Dz

FIFTH DISEASE (PARVOVIRUS B19)
Fifth disease is a mild rash illness that occurs most commonly in children. Caused by the Parvovirus B19.
SIGNS/ SYMPTOMS: 4 to 14 days after exposure and last 20 days
•The ill child typically has a "slapped-cheek" rash on the face.
•lacy red rash on the trunk and limbs.
•Occasionally, the rash may itch.
•Adults who get Dz. (rare) can have joint pain

Route of Infx.= mucosal (person to person)

Dx. by visualizing rash pattern, but if exact Dx. imp. blood test can be done to look for immunoglobulin M (IgM).Usually a mild illness, but may cause a serious illness in persons with sickle-cell disease or similar types of chronic anemia, HIV or other immune deficiencies. Also can cause serious complication for P.G. pts.Treatment: Usually only for symptoms. incase of sever anemia blood transfusions may be necessary. HIV may need hospitalization.

Seasonal Influenza
Influenza (the flu) is a contagious respiratory illness. It can cause mild to severe illness, and at times can lead to death.

Pathogen: influenza viruses
S/S: The flu is different from a cold. The flu usually comes on suddenly and may include these symptoms:
•fever∗
•cough
•sore throat
•runny or stuffy nose
•body aches
•headache
•chills
•some times diarrhea and vomiting (mostly w/ avian flu)

∗Its important to note that not everyone with flu will have a fever.
Rt. of Infxn: person to person (droplet spread)Contagious: Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5-7 days after becoming sick. Children may pass the virus for longer than seven days. Symptoms start one to four days after the virus enters the body.
Treatment: Oseltamirir (Tamiflu) start within 48 hrs. of sx. onset or without sx. but exposure. If after 48 hrs after sx. treat sx. allow immune system to do its job. Immuno compromised individuals may need hospitalization.

Tetanus (lockjaw)
A serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases. Several vaccines are used to prevent tetanus including DTaP, Tdap, DT, and Td.
A disease of the nervous system caused by Clostridium tetani bacteriapathogen: Clostridium tetani (Gram(+), obligate anaerobic bacteria)
s/s:
*early) lockjaw, stiffness in the neck and abdomen, and difficulty swallowing.
*Later)severe muscle spasms, generalized tonic seizure-like activity, severe autonomic nervous system disordersComplications: Bone fractures, abnormal heart rhythm Death in about 10-20% of cases, with the highest rates occurring among older people
Rt of Infx.: Enters the body through a break in the skin. Tetanus is not transmitted from person to person
Vaccination: One dose of DTaP vaccine is recommended at each of the following ages: 2 months, 4 months, 6 months, 15-18 months, 4-6 years old. DTaP vaccine may be given at the same time as other vaccines. After, Tetanus toxoid, every 10 yrs.(If you never had the initial childhood tetanus vaccines, you should receive a series of three tetanus shots). You have about 14 days after infx. for vaccination to work
Treatment:
After dz. evident:
•Antibiotics (for example, metronidazole) to kill the bacteria, tetanus booster shot, if necessary, and occasionally, antitoxin to neutralize the toxin
•wound cleansing to remove any obvious bacteria collections (abscesses) or foreign bodies
•supportive measures•pain medicine as needed•sedatives such as diazepam (Valium) to control muscle spasms
•ventilator support to help with breathing in the event of spasms of the vocal cords or the respiratory muscles
•IV re-hydration because, as muscles spasm constantly, increased metabolic demands are placed on the body.

MRSA (Methicillin resistant Staphylococcus aureus)

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.

MRSA infection is caused by Staphylococcus aureus bacteria — often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal.

Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It's known as health care-associated MRSA, or HA-MRSA. Older adults and people with weakened immune systems are at most risk of HA-MRSA. More recently, another type of MRSA has occurred among otherwise healthy people in the wider community. This form, community-associated MRSA, or CA-MRSA, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia.It often gets into the body through a cut. Once there, it can cause an infection. Staph is one of the most common causes of skin infections in the U.S. Usually, these are minor and don't need special treatment. Less often, staph can cause serious problems like infected wounds or pneumonia.While some antibiotics still work, MRSA is constantly adapting. Researchers developing new antibiotics are having a tough time keeping up. Staph bacteria are normally found on the skin or in the nose of about one-third of the population. If you have staph on your skin or in your nose but aren't sick, you are said to be "colonized" but not infected. Healthy people can be colonized and have no ill effects. However, they can pass the germ to others.

CAUSES:MRSA is a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it.

Staph bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. However, staph infections can cause serious illness. This most often happens in older adults and people who have weakened immune systems, usually in hospitals and long term care facilities. But in the past several years, serious infections have been occurring in otherwise healthy people in the community, for example athletes who share equipment or personal items.

DX. Tissue sample or nasal secretions taken. In the hospital, a pt. may be tested for MRSA if he shows signs of infection or if he is transferred into a hospital from another health care setting where MRSA is known to be present, or if the pt. has a previous history of MRSA.

Treatment: Both hospital- and community-associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors often 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 become less effective as well. Some hospitals are already seeing strains of MRSA that are less easily killed by vancomycin.In some cases, antibiotics may not be necessary. For example, doctors may drain a superficial abscess caused by MRSA rather than treat the infection with drugs.

