Tag: Infection

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Pleurisy

Alternative Name :Pleuritis

Definition:
Pleurisy  is an inflammation of the pleura,  the lining of the pleural cavity surrounding the lungs. Among other things, infections are the most common cause of pleurisy.

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The inflamed pleural layers rub against each other every time the lungs expand to breathe in air. This can cause severe sharp pain with inhalation (also called pleuritic chest pain).

Symptoms:
The main symptom of pleurisy is a sharp or stabbing pain in the chest that gets worse with deep breathing, coughing, sneezing or laughing. The pain may stay in one place, or it may spread to the shoulder or back. Sometimes it becomes a fairly constant dull ache.

Depending on its cause, pleurisy may be accompanied by other symptoms:

*Chest pain when you inhale and exhale (between breaths, you feel almost no pain)
*Shortness of breath
*Dry cough
*Fever and chills
*Rapid, shallow breathing
*Unexplained weight loss
*Sore throat followed by pain and swelling in the joints
*Diarrhea
*Ventricular tachycardia
*Erectile dysfunction
*Vomiting blood
*Vaginal discharge
*Loss of appetite

The sharp, fleeting pain in your chest that pleurisy causes is made worse by coughing, sneezing, moving and breathing, especially deep breathing. In some cases, pain may extend from your chest to your shoulder. You may find relief from pain when you hold your breath or when you apply pressure over the painful area.

When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs, compressing and interfering with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear. An infected pleural effusion is called an empyema.

Causes:
Viral infection is the most common cause of pleurisy. However, many different conditions can cause pleurisy:

*Pneumothorax
*Bacterial infections like pneumonia and tuberculosis
*Autoimmune disorders like systemic lupus erythematosus (or drug-induced lupus erythematosus) and rheumatoid arthritis
*Lung cancer and lymphoma
*Other lung diseases like Cystic Fibrosis, sarcoidosis, asbestosis, lymphangioleiomyomatosis, and mesothelioma
*Pulmonary embolism, a blood clot in the blood vessels that go into the lungs
*Inflammatory bowel disease
*Familial Mediterranean fever, an inherited condition that often causes fever and swelling in the abdomen or lung
*Infection from a fungus or parasite
*Heart surgery, especially coronary artery bypass grafting
*High blood pressure
*Chest injuries
*Aortic dissection
*Can occur with no illness or infection
*Some cases of pleurisy are idiopathic, meaning the cause cannot be determined.

Complications:
*Breathing difficulty
*Collapsed lung due to thoracentesis
*Complications from the original illness

Diagnosis:
Tests to diagnose the underlying cause of  symptoms may include:

*Medical history and physical exam. Doctor will ask detailed questions about your medical history, including other health problems, medications and your recent signs and symptoms. Your doctor may want to examine your chest with a stethoscope. If he or she hears a “snow crunching” sound over the area of your pain, that may be enough to diagnose pleurisy. You may even be able to feel the crunching with your hand. This sign isn’t always present with pleurisy, however.

*Blood tests. A blood test may tell your doctor if you have an infection and, if so, what type of infection you have. Other blood tests also may detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.

Doctor may also order imaging tests or diagnostic procedures.

Imaging tests
Imaging tests to diagnose the underlying cause of pleurisy may include:

*Chest X-ray. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there’s any fluid that doesn’t appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray.

*Computerized tomography (CT) scan. Your doctor will want to investigate any unexplained abnormality seen on chest X-rays with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT scan, a computer translates information from X-rays into images of thin sections (slices) of your chest, producing more-detailed images.

*Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor may use ultrasound to determine whether you have a pleural effusion.

*Magnetic resonance imaging (MRI) . Magnetic resonance imaging (MRI), also called nuclear magnetic resonance (NMR) scanning, uses powerful magnets to show pleural effusions and tumors.

*Arterial blood gas :In arterial blood gas sampling, a small amount of blood is taken from an artery, usually in the wrist. The blood is then checked for oxygen and carbon dioxide levels. This test shows how well the lungs are taking in oxygen.

Diagnostic procedures :-
In some cases,  doctor may remove fluid and tissue from the pleural space for testing. Procedures may include:

*Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor then inserts a needle through your chest wall between your ribs to remove fluid for laboratory analysis. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound guidance over the site of the fluid.

