------------------------

1.Ear infection (Otitis Media) is a common complication of measles.

2.pneumonia in very young children and older patients may be dangerous.

3.encephalitis (brain infection)may ocur in 1 out of 600 patients putting them at risk of suffering seizures, coma or dying.

4.the digestive organs (including the liver),the heart muscle or the kidneys may be damaged in rare cases

A pregnant woman who develops a measles infection has
1.an increased risk of premature labour,

2.miscarriage

3.delivery of a low birth weight baby.

What is the Treatment for Measles?
------------------------------------------

There is no cure for measles.
Treatment is therefore symptomatic.
Fever symptoms are treated with Paracetamol.
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain

Itch may be controlled by antihistamines which can also help to relieve the runny nose.

Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia.

Cough mixtures may be given to relieve the cough.

Plenty of bed rest is necessary.

Lots of fluids helps to prevent dehydration.

A cool-mist humidifier to soothe respiratory passages may help.

Most patients recover completely from measles.

Death is extremely rare (one out of every 1000 cases), usually from pneumonia or encephalitis.

How do You prevent Measles?
-------------------------------------

Measles can be prevented with the measles vaccine, which is usually given to children at the age of 15 months as part of the MMR (measles, mumps and rubella) combination.

A second MMR vaccine is now given at the age of 12 years.

A Simple Guide to Hepatitis A

A Simple Guide to Hepatitis A
-----------------------------------

What is Hepatitis A?
-------------------------

Hepatitis A is a acute inflammatory infection of the liver which is caused by the hepatitis A virus(HAV).

How is Hepatitis A virus spread?
--------------------------------------

The virus is excreted in faeces and transmitted through contaminated food and water. Eating shellfish, cockle shells, prawns or crabs taken from sewage-contaminated water is a common means of contracting hepatitis A.
It can also be acquired by close contact with individuals infected with the virus.
HAV causes the liver to become enlarged, inflamed and tender resulting in all the symptoms of hepatitis.
There is no chronic (long-term) infection.

What are the Symptoms of Hepatitis A?
----------------------------------------------

A person is infectious for 2-3 weeks before he or she experiences symptoms:
1.fever and joint pains

2.jaundice

3.fatigue

4.loss of appetite

5.nausea and vomiting

6.abdominal pain

7.pale coloured stools and dark urine

8.itchy skin due to irritation by the bilirubin.

During the first week of the illness he feels very sick and weak.
As the condition improves, the patient generally feels better after the first week but may requires to rest at home for 6 weeks to avoid damage to the liver.

How is the diagnosis of Hepatitis A made?
-------------------------------------------------

A blood test is the best way to diagnose hepatitis A.
His hepatitis antigens are raised at the early stage but as his condition improves the antibodies become positive.

His liver function tests are also done to assess the damage to the liver.
Usually the serum bilirubin is high, liver enzymes or tramsaminase, alkaline phosphatase are raised in the acute stage of illness.
As the condition improves, these tests gradually returned to normal.

What is the Treatment of Hepatitis A?
---------------------------------------------

There are no medicines for treatment of Hepatitis A except for symptomatic treatment of symptoms.
1.Rest in bed

2.multivitamins especially vitamin B to improve the function of the liver

3.Lots of fluids

4.carbohydrate diet

5.Anti-itch creams and lotions to stop itch

Recovery is usual with very rare cases going on to cirrhosis of the liver.

What is the Prevention of Hepatitis A?
---------------------------------------------

Hepatitis A vaccination is the best protection.
It is usually given in 2 doses within 1 year.

Immune globulin can be given for short-term protection.
It is given before and within 2 weeks after coming in contact with hepatitis A virus.

The vaccine is recommended for travellers travelling to developing countries and people with chronic liver disease.

Always practice good food hygiene.
Avoid food like seafood which may be contaminated by unhygienic water.

Always wash your hands with soap and water after using the toilet, before preparing and eating food.

Recovery is usual within 6 weeks.

