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Strep throat

Other Names:
Streptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat

Definition:
Strep throat is a disease that causes a sore throat (pharyngitis). It is an infection with a germ called Group A Streptococcus bacteria.  Only a small portion of sore throats are the result of strep throat.

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It  is a contagious infection, spread through close contact with an infected individual.  this is not always needed as treatment may be decided based on symptoms. In highly likely or confirmed cases, antibiotics are useful to both prevent complications and speed recovery.

It’s important to identify strep throat for a number of reasons. If untreated, strep throat can sometimes cause complications such as kidney inflammation and rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a rash and even damage to heart valves.

Strep throat is most common between the ages of 5 and 15, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt treatment.

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Symptoms:
Symptoms may be mild or severe.One will often start to feel sick about 2 to 5 days after he or she  come in contact with the strep germ.

Fever may begin suddenly and is often highest on the second day. You may have chills.

You can have a red sore throat, sometimes with white patches. It may hurt to swallow. You may feel swollen, tender glands in your neck.

Other symptoms may include:
*General ill feeling, a loss of appetite and abnormal taste & Fever
*Headache
*Nausea
*Throat pain
*Difficulty swallowing
*Red and swollen tonsils, sometimes with white patches or streaks of pus
*Tiny red spots on the soft or hard palate — the area at the back of the roof of the mouth
*Swollen, tender lymph glands (nodes) in your neck
*Headache
*Rash
*Stomachache and sometimes vomiting, especially in younger children
*Fatigue

It’s possible for you or your child to have many of these signs and symptoms, but not have strep throat. The cause of these signs and symptoms could be a viral infection or some other kind of illness. That’s why your doctor generally tests specifically for strep throat.

It’s also possible to have the bacteria that can cause strep in your throat without having a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria are not currently making them sick.

Some strains of strep throat can lead to a scarlet fever-like rash. The rash first appears on the neck and chest. Then it spreads over the body. It may feel like sandpaper.

Causes:
Strep throat is caused by group A beta-hemolytic streptococcus (GAS). Other bacteria such as non–group A beta-hemolytic streptococci and fusobacterium may also cause pharyngitis. It is spread by direct, close contact with an infected person and thus crowding as may be found in the military and schools increases the rate of transmission. It has been found that dried bacteria in dust are not infectious, although moist bacteria on toothbrushes or similar items can persist for up to fifteen days. Rarely, contaminated food can result in outbreaks. Of children with no signs or symptoms 12% carry GAS in their pharynx and after treatment approximately 15% remain carriers.

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Diagnosis:
The modified Centor criteria maybe used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.

One point is given for each of the criteria:

*Absence of a cough
*Swollen and tender cervical lymph nodes
*Temperature >38.0 °C (100.4 °F)
*Tonsillar exudate or swelling
*Age less than 15 (a point is subtracted if age >44)

The Infectious Disease Society of America however recommends against empirical treatment and considers antibiotics only appropriate following positive testing. Testing is not needed in children under three as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.

Laboratory testing:
A throat culture is the gold standard for the diagnosis of streptococcal pharyngitis with a sensitivity of 90–95%. A rapid strep test (also called rapid antigen detection testing or RADT) may also be used. While the rapid strep test is quicker, it has a lower sensitivity (70%) and statistically equal specificity (98%) as throat culture.

A positive throat culture or RADT in association with symptoms establishes a positive diagnosis in those in which the diagnosis is in doubt. In adults a negative RADT is sufficient to rule out the diagnosis however in children a throat culture is recommended to confirm the result. Asymptomatic individuals should not be routinely tested with a throat culture or RADT because a certain percentage of the population persistently “carries” the streptococcal bacteria in their throat without any harmful results.

Differential diagnosis:
As the symptoms of streptococcal pharyngitis overlap with other conditions it can be difficult to make the diagnosis clinically. Coughing, nasal discharge, diarrhea, and red, irritated eyes in addition to fever and sore throat are more indicative of a viral sore throat than of strep throat. The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in infectious mononucleosis.

Possible Complications & Risk Factors:

*Acute rheumatic fever….click to see
*Scarlet fever
*Streptococcal toxic shock syndrome
*Glomerulonephritis
*Ear infection
*Glomerulonephritis
*Guttate psoriasis
*Mastoiditis
*Peritonsillar abscess
*Sinusitis

Treatment:
A number of medications are available to cure strep throat, relieve its symptoms and prevent its spread.

