Tag Archives: Infectious disease

Immunisation

Definition:
Immunization, or immunisation, is the process by which an individual’s immune system becomes fortified against an agent (known as the immunogen).It  is the process whereby a person is made immune or resistant to an infectious disease.

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Immunization is done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body’s immune system, thus helping to fight or prevent an infection. The fact that mutations can cause cancer cells to produce proteins or other molecules that are known to the body forms the theoretical basis for therapeutic cancer vaccines. Other molecules can be used for immunization as well, for example in experimental vaccines against nicotine (NicVAX) or the hormone ghrelin in experiments to create an obesity vaccine.

Before the introduction of vaccines, the only way people became immune to an infectious disease was by actually getting the disease and surviving it. Smallpox (variola) was prevented in this way by inoculation, which produced a milder effect than the natural disease. It was introduced into England from Turkey by Lady Mary Wortley Montagu in 1721 and used by Zabdiel Boylston in Boston the same year. In 1798 Edward Jenner introduced inoculation with cowpox (smallpox vaccine), a much safer procedure. This procedure, referred to as vaccination, gradually replaced smallpox inoculation, now called variolation to distinguish it from vaccination. Until the 1880s vaccine/vaccination referred only to smallpox, but Louis Pasteur developed immunisation methods for chicken cholera and anthrax in animals and for human rabies, and suggested that the terms vaccine/vaccination should be extended to cover the new procedures. This can cause confusion if care is not taken to specify which vaccine is used e.g. measles vaccine or influenza vaccine.

When this system is exposed to molecules that are foreign to the body, called non-self, it will orchestrate an immune response, and it will also develop the ability to quickly respond to a subsequent encounter because of immunological memory. This is a function of the adaptive immune system. Therefore, by exposing an animal to an immunogen in a controlled way, its body can learn to protect itself: this is called active immunization.

The most important elements of the immune system that are improved by immunization are the T cells, B cells, and the antibodies B cells produce. Memory B cells and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is direct introduction of these elements into the body, instead of production of these elements by the body itself.

The most important elements of the immune system that are improved by immunization are the T cells, B cells, and the antibodies B cells produce. Memory B cells and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is direct introduction of these elements into the body, instead of production of these elements by the body itself.

Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.

Immunizations are definitely less risky and an easier way to become immune to a particular disease than risking a milder form of the disease itself. They are important for both adults and children in that they can protect us from the many diseases out there. Through the use of immunizations, some infections and diseases have almost completely been eradicated throughout the United States and the World. One example is polio. Thanks to dedicated health care professionals and the parents of children who vaccinated on schedule, polio has been eliminated in the U.S. since 1979. Polio is still found in other parts of the world so certain people could still be at risk of getting it. This includes those people who have never had the vaccine, those who didn’t receive all doses of the vaccine, or those traveling to areas of the world where polio is still prevalent.

The Immunization can be achieved in an active or passive manner:
Vaccination is an active form of immunization.

Active immunization/vaccination has been named one of the “Ten Great Public Health Achievements in the 20th Century”.

Active immunization:.click & see
Active immunization can occur naturally when a person comes in contact with, for example, a microbe. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune.

Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated.

The importance of immunization is so great that the American Centers for Disease Control and Prevention has named it one of the “Ten Great Public Health Achievements in the 20th Century”.  Live attenuated vaccines have decreased pathogenicity. Their effectiveness depends on the immune systems ability to replicate and elicits a response similar to natural infection. It is usually effective with a single dose. Examples of live, attenuated vaccines include measles, mumps, rubella, MMR, yellow fever, varicella, rotavirus, and influenza (LAIV).

Passive immunization:……...click & see
Passive immunization is where pre-synthesized elements of the immune system are transferred to a person so that the body does not need to produce these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear.

Passive immunization occurs physiologically, when antibodies are transferred from mother to fetus during pregnancy, to protect the fetus before and shortly after birth.

Artificial passive immunization is normally administered by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment for toxicity, as in for tetanus. The antibodies can be produced in animals, called “serum therapy,” although there is a high chance of anaphylactic shock because of immunity against animal serum itself. Thus, humanized antibodies produced in vitro by cell culture are used instead if available.