What is the difference between Hepatitis A and Hepatitis B?
----------------------------------------------------------------------

Hepatitis A is spread through eating food contaminated with the HAV virus.
Examples include partially cooked shellfish (oysters, clams) or in situations where there is poor hygiene (food/drink/utensils contaminated with an infected person's faeces).
Most people suffer an acute episode and upon recovery have immunity to Hepatitis A.

Hepatitis B is spread by contact with blood or body/fluids of an infected person (including a carrier) or from a carrier mother to her newborn during childbirth.
Hepatitis B infection can lead to hepatitis carrier stage or chronic hepatitis which can results in liver cirrhosis or cancer.

A Simple Guide to Hand, Foot & Mouth Disease

A Simple Guide to Hand, Foot and Mouth Disease
----------------------------------------------------------

What is Hand, Foot and Mouth Disease?
-----------------------------------------------

Hand, Foot and Mouth Disease (HFMD) is an infectious disease usually occurring in children which causes ulcers in the mouth and maculopapular rashes(sometimes blisters) on the palms of the hands and soles of the feet.
Because of the locations of the lesions, the illness is thus called Hand, Foot and Mouth Disease.

What causes Hand, Foot and Mouth Disease?
--------------------------------------------------

Hand, Foot and Mouth Disease is caused by the Coxsackie virus and Enterovirus 71.
Of the 2 viruses the enterovirus is more dangerous with some fatalities in severe cases.
Fatalities are usually due to complications involving the heart and nervous system.
It is usually a mild illness with the rash healing in 5 to 7 days.

How is Hand, Foot and Mouth Disease spread?
----------------------------------------------------

HFMD is usually spread through the direct contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person.

Both adults and children can be affected.

Young children below five years are more prone to the infection.

What are the Symptoms of Hand, Foot and Mouth Disease?
------------------------------------------------------------------

The symptoms usually start after a prodromal peroid of 3 days with:

1.fever

2.sore throat

3.ulcers in the throat, mouth and tongue

4.rash with vesicles (small blisters-- 3-7 mm) on hands, feet and buttock area.
The rash are typically on the palm side of the hands, the sole side of the feet and very characteristic (maculopapular then vesicle) in appearance.

5.loss of appetite

6.headache and bodyaches in the older child or adult

What is the Treatment of Hand, Foot and Mouth Disease?
-------------------------------------------------------------------

There is no specific cure for an viral infection other than symptomatic relief of symptoms.

Antibiotics is not effective and is not indicated.
Paracetamol can given to treat fever.

Drinking lots of water and fluids is important even though sometimes swallowing may be painful.
More fluid is required when a fever is present.

Rinsing of mouth with salt water may soothe the pain of mouth ulcers.

A soft or liquid diet should be given rather than solid food.

Avoid sour fruits or their juices which can cause pain to the mouth ulcers.

Rest and adequate sleep is also important in the child's recovery.

Parents should also be alert to any change in their child's normal behaviour, e.g. irritation and sleepiness.
Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to hospital.

What is the Prevention for Hand, Foot and Mouth Disease?
--------------------------------------------------------------------

All infected children should be kept away from crowded public places (such as schools, preschools, play groups, markets and public transport).

All family members should follow good hygiene practices, including frequent hand washing, to limit the spread of the infection.

A Single Attack usually gives lifelong Immunity!

A Simple Guide to Fever

A Simple Guide to Fever
-----------------------------

What is Fever?
-----------------

A person's normal body temperature is 37.0 degrees Celsius.
Once above this, it is classified as a fever.
Fever is a symptom not an illness.

What is the cause of Fever?
---------------------------------

A Person's body temperature can be influenced by factors such as
1. infection,

2. metabolic rate and

3.environmental temperature.

When any infection entered the body and localised in a part of the body such as the throat ,intestine, nose, urinary tract etc, it does not cause any fever, only symptoms such as sore throat, diarrhoea, nasal discharge or frequent passing of urine.

However once the germ(whether bacteria,virus or parasite) enter the blood stream from the infected area, the body responses immediately by raising the body temperature.
The raising of the body temperature is the body's way of trying to kill the germ by heating the environment which the germ is trying to survive.

High fevers (above 39 degrees Celsius) however can also damage the body especially the brain.
It can cause seizures in children below the age of five (febrile fits).