Antibiotics:
If you or your child has strep throat, your doctor will likely prescribe an oral antibiotic such as:
Penicillin. This drug may be given by injection in some cases — such as if you have a young child who is having a hard time swallowing or is vomiting.
Amoxicillin. This drug is in the same family as penicillin, but is often a preferred option for children because it tastes better and is available as a chewable tablet.

If you or your child is allergic to penicillin, your doctor likely may prescribe:
A cephalosporin such as cephalexin (Keflex)
Clarithromycin (Biaxin)
Azithromycin (Zithromax, Zmax)
Clindamycin

These antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to classmates or family members.

Once treatment begins, you or your child should start feeling better in just a day or two. Call your doctor if you or your child doesn’t feel better after taking antibiotics for 48 hours.

If children taking antibiotic therapy feel well and don’t have a fever, they often can return to school or child care when they’re no longer contagious — usually 24 hours after beginning treatment. But be sure to finish the entire course of medicine. Stopping medication early may lead to recurrences and serious complications, such as rheumatic fever or kidney inflammation.

Untreated streptococcal pharyngitis usually resolves within a few days. Treatment with antibiotics shortens the duration of the acute illness by about 16 hours. The primary reason for treatment with antibiotics is to reduce the risk of complications such as rheumatic fever and retropharyngeal abscesses and they are effective if given within 9 days of the onset of symptoms

Analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) help significantly in the management of pain associated with strep throat. Viscous lidocaine may also be useful. While steroids may help with the pain they are not routinely recommended. Aspirin may be used in adults but is not recommended in children due to the risk of Reye’s syndrome.

Prognosis:
The symptoms of strep throat usually improve irrespective of treatment within three to five days. Treatment with antibiotics reduces the risk of complications and transmission; children may return to school 24 hours after antibiotics are administered. The risk of complications in adults is low. In children acute rheumatic fever is rare in most of the developed world. It is however the leading cause of acquired heart disease in India, sub-Saharan Africa and some parts of Australia.

Prevention:
Tonsillectomy may be a reasonable preventive measure in those with frequent throat infections (more than three a year). The benefits are however small and episodes typically lessen in time regardless of measures taken. Recurrent episodes of pharyngitis which test positive for GAS may also represent a person who is a chronic carrier of GAS who is getting recurrent viral infections. Treating people who have been exposed but who are without symptoms is not recommended. Treating people who are carriers of GAS is not recommended as the risk of spread and complications is low.

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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/Streptococcal_pharyngitis
http://www.nlm.nih.gov/medlineplus/ency/article/000639.htm
http://ww.mayoclinic.com/health/strep-throat/DS00260

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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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Group B Streptococcus (GBS) Infection

Definition:
Infection with Group B Streptococcus (GBS), also known as ‘Streptococcus agalactiae’ and more colloquially as Strep B and group B Strep, can cause serious illness and sometimes death, especially in newborn infants, the elderly, and patients with compromised immune systems. Group B streptococci are also prominent veterinary pathogens, because they can cause bovine mastitis (inflammation of the udder) in dairy cows. The species name “agalactiae” meaning “no milk”, alludes to this.

Streptococcus is a genus of spherical, Gram-positive bacteria of the phylum Firmicutes. Streptococcus agalactiae is a gram-positive streptococcus characterized by the presence of Group B Lancefield antigen, and so takes the name Group B Streptococcus.

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This type of bacteria (not to be confused with group A strep which causes “strep throat”) is commonly found in the human body, and it usually does not cause any symptoms. However, in certain cases it can be a dangerous cause of various infections that affect pregnant women & their newborns .

Group B streptococcal infections affect one in 2,000 babies born every year in the UK and Ireland. About 340 babies a year will develop group B streptococcal infection within seven days of birth (early group B streptococcus disease).

Causes:
The bacteria is found living harmlessly in the vaginal and gastrointestinal tracts of up to 50 per cent of healthy women (and in many men too). It may be passed on to a baby either while the baby is still in the womb or during delivery. Although about 50 per cent of babies born to mothers carrying group B streptococcus pick up the micro-organism, only about one to two per cent of these newborns then go on to develop severe group B streptococcal disease.

Group B streptococcal sepsis is most likely to develop when the baby is premature or if there has been prolonged rupture of the membranes, with many hours passing before the baby is born, or if the baby has no antibodies to group B streptococci.