*Pleural biopsy. If tuberculosis or lung cancer is a suspected cause of your condition,  doctor may perform thoracentesis with pleural biopsy — removal of a sample of tissue to be examined in a pathology laboratory. The biopsy needle has a small hook on the end that lifts away a small piece of tissue. Your doctor may use ultrasound guidance for this procedure as well.

*Thoracoscopy. This procedure, performed while you’re under a general anesthetic, allows a surgeon to see inside your chest and obtain a sample of pleural tissue. First, the surgeon makes one or more small incisions between your ribs. A tube with a tiny video camera is then inserted into your chest cavity – a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Tools designed for this type of surgery allow your surgeon to cut away tissue for testing.
Treatment:
Treatment has several goals:

*Remove the fluid, air, or blood from the pleural space
*Relieve symptoms
*Treat the underlying condition

Procedures:
If large amounts of fluid, air, or blood are not removed from the pleural space, they may put pressure on the lung and cause it to collapse.

The surgical procedures used to drain fluid, air, or blood from the pleural space are as follows:

*During thoracentesis, a needle or a thin, hollow, plastic tube is inserted through the ribs in the back of the chest into the chest wall. A syringe is attached to draw fluid out of the chest. This procedure can remove more than 6 cups (1.5 litres) of fluid at a time.

*When larger amounts of fluid must be removed, a chest tube may be inserted through the chest wall. The doctor injects a local painkiller into the area of the chest wall outside where the fluid is. A plastic tube is then inserted into the chest between two ribs. The tube is connected to a box that suctions the fluid out. A chest x-ray is taken to check the tube’s position.

*A chest tube also is used to drain blood and air from the pleural space. This can take several days. The tube is left in place, and the patient usually stays in the hospital during this time.

*Sometimes the fluid contains thick pus or blood clots, or it may have formed a hard skin or peel. This makes it harder to drain the fluid. To help break up the pus or blood clots, the doctor may use the chest tube to put certain medicines into the pleural space. These medicines are called fibrinolytics. If the pus or blood clots still do not drain out, surgery may be necessary.

Medications:
A couple of medications are used to relieve pleurisy symptoms:

*Paracetamol (acetaminophen) or anti-inflammatory agents to control pain and decrease inflammation. Only indomethacin (brand name Indocin) has been studied with respect to relief of pleurisy.

*Codeine-based cough syrups to control a cough

There may be a role for the use of corticosteroids (for tuberculous pleurisy), tacrolimus (Prograf) and methotrexate (Trexall, Rheumatrex) in the treatment of pleurisy. Further studies are needed.

Alternative Treatmewnt:
A number of alternative or complementary medicines are being investigated for their anti-inflammatory properties, and their use in pleurisy. At this time, clinical trials of these compounds have not been performed.

Extracts from the Brazilian folk remedy Wilbrandia ebracteata (“Taiuia”) have been shown to reduce inflammation in the pleural cavity of mice.  The extract is thought to inhibit the same enzyme, cyclooxygenase-2 (COX-2), as the non-steroidal anti-inflammatory drugs. Similarly, an extract from the roots of the Brazilian Petiveria alliacea plant reduced inflammation in a rat model of pleurisy.  The extract also reduced pain sensations in the rats. An aqueous extract from Solidago chilensis has been shown to reduce inflammation in a mouse model of pleurisy

Lifestyle changes:
The following may be helpful in the management of pleurisy:

*Lie on your painful side. This may actually lessen your pain.

*Take OTC medicines such as ibuprofen (Advil, Motrin, others) as needed to relieve pain and inflammation.

*Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, pneumonia may develop.

*Get plenty of rest. Even when you start to feel better, be careful not to overdo it.

Prognosis:
Pleurisy and other disorders of the pleura can be serious, depending on what caused the inflammation in the pleura.

If the condition that caused the pleurisy or other pleural disorders isn’t too serious and is diagnosed and treated early, one usually can expect a full recovery.

Prevention:
Early treatment of bacterial respiratory infections can prevent pleurisy.