Toxins from bacteria and viruses released into the bloodstream can cause chills and shivering in between or sometimes during temperature spikes.

What are the Symptoms of Fever?
----------------------------------------

1. Headache

2. Bodyaches

3. Chills

4. Shivering

5. Giddiness

6. Loss of appetite

What is the Treatment of Fever?
--------------------------------------

Fever is the body's natural response to a infection, increase in the temperature of the environment and increased metabolic rate.

If the fever is mild (<37.5)and no other problems are present, no medical treatment is necessary.
Just drink more water and rest.

Sponging or bathing in a tub of tepid water can help to reduce the fever. Evaporation of the water cools the skin and thereby reduces body temperature.

Give the person a correct amount of paracetamol which helps to bring down the temperature.

You should see a doctor:
1.If a child of less than 6 months old has a fever.

2.If a fever of more than 39 Degree Celsius cannot be brought down by paracetamol and sponging.

3.If fever lasts for more than 5 days.

4.If there is associated stiff neck and vomiting

5.If there is drowsiness or loss of consciousness

Once the cause of the fever is found and eliminated, the body temperature will reduce spontaneously back to normal.

A Simple Guide to Malaria

A Simple Guide to Malaria
---------------

What is Malaria?
-----------------

Malaria is a parasitic disease transmitted to humans through the bite of infected Anopheles mosquitoes characterised by high fever at certain times of the day, chills and rigors.

What is the cause of Malaria?
-----------------------------------

The cause of Malaria is a parasite called Plasmodium of which there are 4 species:
P.vivax,
P.falciparium,
P.malariae and
P.ovale.
When the parasites (Plasmodium) enter the blood in the human body through the mosquito bite, they travel to the liver.
In the liver after 6 -14 days depending on the species, they mature and then re-enter the bloodstream and infect the red blood cells.
There they multiply inside them.
Within 48 hours of becoming infected in the case of P.vivax, falciparium,and ovale, the red blood cells rupture, releasing more parasites (merozoites) which in turn infect more red blood cells.
In the case of P.malariae, the cycle is 72 hours.
Malaria causes anaemia by the rupturing of the red blood cells.
The large amounts of free haemoglobin released into the circulation after red blood cells rupture accumulate in the liver and spleen causing enlargement.
The symptoms of Malaria occur in cycles of 48 to 72 hours, due to the massive release of merozoites into the bloodstream.

What are the Symptoms of Malaria?
------------------------------------------

1.Fever, chills and sweating -
fever is high coinciding with the release of merozoites in the blood stream.
It drops to a lower fever, then goes up again when the parasites are released into the blood stream again.

2.muscle pain & rigors -
due to the high fever and sweating

3.headache, nausea and vomiting -
due to high fever and liver infection

4.jaundice with enlarged and tender liver
due to infection of the liver

5.anaemia and bloody stools
due to the rupture of the red blood cells

6.convulsion and coma
if the brain is affected.

What are the investigations done in Malaria?
-----------------------------------------------------

Blood smear tests for the malaria parasite-
a thick blood smear done at the height of the fever is able to show up the parasite more accurately than a thin blood film done randomly.

Blood tests for anemia, liver and kidney functions.

What is the Treatment of Malaria?
----------------------------------------

Malaria is treatable and curable.

Antimalarial drugs are readily available.
Drugs used include chloroquine, quinine and primaquine.
The drug used for treatment depends on factors such as
1. age,
2. where the malaria was acquired (as the malarial parasite from certain areas may be resistant to common ant-malarial drugs),
3.drug allergies and
4.G6PD deficiency patients who can have severe reactions to quinine based drugs.

For patients who have G6PD deficiency or are allergic to quinine drugs, the use of Lariam(mefloquine), Malarone(Atovaquone) and Doxycycline have been used effectively against the Malaria parasite.

In severe cases, the person suffering from malaria may require treatment in the intensive care unit of a hospital, especially if there are complications involving the brain or kidneys.

What is the Prognosis of Malaria?
---------------------------------------

The outcome is expected to be good in most cases of malaria with treatment,
but poor in Falciparum infections with complications.

