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Meningitis

Definition;
Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Meningitis may develop in response to a number of causes, most prominently bacteria, viruses and other infectious agents, but also physical injury, cancer, or certain drugs. While some forms of meningitis are mild and resolve on their own, meningitis is a potentially serious condition due to the proximity of the inflammation to the brain and spinal cord. The potential for serious neurological damage or even death necessitates prompt medical attention and evaluation. Infectious meningitis, the most common form, is typically treated with antibiotics and requires close observation. Some forms of meningitis (such as those associated with meningococcus, mumps virus or pneumococcus infections) may be prevented with immunization.

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Anatomy of the brain. In meningitis, the meninges that line the brain become swollen and inflamed.

Signs and symptoms
Severe headache is the most common symptom of meningitis (87 percent) followed by nuchal rigidity (“neck stiffness”, 83 percent). The classic triad of diagnostic signs consists of nuchal rigidity (being unable to flex the neck forward), sudden High fever[1] and altered mental status. All three features are present in only 44% of all cases of infectious meningitis.[2] Other signs commonly associated with meningitis are photophobia (inability to tolerate bright light), phonophobia (inability to tolerate loud noises), irritability and delirium (in small children) and seizures (in 20-40% of cases). In infants (0-6 months), swelling of the fontanelle (soft spot) may be present.

Nuchal rigidity is typically assessed with the patient lying supine, and both hips and knees flexed. If pain is elicited when the knees are passively extended (Kernig’s sign), this indicates nuchal rigidity and meningitis. In infants, forward flexion of the neck may cause involuntary knee and hip flexion (Brudzinski’s sign). Although commonly tested, the sensitivity and specificity of Kernig’s and Brudzinski’s tests are uncertain.[3]

In “meningococcal” meningitis (i.e. meningitis caused by the bacteria Neisseria meningitidis), a rapidly-spreading petechial rash is typical, and may precede other symptoms. The rash consists of numerous small, irregular purple or red spots on the trunk, lower extremities, mucous membranes, conjunctiva, and occasionally on the palms of hands and soles of feet. Other clues to the nature of the cause may be the skin signs of hand, foot and mouth disease and genital herpes, both of which may be associated with viral meningitis.

Diagnosis:
Investigations
Suspicion of meningitis is generally based on the nature of the symptoms and findings on physical examination. Meningitis is a medical emergency, and referral to hospital is indicated. If meningitis is suspected based on clinical examination, early administration of antibiotics is recommended, as the condition may deteriorate rapidly. In the hospital setting, initial management consists of stabilization (e.g. securing the airway in a depressed level of consciousness, administration of intravenous fluids in hypotension or shock), followed by antibiotics if not already administered.

Investigations include blood tests (electrolytes, liver and kidney function, inflammatory markers and a complete blood count) and usually X-ray examination of the chest. The most important test in identifying or ruling out meningitis is analysis of the cerebrospinal fluid (fluid that envelops the brain and the spinal cord) through lumbar puncture (LP). However, if the patient is at risk for a cerebral mass lesion or elevated intracranial pressure (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a lumbar puncture may be contraindicated because of the possibility of fatal brain herniation. In such cases a CT or MRI scan is generally performed prior to the lumbar puncture to exclude this possibility. Otherwise, the CT or MRI should be performed after the LP, with MRI preferred over CT due to its superiority in demonstrating areas of cerebral edema, ischemia, and meningeal inflammation.

During the lumbar puncture procedure, the opening pressure is measured. A pressure of over 180 mm H2O is indicative of bacterial meningitis.

The cerebrospinal fluid (CSF) sample is examined for white blood cells (and which subtypes), red blood cells, protein content and glucose level. Gram staining of the sample may demonstrate bacteria in bacterial meningitis, but absence of bacteria does not exclude bacterial meningitis; microbiological culture of the sample may still yield a causative organism. The type of white blood cell predominantly present predicts whether meningitis is due to bacterial or viral infection. Other tests performed on the CSF sample include latex agglutination test, limulus lysates, or polymerase chain reaction (PCR) for bacterial or viral DNA. If the patient is immunocompromised, testing the CSF for toxoplasmosis, Epstein-Barr virus, cytomegalovirus, JC virus and fungal infection may be performed.

CSF finding in different conditions:-
Condition……………………………..Glucose…………Protein…………….. Cells
Acute bacterial meningitis…………. Low high…… high………….. often > 300/mm³
Acute viral meningitis…………….. Normal normal or high mononuclear,……< 300/mm³
Tuberculous meningitis…………….. Low……….. high pleocytosis, mixed < 300/mm³
Fungal meningitis…………………. Low…………high………………. < 300/mm³
Malignant meningitis………………. Low…………high usually mononuclear
Subarachnoid hemorrhage……………..Normal normal, or high Erythrocytes

In bacterial meningitis, the CSF glucose to serum glucose ratio is < 0.4. The Gram stain is positive in >60% of cases, and culture in >80%. Latex agglutination may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli, Group B Streptococci. Limulus lysates may be positive in Gram-negative meningitis.

Cultures are often negative if CSF is taken after the administration of antibiotics. In these patients, PCR can be helpful in arriving at a diagnosis. It has been suggested that CSF cortisol measurement may be helpful.

Aseptic meningitis refers to non-bacterial causes of meningitis and includes infective etiologies such as viruses and fungi, neoplastic etiologies such as carcinomatous and lymphomatous meningitis, inflammatory causes such as sarcoidosis (neurosarcoidosis)) and chemical causes such as meningitis secondary to the intrathecal introduction of contrast media.

