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Strep throat

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

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

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

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

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

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

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

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

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

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

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

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

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

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

One point is given for each of the criteria:

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

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

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

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

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

Possible Complications & Risk Factors:

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

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

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

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

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

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

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

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

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

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

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

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

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

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Scarlet fever

Alternative Names : Scarlatina

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

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Symptoms:

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

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

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

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

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

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

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

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

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

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

*Difficulty swallowing

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

*Nausea or vomiting

*Headache

*Abdominal pain

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

*Chills

*General discomfort (malaise)

*Muscle aches

*Sore throat

*Swollen, red tongue (strawberry tongue)

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

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

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

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

*Tonsils
*Sinuses
*Skin
*Blood
*Middle ear

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

*Heart
*Joints
*Nervous system
*Skin

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

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

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

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

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

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

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

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

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

Children should be taught  to practice the following healthy habits:

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

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

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

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

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

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Toxic Shock Syndrome

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

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

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

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

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

CLICK & SEE THE PICTURES

You may click to see the pictures of Toxic Shock Syndrome

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

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

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

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

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

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

Package of Rely Tampons

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You may click & see also->

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

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

Resources:
http://en.wikipedia.org/wiki/Toxic_shock_syndrome
http://www.medicalnewstoday.com/articles/175736.php

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Ailmemts & Remedies

Pharyngitis

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Definition:
Pharyngitis: (far-in-jÄ«’ tis) is a painful inflammation of the pharynx, and is colloquially referred to as a sore throat. Infection of the tonsils, tonsillitis may occur simultaneously.
Inflammation of the pharynx (the hollow tube in the back of the throat about 5 inches long that starts behind the nose and ends at the top of the trachea). Pharyngitis is popularly known as a sore throat…CLICK & SEE
Causes, incidence, and risk factors:
The major cause is infection, of which 90% are viral, the remainder caused by bacterial infection and rarely oral thrush (fungal candidiasis e.g. in babies). Some cases of pharyngitis are caused by irritation from agents such as pollutants or chemical substances.

Pharyngitis is caused by a variety of microorganisms. Most cases are caused by a virus, including the virus causing the common cold, flu (influenza virus), adenovirus, mononucleosis, HIV, and various others.

Bacterial causes include Group A streptococcus, which causes strep throat, in addition to corynebacterium, arcanobacterium, Neisseria gonorrhoeae, Chlamydia pneumoniae, and others. In up to 30% of cases, no organism is identified.

Most cases of pharyngitis occur during the colder months — during respiratory disease season. It often spreads among family members.

Strep throat is a serious cause of pharyngitis. The complications of strep throat can include acute rheumatic fever, kidney dysfunction, and severe diseases such as bacteremia and streptococcal toxic shock syndrome.

Symptoms
Sore throat
Strep throat may be accompanied by fever, headache, and swollen lymph nodes in the neck
Viral pharyngitis may be associated with runny nose and postnasal drip
Severe cases may be accompanied by difficulty swallowing and, rarely, difficulty breathing
Additional symptoms are dependent on the underlying microorganisms

Signs and tests
The health care provider will perform an examination of the pharynx to look for drainage or coating. The skin, eyes, and neck lymph nodes may be examined.
A rapid antigen test may be done for strep. If the rapid test is positive, the patient is treated with an antibiotic. If the rapid test is negative, a throat culture may be done.
If there is suspicion for strep throat a streptococcal screen and/or throat swab culture may be performed. Additional throat cultures or blood tests may be done depending on the suspected organism (e.g., mononucleosis, gonorrheae).

Modern Treatment:
The treatment depends on the underlying cause. Viral infections are managed with warm salt water gargles, pain relievers, and fluids. Antibiotics are needed if strep throat is diagnosed.But most sore throats are viral and will not respond to antibiotics. Bacterial causes include Group A streptococcus. The cephalosporin antibiotics such as cephalexin (Keflex, Keftabs, Biocef) and cefadroxil (Duricef) have been found to be much less likely to fail in eradicating the strep than penicillin.

Symptomatic Treatment:
Twenty-two non-antibiotic managements for sore throat have been studied in controlled trials.Analgesics are among the most effective, but there are many simple measures that can also be used.

Avoid foods and liquids highly acidic in nature, as they will provoke temporary periods of intense pain
Analgesics such as NSAIDs can help reduce the pain associated with a sore throat.

Throat lozenges (cough medicine) are often used for short-term pain relief.

Gargling with warm salty water is a popular household remedy, although there is only anecdotal evidence this gives anything other than temporary relief and likewise for the use of aspirin gargles. Gargling with salty water can help clear up mucus.

Honey has long been used for treating sore throats due to its antiseptic properties.

Warm tea (true or herbal) or soup can help temporarily alleviate the pain of a sore throat.

Cold beverages and popsicles numb the nerves of the throat somewhat, alleviating the pain for a brief time.

Mouthwash (when gargled) reduces the pain but only for a brief time.

There have been some studies that show ingesting a solution high in protein can have a profound relieving effect on sore throats, particularly if they are allergy related.

Drinking heavy amounts of liquid reduces the pain for a short time.

Peppermint candy might help with some cases as well as other hard candies. It will reduce the pain for a short time.
Raw juice of papaya leaves may help to recover sore throat.

Yogurt has been shown to help alleviate the pain temporarily by coating the affected area. Milk also has the same effect.

Raw juice of lemon or lime may help destroy bacteria in bacteria-related throat infections but the high acid content may irritate the affected throat tissues more.

Alcohol has a mild analgesic and antiseptic effect, but may also weaken the immune system.

Powdered liquorice root is very effective.

Malt vinegar when gargled is very effective for treating sore throats.

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Expectations (prognosis)
Most cases of pharyngitis go away on their own, without complications.

Complications
The possible complications of strep throat include rheumatic fever, kidney inflammation, chorea, bacteremia (bloodstream infection) and, rarely, streptococcal shock syndrome
In some severe forms of pharyngitis (e.g., severe mononucleosis-pharyngitis) the airway may become blocked.
Peritonsillar abscess or retropharyngeal abscess are possible.

When to call your health care provider
Notify your provider if you develop a persistent sore throat that does not resolve in several days or if you have high fevers, swollen lymph nodes in the neck or rash. If you have a sore throat and develop difficulty breathing, you must seek medical care immediately.

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.

Help taken from :healthline.com and en.wikipedia.org