Resources:
http://en.wikipedia.org/wiki/Immunization
http://www.who.int/topics/immunization/en/

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Scarlet fever

Alternative Names : Scarlatina

Definition:
Scarlet fever is a disease caused by infection with the group A Streptococcus bacteria (the same bacteria that causes strep throat).Once a major cause of death, it is now effectively treated with antibiotics. The term scarlatina may be used interchangeably with scarlet fever, though it is commonly used to indicate the less acute form of scarlet fever that is often seen since the beginning of the twentieth century.
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It can affect people of any age. However, it’s most common between the ages of six and 12.

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Symptoms:

The time between becoming infected and having symptoms is short, generally 1 – 2 days. The illness typically begins with a fever and sore throat.

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The rash usually first appears on the neck and chest, then spreads over the body. It is described as “sandpapery” in feel. The texture of the rash is more important than the appearance in confirming the diagnosis. The rash can last for more than a week. As the rash fades, peeling (desquamation) may occur around the fingertips, toes, and groin area.

The common signs and symptoms that give scarlet fever are as follows:

*Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on the face or neck and spreads to the trunk, arms and legs. If pressure is applied to the reddened skin, it will turn pale.

*Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the surrounding rash.

*Flushed face. The face may appear flushed with a pale ring around the mouth.

*Strawberry tongue. The tongue generally looks red and bumpy, and it’s often covered with a white coating early in the disease.

The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have subsided, the skin affected by the rash often peels. Other signs and symptoms associated with scarlet fever include:

*Fever of 101 F (38.3 C) or higher, often with chills

*Very sore and red throat, sometimes with white or yellowish patches

*Difficulty swallowing

*Enlarged glands in the neck (lymph nodes) that are tender to the touch

*Nausea or vomiting

*Headache

*Abdominal pain

*Bright red color in the creases of the underarm and groin (Pastia’s lines)

*Chills

*General discomfort (malaise)

*Muscle aches

*Sore throat

*Swollen, red tongue (strawberry tongue)

Causes:
Scarlet fever is caused by the same type of bacteria that cause strep throat. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

The infection spreads from person to person via droplets expelled when an infected person coughs or sneezes. The incubation period — the time between exposure and illness — is usually two to four days.

Risk Factors:
Children 6 to 12 years of age are more likely than are other people to get scarlet fever. Scarlet fever germs spread more easily among people in close contact, such as family members or classmates.

Complications:
If scarlet fever goes untreated, the bacteria may spread to the:

*Tonsils
*Sinuses
*Skin
*Blood
*Middle ear

Rarely, scarlet fever can lead to rheumatic fever, a serious condition that can affect the:

*Heart
*Joints
*Nervous system
*Skin

Diagnosis:
Diagnosis of scarlet fever is clinical. The blood test shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (both indications of inflammation), and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications—today rare—include ear and sinus infection, streptococcal pneumonia, empyema thoracis, meningitis and full-blown sepsis, upon which the condition may be called malignant scarlet fever.

Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease, or secondary malignant syndrome of scarlet fever, includes renewed fever, renewed angina, septic ear, nose, and throat complications and kidney infection or rheumatic fever and is seen around the eighteenth day of untreated scarlet fever.

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps, and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks (on very dark skin, the streaks may appear darker than the rest of the skin). Areas of rash usually turn white (or paler brown, with dark complected skin) when pressed on. By the sixth day of the infection, the rash usually fades, but the affected skin may begin to peel. Usually there are other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever at or above 101 °F (38.3 °C), and swollen glands in the neck. Scarlet fever can also occur with a low fever. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. Also, an infected person may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms started, and begins to peel (as above). The infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the person may not get a sore throat.

Treatment:
Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success. Patients should no longer be infectious after taking antibiotics for 24 hours. People who have been exposed to scarlet fever should be watched carefully for a full week for symptoms, especially if aged 3 to young adult. It is very important to be tested (throat culture) and if positive, seek treatment.

A drug-resistant strain of scarlet fever has emerged in Hong Kong, accounting for at least two deaths in that city – the first such in over a decade. The mutant strain of the bacterium is about 60% resistant to the antibiotics, says Professor Kwok-yung Yuen, head of Hong Kong University’s microbiology department. This is compared to a previous strain of the disease, which demonstrated a 10-30% resistance. This new strain may have spread to neighboring Macau and mainland China.

Prognosis:
With proper antibiotic treatment, the symptoms of scarlet fever should get better quickly. However, the rash can last for up to 2 – 3 weeks before it fully goes away.