In the last 30 years it’s been show to be a cause of serious infection in non-pregnant adults too. It’s extremely rare in healthy people and is almost always associated with underlying problems such as diabetes or cancer, or less often, problems with:

•Heart and blood vessels
•Genitourinary system
•Liver disease
•Kidney disease

About five per cent of affected adults will eventually experience a second episode of group B streptococcal disease.

How is group B strep transmitted?
In newborns, GBS infection is acquired through direct contact with the bacteria while in the uterus or during delivery; thus the infection is transmitted from the colonized mother to her newborn. However, not every baby born to a colonized mother will develop GBS infection. Statistics show that about one of every 100-200 babies born to a GBS-colonized mother will develop GBS infection.

There are maternal risk factors, however, that increase the chance of transmitting the disease to the newborn:

•labor or membrane rupture before 37 weeks
•membrane rupture more than 18 hours before delivery
•urinary tract infection with GBS during pregnancy
•previous baby with GBS infection
•fever during labor
•positive culture for GBS colonization at 35-37 weeks
.
Group B strep infection is not a sexually transmitted disease (STD).

Symptoms :
If a pregnant woman is carrying (or ‘colonised with’) group B streptococcus, there is a chance she could pass it to her unborn baby. Most babies will not be harmed and will simply carry the bacteria themselves, but it can cause:

•Early birth
•Stillbirth
•Late miscarriage and complications
Group B streptococcal disease in newborns is divided into early and late disease. Early group B streptococcal neonatal sepsis appears within 24 hours of delivery (and up to seven days afterwards) and accounts for over 80 per cent of cases. Typically it causes signs of pneumonia (breathing problems) or, less often, meningitis. Most of these babies will make a full recovery.

Late group B streptococcal neonatal sepsis appears between one week and three months after birth, and is more likely to cause meningitis. One in ten infected babies will die of blood poisoning, pneumonia or meningitis, while one in five will be affected permanently by cerebral palsy, blindness, deafness or serious learning difficulties.

Once a baby has reached three months of age, group B streptococcal infection is extremely rare.

In vulnerable adults, group B streptococcus can cause a range of different infections at different sites in the body.

Diagnosis:
In pregnant women, routine screening for colonization with GBS is recommended. This test is generally performed between 35-37 weeks of gestation. The test involves using a swab to collect a sample from both the vaginal and rectal area, and results are usually available within 24-72 hours.

In newborns, GBS infection can be diagnosed with blood tests and/or spinal-fluid analysis. Similar testing may be used to diagnose the disease in adults.

Treatment:
For women who test positive for GBS during pregnancy and for those with certain risk factors for developing or transmitting GBS infection during pregnancy, intravenous antibiotics are generally recommended at the time of labor (before delivery). The administration of antibiotics has been shown to significantly decrease GBS infection in newborns. If a pregnant carrier of GBS receives intravenous antibiotics prior to delivery, her baby has a one in 4,000 chance of developing GBS infection. Without antibiotics, her baby has a one in 200 chance of developing GBS infection.

In adults who develop GBS infection, whether they are pregnant women or individuals with chronic medical conditions, intravenous(IV) antibiotics are also recommended.

At this point in time, the best treatment for GBS infection is prevention through routine screening during pregnancy. This testing has served to decrease the overall number of GBS infections in newborns, and there is currently research underway to develop a GBS vaccine.

Should all at-risk women be treated?
Some women prefer not to receive antibiotics if their risk is only slightly increased. Experts advise that the risk of infection in the baby must be balanced against the wishes and beliefs of the woman in labour and against her risk of an adverse reaction to the antibiotics. If a group B streptococcus carrying woman had a healthy baby in a previous pregnancy, she is unlikely to be at greater risk with following pregnancies.

Scientists are trying to develop a vaccine for group B streptococcus, but technical problems mean that it’s likely to be some years before one is available.