What are the Complications of Malaria?
------------------------------------------------

Complications are liver, kidney, spleen or brain damage usually as a result of bleeding and ruptured red blood cells.
1.liver failure and kidney failure
2.destruction of blood cells (haemolytic anaemia)
3.meningitis
4.rupture of the spleen and subsequent massive haemorrhage

What is the Prevention measures against Malaria?
-----------------------------------------------------------

There is no effective vaccine against malaria.
Antimalarial drugs may be given prophylactically to persons travelling to areas where the disease is widespread, or to pregnant women in areas in which the disease is endemic.

Antimalarial drugs should be prescribed for visitors to areas where malaria is prevalent at least one week before entering the area, and continue for 2 weeks after leaving the area.
The types of antimalarial medicine prescribed will depend on the drug-resistance patterns in the areas to be visited. It is very important to know the countries and areas you will be visiting to obtain appropriate preventive support for malaria.

What is the prognosis of Malaria?
---------------------------------------

Most cases of Malaria are completely cured.
In rare cases, reinfection may occur if the patient remains in the endemic area without proper prophylaxis.

How do you prevent Malaria?
-----------------------------------

Preventive measures are concentrated on getting rid of the anopheles mosquito by removing all possible breeding grounds such as places containing stagnant water.

Use of insecticides and natural biologic predators of mosquitoes will help to reduce the population of the anopheles mosquito.

A Simple Guide to Mumps

A Simple Guide to Mumps
------------------------------

What is Mumps?
--------------------

Mumps is a highly contagious viral infection that causes painful swelling in the salivary glands (the glands which produce saliva) which include the parotid, submandibular and submental glands.

How is Mumps spread?
---------------------------

The mumps (paramyxovirus) virus is spread by coughing, sneezing and through the saliva of an infected person.

It can also be spread by contact with contaminated items and surfaces.

It is contagious 1 - 2 days before the appearance of symptoms to 1 - 2 days after the symptoms disappear.

The incubation period is about 18 days.

An attack gives lifelong immunity.

Who is infected in Mumps?
-------------------------------

Although mumps may affect adults, children between the ages of 5 - 15 years are most prone.

What are the Symptoms of Mumps?
-----------------------------------------

Symptoms
1.Prodromal symptoms such as fever, headache and sore throat

2.Facial pain and swelling

3.pain or lumps in their testicles

4.Abdominal pain

Signs:
1.Swollen and tender parotid glands in front of the ear, cheek and neck.
Submandibular glands below the jaws are less affected

2.Dry mouth - less saliva ,fever

3.Males may experience pain or lumps in their testicles, and swelling in the scrotum. However this rarely causes infertility problems.

4.Pain in the abdomen may indicate pancreatitis, a rare complication

5.Meningoencephalitis (infection of the central nervous system) with fever, headache and neck rigidity. It usually does not cause permanent damage.

What is the Treatment of Mumps?
----------------------------------------

Mumps is a viral disease and cannot be cured.
It normally run its course within 1 week.
Treatment of mumps is therefore symptomatic.

1.Rest and soft diet.

2.Lots of fluids

3.Paracetamol can be given to reduce fever and relieve pain. For children, aspirin should not be given because of the risk of Reye's syndrome which can damage the brain.

4.Warm or cold compresses can be given to relieve pain and swelling in the parotid glands.

5.Cool compresses and scrotal support can be given to reduce pain and swelling in the testicles.

6.Avoid foods that stimulate the parotid glands (stimulating the glands causes pain) such as fruit juices and tart beverages.

What are the complications of Mumps?
----------------------------------------------

The mumps virus may affects many different glands including the brain.
It can affect the testes (orchitis)in boys or ovaries (oophoritis) in girls during puberty rarely causing infertility.

It can also affect the pancreas in some patients giving rise to Juvenile Diabetes or pancreatitis.

In the brain rarely encephalitis or meningitis may occur with damage to some brain cells.

What is the prognosis of Mumps?
--------------------------------------

Prognosis is good in all cases.
Very rarely do complications such orchitis or meningitis occur.