Prevention :
Bacteria are spread by direct contact with infected people, or by droplets exhaled by an infected person. Avoid contact with infected people.

Children should be taught  to practice the following healthy habits:

*Wash  hands. Show your child how to wash his or her hands thoroughly with warm soapy water.

*Don’t share dining utensils or food. As a general rule, your child shouldn’t share drinking glasses or eating utensils with friends or classmates. And that rule applies to food, too.

*Cover your mouth and nose. Tell your child to cover his or her mouth and nose when coughing and sneezing to prevent the potential spread of germs.If your child has scarlet fever, wash his or her drinking glasses, utensils and, if possible, toys in hot soapy water or in a dishwasher.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/scarlet-fever/DS00917
http://en.wikipedia.org/wiki/Scarlet_fever
http://www.bbc.co.uk/health/physical_health/conditions/scarletfever1.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000974.htm
http://www.umm.edu/imagepages/19082.htm
http://www.healthofchildren.com/S/Scarlet-Fever.html
http://sigma.ontologyportal.org:4010/sigma/Browse.jsp?kb=SUMO&term=ScarletFever

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Erythrina variegata

Botanical Name :Erythrina variegata
Family: Fabaceae
Genus: Erythrina
Species: E. variegata
Kingdom: Plantae
Order: Fabales

Scientific names:
Erythrina variegata Linn. var. orientalis (Linn.)
Erythrina corallodendron Linn. Bagbag (Ilk.)
Tetradapa javanorum Osbeck
Erythrina indica Linn.
Erythrina carnea Blanco

Common Names:Indian Coral Tree.,Andorogat (Bik.),Merr. Andorogat (Bik.),Bagbok (Ibn.),Dapdap (Tag., Pamp., Bik., Bis.), Dubdub (Ilk.) ,Kabrab (Bik.) ,Karapdap (Tag.) ,Kasindak (Tag.) ,Sabang (Bon.) ,Sulbang (Pamp.) ,Vuvak (Ibn.) , Tiger’s claw (Engl.) ,Indian coral tree (Engl.) ,Hai tong pi (Chin.)

It is known as the Roluos Tree in Cambodia, deigo on Okinawa, drala on Fiji, madar in Bangladesh, Modar in Assam, man da ra ba in Tibet, as thong lang in Thailand and as vông nem in Vietnam.

Habitat :Erythrina variegata is   native to the tropical and subtropical regions of eastern Africa, southern Asia, northern Australia, and the islands of the Indian Ocean and the western Pacific Ocean east to Fiji.

Along the seashore and frequently planted inland hroughout the Philippines.
– Occurs in India to Polynesia.

Description:
Dapdap is a deciduous tree reaching a height of 15 meters, the branches and the branchlets stout and armed with short, few to many sharp prickles. Leaflets are broadly ovate and 8 to 18 centimeters long, with pointed tip and broad base. Racemes are terminal, hairy, dense, and up to 2.5 centimeters long. Flowers are papillonaceous, large and numerous. Calyx is about 4 centimeters long and minutely 5-toothed at the tip, the mouth being very oblique. Petals are bright red and shorter than the calyx, the standard being 7 to 9 centimeters long and the wings and keels subequal. Stamens are 10, upper filaments free nearly to the base or more or less connate with others. Ovary many-ovuled, style incurved. Racemes terminal, hairy, dense and up to 2.5 cm long. Fruits are pods, 10 to 25 centimeters long, 1.5 to 2 centimeters in diameter, and distinctly constricted between the seeds.

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Constituents
• Seeds yield an alkaloid, a fatty oil, and a saponaceous glucoside.
• The alkaloid has properties identical to hypaphorine.
• Leaves and bark yield an a poisonous alkaloid, erythrinine, which acts on the nervous system with effects similar to the alkaloid cytisine.
• Bark, leaves and seeds yield saponin.
• Hydrocyanic acide is found in the leaves, stems, roots, and fruit.
Phytochemical screening yielded eight spiromaine alkaloids and 3 carboxylated indole-3-alkylamines.
• Dried bark yields erythraline, hypaphorine, amino acids, organic acides, erythrinin, erybidin and saponins.

Properties:
• Prepared drug tastes bitter, neutral in effect.
• The bark is bitter, acrid, thermogenic, anti-inflammatory, sedative, carminative, digestive, anthelminthic, rejuvenating, laxative, diuretic and expectorant.
• The leaves are bitter, diuretic, laxative, emmenagogue, stomachic and anthelmintic.
• Erythrina has a narcotic and depressant action on the central nervous system.