Prevention:
Through collaborative efforts clinicians, researchers, professional organizations, parent advocacy groups, and the public health community developed recommendations for intrapartum prophylaxis to prevent perinatal GBS disease. Many organizations have developed perinatal GBS disease prevention and education programs to reduce the incidence of the disease. Information about the recommendations and the prevention programs can be found in medical journals and on the internet. Simple anti-septic wipes do not prevent mother-to-child transmission

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.medicinenet.com/group_b_strep/article.htm
http://www.bbc.co.uk/health/physical_health/conditions/group_b_streptococcus_infection.shtml
http://en.wikipedia.org/wiki/Group_B_streptococcal_infection
http://www.trying-to-conceive.com/pregnancy/preventing-group-b-strep-%E2%80%93-is-it-possible/
http://www.medicaldaily.com/news/20110211/5422/third-trimester-group-b-streptococcus-test-doesnt-accurately-predict-presence-during-labor.htm

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Toxic Shock Syndrome

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Definition:-
Toxic shock syndrome (TSS) is a very rare but potentially fatal illness caused by a bacterial toxin. Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative bacteria include Staphylococcus aureus and Streptococcus pyogenes. Streptococcal TSS is sometimes referred to as toxic shock-like syndrome (TSLS) or Streptococcal Toxic Shock Syndrome (STSS).

TSS, is a serious condition which mainly affects menstruating women using tampons. The patient develops a high fever, diarrhea, vomiting and muscle ache. This is followed by hypotension (low blood pressure), which may eventually lead to shock and death. In some cases there may be a sunburn-like rash with skin peeling.

Experts are not sure why such a significant proportion of toxic shock syndrome patients are women who are menstruating and using a tampon – especially “super absorbent” tampons.

Toxic shock syndrome may also occur as a result of an injury, burn or as a complication of localized infections, such as a boil, as well as with the use of contraceptive sponges.

According to the National Health Service (NHS), UK, approximately 20 patients develop toxic shock syndrome each year in the United Kingdom, of which about 3 die. According to the Centers for Disease Control and Prevention (CDC), USA, toxic shock syndrome affects approximately 1 to 2 in every 100,000 women aged 15-44 years in the USA every year.

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You may click to see the pictures of Toxic Shock Syndrome

Main Routes of infection:-
TSS can occur via the skin (e.g., cuts, surgery, burns), vagina (prolonged tampon exposure), or pharynx. However, most of the large number of individuals who are exposed to or colonized with toxin-producing strains of S. aureus or S. pyogenes do not develop toxic shock syndrome. One reason is that a large percentage of the population have protective antibodies against the toxins that cause TSS. It is not clear why the antibodies are present in people who have never had the disease, but likely that given these bacteria’s pervasiveness and presence in normal flora, minor cuts and such allow natural immunization on a large scale.

It is believed that approximately half the cases of staphylococcal TSS reported today are associated with tampon use during menstruation. However, TSS can also occur in children, men, and non-menstruating women.

Although scientists have recognized an association between TSS and tampon use, no firm causal link has been established. Research conducted by the CDC suggested that use of some high-absorbency tampons increased the risk of TSS in menstruating women. A few specific tampon designs and high-absorbency tampon materials were found to have some association with increased risk of TSS. These products and materials are no longer used in tampons sold in the U.S. (The materials include polyester, carboxymethylcellulose and polyacrylate). Tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.

Toxin production by S. aureus requires a protein-rich environment, which is provided by the flow of menstrual blood, a neutral vaginal pH, which occurs during menstruation, and elevated oxygen levels, which are provided by the tampon that is inserted into the normally anaerobic vaginal environment. Although ulcerations have been reported in women using super-absorbent tampons, the link to menstrual TSS, if any, is unclear. The toxin implicated in menstrual TSS is capable of entering the bloodstream by crossing the vaginal wall in the absence of ulcerations. Women can avoid the risk of contracting TSS by choosing a tampon with the minimum absorbency needed to manage their menstrual flow and using tampons only during active menstruation. Alternately, a woman may choose to use a different kind of menstrual product that may eliminate or reduce the risk of TSS, such as a menstrual cup or sanitary napkin.

History:-
Initial description of toxic shock syndrome
The term toxic shock syndrome was first used in 1978 by a Denver pediatrician, Dr. James K. Todd, to describe the staphylococcal illness in three boys and four girls aged 8–17 years. Even though S. aureus was isolated from mucosal sites in the patients, bacteria could not be isolated from the blood, cerebrospinal fluid, or urine, raising suspicion that a toxin was involved. The authors of the study noted that reports of similar staphylococcal illnesses had appeared occasionally as far back as 1927. But the authors at the time failed to consider the possibility of a connection between toxic shock syndrome and tampon use, as three of the girls who were menstruating when the illness developed were using tampons. Many cases of TSS occurred after tampons were left in the woman using them.

Rely tampons:-
Following a controversial period of test marketing in Rochester, New York and Fort Wayne, Indiana, in August 1978 Procter and Gamble introduced superabsorbent Rely tampons to the United States market in response to women’s demands for tampons that could contain an entire menstrual flow without leaking or replacement. Rely used carboxymethylcellulose (CMC) and compressed beads of polyester for absorption. This tampon design could absorb nearly 20 times its own weight in fluid. Further, the tampon would “blossom” into a cup shape in the vagina in order to hold menstrual fluids without leakage.

Package of Rely Tampons

In January 1980, epidemiologists in Wisconsin and Minnesota reported the appearance of TSS, mostly in menstruating women, to the CDC. S. aureus was successfully cultured from most of the women. A CDC task force investigated the epidemic as the number of reported cases rose throughout the summer of 1980, accompanied by widespread publicity. In September 1980, the CDC reported that users of Rely were at increased risk for developing TSS.

On September 22, 1980, Procter and Gamble recalled Rely following release of the CDC report. As part of the voluntary recall, Procter and Gamble entered into a consent agreement with the FDA “providing for a program for notification to consumers and retrieval of the product from the market.” However, it was clear to other investigators that Rely was not the only culprit. Other regions of the United States saw increases in menstrual TSS before Rely was introduced. It was shown later that higher absorbency of tampons was associated with an increased risk for TSS, regardless of the chemical composition or the brand of the tampon. The sole exception was Rely, for which the risk for TSS was still higher when corrected for its absorbency. The ability of carboxymethylcellulose to filter the S. aureus toxin that causes TSS may account for the increased risk associated with Rely.

By the end of 1980, the number of TSS cases reported to the CDC began to decline. The reduced incidence was attributed not only to the removal of Rely from the market, but also to reduced use of all tampon brands. According to the Boston Women’s Health Book Collective, 942 women were diagnosed with tampon-related TSS in the USA from March 1980 to March 1981, 40 of whom died.

Symptoms:-
Symptoms of toxic shock syndrome vary depending on the underlying cause. TSS resulting from infection with the bacteria Staphylococcus aureus typically manifests in otherwise healthy individuals with high fever, accompanied by low blood pressure, malaise and confusion, which can rapidly progress to stupor, coma, and multi-organ failure. The characteristic rash, often seen early in the course of illness, resembles a sunburn, and can involve any region of the body, including the lips, mouth, eyes, palms and soles. In patients who survive the initial onslaught of the infection, the rash desquamates, or peels off, after 10–14 days.

Signs and symptoms of TSS (toxic shock syndrome) develop suddenly:
Sudden high fever (first symptom) The following signs and symptoms normally appear within a few hours:

*Vomiting
*Diarrhea
*Sunburn-like skin rash, particularly in the palms and soles
*Redness of eyes, mouth and throat
*Fainting
*Feeling faint
*Muscle aches
*Dizziness
*Confusion
*Hypotension (low blood pressure)
*Seizures
*Headaches

Causes of toxic shock syndrome :-
Scientists have been investigating the causes of TSS for over two decades and are still baffled. 20% to 30% of all humans carry the TSS causing bacterium, Staphylococcus aureus on their skin and nose; usually without any complications. Most of us have antibodies which protect us. Scientists believe that some of us do not develop the necessary antibodies.

Some experts suggest that the super-absorbent tampons – the ones that stay inside the body the longest – become breeding grounds for bacteria, while others believe the tampon fibers may scratch the vagina, making it possible for bacteria to get through and into the bloodstream. However, both are just theories without any compelling evidence to back them up.

We do know that the bacteria get into the body via wounds, localized infections, the vagina, the throat or burns. When the toxins (produced by the bacteria) enter the bloodstream they mess up the blood pressure regulating process, resulting in a hypotension (low blood pressure). Hypotension can cause dizziness and confusion (shock). The toxins also attack tissues, including organs and muscles. Kidney failure is a common TSS complication.

TSS does not only develop in young menstruating women. Older women, men and children may also be affected. Women who have been using a diaphragm or a contraceptive sponge have a slightly higher risk of developing TSS. In fact, anyone with a staph or strep infection has the potential to develop TSS (even though it is extremely rare).

Diagnosis:-
In contrast, TSS caused by the bacteria Streptococcus pyogenes, or TSLS, typically presents in people with pre-existing skin infections with the bacteria. These individuals often experience severe pain at the site of the skin infection, followed by rapid progression of symptoms as described above for TSS. In contrast to TSS caused by Staphylococcus, Streptococcal TSS less often involves a sunburn rash.

In either case, diagnosis is based strictly upon CDC criteria modified in 1981 after the initial surge in tampon-associated infections.:

1.Body temperature > 38.9 °C (102.02 °F)
2.Systolic blood pressure < 90 mmHg
3.Diffuse rash, intense erythroderma, blanching (“boiled lobster”) with subsequent desquamation, especially of the palms and soles
4.Involvement of three or more organ systems:

*Gastrointestinal (vomiting, diarrhea)
*Mucous membrane hyperemia (vaginal, oral, conjunctival)
*Renal failure (serum creatinine > 2x normal)
*Hepatic inflammation (AST, ALT > 2x normal)
*Thrombocytopenia (platelet count < 100,000 / mm³)
*CNS involvement (confusion without any focal neurological findings)

To date, there is no specific TSS test. The doctor needs to identify the most common symptoms, as well as checking for signs of organ failure.

*Blood and urine tests – these help determine organ function (or organ failure).

According to the National Health Service (NHS), UK, a confident TSS diagnosis can generally be made when:

*The patient’s temperature is above 38.9C (102.02F)
*The patient’s systolic blood pressure is below 90 mmHG
*The patient has a skin rash
*There is evidence that at least three organs have been affected by the infection

Pathogenesis:-
In both TSS (caused by Staph. aureus) and TSLS (caused by Strep. pyogenes), disease progression stems from a superantigen toxin that allows the non-specific binding of MHC II with T cell receptors, resulting in polyclonal T cell activation. In typical T cell recognition, an antigen is taken up by an antigen-presenting cell, processed, expressed on the cell surface in complex with class II major histocompatibility complex (MHC) in a groove formed by the alpha and beta chains of class II MHC, and recognized by an antigen-specific T cell receptor. By contrast, superantigens do not require processing by antigen-presenting cells but instead interact directly with the invariant region of the class II MHC molecule. In patients with TSS, up to 20% of the body’s T cells can be activated at one time. This polyclonal T-cell population causes a cytokine storm, followed by a multisystem disease. The toxin in S. aureus infections is Toxic Shock Syndrome Toxin-1, or TSST-1.

Treatment:-
The medical team’s aim is to fight the infection as well as supporting any body functions that the infection may have affected. The patient will be hospitalized and may be placed in an intensive care unit.

*Oxygen – the patient will usually be given oxygen to support breathing.

*Fluids – fluids will be administered to prevent dehydration and to bring blood pressure back up to normal.

*Kidneys – a dialysis machine will be used if there is kidney failure. The machine filters toxins and waste out of the bloodstream.

*Other damage – damage to skin, fingers or toes will need to be treated. This often involves draining and cleaning. In severe cases a body extremity or parts of skin may need to be surgically removed.

*Antibiotics – a combination of antibiotics is administered intravenously (directly into the bloodstream).

*Immunoglobulin – these are samples of donated human blood with high levels of antibodies which can fight the toxin. In some cases the medical team may administer immunoglobulin as well as antibiotics.
In the majority of cases the patient responds to treatment within a couple of days. However, he/she may have to stay in hospital for several weeks.

Click to see :->Streptococcal Toxic-Shock Syndrome: Spectrum of Disease, Pathogenesis, and New Concepts in Treatment

Prognosis :-
With proper treatment, patients usually recover in two to three weeks. The condition can, however, be fatal within hours.

Prevention:–
Before going through about possible preventive measures, it is important to remember that the risk of developing TSS is very low. A significant number of experts point to a probably link between tampon absorbency and TSS risk, and advise women to:

*Thoroughly wash their hands before inserting a tampon
*Use the lowest absorbency tampons for their period flow
*Switch from tampons to sanitary towels (or panty liners) during their period
*Change tampons at least as regularly as directed on the pack
*Insert only one tampon at a time (never more than one)
*Insert a fresh tampon when going to bed and replace it immediately in the morning
*Remove the tampon as soon as the period has ended

The Mayo Clinic, USA, advises women to avoid using tampons completely when their flow is very light (use minipads instead).