How is Mumps Prevented?
------------------------------

Mumps can be prevented by administering the Mumps, Measles, Rubella vaccine (MMR). This vaccine is given at the age of 15 months and again at 12 years old.

A Simple Guide to Rubella

A Simple Guide to Rubella
------------------------------

What is Rubella?
---------------------

Rubella is a infectious viral disease characterised by fever, generalised rash and swollen glands behind the ears and in the neck.
It can be spread through the air or by contact.
It can also be transmitted to a foetus by a mother with an active infection.
The disease is usually mild and may even go unnoticed. It is also called German Measles.

What are the Symptoms of Rubella?
------------------------------------------

Most children have few symptoms.
Adults may experience a prodrome (warning symptom) of a fever, headache, malaise, runny nose, and inflamed eyes, that lasts from 1 to 5 days before the rash appears.

A person can transmit the disease from 1 week before the onset of the rash until 1 week after the rash disappears.

The child with rubella may not look or act sick, but symptoms may include:
1. low-grade fever

2.swollen glands behind the ears and at the back and sides of the neck.

3.Loss of appetite, irritability, loss of interest in personal care.

4.Rash (maculopapiular) which appears on the face and torso and spreads to the arms and legs, lasting 3 to 5 days.

5.Rarely joint pain and arthritis (more common in adult women).

Lifelong immunity to the disease follows infection.

What is the danger of Rubella?
-------------------------------------

The disease is potentially dangerous because it is able to produce defects in a developing foetus if the mother is infected during early pregnancy.
About 10 to 15% of women in their childbearing years are susceptible to infection.

Congenital rubella syndrome occurs in 25% or more of infants born to women who acquired rubella during the first trimester of pregnancy.
Defects may occur in an infected foetus and include deafness, cataracts, microcephaly, mental retardation, congenital heart defects, and other defects.
A miscarriage or stillbirth may occur.
Defects are rare if the infection occurs after the 20th week of pregnancy.
Risk factors include lack of immunisation and exposure to an active case of rubella.

What is the Treatment of Rubella?
----------------------------------------

The infected child should stay at home while sick or up to a week after the rash disappears.
There is no cure for Rubella.
Treatment of a child with rubella is usually symptomatic .

Keep your child quiet, especially if she has a fever.
Children should be kept at home while any rash is visible and for a week thereafter.
Avoid scratching the rash.
Apply Calamine lotion or give the child some antihistamine to stop the itch.
Cool sponging will help relieve fever and discomfort from a rash.
An acetaminophen-based pain reliever may also help.

If you are pregnant and are exposed to rubella, you should contact your doctor immediately.
The risk of birth defects is higher the earlier the exposure occurred in your pregnancy.
In some cases, your doctor may advise you to consider a therapeutic termination of your pregnancy.

How do you Prevent Rubella?
-----------------------------------

Two doses of the MMR vaccine are recommended for children.
The MMR (measles, mumps, and rubella vaccine) is now given at 15 months, with a booster at the age of 12.

If your child has rubella, notify any at-risk individuals who have had contact with your child during the illness and up to 10 days before symptoms appeared, so they can seek appropriate care.

Pregnancy Concerns
If you are pregnant, and uncertain of your immunity to rubella, and suspect you have been exposed, contact your doctor immediately. There is a risk the virus can be passed to your unborn child.

If any household member is pregnant and there is any question of her not being immune, your doctor will recommend delaying immunisation of your children to prevent exposing the mother-to-be to the live, though weakened, virus in the vaccine.

At least three months before trying to become pregnant, a woman should have a blood test to see if the rubella antibodies are present.
If antibodies are not present, she should be immunised or reimmunised.

A Simple Guide to Rheumatoid Arthritis

A Simple Guide to Rheumatoid Arthritis
-----------

What is Rheumatoid Arthritis?
-----------

Rheumatoid arthritis is a systemic autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.

Who gets Rheumatoid Arthritis?
--------------------------------------

Rheumatoid Arthritis is one of the most common form of inflammatory arthritis.
It most commonly occurs between the 25 and 50 years.
However it can occur at any age.
Females are 3 times more likely to get Rheumatoid Arthritis than males.