Medicinal Uses:
Part utilized:
Bark and leaves.
Remove spines from bark after collection, rinse, sun-dry.

Folkloric :
• In the Philippines, a sweetened decoction of bark and leaves used as expectorant. Bark also used to facilitate the maturation of boils.
• Leaves and roots used as febrifuge.
• Decoction of leaves used for coughs and asthma.
• Dried bark decoction or infusion in alcohol used for lumbar and leg pain.
• In the Malay Peninsular, bark used for curing toothaches, rounded and pusjhed into the cavity or hollow tooth.
• In the Moluccas, bark chewed for dysentery.
• Pulverized leaves in the form of snuff used for Infantile convulsion and ascariasis.
• Wood rasped in water used for hematuria.
• Bark considered as antibilious and febrifuge.
• In the Peninsula and Indo-China, leaves used for poulticing sores.
• Seeds used internalluy and externally for cancer; externally for abscesses.
• In China, bark used as febrifuge and expectorant.
• In India and China, the bark and leaves are used in many traditional medicinal concoctions. Paribhadra, an Indian preparation, destroys parasites and relieves joint pains. Honeyed leaf juice is used for tapeworm and roundworm diseases. The juice also helps stimulate lactation and menstruation. A poultice of leaves is used for rheumatic join

Studies :-
• Antibacterial: Antibacterial activity of isoflavonoids isolated from Erythrina variegata against methicillin-resistant Staphylococcus aureus: 16 isoflavonoids isolated from Erythrina variegata was screened for antibacterial activity against methicillin-resistant Staph aureus. Of the active compounds, erycristagallin and orientanol B showed the highest anti-MRSA activity.
• Antibacterial / Erycristagallin / Dental Caries Prevention: Study isolated compounds from EV with antibacterial property against cariogenic oral bacteria. Among them was erycristagallin, a potential phytochemical agent for the prevention of dental caries by inhibiting the growth of cariogenic bacteria.
• Anti-osteoporotic Effect: Study showed that E. variegata could suppress the high rate of bone turnover induced by estrogen deficiency and improve the biomechanical properties of bone in the lab rats.
• Alkaloids / Nervous System Effects: The study isolated eight spiroamine alkaloids and three carboxylated indole-3-alkylamines and showed characteristic pharmacological effects: (1) neuromuscular blocking, (2) smooth muscle relaxant, (3) CNS depressant, (4) hypocholeretic, and (5) anticonvulsant effects supporting the indigenous use of the plants.
• Trypsin / Proteinase Inhibitors: Study indicate that E. variegata proteinase inhibitors possess different potency toward serine proteinases in blood coagualation and fibrinolytic systems.
• Antimicrobial / Cytoxicity: Study isolated five compounds from the methanol extract of stem bark of EV: epilupeol, 6-hydroxygenistein, 3ß, 28-dihydroxyolean-12-ene, epilupeol, stigmasterol. Diiferent partitionates showed mild to moderate antimicrobial activity and varying degrees of cytotoxicity.
• Antioxidant / Smooth Muscle Inhibitory Activity: Three new and 14 known compounds were isolated from E variegata. The smooth muscle studies on crude extract and their fractions showed inhibitory response, possibly with involvement of both muscarinic and adrenergic receptors. Significant antioxidant activity and a CNS depressive effect were also noted.
• Lectin / Cytoxicity: Study isolated a human erythrocyte specific lectin from the seeds of E. variegata. The purified lectin was a glycoprotein which induced transformation of peripheral blood lymphocytes in cultures.
Anti-Cancer: Study of methanol extract of the root bark of EV in Swiss albino mice showed a protective effect against Dalton’s Ascitic Lymphoma (DAL) with evidence of a significant increase in life span, decrease in cancer cell number and tumour weight and normalization of hematologic parameters.
• Antioxidant / Hypolipidemic: Study showed the protective effect of seeds of EV on high fat induced hyperlipidemia with lowering of total cholesterol, triglycerides, LDL, and VLDL. The effect may be attributed to decrease cholesterol synthesis, increase cholesterol excretion and expression of LDL receptor and catabolism. The antioxidant effect may play a role in retarding or preventing cardiovascular complications secondary to hyperlipidemia.
• Hypoglycemic Effect: Study concluded that E. variegata demonstrated promising hypoglycemic action in stretozotocin-induced diabetic rats.
• Antibacterial / Mupirocin Synergism: Study isolated an isoflavone, bidwillon B which inhibited the growth of 12 MRSA strains at minimum inhibitory concentrations. Combined with mupirocin, synergistic effects were observed for 11 strains of MRSA. Both compounds act on MRSA via different mechanisms. Bidwillon B presents as a potent phytotherapeutic and/or combination agent with mupirocin in the elimination of nasal and skin carriage of MRSA.