Although the term “viral meningitis” is often used in any patient with a mild meningeal illness with appropriate CSF findings, certain patients will present with clinical and CSF features of viral meningitis, yet ultimately be diagnosed with one of the other conditions categorized as “aseptic meningitis”. This may be prevented by performing polymerase chain reaction or serology on CSF or blood for common viral causes of meningitis (enterovirus, herpes simplex virus 2 and mumps in those not vaccinated for this).

A related diagnostic and therapeutic conundrum is the “partially treated meningitis”, i.e. meningitis symptoms in patients who have already been receiving antibiotics (such as for presumptive sinusitis). In these patients, CSF findings may resemble those of viral meningitis, but antibiotic treatment may need to be continued until there is definitive positive evidence of a viral cause (e.g. a positive enterovirus PCR).

Prediction rules
The Bacterial Meningitis Score predicts reliably whether a child (older than two months) may have infectious meningitis. In children with at least 1 risk factor (positive CSF Gram stain, CSF absolute neutrophil count = 1000 cell/µL, CSF protein = 80 mg/dL, peripheral blood absolute neutrophil count = 10,000 cell/µL, history of seizure before or at presentation time) it had a sensitivity of 100%, specificity of 63.5%, and negative predictive value of 100%

Causes
Most cases of meningitis are caused by microorganisms, such as viruses, bacteria, fungi, or parasites, that spread into the blood and into the cerebrospinal fluid (CSF).[8] Non-infectious causes include cancers, systemic lupus erythematosus and certain drugs. The most common cause of meningitis is viral, and often runs its course within a few days. Bacterial meningitis is the second most frequent type and can be serious and life-threatening. Numerous microorganisms may cause bacterial meningitis, but Neisseria meningitidis (“meningococcus”) and Streptococcus pneumoniae (“pneumococcus”) are the most common pathogens in patients without immune deficiency, with meningococcal disease being more common in children. Staphylococcus aureus may complicate neurosurgical operations, and Listeria monocytogenes is associated with poor nutritional state and alcoholism. Haemophilus influenzae (type B) incidence has been much reduced by immunization in many countries. Mycobacterium tuberculosis (the causative agent of tuberculosis) rarely causes meningitis in Western countries but is common and feared in countries where tuberculosis is endemic.

Treatment
Bacterial meningitis
Bacterial meningitis is a medical emergency and has a high mortality rate if untreated.[9] All suspected cases, however mild, need emergency medical attention. Empiric antibiotics must be started immediately, even before the results of the lumbar puncture and CSF analysis are known. Antibiotics started within 4 hours of lumbar puncture will not significantly affect lab results. Adjuvant treatment with corticosteroids reduces rates of mortality, severe hearing loss and neurological sequelae in adults, specifically when the causative agent is Pneumococcus.

Age group Causes
Neonates Group B Streptococci, Escherichia coli, Listeria monocytogenes
Infants Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae
Children N. meningitidis, S. pneumoniae
Adults S. pneumoniae, N. meningitidis, Mycobacteria, Cryptococci
The choice of antibiotic depends on local advice. In most of the developed world, the most common organisms involved are Streptococcus pneumoniae and Neisseria meningitidis: first line treatment in the UK is a third-generation cephalosporin (such as ceftriaxone or cefotaxime). In those under 3 years of age, over 50 years of age, or immunocompromised, ampicillin should be added to cover Listeria monocytogenes.[11] In the U.S. and other countries with high levels of penicillin resistance, the first line choice of antibiotics is vancomycin and a carbapenem (such as meropenem). In sub-Saharan Africa, oily chloramphenicol or ceftriaxone are often used because only a single dose is needed in most cases.

Staphylococci and gram-negative bacilli are common infective agents in patients who have just had a neurosurgical procedure. Again, the choice of antibiotic depends on local patterns of infection: cefotaxime and ceftriaxone remain good choices in many situations, but ceftazidime is used when Pseudomonas aeruginosa is a problem, and intraventricular vancomycin is used for those patients with intraventricular shunts because of high rates of staphylococcal infection. In patients with intracerebral prosthetic material (metal plates, electrodes or implants, etc.) then sometimes chloramphenicol is the only antibiotic that will adequately cover infection by Staphylococcus aureus (cephalosporins and carbapenems are inadequate under these circumstances).

Once the results of the CSF analysis are known along with the Gram-stain and culture, empiric therapy may be switched to therapy targeted to the specific causative organism and its sensitivities.[citation needed]

*Neisseria meningitidis (Meningococcus) can usually be treated with a 7-day course of IV antibiotics:
*Penicillin-sensitive — penicillin G or ampicillin
*Penicillin-resistant — ceftriaxone or cefotaxime
*Prophylaxis for close contacts (contact with oral secretions) — rifampin 600 mg bid for 2 days (adults) or 10 mg/kg bid (children). Rifampin is not recommended in pregnancy and as such, these patients should be treated with single doses of ciprofloxacin, azithromycin, or ceftriaxone
*Streptococcus pneumoniae (Pneumococcus) can usually be treated with a 2-week course of IV antibiotics:
*Penicillin-sensitive — penicillin G
*Penicillin-intermediate — ceftriaxone or cefotaxime
*Penicillin-resistant — ceftriaxone or cefotaxime + vancomycin
*Listeria monocytogenes is treated with a 3-week course of IV ampicillin + gentamicin.
*Gram negative bacilli — ceftriaxone or cefotaxime
*Pseudomonas aeruginosa — ceftazidime
*Staphylococcus aureus
*Methicillin-sensitive — nafcillin
*Methicillin-resistant — vancomycin
*Streptococcus agalactiae — penicillin G or ampicillin
*Haemophilus influenzae — ceftriaxone or cefotaxime

Viral meningitis
Patients diagnosed with mild viral meningitis may improve quickly enough to not require admission to a hospital, while others may be hospitalized for many more days for observation and supportive care. Overall, the illness is usually much less severe than bacterial meningitis.