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/Pleurisy
http://www.mayoclinic.com/health/pleurisy/DS00244
http://www.nlm.nih.gov/medlineplus/ency/article/001371.htm
http://www.bbc.co.uk/health/physical_health/conditions/pleurisy.shtml

http://www.webmd.com/lung/understanding-pleurisy-basics

http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_whatare.html

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Ailmemts & Remedies Pediatric

Oral thrush

Alternative Names: Candidiasis – oral; Oral thrush; Fungal infection – mouth; Candide – oral

Definition:
Oral thurs  is an infection of yeast fungi of the genus Candida on the mucous membranes of the mouth and tongue. It is frequently caused by Candida albicans, or less commonly by Candida glabrata or Candida tropicalis. Oral thrush may refer to candidiasis in the mouths of babies, while if occurring in the mouth or throat of adults it may also be termed candidosis or moniliasis…

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Although oral thrush can affect anyone, it’s more likely to occur in babies and people who wear dentures, use inhaled corticosteroids or have compromised immune systems. Oral thrush is a minor problem if you’re healthy, but if you have a weakened immune system, symptoms of oral thrush may be more severe and difficult to control.

Symtoms:
Signs and symptoms of oral infection by Candida species may not be immediately noticeable but can develop suddenly and may persist for a long time. The infection usually appears as thick white or cream-colored deposits on mucosal membranes such as the tongue, inner cheeks, gums, tonsils, and palate. The infected mucosa may appear inflamed (red and possibly slightly raised) and sometimes have a cottage cheese-like appearance. The lesions can be painful and will become tender and often bleed if rubbed or scraped. Cracking at the corners of the mouth, a cottony-like sensation inside the mouth, and even temporary loss of taste can occur.

In more severe cases, the infection can spread down the esophagus and cause difficulty swallowing – this is referred to as Esophageal candidiasis. Thrush does not usually cause a fever unless the infection has spread beyond the esophagus to other body parts, such as the lungs (systemic candidiasis).

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In addition to the distinctive lesions, infants can become irritable and may have trouble feeding. The infection can be communicated during breast-feeding to and from the breast and the infant’s mouth repeatedly

Causes:
Thrush is caused by forms of a fungus called Candida. A small amount of this fungus lives in your mouth most of the time. It is usually kept in check by your immune system and other types of germs that also normally live in your mouth.

However, when your immune system is weaker, the fungus can grow, leading to sores (lesions) in your mouth and on your tongue. The following can increase your chances of getting thrush:

•Taking steroid medications
•Having an HIV infection or AIDS
•Receiving chemotherapy for cancer or drugs to suppress your immune system following an organ transplant
•Being very old or very young
•Being in poor health
Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a couple of weeks.

Candida can also cause yeast infections in the vagina.

People who have diabetes and had high blood sugar levels are more likely to get thrush in the mouth (oral thrush), because the extra sugar in your saliva acts like food for Candida.

Taking high doses of antibiotics or taking antibiotics for a long time also increases the risk of oral thrush. Antibiotics kill some of the healthy bacteria that help keep Candida from growing too much.

People with poorly fitting dentures are also more likely to get thrush.

Risk Factors:
*Newborn babies.

*Diabetics with poorly controlled diabetes.

*As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for treatment of lung conditions (e.g., asthma or COPD) may also result in oral candidiasis: the risk may be reduced by regularly rinsing the mouth with water after taking the medication.

*People with an immune deficiency (e.g. as a result of AIDS/HIV or chemotherapy treatment).

*Women undergoing hormonal changes, like pregnancy or those on birth control pills.

*Denture users.

*Tongue piercing

Complications:
Oral thrush is seldom a problem for healthy children and adults, although the infection may return even after it’s been treated. For people with compromised immune systems, however, thrush can be more serious.

If you have HIV, you may have especially severe symptoms in your mouth or esophagus, which can make eating painful and difficult. If the infection spreads to the intestines, it becomes difficult to receive adequate nutrition. In addition, thrush is more likely to spread to other parts of the body if you have cancer or other conditions that weaken the immune system. In that case, the areas most likely to be affected include the digestive tract, lungs and liver.

Diagnosis;
Oral thrush can usually be diagnosed simply by looking at the lesions, but sometimes a small sample is examined under a microscope to confirm the diagnosis.

In older children or adolescents who have no other identified risk factors, an underlying medical condition may be the cause of oral thrush. If your doctor suspects that to be the case, your doctor will perform a physical exam as well as recommend certain blood tests to help find the source of the problem.

If thrush is in your esophagus
Thrush that extends into the esophagus can be serious. To help diagnose this condition, your doctor may ask you to have one or more of the following tests:

*Throat culture. In this procedure, the back of your throat is swabbed with sterile cotton and the tissue sample cultured on a special medium to help determine which bacteria or fungi, if any, are causing your symptoms.