Other Uses:

It is valued as an ornamental tree. Several cultivars have been selected, including ‘Alba’ with white flowers.

It was designated the official flower of Okinawa Prefecture in 1967. The deigo flower features in the popular song Shima Uta by The Boom, one of the most well-known songs associated with Okinawa. In addition, the use of the wood of the deigo tree is one of the unique characteristics of Ryukyuan lacquerware.

In Vietnam, the leaves are used to wrap fermented meat (Vietnamese: nem).

The Tamils call it as “mullu murukkan” . In Siddha medicine it is used especially for menstrual disorders and fissures at penis tip .

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:
http://en.wikipedia.org/wiki/Erythrina_variegata
http://www.stuartxchange.org/Dapdap.html

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Osteomyelitis

Definition:
Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone, myelo- meaning marrow, and -itis meaning inflammation) simply means an infection of the bone or bone marrow. It can be usefully subclassified on the basis of the causative organism (pyogenic bacteria or mycobacteria), the route, duration and anatomic location of the infection.

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It is  is an acute or chronic bone infection and the same can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs.

In children, osteomyelitis most commonly affects the long bones of the legs and upper arm, while adults are more likely to develop osteomyelitis in the bones that make up the spine (vertebrae). People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Once considered an incurable condition, osteomyelitis can be successfully treated today. Most people require surgery to remove parts of the bone that have died — followed by strong antibiotics, often delivered intravenously, typically for at least six weeks.

Symptoms:
Signs and symptoms of osteomyelitis include:

*Fever or chills

*Bone pain

*General discomfort, uneasiness, or ill-feeling (malaise)

*Local swelling, redness, and warmth

*Irritability or lethargy in young children

*Pain in the area of the infection

*Swelling, warmth and redness over the area of the infection

*Excessive sweating

*Low back pain

Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems.

Causes:
Most cases of osteomyelitis are caused by staphylococcus bacteria (more common) or fungi (less common), a type of germ commonly found on the skin or in the nose of even healthy individuals.

*Infection may spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).

*The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.

*A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones are usually affected. In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.

Risk Factors
*Diabetes

*Hemodialysis

*Injected drug use

*Poor blood supply

*Recent trauma

People who have had their spleen removed are also at higher risk for osteomyelitis.

Complications:
When the bone is infected, pus is produced in the bone, which may result in an abscess. The abscess steals the bone’s blood supply. The lost blood supply can result in a complication called chronic osteomyelitis. This chronic infection can cause symptoms that come and go for years.

Other complications include:
*Need for amputation

*Reduced limb or joint function

*Spread of infection to surrounding tissues or the bloodstream

*Septic arthritis. In some cases, infection within bones can spread into a nearby joint

*Impaired growth. In children, the most common location for osteomyelitis is in the softer areas, called growth plates, at either end of the long bones of the arms and legs. Normal growth may be interrupted in infected bones.

*Skin cancer. If your osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer.

Diagnosis:
A physical examination shows bone tenderness and possibly swelling and redness.

Tests may include:

*Blood cultures

*Bone biopsy (which is then cultured)

*Bone scan

*Bone x-ray

*Complete blood count (CBC)

*C-reactive protein (CRP)

*Erythrocyte sedimentation rate (ESR)

*MRI of the bone

*Needle aspiration of the area around affected bones

Treatment:
Osteomyelitis often requires prolonged antibiotic therapy, with a course lasting a matter of weeks or months. A PICC line or central venous catheter is often placed for this purpose. Osteomyelitis also may require surgical debridement. Severe cases may lead to the loss of a limb. Initial first-line antibiotic choice is determined by the patient’s history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities.  Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes.

In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting titled The Gross Clinic.

Prior to the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.

Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.

Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization  can be done

Prognosis
With treatment, the outcome for acute osteomyelitis is usually good.