Unlike bacteria, viruses cannot be killed by antibiotics although drugs such as acyclovir may be employed, especially if herpes virus infection is either suspected or demonstrated.[4]

Fungal meningitis
This form of meningitis is rare in otherwise healthy people but is a higher risk in those who have AIDS, other forms of immunodeficiency (an immune system that does not respond adequately to infections) and immunosuppression (immune system malfunction as a result of medical treatment). In AIDS, Cryptococcus neoformans is the most common cause of fungal meningitis; it requires Indian ink staining of the CSF sample for identification of this capsulated yeast. Fungal meningitis is treated with long courses of highly dosed antifungals.

Complications
In children there are several potential disabilities which result from damage to the nervous system. These include sensorineural hearing loss, epilepsy, diffuse brain swelling, hydrocephalus, cerebral vein thrombosis, intra cerebral bleeding and cerebral palsy. Acute neurological complications may lead to adverse consequences. In childhood acute bacterial meningitis deafness is the most common serious complication. Sensorineural hearing loss often develops during first few days of the illness as a result of inner ear dysfunction, but permanent deafness is rare and can be prevented by prompt treatment of meningitis.

Those that contract the disease during the neonatal period and those infected by S. pneumoniae and gram negative bacilli are at greater risk of developing neurological, auditory, or intellectual impairments or functionally important behaviour or learning disorders which can manifest as poor school performance.

In adults central nervous system complications include brain infarction, brain swelling, hydrocephalus, intracerebral bleeding; systemic complications are dominated by septic shock, adult respiratory distress syndrome and disseminated intravascular coagulation. Those who have underlying predisposing conditions e.g. head injury may develop recurrent meningitis.Case-fatality ratio is highest for gram-negative etiology and lowest for meningitis caused by H. influenzae (also a gram negative bacilli). Fatal outcome in patients over 60 years of age is more likely to be from systemic complications e.g. pneumonia, sepsis, cardio-respiratory failure; however in younger individuals it is usually associated with neurological complications. Age more than 60, low Glasgow coma scale at presentation and seizure within 24 hours increase the risk of death among community acquired meningitis.

Prevention

Immunization
Vaccinations against Haemophilus influenzae (Hib) have decreased early childhood meningitis significantly.

Vaccines against type A and C Neisseria meningitidis, the kind that causes most disease in preschool children and teenagers in the United States, have also been around for a while. Type A is also prevalent in sub-Sahara Africa and W135 outbreaks have affected those on the Hajj pilgrimage to Mecca. Immunisation with the ACW135Y vaccine against four strains is now a visa requirement for taking part in the Hajj.

Vaccines against Type B Neisseria meningitidis are much harder to produce, as its capsule is very weakly immunogenic masking its antigenic proteins. There is also a risk of autoimmune response, and the porA and porB proteins on Type B resemble neuronal molecules. A vaccine called MeNZB for a specific strain of type B Neisseria meningitidis prevalent in New Zealand has completed trials and is being given to many people in the country under the age of 20 free of charge. There is also a vaccine, MenBVac, for the specific strain of type B meningoccocal disease prevalent in Norway, and another specific vaccine for the strain prevalent in Cuba.

Pneumococcal polysaccharide vaccine against Streptococcus pneumoniae is recommended for all people 65 years of age or older. Pneumococcal conjugate vaccine is recommended for all newborns starting at 6 weeks – 2 months, according to American Association of Pediatrics (AAP) recommendations.

Mumps vaccination has led to a sharp decline in mumps virus associated meningitis, which prior to vaccination occurred in 15% of all cases of mumps.

Prophylaxis
In cases of meningococcal meningitis, prophylactic treatment of close relatives with antibiotics (e.g. rifampicin, ciprofloxacin or ceftriaxone) may reduce the risk of further cases.

Click to learn more about Meningitis……………………….(1)…..(2).…….(3)……(4)

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.

Sources:http://en.wikipedia.org/wiki/Meningitis

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Down With a Cold ?

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At some time or another, everyone — even a robust fitness freak — gets felled by the common cold, developing sniffles, sneezing, puffy eyes, fever, body ache and malaise. Children start to develop colds during their first year, the frequency of which may increase to up to six times a year. This leaves the mothers with the feeling that the child is “always ill”. The average adult gets three to four colds a year.

Almost 40 per cent of outpatient medical consultations in a general practice deals with colds and their complications. This is not surprising, as colds are unavoidable infections. They are caused by viruses, 80 per cent of which belong to the rhinovirus family. Not only are there more than a hundred members in this group alone, but the types also mutate at a rapid rate. This makes immunity practically non-existent, or at best short lived. To make matters worse, there is no vaccine available, except for flu or influenza.

Colds are highly contagious. The spread is rapid as the virus, contained in nasal secretions, can be propelled forcefully into the environment by coughing and sneezing. It can also be transferred from the nose to the hands of infected people. Patients can then transfer the virus to door knobs, telephones, banisters, switches and other such objects. The virus can remain dormant but viable for 18 hours or more until it finds a susceptible host. Any person touching the contaminated surface has a 50 per cent chance of picking up the infection.

Infection increases during the rainy season and winter months. People tend to huddle together under umbrellas or shelters. Windows may be kept closed. The close contact and lack of ventilation provide ideal conditions for the spread of the cold virus. Contrary to popular myths, colds are not aggravated by washing the hair at night, eating ice cream or using air-conditioning.

The infection incubates for a day or two before symptoms appear. It may then last a variable period of time, usually 5-14 days. If there is no recovery within two weeks, there may be secondary bacterial infection and complications like sinusitis, ear infection, bronchitis and pneumonia may have set in.

Smokers develop colds more frequently than non-smokers do. Their colds are more severe, take longer to subside and are more likely to be complicated by secondary infection. This is because the cilia — fine protective hairs that line the respiratory passages — are paralysed by nicotine. They, therefore, clear accumulated mucous sluggishly and inefficiently. Also, smokers’ lungs are likely to be scarred, distorted, have a reduced blood supply and function sub-optimally, making elimination of the infection difficult.

Man has reached the moon but a cure for the common cold remains elusive. We still rely on “grandma’s recommendations” of hot drinks like ginger tea, lime juice with honey, rice gruel and chicken soup. These do soothe the irritated throat. Also, resting helps. It reduces the pain in the muscles and bones. Steam inhalations liquefy the secretions and help them to drain, providing relief.

Stuffed and blocked nasal passages can be cleared with saline (not chemical) nose drops. Aspirin and paracetamol reduce fever and pain. Anti histamines reduce itching in the nose and throat and dry up dripping nasal secretions. The older first-generation anti histamines (Avil, Benadryl) are very effective but they cause sedation. The second-generation non-sedating products (loratidine, cetrizine) are less effective.

Many health supplements are advocated to boost immunity and reduce the frequency and severity of attacks. Many are of doubtful efficacy and have not been studied scientifically. Zinc supplements, however, have been proven to be useful. They can be used as lozenges, syrups or tablets. Not more than 10-15 mg a day of elemental zinc should be taken.

Antibiotics do not work and administering them is futile and inappropriate. They do not shorten the course of the infection. Nor do they prevent complications. Antiviral medications used against the influenza and herpes viruses are ineffective against the rhinovirus. If the cold just refuses to go away and there are no bacterial complications, it may not be a cold at all. It may be an idiosyncratic allergic reaction to something inhaled or ingested from the environment. Mosquito coils, liquid repellents, room fresheners and incense sticks are particularly notorious.

The best advice for someone with a cold — “wait it out”.

Sources: The Telegraph (Kolkata, India)

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Methicilling Restsant Staph Aureus (MRSA)

Description:
MRSA is a strain of Staphylococcus aureus (S. aureus) bacteria. S. aureus is a common type of bacteria that normally live on the skin and sometimes in the nasal passages of healthy people. MRSA refers to S. aureus strains that do not respond to some of the antibiotics used to treat staph infections

The bacteria can cause infection when they enter the body through a cut, sore, catheter, or breathing tube. The infection can be minor and local (for example, a pimple), or more serious (involving the heart, lung, blood, or bone).

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MRSA infections are grouped into two types:

•Healthcare-associated MRSA (HA-MRSA) infections occur in people who are or have recently been in a hospital or other health-care facility. Those who have been hospitalized or had surgery within the past year are at increased risk. MRSA bacteria are responsible for a large percentage of hospital-acquired staph infections.

•Community-associated MRSA (CA-MRSA) infections occur in otherwise healthy people who have not recently been in the hospital. The infections have occurred among athletes who share equipment or personal items (such as towels or razors) and children in daycare facilities. Members of the military and those who get tattoos are also at risk. The number of CA-MRSA cases is increasing.

Serious staph infections are more common in people with weak immune systems. This includes patients have been in hospitals or other health care centrs, such as nursing homes and dialysis centers. When a person gets from  these settings, it’s known as health care-associated MRSA (HA-MRSA). HA-MRSA infections typically are associated with invasive procedures or devices, such as surgeries, intravenous tubing or artificial joints.

A much wider community among the healthy people gets MRSA infection. This form, community-associated MRSA (CA-MRSA), often begins as a painful skin boil. It’s spread by skin-to-skin contact. At-risk populations include groups such as high school wrestlers, child care workers and people who live in crowded conditions, living togather with infected people.

Signs and symptoms:

Staph skin infections, including MRSA, generally start as small red bumps that resemble pimples, boils or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.

Other symptoms may include:
•Drainage of pus or other fluids from the site
•FeverFever
•Skin abscessSkin abscess
•Warmth around the infected area

Symptoms of a more serious staph infection may include:
•Chest painChest pain
•ChillsChills
•Cough
•Fatigue
•Fever
•General ill feeling (malaisemalaise)
•Headache
•Muscle achesMuscle aches
•RashRash
•Shortness of breathShortness of breath
MRSA infections start out as small red bumps that can quickly turn into deep, painful abscesses.

Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.

Causes:-
Anyone can get a Staph infection. People are more likely to get a Staph infection if they have:

*Skin-to-skin contact with someone who has a Staph infection

*Contact with items and surfaces that have Staph on them

*Openings in their skin such as cuts or scrapes

*Crowded living conditions

* Poor hygiene

Most Staph skin infections are minor and may be easily treated. Staph also may cause more serious infections, such as infections of the bloodstream, surgical sites, or pneumonia. Sometimes, a Staph infection that starts as a skin infection may worsen. It is important to contact your doctor if your infection does not get better.

Although the survival tactics of bacteria contribute to antibiotic resistance, humans bear most of the responsibility for the problem. Leading causes of antibiotic resistance include:

*Unnecessary antibiotic use in humans. Like other superbugs, MRSA is the result of decades of excessive and unnecessary antibiotic use. For years, antibiotics have been prescribed for colds, flu and other viral infections that don’t respond to these drugs, as well as for simple bacterial infections that normally clear on their own.

*Antibiotics in food and water. Prescription drugs aren’t the only source of antibiotics. In the United States, antibiotics can be found in beef cattle, pigs and chickens. The same antibiotics then find their way into municipal water systems when the runoff from feedlots contaminates streams and groundwater. Routine feeding of antibiotics to animals is banned in the European Union and many other industrialized countries. Antibiotics given in the proper doses to animals who are sick don’t appear to produce resistant bacteria.

*Germ mutation. Even when antibiotics are used appropriately, they contribute to the rise of drug-resistant bacteria because they don’t destroy every germ they target. Bacteria live on an evolutionary fast track, so germs that survive treatment with one antibiotic soon learn to resist others. And because bacteria mutate much more quickly than new drugs can be produced, some germs end up resistant to just about everything. That’s why only a handful of drugs are now effective against most forms of staph.

Risk factors:-
Because hospital and community strains of MRSA generally occur in different settings, the risk factors for the two strains differ.

Risk factors for hospital-acquired (HA) MRSA include:

*A current or recent hospitalization. MRSA remains a concern in hospitals, where it can attack those most vulnerable — older adults and people with weakened immune systems, burns, surgical wounds or serious underlying health problems. A 2007 report from the Association for Professionals in Infection Control and Epidemiology estimates that 1.2 million hospital patients are infected with MRSA each year in the United States. They also estimate another 423,000 are colonized with it.

*Residing in a long-term care facility. MRSA is far more prevalent in these facilities than it is in hospitals. Carriers of MRSA have the ability to spread it, even if they’re not sick themselves.

*Invasive devices. People who are on dialysis, are catheterized, or have feeding tubes or other invasive devices are at higher risk.

*Recent antibiotic use. Treatment with fluoroquinolones (ciprofloxacin, ofloxacin or levofloxacin) or cephalosporin antibiotics can increase the risk of HA-MRSA.

These are the main risk factors for community-acquired (CA) MRSA:

*Young age. CA-MRSA can be particularly dangerous in children. Often entering the body through a cut or scrape, MRSA can quickly cause a wide spread infection. Children may be susceptible because their immune systems aren’t fully developed or they don’t yet have antibodies to common germs. Children and young adults are also much more likely to develop dangerous forms of pneumonia than older people are.

*Participating in contact sports. CA-MRSA has crept into both amateur and professional sports teams. The bacteria spread easily through cuts and abrasions and skin-to-skin contact.

*Sharing towels or athletic equipment. Although few outbreaks have been reported in public gyms, CA-MRSA has spread among athletes sharing razors, towels, uniforms or equipment.

*Having a weakened immune system. People with weakened immune systems, including those living with HIV/AIDS, are more likely to have severe CA-MRSA infections.

*Living in crowded or unsanitary conditions. Outbreaks of CA-MRSA have occurred in military training camps and in American and European prisons.

*Association with health care workers. People who are in close contact with health care workers are at increased risk of serious staph infections.

Diagnosis:-
Doctors diagnose MRSA by checking a tissue sample or nasal secretions for signs of drug-resistant bacteria. The sample is sent to a lab where it’s placed in a dish of nutrients that encourage bacterial growth (culture). But because it takes about 48 hours for the bacteria to grow, newer tests that can detect staph DNA in a matter of hours are now becoming more widely available.

In the hospital, you may be tested for MRSA if you show signs of infection or if you are transferred into a hospital from another healthcare setting where MRSA is known to be present. You may also be tested if you have had a previous history of MRSA.

Treatment:-
Treatment for a Staph skin infection may include taking an antibiotic or having a doctor drain the infection. If you are given an antibiotic, be sure to take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save them to use later.

Both hospital and community associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors generally rely on the antibiotic vancomycin to treat resistant germs. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains. Although vancomycin saves lives, it may grow resistant as well; some hospitals are already seeing outbreaks of vancomycin-resistant MRSA. To help reduce that threat, doctors may drain an abscess caused by MRSA rather than treat the infection with drugs.

How do I keep Staph infections from spreading?

Wash your hands often or use an alcohol-based hand sanitizer
Keep your cuts and scrapes clean and cover them with bandages
Do not touch other people’s cuts or bandages

Do not share personal items like towels or razors.

Prevention:-

Hospitals are fighting back against MRSA infection by using surveillance systems that track bacterial outbreaks and by investing in products such as antibiotic-coated catheters and gloves that release disinfectants.

Still, the best way to prevent the spread of germs is for health care workers to wash their hands frequently, to properly disinfect hospital surfaces and to take other precautions such as wearing a mask when working with people with weakened immune systems.

In the hospital, people who are infected or colonized with MRSA are placed in isolation to prevent the spread of MRSA to other patients and healthcare workers.Visitors and healthcare workers caring for isolated patients may be required to wear protective garments and must follow strict handwashing procedures.

What you can do in the hospital
Here’s what you can do to protect yourself, family members or friends from hospital-acquired infections.

*Ask all hospital staff to wash their hands or use an alcohol-based hand sanitizer before touching you — every time.
Wash your own hands frequently.

*Make sure that intravenous tubes and catheters are inserted under sterile conditions, for example, the person inserting them wears a mask and sterilizes your skin first.

What you can do in your community:-
Protecting yourself from MRSA in your community — which might be just about anywhere — may seem daunting, but these

common-sense precautions can help reduce your risk:

*Wash your hands. Careful hand washing or use an alcohol-based hand sanitizer remains your best defense against germs. Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 62 percent alcohol for times when you don’t have access to soap and water.

*Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.
*Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores may contain MRSA, and keeping wounds covered will help keep the bacteria from spreading.
Shower after athletic games or practices. Shower immediately after each game or practice. Use soap and water. Don’t share towels.

*Sit out athletic games or practices if you have a concerning infection. If you have a wound that’s draining or appears infected — for example is red, swollen, warm to the touch or tender — consider sitting out athletic games or practices until the wound has healed.

*Sanitize linens. If you have a cut or sore, wash towels and bed linens in a washing machine set to the “hot” water setting (with added bleach, if possible) and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.

*Get tested. If you have a skin infection that requires treatment, ask your doctor if you should be tested for MRSA. Doctors may prescribe drugs that aren’t effective against antibiotic-resistant staph, which delays treatment and creates more resistant germs. Testing specifically for MRSA may get you the specific antibiotic you need to effectively treat your infection.

*Use antibiotics appropriately. When you’re prescribed an antibiotic, take all of the doses, even if the infection is getting better. Don’t stop until your doctor tells you to stop. Don’t share antibiotics with others or save unfinished antibiotics for another time. Inappropriate use of antibiotics, including not taking all of your prescription and overuse, contributes to resistance. If your infection isn’t improving after a few days of taking an antibiotic, contact your doctor.

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/mrsa/DS00735/DSECTION=4
http://www.kidsgrowth.com/resources/articledetail.cfm?id=2357

http://www.ronjones.org/Weblinks/MRSA-Photos.html

http://www.nlm.nih.gov/medlineplus/ency/article/007261.htm

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Ailmemts & Remedies

Chickenpox

Definition:

Chickenpox, sometimes called varicella, is a viral infection that used to be common among young children before routine immunization. the infection, with its characteristic rash of blisters, is caused by the varicella zoster virus, which also causes herpes zoster. The virus is transmitted in airborne droplets from the coughs and sneezes of infected people or by direct contact with the blisters. You can catch chickenpox from someone with chickenpox or herpes zoster if you are not immune.

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The illness is usually mild in children, but symptoms are more severe in young babies, older adolescents, and adults. chickenpox can also be more serious in people with reduced immunity, such as those with aids.

It is one of the five classical childhood exanthems or rashes, once a cause of significant morbidity and mortality, but now chiefly of historical importance. Formerly one of the childhood infectious diseases caught by and survived by almost every child, its incidence had been reduced since the introduction and use of a varicella vaccine in 1995 in the U.S. and Canada to inoculate against the disease. Areas such as England, where the vaccine is not mandated, have increasing prevalence rates for chickenpox. Chickenpox is caused by the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes viruses known to affect humans. It starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw pox (pocks), small open sores which heal mostly without scarring.

Chickenpox has a 10-21 day incubation period and is highly contagious through physical contact two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox.

Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and those with a suppressed immune system being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the fetus. This is less of an issue after 20 weeks.

The most common complication of chicken pox is shingles; this is most frequently a late effect.

Causes:

In a typical scenario, a young child is covered in pox and out of school for a week. The first half of the week the child feels miserable from intense itching; the second half from boredom. Since the introduction of the chickenpox vaccine, classic chickenpox is much less common.

Chickenpox is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission. Even those with mild illness after the vaccine may be contagious

Signs and symptoms:
The symptoms of chickenpox appear 1-3 weeks after infection. In children, the illness often starts with a mild fever or headache; in adults, there may be more pronounced flulike symptoms. as infection with the virus progresses, the following symptoms usually become apparent:

· Rash in the form of crops of tiny red spots that rapidly turn into itchy, fluid-filled blisters. within 24 hours the blisters dry out, forming scabs. successive crops occur for 1-6 days. The rash may be widespread or consist of only a few spots, and it can occur anywhere on the head or body.

· Sometimes, discomfort during eating caused by spots in the mouth that have developed into ulcers.

A person is contagious from about 2 days before the rash first appears until it crusts over it about 10-14 days.

Itis a highly contagious disease that spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing. Touching the fluid from a chickenpox blister can also spread the disease. A person with chickenpox is contagious from one to two days before the rash appears until all blisters have formed scabs. This may take five to 10 days. It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.

The chickenpox lesions (blisters) start as a two to four millimeter red papule which develops an irregular outline (a rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This “dew drop on a rose petal” lesion is very characteristic for chickenpox. After about eight to 12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after seven days sometimes leaving a crater-like scar. Although one lesion goes through this complete cycle in about seven days, another hallmark of chickenpox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over. Children are not to be sent back to school until all lesions have crusted over.

Chickenpox is highly contagious and is spread through the air when infected people cough or sneeze, or through physical contact with fluid from lesions on the skin. Zoster, also known as shingles, is a reactivation of chickenpox and may also be a source of the virus for susceptible children and adults. It is not necessary to have physical contact with the infected person for the disease to spread. Those infected can spread chickenpox before they know they have the disease – even before any rash develops. In fact, people with chickenpox can infect others from about two days before the rash develops until all the sores have crusted over, usually four to five days after the rash starts.

