A Simple Guide to Pericarditis

A Simple Guide to Pericarditis
---------------------------------------------

What is Pericarditis?
---------------------------------

Pericarditis is a heart condition where there is inflammation of the pericardiac sac surrounding the heart and roots of the great vessels coming from the heart.

Who is at risk of Pericarditis?
-----------------------------------------

1.most common of all pericardial condition

2.more common in females than males

What is the cause of Pericarditis?
---------------------------------------------------

Pericarditis is caused by:

A.Infections
---------
1.Bacterial- streptococcus

2.Viral - adenovirus, enterovirus, cytomegalovirus, influenza virus, hepatitis B virus, and herpes simplex virus

3.mycotic

4.tuberculosis

B.Non- infection:
--------------------
1.Autoimmune diseases include:

a.Rheumatic fever

b.rheumatoid arthritis

c.systemic lupus erythrematosis

d.drug induced

2.Neoplastic

3.Uremia

4.myxedema

5.trauma

6.myocardial infarction

7.myocarditis,

8.dissecting aortic aneurysm,

9.radiation

What are the Symptoms of Pericarditis?
------------------------------------------------------------

Symptoms:
---------------------

1.Chest pain of sudden onset in the anterior chest

2.Pain is sharp and becomes worse with inspiration due to pleural inflammation.

3.Pain is relieved with sitting up and leaning forward and become worse on lying down

4.Pericardial rub is a diagnostic sign of acute pericarditis.
Absence of this sign does not mean that it is not pericarditis.

This rub is best heard at the left sternal border as a squeaky or scratching sound using the diaphragm of the stethoscope.

The pericardial rub is due to the friction generated by the two inflamed layers of the pericardium.

5.Fever may be present.

How is diagnosis of Pericarditis made?
-------------------------------------------------------

1. History and physical examination
chest pain, Pericarditis episodes

2.Blood tests:
a. A Complete Blood Count may show an elevated white count.

b. serum C-reactive protein may be elevated.

c.increase in serum creatine kinase MB and cardiac troponin I ( both of which are also markers for myocardial injury.

3.Electrocardiogram
ECG changes in acute pericarditis show inflammation of the epicardium (the layer directly surrounding the heart).

Typical ECG changes in acute pericarditis are:

stage 1 -- diffuse, positive, ST elevations with reciprocal ST depression in aVR and V1.
stage 2 -- normalization of ST and PR deviations
stage 3 -- diffuse T wave inversions
stage 4 -- ECG becomes normal OR T waves may be indefinitely inverted

4.Echocardiography
Usually normal in acute pericarditis.

It can reveal pericardial effusion, the presence of which supports the diagnosis.

5. Chest X-ray
Chest X-ray is generally only performed if a pulmonary cause of Pericarditis is suggested.

It is normal in acute pericarditis, but can reveal cardiomegaly (enlarged heart) if the pericardial effusion is more than 200 mL.

6.Cardiac catherisation -Coronary angiography in those patients should indicated normal vascular perfusion.

7. Pericardial fluid examination and biopsy- rarely done except for confirmation of neoplasm and tuberculosis.

What is the Complications of Pericarditis?
------------------------------------------------------

Cardiac tamponade is accumulation of fluid in the pericardial space to cause blockage to the inflow of blood to the heart.

Cardiac tamponade is an emergency and must be treated urgently.


What is the Treatment of Pericarditis?
------------------------------------------------------

Patients with uncomplicated acute pericarditis can be treated by a heart specialist on outpatient basis.

Those with high risk factors will need to be admitted to hospital:

1.sudden onset
2.high fever
3.leukocytosis
4.presence of cardiac tamponade
5.large pericardial effusion (echo-free space > 20 mm) resistant to NSAID treatment
6.low immunity
7.oral anticoagulation therapy
8.acute trauma

Remove the pericardial fluid
----------------------------
Pericardiocentesis is done to remove the fluid in a pericardial effusion through a needle.
It is performed under the following conditions:

moderate or severe cardiac tamponade
diagnosis of suspected purulent, tuberculosis, or neoplastic pericarditis
persistent pericardial effusion
viral or idiopathic pericarditis.