APPENDICITIS

Appendicitis is an inflammation of the appendix, and is a medical emergency. If it is left untreated, the appendix may rupture and cause a potentially fatal infection. Appendicitis is the most common abdominal emergency found in children and young adults. One person in 15 develops appendicitis in his or her lifetime. It is rare in the elderly and in children under the age of two. The causes of appendicitis are not well understood, but it is believed to occur as a result of one or more of these factors: an obstruction within the appendix, the development of an ulceration within the appendix, and the invasion of bacteria. Bacteria may multiply within the appendix, and may eventually rupture.

Signs of rupture: include the presence of symptoms for more than 24 hours, a fever, a high white blood cell count, and a fast heart rate. Very rarely, the inflammation and symptoms of appendicitis may disappear but recur again later.

Symptom of appendicitis: Pain beginning around or above the navel. The pain, which may be severe or only achy and uncomfortable, eventually moves into the right lower corner of the abdomen. There, it becomes more steady and more severe, and often increases with movement, coughing, and so forth. The abdomen often becomes rigid and tender to the touch. Increasing rigidity and tenderness indicates an increased likelihood of perforation and peritonitis. Loss of appetite is very common. N/V may occur in about half of the cases and occasionally there may be constipation or diarrhea. The temperature may be normal or slightly elevated. The presence of a fever may indicate that the appendix has ruptured.

Diagnosis: A careful examination is the best way to diagnose appendicitis. It is often difficult even for experienced physicians to distinguish the symptoms of appendicitis from those of other abdominal disorders. Therefore, very specific questioning and a thorough physical examination are crucial. The physician should ask questions, such as where the pain is centered, whether the pain has shifted, and where the pain began. The physician should press on the abdomen to judge the location of the pain and the degree of tenderness.The typical sequence of symptoms is present in about 50% of cases. In the other half of cases, less typical patterns may be seen, especially in pregnant women, older patients, and infants. In pregnant women, appendicitis is easily masked by the frequent occurrence of mild abdominal pain and nausea from other causes. Elderly patients may feel less pain and tenderness than most patients, thereby delaying diagnosis and treatment, and leading to rupture in 30% of cases. Infants and young children often have diarrhea, vomiting, and fever in addition to pain.While laboratory tests cannot establish the diagnosis, an increased white cell count may point to appendicitis. Urinalysis may help to rule out a urinary tract infection that can mimic appendicitis.Treatment: The treatment of appendicitis is an immediate appendectomy. This may be done by opening the abdomen in the standard open appendectomy technique, or through laparoscopy. In laparoscopy, a smaller incision is made through the navel. Both methods can successfully accomplish the removal of the appendix. It is not certain that laparoscopy holds any advantage over open appendectomy. When the appendix has ruptured, patients undergoing a laparoscopic appendectomy may have to be switched to the open appendectomy procedure for the successful management of the rupture. If a ruptured appendix is left untreated, the condition is fatal.

PELVIC INFLAMMATORY DISEASE (PID)

Pelvic inflammatory disease is a general term for infection of the uterus lining, fallopian tubes, or ovaries. See also: Endometritis

Symptoms
The most common symptoms of PID include:
•Fever (not always present; may come and go)
•Pain or tenderness in the pelvis, lower abdomen, or sometimes the lower back
•Vaginal discharge with abnormal color, texture, or smell

Other symptoms that may occur with PID:
•Bleeding after intercourse
•Chills
•Fatigue
•Frequent or painful urination
•Increased menstrual cramping
•Irregular menstrual bleeding or spotting
•Lack of appetite
•Nausea, with or without vomiting
•No menstruation
•Painful sexual intercourse

Causes: Most cases of pelvic inflammatory disease are caused by bacteria that move from the vagina or cervix into the uterus, fallopian tubes, ovaries, or pelvis. The most common cause of PID is sexual contact without using a condom or other protection. This is called a sexually transmitted disease (STD). Chlamydia and gonorrhea are the two bacteria that cause most cases of PID.

However, bacteria may also enter the body during some surgical or office procedures, such as:
•Childbirth
•Endometrial biopsy
•Insertion of an intrauterine device (IUD)
•Miscarriage
•Therapeutic or elective abortion

In the United States, nearly 1 million women develop PID each year. About 1 in 8 sexually active adolescent girls will develop PID before age 20

.Risk factors include:
•Male sexual partner with gonorrhea or chlamydia
•Multiple sexual partners
•Past history of any sexually transmitted disease
•Past history of PID
•Recent insertion of an IUD
•Sexual activity during adolescence

Tests & diagnosis
You may have a fever and abdominal tenderness. A pelvic examination may show:
•A cervix that bleeds easily
•Cervical discharge
•Pain with movement of the cervix
•Tenderness in the uterus or ovaries

Lab tests that look for signs of infection are:
•C-reactive protein (CRP)
•Erythrocyte sedimentation rate (ESR)
•WBC count

Other tests include:
•Culture of your vagina or cervix to look for gonorrhea, chlamydia, or other causes of PID
•Pelvic ultrasound or CT scan to look for other causes of your symptoms, such as appendicitis or pregnancy, and to look for abscesses or pockets of infection around the tubes and ovaries
•Serum HCG (pregnancy test)Treatment: Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.