*Endoscopic examination. In this procedure, your doctor examines your esophagus, stomach and the upper part of your small intestine (duodenum), using a lighted, flexible tube with a camera on the tip (endoscope).

Treatment:
For thrush in infants, treatment is often NOT necessary. It generally gets better on its own within 2 weeks.

If you develop a mild case of thrush after taking antibiotics, eating yogurt or taking over-the-counter acidophilus capsules can help.

Use a soft toothbrush and rinse your mouth with a diluted 3% hydrogen peroxide solution several times a day.

Good control of blood sugar levels in persons with diabetes may be all that is needed to clear a thrush infection.

Your doctor may prescribe an antifungal mouthwash (nystatin) or lozenges (clotrimazole) to suck on if you have a severe case of thrush or a weakened immune system. These products are usually used for 5 – 10 days. If they don’t work, other medication may be prescribed.

If the infection has spread throughout your body or you have HIV/AIDS, stronger medications may be used, such as fluconazole (Diflucan) or ketoconazole (Nizoral).

Prognosis:
Thrush in infants may be painful, but is rarely serious. Because of discomfort, it can interfere with eating. If it does not resolve on its own within 2 weeks, call your pediatrician.

In adults, thrush that occurs in the mouth can be cured. However, the long-term outlook is dependent on your immune status and the cause of the immune deficit.

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

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000626.htm
http://en.wikipedia.org/wiki/Oral_candidiasis
http://www.bbc.co.uk/health/physical_health/conditions/oralthrush2.shtml
http://www.mayoclinic.com/health/oral-thrush/DS00408

http://www.nlm.nih.gov/medlineplus/ency/imagepages/17284.htm

http://www.clivir.com/lessons/show/yeast-infection-in-mouth-and-throat.html

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Onycholysis

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Definition:
Onycholysis is a diseases whose symptoms appear as the separation of the nail plate from the nail bed on your fingers and toes. But that is not the full definition. The separation must be gradual and must be painless. Onycholysis can happen due to a number of reasons including trauma, onychomycosis or fungal infection in the nails. Onycholysis is generally seen in adulthood and might be symptomatic of other skin diseases or infections, allergic contact to some compounds like acrylic nail products, consequence of an injury, or hyperactive thyroid glands.

click to see

Click to see the picture

Onycholysis disease is not restricted to any one sex but generally women are more prone to it specially those who keep long fingernails. Actually long fingernails result in its tip being hit against hard objects repeatedly. It is also seen that the affected nails don’t show any skin inflammation and the finger nail remains firm and smooth. It is simply because onycholysis is not a disease of the nails tissue matrix.

Symptoms:
It is actually very easy to spot Onycholysis nail disease. You’ll find that the nail lifts itself from its bed and there is a gap between the pink portion of the nail and the white outside edge of the finger nail.
Click to see the picture
One way of determining Onycholysis has set in to check for signs of discoloration underneath the nail since this may occur as a result of secondary infection. The painless and spontaneous separation of the nail plate starts at the distal free margin and gradually progresses proximally. That actually signifies secondary infection making the situation more serious. Secondary infections might also result in the deformation of the shape of the nail plate and appearance of pits and indentations in the nail surface.
Larger portion of the nail may become opaque, get whitened or discolored to yellow or green and this calls for medical attention.

Causes:
*Idiopathic
*Trauma e.g. excessive manicuring
*Infection: especially fungal
*Skin disease: psoriasis, dermatitis
*Impaired peripheral circulation e.g. Raynaud’s
*Systemic disease: hyper- and hypothyroidism, reactive arthritis

Diagnosis:
Diagnosing Onycholysis is simple and straight forward. To diagnose Onycholysis you must examine closely your fingernails and the toenails for nail plate separation, opacity and discoloration and effects the disease might have on the peripheral skin surrounding your nails and toes. If you feel that something is wrong but can’t make a clear diagnostic, you need to go see your doctor or physician who would look for and diagnose for other symptoms and search for other symptomatic signs of the disease such as skin appearance around your nails or the appearance of indentations in the surface or the color and shape of the nails. Doctors search for sign of rashes on the skin or even check for related symptoms linked to thyroid problems. If the diagnostic suspicious of your doctor leans towards fungal infection, some tissues from beneath your nail plate might be scraped out for further testing.

Treatment:

Treatment usually involves tackling the underlying cause, such as a fungal infection.