The National Health Service (NHS), UK, advises that people who have had TSS should avoid using tampons.

Women who use a diaphragm, cap or contraceptive sponge should follow the manufacturer’s instructions carefully (regarding how long to leave the device inside the vagina). The NHS advises women who have had TSS to use an alternative method of contraception.

You may click & see also->

*Necrotizing fasciitis  :
*Septic shock    :
*Toxic headache :

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/Toxic_shock_syndrome
http://www.medicalnewstoday.com/articles/175736.php

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Diagnonistic Test

Rapid Strep Test (RADT)

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For a rapid strep test, the throat and tonsils are swabbed to collect bacteria from the infected area for testing. The bacteria are analyzed to see whether strep (streptococcal) bacteria are causing the sore throat.

.This scanning electron micrograph shows disease-causing Streptococcus bacteria, commonly found in the human mouth, throat, respiratory tract, bloodstream, and wounds. Often airborne in hospitals, schools, and other public places, Streptococcus bacteria are responsible for infections such as strep throat, scarlet fever, and some types of pneumonia.

A throat infection with streptococcus bacteria (called strep throat) needs to be treated with an antibiotic. A test is commonly used to find out whether streptococcus bacteria are present on your throat surface. The traditional test for a strep throat has been a throat culture, which takes two to three days to produce results. Several different types of rapid strep tests, however, can produce results within minutes to hours. A rapid strep test can only detect the presence of Group A strep, the one most likely to cause serious throat infections; it does not detect other kinds of strep or other bacteria.

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A good sample of throat secretions is needed to make sure the test is accurate. A person must remain very still during the procedure so that the doctor is able to collect enough secretions for an accurate test.

The Rapid Strep Test works by detecting the presence of a carbohydrate antigen unique to Group A Streptococcus. This may account for some of the problems with the Rapid Strep Test sensitivity. Gargling, eating or other infusion of liquids into the mouth prior to the test may affect the results. If the test is performed before sufficient organisms are present in the throat, or late in the infection when most of the strep germs have been cleared by the immune system, or if it is performed after someone has been partially treated with antibiotics that kill the organism, then the Rapid Strep Test is less likely to detect the organism.

If the Rapid Strep Test detects strep, the infection should be treated with appropriate antibiotics to prevent long-term damage and sequelae. Should the Rapid Strep Test fail to detect strep throat, the clinician might still treat the throat infection based on his or her own judgment.

How do you prepare for the test?
No preparation is necessary.

When it is required to do?

A rapid strep test may be done in the following cases:

*A person has symptoms of strep throat infection.

*A person has been exposed to strep during an epidemic of rheumatic fever.

The person has a personal or family history of rheumatic fever or other serious infections (such as toxic shock syndrome) and has been exposed to strep. In these cases, if there are no symptoms, a culture may be done first because it is more accurate than a rapid strep test.

In general, it is not necessary to test people who have been exposed to strep throat but do not have any symptoms.

What happens when the test is performed?
A cotton swab is rubbed against the back of your throat to gather a sample of mucus. This takes only a second or two and makes some people feel a brief gagging or choking sensation. The mucus sample is then tested for a protein that comes from the strep bacteria.


Risk factor.:-
There are no risks.

Anything to be done after the test?
Nothing

How long is it before the result of the test is known?
Results may be available in minutes to a few hours. Often the doctor will ask you to wait in the office until the result is back.

Results:-
Findings of a rapid strep test may include the following:

Normal
A normal or negative test means that strep bacteria may not be present.

Sometimes, negative results are wrong. This means that you may have a negative rapid strep test result and still have strep throat.
A throat culture may be done if the rapid strep test result is negative.

Abnormal
An abnormal or positive strep test means that strep bacteria are present.

Antibiotic treatment can be started.
A positive test result does not distinguish those people with an active strep infection from those who are carriers of strep bacteria but actually have a viral infection (rather than a bacterial one).
What To Think About:
The rapid strep test costs less than a throat culture and may diagnose strep throat quickly

Resources:
https://www.health.harvard.edu/diagnostic-tests/rapid-strep-test.htm
http://www.webmd.com/a-to-z-guides/rapid-strep-test-for-strep-throat
http://en.wikipedia.org/wiki/RADT

http://encarta.msn.com/media_461520073_761574409_-1_1/streptococcus_bacteria.html

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