The outlook is worse for those with long-term (chronic) osteomyelitis, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation.

The outlook for those with an infection of an orthopedic prosthesis depends, in part, on:

*The patient’s health

*The type of infection

*Whether the infected prosthesis can be safely removed

Prevention:
Prompt and complete treatment of infections is helpful. People who are at high risk or who have a compromised immune system should see a health care provider promptly if they have signs of an infection anywhere in the body.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000437.htm
http://en.wikipedia.org/wiki/Osteomyelitis
http://www.bbc.co.uk/health/physical_health/conditions/osteomyelitis2.shtml
http://www.mayoclinic.com/health/osteomyelitis/DS00759
http://www.medicalook.com/Joint_pain/Osteomyelitis.html
http://www.orthopediatrics.com/docs/Guides/back_pain.html

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Lyme disease

Definition:
Lyme disease is an infection caused by bacteria called Borrelia burgdorferi, which is transmitted to humans by ticks that feed on the blood of animals such as deer or sheep, mice, hedgehogs, pheasants, hamsters and squirrels. It was first recognized in the United States in 1975 after a mysterious outbreak of arthritis near Old Lyme, Connecticut. Since then, reports of Lyme disease have increased dramatically, and the disease has become an important public health problem.

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It is an inflammatory disease and is the most common tick-borne disease in North America, Europe, and Asia. Connecticut has the highest annual rate of new cases of Lyme disease each year. The name Lyme disease was used because of the number of children in Lyme, Connecticut who first developed this problem back in the late 1970s.

More than 90 percent of the Lyme disease cases in the United States continue to occur in Connecticut and nine other states including New York, New Jersey, Rhode Island, Massachusetts, Pennsylvania, Wisconsin, Delaware, Maryland, and Minnesota.

However, the link between tick bites and a condition affecting the nervous system has been recognised for much longer and was known as tick-borne meningoencephalitis

Ticks can be tiny, just one or two mm across and their saliva contains painkillers, anticoagulants and immune suppressants. Many bites, therefore, go unnoticed. If undetected, the tick will typically remain in place for several days, and will drop off when finished feeding.

The bacteria are carried in the tick’s gut, and can take some time to move into its mouthparts and then into your body. The risk of infection increases the longer the tick is left in position. Normally, the risk is minimal if the tick is removed or falls off within 24 hours. However, it’s possible to be infected at any time after a bite. A partially fed tick, for example, can pass on the infection relatively quickly. In any given tick population, it’s thought that about 15 to 20 per cent carry Lyme disease. Only a small percentage of tick bites will lead to the condition.

Once the person is infected with Borrelia burgdorferi bacteria, there are several possible outcomes. The infection may be cleared without problems (some people have no symptoms but develop antibodies showing they have been exposed to the bacteria).

Alternatively the bacteria may spread through the body causing symptoms of infection, or in some cases it may trigger an immune response that leads to symptoms such as arthritis.

Symptoms:
The initial tick bite may be so small that more than half of those bitten don’t even notice or remember a bite. Between two days and four weeks later, an expanding, circular red rash appears in about 40 per cent of cases, usually at or near the site of the bite.

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Sometimes several of these rashes appear, which usually don’t itch or burn. Tiredness, headache, joint pains and flu-like symptoms may also occur. If no treatment is given, the rash will typically persist for two to three weeks. After that about one in three people have no further problems.

If no treatment is received, more than 60 per cent of those with Lyme disease will go on to stage 2 of the condition within six months. A wide range of symptoms have been recorded including:

•Fatigue
•Symptoms similar to meningitis
•Peripheral nervous symptoms such as numbness or tingling sensations
•In some cases psychiatric symptoms
These episodes may go on for many years. There may also be problems with nerve palsies (for example, weakness of the nerves to the muscles of the face), inflammation or damage of the nerves, abnormal heart rhythms, and severe malaise.

For some people Lyme disease then persists in a chronic form or Stage 3, where arthritis, neurological damage and fibromyalgia (severe aching and weak muscles) continue to affect them long term.

The symptoms of Lyme disease are partly determined by the particular strain of B burgdorferi bacteria. The strain most often seen in Europe tends to lead to neurological or nerve disease.

Causes:
It’s not just visitors to rural North America who might be exposed to these tick-borne infections. Infected ticks can be found across the UK, and anyone who enjoys exploring UK’s woodlands and uplands may also be at risk. People like gamekeepers, farmers and hunters are also at risk.