Treatment of underlying cause
--------------------------------------------

a.In idiopathic or viral pericarditis, NSAID(ibuprofen) is the mainstay treatment.

Goal of therapy is to reduce pain and inflammation.

Failure to respond to NSAIDs within one week (indicated by persistence of fever, worsening of condition, new pericardial effusion, or continuing chest pain) indicate the cause is not viral or idiopathic.

Colchicine can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis.

b.Anti tuberculous treatment must be given to Tuberculous patients.

c.Chemotherapy is given for cancer patients.

d.Autoimmune disease:
Systemic corticosteroids are usually reserved for those with autoimmune disease.

Surgery
---------------------
Pericardial window or removal of pericardium is done especially when there is possiblity of cardiac tamponade.

Proteolytic enzymes:
--------------------------
Proteolytic enzymes is used to dissolve the fluid in the pericardial sac.


What is the prognosis of Pericarditis?
---------------------------------------------------

Most cases of patients have recurrent pericarditis and become chronic after acute episode.

Response to surgery may not be very satisfactory especially with long standing chronic pericarditis.

What are the prevention measures for Pericarditis?
--------------------------------------------------------------

Rest and a healthy lifestyle may help to prevent an onset or recurrence of Pericarditis.

Avoid stress and anxiety.

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 Croup

A Simple Guide to Croup
-----------------------------------

What is Croup?
---------------------------

Croup is an acute viral disease of the upper and lower respiratory tract associated with inspiratory stridor ( whistling obstructive sound during inhalation) and respiratory distress in severe cases.

It typically affects infants and children below 6 years old.

It causes a typically barking type of cough and hoarseness of the voice due to obstruction at the vocal box.


What are the causes of Croup?
----------------------------------------

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

1.parainfluenza virus, primarily types 1 and 2

2.Other viral infections such as adenorhinovirnese, enterovirus and mycoplasma pneumoniae

Genetic predisposition:
------------------------

Some families are more prone than others to get the disease.
It is also more common in males than females.


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

Symptoms:

1.harsh barking cough

2.sneeze

3.inspiratory stridor (a high-pitched whistling sound during inspiration),

4.nausea and vomiting

5.fever.

6.Hoarseness -usually present

7.respiratory distress due to airway obstruction

8.lethargy

Signs:

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

2.Prolonged inspiration on auscultation with laryngeal stridor

3.Chest retraction

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

This will considered as a medical emergency.


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

1.Symptoms and signs of fever, laryngeal stridor and barking cough

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

5.frontal X-ray of the C-spine
the presence of the the steeple sign confirms the diagnosis of croup.


What are the complications of Croup?
-----------------------------------------------

1.Respiratory distress

2.Bacterial tracheitis


What is the treatment of Croup?
------------------------------------

1.Rest, fluids and oxygen

2.Humidifiers and steam inhalations

3.Corticosteroids especially dexamethasone are the most commonly used agent as it reduces inflammation

4.Antibiotics are not useful because the cause is viral. If there is bacterial tracheitis, antibiotics may be needed

5.Bronchodilators such as theophylline, epinephrine, ventolin, bricanyl are all helpful to open the airways

6.Intubation and tracheostomy may be needed in severe cases.


What is the prognosis of Croup ?
------------------------------------------

This depends on the severity and type of infection.

Most cases, if treated early and correctly, recovered completely with return of normal lung function within 7 days.


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

Vaccination against the influenza virus may help.

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 Meningitis

A Simple Guide to Meningitis
-----------------------------------

What is Meningitis?
---------------------------

Meningitis is a serious medical disease which causes inflammation and infection of the meninges which are the protective lining of the spinal cord and brain.

What are the causes of Meningitis?
----------------------------------------

The causes of Meningitis may be divided into:

Infections:
------------
1.viral infections are the most common and are usually mild
(enterovirus, herpes simplex virus 2 and mumps) except for Hand mouth and foot disease(enterovirus EV7)which can cause fatality in children

2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal meningitis can cause outbreaks(spread easily).