Possible Complications:

*Women who get chickenpox during pregnancy are at risk for congenital infection of the fetus.

*Newborns are at risk for severe infection, if they are exposed and their mothers are not immune.

*A secondary infection of the blisters may occur.

*Encephalitis is a serious, but rare complication.

*Reye’s syndrome, pneumonia, myocarditis, and transient arthritis are other possible complications of chickenpox

*Cerebellar ataxia may appear during the recovery phase or later. This is characterized by a very unsteady walk.
The most common complication of chickenpox is bacterial infection of the blisters due to scratching. other complications include pneumonia, which is more common in adults, and rarely inflammation of the brain. newborn babies and people with reduced immunity are at higher risk of complications. Rarely, if a woman develops chickenpox in early pregnancy, the infection may result in fetal abnormalities.

Later in life, chickenpox viruses remaining dormant in the nerves can reactivate, causing shingles.

Secondary infections, such as inflammation of the brain, can occur in immunocompromised individuals. This is more dangerous with shingles.

Congenital defects in babies:
These may occur if the child’s mother was exposed to the zoster virus during pregnancy. Effects on the fetus may be minimal in nature but physical deformities range in severity from under developed toes and fingers, to severe anal and bladder malformation. Possible problems include:

*Damage to brain: encephalitis, microcephaly, hydrocephaly, aplasia of brain

*Damage to the eye (optic stalk, optic cap, and lens vesicles), microphthalmia, cataracts, chorioretinitis, optic atrophy

*Other neurological disorder: damage to cervical and lumbosacral spinal cord, motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner’s syndrome

*Damage to body: hypoplasia of upper/lower extremities, anal and bladder sphincter dysfunction

*Skin disorders: (cicatricial) skin lesions, hypopigmentation

Diagnosis:
Chickenpox can usually be diagnosed from the appearance of the rash. Children with mild infections do not need to see a doctor, and rest and simple measures to reduce fever are all that are needed for a full recovery. calamine lotion may help relieve itching. To prevent skin infections, keep fingernails short and avoid scratching. people at risk of severe attacks, such as babies, older adolescents, adults, and people with reduced immunity, should see their doctor immediately. An antiviral drug may be given to limit the effect of the infection, but it must be taken in the early stages of the illness in order to be effective.

Prognosis and treatment:
Children who are otherwise healthy usually recover within 10-14 days from the onset of the rash, but they may have permanent scars where blisters have become infected with bacteria and then been scratched. Adolescents, adults, and people with reduced immunity take longer to recover from chickenpox.

Chickenpox infection tends to be milder the younger a child is and symptomatic treatment, with a little sodium bicarbonate in baths or antihistamine medication to ease itching, and paracetamol (acetaminophen) to reduce fever, are widely used. Ibuprofen can also be used on advice of a doctor. However, aspirin or products containing aspirin must not be given to children with chickenpox (or any fever-causing illness), as this risks causing the serious and potentially fatal Reye’s Syndrome.

There is no evidence to support the effectiveness of topical application of calamine lotion, a topical barrier preparation containing zinc oxide in spite of its wide usage and excellent safety profile.

It is important to maintain good hygiene and daily cleaning of skin with warm water to avoid secondary bacterial infection. Infection in otherwise healthy adults tends to be more severe and active; treatment with antiviral drugs (e.g. acyclovir) is generally advised. Patients of any age with depressed immune systems or extensive eczema are at risk of more severe disease and should also be treated with antiviral medication. In the U.S., 55 percent of chickenpox deaths are in the over-20 age group, even though they are a tiny fraction of the cases.

In most cases, it is enough to keep children comfortable while their own bodies fight the illness. Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Lotions containing antihistamines are not proven more effective. Trim the fingernails short to reduce secondary infections and scarring.

Safe antiviral medicines have been developed. To be effective, they usually must be started within the first 24 hours of the rash. For most otherwise healthy children, the benefits of these medicines may not outweigh the costs. Adults and teens, at risk for more severe symptoms, may benefit if the case is seen early in its course

In addition, for those with skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma), or those who have recently taken steroids, the antiviral medicines may be very important. The same is also true for adolescents and children who must take aspirin on an ongoing basis.

Some doctors also give antiviral medicines to people in the same household who subsequently come down with chickenpox. Because of their increased exposure, they would normally experience a more severe case of chickenpox.

DO NOT USE ASPIRIN for someone who may have chickenpox. Use of aspirin has been associated with Reyes Syndrome. Ibuprofen has been associated with more severe secondary infections. Acetaminophen may be used.

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Prevention:
Once you catch chickenpox, the virus usually stays in your body forever. You probably will not get chickenpox again, but the virus can cause shingles in adults. A chickenpox vaccine can help prevent most cases of chickenpox, or make it less severe if you do get it.

One attack of chickenpox gives lifelong immunity to the disease. However, the varicella zoster virus remains dormant within nerve cells and may reactivate years later, causing herpes zoster. Immunization against chickenpox is now routine for babies aged 12-18 months and is recommended for children aged 11-12 years who have neither had chickenpox nor been immunized.

Vaccination:

A varicella vaccine has been available since 1995 to inoculate against the disease. Some countries require the varicella vaccination or an exemption before entering elementary school. Protection is not lifelong and further vaccination is necessary five years after the initial immunization.