Nail changes aren’t usually permanent, but they can take many months to resolve, even after treatment.
*Some of the remedial measures one can take for Onycholysis at home include regular trimming of nails to ensure they remain short and clean (manageable too) and using a skin softening hand cream to nourish the nails and hands.
*If Onycholysis has set in due to nail biting, picking or tearing, the person can consider seeking psychological counseling to get the necessary encouragement and guidance to underlying problems to stop this behavior.
*Persons suffering from Onycholysis should wear light cotton gloves under vinyl gloves for wet work and avoid keeping their hands immersed for prolonged periods in water.


*If Onycholysis has set in on the feet, one should avoid wearing tight shoes and trim the nails straight across the top only.

Prevention:
What you can do is to take some preventive steps to avoid the occurrence of onycholysis. You can start with avoiding exposure to harsh chemicals like nail polish remover. You would do well to wear cotton gloves or rubber gloves while immersing your nails in water repeatedly. Nails expand when it is moisten and shrinks when it dries. And yes, clip your nails at the affected portion and try to keep your nails short to avoid further trauma from getting damaged everyday.

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/Onycholysis
http://www.fuelthemind.com/health/health/Onycholysis_nail_disease.html
http://beautytips.ygoy.com/nail-disorders/onycholysis.php
http://www.nlm.nih.gov/medlineplus/ency/imagepages/2010.htm

http://www.bbc.co.uk/health/physical_health/conditions/onycholysis1.shtml

http://www.primehealthchannel.com/onycholysis-definition-causes-symptoms-pictures-and-treatment.html

http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Clinical%20Images/Onycholysis-18.jpg

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Osteomyelitis

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

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

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

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

Symptoms:
Signs and symptoms of osteomyelitis include:

*Fever or chills

*Bone pain

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

*Local swelling, redness, and warmth

*Irritability or lethargy in young children

*Pain in the area of the infection

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

*Excessive sweating

*Low back pain

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

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

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

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

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

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

Risk Factors
*Diabetes

*Hemodialysis

*Injected drug use

*Poor blood supply

*Recent trauma

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

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

Other complications include:
*Need for amputation

*Reduced limb or joint function

*Spread of infection to surrounding tissues or the bloodstream

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

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

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

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

Tests may include:

*Blood cultures

*Bone biopsy (which is then cultured)

*Bone scan

*Bone x-ray

*Complete blood count (CBC)

*C-reactive protein (CRP)

*Erythrocyte sedimentation rate (ESR)

*MRI of the bone

*Needle aspiration of the area around affected bones

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

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

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

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

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

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

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

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

*The patient’s health

*The type of infection

*Whether the infected prosthesis can be safely removed

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

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

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

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Mastitis

Definition
Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness of the breast. If you have mastitis, you might also experience fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis), although in rare circumstances this condition can occur outside of lactation.

click to see the pictures

The term mastitis is from the Greek word mastos, for breast, and itis, for inflammation of. The response to injury to the udder of sheep is called inflammation. Mastitis is the reaction of milk -secreting tissue to injury produced by physical force, chemicals introduced into the gland or most commonly from bacteria and their toxins.

Click to see the picture   :Udder of a of a Roux du Valais sheep after a healed mastitis, one teat was lost due to the disease.

In most cases, lactation mastitis occurs within the first three months after giving birth (postpartum), but it can happen later during breast-feeding. The condition can leave you feeling exhausted and rundown, making it difficult to care for your baby.

Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But you can continue breast-feeding while you have mastitis.

Types:
It is called puerperal mastitis when it occurs in lactating mothers and non-puerperal otherwise. Mastitis can occur in men, albeit rarely. Inflammatory breast cancer has symptoms very similar to mastitis and must be ruled out.

The popular misconception that mastitis in humans is an infection is highly misleading and in many cases incorrect. Infections play only a minor role in the pathogenesis of both puerperal and nonpuerperal mastitis in humans and many cases of mastitis are completely aseptic under normal hygienic conditions. Infection as primary cause of mastitis is presumed to be more prevalent in veterinary mastitis and poor hygienic conditions.

The symptoms are similar for puerperal and nonpuerperal mastitis but predisposing factors and treatment can be very different.

Click to see the picture    Serous exudate from bovine udder in E. coli mastitis at left. Normal milk at right.

Puerperal:
Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. Since one of the most prominent symptoms is tension and engourgement of the breast, it is thought to be caused by blocked milk ducts or milk excess. It is relatively common, estimates range depending on methodology between 5-33%. However only about 0.4-0.5% of breastfeeding mothers develop an abscess.