E.coli, Group B streptococus and Pseudomonas infection are common in neonates.

Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae are common in infants and children

Streptococcus pneumoniae, N. meningitidis, Mycobacteria are more common in adults.

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

3.fungi
Cryptococcus neoformans is the most common cause of fungal meningitis

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

Non infectious causes usually irritates the meninges through inflammation and auto immune reactions:

1.cancers,

2.systemic lupus erythematosus

3.drugs.

4.head injury

5.post neurosurgical procedures


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

The triad of symptoms which often defines meningitis are:

1.Severe headache

2.Neck rigidity (unable to flex the neck forward),
A positive Kernig's sign means that the neck will painful when one hip is flexed to 90 degrees and the knee flexed to 90 degrees in a patient lying supine.

3.vomiting

Other symptoms are:

4.high fever

5.mental confusion.

6.Malaise

7.photo-phobia (inability to tolerate bright light),

8.phono-phobia (inability to tolerate loud noises),

9.irritability especially in small children

10.seizures .

11.swelling of the fontanelle may be present in infants

12.rash with numerous small, irregular red spots on the body, lower legs, soles of feet, palms

13.ulcers of the mouth (present in hand,mouth and foot disease).

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

1.Classical symptoms and signs as above especially neck rigidity

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

3.X-rays of chest and brain

4.cerebrospinal fluid (CSF) analysis via lumbar puncture is examined for white blood cells, red blood cells, protein content, glucose level and micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs)

A pressure of over 180 mm suggests bacterial meningitis.

5.CSF glucose is low,protein high and cells high in bacterial meningitis,
CSF glucose is normal,protein normal and cells high in viral meningitis
CSF glucose is low,protein high and cells high in fungal meningitis

6.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

What are the complications of Meningitis?
-----------------------------------------------

1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome

7.seizures also more in children

8.pneumonia especially in the elderly

What is the treatment of Meningitis?
------------------------------------

1.Hospitalization should be immediate as meningitis is an life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of anti-fungals may be given for Fungal meningitis 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 Meningitis?
------------------------------------------

This depends on the severity and type of infection.

Viral infections except for enterovirus EV7 usually recover quickly.

Bacterial infections such as meningococcus and pneumococcus are more dangerous.

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

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

Vaccines against type A and C Neisseria meningitidis are used to prevent these types of meningitis especially in those who travel abroad.

Vaccines against type B Neisseria meningitidis have yet to be produced athough a drug company is doing research on the production of this vaccine.

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

Mumps vaccination as part of Measles, mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis

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 Coryza(Common Cold)

A Simple Guide to Coryza( Common Cold )
-----------------------------------

What is Coryza(Common Cold)?
---------------------------------------

Coryza or Common Cold is one of the most common infections contracted by humans.It is characterised by inflammation of the mucous membranes of the nose and throat, with sneezing, sore throat, and mild coughing.

What causes Coryza (Common Cold)?
------------------------------------

The Common Cold is caused by one of the viral infections of the upper respiratory tract. There are over 200 different viruses which can cause a common cold.

Some of the common viruses include: rhinovirus, respiratory syncytial virus (RSV), coronavirus, parainfluenza.

What are the Symptoms of Coryza(Common Cold)?
------------------------------------------------------------

Generally the common cold viruses produces mild but uncomfortable symptoms:

1.Runny nose
2.Sneezing
3.Nasal congestion
4.Tiredness
5.Headache especially around the eyes and forehead
6.Fever low grade rare

Symptoms usually last less than two weeks.

What is the Treatment of Coryza(Common Cold)?
-----------------------------------------------------------

Usually a common cold runs its course without complications in one to two weeks.
Because there is no cure for a viral infection, treatment is aim at relieving symptoms.

1.Rest is the most important part of treatment. A rested patient will recover faster.