What causes Rheumatoid Arthritis?
-------------------------------------------

Rheumatoid Arthritis is an autoimmune disease..
Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system which consists of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections.
Patients with autoimmune diseases have antibodies in their blood that target their own body tissues .

What are the symptoms of Rheumatoid Arthritis?
-----------------------------------------------------------

Most common symptoms are pain, swelling, stiffness, warmth and sometimes redness of the joints.

Rheumatoid Arthritis is suspected when there are:
1. Swelling in the joints especially those of the hands,elbows,knees,ankles and feet.

2. Stiffness in the joints in the mornings which can last more than an hour or after prolonged rest

3.redness and warmth in one's joints

4.Persistent pain or tenderness in a joint for more than a month

5.Inability to move or use a joint normally

6. Unexplained weight loss and appetite, fatigue, or weakness together with joint pains

What tests are done to confirm Rheumatoid Arthritis?
----------------------------------------------------------------

Abnormal blood antibodies can be found in patients with rheumatoid arthritis.

1.A blood antibody called "rheumatoid factor" can be found in 80% of patients.

2.Another antibody called "the antinuclear antibody" (ANA) is also frequently found in patients with rheumatoid arthritis.

3.Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein.

4.A blood test called the sedimentation rate (ESR) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed rate is used as a crude measure of the inflammation of the joints.

The rheumatoid factor, ANA, sed rate, and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis

How does the Rheumatoid Arthritis starts?
--------------------------------------------------

Rheumatoid Arthritis may start gradually or with a sudden and severe attack.
It usually attacks many joints at one time.
Rheumatoid arthritis is a chronic disease, characterized by periods of disease flares and remissions.

Where does Rheumatoid Arthritis occur?
-------------------------------------------------

In rheumatoid arthritis, multiple joints are usually affected in a symmetrical pattern.
It most commonly affects the hands and feet,often in a systemic pattern(both right and left joints are affected).
Other joints affected are the elbow,knees,and ankles.
Less common are shoulder,hip and spine.

What are the Complications of Rheumatoid Arthritis?
----------------------------------------------------------------

Rheumatoid Arthritis can result in joint deformities and disability especially in untreated severe cases.
Daily activities such as bathing,dressing, walking and even writing may be difficult.
Besides the joints, Rheumatoid Arthritis may sometimes affect other organs such as the eyes,lungs,skin,intestines,nerves and bone marrow.
Mild fever, fatigue, loss of appetite and loss of weight may be present.
Severe Rheumatoid Arthritis is associated with an incresed risk of mortality.

How is Rheumatoid Arthritis treated?
--------------------------------------------

There is no known cure for rheumatoid arthritis.
Therefore the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Rheumatoid Arthritis can be broadly classified into:
1. Non-drug therapy:
Weight loss is an effective way to reduce the stress on the joints and minimise the pain Walking sticks are useful ways to offload the stress on the affected weight bearing joints such as hips or knee.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibilty are useful to minimise the disability of Rheumatoid Arthritis. A range of motion exercises is useful to keep the joints supple and mobile.
Water based exercises are a good alternative form of aerobic workout by patients afflicted by Rheumatoid Arthritis. The warm water especially is a good medium for joint mobility and together with the buoyancy of water it helps to minimse the body weight impact on the joints.
2. Drug therapy

There are 2 main types of drugs:
1. symptom modifying helps to alleviate the symptoms but do not change the natural history of the conditions. Examples are Non-steroidal Anti-inflamatory Drugs(NSAIDS) like diclofenac.

2. disease modifying drugs such as steroids, methothrexate, sulphasalazine, redaura, hydroxychloroquine have been shown to slow down the damage caused by Rheumatoid Arthritis. However they cause a lot of side effects such as anemia, abnormal white cells, kidney damage,liver damage, vision loss so the medications must be monitored all the time.
It is important that the disease should be controlled before irreversible joint damage occurs.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira).

3. Surgery

Surgery is used as a last result to correct deformities and reduce disability.

The treatment of rheumatoid arthritis optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally surgery.