Nonpuerperal:
The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding. This article includes description of mastitis as well as various kinds of mammary abscesses. Skin related conditions like dermatitis and foliculitis are a separate entity.

Names for non-puerperal mastitis are not used very consistently and include Mastitis, Subareolar Abscess, Duct Ectasia, Periductal Inflammation, Zuska’s Disease and others.

Symptoms:
Lactation mastitis usually affects only one breast and the symptoms can develop quickly.[3] The signs and symptoms usually appear suddenly and they include:

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*Breast tenderness or warmth to the touch
*General malaise or feeling ill
*Swelling of the breast
*Pain or a burning sensation continuously or while breast-feeding
*Skin redness, often in a wedge-shaped pattern
*Fever of 101 F (38.3 C) or greater [4]
*The affected breast can then start to appear lumpy and red.

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Some women may also experience flu-like symptoms such as:

*Aches
*Shivering and chills
*Feeling anxious or stressed
*Fatigue
*Breast engorgement

Contact should be made with a health care provider with special breastfeeding competence as soon as the patient recognizes the combination of signs and symptoms. Most of the women first experience the flu-like symptoms and just after they may notice a sore red area on the breast. Also, women should seek medical care if they notice any abnormal discharge from the nipples, if breast pain is making it difficult to function each day or they have prolonged, unexplained breast pain.

Causes:
Since the 1980s mastitis has often been divided into non-infectious and infectious sub-groups. However, recent research [6] suggests that it may not be feasible to make divisions in this way. It has been shown that types and amounts of potentially pathogenic bacteria in breast milk are not correlated to the severity of symptoms. Moreover, although only 15% of women with mastitis in Kvist et al.’s study were given antibiotics, all recovered and few had recurring symptoms. Many healthy breastfeeding women wishing to donate breast milk have potentially pathogenic bacteria in their milk but have no symptoms of mastitis.

Mastitis typically develops when the milk is not properly removed from the breast. Milk stasis can lead to the milk ducts in the breasts becoming blocked, as the breast milk not being properly and regularly expressed.  It has also been suggested that blocked milk ducts can occur as a result of pressure on the breast, such as tight-fitting clothing or an over-restrictive bra, although there is sparse evidence for this supposition . Mastitis may occur when the baby is not appropriately attached to the breast while feeding, when the baby has infrequent feeds or has problems suckling the milk out of the breast.

Experts are still unsure why breast milk can cause the breast tissue to become inflamed. One theory is that it may be due to the presence of cytokines in breast milk. Cytokines are special proteins that are used by the immune system and are passed on to the baby in order to help them resist infection. It may be the case that the woman’s immune system mistakes these cytokines for a bacterial or viral infection and responds by inflaming the breast tissue in an attempt to stop the spread of what the body perceives as an infection.

Some women (approximately 15% in Kvist et al. study) will require antibiotic treatment for infection which is usually caused by bacteria from the skin or the baby’s mouth that entering the milk ducts through skin lesions of the nipple or through the opening of the nipple.[8] Infection is usually caused by staphylococcus aureus.

Mastitis is quite common among breastfeeding women. The WHO estimates that although incidences vary between 2.6% and 33%, the prevalence globally is approximately 10% of breastfeeding women. Most mothers who develop mastitis usually do so within the first few weeks after delivery. Most breast infections occur within the first or second month after delivery or at the time of weaning.  However, in rare cases it affects women who are not breastfeeding.

Mastitis can also develop after nipple piercing. In some rare cases, however, Mastitis can occur in men.

Risk Factors:
Women who are breastfeeding are at risk for developing mastitis especially if they have sore or cracked nipples or have had mastitis before while breastfeeding another baby. Also, the chances of getting mastitis increases if women use only one position to breastfeed or wear a tight-fitting bra, which may restrict milk flow

Women with diabetes, chronic illness, AIDS, or an impaired immune system may be more susceptible to the development of mastitis.

Complications:
Complications that may arise from mastitis include recurrence, milk stasis and abscess. The abscess is the most severe complication that women can get from this condition. Also, women who have had mastitis once are likely to develop it again with a future child or with the same infant. Recurrence appears especially in cases of delayed or inadequate treatment.

Milk stasis is another complication that may arise from mastitis and it occurs when the milk is not completely drained from the breast. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation.