2.Adequate warm Fluids helps to keep the mucus membranes moist to allow infected mucus to flow better and also to replace wet mucus lost during the runny nose.

3.If there is any fever, headaches and pains, paracetamol can be given to relieve symptoms.

4.Oral (tablet or syrup) decongestants may also relieve nasal symptoms.
Antihistamines may be of some benefit in reducing mucus production.

5.Decongestant sprays can relieve block nose temporarily, but should not be used for more than three days. Longer use can lead to rebound congestion with more symptoms of congestion.

6.Antibiotics and vitamin C are not helpful in relieving symptoms of the common cold.

What are the Complications of Coryza(Common Cold)?

-----------------------------------------------------------------

Very rarely young children may develop bronchiolitis, viral pneumonia, and croup.

Some infants less than 3 months of age are particularly susceptible to developing secondary bacterial lower respiratory infections.

Two thirds of people over 60 years who live in the community and develop a rhinovirus infection can be expected to develop a lower respiratory tract illness.

Acute otitis media occurs in 2% of people with a cold.

Bacterial infection of the paranasal sinuses occurs in 0.5% of people with a cold.

People with chronic obstructive pulmonary disease who have a rhinovirus infection are more likely to have a longer duration of illness, a more severe illness, and to cough for longer afterwards than those without lung disease.

What is the Prognosis of Coryza(Common Cold)?

----------------------------------------------------------

The median duration of a common cold is a week.

Rarely the commn cold will last up to 2 weeks.

In smokers with a rhinovirus infection the cough is more likely to be troublesome and prolonged.

A Simple Guide to Gastroenteritis

A Simple Guide to Gastroenteritis
-------------------------------------

What is Gastroenteritis?
---------------------------

Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites resulting in leakage of fluid from the cell into the intestine(diarrhea),abdominal pain and vomiting.

What are the causes of Gastroenteritis?
--------------------------------------------

Viral Gastroenteritis:
The most common cause of Gastroenteritis is Viral.

Rota virus is the leading cause among children 3 to 15 months old and the most common cause of diarrhea in children under the age of 5 years.

Adenovirus occurs mainly in children under the age of 2 years.

Caliciviruses especially the norovirus cause infection in people of all ages.

Astrovirus also infects primarily infants, young children, and the elderly.

Bacterial Gastroenteritis:
The most common cause is the E. coli bacteria, usually mild with diarrhea, abdominal pain and occasional vomiting. It rarely cause fever.

Salmonella, Shigella ,Vibrio cholerae, are more serious bacterial infection causing diarrhea and high fever.

Parasitic Gastroenteritis:
Most common is amoebic dysentery,common in India and Africa.
Other parasitic infection are giardiasis and threadworms.

What are symptoms of Gastroenteritis?
----------------------------------------------

The main symptoms of gastroenteritis are
1. watery diarrhea
2. abdominal pain
3. vomiting
4. headache
5. fever.
6.loss of appetite and energy

Symptoms usually appear within 4 to 48 hours after exposure to the germ and last for 1 to 2 days, though symptoms can last as long as 10 days.

How is Gastroenteritis transmitted?
------------------------------------------

Gastroenteritis can be highly contagious. The germs are commonly transmitted by people with unwashed hands.
People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.
Noroviruses in particular, are typically spread to other people by contact with stool or vomit of infected people and through contaminated water or food—especially oysters, prawns, crabs, lobsters, cockleshells from contaminated breeding waters.

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

Doctors generally diagnose gastroenteritis based on the symptoms and a physical examination. Your doctor may ask for a stool sample to test for rotavirus or to rule out bacteria or parasites as the cause of your symptoms.

How is Gastroenteritis treated?
-------------------------------------

Most cases of viral gastroenteritis resolve without specific treatment.
Antibiotics are not effective against viral infections.

The primary goal of treatment is to reduce the symptoms which may include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).

Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, vomiting, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.

The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness

Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.

The following steps may help relieve the symptoms of gastroenteritis.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes. 4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.

How is Gastroenteritis prevented?
----------------------------------------

You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated