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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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Bell’s Palsy

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Definition:-
Bell’s palsy or idiopathic facial paralys  is a dysfunction of cranial nerve VII (the facial nerve) that results in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell’s palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell’s palsy is the most common acute mononeuropathy (disease involving only one nerve) and is the most common cause of acute facial nerve paralysis.

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Bell’s palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day. It can occur bilaterally resulting in total facial paralysis in around 1% of cases.

It is thought that an inflammatory condition leads to swelling of the facial nerve. The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell’s palsy has been found.

Corticosteroids have been found to improve outcomes while anti-viral drugs have not. Early treatment is necessary for steroids to be effective. Most people recover spontaneously and achieve near-normal to normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment.

Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision. In some cases denture wearers experience some discomfort.

Bell’s palsy occurs when the nerve that controls facial muscles on one side of your face becomes swollen or inflamed. As a result of Bell’s palsy, your face feels stiff. Half your face appears to droop, your smile is one-sided, and your eye resists closing.

Bell’s palsy can affect anyone, but rarely affects people under the age of 15 or over the age of 60.

For most people, Bell’s palsy symptoms improve within a few weeks, with complete recovery in three to six months. About 10 percent will experience a recurrence of Bell’s palsy, sometimes on the other side of the face. A small number of people continue to have some Bell’s palsy signs and symptoms for life.

Bell’s palsy occurs more often in people who:

*Are pregnant, especially during the third trimester, or who are in the first week after giving birth
*Have diabetes
*Have an upper respiratory infection, such as the flu or a cold

Also, some people who have recurrent attacks of Bell’s palsy, which is rare, have a family history of recurrent attacks. In those cases, there may be a genetic predisposition to Bell’s palsy.

Symptoms:–
Bell’s palsy is characterized by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. Facial palsy is typified by inability to control movement in the facial muscles. The paralysis is of the infranuclear/lower motor neuron type.

The facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, and salivation. They also innervate the stapedial (stapes) muscles of the middle ear and carry taste sensations from the anterior two thirds of the tongue.

Clinicians should determine whether the forehead muscles are spared. Due to an anatomical peculiarity, forehead muscles receive innervation from both sides of the brain. The forehead can therefore still be wrinkled by a patient whose facial palsy is caused by a problem in one of the hemispheres of the brain (central facial palsy). If the problem resides in the facial nerve itself (peripheral palsy) all nerve signals are lost on the ipsilateral (same side of the lesion) half side of the face, including to the forehead (contralateral forehead still wrinkles).

One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. The major differences in this condition are the presence of small blisters, or vesicles, on the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete).

Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy.

The main symptom of Bell’s palsy is a sudden weakness or paralysis in one side of your face that causes it to droop. This may make it hard for you to close your eye on that side of your face.

Other symptoms include:

*Drooling.
*Eye problems, such as excessive tearing or a dry eye.
*Loss of ability to taste.
*Pain in or behind your ear.
*Numbness in the affected side of your face.
*Increased sensitivity to sound.
*Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days — making it difficult to smile or close your eye on the affected side
*Facial droop and difficulty making facial expressions
*Pain around the jaw or in or behind your ear on the affected side
*Increased sensitivity to sound on the affected side
*Headache
*Changes in the amount of tears and saliva you produce

In rare cases, Bell’s palsy can affect the nerves on both sides of your face.


Cause:-
Some viruses are thought to establish a persistent (or latent) infection without symptoms, e.g. the Zoster virus of the face and Epstein-Barr viruses, both of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested as cause behind the acute Bell’s palsy. Studies suggest that this new activation could be preceded by trauma, environmental factors, and metabolic or emotional disorders, thus suggesting that stress – emotional stress, environmental stress (e.g. cold), physical stress (e.g. trauma) – in short, a host of different conditions, may trigger reactivation.

Other viruses that have been linked to Bell’s palsy include:

*The virus that causes chickenpox and shingles (herpes zoster)
*The virus that causes mononucleosis (Epstein-Barr)
*Another virus in the same family (cytomegalovirus)

With Bell’s palsy, the nerve that controls your facial muscles, which passes through a narrow corridor of bone on its way to your face, becomes inflamed and swollen — usually from a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

Pathology:–
It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell’s palsy per se. Possible causes include tumor, meningitis, stroke, diabetes mellitus, head trauma and inflammatory diseases of the cranial nerves (sarcoidosis, brucellosis, etc.). In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy. In a few cases, bilateral facial palsy has been associated with acute HIV infection.

In some research the herpes simplex virus type 1 (HSV-1) was identified in a majority of cases diagnosed as Bell’s palsy. This has given hope for anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir). Other research[5] however, identifies HSV-1 in only 31 cases (18 percent), herpes zoster (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases clinically diagnosed as Bell’s Palsy. That infection with herpes simplex virus should play a major role in cases diagnosed as Bell’s palsy therefore remains a hypothesis that requires further research.

In addition, the herpes simplex virus type 1 (HSV-1) infection is associated with demyelination of nerves. This nerve damage mechanism is different from the above mentioned – that oedema, swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage. Demyelination may not even be directly caused by the virus, but by an unknown immune system response. The quote below captures this hypothesis and the implication for other types of treatment:

It is also possible that HSV-1 replication itself is not responsible for the damage to the facial nerves and that inhibition of HSV-1 replication by acyclovir does not prevent the progression of nerve dysfunction. Because the demyelination of facial nerves caused by HSV-1 reactivation, via an unknown immune response, is implicated in the pathogenesis of HSV-1-induced facial palsy, a new strategy of treatment to inhibit such an immune reaction may be also effective.

Diagnosis:-
Bell’s palsy is a diagnosis of exclusion; by elimination of other reasonable possibilities. Therefore, by definition, no specific cause can be ascertained. Bell’s palsy is commonly referred to as idiopathic or cryptogenic, meaning that it is due to unknown causes. Being a residual diagnostic category, the Bell’s Palsy diagnosis likely spans different conditions that our current level of medical knowledge cannot distinguish. This may inject fundamental uncertainty into the discussion below of etiology, treatment options, recovery patterns etc. See also the section below on Other symptoms. Studies   show that a large number of patients (45%) are not referred to a specialist, which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. A significant number of cases are misdiagnosed (ibid.). This is unsurprising from a diagnosis of exclusion, which depends on a thorough investigation.

Risk Factors:–
Although a mild case of Bell’s palsy normally disappears within a month, recovery from a case involving total paralysis varies. Complications may include:

*Irreversible damage to your facial nerve
*Misdirected regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you’re trying to move others (synkinesis) — for example, when you smile, the eye on the affected side may close
*Partial or complete blindness of the eye that won’t close, due to excessive dryness and scratching of the cornea, the clear protective covering of the eye.

Treatment:=
In patients presenting with incomplete facial palsy, where the prognosis for recovery is very good, treatment may be unnecessary. Patients presenting with complete paralysis, marked by an inability to close the eyes and mouth on the involved side, are usually treated. Early treatment (within 3 days after the onset) is necessary for therapy to be effective.[9] Steroids have been shown to be effective at improving recovery while antivirals have not.

Steroids
Corticosteroid such as prednisone significantly improves recovery at 6 months and are thus recommended.

Antivirals
Antivirals (such as acyclovir) are ineffective in improving recovery from Bell’s palsy beyond steroids alone. They were however commonly prescribed due to a theoretical link between Bell’s palsy and the herpes simplex and varicella zoster virus.

Physical therapy
Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery
One way to relieve the pressure on the facial nerve is to surgically open the bony passage through which it passes. This decompression surgery is controversial and rarely recommended. In some cases, however, plastic surgery may be needed to make your face look and work better.

Home Remedy  & Lyfe Style:–
Home treatment may include:
*Protecting the eye you can’t close. Using lubricating eyedrops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched.

*Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help ease your pain.

*Applying moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.

*Doing your physical therapy exercises. Massaging and exercising your face according to your physical therapist’s advice may help relax your facial muscles.

Alternative medicine:–
Although there’s little scientific evidence to support the use of alternative medicine for people with Bell’s palsy, some people with the condition may benefit from the following:

*Relaxation techniques, such as meditation and yoga, may relieve muscle tension and chronic pain.

*Acupuncture, placing thin needles into your skin to relieve pain, may stimulate nerves and muscles, offering some relief.(The efficacy of acupuncture remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).

*Biofeedback training, by teaching you to use your thoughts to control your body, may help you gain better control over your facial muscles.

*Vitamin therapy — specifically B-12, B-6 and zinc — may help nerve growth

Prognosis:
Even without any treatment, Bell’s palsy tends to carry a good prognosis. In a 1982 study, when no treatment was available, of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later. After a follow-up of at least 1 year or until restoration, complete recovery had occurred in more than two thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients. Another study found that incomplete palsies disappear entirely, nearly always in the course of one month. The patients who regain movement within the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop sequelae. A third study found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis.

Major complications of the condition are chronic loss of taste (ageusia), chronic facial spasm and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete paralysis. Where the eye does not close completely, the blink reflex is also affected, and care must be taken to protect the eye from injury.

Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections that branch out to their proper destinations. During regrowth, nerves are generally able to track the original path to the right destination – but some nerves may sidetrack leading to a condition known as synkinesis. For instance, regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. For example, when the person closes the eye, the corner of the mouth lifts involuntarily.

In addition, around 6%[citation needed] of patients exhibit crocodile tear syndrome, also called gustatolacrimal reflex or Bogorad’s Syndrome, on recovery, where they will shed tears while eating. This is thought to be due to faulty regeneration of the facial nerve, a branch of which controls the lacrimal and salivary glands. Gustatorial sweating can also occur.

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://en.wikipedia.org/wiki/Bell’s_palsy
http://www.mayoclinic.com/health/bells-palsy/DS00168
http://www.webmd.com/brain/tc/bells-palsy-treatment-overview

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Cat-Scratch Disease

Definition:
Cat-scratch disease is an infection caused by bacteria (germs) carried in cat saliva. The bacteria can be passed from a cat to a human. Doctors and researchers think cats may get the bacteria from fleas, although this hasn’t been proved.

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.You can get cat-scratch disease from a cat bite or cat scratch. You can get the infection after a cat scratches you if the cat’s paws have the bacteria on them. (A cat can get the bacteria on its paws when it licks itself.) With a cat bite, the cat can pass the bacteria to you in its saliva. You can also get the bacteria in your eyes if you pet a cat that has the bacteria on its fur and then rub your eyes. Many people who get cat-scratch disease do not remember being scratched or bitten by a cat.

Cat-scratch disease is not a severe illness in people who are healthy. But it can be a problem in people with weak immune systems. People with weak immune systems include those who are receiving chemotherapy for cancer, those who have diabetes or those who have acquired immunodeficiency syndrome (AIDS).

It is a bacterial disease caused by Bartonella henselae. Most people with CSD have been bitten or scratched by a cat and developed a mild infection at the point of injury. Lymph nodes, especially those around the head, neck, and upper limbs, become swollen. Additionally, a person with CSD may experience fever, headache, fatigue, and a poor appetite. Rare complications of B. henselae infection are bacillary angiomatosis and Parinaud’s oculolandular syndrome.


Other Names:
The condition has also been termed Cat-Scratch Adenitis, Cat-Scratch-Oculoglandular Syndrome, Debre’s Syndrome, Debre-Mollaret Syndrome, Foshay-Mollaret Cat-Scratch Fever, Foshay-Mollaret syndrome, Foshay-Mollaret Cat-Scratch Fever Syndrome, Lymphadenitis-Regional Non-bacterial, Lymphoreticulosis-Benign Inoculation, maladie des griffes du chat, Parinaud oculoglandular disease, and Petzetakis’ disease.CSD; Cat scratch fever; Bartonellosis

Transmission
The cat was recognized as the vector of the disease in 1950 by Dr. Robert Debré.

The causative organism was first thought to be Afipia felis, but this was disproved by immunological studies demonstrating that cat scratch fever patients developed antibodies to two other organisms, Bartonella henselae and Bartonella clarridgeiae, which are rod-shaped Gram negative bacteria.

Kittens are more likely to carry the bacteria in their blood, and are therefore more likely to transmit the disease than are adult cats.

Ticks are also a major transmitter of this disease. It is often transmitted at the same time a human may get Lyme Disease.

Causes :

Cat scratch disease is caused by Bartonella henselae. The disease is spread through contact with an infected cat (a bite or scratch), or contact with cat saliva on broken skin or the white of the eye.

About 2 – 3 weeks after becoming infection, lymph nodes swelling (lymphadenopathy) occurs near the site of the scratch or bite.

Occasionally, an infected lymph node may form a tunnel (fistula) through the skin and drain. Cat scratch disease is a common causes of chronic lymph node swelling in children.

Sign & Symptoms:

A person who has had contact with a cat may show common symptoms, including:

* Bump (papule) or blister (pustule) at site of injury (usually the first sign)
* Lymph node swelling near the scratch or bite
* Fever (in some patients)
* Fatigue
* Overall discomfort (malaise)
* Headache

Less common symptoms may include:

* Loss of appetite
* Weight loss
* Enlarged spleen
* Sore throat
* Draining lymph nodes
A sore may develop where a cat has bitten or scratched you. The sore might not happen right away. It may take 3 to 10 days for the sore to appear after the bite or scratch.

The sore may take a long time to heal. An infection of the lymph nodes (also called lymph glands) also develops, most often in the glands that are near the place where you got the cat scratch or cat bite. For example, if the infection is from a cat scratch on your arm, the glands in your armpit may become tender and swollen. The lymph nodes may swell to an inch or more in size.

Cat scratch fever presents with tender regional lymphadenopathy, sterile suppurative papules at the site of inoculation, slight fever, headache, chills, backache, abdominal pain, malaise, alteration of mental status, and convulsions. It may take 7 to 14 days, or as long as two months, before symptoms appear. Most cases are benign and self-limiting, but lymphadenopathy may persist for several months after other symptoms disappear. The prognosis is generally favorable. In temperate climates, most cases occur in fall and winter. The disease usually resolves spontaneously, with or without treatment, in one month. In immunocompromised patients more severe complications sometimes occur.

Exams and Tests :

A scratch or injury and a history of contact with a cat indicates that cat scratch disease is a possible cause of the lymph node swelling. In some cases, physical examination also shows an enlarged spleen (splenomegaly).

The disease often goes unrecognized because of the difficulty in testing. However, the Bartonella henselae IFA test is highly sensitive and specific for the detection of infection caused by this bacteria.

Other tests used in the diagnosis of cat scratch disease:

* Lymph node biopsy to rule out other causes of swollen glands

When to call a Doctor?
Call your family doctor if you notice any of the following problems:

* A cat scratch or bite that does not heal in the usual length of time.
* An area of redness around a cat scratch or bite that continues to get bigger for more than 2 days after the injury.
* Fever that lasts for several days after a cat scratch or bite.
* Painful and swollen lymph nodes for more than 2 or 3 weeks.
* Bone or joint pain, abdominal pain (without fever, vomiting or diarrhea) or an unusual degree of tiredness for more than 2 or 3 weeks.

Treatment:

In AIDS patients and in other people who have suppressed immune systems, cat scratch disease is more serious, and treatment with antibiotics is recommended.

Azithromycin, ciprofloxacin, doxycycline, and multiple other antibiotics have been used successfully.

In most people, cat-scratch disease clears up without treatment. However, antibiotics (medicines that kill bacteria) may be needed when infected lymph nodes stay painful and swollen for more than 2 or 3 months. Antibiotics may also help if you have a fever for a long time or if the infection is in your bones, liver or another organ.

If a lymph node is very large or painful, your doctor may drain it to help relieve the pain. The lymph node is drained by putting a needle through normal skin off to the side of the node and moving the needle to the swollen node. The needle is then inserted into the node and the fluid in the node is drained out.

Treatment for the cat:

Cats require no treatment. The bacteria doesn’t cause cats to get sick. They merely carry the bacteria that causes cat-scratch disease in people.

Resources:
http://familydoctor.org/online/famdocen/home/healthy/firstaid/bites/024.html
http://www.nlm.nih.gov/medlineplus/ency/article/001614.htm
http://en.wikipedia.org/wiki/Cat_scratch_fever

Prognosis:

In children with normal immune systems, full recovery without treatment is the norm. In immunocompromised people, treatment with antibiotics generally leads to recovery.

Possible Complications:

* Parinaud’s syndrome
* Encephalopathy
* Neuroretinitis
* Osteomyelitis


Prevention:

Avoiding contact with cats prevents the disease. Where this is not reasonable, good hand-washing after playing with a cat, avoiding scratches and bites, and avoiding cat saliva will lessen the risk of infection.

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://familydoctor.org/online/famdocen/home/healthy/firstaid/bites/024.html
http://www.nlm.nih.gov/medlineplus/ency/article/001614.htm
http://en.wikipedia.org/wiki/Cat_scratch_fever

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Bell’s Palsy

Other Name: Facial Palsy

Definition:
Bell’s palsy is a paralysis of the facial nerve resulting in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell’s Palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell’s palsy is the most common acute mononeuropathy (disease involving only one nerve), and is the most common cause of acute facial nerve paralysis.

Bell’s palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day.

It is thought that an inflammatory condition leads to swelling of the facial nerve (nervus facialis). The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell’s palsy has been found, but clinical and experimental evidence suggests herpes simplex type 1 infection may play a role.

Doctors may prescribe anti-inflammatory and anti-viral drugs. Early treatment is necessary for the drug therapy to have effect. The effect of treatment is still controversial. Most people recover spontaneously and achieve near-normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment.

Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision.

For many people, the first guess would be a stroke. But if your muscle weakness or paralysis affects only your face, a more likely cause is Bell’s palsy.

Each year, about 40,000 Americans develop Bell’s palsy, a condition that occurs when the nerve that controls the facial muscles becomes swollen or compressed. The problem can occur at any age, but rarely affects people under the age of 15 or over the age of 60.

For most people, Bell’s palsy symptoms begin to improve within a few weeks, with complete recovery within three to six months. Between 8 percent and 10 percent will experience a recurrence of the signs and symptoms, sometimes on the opposite side of the face. And a small number of people never recover and continue to have some signs and symptoms for life.

Investigation:
Bell’s palsy (or facial palsy) is characterized by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. Facial palsy is typified by inability to control movement in the facial muscles. The paralysis is of the infranuclear/lower motor neuron type.

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Click to learn more about Bell’s Polsy ( Facial nerve & how it works etc.)

The facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, and salivation. They also innervate the stapedial (stapes) muscles of the middle ear and carry taste sensations from the anterior two thirds of the tongue.

Clinicians should determine whether all branches of the facial nerve are involved, or whether the forehead muscles are spared. Since forehead muscles receive innervation from both sides of the brain, the forehead can still be wrinkled by a patient whose facial palsy is caused by a problem in the brain (central facial palsy) but not if the problems resides in the facial nerve itself (peripheral palsy).

One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. The major differences in this condition are the presence of small blisters, or vesicles, of the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete).

Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy.
Signs and symptoms:

Signs and symptoms of Bell’s palsy may include:

*Sudden onset of paralysis or weakness on one side of your face, making it difficult to smile or close your eye on the affected side

*Facial droop and difficulty with facial expressions

*Pain behind or in front of your ear on the affected side

*Sounds that seem louder on the affected side

*Pain, usually in the ear on the affected side

*Headache

*Loss of taste

*Changes in the amount of tears and saliva your body produces

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Other symptoms are:
Although defined as a mononeuritis (involving only one nerve), patients diagnosed with Bell’s palsy may have “myriad neurological symptoms” including “facial tingling, moderate or severe headache/neck pain, memory problems, balance problems, ipsilateral limb paresthesias, ipsilateral limb weakness, and a sense of clumsiness” that are “unexplained by facial nerve dysfunction”. This is yet an enigmatic facet of this condition.

Causes:
It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell’s palsy per se. Possible causes include tumor, meningitis, stroke, diabetes mellitus, head trauma and inflammatory diseases of the cranial nerves (sarcoidosis, brucellosis, etc.). In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy, and they exhibit many of the same symptoms as people with Bell’s palsy; this is often due to a traumatic birth which causes irreparable damage to the facial nerve, i.e. acute facial nerve paralysis.

In some research the herpes simplex virus type 1 (HSV-1) was identified in a majority of cases diagnosed as Bell’s palsy. This has given hope for anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir). Other research[3] however, identifies HSV-1 in only 31 cases (18 percent), herpes zoster (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases clinically diagnosed as Bell’s Palsy,. That infection with herpes simplex virus should play a major role in cases diagnosed as Bell’s palsy therefore remains a hypothesis that requires further research.

The herpes simplex virus type 1 (HSV-1) infection is associated with demyelination of nerves. This nerve damage mechanism is different from the above mentioned – that oedema, swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage. Demyelination may not even be directly caused by the virus, but by an unknown immune system response. The quote below captures this hypothesis and the implication for other types of treatment:

It is also possible that HSV-1 replication itself is not responsible for the damage to the facial nerves and that inhibition of HSV-1 replication by acyclovir does not prevent the progression of nerve dysfunction. Because the demyelination of facial nerves caused by HSV-1 reactivation, via an unknown immune response, is implicated in the pathogenesis of HSV-1-induced facial palsy, a new strategy of treatment to inhibit such an immune reaction may be effective.

Virus reactivation
Some viruses are thought to establish a persistent (or latent) infection without symptoms, e.g. Epstein-Barr virus of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested as cause behind the acute Bell’s palsy. Studies suggest that this new activation could be preceded by trauma, environmental factors, and metabolic or emotional disorders, thus suggesting that stress – emotional stress, environmental stress (e.g. cold), physical stress (e.g. trauma) – in short, a host of different conditions, may trigger reactivation.

Smile with Bell’s palsy..

The most common cause of Bell’s palsy appears to be the herpes simplex virus, which also causes cold sores and genital herpes. Other viruses that have been linked to Bell’s palsy include the virus that causes chickenpox and shingles (herpes zoster), the virus that causes mononucleosis (Epstein-Barr), and another virus in the same family (cytomegalovirus).

Diagnosis:
There is no specific laboratory test to confirm a diagnosis of Bell’s palsy. Your doctor may be able to make a preliminary diagnosis of Bell’s palsy by looking at your face and asking you to try to move your facial muscles.

Other conditions — such as a stroke, infections and tumors — also may cause facial muscle weakness, mimicking Bell’s palsy. If after a few days there’s still doubt about the diagnosis, your doctor may recommend other tests:

Electromyography (EMG). This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.
Imaging scans. An X-ray, magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to eliminate other possible sources of pressure on the facial nerve, such as an infection, tumor or skull fracture.

Bell’s palsy is a diagnosis of exclusion; by elimination of other reasonable possibilities. Therefore, by definition, no specific cause can be ascertained. Bell’s palsy is commonly referred to as idiopathic or cryptogenic, meaning that it is due to unknown causes. Being a residual diagnostic category, the Bell’s Palsy diagnosis likely spans different conditions which our current level of medical knowledge cannot distinguish. This may inject fundamental uncertainty into the discussion below of etiology, treatment options, recovery patterns etc. See also the section below on Other symptoms. Studies[1] show that a large number of patients (45%) are not referred to a specialist, which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. A significant number of cases are misdiagnosed (ibid.). This is unsurprising from a diagnosis of exclusion, which depends on a thorough investigation.

Treatment:
Most people with Bell’s palsy recover fully — with or without treatment. But your doctor may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell’s palsy.

Treatment is a matter of controversy. In patients presenting with incomplete facial palsy, where the prognosis for recovery is very good, treatment may be unnecessary. However, patients presenting with complete paralysis, marked by an inability to close the eyes and mouth on the involved side, are usually treated with anti-inflammatory corticosteroids. Prednisolone, a corticosteroid, if used early in treatment of Bell’s palsy, significantly improves the chances of complete recovery at 3 and 9 months when compared to treatment with acyclovir, an anti-viral drug, or no treatment at all. The likely association of Bell’s palsy with the herpes virus has led most American neurologists to prescribe a course of anti-viral medication (such as acyclovir) to all patients with unexplained facial palsy, although a large study showed no additional benefit from acyclovir beyond that from prednisolone alone. Surgical procedures to decompress the facial nerve have been attempted, but have not been proven beneficial. Acupuncture has also been studied, with inconclusive results.

A practice parameter from the American Academy of Neurology states that “corticosteroids are safe and probably effective, and that acyclovir is safe and possibly effective”. Early treatment (ie, within 3 days after the onset) is necessary for acyclovir-prednisone therapy to be effective. If the patient presents 10 days after the onset of symptoms, no drug treatment is necessary. (ibid.)

Medications:
Study results have been mixed regarding the effectiveness of two types of drugs commonly used to treat Bell’s palsy — corticosteroids and antiviral medications.

Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, it will fit more comfortably within the bony corridor that surrounds it. If Bell’s palsy is triggered by a virus, then an antiviral drug — such as acyclovir or valacyclovir — may stop the progression of the viral infection.

Some clinical studies show benefit from early treatment with corticosteroids, antivirals or a combination of both types of drugs. Other studies do not. Evidence of the effectiveness of corticosteroids appears to be stronger than that for antiviral drugs.

Physical therapy :
Paralyzed muscles can shrink and shorten, causing permanent contractures. Massaging and exercising your facial muscles may help prevent this from occurring. Moist heat may help relieve pain.

Alternative medication:

Some people with Bell’s palsy may benefit from:

*Relaxation techniques
*Acupuncture
*Biofeedback training
*Vitamin therapy — specifically B-12, B-6 and zinc
*In traditional Chinese medicine, Bell’s palsy is attributed to a “wind cold” attack brought about by exposure to wind.

Recovery:
Even without any treatment, Bell’s palsy tends to carry a good prognosis. In a study of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later. After a follow-up of at least 1 year or until restoration, complete recovery had occurred in more than two thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients. Another study finds that incomplete palsies disappear entirely, nearly always in the course of one month. The patients who regain movement within the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop sequelae. A third study found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis.

Self-care:
If you can’t close your eye, you’ll need to keep the eye moist with hourly eyedrops during the day and an eye ointment at night. If the clear protective covering of the eye — called the cornea — becomes too dry, it can cause permanent vision loss. Your doctor may want you to wear glasses or goggles during the day and an eye patch at night to protect your eye from getting poked or scratched.

Complications:
Major complications of the condition are chronic loss of taste (ageusia), chronic facial spasm and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete paralysis. Where the eye does not close completely, the reflex is also affected; great care should be taken to protect the eye from injury.

Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections which branch out to their proper destinations. During regrowth, nerves are generally able to track the original path to the right destination – but some nerves may sidetrack leading to a condition known as synkinesis. For instance, regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. For example, when the person closes the eye, the corner of the mouth lifts involuntarily.

In addition, around 6% of patients exhibit crocodile tear syndrome on recovery, where they will shed tears while eating. This is thought to be due to faulty regeneration of the facial nerve, a branch of which controls the lacrimal and salivary glands.

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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://en.wikipedia.org/wiki/Bell’s_palsy
http://www.mayoclinic.com/health/bells-palsy/

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Ailmemts & Remedies

Tick-Borne Disease

Tick-borne diseases are diseases or illnesses transmitted by ticks. As the incidence of tick-borne illnesses increases and the geographic areas in which they are found expand, it becomes increasingly important that health professionals be able to distinguish the diverse, and often overlapping, clinical presentations of these diseases.

Adult Female Deer Tick
Deer ticks are responsible for causing Lyme disease, babesiosis and anaplasmosis (formerly human granulocytic ehrlichiosis

Adult Female Dog Tick
Dog ticks are responsible for causing Rocky Mountain spotted fever and certain types of tularemia.

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.Tick-borne illnesses are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. Because ticks can harbor more than one disease-causing agent, patients can be infected with more than one pathogen at the same time, compounding the difficulty in diagnosis and treatment.

In general, specific laboratory tests are not available to rapidly diagnose tick-borne diseases. Due to their seriousness, antibiotic treatment is often justified based on clinical presentation alone.

Major tick-borne diseases include:

*Lyme disease

Organism: Borrelia burgdorferi sensu lato (bacterium)
Vector: deer tick (Ixodes scapularis (=I. dammini), I. pacificus, I. ricinus (Europe), I. persulcatus (Asia))
Endemic to: North America and Eurasia

*Tick-borne meningoencephalitis

Organism: TBEV aka FSME virus, a flavivirus
Vector: deer tick (Ixodes scapularis)
Endemic to: Europe and Northern Asia

*Rocky Mountain Spotted Fever

Organism: Rickettsia rickettsii
Vector: Dermacentor variabilis, D. andersoni
Region (US): East, South West
Vector: Amblyomma cajennense
Region (Brazil): São Paulo, Rio de Janeiro, Minas Gerais.

*Babesiosis

Organism: Babesia microti, B. equi
Vector: I. scapularis, I. pacificus
Region (US): Northeast West Coast

*Ehrlichiosis anaplasmosis (formerly human granulocytic ehrlichiosis or HGE)

Organism: Ehrlichia chaffeensis, E. equi (renamed to Anaplasma phagocytophilum)
Vector: Amblyomma americanum, I. scapularis
Region (US): South-Atlantic South-Central

*Relapsing fever

Organism: Borrelia species
Vector: Ornithodoros species
Region (US): West

*Colorado tick fever

Organism: Coltivirus
Vector: D. andersoni
Region (US): West

*Tularemia

Organism: Francisella tularensis, A. americanum
Organism: D. andersoni, D. variabilis
Region (US): Southeast, South-Central, West, Widespread

*Tick paralysis

Cause: Toxin
Vector: D. andersoni, D. variabilis West
Region (US): East
*Cytauxzoonosis
Organism: C. felis
Vector: D. variabilis (American Dog Tick)
Region (US): South, Southeast

Click to learn more about Tickborne Diseases.…….(1)…...(2).…..(3)

Sources:http://en.wikipedia.org/wiki/Tick-borne_disease

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