Delayed treatment or inadequate treatment, especially in mastitis related to milk stasis, may lead to the formation of an abscess within the breast tissue. An abscess is a collection of pus that develops into the breast which ultimately requires surgical drainage.

Diagnosis:
The diagnosis of mastitis and breast abscess can usually be made based on a physical examination. The doctor will also take into account the signs and symptoms of the condition.

However, if the doctor is not sure whether the mass is an abscess or a tumor, an ultrasound may be performed. The ultrasound provides a clear image of the breast tissue and may be helpful in distinguishing between simple mastitis and abscess or in diagnosing an abscess deep in the breast. The test consists of placing an ultrasound probe over the breast.

In cases of infectious mastitis, cultures may be needed in order to determine what type of organism is causing the infection. Cultures are helpful in deciding the specific type of antibiotics that will be used in curing the disease. These cultures may be taken either from the breast milk or of the material aspirated from an abscess.

Mammograms or breast biopsies are normally performed on women who do not respond to treatment or on non-breastfeeding women. This type of tests is sometimes ordered to exclude the possibility of a rare type of breast cancer which causes symptoms similar to those of mastitis.

Treatment:
If you develop a painful, red or swollen breast, and especially if you have generalized symptoms such as a fever, it’s important to see your doctor because there may be infection that needs treatment with antibiotics.

You should try to continue breastfeeding. Although mastitis may interfere with breastfeeding – because the breasts become distorted in shape, for example – it is often the best treatment because it empties the breast.

In fact it’s important to persevere, because otherwise engorged breasts rapidly lead to a fall in milk production, as the body sees it as a signal that more milk is being produced than is needed.

With engorgement, if the affected area is not drained there’s a risk of infection developing. Try to give frequent feeds varying the position of the baby (many recommend a position where the baby’s chin points towards the affected area). Offer the affected breast first for the best chance of good drainage.

You can also try massaging the affected area of the breast as you feed, and applying warmth to the area.

There’s no risk to the baby from infection being passed on in the milk, so this is not a reason to stop feeding.

You can try to relieve the symptoms with cooling treatments – everything from cabbage leaves to cold flannels to gel-filled cool packs. Gentle breast massage can also help. If there is no infection, medicines are often not very effective in resolving the mastitis but may help with symptoms.

Paracetamol or ibuprofen may ease pain and reduce fever for example. These are usually safe although ibuprofen can get through into breast milk in small amounts – this doesn’t usually do any harm but you should check with your GP if your baby was born prematurely, had a low birth weight or any other medical problems. Paracetamol can also pass through into breast milk in tiny amounts but is thought to be even less likely to do harm.

Lifestyle and home remedies :
If you have mastitis, it’s safe to continue breast-feeding. Continuing breast-feeding offers the added benefit of helping clear the infection in your breast.

To relieve your discomfort:

*Maintain your breast-feeding routine.
*Get as much rest as possible.
*Avoid prolonged engorgement before breast-feeding.
*Use varied positions to breast-feed.
*Drink plenty of fluids.
*If you have trouble emptying a portion of your breast, apply warm compresses to the breast or take a warm shower before breast-feeding or pumping milk.
*Wear a supportive bra.
*While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

If breast-feeding on the infected breast is too painful or your infant refuses to nurse on that breast, try pumping or hand-expressing milk.

Prevention :
To get your breast-feeding relationship with your infant off to its best possible start — and to avoid complications such as mastitis — consider making an appointment with a lactation consultant. A lactation consultant can give you tips and provide invaluable advice for proper breast-feeding technique.

Minimize your chances of getting mastitis by fully draining the milk from your breasts while breast-feeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses for only a few minutes on the second breast — or not at all — start breast-feeding on that breast the next time you feed your baby.

Alternate the breast you offer first at each breast-feeding, and change the position you use to breast-feed from one feeding to the next. Make sure your baby latches on properly during feedings. Finally, don’t let your baby use your breast as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they’re not hungry

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/mastitis1.shtml
http://www.riversideonline.com/health_reference/Womens-Health/DS00678.cfm
http://en.wikipedia.org/wiki/Mastitis
http://www.breastfeedingbasics.com/html/breast_infections.shtml
http://glamomamas.com/2011/05/breastfeeding-it%E2%80%99s-choice/

http://melancoholismo.blogspot.com/2009/12/humor-patologico-5-muestra-del-extrano.html

http://www.righthealth.com/topic/mastitis/overview/adam_images?img=4

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