In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune and have direct patient contact. Population-based immunization against varicella is not otherwise practiced in the UK, because of lack of evidence of lasting efficacy or public health benefit.

Vaccination reactions:
Common and mild reactions following vaccination may include:

*Fever of 101.9 (38.9 C) up to 42 days after injection

*Soreness, itching at the site of injection within 2 days

*Rash occurring at site of injection anywhere form 8 to 19 days after injection. If this happens you are considered contagious.

*Rash on other parts of body anywhere from 5 to 26 days after injection. If this happens you are considered contagious.

Fever and discomfort may be lessened by taking medication containing paracetamol (aka acetaminophen, such as Panadol, Tempra, Tylenol) or ibuprofen.

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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/Chickenpox
http://www.nlm.nih.gov/medlineplus/ency/article/001592.htm
http://www.charak.com/DiseasePage.asp?thx=1&id=117

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Herbs & Plants

Chalmogra(Tuvrak)

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Botanical Name: Hydnocarpus laurifolia/wightianus
Family: Achariaceae
Kingdom:Plantae
Clade: Rosids
Order: Malpighiales
Family: Achariaceae
Genus: Hydnocarpus
Species:H. wightianus

Synonym: Hydnocarpus laurifolia

Indian Name: Garudphal

Common name: Jangli almond

Bengali name: Choulmogara

Hindi:Calmogara, Chalmogra, Chaulmoogra, Jangli badam
Kannada: Chalmogra yenne mara, Mirolhakai, Surti, Suranti, Toratti, Garudaphala
Malayalam: Kodi, Maravatty, Marotti, Nirvatta, Nirvetti
Marathi: Kadu Kawath
Sanskrit: Tuvaraka, Turveraka, Tuvrak, Kushtavairi
Tamil: Maravetti, Maravattai, Marotti
Telugu: Niradi-vittulu

Habitat: This tree found in tropical forests and western ghats of South India.

Description and Composition
Chalmogra is a tall evergreen tree with whitish wood. It has sharply-toothed, smooth and shining leaves, spherical fruits, about the size of an apple, with a rough thick brown rind. Within the fruit there are 10 to 20 angular seeds, embedded in a scanty white pulp. The trade name chalmogra is based on the local name of the tree. It is leathery-leaved tree of western India bearing round fruits with brown densely-hairy rind enclosing oily pulp that yields hydnocarpus oil.

Chalmogra has been used in the Ayurvedic system of medicine for leprosy since many centuries. In ancient Buddhist literature the efficacy of raw chalmogra seeds in treating leprosy is mentioned. Records show that the oil extracted from its seeds has been used in the treatment of leprosy and other skin diseases since 1595. In the Makhzanel-Adwiya, one of the oldest books on Mohammedan materia medica, mention is made of the use of the seeds under the name of chalmogri

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By 1868, the curative effects of chalmogra were so well­ known that it was made official in the Pharmacopoeia of India. It was, however, not till 1904, when Fredrick B. Power and his collaborators published in detail the chemistry of chalmogra oil, that the attention of the scientific world was drawn to this valuable drug. Experiments have proven its bactricidal properties. The seeds of chalmogra yield a fatty oil. The oil contains hydnocarpic acid, oleic acid and palmitic acid.

Chemistry:

It contains hypnocarpic acid, chaulmoorgic acid and its homologues. It also contains oleic acid and palmitic acids.
The oil is unusual in not being made up of straight chain fatty acids but acids with a cyclic group at the end of the chain. Seeds are ovoid, irregular and angular, 1 to 1 1/4 inches long, 1 inch wide, skin smooth, grey, brittle; kernel oily and dark brown. A fatty oil is obtained by expression, known officially as Gynocardia oil in Britain, as Oleum Chaulmoograe in the U.S.A

Benefits and Healing Power of Chalmogra Herb:

A local stimulant, useful in correcting disordered processes of nutrition.
The bark of the tree contains tannins, which are beneficial in the treatment of fever. The oil extracted from the seeds is useful in leprosy and skin disorders.
The oil from the seeds has medicinal properties. It is a tonic, useful in correcting disordered processes of nutrition and in restoring the normal function of the system. It is also a local stimulant.

Fevers :– The bark of the tree contains tannins, which are beneficial in the treatment of fevers.
Leprosy :- The oil extracted from the seeds is useful in leprosy. It should be applied locally to the affected parts. Recently chalmogra has been recognized in the allopathic medicine as a valuable remedy for leprosy.

Skin Disorders :– Chalmogra oil is a specific medicine for treating skin diseases. It is locally used in rheumatism and phthisis or tuberculosis. It is an effective dressing for scaly eruptions and chronic skin diseases, even those of syphilitic origin. A liniment made of equal parts of the oil and lime water is applied to scald heads, leprous ulcerations, rheumatic pains and scruf, or a scaly condition, on the head.
A paste of the seeds is a domestic remedy for wounds and certain skin diseases like eczema, ringworm and scabies. The infusion is used as a disinfectant for vaginal infection in gonorrhea and foetid discharges, especially after childbirth.

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

Resources:
http://www.vitamins-minerals-supplements.org/herbs/chalmogra.htm
http://www.allayurveda.com/herbalcure_us2.htm

https://en.wikipedia.org/wiki/Hydnocarpus_wightiana

 

https://easyayurveda.com/2012/09/22/tuvaraka-hydnocarpus-laurifolia-qualities-ayurveda-details/

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