Early treatment of rheumatoid arthritis results in better outcomes.

A Simple Guide to Tonsillitis

A Simple Guide to Tonsillitis
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What is Tonsillitis?
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Tonsillitis is inflammation (swelling) of the tonsils.
The tonsils are lymph nodes in the back of the mouth and top of the throat.
They normally help to filter out bacteria and other germs to prevent infection in the body.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing tonsillitis.
The infection may also be present in the throat and surrounding areas, causing pharyngitis. The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils (areas of tonsil tissue at the back of the tongue).

What causes Tonsillitis?
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Viral or bacterial infections and low immunity lead to tonsillitis and its complications.
Viral:
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis.
Bacteria:
Bacteria cause 15-30 percent of pharyngotonsillitis cases.
Streptococcus pyogenes is the most common bacteria causing acute Tonsillitis

Who gets tonsillitis?
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Tonsillitis most often occurs in children but rarely in children younger than 2 years.
Tonsillitis caused by Streptococcus species typically occurs in children aged 5-15 years.
Viral tonsillitis is more common in younger children.
A peritonsillar abscess is usually found in young adults but occur occasionally in children.

What are types of Tonsillitis?
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There are several variations of tonsillitis:
1.acute
2.recurrent
3.chronic tonsillitis and
4.peritonsillar abscess.

What are the symptoms of tonsillitis?
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The type of tonsillitis determines what symptoms will occur.

Acute tonsillitis:
Patients have a
Ear pain
Fever, chills
Headache
Sore throat - severe, lasts longer than 48 hours
Tenderness of the jaw and throat
Voice changes, loss of voice
Foul breath
dysphagia (difficulty swallowing)
Odynophagia (painful swallowing) and
tender cervical lymph nodes.

Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnea.
Lethargy and malaise are common.

These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.

Recurrent tonsillitis:
This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.

Chronic tonsillitis:
Individuals often have
Chronic sore throat,
Foul breath,
Enlarged tonsils, and
Persistently tender cervical nodes.

Peritonsillar abscess:
Individuals often have
Severe throat pain,
fever, Drooling,
Foul breath,
Trismus (difficulty opening the mouth), and
Muffled voice quality (as if talking with a hot potato in his or her mouth).

What are the signs of Tonsillitis?
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The health care provider will look in the mouth and throat for signs of:

1.enlarged, visible tonsils that are usually reddened with white spots (pus) on them.

2.enlarged and tender lymph nodes of the jaw and neck.

3.Fever and chills.

4.Open-mouth breathing and muffled voice resulting from obstructive enlarged tonsils.

5.neck and jaw stiffness (often found in acute tonsillitis).

6.Signs of dehydration (found by examination of skin and mucosa).

7.Palatal petechiae (pinpoint bleeding spots on the soft palate).

8.Unilateral bulging above and to the side of one of the tonsils in peritonsillar abscess .

A culture of the tonsils may show bacterial infection.
A culture for the streptococcus bacteria (strep) may be taken using a throat swab because it is the most common and most dangerous form of tonsillitis.

What is the treatment of Tonsillitis?
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1.If the cause of the tonsillitis is bacteria such as strep, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.Some health care providers will treat all tonsillitis with antibiotics to prevent the chance of strep-related complications.

2.Rest to allow the body to heal.

3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the throat. Gargle with warm salt water or suck on lozenges (containing benzocaine or similar ingredients) to reduce pain.Fluid replacement and pain control are important.

4.Hospitalization may be required in severe cases and when there is airway obstruction.

5. When the condition is chronic or recurrent, a surgical procedure to remove the tonsils (tonsillectomy) is often recommended.

What is the Prognosis of Tonsillitis?
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Tonsillitis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
A tonsillectomy may be recommended if tonsillitis is severe, recurrent, or does not respond to antibiotics.

What are the Complications of Tonsillitis?
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1.Complications of untreated strep tonsillitis may be severe:
Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure

2.Dehydration from difficulty swallowing fluids

3.Blocked airway from enlarged tonsils

4.Peritonsillar abscess or abscess in other parts of the throat