Cases have occurred in urban parks and gardens too. The common factor is the presence of deep vegetation and a supply of mammals and birds for ticks to feed on.

Diagnosis
Doctors diagnose Lyme disease based on your health history and a physical exam. Your doctor may order blood tests, but they are only used to confirm the diagnosis. The techniques used to test your blood are called ELISA and Western blot. Both tests can sometimes give false positive or unclear results. If you have had the infection for less than six weeks, your body may not even be making enough antibodies to be detected in the tests.

Lyme disease affecting the knee must be differentiated from septic (infectious) arthritis, which has both a different cause and a different treatment. The two distinguishing features of septic knee arthritis that set it apart from Lyme knee arthritis are refusal to put weight on the knee and fever (more then 101.5 degrees Fahrenheit). Patients with Lyme disease may have a low-grade fever and pain on weight-bearing but do not exhibit the high fever and refusal to put weight on the affected leg observed more often with septic knee arthritis.

When trying to rule out septic arthritis, the synovial fluid (the lubricating fluid of a joint) or spinal fluid may need to be analyzed. Studies show that patients with septic (infectious) knee arthritis are 3.6 times more likely to have a high synovial fluid cell count compared with patients with Lyme disease. But some patients with Lyme disease have elevated synovial fluid cell count, too so this test is just one of many tools used to diagnose the problem. The fluid can also be cultured to identify the presence of bacteria such as staphylococcus aureus (staph infection), streptococcus pneumonia (strep infection), or other less common types of bacterial infections. Bacteria associated with septic arthritis help rule out a diagnosis of Lyme disease.

Treatment:
If you think you may have been bitten, tell your doctor, and mention where you’ve been walking, especially if you know that there are ticks in that area. When infection with Lyme disease is suspected, blood tests can be used to help support the diagnosis, but don’t identify all cases.

Once Lyme disease has been diagnosed, treatment is with antibiotics which need to be at high dose and may need to be given as a prolonged course , sometimes even intravenously for maximum effect. Some complications of Lyme disease need specific treatments – for example if a person develops a slow heart rhythm, they may need a pacemaker

In most cases symptoms settle (even if treatment isn’t given, symptoms may eventually get better) but Lyme disease can cause more serious long term problems. Given the small amount of research in this area, medical opinion is divided as to the cause and best treatment for long term symptoms.

Prevention:
To prevent Lyme disease, avoid grasslands and wooded areas where incidence of the disease is high. When outside in these areas, apply insect repellent containing DEET (n,n-diethyl-m toluamide) to exposed skin. Apply permethrin (kills ticks on contact) to clothes and avoid getting this substance on the skin because it is toxic.

Wearing long-sleeved shirts and pants tucked into boots may prevent ticks from reaching the skin. Light-colored clothing makes it easier to see ticks.

Check clothing and skin carefully, especially where clothing touches the skin (e.g., cuffs, underwear elastic). Shower after all outdoor activities; if a tick is on the skin but unattached, it may wash off.

Avoid being bitten. Ticks in the nymph stage are tiny and spider-like (about the size of a poppy seed), so are difficult to see. The larger ticks you might see on your pets are the adult stage of the same species. They can attach to any part of the body, especially to moist or hairy areas in the groin, armpits, and scalp.

When camping or walking in places where the ticks may be, the following measures are helpful:

•Wear long sleeves and trousers
•Tuck trousers into socks
•Wear light-coloured clothing so ticks are easier to see
•Try not to sit on the ground in areas of vegetation
•Consider using insect repellents
•Keep to pathways and, where possible, avoid areas of overgrown vegetation
•Check for ticks regularly during the day and especially before going to bed
•Remove any ticks found attached to the skin straight away

Remove ticks using a purpose made tool, or fine forceps, which hold the tick close to the skin without squeezing its body. Apply antiseptic cream after removal. Don’t use your fingers, or apply heat, petroleum jelly or any other creams or chemicals.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/lymedisease1.shtml
http://www.idph.state.il.us/public/hb/hblyme.htm
http://www.healthcommunities.com/lyme-disease/lyme-disease-prevention.shtml?c1=GAW_SE_NW&source=GAW&kw=lymes_disease_signs_and_symptoms&cr5=11776947702
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19617.htm
http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=a8f19ed4a4860e4dc3e8a8c8b2489cbe

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